Attentional functions in children and adolescents with attention-deficit/hyperactivity disorder with and without comorbid tic disorder.

PubMed

Greimel, E; Herpertz-Dahlmann, B; Günther, T; Vitt, C; Konrad, K

2008-01-01

Although the coexistence of attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) is common, the nature of association is yet not fully understood. Thus, the aim of the present study was to explore attentional dysfunction in children with pure ADHD compared to children with comorbid ADHD + TD. Three groups of 20 children each, aged 8-15 years with either ADHD, ADHD + chronic tic disorder or Tourette syndrome (ADHD + TD) and a healthy control group were compared in their performance on three computerized attention tasks. Tasks of sustained attention, selective attention and interference control were employed. In addition, parental ratings of ADHD symptom severity and behaviour problems were obtained. Both clinical groups were rated as equally inattentive, however, externalising symptoms were more severe in the ADHD group. Objective measures of attentional performance revealed differences between the groups: whereas the ADHD group was markedly impaired in sustaining attention and selective attention/inhibitory control, the ADHD + TD group only showed marginal deficits in selective attention/inhibitory control. Possible explanations for the superior performance of the comorbid group are discussed: In particular, the results may indicate that in some patients, the tic disorder produces behavioural symptoms of ADHD, but not the broad neurocognitive deficits that usually are associated with ADHD. Alternatively, compensatory neural mechanisms of TD patients may result in a better neuropsychological performance of comorbid patients relative to patients suffering from pure ADHD.

Risky decision making in adults with ADHD.

PubMed

Matthies, S; Philipsen, A; Svaldi, J

2012-09-01

Risky decision making and disadvantageous choices constitute core characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). Consequences include negative psychosocial and health-related outcomes. However, risky decision making and its interrelations with emotional states in ADHD are poorly understood. Therefore, the authors investigated risky decision making without and after boredom induction in adults with and without ADHD. In study 1, ADHD patients (n = 15) and age/education matched controls (CG; n = 16) were compared on the Game of Dice Task (GDT), an established task measuring decision making in unambiguous situations. In study 2, ADHD patients (n = 14) and CG (n = 13) underwent boredom induction prior to the GDT. In study 1, ADHD patients selected the disadvantageous alternatives significantly more often than CG. In study 2, no significant group differences were found due to an increase in risky decision making in CG following the boredom induction. Even if severity of depression did not affect our results, it may be necessary to compare GDT responses in ADHD patients with and without current depression. Risk as a motor of disadvantageous decision making needs to be taken into account in therapeutic contexts as a maintenance factor of dysfunctional behaviour. The findings of study 2 are in line with postulated alterations of emotional state adjustment in ADHD. The link between decisions making and emotional regulation in ADHD needs further attention in research. Copyright © 2012 Elsevier Ltd. All rights reserved.

Early developmental, temperamental and educational problems in 'substance use disorder' patients with and without ADHD. Does ADHD make a difference?

PubMed

Skutle, Arvid; Bu, Eli Torild Hellandsjø; Jellestad, Finn Konow; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Verspreet, Sofie; Carpentier, Pieter Jan; Ramos-Quiroga, Josep Antoni; Franck, Johan; Konstenius, Maija; Kaye, Sharlene; Demetrovics, Zsolt; Barta, Csaba; Fatséas, Melina; Auriacombe, Marc; Johnson, Brian; Faraone, Stephen V; Levin, Frances R; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A; Koeter, Maarten W J; van den Brink, Wim; Moggi, Franz; Møller, Merete; van de Glind, Geurt

2015-12-01

The prevalence of ADHD among patients with substance use disorder (SUD) is substantial. This study addressed the following research questions: Are early developmental, temperamental and educational problems overrepresented among SUD patients with ADHD compared to SUD patients without ADHD? Do this comorbid group receive early help for their ADHD, and are there signs of self-medicating with illicit central stimulants? An international, multi-centre cross-sectional study was carried out involving seven European countries, with 1205 patients in treatment for SUD. The mean age was 40 years and 27% of the sample was female. All participants were interviewed with the Mini International Neuropsychiatric Interview Plus and the Conners' Adult ADHD Diagnostic Interview for DSM-IV. SUD patients with ADHD ( n  = 196; 16.3% of the total sample) had a significantly slower infant development than SUD patients without ADHD ( n  = 1,009; 83.4%), had greater problems controlling their temperament, and had lower educational attainment. Only 24 (12%) of the current ADHD positive patients had been diagnosed and treated during childhood and/or adolescence. Finally, SUD patients with ADHD were more likely to have central stimulants or cannabis as their primary substance of abuse, whereas alcohol use was more likely to be the primary substance of abuse in SUD patients without ADHD. The results emphasize the importance of early identification of ADHD and targeted interventions in the health and school system, as well as in the addiction field.

Interaction of recalled parental ADHD symptoms and rearing behavior with current attachment and emotional dysfunction in adult offspring with ADHD.

PubMed

Edel, Marc-Andreas; Juckel, Georg; Brüne, Martin

2010-06-30

Research into attachment and emotion regulation has shown that children with ADHD are at risk of developing attachment disorders and emotion regulation disturbances, which in part may be due to the rearing style of their parents. No such data exists for adults with persistent ADHD. We hypothesized that current attachment style and emotion processing of adult patients with ADHD may be influenced by the presence of parental ADHD symptoms when the now adult patients were children, assuming that ADHD symptoms of parents have an impact on their parenting style. We examined recalled parental ADHD symptoms and rearing style as well as current attachment and emotion regulation abilities in a sample of 73 adults with ADHD using several self-rating instruments. Recalled prevalence of ADHD symptoms in the mother, and less so in the father, of adult patients with ADHD was significantly associated with partly adverse parental rearing styles, current attachment problems in romantic partnerships and emotion regulation disturbances compared with adult ADHD patients without possibly affected parent. ADHD symptoms in parents of children with ADHD may present a risk factor for attachment problems and poor emotion regulation when ADHD children are grown.

Screening for ADHD in an Adult Social Phobia Sample

ERIC Educational Resources Information Center

Mortberg, Ewa; Tilfors, Kerstin; Bejerot, Susanne

2012-01-01

Objective: Recent studies have suggested a link between a primary anxiety disorder and ADHD. Method: A total of 39 participants with a primary diagnosis of social phobia were compared with 178 patients with ADHD and 88 patients with other psychiatric disorders on measures for childhood and adult ADHD (the Wender Utah Rating Scale and the Adult…

Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

PubMed Central

van Emmerik-van Oortmerssen, Katelijne; van de Glind, Geurt; Koeter, Maarten W. J.; Allsop, Steve; Auriacombe, Marc; Barta, Csaba; Bu, Eli Torild H.; Burren, Yuliya; Carpentier, Pieter-Jan; Carruthers, Susan; Casas, Miguel; Demetrovics, Zsolt; Dom, Geert; Faraone, Stephen V.; Fatseas, Melina; Franck, Johan; Johnson, Brian; Kapitány-Fövény, Máté; Kaye, Sharlene; Konstenius, Maija; Levin, Frances R.; Moggi, Franz; Møller, Merete; Ramos-Quiroga, J. Antoni; Schillinger, Arild; Skutle, Arvid; Verspreet, Sofie; van den Brink, Wim; Schoevers, Robert A.

2014-01-01

Aims To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.8–4.2], BPD (OR = 7.0, 95% CI = 3.1–15.6 for alcohol; OR = 3.4, 95% CI = 1.8–6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR = 4.1, 95% CI = 2.1–7.8) and HME (OR = 4.3, 95% CI = 2.1–8.7) were all more prevalent in ADHD+ compared with ADHD− patients (P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P < 0.01), increased HME and ASPD in the hyperactive/impulsive (P < 0.01) and combined subtypes (P < 0.001) and increased BPD in all subtypes (P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders. PMID:24118292

Effect of Atomoxetine Treatment on Reading and Phonological Skills in Children with Dyslexia or Attention-Deficit/Hyperactivity Disorder and Comorbid Dyslexia in a Randomized, Placebo-Controlled Trial.

PubMed

Shaywitz, Sally; Shaywitz, Bennett; Wietecha, Linda; Wigal, Sharon; McBurnett, Keith; Williams, David; Kronenberger, William G; Hooper, Stephen R

2017-02-01

Evaluated the effects of atomoxetine on the reading abilities of children with dyslexia only or attention-deficit/hyperactivity disorder (ADHD) and comorbid dyslexia. Children aged 10-16 years (N = 209) met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria for dyslexia only (n = 58), ADHD and comorbid dyslexia (n = 124), or ADHD only (n = 27) and were of normal intelligence. Patients were treated with atomoxetine (1.0-1.4 mg/kg/day) or placebo in a 16-week, randomized, placebo-controlled, double-blind trial. The dyslexia-only and ADHD and comorbid dyslexia groups were randomized 1:1; the ADHD-only group received atomoxetine in a blinded manner. Reading abilities were measured with the Woodcock Johnson III (WJIII), Comprehensive Test of Phonological Processing (CTOPP), Gray Oral Reading Tests-4, and Test of Word Reading Efficiency. Atomoxetine-treated dyslexia-only patients compared with placebo patients had significantly greater improvement (p < 0.02) with moderate to approaching high effect sizes (ES) on WJIII Word Attack (ES = 0.72), Basic Reading Skills (ES = 0.48), and Reading Vocabulary (ES = 0.73). In the atomoxetine-treated ADHD and comorbid dyslexia group, improvement on the CTOPP Elision measure (ES = 0.50) was significantly greater compared with placebo (p < 0.02). Total, inattentive, and hyperactive/impulsive ADHD symptom reductions were significant in the atomoxetine-treated ADHD and comorbid dyslexia group compared with placebo, and from baseline in the ADHD-only group (p ≤ 0.02). ADHD symptom improvements in the ADHD and comorbid dyslexia group were not correlated with improvements in reading. Atomoxetine treatment improved reading scores in patients with dyslexia only and ADHD and comorbid dyslexia. Improvements for patients with dyslexia only were in critical components of reading, including decoding and reading vocabulary. For patients with ADHD and comorbid dyslexia, improvements in reading scores were distinct from improvement in ADHD inattention symptoms alone. These data represent the first report of improvements in reading measures following pharmacotherapy treatment in patients with dyslexia only evaluated in a randomized, double-blind trial.

Effect of Atomoxetine Treatment on Reading and Phonological Skills in Children with Dyslexia or Attention-Deficit/Hyperactivity Disorder and Comorbid Dyslexia in a Randomized, Placebo-Controlled Trial

PubMed Central

Shaywitz, Bennett; Wietecha, Linda; Wigal, Sharon; McBurnett, Keith; Williams, David; Kronenberger, William G.; Hooper, Stephen R.

2017-01-01

Abstract Objectives: Evaluated the effects of atomoxetine on the reading abilities of children with dyslexia only or attention-deficit/hyperactivity disorder (ADHD) and comorbid dyslexia. Methods: Children aged 10–16 years (N = 209) met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria for dyslexia only (n = 58), ADHD and comorbid dyslexia (n = 124), or ADHD only (n = 27) and were of normal intelligence. Patients were treated with atomoxetine (1.0–1.4 mg/kg/day) or placebo in a 16-week, randomized, placebo-controlled, double-blind trial. The dyslexia-only and ADHD and comorbid dyslexia groups were randomized 1:1; the ADHD-only group received atomoxetine in a blinded manner. Reading abilities were measured with the Woodcock Johnson III (WJIII), Comprehensive Test of Phonological Processing (CTOPP), Gray Oral Reading Tests-4, and Test of Word Reading Efficiency. Results: Atomoxetine-treated dyslexia-only patients compared with placebo patients had significantly greater improvement (p < 0.02) with moderate to approaching high effect sizes (ES) on WJIII Word Attack (ES = 0.72), Basic Reading Skills (ES = 0.48), and Reading Vocabulary (ES = 0.73). In the atomoxetine-treated ADHD and comorbid dyslexia group, improvement on the CTOPP Elision measure (ES = 0.50) was significantly greater compared with placebo (p < 0.02). Total, inattentive, and hyperactive/impulsive ADHD symptom reductions were significant in the atomoxetine-treated ADHD and comorbid dyslexia group compared with placebo, and from baseline in the ADHD-only group (p ≤ 0.02). ADHD symptom improvements in the ADHD and comorbid dyslexia group were not correlated with improvements in reading. Conclusions: Atomoxetine treatment improved reading scores in patients with dyslexia only and ADHD and comorbid dyslexia. Improvements for patients with dyslexia only were in critical components of reading, including decoding and reading vocabulary. For patients with ADHD and comorbid dyslexia, improvements in reading scores were distinct from improvement in ADHD inattention symptoms alone. These data represent the first report of improvements in reading measures following pharmacotherapy treatment in patients with dyslexia only evaluated in a randomized, double-blind trial. PMID:27410907

Predominantly Inattentive Type of ADHD is Associated With Social Anxiety Disorder.

PubMed

Koyuncu, Ahmet; Ertekin, Erhan; Yüksel, Çağrı; Aslantaş Ertekin, Banu; Çelebi, Fahri; Binbay, Zerrin; Tükel, Raşit

2015-10-01

The aim of this study was to determine the frequency of childhood ADHD comorbidity in patients with social anxiety disorder (SAD), and the influence of this comorbidity on various demographic and clinical variables in SAD. A total of 130 patients with SAD were assessed with K-SADS-PL's (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version) behavioral disorders module to determine the childhood diagnosis of ADHD. Patients with or without a comorbid childhood ADHD were compared in terms of clinical characteristics and rating scores. The mean age at onset of SAD was lower, and lifetime major depressive disorder and bipolar disorder (BD) comorbidity were higher in the SAD-ADHD group than in the SAD-without ADHD group. We have found high ADHD comorbidity in patients with SAD. Presence of comorbid ADHD was associated with increased severity, functional impairment, and BD comorbidity. © 2014 SAGE Publications.

A multidimensional approach of impulsivity in adult attention deficit hyperactivity disorder.

PubMed

Lopez, Régis; Dauvilliers, Yves; Jaussent, Isabelle; Billieux, Joël; Bayard, Sophie

2015-06-30

We aimed to compare adult patients with attention deficit hyperactivity disorder (ADHD) and matched controls on four dimensions of impulsivity (urgency, lack of premeditation, lack of perseverance, and sensation seeking) and to examine the association between impulsivity and ADHD symptoms. The study was conducted on 219 participants: 72 adult ADHD patients and 147 aged and gender matched controls. All participants completed questionnaires measuring the various facets of impulsivity (UPPS Impulsive Behavior Scale), ADHD and depressive symptoms severity. Patients were also assessed for ADHD subtypes, mood disorders, and addictive behaviors. ADHD patients exhibited higher urgency, lower premeditation and lower perseverance in comparison to controls. Lack of perseverance showed the strongest association with ADHD (area under curve=0.95). Patients with combined inattentive and hyperactive/impulsive subtypes reported more frequently substance abuse problems and had higher scores on urgency and sensation seeking dimensions of impulsivity than those with predominantly inattentive subtype. We report for the first time a multidimensional evaluation of impulsivity in adult ADHD patients. The UPPS Impulsive Behavior Scale may constitute a useful screening tool for ADHD in adults and may help to further understanding the psychological mechanisms underlying the differences between the ADHD subgroups. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Improving Interference Control in ADHD Patients with Transcranial Direct Current Stimulation (tDCS)

PubMed Central

Breitling, Carolin; Zaehle, Tino; Dannhauer, Moritz; Bonath, Björn; Tegelbeckers, Jana; Flechtner, Hans-Henning; Krauel, Kerstin

2016-01-01

The use of transcranial direct current stimulation (tDCS) in patients with attention deficit hyperactivity disorder (ADHD) has been suggested as a promising alternative to psychopharmacological treatment approaches due to its local and network effects on brain activation. In the current study, we investigated the impact of tDCS over the right inferior frontal gyrus (rIFG) on interference control in 21 male adolescents with ADHD and 21 age matched healthy controls aged 13–17 years, who underwent three separate sessions of tDCS (anodal, cathodal, and sham) while completing a Flanker task. Even though anodal stimulation appeared to diminish commission errors in the ADHD group, the overall analysis revealed no significant effect of tDCS. Since participants showed a considerable learning effect from the first to the second session, performance in the first session was separately analyzed. ADHD patients receiving sham stimulation in the first session showed impaired interference control compared to healthy control participants whereas ADHD patients who were exposed to anodal stimulation, showed comparable performance levels (commission errors, reaction time variability) to the control group. These results suggest that anodal tDCS of the right inferior frontal gyrus could improve interference control in patients with ADHD. PMID:27147964

Improving Interference Control in ADHD Patients with Transcranial Direct Current Stimulation (tDCS).

PubMed

Breitling, Carolin; Zaehle, Tino; Dannhauer, Moritz; Bonath, Björn; Tegelbeckers, Jana; Flechtner, Hans-Henning; Krauel, Kerstin

2016-01-01

The use of transcranial direct current stimulation (tDCS) in patients with attention deficit hyperactivity disorder (ADHD) has been suggested as a promising alternative to psychopharmacological treatment approaches due to its local and network effects on brain activation. In the current study, we investigated the impact of tDCS over the right inferior frontal gyrus (rIFG) on interference control in 21 male adolescents with ADHD and 21 age matched healthy controls aged 13-17 years, who underwent three separate sessions of tDCS (anodal, cathodal, and sham) while completing a Flanker task. Even though anodal stimulation appeared to diminish commission errors in the ADHD group, the overall analysis revealed no significant effect of tDCS. Since participants showed a considerable learning effect from the first to the second session, performance in the first session was separately analyzed. ADHD patients receiving sham stimulation in the first session showed impaired interference control compared to healthy control participants whereas ADHD patients who were exposed to anodal stimulation, showed comparable performance levels (commission errors, reaction time variability) to the control group. These results suggest that anodal tDCS of the right inferior frontal gyrus could improve interference control in patients with ADHD.

Comparison of therapy augmentation and deviation rates from the recommended once-daily dosing regimen between LDX and commonly prescribed long-acting stimulants for the treatment of ADHD in youth and adults.

PubMed

Setyawan, Juliana; Hodgkins, Paul; Guérin, Annie; Gauthier, Geneviève; Cloutier, Martin; Wu, Eric; Erder, M Haim

2013-10-01

To compare therapy augmentation and deviation rates from the recommended once-daily dosing regimen in Attention Deficit Hyperactivity Disorder (ADHD) patients initiated on lisdexamfetamine (LDX) vs other once-daily Food and Drug Administration (FDA) approved stimulants. ADHD patients initiated on a long-acting ADHD stimulant medication (index medication) in/after 2007 were selected from a large U.S. administrative claims database. Patients were required to be persistent for ≥90 days and continuously enrolled in their healthcare plan for ≥12 months following treatment initiation date. Based on age and previous treatment status, patients were classified into treatment-naïve children and adolescents (6-17 years old), previously treated children and adolescents, treatment-naïve adults (≥18 years old), and previously treated adults. Furthermore, patients were classified into four mutually exclusive treatment groups, based on index medication: lisdexamfetamine (LDX), osmotic release methylphenidate hydrochloride long-acting (OROS MPH), other methylphenidate/dexmethylphenidate long-acting (MPH LA), and amphetamine/dextroamphetamine long-acting (AMPH LA). The average daily consumption was measured as the quantity of index medication supplied in the 12-month study period divided by the total number of days of supply. Therapy augmentation was defined as the use of another ADHD medication concomitantly with the index medication for ≥28 consecutive days. Therapy augmentation and deviation rates from the recommended once-daily dosing regimen were compared between treatment groups using multivariate logistic regression models. Compared to the other treatment groups, LDX patients were less likely to augment with another ADHD medication (range odds ratios [OR]; 1.28-3.30) and to deviate from the recommended once-daily dosing regimen (range OR; 1.73-4.55), except for previously treated adult patients, where therapy augmentation differences were not statistically significant when compared to OROS MPH and MPH LA patients. This study did not control for ADHD severity. Overall, compared to LDX-treated patients, patients initiated on other ADHD medications were equally or more likely to have a therapy augmentation and more likely to deviate from the recommended once-daily dosing regimen.

Long-QT Syndrome and Therapy for Attention Deficit/Hyperactivity Disorder.

PubMed

Zhang, Claire; Kutyifa, Valentina; Moss, Arthur J; McNitt, Scott; Zareba, Wojciech; Kaufman, Elizabeth S

2015-10-01

Stimulants are the mainstay therapy for attention deficit/hyperactivity disorder (ADHD) and are associated with adrenergic side effects. There are limited data on the clinical course of patients treated for ADHD who have long-QT syndrome (LQTS), for which β-blockade is the goal of therapy. LQTS patients from the Rochester-based LQTS Registry (open-enrollment between 1979 and 2003; follow-up from 1979 to present) treated with stimulant or nonstimulant ADHD medications (n = 48) were compared to a 2:1 age-, gender-, and QTc-duration matched LQTS control group not exposed to ADHD medications (n = 96). Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate risk of cardiac events (syncope, aborted cardiac arrest, and sudden cardiac death) in LQTS patients treated with ADHD medications. During a mean follow-up of 7.9 ± 5.4 years after initiation of ADHD medication at a mean age 10.7 ±7.3 years, there was a 62% cumulative probability of cardiac events in the ADHD treatment group compared to 28% in the matched LQTS control group (P < 0.001). Time-dependent use of ADHD medication was associated with an increased risk for cardiac events (HR = 3.07; P = 0.03) in the multivariate Cox model adjusted for time-dependent β-blocker use and prior cardiac events. Subgroup gender analyses showed that time-dependent ADHD medication was associated with an increased risk in male LQTS patients (HR = 6.80, P = 0.04). LQTS patients treated with ADHD medications have increased risk for cardiac events, particularly syncope, and this risk is augmented in males. The findings highlight the importance of heightened surveillance for LQTS patients on ADHD medications. © 2015 Wiley Periodicals, Inc.

Attention-deficit hyperactivity disorder comorbidity and antidepressant resistance among patients with major depression: A nationwide longitudinal study.

PubMed

Chen, Mu-Hong; Pan, Tai-Long; Hsu, Ju-Wei; Huang, Kai-Lin; Su, Tung-Ping; Li, Cheng-Ta; Lin, Wei-Chen; Tsai, Shih-Jen; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

2016-11-01

The comorbidity between attention deficit hyperactivity disorder (ADHD) and major depression is common. However, the influence of ADHD comorbidity in the response or resistance to antidepressants remains unknown among patients with major depression. 1891 patients with major depression and ADHD and 1891 age-/sex-matched patients with major depression only were enrolled and followed for 1 year in our study. Use of antidepressants and ADHD medications during 1-year follow-up period were assessed. Antidepressant resistance was defined as treatment failure in two or more than two different antidepressants for adequate treatment dose and duration. Patients with major depression and ADHD had an increased risk of treatment resistance to antidepressants (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.63-3.32) compared with patients with major depression only after adjusting for demographic characteristics and other psychiatric comorbidities. Regular treatment for ADHD would reduce this risk (OR: 1.76, 95% CI: 0.72-4.27). Anxiety (OR: 3.15, 95% CI: 2.24-4.44) and substance use (OR: 2.45, 95% CI: 1.16-5.17) disorders were also associated with an elevated likelihood of resistance to antidepressants during the follow-up. Patients who had dual diagnoses of major depression and ADHD were more likely to have treatment resistance to antidepressants compared with patients with major depression only. Prompt and regular treatment for ADHD would reduce this risk. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

Influence of stimulants on electrodermal studies in Fragile X syndrome.

PubMed

Hagerman, Randi J; Miller, Lucy J; McGrath-Clarke, Jude; Riley, Karen; Goldson, Edward; Harris, Susan W; Simon, Jody; Church, Kelly; Bonnell, Julie; Ognibene, Todd C; McIntosh, Daniel N

2002-05-01

Attention Deficit Hyperactivity Disorder (ADHD) is seen in the majority of children with Fragile X Syndrome (FraX). Previous work has documented an enhanced sweat response to stimuli in children with FraX compared to controls utilizing electrodermal response (EDR) measures. The present study assesses the EDRs both on and off stimulants in 19 children with ADHD and FraX compared to 17 age- and IQ-matched control patients with ADHD and developmental delays. Although the baseline EDRs were comparable between FraX patients and controls, the patients with FraX had a significant decrease in EDR amplitude and number of peaks when treated with stimulants compared to controls. This suggests that patients with FraX are more responsive to the enhancement of inhibitory systems that occur with stimulant use for ADHD. The use of a quantifiable measure, such as EDR, is recommended in future studies of treatment efficacy. Copyright 2002 Wiley-Liss, Inc.

Changes in Behaviour Symptoms of Patients with Attention Deficit/Hyperactivity Disorder during Treatment: Observation from Different Informants.

PubMed

Wang, Liang-Jen; Chen, Chih-Ken; Huang, Yu-Shu

2013-03-01

The aim of this study was to determine changes in behaviour among patients with attention deficit/hyperactivity disorder (ADHD) by different informants during treatment in the clinical setting. Seventy-nine patients with ADHD were recruited. They completed 12-months of treatment with oral short-acting methylphenidate, two-to-three times per day, at a dose of 0.3-1.0 mg/kg. Among the 79 patients (mean age, 9.1±1.9 years), 39 were classified as the ADHD-C/H type (hyperactive-impulsive type and combined type) and 40 as the ADHD-I type (inattentive type). At baseline, and after 12 months, their behaviour was assessed using the Child Behaviour Checklist (CBCL), Teacher's Report Form (TRF), ADHD Rating Scale (ADHD-RS), and Clinical Global Impression-Severity (CGI-S). Patients classified as the ADHD-C/H type had higher scores on three CBCL subscales, on the ADHD-RS and CGI-S compared to the ADHD-I type patients. After 12-months of treatment, for all patients, there were significant improvements in the four subscales of the TRF as well as the ADHD-RS and CGI-S scores, but not on the CBCL. In addition, the patients with the ADHD-C/H type had greater improvements on the four subscales of the TRF after treatment. However, there were no differences noted on the CBCL, ADHD-RS and CGI-S. The results of this study showed that during treatment, in the clinical setting, there are different assessments of behaviour symptoms, associated with ADHD, reported by different informants. Assessments of behaviour profiles from multiple informants are crucial for establishing a fuller picture of patients with ADHD.

Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who request treatment for cocaine use disorders.

PubMed

Pérez de Los Cobos, José; Siñol, Núria; Puerta, Carmen; Cantillano, Vanessa; López Zurita, Cristina; Trujols, Joan

2011-01-30

To characterize those patients with probable adult attention deficit hyperactivity disorder (ADHD) who ask for treatment of cocaine use disorders; to estimate the prevalence of probable adult ADHD among these patients. This is a cross-sectional and multi-center study performed at outpatient resources of 12 addiction treatment centers in Spain. Participants were treatment-seeking primary cocaine abusers recruited consecutively at one center and through convenience sampling at the other centers. Assessments included semi-structured clinical interview focused on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) ADHD criteria adapted to adulthood, and the Wender-Utah Rating Scale (WURS) for screening childhood history of ADHD according to patients. Probable adult ADHD was diagnosed when patients met DSM-IV criteria of ADHD in adulthood and scored WURS>32. All participants were diagnosed with current cocaine dependence (n=190) or abuse (n=15). Patients with probable adult ADHD, compared with patients having no lifetime ADHD, were more frequently male, reported higher impulsivity, and began to use nicotine, alcohol, cannabis, or cocaine earlier. Before starting the current treatment, patients with probable adult ADHD also showed higher cocaine craving for the previous day, less frequent cocaine abstinence throughout the previous week, and higher use of cocaine and tobacco during the previous month. Impulsivity and male gender were the only independent risk factors of probable adult ADHD in a logistic regression analysis. The prevalence of probable adult ADHD was 20.5% in the sub-sample of patients consecutively recruited (n=78). A diagnosis of probable adult ADHD strongly distinguishes among treatment-seeking cocaine primary abusers regarding past and current key aspects of their addictive disorder; one-fifth of these patients present with probable adult ADHD. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Relationship between bipolar disorder and attention deficit hyperkinetic disorder: An exploratory study.

PubMed

Jhanda, Soumya; Malhotra, Savita; Grover, Sandeep

2018-05-19

This study aimed to evaluate the impact of comorbid attention deficit hyperkinetic disorder (ADHD) on Bipolar disorder (BD). Patients aged 13-40 years with diagnosis of BD with ADHD (N = 30) were compared to those with BD without ADHD (N = 69) for clinical course, functional outcome and quality of life. Those with BD + ADHD had significantly lower age of onset of BD (p < 0.001), a significantly higher number of total lifetime episodes (p = 0.002), higher number of lifetime manic episodes (p = 0.008), higher number of hospitalizations (p = 0.004) and higher prevalence of family history of BD as compared to those with BD without ADHD (p = 0.043). BD + ADHD group had poor response to conventional mood stabilizers and significantly higher prescriptions of atypical antipsychotics (p = 0.001) and higher rates of antidepressant-induced switch. Also, BD + ADHD group had significantly lower level of functioning in personal, occupational and social domains and reduced quality of life. In the BD + ADHD group, 40% patients had persistence of ADHD into adulthood. Comorbid current ADHD had more negative impact on the course and outcome of BD, when compared with those with ADHD in the past. Comorbid ADHD has negative impact on the course and outcome of BD. Copyright © 2018 Elsevier B.V. All rights reserved.

Set shifting and working memory in adults with attention-deficit/hyperactivity disorder.

PubMed

Rohlf, Helena; Jucksch, Viola; Gawrilow, Caterina; Huss, Michael; Hein, Jakob; Lehmkuhl, Ulrike; Salbach-Andrae, Harriet

2012-01-01

Compared to the high number of studies that investigated executive functions (EF) in children with attention-deficit/hyperactivity disorder (ADHD), a little is known about the EF performance of adults with ADHD. This study compared 37 adults with ADHD (ADHD(total)) and 32 control participants who were equivalent in age, intelligence quotient (IQ), sex, and years of education, in two domains of EF--set shifting and working memory. Additionally, the ADHD(total) group was subdivided into two subgroups: ADHD patients without comorbidity (ADHD(-), n = 19) and patients with at least one comorbid disorder (ADHD(+), n = 18). Participants fulfilled two measures for set shifting (i.e., the trail making test, TMT and a computerized card sorting test, CKV) and one measure for working memory (i.e., digit span test, DS). Compared to the control group the ADHD(total) group displayed deficits in set shifting and working memory. The differences between the groups were of medium-to-large effect size (TMT: d = 0.48; DS: d = 0.51; CKV: d = 0.74). The subgroup comparison of the ADHD(+) group and the ADHD(-) group revealed a poorer performance in general information processing speed for the ADHD(+) group. With regard to set shifting and working memory, no significant differences could be found between the two subgroups. These results suggest that the deficits of the ADHD(total) group are attributable to ADHD rather than to comorbidity. An influence of comorbidity, however, could not be completely ruled out as there was a trend of a poorer performance in the ADHD(+) group on some of the outcome measures.

Sustained attention in adult ADHD: time-on-task effects of various measures of attention.

PubMed

Tucha, Lara; Fuermaier, Anselm B M; Koerts, Janneke; Buggenthin, Rieka; Aschenbrenner, Steffen; Weisbrod, Matthias; Thome, Johannes; Lange, Klaus W; Tucha, Oliver

2017-02-01

Neuropsychological research on adults with ADHD showed deficits in various aspects of attention. However, the majority of studies failed to explore the change of performance over time, so-called time-on-task effects. As a consequence, little is known about sustained attention performance of adults with ADHD. The aim of the present study was therefore to test the hypothesis of sustained attention deficits of adults with ADHD. Twenty-nine adults with ADHD and 30 healthy individuals were assessed on four 20-min tests of sustained attention, measuring alertness, selective attention, divided attention and flexibility. The deterioration of performance over time (time-on-task effects) was compared between patients with ADHD and healthy individuals to conclude on sustained attention performance. Compared to healthy individuals, patients with ADHD showed significant deficits of medium size in selective attention and divided attention. Furthermore, medium sustained attention deficits was observed in measures of alertness, selective attention and divided attention. This study supports the notion of sustained attention deficits of adults with ADHD.

[Attention deficit hyperactivity disorder and epilepsy in childhood].

PubMed

Idiazábal-Alecha, M Angeles; Kosno, Magdalena

2012-02-29

Both attention deficit hyperactivity disorder (ADHD) and epilepsy are common disorders in childhood. ADHD and epilepsy can be detrimental to the behavior, learning and social relations of affected children. Children with epilepsy and ADHD tend to be at higher risk of school difficulties compared with children who suffer from epilepsy only. We review the works on the prevalence of ADHD in the epileptic population, the prevalence of epilepsy in children with ADHD, and electroencephalographic abnormalities observed in patients with ADHD. The prevalence of ADHD in childhood epilepsy is higher than in the general population and as is the rate of epilepsy in ADHD. Further studies are required to assess the bidirectional relationship between ADHD and epilepsy and the impact of electroencephalographic abnormalities in the clinical course of these patients.

Voxel-based morphometry analysis reveals frontal brain differences in participants with ADHD and their unaffected siblings.

PubMed

Bralten, Janita; Greven, Corina U; Franke, Barbara; Mennes, Maarten; Zwiers, Marcel P; Rommelse, Nanda N J; Hartman, Catharina; van der Meer, Dennis; O'Dwyer, Laurence; Oosterlaan, Jaap; Hoekstra, Pieter J; Heslenfeld, Dirk; Arias-Vasquez, Alejandro; Buitelaar, Jan K

2016-06-01

Data on structural brain alterations in patients with attention-deficit/hyperactivity disorder (ADHD) have been inconsistent. Both ADHD and brain volumes have a strong genetic loading, but whether brain alterations in patients with ADHD are familial has been underexplored. We aimed to detect structural brain alterations in adolescents and young adults with ADHD compared with healthy controls. We examined whether these alterations were also found in their unaffected siblings, using a uniquely large sample. We performed voxel-based morphometry analyses on MRI scans of patients with ADHD, their unaffected siblings and typically developing controls. We identified brain areas that differed between participants with ADHD and controls and investigated whether these areas were different in unaffected siblings. Influences of medication use, age, sex and IQ were considered. Our sample included 307 patients with ADHD, 169 unaffected siblings and 196 typically developing controls (mean age 17.2 [range 8-30] yr). Compared with controls, participants with ADHD had significantly smaller grey matter volume in 5 clusters located in the precentral gyrus, medial and orbitofrontal cortex, and (para)cingulate cortices. Unaffected siblings showed intermediate volumes significantly different from controls in 4 of these clusters (all except the precentral gyrus). Medication use, age, sex and IQ did not have an undue influence on the results. Our sample was heterogeneous, most participants with ADHD were taking medication, and the comparison was cross-sectional. Brain areas involved in decision making, motivation, cognitive control and motor functioning were smaller in participants with ADHD than in controls. Investigation of unaffected siblings indicated familiality of 4 of the structural brain differences, supporting their potential in molecular genetic analyses in ADHD research.

Voxel-based morphometry analysis reveals frontal brain differences in participants with ADHD and their unaffected siblings

PubMed Central

Bralten, Janita; Greven, Corina U.; Franke, Barbara; Mennes, Maarten; Zwiers, Marcel P.; Rommelse, Nanda N.J.; Hartman, Catharina; van der Meer, Dennis; O’Dwyer, Laurence; Oosterlaan, Jaap; Hoekstra, Pieter J.; Heslenfeld, Dirk; Arias-Vasquez, Alejandro; Buitelaar, Jan K.

2016-01-01

Background Data on structural brain alterations in patients with attention-deficit/hyperactivity disorder (ADHD) have been inconsistent. Both ADHD and brain volumes have a strong genetic loading, but whether brain alterations in patients with ADHD are familial has been underexplored. We aimed to detect structural brain alterations in adolescents and young adults with ADHD compared with healthy controls. We examined whether these alterations were also found in their unaffected siblings, using a uniquely large sample. Methods We performed voxel-based morphometry analyses on MRI scans of patients with ADHD, their unaffected siblings and typically developing controls. We identified brain areas that differed between participants with ADHD and controls and investigated whether these areas were different in unaffected siblings. Influences of medication use, age, sex and IQ were considered. Results Our sample included 307 patients with ADHD, 169 unaffected siblings and 196 typically developing controls (mean age 17.2 [range 8–30] yr). Compared with controls, participants with ADHD had significantly smaller grey matter volume in 5 clusters located in the precentral gyrus, medial and orbitofrontal cortex, and (para)cingulate cortices. Unaffected siblings showed intermediate volumes significantly different from controls in 4 of these clusters (all except the precentral gyrus). Medication use, age, sex and IQ did not have an undue influence on the results. Limitations Our sample was heterogeneous, most participants with ADHD were taking medication, and the comparison was cross-sectional. Conclusion Brain areas involved in decision making, motivation, cognitive control and motor functioning were smaller in participants with ADHD than in controls. Investigation of unaffected siblings indicated familiality of 4 of the structural brain differences, supporting their potential in molecular genetic analyses in ADHD research. PMID:26679925

Differences in the association between childhood trauma history and borderline personality disorder or attention deficit/hyperactivity disorder diagnoses in adulthood.

PubMed

Ferrer, Marc; Andión, Óscar; Calvo, Natalia; Ramos-Quiroga, Josep A; Prat, Mònica; Corrales, Montserrat; Casas, Miguel

2017-09-01

Common environmental etiological factors between borderline personality disorder (BPD) and attention deficit/hyperactivity disorder (ADHD) have not been fully studied. The main aim of this study was to investigate the relationship between childhood trauma histories, assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF), with adult BPD, ADHD or BPD-ADHD diagnoses. Comorbid BPD-ADHD patients exhibited significantly higher clinical severity and higher scores in the Total Neglect Scale, compared to BPD and ADHD patients, and only a marginal difference was observed for Sexual Abuse when BPD and ADHD patients were compared. Physical Trauma Scales were associated with ADHD diagnosis, whereas Emotional Abuse and Sexual Abuse Scales were associated with BPD or BPD-ADHD diagnoses. The study findings support the association between experiencing traumatic events in childhood and a higher clinical severity of BPD in adulthood. Furthermore, physical trauma history in childhood could be associated with the persistence of ADHD in adulthood and emotional or sexual abuse with later development of BPD or comorbid BPD-ADHD. Whereas experiencing childhood traumas is associated with later development of more general psychopathology, our study supports that a specific type of traumatic event could increase the risk for the consolidation of a concrete psychiatric disorder in the trajectory from childhood to adulthood of vulnerable subjects.

Reduction of bulimia nervosa symptoms after psychostimulant initiation in patients with comorbid ADHD: five case reports.

PubMed

Keshen, Aaron; Ivanova, Iryna

2013-01-01

Studies reveal a higher occurrence of bulimia nervosa (BN) in patients with attention deficit/hyperactivity disorder (ADHD) compared to controls. Due to this high degree of comorbidity, some clinicians have used psychostimulants in this population. The goal of this article is to describe five patients with comorbid BN and ADHD and their responses to a course of psychostimulants. After medication initiation, all five patients experienced a decrease in binge/purging and an improvement in ADHD symptoms. Overall, the medications were well tolerated. Possible mechanisms underlying the relationship between ADHD and BN, and words of caution are discussed. The need for clinical trials to further evaluate the efficacy of psychostimulants in this population is warranted.

[Pre- and perinatal risk factors in autism spectrum disorder and attention deficit/hyperactivity disorder].

PubMed

Schmitz, Johanna C; Cholemkery, Hannah; Medda, Juliane; Freitag, Christine M

2017-01-01

Epidemiological studies indicate the relevance of pre- and perinatal risk factors for the genesis of attention deficit/hyperactivity disorder and autism spectrum disorder. This study compares potential risk factors in a clinical sample of children with ADHD, ASD, the combination of both diseases, ADHD and oppositional defiant or conduct disorder (ADHD & ODD/CD) and examined whether the existence of additional risk factors promotes the occurrence of combined diseases. We compared the pre- and perinatal risk factors of 341 patients (299 boys, 42 girls) from a clinical population, differentiating between children with ADHD (n=80), ASD (n=122), ADHD & ASD (n=55), or ADHD & ODD/CD (n=84). We observed a higher rate of maternal smoking, a higher rate of migration, and lower parental education among the children with ADHD & ODD/CD compared to those with ASD or ADHD. The rate of migration background was higher among the children with ASD compared to children with ADHD. Miscarriage was a specific risk factor for ADHD & ASD. Numerous risk factors described in epidemiological studies occurred only rarely in our clinical sample. The distribution of most risk factors was comparable between the examined diseases.

Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence.

PubMed

Shushakova, Anna; Ohrmann, Patricia; Pedersen, Anya

2018-06-01

Emotional dysregulation (ED) is being increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD), but the pathophysiological underpinnings remain unclear. In this study, we provide meaningful electrophysiological evidence of ED in adult patients with ADHD (n = 39) compared to healthy controls (n = 40) by exploring the electrophysiological correlates of the emotion regulation strategies reappraisal, distraction, and expressive suppression. Event-related potentials (ERPs) were recorded during passive viewing of neutral and negative images, as well as during emotion regulation. The patients with ADHD exhibited increased frontal late positive potential (LPP) amplitudes during passive viewing of the aversive images and during emotion regulation. Compared with the healthy controls, a subgroup of medication-naïve patients with ADHD (n = 25) also exhibited larger centroparietal LPP amplitudes and provided more negative ratings of the aversive and neutral images. Both the frontal and centroparietal LPP amplitudes were associated with ADHD symptom severity. However, no significant deficit in LPP modulation during emotion regulation was found. These findings strongly support the clinical observation of increased emotional responsivity toward negative stimuli and difficulty during the implementation of emotion regulation strategies and thus encourage the implementation of emotion regulation modules in the treatment of adult patients with ADHD.

EEG correlates of visual short-term memory as neuro-cognitive endophenotypes of ADHD.

PubMed

Wiegand, Iris; Hennig-Fast, Kristina; Kilian, Beate; Müller, Hermann J; Töllner, Thomas; Möller, Hans-Jürgen; Engel, Rolf R; Finke, Kathrin

2016-05-01

Attention deficit hyperactivity disorder (ADHD) frequently persists into adulthood. A reduction in visual short-term memory (vSTM) storage capacity was recently suggested as a potential neuro-cognitive endophenotype, i.e., a testable marker of an individual's liability for developing ADHD. This study aimed at identifying markers of the brain abnormalities underlying vSTM reductions in adult ADHD. We combined behavioral parameter-based assessment with electrophysiology in groups of adult ADHD patients and healthy age-matched controls. Amplitudes of ERP markers of vSTM storage capacity, the contralateral delay activity (CDA) and the P3b, were analyzed according to (i) differences between individuals with higher vs. lower storage capacity K and (ii) differences between ADHD patients and control participants. We replicated the finding of reduced storage capacity in adult ADHD. Across groups, individuals with higher relative to lower storage capacity showed a larger CDA and P3b. We further found differences between the patient and control groups in the ERPs: The CDA amplitude was attenuated in an early time window for ADHD patients compared to control participants, and was negatively correlated with ADHD patients' symptom severity ratings. Furthermore, the P3b was larger in ADHD patients relative to control participants. These electrophysiological findings indicate altered brain mechanisms underlying visual storage capacity in ADHD, which are characterized by deficient encoding and maintenance, and increased recruitment of control processes. Accordingly, (quantifiable) ERP markers of vSTM in adult ADHD bear candidacy as neuro-cognitive endophenotypes of the disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

Risk of Injury Associated With Attention-Deficit/Hyperactivity Disorder in Adults Enrolled in Employer-Sponsored Health Plans: A Retrospective Analysis

PubMed Central

Montejano, Leslie; Sasané, Rahul; Huse, Dan

2011-01-01

Objective: Attention-deficit/hyperactivity disorder (ADHD) is linked to an increased risk of injury in children. This retrospective analysis evaluated the risk and type of injury associated with ADHD in adults. Method: Data were taken from the MarketScan databases, which provide details of health care claims and productivity data for individuals and their dependents with access to employer-sponsored health plans. Adults (aged 18–64 years) with ≥ 2 ADHD-related diagnostic claims (using ICD-9-CM codes) between 2002 and 2007 and evidence of ADHD treatment in 2006 (n = 31,752) were matched to controls without ADHD (1:3; n = 95,256) or individuals with a depression diagnosis (using ICD-9-CM codes; 1:1; n = 29,965). Injury claims were compared between cohorts, and multivariate analyses controlled for differences that remained after matching. Results: Injury claims were more common in individuals with ADHD than in non-ADHD controls (21.5% vs 15.7%; P < .0001) or individuals with depression (21.4% vs 20.5%; P = .008). Multivariate analyses indicated that the relative risk of injury claims was higher in individuals with ADHD than in the non-ADHD control (odds ratio [OR] = 1.32; 95% CI, 1.27–1.37; P < .01) and depression (OR = 1.13; 95% CI, 1.07–1.18; P < .01) groups. Injury claims increased total direct health care expenditure; total expenditures for ADHD patients with injuries were $6,482 compared with $3,722 for ADHD patients without injuries (P < .0001). Comparison of injury-related costs were similar between ADHD patients and non-ADHD controls ($1,109 vs $1,041, respectively), but higher for depression patients than for ADHD patients ($1,792 vs $1,084; P < .01). Injury claim was also associated with increased short-term disability expenditures, as ADHD patients with injury incurred higher mean cost than those without injury ($1,303 vs $620; P = .0001), but lower than those with injury in the depression cohort (vs $2,152; P = .0099) Conclusions: Adults with ADHD were more likely to incur injury claims than non-ADHD controls or adults with depression in this sample selected on the basis of claims data rather than clinical referrals. Most injuries were relatively minor; however, individuals with injuries incurred higher total direct health care costs than those without injuries. Furthermore, the ratio of indirect costs due to workplace absence to direct health care costs was higher for adults with ADHD than for adults with depression, demonstrating not only the impact of ADHD in the workplace, but also the importance of accounting for productivity data in calculating the true economic burden of ADHD in adults. PMID:21977357

Comparison of QEEG Findings between Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) without Comorbidity and ADHD Comorbid with Internet Gaming Disorder

PubMed Central

2017-01-01

Internet gaming disorder (IGD) is often comorbid with attention deficit hyperactivity disorder (ADHD). In this study, we compared the neurobiological differences between ADHD comorbid with IGD (ADHD+IGD group) and ADHD without comorbidity (ADHD-only group) by analyzing quantitative electroencephalogram (QEEG) findings. We recruited 16 male ADHD+IGD, 15 male ADHD-only adolescent patients, and 15 male healthy controls (HC group). Participants were assessed using Young's Internet Addiction Scale and ADHD Rating Scale. Relative power and inter- and intra-hemispheric coherences of brain waves were measured using a digital electroencephalography (EEG) system. Compared to the ADHD-only group, the ADHD+IGD group showed lower relative delta power and greater relative beta power in temporal regions. The relative theta power in frontal regions were higher in ADHD-only group compared to HC group. Inter-hemispheric coherence values for the theta band between F3–F4 and C3–C4 electrodes were higher in ADHD-only group compared to HC group. Intra-hemispheric coherence values for the delta, theta, alpha, and beta bands between P4–O2 electrodes and intra-hemispheric coherence values for the theta band between Fz–Cz and T4–T6 electrodes were higher in ADHD+IGD group compared to ADHD-only group. Adolescents who show greater vulnerability to ADHD seem to continuously play Internet games to unconsciously enhance attentional ability. In turn, relative beta power in attention deficit in ADHD+IGD group may become similar to that in HC group. Repetitive activation of brain reward and working memory systems during continuous gaming may result in an increase in neuronal connectivity within the parieto-occipital and temporal regions for the ADHD+IGD group. PMID:28145657

Comparison of QEEG Findings between Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) without Comorbidity and ADHD Comorbid with Internet Gaming Disorder.

PubMed

Park, Jeong Ha; Hong, Ji Sun; Han, Doug Hyun; Min, Kyoung Joon; Lee, Young Sik; Kee, Baik Seok; Kim, Sun Mi

2017-03-01

Internet gaming disorder (IGD) is often comorbid with attention deficit hyperactivity disorder (ADHD). In this study, we compared the neurobiological differences between ADHD comorbid with IGD (ADHD+IGD group) and ADHD without comorbidity (ADHD-only group) by analyzing quantitative electroencephalogram (QEEG) findings. We recruited 16 male ADHD+IGD, 15 male ADHD-only adolescent patients, and 15 male healthy controls (HC group). Participants were assessed using Young's Internet Addiction Scale and ADHD Rating Scale. Relative power and inter- and intra-hemispheric coherences of brain waves were measured using a digital electroencephalography (EEG) system. Compared to the ADHD-only group, the ADHD+IGD group showed lower relative delta power and greater relative beta power in temporal regions. The relative theta power in frontal regions were higher in ADHD-only group compared to HC group. Inter-hemispheric coherence values for the theta band between F3-F4 and C3-C4 electrodes were higher in ADHD-only group compared to HC group. Intra-hemispheric coherence values for the delta, theta, alpha, and beta bands between P4-O2 electrodes and intra-hemispheric coherence values for the theta band between Fz-Cz and T4-T6 electrodes were higher in ADHD+IGD group compared to ADHD-only group. Adolescents who show greater vulnerability to ADHD seem to continuously play Internet games to unconsciously enhance attentional ability. In turn, relative beta power in attention deficit in ADHD+IGD group may become similar to that in HC group. Repetitive activation of brain reward and working memory systems during continuous gaming may result in an increase in neuronal connectivity within the parieto-occipital and temporal regions for the ADHD+IGD group.

Associations of pineal volume, chronotype and symptom severity in adults with attention deficit hyperactivity disorder and healthy controls.

PubMed

Bumb, Jan Malte; Mier, Daniela; Noelte, Ingo; Schredl, Michael; Kirsch, Peter; Hennig, Oliver; Liebrich, Luisa; Fenske, Sabrina; Alm, Barbara; Sauer, Carina; Leweke, Franz Markus; Sobanski, Esther

2016-07-01

The pineal gland, as part of the human epithalamus, is the main production site of peripheral melatonin, which promotes the modulation of sleep patterns, circadian rhythms and circadian preferences (morningness vs. eveningness). The present study analyses the pineal gland volume (PGV) and its association with circadian preferences and symptom severity in adult ADHD patients compared to healthy controls. PGV was determined manually using high-resolution 3T MRI (T1-magnetization prepared rapid gradient echo) in medication free adult ADHD patients (N=74) compared to healthy controls (N=86). Moreover, the Morningness-Eveningness Questionnaire (MEQ), the ADHD Diagnostic Checklist and the Wender-Utah Rating Scale were conducted. PGV differed between both groups (patients: 59.9±33.8mm(3); healthy controls: 71.4±27.2mm(3), P=0.04). In ADHD patients, more eveningness types were revealed (patients: 29%; healthy controls: 17%; P=0.05) and sum scores of the MEQ were lower (patients: 45.8±11.5; healthy controls 67.2±10.1; P<0.001). Multiple regression analyses indicated a positive correlation of PGV and MEQ scores in ADHD (β=0.856, P=0.003) but not in healthy controls (β=0.054, P=0.688). Patients' MEQ scores (β=-0.473, P=0.003) were negatively correlated to ADHD symptoms. The present results suggest a linkage between the PGV and circadian preference in adults with ADHD and an association of the circadian preference to symptom severity. This may facilitate the development of new chronobiological treatment approaches for the add-on treatment in ADHD. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

Hyperfocusing as a dimension of adult attention deficit hyperactivity disorder.

PubMed

Ozel-Kizil, Erguvan Tugba; Kokurcan, Ahmet; Aksoy, Umut Mert; Kanat, Bilgen Bicer; Sakarya, Direnc; Bastug, Gulbahar; Colak, Burcin; Altunoz, Umut; Kirici, Sevinc; Demirbas, Hatice; Oncu, Bedriye

2016-12-01

Patients with Attention Deficit Hyperactivity Disorder (ADHD) suffer not only from inability to focus but also from inability to shift attention for events that trigger their interests. This phenomenon is called "hyperfocusing". Previous literature about hyperfocusing is scarce and relies mainly on case reports. The study aimed to investigate and compare the severity of hyperfocusing in adult ADHD with and without psycho-stimulant use. ADHD (DSM-IV-TR) patients either psycho-stimulant naive (n=53) or on psycho-stimulants (n=79) from two ADHD clinics were recruited. The control group (n=65) consisted of healthy university students. A socio-demographic form, the Beck Depression Inventory, the Wender-Utah Rating Scale, the Adult ADHD Self- Report Scale and the Hyperfocusing Scale were applied to the participants. There was no difference between total Hyperfocusing Scale and Adult ADHD Self- Report Scale scores of two patient groups, but both have higher scores than controls (p<0.001). Hyperfocusing is higher in adult ADHD and there was no difference between stimulant-naive patients or patients on stimulants. Hyperfocusing can be defined as a separate dimension of adult ADHD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reduced Capacity in a Dichotic Memory Test for Adult Patients with ADHD

ERIC Educational Resources Information Center

Dige, Niels; Maahr, Eija; Backenroth-Ohsako, Gunnel

2010-01-01

Objective: To evaluate whether a dichotic memory test would reveal deficits in short-term working-memory recall and long-term memory recall in a group of adult patients with ADHD. Methods: A dichotic memory test with ipsilateral backward speech distraction in an adult ADHD group (n = 69) and a control group (n = 66) is used to compare performance…

Need for care and life satisfaction in adult substance use disorder patients with and without attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

PubMed

Kronenberg, Linda M; Goossens, Peter J J; van Etten, Derk M; van Achterberg, Theo; van den Brink, Wim

2015-01-01

To identify care needs of adult substance use disorder (SUD) patients with and without co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). An exploratory study using the European Addiction Severity Index, the Camberwell Assessment of Needs, and the Manchester Short Assessment of Quality of Life to assess and compare care needs and perceived quality of life. All patients are dissatisfied with parts of their existence. SUD patients have fewer care needs than SUD patients with co-occurring ADHD or ASD. The SUD and SUD + ADHD groups report needs in similar domains. The SUD + ASD group shows a greater number of and more extensive care needs. Differences in the care needs of adult SUD patients with and without ADHD or ASD should be taken into account when developing evidence-based nursing care interventions. © 2014 Wiley Periodicals, Inc.

Pharmacotherapy for the treatment of aggression in pediatric and adolescent patients with autism spectrum disorder comorbid with attention-deficit hyperactivity disorder: A questionnaire survey of 571 psychiatrists.

PubMed

Yamamuro, Kazuhiko; Tsujii, Noa; Ota, Toyosaku; Kishimoto, Toshifumi; Iida, Junzo

2017-08-01

Both attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are frequently accompanied by serious aggression that requires psychiatric treatment. However, little is known about the experiences psychiatrists have had using pharmacotherapy to treat aggression in patients who have both ASD and ADHD (ASD/ADHD). The purpose of this study was to examine the experiences of Japanese child and adolescent psychiatrists in prescribing medication for aggression in patients with ASD/ADHD. A prospective questionnaire was mailed to 2001 psychiatrists affiliated with the Japanese Society for Child and Adolescent Psychiatry. Multivariate logistic regression analysis was used to identify factors predicting the outcome of pharmacotherapeutic treatment of aggression in pediatric and adolescent patients with ASD/ADHD. Of 2001 psychiatrists, 571 (28.5%) completed the full questionnaire (final sample). Of these, 488 (85.4%) prescribed psychotropic medication in treating pediatric and adolescent patients with ASD/ADHD, 299 (61.3%) of them doing so to treat aggression. Prescribers' duration of practice (odds ratio, 1.055; P = 0.038) and patient symptoms of residual impulsivity (odds ratio, 2.479; P = 0.039) increased the odds of prescribing psychotropic medications to treat aggression in these patients. The respondents reported a similar effect for patients with ADHD/ASD compared with those with ADHD only in treating aggression. Japanese psychiatrists tended to prescribe psychotropic medication for aggression in pediatric and adolescent patients with ASD/ADHD. Future studies examining aggression in pediatric and adolescent patients with ASD/ADHD should aim to accumulate evidence for the use of psychotropic medications, which could help clinicians make better decisions. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

Investigation into the plasma concentration of ω3 polyunsaturated fatty acids in Japanese attention-deficit hyperactivity disorder patients.

PubMed

Yonezawa, Ken; Nonaka, Shunsuke; Iwakura, Yuka; Kusano, Yuka; Funamoto, Yuko; Kanchi, Nobukazu; Yamaguchi, Naohiro; Kusumoto, Yuko; Imamura, Akira; Ozawa, Hiroki

2018-06-20

Several studies report that patients with attention-deficit hyperactivity disorder (ADHD) have a low plasma concentration of polyunsaturated fatty acids (PUFAs). Since fish intake varies among countries and is high in Japan, those results may not apply to Japanese patients with ADHD. However, there is currently not enough evidence to support this. We compared the plasma PUFAs levels of patients with ADHD with the standard reference levels for healthy subjects, and examined the relationship between those PUFAs levels and the subject's psychological evaluation. The subjects were 24 patients (age < 20 years) previously diagnosed with ADHD (according to the DSM-IV-TR criteria) at the psychiatric department of the Nagasaki University Hospital, between November 2010 and November 2015. The plasma concentrations of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (AA) were measured using gas chromatography. Data pertaining to global assessment of functioning (GAF), clinical global impressions, ADHD Rating Scale-IV, and the drug used for treatment (atomoxetine or methylphenidate) were obtained from the medical records. The plasma concentrations of DHA, EPA, and EPA/AA were significantly lower than the normal reference range, indicating that ADHD patients present an imbalance in PUFAs levels. This trend is similar to ADHD patients in other countries and replacement therapy in Japanese ADHD patients may be useful.

Delay discounting and response disinhibition under acute experimental stress in women with borderline personality disorder and adult attention deficit hyperactivity disorder.

PubMed

Krause-Utz, A; Cackowski, S; Daffner, S; Sobanski, Esther; Plichta, Michael M; Bohus, M; Ende, G; Schmahl, C

2016-11-01

Impulsivity is a core feature of borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD). In BPD, impulsive behavior primarily occurs under acute stress; impulse control deficits under non-stress conditions may be partly related to co-morbid ADHD. We aimed to investigate whether acute experimental stress has an impact on self-reported impulsivity, response inhibition (action withholding, action cancelation) and delay discounting in BPD compared to ADHD. Thirty female BPD patients, 28 female ADHD patients (excluding patients with co-morbid BPD and ADHD), and 30 female healthy controls (HC) completed self-reports and behavioral measures of impulsivity (IMT, assessing action withholding; GoStop, measuring action cancelation, Delay Discounting Task) under baseline conditions and after an experimental stress induction (Mannheim Multicomponent Stress Test). Both patient groups reported higher impulsivity than HC, ADHD reported higher trait impulsivity than BPD. On the IMT, ADHD showed significant action-withholding deficits under both conditions, while BPD performed significantly worse than HC under stress. In BPD but not ADHD and HC, action-withholding deficits (IMT) were significantly increased under stress compared to baseline, while no group/stress effects were found for action cancelation (GoStop). Delay discounting was significantly more pronounced in BPD than in HC (no stress effect was found). In BPD, behavioral deficits in action withholding (but not in action cancelation) appear to be influenced by acute experimental stress. Delay discounting seems to be a general feature of BPD, independent of co-morbid ADHD and acute stress, possibly underlying typical expressions of behavioral impulsivity in the disorder.

Real-World Dosing Patterns of Atomoxetine in Adults with Attention-Deficit/Hyperactivity Disorder.

PubMed

Kabul, Samaneh; Alatorre, Carlos; Montejano, Leslie B; Farr, Amanda M; Clemow, David B

2015-12-01

The aim was to investigate the dosing patterns of atomoxetine monotherapy in adult patients with attention-deficit/hyperactivity disorder (ADHD) in a retrospective analysis. Adult (≥ 18 years) patients with ADHD newly initiated on atomoxetine with ≥ 1 outpatient pharmacy claim for atomoxetine between January 2006 and December 2011 were selected from the Truven Health MarketScan(®) Commercial database. After a 30-day titration period, dosing patterns of atomoxetine monotherapy were analyzed in the 12 months following initiation. In addition, patient demographic and clinical characteristics were compared to identify characteristics associated with suboptimal versus recommended dosing. Of the 12,412 adult patients with ADHD newly initiated on atomoxetine, 4548 (36.6%) were suboptimally dosed, whereas 3323 (26.7%) were treated at recommended dose. Overall, study patients were treated at a mean (standard deviation [SD]) dose of 68.5 (44.9) mg/day. The suboptimal dosing cohort included significantly more females (54% vs. 44%, P < 0.001) and had fewer patients with pre-index use of other ADHD medications (17% vs. 20%, P < 0.001) compared with the recommended dosing cohort. Adult patients with ADHD receiving atomoxetine therapy in a real-world setting are often dosed suboptimally. Increasing the awareness on optimal dosing strategy among clinicians and patients is warranted to maximize the therapeutic benefits of atomoxetine among adult patients with ADHD. © 2015 Eli Lilly and Company. CNS Neuroscience and Therapeutics published by John Wiley & Sons Ltd.

Bipolar symptoms in adult attention-deficit/hyperactivity disorder: a cross-sectional study of 510 clinically diagnosed patients and 417 population-based controls.

PubMed

Halmøy, Anne; Halleland, Helene; Dramsdahl, Margaretha; Bergsholm, Per; Fasmer, Ole Bernt; Haavik, Jan

2010-01-01

Bipolar spectrum disorders (BSD) have several symptoms and features in common with attention-deficit/hyperactivity disorder (ADHD). Here we explored the prevalence of BSD and the relationship between symptoms of BSD and ADHD in adult ADHD patients. Norwegian adults diagnosed with DSM-IV ADHD during 1997 through 2007 (n = 510) and a random sample of 417 controls from the general population (aged 18-40 years) were recruited and responded to 85 questions rating symptoms of ADHD, lifetime symptoms of mood disorders, other comorbid conditions, and sociodemographic data. According to the Mood Disorder Questionnaire (MDQ), 50.6% of the ADHD patients screened positive for BSD, compared to 8.3% of the controls. In comparison, the prevalence of BSD according to DSM-IV in a subsample of interviewed patients (n = 50) was 32%. In the whole study sample (N = 927), an ADHD diagnosis was the strongest predictor for screening positive on the MDQ (OR = 5.0, P < .001), but the correlation between dimensional symptom levels of ADHD and of BSD was strongest in the control group (Pearson correlation r = 0.7, P < .001 vs r = 0.3, P < .001). Patients screening positive on the MDQ had significantly more drug problems, higher ADHD symptom scores, and lower educational and occupational levels. Our findings illustrate the close relationship between some symptoms of BSD and ADHD in adults. In clinical and research settings, patients screening positive for BSD should be assessed for a possible underlying or coexisting ADHD condition and vice versa. ©Copyright 2010 Physicians Postgraduate Press, Inc.

Diagnostic profiles of adult psychiatric outpatients with and without attention deficit hyperactivity disorder.

PubMed

Gorlin, Eugenia I; Dalrymple, Kristy; Chelminski, Iwona; Zimmerman, Mark

2016-10-01

Despite growing recognition that attention deficit/hyperactivity disorder (ADHD) is a highly prevalent, impairing, and comorbid disorder that persists into adulthood, reports on the nature and extent of its psychiatric comorbidities have been mixed to date. This study compared the prevalence rates of all major Axis I disorders as well as borderline personality disorder in an unselected sample of adult psychiatric outpatients with and without ADHD. As part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we administered a DSM-IV-based semi-structured diagnostic interview assessing ADHD and other psychiatric disorders to 1134 patients presenting for initial evaluation at an outpatient psychiatric practice. Logistic regression analyses were used to compare the rates of each disorder in patients with versus without an ADHD diagnosis (both overall and by Combined and Inattentive type). Patients with (versus without) any ADHD diagnosis had significantly higher rates of bipolar disorder, social phobia, impulse control disorders, eating disorders, and BPD, and significantly lower rates of major depressive disorder and adjustment disorder (all p<.05). Patients with (versus without) ADHD-Inattentive type had significantly higher rates of social phobia and eating disorders, whereas those with (versus without) the ADHD-Combined type had significantly higher rates of bipolar disorder, alcohol dependence, and BPD (all p<.05). In this novel investigation of the psychiatric profiles of an unselected sample of treatment-seeking adult outpatients with versus without ADHD, a distinct pattern of comorbidities emerged across subtypes, with implications for the accurate assessment and treatment of patients presenting for psychiatric care. Copyright © 2016 Elsevier Inc. All rights reserved.

How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis.

PubMed

Levin, Frances R; Choi, C Jean; Pavlicova, Martina; Mariani, John J; Mahony, Amy; Brooks, Daniel J; Nunes, Edward V; Grabowski, John

2018-05-01

Attention-deficit hyperactivity disorder (ADHD) is overrepresented among individuals seeking treatment for substance use disorders. We previously reported that treatment with extended release mixed amphetamine salts (MAS-XR) increased abstinence, compared to placebo, among patients with co-occurring ADHD and cocaine dependence. This secondary analysis investigates the temporal relationship between ADHD improvement and cocaine abstinence in the first six weeks of the trial. The study was a three-arm, randomized, double-blinded, placebo-controlled, 14-week trial comparing MAS-XR (60 mg or 80 mg daily) versus placebo among 126 participants with ADHD and cocaine dependence. An autoregressive cross-lagged structural equation model was fit and evaluated weekly ADHD improvement (defined as ≥30% reduction in the Adult ADHD Investigator Symptom Rating Scale) and urine-confirmed abstinence over the first six weeks. The proportion of patients with each of the possible overall patterns of response was: ADHD improves before cocaine abstinence: 24%; Cocaine abstinence occurs before ADHD improvement: 12%; ADHD improvement and abstinence occur during the same week: 6%; ADHD improves but abstinence never achieved: 34%; Abstinence achieved but ADHD never improves: 6%; Neither ADHD improvement nor abstinence: 18%. A significant cross-lagged association was found; subjects with ADHD improvement at week 2 had significantly higher odds of cocaine abstinence at week 3 (p = .014). When treating co-occurring ADHD and cocaine dependence with stimulant medication, abstinence is most likely preceded by improvement in ADHD, which tends to occur early with medication treatment. Other observed temporal patterns suggest the potential complexity of the relationship between ADHD and cocaine dependence. Copyright © 2018. Published by Elsevier B.V.

Concurrent cannabis use during treatment for comorbid ADHD and cocaine dependence: effects on outcome.

PubMed

Aharonovich, Efrat; Garawi, Fatima; Bisaga, Adam; Brooks, Daniel; Raby, Wilfrid N; Rubin, Eric; Nunes, Edward V; Levin, Frances R

2006-01-01

Cannabis is the most widely used illicit substance in the United States with especially high prevalence of use among those with psychiatric disorders. Few studies have examined the relationship between concurrent cannabis use and treatment outcome among patients receiving treatment for comorbid substance abuse and psychiatric disorders. This study investigated the effects of cannabis use on treatment retention and abstinence from cocaine among cocaine dependent patients with Attention Deficit Hyperactivity Disorder (ADHD). Cocaine dependent patients diagnosed with current ADHD (DSM-IV, N = 92) aged 25 to 51 participated in a randomized clinical trial of methylphenidate for treatment of ADHD and cocaine dependence in an outpatient setting. The majority of patients (69%) used cannabis during treatment. Results suggest that moderate/intermittent cannabis users had greater retention rates compared to abstainers and consistent users (p = .02). This study is the first to examine concurrent cannabis use in cocaine dependent patients diagnosed with ADHD.

Burden of illness and health care resource utilization in adult psychiatric outpatients with attention-deficit/hyperactivity disorder in Europe.

PubMed

Karlsdotter, Kristina; Bushe, Chris; Hakkaart, L; Sobanski, Esther; Kan, C C; Lebrec, Jeremie; Kraemer, Susanne; Dieteren, Nicole A H M; Deberdt, Walter

2016-09-01

To assess the burden of illness and health care resource utilization of adult nonpsychotic psychiatric outpatients with attention-deficit/hyperactivity disorder (ADHD) in Europe. This was a multicountry, cross-sectional, observational study where unselected routine patients from clinical psychiatric outpatient settings were screened and assessed for ADHD. Patients were evaluated using the Clinical Global Impressions of Severity (CGI-S) scale, the Sheehan Disability Scale (SDS), and the EuroQol-5 Dimensions questionnaire. Data on comorbidities, functional impairment, and health care resource utilization were captured. The study enrolled 2284 patients, of whom 1986 completed the study. The prevalence of ADHD was 17.4%, of whom 46.0% had a previous ADHD diagnosis. Patients with ADHD had a high clinical burden with psychiatric comorbidities, especially depression (43.0%) and anxiety disorders (36.4%). Substance abuse (9.2% vs. 3.4%) and alcohol abuse (10.3% vs. 5.2%) were more common in the ADHD cohort vs. the non-ADHD cohort. Only 11.5% of the patients with ADHD had no other psychiatric disorder. Various measures indicated a significantly poorer level of functioning for patients with ADHD than without ADHD, as indicated by higher scores for CGI-S (3.8 vs. 3.3) and SDS (18.9 vs. 11.6) and higher percentages of debt (35.5% vs. 24.3%) and criminality (13.8% vs. 6.1%). Lastly, the health care resource utilization was considerable and similar between adult psychiatric outpatients diagnosed and not diagnosed with ADHD. Although care was taken when choosing the sites for this study, to make it representative of the general outpatient adult psychiatric population, caution should be advised in generalizing the findings of our study to the general ADHD or psychiatric outpatient population. This was an observational study, thus no inference on causality can be drawn. Having ADHD imposes a considerable health and social burden on patient and health care resource utilization comparable to other chronic psychiatric disorders.

Excessive daytime sleepiness in adult patients with ADHD as measured by the Maintenance of Wakefulness Test, an electrophysiologic measure.

PubMed

Bioulac, Stéphanie; Chaufton, Cyril; Taillard, Jacques; Claret, Astrid; Sagaspe, Patricia; Fabrigoule, Colette; Bouvard, Manuel P; Philip, Pierre

2015-07-01

To quantify the objective level of sleepiness in adult attention-deficit/hyperactivity disorder (ADHD) patients and to determine the relationship between excessive daytime sleepiness and simulated driving performance. Forty adult ADHD patients (DSM-IV criteria) and 19 matched healthy control subjects were included between June 30, 2010, and June 19, 2013. All participants completed the Epworth Sleepiness Scale and the Manchester Driving Behavior Questionnaire. After nocturnal polysomnography, they performed 2 neuropsychological tests, a 4 × 40-minute Maintenance of Wakefulness Test, and a 1-hour driving session. The primary outcome measure was the mean sleep latency on the Maintenance of Wakefulness Test. ADHD patients were divided into 3 groups defined by their Maintenance of Wakefulness Test scores. Participants (patients and control subjects) were allocated as follows: sleepy ADHD (0-19 min), intermediate ADHD (20-33 min), alert ADHD (34-40 min), and control group (34-40 min). The driving performance outcome was the mean standard deviation of lateral position of the vehicle during the simulated session. The group mean (SD) Epworth Sleepiness Scale score was higher in ADHD patients (12.1 [4.4]) than in controls (6.0 [2.7]) (P < .001). On the basis of the Maintenance of Wakefulness Test scores, 14 patients (35%) were in the sleepy group, 20 (50%) were in the intermediate group, and only 6 (15%) were in the alert group. Sleepy ADHD patients exhibited significantly deteriorated driving performance compared to the other 3 groups (P < .01). Our study shows that a significant proportion of adult ADHD patients exhibit an objective excessive daytime sleepiness, which, in addition, has an impact on simulated driving performance. Excessive daytime sleepiness, therefore, may be a key element needed to better evaluate these ADHD patients. ClinicalTrials.gov identifier: NCT01160874. © Copyright 2015 Physicians Postgraduate Press, Inc.

Toward an objective indexing system for ADHD-screening using children's activity monitoring.

PubMed

Kam, Hye Jin; Choi, Jong Pil; Park, Rae Woong

2008-11-06

Signs of ADHD are discernible in specific situations, and usually assessed according to subjective impressions. We performed a preliminary comparative study from children's activity at a natural classroom environment with 3-axis accelerator for a feasible objective index. From a total of 157 children (7-9 yrs) and clinically diagnosed 24 children out of them, variances in 1-min epoch mean activity had shown significant differences among the subgroups: (1) ADHD=.0194, Other Diseases=.0080, Normal=.0009; (2) ADHD=.0194, non-ADHD=.0057(p<.01, respectively). There were also significant differences in high-level activity (>1.6G) features among subgroups with the same order (p<.01, respectively). ADHD patients exhibited more dispersed activities and higher high-level activity ratio than normal. Activity features can be useful to build an objective indexing system for screening ADHD patients.

Patient-reported Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales in pediatric patients with attention-deficit/hyperactivity disorder and comorbid psychiatric disorders: feasibility, reliability, and validity.

PubMed

Limbers, Christine A; Ripperger-Suhler, Jane; Heffer, Robert W; Varni, James W

2011-06-01

The primary objective of the study was to evaluate the feasibility, reliability, and validity of the Pediatric Quality of Life Inventory™ (PedsQL) 4.0 Generic Core Scales as a patient self-reported health-related quality of life measurement instrument in pediatric patients with attention-deficit/hyperactivity disorder (ADHD) and physician-diagnosed comorbid psychiatric disorders being seen in a pediatric psychiatric clinic. The secondary objective was to evaluate parent proxy-reported PedsQL in this population. One hundred seventy-nine children with ADHD and comorbid psychiatric disorders ages 5 to 18 years and 181 parents completed the PedsQL 4.0 Generic Core Scales and parents also completed the Vanderbilt ADHD Diagnostic Rating Scales. Known-groups discriminant validity comparisons were made between the sample of pediatric patients with ADHD and comorbid psychiatric disorders and healthy, cancer, and type 1 diabetes samples. The PedsQL evidenced minimal missing responses for patient self-report and parent proxy-report (0.2% and 0.5%, respectively), demonstrated no significant floor or ceiling effects, and achieved excellent reliability for the Total Scale Score (α = 0.85 patient self-report, 0.92 parent proxy-report). Pediatric patients with ADHD and comorbid psychiatric disorders and their parents reported statistically significantly worse PedsQL scores than healthy children, with large effect sizes across all domains, supporting known-groups discriminant validity. Pediatric patients with ADHD and comorbid psychiatric disorders and their parents reported worse PedsQL scores compared to pediatric patients with cancer and diabetes with the exception of physical health, in which pediatric cancer patients manifested lower physical health, indicating the relative severe impact of ADHD and comorbid psychiatric disorders. More severe ADHD symptoms were generally associated with more impaired PedsQL scores, supporting construct validity. These data demonstrate the feasibility, reliability, and validity of patient self-reported PedsQL 4.0 Generic Core Scales in this high risk population of pediatric patients and highlight the profound negative impact of ADHD and comorbid psychiatric disorders on generic health-related quality of life, comparable to or worse than serious pediatric chronic physical diseases. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Prevalence rates of youths diagnosed with and medicated for ADHD in a nationwide survey in Taiwan from 2000 to 2011.

PubMed

Wang, L-J; Lee, S-Y; Yuan, S-S; Yang, C-J; Yang, K-C; Huang, T-S; Chou, W-J; Chou, M-C; Lee, M-J; Lee, T-L; Shyu, Y-C

2017-12-01

Public controversy regarding the potential overdiagnosis and overmedication of children with attention-deficit/hyperactivity disorder (ADHD) has continued for decades. This study used the National Health Insurance Research Database of Taiwan (NHIRD-TW) to explore trends in ADHD diagnosis in youths and the proportion of those receiving medication, with the aim of determining whether ADHD is overdiagnosed and overmedicated in Taiwan. Youths (age ≤18 years) who had at least two NHIRD-TW claims records with ADHD diagnosis between January 2000 and December 2011 were selected as the subject cohort. In total, the study sample comprised 145 018 patients with ADHD (mean age at a diagnosis of ADHD: 7.7 ± 3.1 years; 21.4% females). The number of cases of ADHD were calculated annually for each year (from 2000 to 2011), and the number of cases per year who received medication was determined as those with at least one record of pharmacotherapy (immediate-release methylphenidate, osmotic controlled-release formulation of methylphenidate, and atomoxetine) in each year. The prevalence rates of a diagnosis of ADHD in the youths ranged from 0.11% in 2000 to 1.24% in 2011. Compared with children under 6 years of age, the ADHD diagnosis rates in children aged between 7 and 12 years (ratio of prevalence rates = 4.36) and in those aged between 13 and 18 years (ratio of prevalence rates = 1.42) were significantly higher during the study period. The prevalence in males was higher than that in females (ratio of prevalence rates = 4.09). Among the youths with ADHD, 50.2% received medications in 2000 compared with 61.0% in 2011. The probability of receiving ADHD medication increased with age. More male ADHD patients received medications that females patients (ratio of prevalence rates = 1.16). The rate of ADHD diagnosis was far lower than the prevalence rate (7.5%) identified in a previous community study using face-to-face interviews. Approximately 40-50% of the youths with ADHD did not receive any medications. These findings are not consistent with a systematic public opinion about overdiagnosis or overmedication of ADHD in Taiwan.

Childhood Attention-Deficit/Hyperactivity Disorder, Sex, and Obesity: A Longitudinal Population-Based Study.

PubMed

Aguirre Castaneda, Roxana L; Kumar, Seema; Voigt, Robert G; Leibson, Cynthia L; Barbaresi, William J; Weaver, Amy L; Killian, Jill M; Katusic, Slavica K

2016-03-01

To assess obesity rates during childhood and young adulthood in patients with attention-deficit/hyperactivity disorder (ADHD) and age- and sex-matched controls derived from a population-based birth cohort because cross-sectional studies suggest an association between ADHD and obesity. Study subjects included patients with childhood ADHD (n=336) and age- and sex-matched non-ADHD controls (n=665) from a 1976 to 1982 birth cohort (N=5718). Height, weight, and stimulant treatment measurements were abstracted retrospectively from medical records documenting care provided from January 1, 1976, through August 31, 2010. The association between ADHD and obesity in patients with ADHD relative to controls was estimated using Cox models. Patients with attention-deficit/hyperactivity disorder were 1.23 (95% CI, 1.00-1.50; P<.05) times more likely to be obese during the follow-up period than were non-ADHD controls. This association was not statistically significant in either sex (female participants: hazard ratio [HR], 1.49; 95% CI, 0.98-2.27; P=.06; male participants HR, 1.17, 95% CI, 0.92-1.48; P=.20). Patients with ADHD who were not obese as of the date ADHD research diagnostic criteria were met were 1.56 (95% CI, 1.14-2.13; P<.01) times more likely to be obese during the subsequent follow-up than were controls. This association was statistically significant in female study subjects (HR, 2.02; 95% CI, 1.13-3.60; P=.02), but not in male participants (HR, 1.41; 95% CI, 0.97-2.05; P=.07). A higher proportion of patients with ADHD were obese after the age of 20 years compared with non-ADHD controls (34.4% vs 25.1%; P=.01); this difference was observed only in female patients (41.6% vs 19.2%). There were no differences in obesity rates between stimulant-treated and nontreated patients with ADHD. Childhood ADHD is associated with obesity during childhood and young adulthood in females. Treatment with stimulant medications is not associated with the development of obesity up to young adulthood. Copyright © 2016. Published by Elsevier Inc.

Neural response during anticipation of monetary loss is elevated in adult attention deficit hyperactivity disorder.

PubMed

Wilbertz, Gregor; Delgado, Mauricio R; Tebartz Van Elst, Ludger; Maier, Simon; Philipsen, Alexandra; Blechert, Jens

2017-06-01

Risky behaviour seriously impacts the life of adult patients with attention deficit hyperactivity disorder (ADHD). Such behaviours have often been attributed to their exaggerated reward seeking, but dysfunctional anticipation of negative outcomes might also play a role. The present study compared adult patients with ADHD (n = 28) with matched healthy controls (n = 28) during anticipation of monetary losses versus gains while undergoing functional magnetic resonance imaging (fMRI) and skin conductance recording. Skin conductance was higher during anticipation of losses compared to gains in both groups. Affective ratings of predictive cues did not differ between groups. ADHD patients showed increased activity in bilateral amygdalae, left anterior insula (region of interest analysis) and left temporal pole (whole brain analysis) compared to healthy controls during loss versus gain anticipation. In the ADHD group higher insula and temporal pole activations went along with more negative affective ratings. Neural correlates of loss anticipation are not blunted but rather increased in ADHD, possibly due to a life history of repeated failures and the respective environmental sanctions. Behavioural adaptations to such losses, however, might differentiate them from controls: future research should study whether negative affect might drive more risk seeking than risk avoidance.

[Attention deficit hyperactivity disorder in adults. Benchmarking diagnosis using the Wender-Reimherr adult rating scale].

PubMed

Rösler, M; Retz, W; Retz-Junginger, P; Stieglitz, R D; Kessler, H; Reimherr, F; Wender, P H

2008-03-01

We report on a study comparing different systems for the diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood. Recruited for evaluation were 168 patients referred to our ADHD outpatient unit. We used the Diagnostic and Statistical Manual of Mental Disorders 4th edn. (DSM-IV), International Classification of Diseases 10th edn. (ICD-10), and Utah criteria for diagnostic assessment and the Wender Utah rating scale, ADHD Self Report (ADHD-SR), and Wender Reimherr Adult Attention Deficit Disorder Rating Scale as psychopathological assessment tools. We present basic psychometric data of the Wender-Reimherr Interview (WRI). Internal consistency was determined as 0.82 (alpha). The inter-rater reliability was 1.0 (kappa coefficient) regarding ADHD diagnoses, and the ICC was 0.98 referring to the WRI total scores. The convergent validity with the ADHD-SR was 0.65 (Spearman coefficient). In 126 of 168 patients an ADHD diagnosis was made according to at least one of the three systems. The DSM-IV diagnostic set led to 119 ADHD diagnoses. As compared with the two other systems, this is about the minimum level for an ADHD diagnosis. All of the 87 ADHD diagnoses according to ICD-10 were covered by DSM-IV. The ICD-10 had no independent psychopathological items and therefore offered no additional points for the diagnostic procedure than the DSM-IV. The situation regarding Utah criteria is different. These criteria contain seven psychopathological domains: inattention, hyperactivity, disorganisation, impulsivity, affective lability, overreactivity, and hot temper. They can be assessed by use of the WRI. Ninety-three of 168 patients were diagnosed as having ADHD according to the Utah concept, which is much lower than with the DSM-IV. The particular definition of the disorder by the Utah criteria resulted in seven patients having only a Utah diagnosis but no DSM-IV diagnosis. Thus we are in a position to say that the Utah criteria have a relatively high level for making an ADHD diagnosis but in certain cases move beyond the DSM-IV. Of the patients 56% had ADHD diagnoses according to all three classification instruments. Examining the factor structure of the ADHD psychopathology represented by seven WRI and three ADHD-SR subscales, we found a two-factor solution explaining for 63% of the variance. Factor 1 was designated by impulsivity, affective lability, hyperactivity, and hot temper; factor 2 consisted of inattention, disorganisation, and overreactivity.

Self-esteem evaluation in children and adolescents suffering from ADHD.

PubMed

Mazzone, Luigi; Postorino, Valentina; Reale, Laura; Guarnera, Manuela; Mannino, Valeria; Armando, Marco; Fatta, Laura; De Peppo, Lavinia; Vicari, Stefano

2013-01-01

Several recent studies investigated the relationship between self-esteem and ADHD, however, the results are still controversial. In the present study we analyze the characteristics of self-esteem in a sample of children and adolescents suffering from ADHD, with a particular focus on the relationship between ADHD symptoms severity and treatment strategies. A total of 85 patients with ADHD (44 drug-free and 41 drug-treated, 23 of which atomoxetine-treated and 18 Methylphenidate-treated) and 26 healthy controls were enrolled in the study in order to evaluate self-esteem using the Self-esteem Multidimensional Test (TMA). ADHD subjects revealed lower scores on all self-esteem domains compared to controls. Both ADHD drug-free (47.1%) and ADHD drug-treated (44.1%) groups showed significantly higher rates of subjects in the pathological range as compared to normal control group (8.8%) (p <.001) with a higher percentage of subjects in the pathological range. Among ADHD drug-treated subjects, the methylphenidate group showed higher self-esteem scores as compared to the atomoxetine group. A lower self-esteem profile is more common in subjects suffering from ADHD than in healthy controls, suggesting the importance of an early detection of psychological well-being in these children in order to reduce the ADHD symptoms long-term impacts.

Self-Esteem Evaluation in Children and Adolescents Suffering from ADHD

PubMed Central

Mazzone, Luigi; Postorino, Valentina; Reale, Laura; Guarnera, Manuela; Mannino, Valeria; Armando, Marco; Fatta, Laura; De Peppo, Lavinia; Vicari, Stefano

2013-01-01

Background: Several recent studies investigated the relationship between self-esteem and ADHD, however, the results are still controversial. In the present study we analyze the characteristics of self-esteem in a sample of children and adolescents suffering from ADHD, with a particular focus on the relationship between ADHD symptoms severity and treatment strategies. Methods: A total of 85 patients with ADHD (44 drug-free and 41 drug-treated, 23 of which atomoxetine-treated and 18 Methylphenidate-treated) and 26 healthy controls were enrolled in the study in order to evaluate self-esteem using the Self-esteem Multidimensional Test (TMA). Results: ADHD subjects revealed lower scores on all self-esteem domains compared to controls. Both ADHD drug-free (47.1%) and ADHD drug-treated (44.1%) groups showed significantly higher rates of subjects in the pathological range as compared to normal control group (8.8%) (p <.001) with a higher percentage of subjects in the pathological range. Among ADHD drug-treated subjects, the methylphenidate group showed higher self-esteem scores as compared to the atomoxetine group. Conclusion: A lower self-esteem profile is more common in subjects suffering from ADHD than in healthy controls, suggesting the importance of an early detection of psychological well-being in these children in order to reduce the ADHD symptoms long-term impacts. PMID:23878614

Linear and non-linear analyses of Conner's Continuous Performance Test-II discriminate adult patients with attention deficit hyperactivity disorder from patients with mood and anxiety disorders.

PubMed

Fasmer, Ole Bernt; Mjeldheim, Kristin; Førland, Wenche; Hansen, Anita L; Syrstad, Vigdis Elin Giæver; Oedegaard, Ketil J; Berle, Jan Øystein

2016-08-11

Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder. Therefore it is important to look for factors that can contribute to better diagnosis and classification of these patients. The aims of the study were to characterize adult psychiatric out-patients with a mixture of mood, anxiety and attentional problems using an objective neuropsychological test of attention combined with an assessment of mood instability. Newly referred patients (n = 99; aged 18-65 years) requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited, and were given a comprehensive diagnostic evaluation including the self-report form of the cyclothymic temperament scale and Conner's Continuous Performance Test II (CPT-II). In addition to the traditional measures from this test we have extracted raw data and analysed time series using linear and non-linear mathematical methods. Fifty patients fulfilled criteria for ADHD, while 49 did not, and were given other psychiatric diagnoses (clinical controls). When compared to the clinical controls the ADHD patients had more omission and commission errors, and higher reaction time variability. Analyses of response times showed higher values for skewness in the ADHD patients, and lower values for sample entropy and symbolic dynamics. Among the ADHD patients 59 % fulfilled criteria for a cyclothymic temperament, and this group had higher reaction time variability and lower scores on complexity than the group without this temperament. The CPT-II is a useful instrument in the assessment of ADHD in adult patients. Additional information from this test was obtained by analyzing response times using linear and non-linear methods, and this showed that ADHD patients with a cyclothymic temperament were different from those without this temperament.

Comorbidity in adults with attention-deficit hyperactivity disorder.

PubMed

Cumyn, Lucy; French, Lisa; Hechtman, Lily

2009-10-01

To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD). Adult patients (n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD (n = 335), there were those with ADHD inattentive subtype (ADHD-I) (n = 199), hyperactive-impulsive subtype (ADHD-H) (n = 24), or combined ADHD subtype (ADHD-C) (n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders. Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive-compulsive personality disorder, passive-aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD). Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD. Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.

Specific cognitive-neurophysiological processes predict impulsivity in the childhood attention-deficit/hyperactivity disorder combined subtype.

PubMed

Bluschke, A; Roessner, V; Beste, C

2016-04-01

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders in childhood. Besides inattention and hyperactivity, impulsivity is the third core symptom leading to diverse and serious problems. However, the neuronal mechanisms underlying impulsivity in ADHD are still not fully understood. This is all the more the case when patients with the ADHD combined subtype (ADHD-C) are considered who are characterized by both symptoms of inattention and hyperactivity/impulsivity. Combining high-density electroencephalography (EEG) recordings with source localization analyses, we examined what information processing stages are dysfunctional in ADHD-C (n = 20) compared with controls (n = 18). Patients with ADHD-C made more impulsive errors in a Go/No-go task than healthy controls. Neurophysiologically, different subprocesses from perceptual gating to attentional selection, resource allocation and response selection processes are altered in this patient group. Perceptual gating, stimulus-driven attention selection and resource allocation processes were more pronounced in ADHD-C, are related to activation differences in parieto-occipital networks and suggest attentional filtering deficits. However, only response selection processes, associated with medial prefrontal networks, predicted impulsive errors in ADHD-C. Although the clinical picture of ADHD-C is complex and a multitude of processing steps are altered, only a subset of processes seems to directly modulate impulsive behaviour. The present findings improve the understanding of mechanisms underlying impulsivity in patients with ADHD-C and might help to refine treatment algorithms focusing on impulsivity.

Event-related potentials reflect the efficacy of pharmaceutical treatments in children and adolescents with attention deficit/hyperactivity disorder.

PubMed

Yamamuro, Kazuhiko; Ota, Toyosaku; Iida, Junzo; Nakanishi, Yoko; Matsuura, Hiroki; Uratani, Mitsuhiro; Okazaki, Kosuke; Kishimoto, Naoko; Tanaka, Shohei; Kishimoto, Toshifumi

2016-08-30

Few objective biological measures of pharmacological treatment efficacy exist for attention deficit/hyperactivity disorder (ADHD). Although we have previously demonstrated that event-related potentials (ERPs) reflect the effects of osmotic-release methylphenidate in treatment of naïve pediatric patients with ADHD, whether this is true for the therapeutic effects of atomoxetine (ATX) is unknown. Here, we used the Japanese version of the ADHD rating-scale IV to evaluate 14 patients with ADHD, and compared their ERP data with 14 age- and sex-matched controls. We measured P300 and mismatch negativity (MMN) components during an auditory oddball task before treatment (treatment naïve) and after 2 months of ATX treatment. Compared with controls, P300 components at baseline were attenuated and prolonged in the ADHD group at Fz (fronto-central), Cz (centro-parietal), Pz (parietal regions), C3 and C4 electrodes. ATX treatment reduced ADHD symptomology, and after 2 months of treatment, P300 latencies at Fz, Cz, Pz, C3, and C4 electrodes were significantly shorter than those at baseline. Moreover, MMN amplitudes at Cz and C3 electrodes were significantly greater than those at baseline. Thus, ERPs may be useful for evaluating the pharmacological effects of ATX in pediatric and adolescent patients with ADHD. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Neurological soft signs are associated with attentional dysfunction in children with attention deficit hyperactivity disorder.

PubMed

Pitzianti, Mariabernarda; D'Agati, Elisa; Casarelli, Livia; Pontis, Marco; Kaunzinger, Ivo; Lange, Klaus W; Tucha, Oliver; Curatolo, Paolo; Pasini, Augusto

2016-11-01

Inattention is one of the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Most of patients with ADHD show motor impairment, consisting in the persistence of neurological soft signs (NSS). Our aim was to evaluate attentional and motor functioning in an ADHD sample and healthy children (HC) and possible link between attentional dysfunction and motor impairment in ADHD. Twenty-seven drug-naive patients with ADHD and 23 HC were tested with a test battery, measuring different aspects of attention. Motor evaluation has provided three primary variables: overflow movements (OM), dysrhythmia and total speed of timed activities. Compared to HC, patients were impaired in a considerable number of attentional processes and showed a greater number of NSS. Significant correlations between disturbances of attention and motor abnormalities were observed in ADHD group. Our findings suggest that attentional processes could be involved in the pathophysiology of the NSS and add scientific evidence to the predictive value of NSS as indicators of the severity of functional impairment in ADHD. Given the marked improvement or complete resolution of NSS following treatment with methylphenidate, we suggest that evaluation of NSS is useful to monitor the effectiveness of pharmacological treatment with MPH in ADHD.

Shared and disorder-specific task-positive and default mode network dysfunctions during sustained attention in paediatric Attention-Deficit/Hyperactivity Disorder and obsessive/compulsive disorder.

PubMed

Norman, Luke J; Carlisi, Christina O; Christakou, Anastasia; Cubillo, Ana; Murphy, Clodagh M; Chantiluke, Kaylita; Simmons, Andrew; Giampietro, Vincent; Brammer, Michael; Mataix-Cols, David; Rubia, Katya

2017-01-01

Patients with Attention-Deficit/Hyperactivity Disorder (ADHD) and obsessive/compulsive disorder (OCD) share problems with sustained attention, and are proposed to share deficits in switching between default mode and task positive networks. The aim of this study was to investigate shared and disorder-specific brain activation abnormalities during sustained attention in the two disorders. Twenty boys with ADHD, 20 boys with OCD and 20 age-matched healthy controls aged between 12 and 18 years completed a functional magnetic resonance imaging (fMRI) version of a parametrically modulated sustained attention task with a progressively increasing sustained attention load. Performance and brain activation were compared between groups. Only ADHD patients were impaired in performance. Group by sustained attention load interaction effects showed that OCD patients had disorder-specific middle anterior cingulate underactivation relative to controls and ADHD patients, while ADHD patients showed disorder-specific underactivation in left dorsolateral prefrontal cortex/dorsal inferior frontal gyrus (IFG). ADHD and OCD patients shared left insula/ventral IFG underactivation and increased activation in posterior default mode network relative to controls, but had disorder-specific overactivation in anterior default mode regions, in dorsal anterior cingulate for ADHD and in anterior ventromedial prefrontal cortex for OCD. In sum, ADHD and OCD patients showed mostly disorder-specific patterns of brain abnormalities in both task positive salience/ventral attention networks with lateral frontal deficits in ADHD and middle ACC deficits in OCD, as well as in their deactivation patterns in medial frontal DMN regions. The findings suggest that attention performance in the two disorders is underpinned by disorder-specific activation patterns.

Impact of head models in N170 component source imaging: results in control subjects and ADHD patients

NASA Astrophysics Data System (ADS)

Beltrachini, L.; Blenkmann, A.; von Ellenrieder, N.; Petroni, A.; Urquina, H.; Manes, F.; Ibáñez, A.; Muravchik, C. H.

2011-12-01

The major goal of evoked related potential studies arise in source localization techniques to identify the loci of neural activity that give rise to a particular voltage distribution measured on the surface of the scalp. In this paper we evaluate the effect of the head model adopted in order to estimate the N170 component source in attention deficit hyperactivity disorder (ADHD) patients and control subjects, considering faces and words stimuli. The standardized low resolution brain electromagnetic tomography algorithm (sLORETA) is used to compare between the three shell spherical head model and a fully realistic model based on the ICBM-152 atlas. We compare their variance on source estimation and analyze the impact on the N170 source localization. Results show that the often used three shell spherical model may lead to erroneous solutions, specially on ADHD patients, so its use is not recommended. Our results also suggest that N170 sources are mainly located in the right occipital fusiform gyrus for faces stimuli and in the left occipital fusiform gyrus for words stimuli, for both control subjects and ADHD patients. We also found a notable decrease on the N170 estimated source amplitude on ADHD patients, resulting in a plausible marker of the disease.

Atomoxetine Treatment for Pediatric Patients with Attention-Deficit/Hyperactivity Disorder with Comorbid Anxiety Disorder

ERIC Educational Resources Information Center

Geller, Daniel; Donnelly, Craig; Lopez, Frank; Rubin, Richard; Newcorn, Jeffrey; Sutton, Virginia; Bakken, Rosalie; Paczkowski, Martin; Kelsey, Douglas; Sumner, Calvin

2007-01-01

Objective: Research suggests 25% to 35% of children with attention-deficit/hyperactivity disorder (ADHD) have comorbid anxiety disorders. This double-blind study compared atomoxetine with placebo for treating pediatric ADHD with comorbid anxiety, as measured by the ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored…

Efficacy and safety of atomoxetine hydrochloride in Korean adults with attention-deficit hyperactivity disorder.

PubMed

Lee, Soyoung Irene; Song, Dong-Ho; Shin, Dong Won; Kim, Ji Hoon; Lee, Young Sik; Hwang, Jun-Won; Park, Tae Won; Yook, Ki-Hwan; Lee, Jong Il; Bahn, Geon Ho; Hirata, Yuko; Goto, Taro; Takita, Yasushi; Takahashi, Michihiro; Lee, Sanghoon; Treuer, Tamás

2014-12-01

This article aims to assess the efficacy and safety of atomoxetine in Korean adults with attention-deficit hyperactivity disorder (ADHD). This post hoc double-blind, placebo-controlled study of atomoxetine (40-120 mg/day) over 10 weeks in adults with ADHD at 45 Japanese, Korean, and Taiwanese study sites focused on patient data from Korea (atomoxetine, n = 37; placebo, n = 37). Primary efficacy outcome was change in baseline-to-endpoint Conners' Adult ADHD Rating Scale-Investigator-rated: Screening Version (CAARS-Inv:SV) Total ADHD Symptoms score. Secondary efficacy outcomes included changes in Adult ADHD Quality of Life (AAQoL) total, Behavior Rating Inventory of Executive Function-Adult Version Self-Report (BRIEF-A:Self-Report), and Clinical Global Impression-ADHD-Severity (CGI-ADHD-S) scale scores. Atomoxetine-treated patients demonstrated a mean 18.9-point reduction in CAARS-Inv:SV total ADHD Symptoms score, compared with the 7.45-point reduction in placebo-treated patients (P ≤ 0.01). Significantly greater improvement was found for atomoxetine versus placebo in CGI-ADHD-S (P ≤ 0.01), BRIEF-A:Self-Report global executive composite (P ≤ 0.05), and metacognition index (P ≤ 0.01) executive function scores. Nausea, decreased appetite, and dry mouth were reported with significantly greater frequency by atomoxetine-treated patients, and only one placebo-treated patient discontinued because of adverse event. A 2.1-kg reduction in weight and a 7.5-beat/minute increase in pulse rate were observed in atomoxetine-treated patients. These data support a significant benefit of 80- to 120-mg once daily atomoxetine versus placebo for treatment of ADHD in adult Korean patients. A high placebo response rate was observed in this adult Korean sample; a higher discontinuation rate was also observed in atomoxetine-treated patients. These observations warrant further investigation. © 2014 Wiley Publishing Asia Pty Ltd.

Anxiety reduction on atomoxetine and methylphenidate medication in children with ADHD.

PubMed

Snircova, Eva; Marcincakova-Husarova, Veronika; Hrtanek, Igor; Kulhan, Tomas; Ondrejka, Igor; Nosalova, Gabriela

2016-06-01

Atomoxetine and methylphenidate are widely used to treat attention-deficit-hyperactivity disorder (ADHD) with similar effectiveness after 8 weeks of treatment, when atomoxetine has reached its a full effect. Both drugs have also been shown to have an effect on comorbid anxiety. To the best of our knowledge, no study has compared their effect on the dynamics of anxiety symptom reduction. The aim of this study was to compare the medication effect on core and comorbid anxiety symptom dynamics in children with ADHD. Sixty-nine patients participated in the study: 36 patients were taking atomoxetine and 33 patients, methylphenidate. Therapeutic effect on core symptoms of ADHD was measured on the ADHD-rating scale IV, and symptoms of anxiety were measured using the Conners Parent Rating Scale (CPRS). Symptoms were measured prior to and every 2 weeks during 8 weeks of treatment. There was a significant decrease in CPRS anxiety subscale score in both medication groups. Anxiety subscale score was significantly lower in the atomoxetine group in the fourth week, and lasted through to 8 weeks of medication. Both atomoxetine and methylphenidate reduced the symptoms of ADHD and anxiety. Atomoxetine was more effective in anxiety symptom reduction from the fourth week of treatment. © 2015 Japan Pediatric Society.

Treating nicotine dependence by targeting attention-deficit/ hyperactivity disorder (ADHD) with OROS methylphenidate: the role of baseline ADHD severity and treatment response.

PubMed

Nunes, Edward V; Covey, Lirio S; Brigham, Gregory; Hu, Mei-Chen; Levin, Frances R; Somoza, Eugene C; Winhusen, Theresa M

2013-10-01

To determine whether treatment of attention-deficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment. This is a secondary analysis of data from a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites; the original trial was sponsored by the National Drug Abuse Clinical Trials Network. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n = 127) or matching placebo (n = 128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions. Treatment interacted with both ADHD-RS score at baseline (P = .01) and change in ADHD-RS score during treatment (P = .008). Among patients with higher ADHD-RS scores (> 36) at baseline and the most improvement in ADHD during treatment (ADHD-RS change score ≥ 24), 70.0% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo (P = .02). In contrast, among patients with the lowest ADHD-RS baseline scores (≤ 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo (P = .02). OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD. ClinicalTrials.gov identifier: NCT00253747. © Copyright 2013 Physicians Postgraduate Press, Inc.

Antisocial violent offenders with attention deficit hyperactivity disorder demonstrate akathisia-like hyperactivity in three-channel actometry.

PubMed

Tuisku, Katinka; Virkkunen, Matti; Holi, Matti; Lauerma, Hannu; Naukkarinen, Hannu; Rimon, Ranan; Wahlbeck, Kristian

2003-01-01

Actometry enables quantitative and qualitative analysis of various hyperactivity disorders. Antisocial violent offenders have demonstrated diurnal increases in motor activity that may be related to attention deficit hyperactivity disorder (ADHD) that often precedes antisocial development. Motor restlessness in ADHD has common features with neuroleptic-induced akathisia. In this study, three-channel actometry was used to compare 15 antisocial violent offenders who had a history of ADHD with 15 healthy control subjects and 10 akathisia patients. The Barnes Akathisia Rating Scale (BARS) was used for clinical evaluation of akathisia symptoms. Ankle movement indices and the ankle-waist ratio differentiated the antisocial patients from the healthy controls significantly, with no overlap, and the same parameters expectedly differentiated the akathisia patients from the healthy controls. The repetitive, rhythmic pattern of akathisia was found in 13 of the 15 antisocial patients. Nine of the antisocial patients scored 2 or 3 (mild to moderate akathisia) on the BARS. Thus, the motor hyperactivity of antisocial ADHD patients has common features with mild akathisia. This may be due to a common hypodopaminergic etiology of ADHD and akathisia.

Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults

ERIC Educational Resources Information Center

Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory

2010-01-01

Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from…

[Clinical and neurophysiological heterogeneity of attention deficit hyperactivity disorder].

PubMed

Chutko, L S; Yakovenko, E A; Surushkina, S Yu; Anisimova, T I; Kropotov, Yu D

To determine clinical/neurophysiological characteristics of different forms of attention deficit hyperactivity disorder (ADHD) and the efficacy of treatment with cerebrolysin. Sixty children, aged 9 to 12 years, with ADHD were examined using clinical and electroencephalographic methods. Idiopathic and residual-organic forms were compared. The study shows significantly higher levels of impulsivity and hyperactivity in children with residual-organic form of the disease. There were significant differences in the amplitude component of engaging in action (P3 Go) and the amplitude of the action suppression component (P3 NOGO) in patients with different forms of ADHD. The high clinical efficacy (improvement in 70.0% of patients with idiopathic form of ADHD and 86.7% of patients with residual-organic form of the disease) was found.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lou, H.C.; Henriksen, L.; Bruhn, P.

We have previously reported that periventricular structures are hypoperfused in attention deficit and hyperactivity disorder (ADHD). This study has expanded the number of patients, who were divided into two groups: six patients with pure ADHD, and 13 patients with ADHD in combination with other neurologic symptoms. By using xenon 133 inhalation and emission tomography, the regional cerebral blood flow distribution was determined and compared with a control group. Striatal regions were found to be hypoperfused and, by inference, hypofunctional in both groups. This hypoperfusion was statistically significant in the right striatum in ADHD, and in both striatal regions in ADHDmore » with other neuropsychologic and neurologic symptoms. The primary sensory and sensorimotor cortical regions were highly perfused. Methylphenidate increased flow to striatal and posterior periventricular regions, and tended to decrease flow to primary sensory regions. Low striatal activity, partially reversible with methylphenidate, appears to be a cardinal feature in ADHD.« less

Bupropion versus methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder: randomized double-blind study.

PubMed

Jafarinia, Morteza; Mohammadi, Mohammad-Reza; Modabbernia, Amirhossein; Ashrafi, Mandana; Khajavi, Danial; Tabrizi, Mina; Yadegari, Noorollah; Akhondzadeh, Shahin

2012-07-01

To compare the safety and efficacy of bupropion with methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). In a 6-week randomized double-blind study, 44 patients with a DSM-IV-TR diagnosis of ADHD were randomly assigned to receive bupropion 100-150 mg/day (100 mg/day for <30 kg and 150 mg/day for >30 kg) or methylphenidate 20-30 mg/day. Symptoms were assessed using Teacher and Parent Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) at baseline and weeks 3 and 6. Forty patients had at least one post-baseline measurement, and 38 patients completed the trial. No significant difference was found between the two groups on the Parent and Teacher ADHD-RS-IV scores ([F(1, 38) = 0.266, p = 0.609] and [F(1, 38) = 0.001, p = 0.972], respectively). By week 6, 18 patients (90%) in each group achieved response on the Parent scale (Fisher's exact test p-value = 1.0). With the Teacher ADHD-RS-IV used, eight (40%) patients in the bupropion group and 12 (60%) patients in the methylphenidate group achieved response by week 6 (χ(2) (1) = 1.600, p = 0.206). Headache was observed more frequently in the methylphenidate group. Frequency of other side effects was not significantly different between the two groups. Bupropion has a comparable safety and efficacy profile with methylphenidate in children and adolescents with ADHD. Copyright © 2012 John Wiley & Sons, Ltd.

ADHD and nicotine use in schizophrenia or Asperger syndrome: a controlled study.

PubMed

Hallerbäck, Maria Unenge; Lugnegård, Tove; Gillberg, Christopher

2014-07-01

To examine ADHD prevalence, rating scales, and relationship to nicotine use in adults with schizophrenia or Asperger syndrome. Ninety-five individuals, 41 with schizophrenia and 54 with Asperger syndrome, were included. Self-rating of adult ADHD symptoms with the Wender-Reimherr Adult Attention Deficit Diagnostic Rating Scale (WRAADDS), parent rating of proband's ADHD childhood and adult life symptoms using the Swanson, Nolan, and Pelham Questionnaire (SNAP), and report of clinical ADHD diagnosis were included as ADHD measures. Nicotine use data were compared with data from a population sample. In all, 10% of the schizophrenia group and 30% of the Asperger syndrome group had a clinical ADHD diagnosis. Nicotine dependency in the whole sample was closely linked to ADHD. The prevalence of comorbid ADHD was high in schizophrenia and Asperger syndrome. The WRAADDS self-rating scale for ADHD can be one useful tool for assessing comorbid ADHD in these patient groups. © 2012 SAGE Publications.

Nightmare frequency in adults with attention-deficit hyperactivity disorder.

PubMed

Schredl, Michael; Bumb, J Malte; Alm, Barbara; Sobanski, Esther

2017-02-01

Nightmare frequency in adult ADHD patients has not yet been studied systematically. In a sample of 65 patients, it could be shown that nightmare frequency was elevated in ADHD patients compared to a sample representative for Germany. Frequent nightmares (once a week or more often) were reported by 4.62 % of the patients and 1.77 % of the controls. This increase was neither explained by the increased dream recall in general nor by the presence of a comorbid mental disorder. Questions about nightmares should be included in the diagnostic procedures for ADHD patients, and it should be tested whether well-established nightmare treatment strategies like imagery rehearsal treatment might be beneficial to those patients with nightmares.

A randomised controlled trial of combined EEG feedback and methylphenidate therapy for the treatment of ADHD.

PubMed

Li, Li; Yang, Li; Zhuo, Chuan-jun; Wang, Yu-Feng

2013-08-22

To evaluate the efficacy of combined methylphenidate and EEG feedback treatment for children with ADHD. Forty patients with ADHD were randomly assigned to the combination group (methylphenidate therapy and EEG feedback training) or control group (methylphenidate therapy and non-feedback attention training) in a 1:1 ratio using the double-blind method. These patients, who met the DSM-IV diagnostic criteria and were aged between 7 and 16 years, had obtained optimal therapeutic effects by titrating the methylphenidate dose prior to the trial. The patients were assessed using multiple parameters at baseline, after 20 treatment sessions, after 40 treatment sessions, and in 6-month follow-up studies. Compared to the control group, patients in the combination group had reduced ADHD symptoms and improved in related behavioural and brain functions. The combination of EEG feedback and methylphenidate treatment is more effective than methylphenidate alone. The combined therapy is especially suitable for children and adolescents with ADHD who insufficiently respond to single drug treatment or experience drug side effects.

Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis

PubMed Central

Gloss, David; Varma, Jay K.; Pringsheim, Tamara; Nuwer, Marc R.

2016-01-01

Objective: To evaluate the evidence for EEG theta/beta power ratio for diagnosing, or helping to diagnose, attention-deficit/hyperactivity disorder (ADHD). Methods: We identified relevant studies and classified them using American Academy of Neurology criteria. Results: Two Class I studies assessing the ability of EEG theta/beta power ratio and EEG frontal beta power to identify patients with ADHD correctly identified 166 of 185 participants. Both studies evaluated theta/beta power ratio and frontal beta power in suspected ADHD or in syndromes typically included in an ADHD differential diagnosis. A bivariate model combining the diagnostic studies shows that the combination of EEG frontal beta power and theta/beta power ratio has relatively high sensitivity and specificity but is insufficiently accurate. Conclusions: It is unknown whether a combination of standard clinical examination and EEG theta/beta power ratio increases diagnostic certainty of ADHD compared with clinical examination alone. Recommendations: Level B: Clinicians should inform patients with suspected ADHD and their families that the combination of EEG theta/beta power ratio and frontal beta power should not replace a standard clinical evaluation. There is a risk for significant harm to patients from ADHD misdiagnosis because of the unacceptably high false-positive diagnostic rate of EEG theta/beta power ratio and frontal beta power. Level R: Clinicians should inform patients with suspected ADHD and their families that the EEG theta/beta power ratio should not be used to confirm an ADHD diagnosis or to support further testing after a clinical evaluation, unless such diagnostic assessments occur in a research setting. PMID:27760867

Methylphenidate and emotional-motivational processing in attention-deficit/hyperactivity disorder.

PubMed

Conzelmann, Annette; Woidich, Eva; Mucha, Ronald F; Weyers, Peter; Müller, Mathias; Lesch, Klaus-Peter; Jacob, Christian P; Pauli, Paul

2016-08-01

In line with the assumption that emotional-motivational deficits are one core dysfunction in ADHD, in one of our previous studies we observed a reduced reactivity towards pleasant pictures in adult ADHD patients as compared to controls. This was indicated by a lack of attenuation of the startle reflex specifically during pleasant pictures in ADHD patients. The first choice medical agents in ADHD, methylphenidate (MPH), is discussed to normalize these dysfunctions. However, experimental evidence in the sense of double-blind placebo-controlled study designs is lacking. Therefore, we investigated 61 adult ADHD patients twice, one time with placebo and one time with MPH with the same experimental design as in our study previously and assessed emotion processing during the presentation of pleasant, neutral and unpleasant pictures. We obtained startle reflex data as well as valence and arousal ratings in association with the pictures. As previously shown, ADHD patients showed a diminished startle attenuation during pleasant pictures while startle potentiation during unpleasant pictures was normal. Valence and arousal ratings unsuspiciously increased with increasing pleasantness and arousal of the pictures, respectively. There were no significant influences of MPH. The study replicates that ADHD patients show a reduced reactivity towards pleasant stimuli. MPH did not normalize this dysfunction. Possibly, MPH only influences emotions during more complex behavioural tasks that involve executive functions in adults with ADHD. Our results emphasize the importance for the use of double-blind placebo-controlled designs in psychopharmacological research.

Mild head injury and attention deficit hyperactivity disorder in children.

PubMed

Chasle, Veronique; Riffaud, Laurent; Longuet, Romain; Martineau-Curt, Marie; Collet, Yann; Le Fournier, Luc; Pladys, Patrick

2016-12-01

Post-concussion syndrome is a well-described complication following moderate and severe head trauma but whether it occurs after mild head injury in children remains unclear. The aim of this study was to evaluate whether exposure to mild head injury with potential additional risk factors (non-surgical lesion on computed tomographic, high kinetic trauma, or Glasgow Coma Scale <15) is associated with attention deficit hyperactivity disorder (ADHD) after the head trauma. This study was performed in an emergency department on children admitted between 2009 and 2013. It compared victims of mild head injury aged 6-16 years with matched children presenting isolated non-surgical forearm fracture (ratio1/2). ADHD was assessed using Conners' Global Index-Parent short version 3-40 months after the trauma. The patients were compared using chi-square test or Fisher's exact test, t test or u-test as appropriate with a p value set at 0.05. During the study period, 676 patients were admitted for mild head injury. Among them, 34 (5 %) fulfilled the inclusion criteria and were compared with 64 matched patients admitted for a forearm fracture. The groups were comparable. ADHD was observed in both groups (18 % in the mild head injury group, 11 % in the control group) with no significant differences between groups. The prevalence was high when compared to an expected frequency of 3.5-5.6 % in children aged 6-12 years in the general population. These results suggest that pre-existing ADHD may have contributed to injury proneness in both groups and does not argue for a specific risk of ADHD induced by mild head injury. The diagnosis of ADHD should be evoked at admission of children aged 6-16 years presenting with a trauma.

Results from 2 proof-of-concept, placebo-controlled studies of atomoxetine in children with attention-deficit/hyperactivity disorder.

PubMed

Spencer, Thomas; Heiligenstein, John H; Biederman, Joseph; Faries, Douglas E; Kratochvil, Christopher J; Conners, C Keith; Potter, William Z

2002-12-01

Atomoxetine is a nonstimulant drug being studied for the treatment of attention-deficit/hyperactivity disorder (ADHD). Atomoxetine is a highly specific inhibitor of the presynaptic norepinephrine transporter with minimal affinity for other noradrenergic receptors or other neurotransmitter transporters or receptors. Results of 2 proof-of-concept studies are reported that tested the hypothesis that a selective inhibitor of presynaptic norepinephrine uptake would be effective for the treatment of ADHD in school-aged children. Two identical 12-week, stratified, randomized, double-blind, placebo-controlled trials were conducted in children who met DSM-IV criteria for ADHD. The primary efficacy outcome measure was the mean change from baseline to endpoint in the Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD RS) total score. Secondary efficacy measures included the Clinical Global Impressions-ADHD-Severity (CGI-ADHD-S) and the Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S). A total of 291 patients were randomized in the 2 trials combined (Study 1, N = 147; Study 2, N = 144). Stimulant-naive patients were randomized to atomoxetine, placebo, or methylphenidate. Patients with prior stimulant exposure were randomized to atomoxetine or placebo. Atomoxetine significantly reduced ADHD RS total scores compared with placebo in each study (p <.001). Changes in the CGI-ADHD-S (Study 1: p =.003; Study 2: p =.001) and CPRS-ADHD Index (Study 1: p =.023; Study 2: p <.001) also showed atomoxetine to be statistically significantly superior to placebo in reducing ADHD symptoms. Atomoxetine was found to be well tolerated in this population of pediatric patients. Two studies of atomoxetine early in its development confirmed that atomoxetine, a specific and selective inhibitor of noradrenergic uptake, was effective for the treatment of children with ADHD. In addition, atomoxetine was found to be well tolerated.

Autism and ADHD Symptoms in Patients with OCD: Are They Associated with Specific OC Symptom Dimensions or OC Symptom Severity?

ERIC Educational Resources Information Center

Anholt, Gideon E.; Cath, Danielle C.; van Oppen, Patricia; Eikelenboom, Merijn; Smit, Johannes H.; van Megen, Harold; van Balkom, Anton J. L. M.

2010-01-01

In obsessive-compulsive disorder (OCD), the relationship between autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) symptom, and obsessive-compulsive (OC) symptom dimensions and severity has scarcely been studied. Therefore, 109 adult outpatients with primary OCD were compared to 87 healthy controls on OC, ADHD and…

The Efficacy of Adapted MBCT on Core Symptoms and Executive Functioning in Adults With ADHD: A Preliminary Randomized Controlled Trial.

PubMed

Hepark, Sevket; Janssen, Lotte; de Vries, Alicia; Schoenberg, Poppy L A; Donders, Rogier; Kan, Cornelis C; Speckens, Anne E M

2015-11-20

The aim of this study was to examine the effectiveness of mindfulness as a treatment for adults diagnosed with ADHD. A 12-week-adapted mindfulness-based cognitive therapy (MBCT) program is compared with a waiting list (WL) group. Adults with ADHD were randomly allocated to MBCT (n = 55) or waitlist (n = 48). Outcome measures included investigator-rated ADHD symptoms (primary), self-reported ADHD symptoms, executive functioning, depressive and anxiety symptoms, patient functioning, and mindfulness skills. MBCT resulted in a significant reduction of ADHD symptoms, both investigator-rated and self-reported, based on per-protocol and intention-to-treat analyses. Significant improvements in executive functioning and mindfulness skills were found. Additional analyses suggested that the efficacy of MBCT in reducing ADHD symptoms and improving executive functioning is partially mediated by an increase in the mindfulness skill "Act With Awareness." No improvements were observed for depressive and anxiety symptoms, and patient functioning. This study provides preliminary support for the effectiveness of MBCT for adults with ADHD. © The Author(s) 2015.

Cerebellar Volume in Children With Attention-Deficit Hyperactivity Disorder (ADHD).

PubMed

Wyciszkiewicz, Aleksandra; Pawlak, Mikolaj A; Krawiec, Krzysztof

2017-02-01

Attention Deficit Hyperactivity Disorder (ADHD) is associated with altered cerebellar volume and cerebellum is associated with cognitive performance. However there are mixed results regarding the cerebellar volume in young patients with ADHD. To clarify the size and direction of this effect, we conducted the analysis on the large public database of brain images. The aim of this study was to confirm that cerebellar volume in ADHD is smaller than in control subjects in currently the largest publicly available cohort of ADHD subjects.We applied cross-sectional case control study design by comparing 286 ADHD patients (61 female) with age and gender matched control subjects. Volumetric measurements of cerebellum were obtained using automated segmentation with FreeSurfer 5.1. Statistical analysis was performed in R-CRAN statistical environment. Patients with ADHD had significantly smaller total cerebellar volumes (134.5±17.11cm 3 vs.138.90±15.32 cm 3 ). The effect was present in both females and males (males 136.9±14.37 cm 3 vs. 141.20±14.75 cm 3 ; females 125.7±12.34 cm 3 vs. 131.20±15.03 cm 3 ). Age was positively and significantly associated with the cerebellar volumes. These results indicate either delayed or disrupted cerebellar development possibly contributing to ADHD pathophysiology.

The effects of atomoxetine on emotional control in adults with ADHD: An integrated analysis of multicenter studies.

PubMed

Asherson, P; Stes, S; Nilsson Markhed, M; Berggren, L; Svanborg, P; Kutzelnigg, A; Deberdt, W

2015-06-01

To investigate the effects of atomoxetine on emotional control in adults with ADHD. We performed an integrated analysis using individual patient data pooled from three Eli Lilly-sponsored studies. An integrated analysis can be viewed as a meta-analysis of individual patient-level data, rather than study-level summary data. Two populations were identified: a large sample of patients with pre-treatment baseline data (the "overall population"; n=2846); and a subset of these patients with placebo-controlled efficacy data from baseline to 10 or 12 weeks after initiating treatment (the "placebo-controlled population"; n=829). At baseline, in the overall population, ∼50% of ADHD patients had BRIEF-AS (Behavior Rating Inventory of Executive Function-Adult Version Self-Report) Emotional control subscores between 21 and 30, compared with ∼10% of normative subjects in the BRIEF-A manual. At endpoint, in the placebo-controlled population, atomoxetine led to a small (effect size 0.19) but significant (P=0.013) treatment effect for emotional control. The effect size was 0.32 in patients with BRIEF-AS Emotional control scores>20 at baseline. Improvements in emotional control correlated with improvements in the core ADHD symptoms and quality-of-life. As deficient emotional control is associated with impaired social, educational and occupational functioning over and above that explained by core ADHD symptoms alone, improvements in emotional control may be clinically relevant. At baseline, adults with ADHD were more likely to have impaired emotional control than normative subjects. In the adult ADHD patients, atomoxetine treatment was associated with improvements in emotional control, as well as in core ADHD symptoms and quality-of-life. Copyright © 2015. Published by Elsevier Masson SAS.

Effect of EEG Biofeedback on Cognitive Flexibility in Children with Attention Deficit Hyperactivity Disorder With and Without Epilepsy.

PubMed

Bakhtadze, Sophia; Beridze, Maia; Geladze, Nana; Khachapuridze, Nana; Bornstein, Natan

2016-03-01

Attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders in school-aged children. Symptoms consistent with ADHD have been observed in 8-77 % of children with epilepsy. Researchers have been motivated to search for alternative forms of treatment because 30 % of patients with ADHD cannot be treated by psychostimulants. Several studies support the use of a multimodal treatment approach that includes neurofeedback (NF) for the long-term management of ADHD. These studies have shown that NF provides a sustained effect, even without concurrent treatment with stimulants. We aimed to assess cognitive flexibility in ADHD children with and without temporal lobe epilepsy (TLE), and to evaluate the effects of NF on cognitive flexibility in these groups of children. We prospectively evaluated 69 patients with ADHD aged 9-12 years. The control group was 26 ADHD children without TLE who received no treatment. The first experimental group comprised 18 children with ADHD. The second experimental group comprised 25 age-matched ADHD children with TLE. This group was further divided in two subgroups. One subgroup comprised those with mesial temporal lobe epilepsy (16 patients, 9 with hippocampal sclerosis and 7 with hippocampal atrophy), and the other with lateral temporal lobe epilepsy (9 patients, 5 with temporal lobe dysplasia, 3 with temporal lobe cysts, and 1 with a temporal lobe cavernoma). We treated their ADHD by conducting 30 sessions of EEG NF. Reaction time and error rates on the Trail Making Test Part B were compared before and after treatment, and significant differences were found for all groups of patients except those who had mesial temporal lobe epilepsy with hippocampal atrophy. Our results demonstrate that in most cases, NF can be considered an alternative treatment option for ADHD children even if they have TLE. Additional studies are needed to confirm our results.

Working Memory and Response Inhibition as One Integral Phenotype of Adult ADHD? A Behavioral and Imaging Correlational Investigation

ERIC Educational Resources Information Center

Schecklmann, Martin; Ehlis, Ann-Christine; Plichta, Michael M.; Dresler, Thomas; Heine, Monika; Boreatti-Hummer, Andrea; Romanos, Marcel; Jacob, Christian; Pauli, Paul; Fallgatter, Andreas J.

2013-01-01

Objective: It is an open question whether working memory (WM) and response inhibition (RI) constitute one integral phenotype in attention deficit hyperactivity disorder (ADHD). Method: The authors investigated 45 adult ADHD patients and 41 controls comparable for age, gender, intelligence, and education during a letter n-back and a stop-signal…

Attention-deficit hyperactivity disorder symptoms in children and adolescents with sex chromosome aneuploidy: XXY, XXX, XYY, and XXYY.

PubMed

Tartaglia, Nicole R; Ayari, Natalie; Hutaff-Lee, Christa; Boada, Richard

2012-05-01

Attentional problems, hyperactivity, and impulsivity have been described as behavioral features associated with sex chromosome aneuploidy (SCA). In this study, the authors compare attention-deficit hyperactivity disorder (ADHD) symptoms in 167 participants aged 6 to 20 years with 4 types of SCA (XXY n = 56, XYY n = 33, XXX n = 25, and XXYY n = 53). They also evaluate factors associated with ADHD symptomatology (cognitive and adaptive scores, prenatal vs postnatal ascertainment) and describe the clinical response to psychopharmacologic medications in a subset of patients treated for ADHD. Evaluation included medical and developmental history, cognitive and adaptive functioning assessment, and parent and teacher ADHD questionnaires containing DSM-IV criteria. In the total study group, 58% (96/167) met DSM-IV criteria for ADHD on parent-report questionnaires (36% in XXY, 52% in XXX, 76% in XYY, and 72% in XXYY). The Inattentive subtype was most common in XXY and XXX, whereas the XYY and XXYY groups were more likely to also have hyperactive/impulsive symptoms. There were no significant differences in Verbal, Performance, or Full Scale IQ between children with symptom scores in the ADHD range compared with those below the ADHD range. However, adaptive functioning scores were significantly lower in the group whose scores in the ADHD range were compared with those of the group who did not meet ADHD DSM-IV criteria. Those with a prenatal diagnosis of XXY were less likely to meet criteria for ADHD compared with the postnatally diagnosed group. Psychopharmacologic treatment with stimulants was effective in 78.6% (66/84). Children and adolescents with SCA are at increased risk for ADHD symptoms. Recommendations for ADHD evaluation and treatment in consideration of other aspects of the SCA medical and behavioral phenotype are provided.

Attention-Deficit Hyperactivity Disorder Symptoms in Children and Adolescents with Sex Chromosome Aneuploidy: XXY, XXX, XYY, and XXYY

PubMed Central

Tartaglia, Nicole R.; Ayari, Natalie; Hutaff-Lee, Christa; Boada, Richard

2012-01-01

Objective Attentional problems, hyperactivity, and impulsivity have been described as behavioral features associated with sex chromosome aneuploidy (SCA). In this study, the authors compare attention-deficit hyperactivity disorder (ADHD) symptoms in 167 participants aged 6 to 20 years with 4 types of SCA (XXY n = 56, XYY n = 33, XXX n = 25, and XXYY n = 53). They also evaluate factors associated with ADHD symptomatology (cognitive and adaptive scores, prenatal vs postnatal ascertainment) and describe the clinical response to psychopharmacologic medications in a subset of patients treated for ADHD. Methods Evaluation included medical and developmental history, cognitive and adaptive functioning assessment, and parent and teacher ADHD questionnaires containing DSM-IV criteria. Results In the total study group, 58% (96/167) met DSM-IV criteria for ADHD on parent-report questionnaires (36% in XXY, 52% in XXX, 76% in XYY, and 72% in XXYY). The Inattentive subtype was most common in XXY and XXX, whereas the XYY and XXYY groups were more likely to also have hyperactive/impulsive symptoms. There were no significant differences in Verbal, Performance, or Full Scale IQ between children with symptom scores in the ADHD range compared with those below the ADHD range. However, adaptive functioning scores were significantly lower in the group whose scores in the ADHD range were compared with those of the group who did not meet ADHD DSMIV criteria. Those with a prenatal diagnosis of XXY were less likely to meet criteria for ADHD compared with the postnatally diagnosed group. Psychopharmacologic treatment with stimulants was effective in 78.6% (66/84). Conclusions Children and adolescents with SCA are at increased risk for ADHD symptoms. Recommendations for ADHD evaluation and treatment in consideration of other aspects of the SCA medical and behavioral phenotype are provided. PMID:22333574

Reduced hemispheric asymmetry of brain anatomical networks in attention deficit hyperactivity disorder.

PubMed

Li, Dandan; Li, Ting; Niu, Yan; Xiang, Jie; Cao, Rui; Liu, Bo; Zhang, Hui; Wang, Bin

2018-05-11

Despite many studies reporting a variety of alterations in brain networks in patients with attention deficit hyperactivity disorder (ADHD), alterations in hemispheric anatomical networks are still unclear. In this study, we investigated topology alterations in hemispheric white matter in patients with ADHD and the relationship between these alterations and clinical features of the illness. Weighted hemispheric brain anatomical networks were first constructed for each of 40 right-handed patients with ADHD and 53 matched normal controls. Then, graph theoretical approaches were utilized to compute hemispheric topological properties. The small-world property was preserved in the hemispheric network. Furthermore, a significant group-by-hemisphere interaction was revealed in global efficiency, local efficiency and characteristic path length, attributed to the significantly reduced hemispheric asymmetry of global and local integration in patients with ADHD compared with normal controls. Specifically, reduced asymmetric regional efficiency was found in three regions. Finally, we found that the abnormal asymmetry of hemispheric brain anatomical network topology and regional efficiency were both associated with clinical features (the Adult ADHD Self-Report Scale and Wechsler Adult Intelligence Scale) in patients. Our findings provide new insights into the lateralized nature of hemispheric dysconnectivity and highlight the potential for using brain network measures of hemispheric asymmetry as neural biomarkers for ADHD and its clinical features.

Attention-deficit hyperactivity disorder, its treatment with medication and the probability of developing a depressive disorder: A nationwide population-based study in Taiwan.

PubMed

Lee, Min-Jing; Yang, Kang-Chung; Shyu, Yu-Chiau; Yuan, Shin-Sheng; Yang, Chun-Ju; Lee, Sheng-Yu; Lee, Tung-Liang; Wang, Liang-Jen

2016-01-01

The purpose of this study is to determine the risk of developing depressive disorders by evaluating children with attention-deficit/hyperactivity disorder (ADHD) in comparison to controls that do not have ADHD, as well as to analyze whether the medications used to treat ADHD, methylphenidate (MPH) and atomoxetine (ATX), influence the risk of depression. A group of patients newly diagnosed with ADHD (n=71,080) and age- and gender-matching controls (n=71,080) were chosen from Taiwan's National Health Insurance database during the period of January 2000 to December 2011. Both the patients and controls were monitored through December 31, 2011. We also explore the potential influence of the length of MPH and ATX treatment on developing depressive disorders. The ADHD patients showed a significantly increased probability of developing a depressive disorder when compared to the control group (ADHD: 5.3% vs. 0.7%; aHR, 7.16, 99% CI: 6.28-8.16). Regarding treatment with MPH, a longer MPH use demonstrates significant protective effects against developing a depressive disorder (aOR, 0.91, 99%CI: 0.88-0.94). However, the duration of ATX treatment could not be significantly correlated with the probability of developing a depressive disorder. The database employed in this study lacks of comprehensive clinical information for the patients with ADHD. Potential moderating factors between ADHD and depression were not considered in-depth in this study. The results of this study reveal that youths diagnosed with ADHD have a greater risk of developing depressive disorders. Long-term treatment with MPH correlated to the reduced probability of developing a depressive disorder among youths with ADHD. Copyright © 2015 Elsevier B.V. All rights reserved.

The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population

PubMed Central

2012-01-01

Background Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. Methods Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing. Results At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children’s Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04). Conclusions ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability. PMID:23083209

Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): an open-label prospective study of time in treatment, dose, side-effects and comorbidity.

PubMed

Fredriksen, Mats; Dahl, Alv A; Martinsen, Egil W; Klungsøyr, Ole; Haavik, Jan; Peleikis, Dawn E

2014-12-01

How to generalize from randomized placebo controlled trials of ADHD drug treatment in adults to 'real-world' clinical practice is intriguing. This open-labeled prospective observational study examined the effectiveness of long-term stimulant and non-stimulant medication in adult ADHD including dose, side-effects and comorbidity in a clinical setting. A specialized ADHD outpatient clinic gave previously non-medicated adults (n=250) with ADHD methylphenidate as first-line drug according to current guidelines. Patients who were non-tolerant or experiencing low efficacy were switched to amphetamine or atomoxetine. Primary outcomes were changes of ADHD-symptoms evaluated with the Adult ADHD Self-Report Scale (ASRS) and overall severity by the Global Assessment of Functioning (GAF). Secondary outcomes were measures of mental distress, and response on the Clinical-Global-Impressions-Improvement Scale. Data at baseline and follow-ups were compared in longitudinal mixed model analyses for time on-medication, dosage, comorbidity, and side-effects. As results, 232 patients (93%) completed examination at the 12 month endpoint, and 163 (70%) remained on medication. Compared with the patients who discontinued medication, those still on medication had greater percentage reduction in ASRS-scores (median 39%, versus 13%, P<0.001) and greater improvement of GAF (median 20% versus 4%, P<0.001) and secondary outcomes. Continued medication and higher cumulated doses showed significant associations to sustained improvement. Conversely, psychiatric comorbidity and side-effects were related to lower effectiveness and more frequent termination of medication. Taken together, one-year treatment with stimulants or atomoxetine was associated with a clinically significant reduction in ADHD symptoms and mental distress, and improvement of measured function. No serious adverse events were observed. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population.

PubMed

Mordre, Marianne; Groholt, Berit; Sandstad, Berit; Myhre, Anne Margrethe

2012-10-19

Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17-39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan-Meier survival analyses and logrank testing. At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children's Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04). ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.

Neural mechanisms of response inhibition and impulsivity in 22q11.2 deletion carriers and idiopathic attention deficit hyperactivity disorder.

PubMed

Montojo, C A; Congdon, E; Hwang, L; Jalbrzikowski, M; Kushan, L; Vesagas, T K; Jonas, R K; Ventura, J; Bilder, R M; Bearden, C E

2015-01-01

•22q11DS offers a compelling model to understand the neural substrates of attentional dysfunction.•First study directly comparing neural function in 22q11DS vs. ADHD patients•22q11DS and ADHD patients show a shared deficit in RI-related activation.•ADHD patients showed greater activity in the middle frontal gyrus than 22q11DS during RI.•Neural activity is inversely correlated with self-reported Cognitive Impulsivity in 22q11DS.

Systematic Review of Patients' and Parents' Preferences for ADHD Treatment Options and Processes of Care.

PubMed

Schatz, Nicole K; Fabiano, Gregory A; Cunningham, Charles E; dosReis, Susan; Waschbusch, Daniel A; Jerome, Stephanie; Lupas, Kellina; Morris, Karen L

2015-12-01

Patient preferences are an important topic of study with respect to attention-deficit hyperactivity disorder (ADHD) interventions, as there are multiple treatment choices available, multiple developmental levels to consider, and multiple potential individuals involved in treatment (children, parents, and adults with ADHD). Stated preference methods such as discrete choice experiment (DCE), best-worst scaling (BWS), and other utility value methods such as standard gamble interview (SGI) and time trade-off (TTO) are becoming more common in research addressing preferences for ADHD treatments. A synthesis of this research may facilitate improved patient-centered and family-centered treatment for ADHD. The purpose of this review was to synthesize reports across existing DCE, BWS, TTO, and SGI studies to assess which aspects of ADHD treatment are most studied as well as most preferred and influential in treatment decisions. MEDLINE, PsycINFO. A total of 41 studies referring to preferences for ADHD treatment were identified through the initial search and contact with researchers. Of these, 13 reported ADHD treatment preference data from a study using DCE, BWS, or SGI methods. No TTO studies were identified that met inclusion criteria. Methods and designs varied considerably across studies. Relatively few studies focused on preferences among children, adolescents, and adults compared with those that focused on the preferences of parents of children with ADHD. The majority of studies focused primarily on medication treatments, with many fewer focused on psychosocial treatments. Some studies indicated that parents of children with ADHD prefer to avoid stimulant medications in favor of behavioral or psychosocial interventions. Others report that parents see medication as a preferred treatment. Treatment outcome is a particularly salient attribute for treatment decisions for many informants. Potential outcomes of various treatments play a proximal role in patients' and families' decisions for ADHD treatment. Because the majority of studies focus on medication treatments for children with ADHD, more research is necessary to understand preferences related to behavioral and other psychosocial treatments both as stand-alone interventions and used in combination with medication. Additional research is also needed to assess the treatment preferences of adults with ADHD. In general, DCE, BWS, and SGI methods allow measurement of patient preferences in a manner that approximates the uncertainty and trade-offs inherent in real-world treatment decision making and provides valuable information to inform patient-centered and family-centered treatment.

Efficacy and Safety Extrapolation Analyses for Atomoxetine in Young Children with Attention-Deficit/Hyperactivity Disorder.

PubMed

Upadhyaya, Himanshu; Kratochvil, Christopher; Ghuman, Jaswinder; Camporeale, Angelo; Lipsius, Sarah; D'Souza, Deborah; Tanaka, Yoko

2015-12-01

This extrapolation analysis qualitatively compared the efficacy and safety profile of atomoxetine from Lilly clinical trial data in 6-7-year-old patients with attention-deficit/hyperactivity disorder (ADHD) with that of published literature in 4-5-year-old patients with ADHD (two open-label [4-5-year-old patients] and one placebo-controlled study [5-year-old patients]). The main efficacy analyses included placebo-controlled Lilly data and the placebo-controlled external study (5-year-old patients) data. The primary efficacy variables used in these studies were the ADHD Rating Scale-IV Parent Version, Investigator Administered (ADHD-RS-IV-Parent:Inv) total score, or the Swanson, Nolan and Pelham (SNAP-IV) scale score. Safety analyses included treatment-emergent adverse events (TEAEs) and vital signs. Descriptive statistics (means, percentages) are presented. Acute atomoxetine treatment improved core ADHD symptoms in both 6-7-year-old patients (n=565) and 5-year-old patients (n=37) (treatment effect: -10.16 and -7.42). In an analysis of placebo-controlled groups, the mean duration of exposure to atomoxetine was ∼ 7 weeks for 6-7-year-old patients and 9 weeks for 5-year-old patients. Decreased appetite was the most common TEAE in atomoxetine-treated patients. The TEAEs observed at a higher rate in 5-year-old versus 6-7-year-old patients were irritability (36.8% vs. 3.6%) and other mood-related events (6.9% each vs. <3.0%). Blood pressure and pulse increased in both 4-5-year-old patients and 6-7-year-old patients, whereas a weight increase was seen only in the 6-7-year-old patients. Although limited by the small sample size of the external studies, these analyses suggest that in 5-year-old patients with ADHD, atomoxetine may improve ADHD symptoms, but possibly to a lesser extent than in older children, with some adverse events occurring at a higher rate in 5-year-old patients.

Pilot study of brain morphometry in a sample of Brazilian children with attention deficit hyperactivity disorder: influence of clinical presentation.

PubMed

Pastura, Giuseppe; Kubo, Tadeu Takao Almodovar; Gasparetto, Emerson Leandro; Figueiredo, Otavio; Mattos, Paulo; Prüfer Araújo, Alexandra

2017-12-01

Currently, the diagnosis of attention deficit hyperactivity disorder (ADHD) rests on clinical criteria. Nonetheless, neuroimaging studies have demonstrated that children with ADHD have different cortical thickness and volume measures to typically developing children (TDC). In general, studies do not evaluate the influence of clinical presentation in the brain morphometry of ADHD children. Our objective was to perform a pilot study in order to evaluate cortical thickness and brain volume in a sample of Brazilian ADHD children and compare these to those of TDC, taking into account the influence of clinical presentation. We performed an analytic study comparing 17 drug-naïve ADHD children of both genders, aged between 7 and 10, and 16 TDC. ADHD subjects were first considered as one group and further separated based on clinical presentation. The brain volume did not differ between patients and TDC. Smaller cortical thicknesses were identified on the left superior, medium and inferior temporal cortex, as well as in the left inferior parietal cortex. When compared to TDC, combined and inattentive ADHD presentations depicted smaller cortical thickness with high significance and power. The same magnitude of results was not observed when comparing inattentive ADHD and TDC. In this pilot study, ADHD is associated with abnormalities involving the cortical thickness of the posterior attentional system. The cortical thickness in the left superior, medium and inferior temporal cortex, as well as in the left inferior parietal cortex may differ according to ADHD presentations.

Comorbidity of ADHD and subsequent bipolar disorder among adolescents and young adults with major depression: a nationwide longitudinal study.

PubMed

Chen, Mu-Hong; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Li, Cheng-Ta; Lin, Wei-Chen; Chang, Wen-Han; Chen, Tzeng-Ji; Pan, Tai-Long; Su, Tung-Ping; Bai, Ya-Mei

2015-05-01

Previous studies have found that attention-deficit hyperactivity disorder (ADHD) in childhood and adolescence is associated with an increased risk of major depression and bipolar disorder in later life. However, the effect of ADHD comorbidity on the diagnostic conversion to bipolar disorder among patients with major depression is still uncertain. Using the Taiwan National Health Insurance Research Database, 58,023 subjects < 30 years of age who had major depression with (n = 1,193) or without (n = 56,830) ADHD comorbidity between the years 2000 and 2008 were enrolled in our study. Subjects who developed bipolar disorder during the follow-up to the end of 2011 were identified. Adolescents and young adults who had major depression with ADHD comorbidity had an increased incidence of subsequent bipolar disorder (18.9% versus 11.2%, p < 0.001) compared to those without ADHD. Cox regression analysis showed that ADHD comorbidity was an independent risk factor (hazard ratio = 1.50, 95% confidence interval 1.30-1.72) predicting subsequent bipolar disorder among those with major depression, adjusting for demographic data and psychiatric comorbidities. Patients with comorbid diagnoses of major depression and ADHD had an increased risk of diagnostic conversion to bipolar disorder compared to those who had major depression alone. Further studies would be required to validate this finding and to investigate the possible underlying mechanisms. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[The Relationship Between Emotion Recognition and the Symptoms of Attention Deficit and Impulsivity in Adult Patients With Attention Deficit Hyperactivity Disorder].

PubMed

Baran Tatar, Zeynep; Yargıç, İlhan; Oflaz, Serap; Büyükgök, Deniz

2015-01-01

Interpersonal relationship disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) can be associated with the impairment of non-verbal communication. The purpose of our study was to compare the emotion recognition, facial recognition and neuropsychological assessments of adult ADHD patients with those of healthy controls, and to thus determine the effect of neuropsychological data on the recognition of emotional expressions. This study, which was based on a case-control model, was conducted with patients diagnosed with ADHD according to the DSM-IV-TR, being followed and monitored at the adult ADHD clinic of the Psychiatry Department of the Istanbul University Istanbul Medical Faculty Hospital. The study group consisted of 40 adults (27.5% female) between the ages of 20-65 (mean age 25.96 ± 6.07; education level: 15.02±2.34 years) diagnosed with ADHD, and 40 controls who were matched/similar with the study group with respect to age, gender, and education level. In the ADHD group, 14 (35%) of the patients had concomitant diseases. Pictures of Facial Affect, the Benton Face Recognition Test, and the Continuous Performance Test were used to respectively evaluate emotion recognition, facial recognition, and attention deficit and impulsivity of the patients. It was determined that, in comparison to the control group, the ADHD group made more mistakes in recognizing all types of emotional expressions and neutral expressions. The ADHD group also demonstrated more cognitive mistakes. Facial recognition was similar in both groups. It was determined that impulsivity had a significant effect on facial recognition. The social relationship disorders observed in ADHD can be affected by emotion recognition processes. In future studies, it may be possible to investigate the effects that early psychopharmacological and psychotherapeutic interventions administered for the main symptoms of ADHD have on the impairment of emotion recognition.

Personality Traits and Comorbidity in Adults With ADHD.

PubMed

Instanes, Johanne Telnes; Haavik, Jan; Halmøy, Anne

2016-10-01

To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures. Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI. The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD). It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD. © The Author(s) 2013.

Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity

PubMed Central

Huss, Michael; Duhan, Praveen; Gandhi, Preetam; Chen, Chien-Wei; Spannhuth, Carsten; Kumar, Vinod

2017-01-01

Attention-deficit/hyperactivity disorder (ADHD) is a chronic psychiatric disorder characterized by hyperactivity and/or inattention and is often associated with a substantial impact on psychosocial functioning. Methylphenidate (MPH), a central nervous system stimulant, is commonly used for pharmacological treatment of adults and children with ADHD. Current practice guidelines recommend optimizing MPH dosage to individual patient needs; however, the clinical benefits of individual dose optimization compared with fixed-dose regimens remain unclear. Here we review the available literature on MPH dose optimization from clinical trials and real-world experience on ADHD management. In addition, we report safety and efficacy data from the largest MPH modified-release long-acting Phase III clinical trial conducted to examine benefits of dose optimization in adults with ADHD. Overall, MPH is an effective ADHD treatment with a good safety profile; data suggest that dose optimization may enhance the safety and efficacy of treatment. Further research is required to establish the extent to which short-term clinical benefits of MPH dose optimization translate into improved long-term outcomes for patients with ADHD. PMID:28740389

Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity.

PubMed

Huss, Michael; Duhan, Praveen; Gandhi, Preetam; Chen, Chien-Wei; Spannhuth, Carsten; Kumar, Vinod

2017-01-01

Attention-deficit/hyperactivity disorder (ADHD) is a chronic psychiatric disorder characterized by hyperactivity and/or inattention and is often associated with a substantial impact on psychosocial functioning. Methylphenidate (MPH), a central nervous system stimulant, is commonly used for pharmacological treatment of adults and children with ADHD. Current practice guidelines recommend optimizing MPH dosage to individual patient needs; however, the clinical benefits of individual dose optimization compared with fixed-dose regimens remain unclear. Here we review the available literature on MPH dose optimization from clinical trials and real-world experience on ADHD management. In addition, we report safety and efficacy data from the largest MPH modified-release long-acting Phase III clinical trial conducted to examine benefits of dose optimization in adults with ADHD. Overall, MPH is an effective ADHD treatment with a good safety profile; data suggest that dose optimization may enhance the safety and efficacy of treatment. Further research is required to establish the extent to which short-term clinical benefits of MPH dose optimization translate into improved long-term outcomes for patients with ADHD.

Depressive symptoms and the role of affective temperament in adults with attention-deficit/hyperactivity disorder (ADHD): A comparison with bipolar disorder.

PubMed

Torrente, Fernando; López, Pablo; Lischinsky, Alicia; Cetkovich-Bakmas, Marcelo; Manes, Facundo

2017-10-15

To investigate the characteristics of depressive symptoms and the influence of affective temperament in adults with attention-deficit/hyperactivity disorder (ADHD), in comparison with bipolar disorder (BD) patients and healthy controls (HCs). Sixty patients with ADHD, 50 patients with BD, and 30 HCs were assessed with instruments for measuring depressive symptoms (Beck Depression Inventory-II), and affective temperaments (Temperament Scale of Memphis, Pisa and San Diego, self-administered version; TEMPS-A). In addition, participants were evaluated with scales for measuring ADHD symptoms, impulsiveness, anxiety, executive dysfunction, and quality of life. ADHD patients showed levels of depressive symptoms similar to BD patients and higher than HCs. Only neurovegetative symptoms of depression differentiated ADHD and BD groups (BD > ADHD). Depressive symptoms in ADHD patients correlated positively with core ADHD, impulsivity, anxiety, and dysexecutive symptoms and negatively with quality of life. Thirty-eight percent of patients with ADHD scored above the cutoff for at least one affective temperament. Cyclothymic was the more common affective temperament (25%). ADHD patients with affective temperamental traits were more depressed and impulsive than patients without those traits and showed a symptomatic profile analogous to BD patients. The small size of resultant samples when ADHD group was stratified by the presence of affective temperament. In addition, results may not generalize to less severe ADHD patients from the community. Concomitant depressive symptoms constitute a common occurrence in adults with ADHD that carries significant psychopathological and functional consequences. The concept of affective temperaments may be an interesting link for explaining depressive symptomatology and emotional impulsivity in a subgroup of patients with ADHD, beyond the classic idea of comorbidity. Copyright © 2017 Elsevier B.V. All rights reserved.

The Development of an Embedded Figures Test for the Detection of Feigned Attention Deficit Hyperactivity Disorder in Adulthood

PubMed Central

Fuermaier, Anselm B. M.; Tucha, Oliver; Koerts, Janneke; Grabski, Meryem; Lange, Klaus W.; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Lara

2016-01-01

Objectives It has been shown that an increasing number of adults deliberately feign attention deficit hyperactivity disorder (ADHD), which demonstrates the need for new tests designed to detect feigned ADHD. Methods An Embedded Figures Test (EFT) was developed for the detection of feigned ADHD in adulthood. EFT performance of 51 adults with ADHD was compared to the performance of 52 matched healthy individuals, as well as to 268 undergraduate students who were randomly allocated in a simulation design to one of four experimental conditions, i.e. a control group, a naïve simulation group, a symptom-coached simulation group or a test-coached simulation group. Furthermore, an independent sample of 11 adults with ADHD as well as a sample of 17 clinicians experienced in the work with adults with ADHD were assessed for further validation of the EFT. Results The EFT was relatively easy to perform for both patients with ADHD and healthy comparisons as shown by low error rates and non-significant group differences. However, simulation groups differed from patients with ADHD by significant and large effects. An EFT index for the prediction of feigned ADHD was derived based on logistic regression coefficients. Receiver Operating Characteristics (ROC) demonstrated good classification accuracy of feigned ADHD relative to ADHD (AUC = 94.8%), i.e. high sensitivity (88%) and specificity (90%). Conclusions This study supports the utility of the EFT for the detection of feigned adult ADHD. PMID:27732620

The Development of an Embedded Figures Test for the Detection of Feigned Attention Deficit Hyperactivity Disorder in Adulthood.

PubMed

Fuermaier, Anselm B M; Tucha, Oliver; Koerts, Janneke; Grabski, Meryem; Lange, Klaus W; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Lara

2016-01-01

It has been shown that an increasing number of adults deliberately feign attention deficit hyperactivity disorder (ADHD), which demonstrates the need for new tests designed to detect feigned ADHD. An Embedded Figures Test (EFT) was developed for the detection of feigned ADHD in adulthood. EFT performance of 51 adults with ADHD was compared to the performance of 52 matched healthy individuals, as well as to 268 undergraduate students who were randomly allocated in a simulation design to one of four experimental conditions, i.e. a control group, a naïve simulation group, a symptom-coached simulation group or a test-coached simulation group. Furthermore, an independent sample of 11 adults with ADHD as well as a sample of 17 clinicians experienced in the work with adults with ADHD were assessed for further validation of the EFT. The EFT was relatively easy to perform for both patients with ADHD and healthy comparisons as shown by low error rates and non-significant group differences. However, simulation groups differed from patients with ADHD by significant and large effects. An EFT index for the prediction of feigned ADHD was derived based on logistic regression coefficients. Receiver Operating Characteristics (ROC) demonstrated good classification accuracy of feigned ADHD relative to ADHD (AUC = 94.8%), i.e. high sensitivity (88%) and specificity (90%). This study supports the utility of the EFT for the detection of feigned adult ADHD.

Attention deficit/hyperactivity disorders with co-existing substance use disorder is characterized by early antisocial behaviour and poor cognitive skills

PubMed Central

2013-01-01

Background Attention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse. The Swedish legislation on compulsory healthcare can be applied to persons with severe substance abuse who can be treated involuntarily during a period of six months. This context enables a reliable clinical assessment of ADHD in individuals with severe substance use disorder (SUD). Methods In the context of compulsory care for individuals with severe SUD, male patients were assessed for ADHD, co-morbid psychiatric symptoms, psychosocial background, treatment history, and cognition. The data from the ADHD/SUD group (n = 60) was compared with data from (1) a group of individuals with severe substance abuse without known ADHD (SUD group, n = 120), as well as (2) a group with ADHD from an outpatient psychiatric clinic (ADHD/Psych group, n = 107). Results Compared to the general SUD group in compulsory care, the ADHD/SUD group had already been significantly more often in compulsory care during childhood or adolescence, as well as imprisoned more often as adults. The most common preferred abused substance in the ADHD/SUD group was stimulant drugs, while alcohol and benzodiazepine abuse was more usual in the general SUD group. Compared to the ADHD/Psych group, the ADHD/SUD group reported more ADHD symptoms during childhood and performed poorer on all tests of general intellectual ability and executive functions. Conclusions The clinical characteristics of the ADHD/SUD group differed from those of both the SUD group and the ADHD/Psych group in several respects, indicating that ADHD in combination with SUD is a particularly disabling condition. The combination of severe substance abuse, poor general cognitive ability, severe psychosocial problems, including indications of antisocial behaviour, and other co-existing psychiatric conditions should be considered in treatment planning for adults with ADHD and SUD. PMID:24330331

Evaluation of estrogen and G protein-coupled estrogen receptor 1 (GPER) levels in drug-naïve patients with attention deficit hyperactivity disorder (ADHD).

PubMed

Sahin, Nilfer; Altun, Hatice; Kurutaş, Ergül Belge; Fındıklı, Ebru

2018-05-20

Estrogen has a crucial role in the regulation of reproductive and neuroendocrine function and exerts its effects through two classes of receptors, nuclear and membrane estrogen receptors (mERs). G protein-coupled estrogen receptor 1 (GPER) is a member of mERs, and despite limited research on the levels of GPER in patients with psychiatric diseases, a role of GPER in such conditions has been suggested. Here we evaluated serum estrogen and GPER levels in children with attention deficit hyperactivity disorder (ADHD) in relation to their age- and gender-matched healthy controls. A total of 82 children were included in the study, 47 drug- naïve patients with ADHD (age: 6-12 years; male/female: 34/13) and 35 healthy controls (age: 6-12 years; male/female: 19/16). The subgroups according to ADHD types were inattentive, hyperactive/impulsive, and combined. Serum estrogen was measured using an immunoassay system, while serum GPER was determined using a commercial sandwich enzyme-linked immunosorbent assay kit. Estrogen levels in children with ADHD were similar as in control group, while GPER levels were significantly lower in ADHD group compared to controls (p < 0.05). Logistic regression analysis showed a significant association between GPER levels and ADHD (p < 0.05), and no association between estrogen levels and ADHD (p > 0.05). No significant differences were found in GPER and estrogen levels between ADHD subgroups (p > 0.05). To the best of our knowledge, this study is the first to investigate estrogen and GPER levels in ADHD. Our preliminary findings suggest a relationship between serum GPER levels and ADHD, and this should be further investigated.

Descriptive comparison of drug treatment-persistent, -nonpersistent, and nondrug treatment patients with newly diagnosed attention deficit/hyperactivity disorder in Germany.

PubMed

Braun, Sebastian; Russo, Leo; Zeidler, Jan; Linder, Roland; Hodgkins, Paul

2013-05-01

Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous behavioral disorder commonly found in children, with serious lifetime health and social consequences for both children and their parents. Public awareness of ADHD in Germany has increased in the past decade, but little is known about the costs of treating newly diagnosed patients in clinical practice. This study aimed to describe the resource utilization and treatment costs of patients aged 6 to 17 years with newly diagnosed ADHD, using patient data from a German sickness fund, and to quantify resource utilization by drug treatment and treatment persistence. To identify patients with newly diagnosed ADHD, the second largest German sickness fund was utilized. Complete claims data of all de-identified patients meeting eligibility criteria for 2007 and 2008 were extracted. Patients were divided into 1 of 3 treatment groups: drug treatment-persistent, drug treatment-nonpersistent, and nondrug treatment. The differences in costs and resource utilization are reported in a descriptive manner, with paired and unpaired 2-sample Wilcoxon tests used. Of 3407 newly diagnosed patients with ADHD, 1105 (32%) received an ADHD-specific drug following diagnosis; the remaining 2302 comprised the nondrug treatment group. Of the total number of drug-treated patients, 1-year observational data were available for only 786 methylphenidate users (71%). Of these, 503 patients (64%) comprised the drug treatment-persistent group (those having at least 1 prescription every 3 months during the 12 months following their first ADHD prescription) and 283 (36%) comprised the drug treatment-nonpersistent group. After excluding those patients with <12 months of follow-up, 1779 patients (52%) were included in the nondrug-treatment group. Outpatient visits and the number of drug prescriptions and associated costs were highest in the drug treatment-persistent group (P = 0.05); however, the number of hospital admissions and days spent in-hospital were lowest in this group. Significant average savings of €347/y in overall costs(P ¼ 0.05) were noted for the drug treatment–persistent group compared with the drug treatment–non persistent group. Nondrug-treated patients had €181/y lower costs (P ¼ 0.05) comparedtodrugtreatment-persistentgroup.Drugtreatment-nonpersistentpatientswerethemost expensive group [corrected]. These mean savings were €739/y and €552/y (drug treatment-persistent group and drug treatment-nonpersistent group, respectively) compared with nondrug-treated patients. There are potential cost-savings benefits when patients are treatment persistent compared to nonpersistent [corrected]. Therefore, future disease-management programs might consider treatment persistence as potentially reducing overall payer costs. Additionally, the clinical and psychosocial situations of patients and their families should be taken into account. Copyright © 2013. Published by EM Inc USA.

Turning Points in the Lives of Youth of With/Without ADHD: Are They Linked to Changes in Substance Use?

PubMed

Jensen, Peter S; Yuki, Kumi; Murray, Desiree; Mitchell, John T; Weisner, Thomas; Hinshaw, Steven; Molina, Brooke; Swanson, James; Arnold, L Eugene; Hechtman, Lily; Wells, Karen

2017-04-01

This study examines the behavior beliefs, social supports, and turning points in individuals with/without ADHD related to their substance use/abuse (SU/A) decisions. The coded interviews from 60 participants with/without ADHD were compared for their SU/A decisions and precipitants with these decisions among abstainers, persisters, and desisters. ADHD participants reported fewer social advantages to avoid SU/A than non-ADHD participants. Desisters and persisters reported more social advantages of using drugs than abstainers. Persisters reported both more negative and positive psychological/physiological effects of SU/A. ADHD participants reported fewer positive role models in their lives. Non-ADHD patients reported more positive turning points than ADHD participants, regardless of SU/A status. ADHD individuals face challenges in making healthy decisions about SU/A due to lack of positive role models. Reinforcing accurate behavioral beliefs may be important to change behaviors in individuals with SU/A or to prevent SU/A initiation in ADHD individuals.

The effect of methylphenidate on decision making in patients with borderline personality disorder and attention-deficit/hyperactivity disorder.

PubMed

Gvirts, Hila Z; Lewis, Yael D; Dvora, Shira; Feffer, Kfir; Nitzan, Uriel; Carmel, Ziv; Levkovitz, Yechiel; Maoz, Hagai

2018-07-01

Impaired decision making in patients with borderline personality disorder (BPD) has been reported in several studies. Although methylphenidate (MPH) is known to ameliorate impaired decision making in patients with attention-deficit/hyperactivity disorder (ADHD), it has not yet been examined in patients with BPD. We therefore assessed the efficacy of a single dose of MPH on cognitive functions and decision making in patients with BPD. Twenty-two patients diagnosed with BPD participated in the study. The study was a randomized, double-blind placebo-controlled, random block order cross-over trial. Patients participated in two sessions and performed the Test of Variables of Attention, a digit-span test, and the computerized Iowa Gambling Task, after they had been administered either the MPH or a placebo. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale-18. Lower scores on the inattention symptoms scale were associated with a greater improvement in decision making following the administration of MPH when compared with improvements in patients with higher ADHD scores [F(1,17)=5.63, P=0.030]. We conclude that MPH may improve decision making in patients with BPD, although this effect is mediated by the level of ADHD symptoms. Further studies are needed to assess whether a prolonged beneficial effect of MPH on decision making in patients with BPD might also be present in 'real life'.

Noncredible cognitive performance at clinical evaluation of adult ADHD: An embedded validity indicator in a visuospatial working memory test.

PubMed

Fuermaier, Anselm B M; Tucha, Oliver; Koerts, Janneke; Lange, Klaus W; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Lara

2017-12-01

The assessment of performance validity is an essential part of the neuropsychological evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). Most available tools, however, are inaccurate regarding the identification of noncredible performance. This study describes the development of a visuospatial working memory test, including a validity indicator for noncredible cognitive performance of adults with ADHD. Visuospatial working memory of adults with ADHD (n = 48) was first compared to the test performance of healthy individuals (n = 48). Furthermore, a simulation design was performed including 252 individuals who were randomly assigned to either a control group (n = 48) or to 1 of 3 simulation groups who were requested to feign ADHD (n = 204). Additional samples of 27 adults with ADHD and 69 instructed simulators were included to cross-validate findings from the first samples. Adults with ADHD showed impaired visuospatial working memory performance of medium size as compared to healthy individuals. Simulation groups committed significantly more errors and had shorter response times as compared to patients with ADHD. Moreover, binary logistic regression analysis was carried out to derive a validity index that optimally differentiates between true and feigned ADHD. ROC analysis demonstrated high classification rates of the validity index, as shown in excellent specificity (95.8%) and adequate sensitivity (60.3%). The visuospatial working memory test as presented in this study therefore appears sensitive in indicating cognitive impairment of adults with ADHD. Furthermore, the embedded validity index revealed promising results concerning the detection of noncredible cognitive performance of adults with ADHD. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The efficacy of atomoxetine in treating adult attention deficit hyperactivity disorder (ADHD): A meta-analysis of controlled trials.

PubMed

Ravishankar, Vinutha; Chowdappa, Suresh Vedaveni; Benegal, Vivek; Muralidharan, Kesavan

2016-12-01

Atomoxetine, a non-stimulant, is FDA approved drug used in the management of adult ADHD. Since the presentation of adult ADHD is different from the childhood onset condition, there is an urgent need to study the efficacy of atomoxetine on the different symptom domains of adult ADHD. To study the efficacy of atomoxetine in treating adult ADHD compared to placebo, we performed a Medline search for English language publications of Randomized Controlled Trials (RCTs) comparing atomoxetine to placebo for adult ADHD using the keywords "adult ADHD", "atomoxetine" and "placebo". A total of 41 RCTs were returned of which we included 13 relevant RCTs reporting data on 1824 patients with adult ADHD in the analysis. Standardized mean difference between atomoxetine and placebo for the mean baseline-to-endpoint change in total ADHD scores, impulsivity/hyperactivity and inattention scores was calculated, with a 95% confidence limit. Atomoxetine had superior efficacy than placebo on overall adult ADHD scores [-0.45; 95% CI -0.54, -0.35; overall effect p<0.00001]. Atomoxetine was superior to placebo on the domains of both inattention [-0.42; 95% CI -0.49, -0.35; overall effect p<0.00001] and impulsivity/hyperactivity [-0.36; 95% CI -0.44, -0.29; overall effect p<0.00001]. Atomoxetine was significantly more efficacious (p<0.00001) in treating inattention than hyperactivity/impulsivity. Atomoxetine is efficacious in treating adult ADHD compared to placebo, though the efficacy is significantly superior for inattention than hyperactivity/impulsivity. Copyright © 2016. Published by Elsevier B.V.

Using the Autism-spectrum quotient to discriminate Autism Spectrum Disorder from ADHD in adult patients with and without comorbid Substance Use Disorder.

PubMed

Sizoo, Bram B; van den Brink, Wim; Gorissen-van Eenige, Marielle; Koeter, Maarten W; van Wijngaarden-Cremers, Patricia J M; van der Gaag, Rutger Jan

2009-09-01

It is unknown whether the Autism-spectrum quotient (AQ) can discriminate between Autism Spectrum Disorder (ASD) and Attention Deficit and Hyperactivity Disorder (ADHD) with or without comorbid Substance Use Disorder (SUD). ANOVA's were used to analyse the mean AQ (sub)scores of 129 adults with ASD or ADHD. We applied receiver operating characteristic (ROC) computations to assess discriminant power. All but one of the mean AQ (sub)scores were significantly higher for adults with ASD compared to those with ADHD. The SUD status in general was not significantly associated with AQ (sub)scores. On the Social Skills subscale patients with ASD and comorbid SUD showed less impairment than those without SUD. The cut-off score 26 yielded 73% correct classifications. The clinical use of the AQ in differentiating between ASD and ADHD is limited.

ADHD Medication and Substance-Related Problems.

PubMed

Quinn, Patrick D; Chang, Zheng; Hur, Kwan; Gibbons, Robert D; Lahey, Benjamin B; Rickert, Martin E; Sjölander, Arvid; Lichtenstein, Paul; Larsson, Henrik; D'Onofrio, Brian M

2017-09-01

Substance use disorders are major contributors to excess mortality among individuals with attention deficit hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events. The authors analyzed 2005-2014 commercial health care claims from 2,993,887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., emergency department visits related to substance use disorders) during months in which patients received prescribed stimulant medication or atomoxetine relative to the risk during months in which they did not. In adjusted within-individual comparisons, relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio=0.65, 95% CI=0.64-0.67), and female patients had 31% lower odds of concurrent substance-related events (odds ratio=0.69, 95% CI=0.67-0.71). Moreover, male patients had 19% lower odds of substance-related events 2 years after medication periods (odds ratio=0.81, 95% CI=0.78-0.85), and female patients had 14% lower odds of substance-related events 2 years after medication periods (odds ratio=0.86, 95% CI= 0.82-0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women. These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

Copy number variants in attention-deficit hyperactive disorder: identification of the 15q13 deletion and its functional role.

PubMed

Valbonesi, Stefano; Magri, Chiara; Traversa, Michele; Faraone, Stephen V; Cattaneo, Annamaria; Milanesi, Elena; Valenti, Vera; Gennarelli, Massimo; Scassellati, Catia

2015-04-01

Evidence has supported a role for rare copy number variants in the etiology of attention-deficit hyperactivity disorder (ADHD), in particular, the region 15q13, which is also a hot spot for several neuropsychiatric disorders. This region spans several genes, but their role and the biological implications remain unclear. We carried out, for the first time, an analysis of the 15q13 region in an Italian cohort of 117 ADHD patients and 77 controls using the MLPA method, confirmed by a genome single-nucleotide polymorphism array. In addition, we probed for downstream effects of the 15q13 deletions on gene expression by carrying out a transcriptomic analysis in blood. We found 15q13 deletions in two ADHD patients and identified 129 genes as significantly dysregulated in the blood of the two ADHD patients carrying 15q13 deletions compared with ADHD patients without 15q13 deletions. As expected, genes in the deleted region (KLF13, MTMR10) were downregulated in the two patients with deletions. Moreover, a pathway analysis identified apoptosis, oxidation reduction, and immune response as the mechanisms that were altered most significantly in the ADHD patients with 15q13 deletions. Interestingly, we showed that deletions in KLF13 and CHRNA7 influenced the expression of genes belonging to the same immune/inflammatory and oxidative stress signaling pathways. Our findings are consistent with the presence of 15q13 deletions in Italian ADHD patients. More interestingly, we show that pathways related to immune/inflammatory response and oxidative stress signaling are affected by the deletion of KFL13 and CHRNA7. Because the phenotypic effects of 15q13 are pleiotropic, our findings suggest that there are shared biologic pathways among multiple neuropsychiatric conditions.

Neural activation during response inhibition in adult Attention-Deficit/Hyperactivity Disorder: Preliminary findings on the effects of medication and symptom severity

PubMed Central

Congdon, Eliza; Altshuler, Lori L.; Mumford, Jeanette A.; Karlsgodt, Katherine H.; Sabb, Fred W.; Ventura, Joseph; McGough, James J.; London, Edythe D.; Cannon, Tyrone D.; Bilder, Robert M.; Poldrack, Russell A.

2014-01-01

Studies of adults with attention-deficit/hyperactivity disorder (ADHD) have suggested that they have deficient response inhibition, but findings concerning the neural correlates of inhibition in this patient population are inconsistent. We used the Stop-Signal task and functional magnetic resonance imaging (fMRI) to compare neural activation associated with response inhibition between adults with ADHD (N = 35) and healthy comparison subjects (N = 62), and in follow-up tests to examine the effect of current medication use and symptom severity. There were no differences in Stop-Signal task performance or neural activation between ADHD and control participants. Among the ADHD participants, however, significant differences were associated with current medication, with individuals taking psychostimulants (N = 25) showing less stopping-related activation than those not currently receiving psychostimulant medication (N = 10). Follow-up analyses suggested that this difference in activation was independent of symptom severity. These results provide evidence that deficits in inhibition-related neural activation persist in a subset of adult ADHD individuals, namely those individuals currently taking psychostimulants. These findings help to explain some of the disparities in the literature, and advance our understanding of why deficits in response inhibition are more variable in adult, as compared with child and adolescent, ADHD patients. PMID:24581734

A situation-specific approach to measure attention in adults with ADHD: The everyday life attention scale (ELAS).

PubMed

Groen, Yvonne; Fuermaier, Anselm B M; Tucha, Lara; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Oliver

2018-03-14

This study describes the development and utility of a new self-report measure of attentional capacities of adults with Attention Deficit Hyperactivity Disorder (ADHD): the Everyday Life Attention Scale (ELAS). Different from previous attention scales, attentional capacities are rated for nine everyday situations. Study 1 investigated the factor structure, validity, and reliability of the ELAS in 1206 healthy participants. Confirmatory factor analysis supported a situation-specific approach which categorizes everyday attention into nine situation scales: Reading, Movie, Activity, Lecture, Conversation, Assignment, Cooking, Cleaning up, and Driving. Each scale was composed of ratings for sustained, focused, selective, and divided attention as well as motivation, and had good internal consistency. Most scales showed weak correlations with ADHD Symptoms, Executive Functioning, and Memory Efficacy. Study 2 further investigated the sensitivity of the ELAS in 80 adults with ADHD compared to matched healthy controls and a mixed clinical group of 56 patients diagnosed with other psychiatric disorders. Compared to healthy controls, patients with ADHD reported reduced attentional capacities with large effect sizes on all situation scales and had a substantially higher number of situations with impaired attention scores. The ELAS may become useful in the clinical evaluation of ADHD and related psychiatric disorders in adults.

[Substance use disorders and ADHD: an overview of recent Dutch research].

PubMed

van Emmerik-van Oortmerssen, K; Crunelle, C L; Carpentier, P J

2013-01-01

ADHD is an important risk factor for the development of substance use disorders (SUD). To provide an overview of recent Dutch research into the prevalence of ADHD in SUD populations and the neurobiological substrate of the reduced effect of pharmacological treatment of this patient group. We describe three studies: a meta-analysis and meta-regression analysis of the prevalence of ADHD in 6689 SUD patients; a cross-sectional study of the prevalence of ADHD and several other psychiatric disorders in 193 methadon maintenance patients, and finally a study in which the availability and occupation of dopamine transporters before and after methylphenidate treatment were measured using SPECT scans in 24 ADHD patients with and without cocaine addiction. The prevalence of ADHD in SUD patients is estimated to be 23.1% (95% confidence interval 19.4-27.2). This prevalence is influenced by the diagnostic instrument for ADHD and by the substance of abuse: cocaine is associated with a lower ADHD prevalence than other substances. The prevalence found among methadone maintenance patients was similar, namely 24.9%; additional comorbid psychiatric disorders were also frequently present. In the imaging study, lower availability of dopamine transporters and lower occupation by methylphenidate were found in cocaine-dependent ADHD patients than in ADHD patients without SUD. These studies confirm the high prevalence of ADHD in SUD patients, and provide a possible explanation for the reduced efficacy of methylphenidate in this patient population.

The role of comorbid major depressive disorder in the clinical presentation of adult ADHD.

PubMed

Fischer, Aline G; Bau, Claiton H D; Grevet, Eugenio H; Salgado, Carlos A I; Victor, Marcelo M; Kalil, Katiane L S; Sousa, Nyvia O; Garcia, Christiane R; Belmonte-de-Abreu, Paulo

2007-12-01

Most adults with attention-deficit/hyperactivity disorder (ADHD) are not recognized and remain untreated, although a large fraction of these individuals are diagnosed and treated for other comorbid mental disorders, such as major depressive disorder (MDD). The fact that MDD is one of the most commonly occurring mental disorders with high comorbidity with adult ADHD raises the question whether such comorbidity is associated with differences in the clinical picture of ADHD. Three hundred and twenty adult ADHD outpatients were evaluated. Diagnoses followed DSM-IV criteria. Interviews to evaluate ADHD and oppositional defiant disorder (ODD) were performed based on the Portuguese version of K-SADS-E. Psychiatric comorbidities were investigated using SCID-IV and MINI. Regression models were applied to test MDD association with clinical and demographic outcomes. Subjects presenting ADHD and MDD had a higher frequency of generalized anxiety disorder and social phobia and a lower frequency of substance dependence, grade repetition and school suspensions, when compared to subjects with ADHD without MDD. Furthermore, adults presenting ADHD and MDD reported higher demand for psychotherapy and pharmacological treatment prior to enrollment in the study when compared to ADHD subjects free of MDD. However, contrary to what could be expected based on these data, the presence of MDD was not associated with an earlier ADHD diagnosis. These results point to the need for research and medical education into an earlier and more efficient ADHD diagnosis in patients who search for mental health care.

The Possible Effect of Methylphenidate Treatment on Empathy in Children Diagnosed with Attention-Deficit/Hyperactivity Disorder, Both With and Without Comorbid Oppositional Defiant Disorder.

PubMed

Golubchik, Pavel; Weizman, Abraham

2017-06-01

To assess the Empathizing Quotient (EQ) of patients diagnosed with attention-deficit/hyperactivity disorder (ADHD) only or comorbid with oppositional defiant disorder (ODD) and compare the two groups' responses to methylphenidate (MPH) treatment. Fifty-two children (8-18 years) diagnosed with ADHD, 26 of whom were also diagnosed with comorbid ODD (ADHD/ODD), were treated with MPH for 12 weeks. The level of EQ was assessed with the Children's version of the Empathizing Quotient (EQ-C) and the severity of ADHD symptoms with the ADHD Rating Scale (ADHD-RS). Assessments were done at baseline and at end point. A significant increase in EQ scores was obtained in both groups following MPH treatment (p = 0.003 for ADHD/ODD; p = 0.002 for ADHD). Significant correlation was found in the ADHD group between the changes in ADHD-RS and those in EQ, following MPH treatment (p = 0.015), but not in the ADHD/ODD group (p = 0.48). A correlation exists between MPH-related improvement in ADHD symptoms and between more empathy in children with ADHD not comorbid with ODD.

[The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness].

PubMed

Schlander, M; Trott, G-E; Schwarz, O

2010-03-01

In the German region of Nordbaden, 5% of children (aged 7-12 years) and 1.3% of adolescents (aged 13-19 years) were diagnosed with attention deficit hyperactivity disorder (ADHD) in 2003. About two thirds of these patients were not seen by a physician specialized in psychiatry. Now the National Association of Statutory Health Insurance Physicians in Germany (Kassenaerztliche Bundesvereinigung, KBV) has developed a proposal for the integrated provision of care for these patients, combining a guidelines-oriented multidisciplinary approach with a system of quality assurance. Against this background, currently available ADHD-related data are presented, covering epidemiology, comorbidity and differential diagnosis, health care utilization, and cost of illness. According to administrative data analyses from Nordbaden, direct medical costs for patients with ADHD, from the perspective of statutory health insurance (SHI), exceed those of matched controls by a factor of >2.5. On this basis, ADHD-related expenditures of the German SHI may be estimated at around EUR 260 million in 2003, and almost certainly will have continued to grow further since. In addition to this, a diagnosis of ADHD is associated with substantial indirect cost. Although the literature on the burden of ADHD is incomplete, it seems plausible that the cost of illness might be comparable to that reported for alcohol and addiction disorders. Thus we anticipate an increasing relevance of formal health economic evaluations of health care programs offered to patients with ADHD.

Neural hyperactivity related to working memory in drug-naive boys with attention deficit hyperactivity disorder.

PubMed

Li, Yuanyuan; Li, Fei; He, Ning; Guo, Lanting; Huang, Xiaoqi; Lui, Su; Gong, Qiyong

2014-08-04

Impaired working memory is thought to be a core feature of attention deficit hyperactivity disorder (ADHD). Previous imaging studies investigating working memory in ADHD have used tasks involving different cognitive resources and ignoring the categorical judgments about objects that are essential parts of performance in visual working memory tasks, thus complicating the interpretation of their findings. In the present study, we explored differential neural activation in children and adolescents with ADHD and in healthy controls using functional magnetic resonance imaging (fMRI) with the categorical n-back task (CN-BT), which maximized demands for executive reasoning while holding memory demands constant. A total of 33 drug-naive, right-handed male ADHD without comorbidity (mean age 9.9±2.4 years) and 27 right-handed, healthy male controls (mean age 10.9±2.7 years) were recruited in the present study. Event-related fMRI was used to study differences in brain activity during the CN-BT between the two groups. The two groups did not differ in their accuracy in the CN-BT, although the ADHD patients showed significantly shorter reaction times to correct responses than did the controls. During the CN-BT, both ADHD patients and controls showed significant positive and negative activations by the correct responses, mainly in the sensory-motor pathways and the striato-cerebellum circuit. Additionally, the ADHD patients showed significantly higher activation in the bilateral globus pallidus and the right hippocampus compared with the controls. There was also a positive correlation between hyperactivation of the left globus pallidus and the reaction time to correct responses in ADHD. In contrast to controls, ADHD patients showed neural hyperactivation in the striatum and mediotemporal areas during a working memory task involving categorization. Hyperfunction in these areas might be the pathophysiological foundation of ADHD, related to the deficits of working memory and the impulsive symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

Absence of gender effect on children with attention-deficit/hyperactivity disorder as assessed by optimized voxel-based morphometry.

PubMed

Yang, Pinchen; Wang, Pei-Ning; Chuang, Kai-Hsiang; Jong, Yuh-Jyh; Chao, Tzu-Cheng; Wu, Ming-Ting

2008-12-30

Brain abnormalities, as determined by structural magnetic resonance imaging (MRI), have been reported in patients with attention-deficit hyperactivity disorder (ADHD); however, female subjects have been underrepresented in previous reports. In this study, we used optimized voxel-based morphometry to compare the total and regional gray matter volumes between groups of 7- to 17-year-old ADHD and healthy children (total 114 subjects). Fifty-seven children with ADHD (n=57, 35 males and 22 females) and healthy children (n=57) received MRI scans. Segmented brain MRI images were normalized into standardized stereotactic space, modulated to allow volumetric analysis, smoothed and compared at the voxel level with statistical parametric mapping. Global volumetric comparisons between groups revealed that the total brain volumes of ADHD children were smaller than those of the control children. As for the regional brain analysis, the brain volumes of ADHD children were found to be bilaterally smaller in the following regions as compared with normal control values: the caudate nucleus and the cerebellum. There were two clusters of regional decrease in the female brain, left posterior cingulum and right precuneus, as compared with the male brain. Brain regions showing the interaction effect of diagnosis and gender were negligible. These results were consistent with the hypothesized dysfunctional systems in ADHD, and they also suggested that neuroanatomical abnormalities in ADHD were not influenced by gender.

Cytogenetic Effects of Chronic Methylphenidate Treatment and Chronic Social Stress in Adults with Attention-Deficit/Hyperactivity Disorder.

PubMed

Kittel-Schneider, S; Spiegel, S; Renner, T; Romanos, M; Reif, A; Reichert, S; Heupel, J; Schnetzler, L; Stopper, H; Jacob, C

2016-07-01

Methylphenidate (MPH) is widely used to treat childhood and adult attention-deficit/hyperactivity disorder (ADHD). However, there are still safety concerns about side effects in long-term treatment. The aim of this study was to assess cytogenetic effects of chronic MPH treatment in adult ADHD and to find out if chronic social stress is attenuated by medication and to investigate whether chronic psychosocial stress leads to mutagenic effects by itself. Lymphocytes for micronucleus assay and saliva samples for cortisol measurement were collected from adult ADHD patients and healthy controls. Stress exposure of the last 3 months was assessed by TICS (Trier Inventory for Chronic Stress). We could not detect an influence of MPH treatment on cytogenetic markers. ADHD patients displayed significantly higher chronic stress levels measured by TICS compared to healthy controls which were influenced by duration of MPH treatment. ADHD patients also showed significantly lower basal cortisol levels. We could corroborate that there are neither cytogenetic effects of chronic stress nor of chronic MPH intake even after several years of treatment. © Georg Thieme Verlag KG Stuttgart · New York.

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder.

PubMed

Norman, Luke J; Carlisi, Christina O; Christakou, Anastasia; Murphy, Clodagh M; Chantiluke, Kaylita; Giampietro, Vincent; Simmons, Andrew; Brammer, Michael; Mataix-Cols, David; Rubia, Katya

2018-03-24

The aim of the current paper is to provide the first comparison of computational mechanisms and neurofunctional substrates in adolescents with attention-deficit/hyperactivity disorder (ADHD) and adolescents with obsessive-compulsive disorder (OCD) during decision making under ambiguity. Sixteen boys with ADHD, 20 boys with OCD, and 20 matched control subjects (12-18 years of age) completed a functional magnetic resonance imaging version of the Iowa Gambling Task. Brain activation was compared between groups using three-way analysis of covariance. Hierarchical Bayesian analysis was used to compare computational modeling parameters between groups. Patient groups shared reduced choice consistency and relied less on reinforcement learning during decision making relative to control subjects, while adolescents with ADHD alone demonstrated increased reward sensitivity. During advantageous choices, both disorders shared underactivation in ventral striatum, while OCD patients showed disorder-specific underactivation in the ventromedial orbitofrontal cortex. During outcome evaluation, shared underactivation to losses in patients relative to control subjects was found in the medial prefrontal cortex and shared underactivation to wins was found in the left putamen/caudate. ADHD boys showed disorder-specific dysfunction in the right putamen/caudate, which was activated more to losses in patients with ADHD but more to wins in control subjects. The findings suggest shared deficits in using learned reward expectancies to guide decision making, as well as shared dysfunction in medio-fronto-striato-limbic brain regions. However, findings of unique dysfunction in the ventromedial orbitofrontal cortex in OCD and in the right putamen in ADHD indicate additional, disorder-specific abnormalities and extend similar findings from inhibitory control tasks in the disorders to the domain of decision making under ambiguity. Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Association Between Medication Use and Performance on Higher Education Entrance Tests in Individuals With Attention-Deficit/Hyperactivity Disorder.

PubMed

Lu, Yi; Sjölander, Arvid; Cederlöf, Martin; D'Onofrio, Brian M; Almqvist, Catarina; Larsson, Henrik; Lichtenstein, Paul

2017-08-01

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Periods with and without ADHD medication use. Scores from the higher education entrance examination (score range, 1-200 points). Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.

Memory consolidation of socially relevant stimuli during sleep in healthy children and children with attention-deficit/hyperactivity disorder and oppositional defiant disorder: What you can see in their eyes.

PubMed

Prehn-Kristensen, Alexander; Molzow, Ina; Förster, Alexandra; Siebenhühner, Nadine; Gesch, Maxime; Wiesner, Christian D; Baving, Lioba

2017-02-01

Children with attention-deficit/hyperactivity disorder (ADHD) display deficits in sleep-dependent memory consolidation, and being comorbid with oppositional defiant disorder (ODD), results in deficits in face processing. The aim of the present study was to investigate the role of sleep in recognizing faces in children with ADHD+ODD. Sixteen healthy children and 16 children diagnosed with ADHD+ODD participated in a sleep and a wake condition. During encoding (sleep condition at 8p.m.; wake condition at 8a.m.) pictures of faces were rated according to their emotional content; the retrieval session (12h after encoding session) contained a recognition task including pupillometry. Pupillometry and behavioral data revealed that healthy children benefited from sleep compared to wake with respect to face picture recognition; in contrast recognition performance in patients with ADHD+ODD was not improved after sleep compared to wake. It is discussed whether in patients with ADHD+ODD social stimuli are preferentially consolidated during daytime. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Efficacy and Safety Extrapolation Analyses for Atomoxetine in Young Children with Attention-Deficit/Hyperactivity Disorder

PubMed Central

Kratochvil, Christopher; Ghuman, Jaswinder; Camporeale, Angelo; Lipsius, Sarah; D'Souza, Deborah; Tanaka, Yoko

2015-01-01

Abstract Objectives: This extrapolation analysis qualitatively compared the efficacy and safety profile of atomoxetine from Lilly clinical trial data in 6–7-year-old patients with attention-deficit/hyperactivity disorder (ADHD) with that of published literature in 4–5-year-old patients with ADHD (two open-label [4–5-year-old patients] and one placebo-controlled study [5-year-old patients]). Methods: The main efficacy analyses included placebo-controlled Lilly data and the placebo-controlled external study (5-year-old patients) data. The primary efficacy variables used in these studies were the ADHD Rating Scale-IV Parent Version, Investigator Administered (ADHD-RS-IV-Parent:Inv) total score, or the Swanson, Nolan and Pelham (SNAP-IV) scale score. Safety analyses included treatment-emergent adverse events (TEAEs) and vital signs. Descriptive statistics (means, percentages) are presented. Results: Acute atomoxetine treatment improved core ADHD symptoms in both 6–7-year-old patients (n=565) and 5-year-old patients (n=37) (treatment effect: −10.16 and −7.42). In an analysis of placebo-controlled groups, the mean duration of exposure to atomoxetine was ∼7 weeks for 6–7-year-old patients and 9 weeks for 5-year-old patients. Decreased appetite was the most common TEAE in atomoxetine-treated patients. The TEAEs observed at a higher rate in 5-year-old versus 6–7-year-old patients were irritability (36.8% vs. 3.6%) and other mood-related events (6.9% each vs. <3.0%). Blood pressure and pulse increased in both 4–5-year-old patients and 6–7-year-old patients, whereas a weight increase was seen only in the 6–7-year-old patients. Conclusions: Although limited by the small sample size of the external studies, these analyses suggest that in 5-year-old patients with ADHD, atomoxetine may improve ADHD symptoms, but possibly to a lesser extent than in older children, with some adverse events occurring at a higher rate in 5-year-old patients. PMID:25265343

Criterion and concurrent validity of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) Spanish version.

PubMed

Ramos-Quiroga, Josep Antoni; Bosch, Rosa; Richarte, Vanesa; Valero, Sergi; Gómez-Barros, Nuria; Nogueira, Mariana; Palomar, Gloria; Corrales, Montse; Sáez-Francàs, Naia; Corominas, Margarida; Real, Alberto; Vidal, Raquel; Chalita, Pablo J; Casas, Miguel

2012-01-01

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in adulthood. Its diagnosis requires a retrospective evaluation of ADHD symptoms in childhood, the continuity of these symptoms in adulthood, and a differential diagnosis. For these reasons, diagnosis of ADHD in adults is a complex process which needs effective diagnostic tools. To analyse the criterion validity of the CAADID semi-structured interview, Spanish version, and the concurrent validity compared with other ADHD severity scales. An observational case-control study was conducted on 691 patients with ADHD. They were out-patients treated in a program for adults with ADHD in a hospital. A sensitivity of 98.86%, specificity 67.68%, positive predictive value 90.77% and a negative predictive value 94.87% were observed. Diagnostic precision was 91.46%. The kappa index concordance between the clinical diagnostic interview and the CAADID was 0.88. Good concurrent validity was obtained, the CAADID correlated significantly with WURS scale (r=0.522, P<.01), ADHD Rating Scale (r=0.670, P<.0.1) and CAARS (self-rating version; r=0.656, P<.01 and observer-report r=0.514, P<.01). CAADID is a valid and useful tool for the diagnosis of ADHD in adults for clinical, as well as for research purposes. Copyright © 2012 SEP y SEPB. Published by Elsevier España, S.L. All rights reserved.

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms.

PubMed

Safren, Steven A; Otto, Michael W; Sprich, Susan; Winett, Carol L; Wilens, Timothy E; Biederman, Joseph

2005-07-01

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.

Asperger Syndrome: a frequent comorbidity in first diagnosed adult ADHD patients?

PubMed

Roy, Mandy; Ohlmeier, Martin D; Osterhagen, Lasse; Prox-Vagedes, Vanessa; Dillo, Wolfgang

2013-06-01

Because adult ADHD is often accompanied by psychiatric comorbidities, the diagnostic process should include a thorough investigation for comorbid disorders. Asperger-Syndrome is rarely reported in adult ADHD and commonly little attention is paid to this possible comorbidity. We investigated 53 adult ADHD-patients which visited our out patient clinic for first ADHD-diagnosis (17 females, 36 males; range of age: 18-56 years) for the frequency of a comorbid Asperger-Syndrome. Diagnosis of this autism-spectrum disorder was confirmed by applying the appropriate DSM-IV-criteria. Additionally we tested the power of the two screening-instruments "Autism-spectrum quotient" (AQ) and "Empathy quotient" (EQ) by Baron-Cohen for screening Asperger-Syndrome in adult ADHD. Eight ADHD-patients were diagnosed with a comorbid Asperger-Syndrome (15.1%). The difference in AQ- and EQ-scores between pure ADHD-patients and comorbid patients was analysed, showing significantly higher scores in AQ and significant lower scores in EQ in comorbid patients. Results show that the frequency of Asperger-Syndrome seems to be substantially increased in adult ADHD (versus the prevalence of 0.06% in the general population), indicating that investigators of adult ADHD should also be attentive to autism-spectrum disorders. Especially the AQ seems to be a potential screening instrument for Asperger-Syndrome in adult ADHD-patients.

Psychosis proneness and ADHD in young relatives of schizophrenia patients.

PubMed

Keshavan, Matcheri S; Sujata, Mandayam; Mehra, Akhil; Montrose, Debra M; Sweeney, John A

2003-01-01

Symptoms resembling the attentional deficit hyperactivity disorder (ADHD) are frequently observed in young relatives at risk for schizophrenia (HR). We examined the frequency of the ADHD syndrome and its relationship to psychosis related psychopathology and neurobehavioral abnormalities in young HR subjects (n=29) and healthy comparison subjects (HC; n=30). Thirty-one percent of HR subjects (n=9) had ADHD as a lifetime Axis-I diagnosis (HR-A). Compared to healthy comparison subjects, the HR-A group had impaired neurological function. The HR-A group but not the HR subjects without ADHD had higher scores on the Chapman's magical ideation and perceptual aberration scales. Thus, ADHD-like features are more prevalent in the HR population than the one described in the general population and are associated with more frequent psychosis-like clinical features. Longitudinal studies can clarify whether an "ADHD subgroup" within HR subjects predict an increased risk for future emergence of schizophrenia.

Low dopamine transporter occupancy by methylphenidate as a possible reason for reduced treatment effectiveness in ADHD patients with cocaine dependence.

PubMed

Crunelle, Cleo L; van den Brink, Wim; Veltman, Dick J; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Schoevers, Robert A; Booij, Jan

2013-12-01

Methylphenidate (MPH) occupies brain striatal dopamine transporters (DATs) and is an effective treatment for attention deficit hyperactivity disorder (ADHD). However, patients with ADHD and comorbid cocaine dependence do not benefit significantly from treatment with MPH. To better understand the neurobiology of this phenomenon, we examined DAT availability and the effects of MPH treatment on DAT occupancy in ADHD patients with and without cocaine dependence. ADHD patients without a comorbid substance use disorder (N=16) and ADHD patients with comorbid cocaine dependence (N=8) were imaged at baseline and after two weeks MPH treatment using single photon emission computed tomography (SPECT) with the DAT tracer [(123)I]FP-CIT. Changes in ADHD symptoms were measured with the ADHD symptom rating scale (ASRS). At baseline, we observed lower striatal DAT availability in ADHD patients with cocaine dependence. Following fixed MPH treatment, MPH occupied significantly less striatal DATs in cocaine-dependent than in non-cocaine dependent ADHD patients. There were no significant correlations between baseline DAT availability or DAT occupancy by MPH and ADHD symptom improvement. However, we did find significant correlations between DAT occupancy by MPH and decreases in impulsivity scores and years of cocaine use. These preliminary findings suggest that low DAT occupancy is not the reason why ADHD patients with cocaine dependence do not benefit from MPH treatment. It also suggests that higher dosages of MPH in these patients are probably not the solution and that medications directed at other pharmacological targets should be considered in these comorbid ADHD patients. This trial is registered at the Dutch Trial Register, www.trialregister.nl, under Trial ID number NTR3127. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

Microstructural abnormalities of the brain white matter in attention-deficit/hyperactivity disorder

PubMed Central

Chen, Lizhou; Huang, Xiaoqi; Lei, Du; He, Ning; Hu, Xinyu; Chen, Ying; Li, Yuanyuan; Zhou, Jinbo; Guo, Lanting; Kemp, Graham J.; Gong, Qiyong

2015-01-01

Background Attention-deficit/hyperactivity disorder (ADHD) is an early-onset neurodevelopmental disorder with multiple behavioural problems and executive dysfunctions for which neuroimaging studies have reported a variety of abnormalities, with inconsistencies partly owing to confounding by medication and concurrent psychiatric disease. We aimed to investigate the microstructural abnormalities of white matter in unmedicated children and adolescents with pure ADHD and to explore the association between these abnormalities and behavioural symptoms and executive functions. Methods We assessed children and adolescents with ADHD and healthy controls using psychiatric interviews. Behavioural problems were rated using the revised Conners’ Parent Rating Scale, and executive functions were measured using the Stroop Colour-Word Test and the Wisconsin Card Sorting test. We acquired diffusion tensor imaging data using a 3 T MRI system, and we compared diffusion parameters, including fractional anisotropy (FA) and mean, axial and radial diffusivities, between the 2 groups. Results Thirty-three children and adolescents with ADHD and 35 healthy controls were included in our study. In patients compared with controls, FA was increased in the left posterior cingulum bundle as a result of both increased axial diffusivity and decreased radial diffusivity. In addition, the averaged FA of the cluster in this region correlated with behavioural measures as well as executive function in patients with ADHD. Limitations This study was limited by its cross-sectional design and small sample size. The cluster size of the significant result was small. Conclusion Our findings suggest that white matter abnormalities within the limbic network could be part of the neural underpinning of behavioural problems and executive dysfunction in patients with ADHD. PMID:25853285

Occupational Outcome in Adult ADHD: Impact of Symptom Profile, Comorbid Psychiatric Problems, and Treatment--A Cross-Sectional Study of 414 Clinically Diagnosed Adult ADHD Patients

ERIC Educational Resources Information Center

Halmoy, Anne; Fasmer, Ole Bernt; Gillberg, Christopher; Haavik, Jan

2009-01-01

Objective: To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in adult ADHD patients. Method: Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status. Results: Of the patients, 24%…

A comparative study of axis I antecedents before age 18 of unipolar depression, bipolar disorder and schizophrenia.

PubMed

Rubino, I Alex; Frank, Ellen; Croce Nanni, Roberta; Pozzi, Daniela; Lanza di Scalea, Teresa; Siracusano, Alberto

2009-01-01

Despite a large scientific literature on early clinical precursors of schizophrenia, bipolar disorder and unipolar depression, few data are available on axis I disorders preceding the adult onset of these illnesses. Disorders before the age of 18 years were retrospectively assessed with a structured interview in 3 groups of consecutive adult inpatients with DSM-IV diagnoses of schizophrenia (n = 197), major depressive disorder (n = 287) and bipolar disorder (n = 132). Only patients with adult onset of schizophrenia and of mania/hypomania were included. A sample of the general population served as control group (n = 300). The clinical groups significantly outnumbered the control sample on the majority of early axis I diagnoses. Schizophrenia was significantly associated (1) with attention deficit hyperactivity disorder (ADHD), ADHD inattentive subtype, ADHD hyperactive subtype and primary nocturnal enuresis, compared to unipolar depression, and (2) with social phobia and ADHD inattentive subtype, compared to bipolar disorder. Oppositional defiant disorder was significantly associated with bipolar disorder, compared to the other clinical and control groups. The ADHD hyperactive subtype predicted the adult onset of bipolar disorder compared to unipolar depression. Externalizing disorders seem of special importance as regards the clinical pathways toward schizophrenia.

Neural activation during response inhibition in adult attention-deficit/hyperactivity disorder: preliminary findings on the effects of medication and symptom severity.

PubMed

Congdon, Eliza; Altshuler, Lori L; Mumford, Jeanette A; Karlsgodt, Katherine H; Sabb, Fred W; Ventura, Joseph; McGough, James J; London, Edythe D; Cannon, Tyrone D; Bilder, Robert M; Poldrack, Russell A

2014-04-30

Studies of adults with attention-deficit/hyperactivity disorder (ADHD) have suggested that they have deficient response inhibition, but findings concerning the neural correlates of inhibition in this patient population are inconsistent. We used the Stop-Signal task and functional magnetic resonance imaging (fMRI) to compare neural activation associated with response inhibition between adults with ADHD (N=35) and healthy comparison subjects (N=62), and in follow-up tests to examine the effect of current medication use and symptom severity. There were no differences in Stop-Signal task performance or neural activation between ADHD and control participants. Among the ADHD participants, however, significant differences were associated with current medication, with individuals taking psychostimulants (N=25) showing less stopping-related activation than those not currently receiving psychostimulant medication (N=10). Follow-up analyses suggested that this difference in activation was independent of symptom severity. These results provide evidence that deficits in inhibition-related neural activation persist in a subset of adult ADHD individuals, namely those individuals currently taking psychostimulants. These findings help to explain some of the disparities in the literature, and advance our understanding of why deficits in response inhibition are more variable in adult, as compared with child and adolescent, ADHD patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Is motor activity during cognitive assessment an indicator for feigned attention-deficit/hyperactivity disorder (ADHD) in adults?

PubMed

Fuermaier, Anselm B M; Tucha, Oliver; Koerts, Janneke; Send, Tabea S; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Lara

2018-04-25

Several approaches, ranging from self-ratings of symptoms and impairments to objective neuropsychological testing, have been utilized during clinical evaluation in order to assess symptom and performance validity of individuals with attention-deficit/hyperactivity disorder (ADHD) in adulthood. Motor activity has not been considered yet in this context, which is surprising given that hyperactivity is a prominent characteristic of ADHD. Hence, the goal of the present study was to explore the incremental value of motor activity when assessing the credibility of individuals with adult ADHD at clinical evaluation. Forty-six patients diagnosed with ADHD took part in the study. A simulation design was performed, in which 152 healthy individuals were allocated to either a control condition (n = 36) or one of three simulation conditions (n = 116), the latter requesting participants to feign ADHD. All participants completed a self-rating scale of cognitive functioning and performed a computerized test for vigilance. Body movements were recorded during vigilance testing via a motion tracker attached to the back of the participant's chair. Patients with ADHD reported significantly more pronounced cognitive complaints and performed significantly poorer on the vigilance test than control participants. Simulators of ADHD, as compared to genuine patients, showed excessively low performance on the vigilance test. However, neither self-ratings of cognitive functioning nor measures of motor activity were suitable to distinguish genuine from feigned ADHD. A hierarchical logistic regression model showed that motor activity had no incremental value in detecting feigned ADHD when vigilance test performance has already been considered. Standard neuropsychological tests of vigilance may be useful to measure both performance and credibility of individuals with adult ADHD at clinical evaluation. In contrast, self-reports of symptoms and impairments, as well as measures of body movements, may not support the assessment of credibility in this context.

Efficacy and Safety of Atomoxetine Hydrochloride in Asian Adults With ADHD.

PubMed

Goto, Taro; Hirata, Yuko; Takita, Yasushi; Trzepacz, Paula T; Allen, Albert J; Song, Dong-Ho; Gau, Susan Shur-Fen; Ichikawa, Hironobu; Takahashi, Michihiro

2017-01-01

The efficacy and safety of atomoxetine was assessed in adult ADHD patients from Japan, Korea, and Taiwan in this first placebo-controlled Asian clinical study in adults of an ADHD medication. Atomoxetine was compared with placebo (195 atomoxetine, 196 placebo) over 10 weeks. The change from baseline to endpoint and changes over time in the Conners' Adult ADHD Rating Scale-Investigator Rated: Screening Version total score (CAARS-Inv: SV total score) were assessed along with changes in quality of life (QoL) and executive function. Atomoxetine treatment resulted in a mean reduction of -14.3 (placebo, -8.8) in CAARS-Inv: SV total score and a steady increase of between-group differences from Week 2. Improvements in QoL and executive functioning were also observed. Treatment-emergent adverse events leading to discontinuation were infrequent (atomoxetine: 5.2%, placebo: 1.5%). Atomoxetine was tolerable and effective in improving QoL and executive function as well as ameliorating core ADHD symptoms in adult Asian patients.

Enhanced emotional interference on working memory performance in adults with ADHD.

PubMed

Marx, Ivo; Domes, Gregor; Havenstein, Carolin; Berger, Christoph; Schulze, Lars; Herpertz, Sabine C

2011-09-01

Subjects with attention-deficit/hyperactivity disorder (ADHD) suffer from both executive dysfunction and deficits in emotion regulation. However, up to now, there has been no research demonstrating a clear impact of emotional dysregulation on cognitive performance in subjects with ADHD. Male and female adults with ADHD (n=39) and gender- and IQ-matched control subjects (n=40) performed an emotional working memory task (n-back task). In the background of the task, we presented neutral and negative stimuli varied in emotional saliency (negative pictures with low saliency, negative pictures with high saliency), but subjects were instructed to ignore these pictures and to process the working memory task as quickly and as accurately as possible. Compared to control subjects, ADHD patients showed both a general working memory deficit and enhanced distractability by emotionally salient stimuli in terms of lower n-back performance accuracy. In particular, while controls showed impaired WM performance when presented with highly arousing negative background pictures, a comparable decrement was observed in the ADHD group already with lowly arousing pictures. Our results suggest that difficulties in suppressing attention towards emotionally laden stimuli might result from deficient executive control in ADHD.

Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial.

PubMed

Hoxhaj, E; Sadohara, C; Borel, P; D'Amelio, R; Sobanski, E; Müller, H; Feige, B; Matthies, S; Philipsen, Alexandra

2018-06-01

Mindfulness training is a promising treatment approach in adult ADHD. However, there has not yet been a randomized controlled trial comparing mindfulness to an active control condition. In this study, we assessed the efficacy of a mindfulness training program (MAP) compared to structured psychoeducation (PE). After randomization 81 medication-free adult ADHD patients participated either in an 8-week MAP or PE group program. At baseline (T1), after 8 weeks (T2) and after 8 months (T3), severity of ADHD and associated symptoms (depression, general psychopathology, quality of life) were measured with the Conner's ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Brief Symptom Inventory (BSI) and the SF-36 by self and blind observer ratings. Both groups showed significant pre-post improvements in observer-rated Inattention scale (p < .001, partial η 2  = 0.18) and in associated symptomatology, which persisted through 6 months of follow-up. There were no significant differences regarding symptom reduction between the treatment groups. Women benefited more compared to men irrespective of treatment group. Men showed the most pronounced changes under MAP. In the current study, MAP was not superior to PE regarding symptom reduction in adult ADHD. Both interventions, mindfulness meditation and PE, were efficacious in reducing symptom load in adult ADHD. Furthermore in exploratory post hoc tests the study provides evidence for a potential gender-specific treatment response in adult ADHD.

Substance-Related and Addictive Disorders as a Risk Factor of Suicide and Homicide among Patients with ADHD: A Mini Review.

PubMed

Yoshimasu, Kouichi

2016-01-01

To discuss the role of substance-related and addictive disorders (SRAD) that lead patients with attention-deficit hyperactivity disorder (ADHD) to suicide and homicide. Relevant articles were searched via PubMed using several keywords related to this issue. Most of the articles included in this review were published after 2000. Patients with ADHD often fall into crises of catastrophic life events such as suicide or homicide. SRAD play an important role in leading ADHD patients to such events. Because ADHD is characterized by inattentiveness and impulsivity, any kinds of substances, legal or illegal, can deteriorate ADHD symptoms, leading ADHD patients to such catastrophic events. There are several pathways that connect ADHD with SRAD, which are roughly divided into two ways: internalizing mental disorders and externalizing mental disorders. The former includes depression and anxiety disorders characterized by self-inhibition or withdrawal. The latter typically includes conduct disorder or oppositional defiant disorder, as well as antisocial personality disorder, characterized by aggressive or antisocial behaviors or emotions towards others. These comorbid psychiatric disorders are apt to lead ADHD patients to SRAD, and once these patients suffer from SRAD, risk of catastrophic life events seems to increase due to the irreversibility of their adverse mentality. Comorbid mental disorders with ADHD can act, at least partially, as mediators from ADHD to SRAD. SRAD can be a critical risk factor of suicide and homicide among patients with ADHD. Early interventions for families with ADHD and psychiatric comorbidities may work as effective preventive strategies against such events. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Injury among stimulant-treated youth with ADHD.

PubMed

Marcus, Steven C; Wan, George J; Zhang, Huabin F; Olfson, Mark

2008-07-01

To assess risk factors for injury among children and adolescents treated with stimulants for ADHD. An analysis was performed of pharmacy and service claims data from 2000-2003 California Medicaid (Medi-Cal) focusing on children and adolescents ages 6 to 17 years who initiated stimulant therapy for ADHD. Bivariate and multivariate analyses were performed to examine associations of demographic and clinical characteristics with injury. In a Cox proportional hazard model that controlled for background patient characteristics, patients ages 13 to 17 years, male gender, prescription of anxiolytic/hypnotic medications, and diagnosis of a mood disorder were each independently associated with increased risk of injury, whereas African American ancestry and other minority racial/ethnic ancestry were associated with lower risk. Youth with high stimulant medication possession ratios (MPR) had a nonsignificantly lower risk of injury as compared to those with a low stimulant MPR. These findings reveal several patient characteristics that may be associated with increased risk of injury among children and adolescents treated for ADHD.

Adult attention deficit hyperactivity disorder in an anxiety disorders population.

PubMed

Van Ameringen, Michael; Mancini, Catherine; Simpson, William; Patterson, Beth

2011-08-01

Adult Attention Deficit Hyperactivity Disorder (ADHD) is a life-long, chronic disorder, which has its onset in childhood and is associated with significant functional impairment. ADHD appears to be highly comorbid with other psychiatric disorders, however, literature is lacking concerning ADHD/anxiety comorbidity. To that end, we examined the prevalence of ADHD in an anxiety disorder sample. Consecutive patients referred to an anxiety disorders clinic completed a variety of anxiety disorder self-report measures as well as the Adult ADHD self-report scale and were clinically assessed using the Structured Clinical Interview for DSM-IV, and the ADHD module of the Mini International Neuropsychiatric Interview. Of the 129 patients assessed, the rate of adult ADHD was 27.9%. The mean age of the sample was 33.1 ± 12.5 years, and the mean baseline CGI-S was 4.6 ± 1.1 (moderate to marked severity). The majority of the sample was female (63.6%) and single (49.5%). The most common comorbid disorders associated with ADHD were major depressive disorder (53.8%), social phobia (38.5%), generalized anxiety disorder (23.1%), and impulse control disorders (30.8%). Individuals with ADHD had higher symptom severity scores for obsessive-compulsive disorder, (P≤ 0.05) and for GAD (P≤ 0.05) and reported a significantly earlier age of onset for depression as compared to those without (P≤ 0.05). The prevalence of adult ADHD was higher in our anxiety disorders clinic sample than found in the general population. Clinical implications of these findings are discussed. © 2010 Blackwell Publishing Ltd.

Resting-State Neurophysiological Activity Patterns in Young People with ASD, ADHD, and ASD + ADHD.

PubMed

Shephard, Elizabeth; Tye, Charlotte; Ashwood, Karen L; Azadi, Bahar; Asherson, Philip; Bolton, Patrick F; McLoughlin, Grainne

2018-01-01

Altered power of resting-state neurophysiological activity has been associated with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), which commonly co-occur. We compared resting-state neurophysiological power in children with ASD, ADHD, co-occurring ASD + ADHD, and typically developing controls. Children with ASD (ASD/ASD + ADHD) showed reduced theta and alpha power compared to children without ASD (controls/ADHD). Children with ADHD (ADHD/ASD + ADHD) displayed decreased delta power compared to children without ADHD (ASD/controls). Children with ASD + ADHD largely presented as an additive co-occurrence with deficits of both disorders, although reduced theta compared to ADHD-only and reduced delta compared to controls suggested some unique markers. Identifying specific neurophysiological profiles in ASD and ADHD may assist in characterising more homogeneous subgroups to inform treatment approaches and aetiological investigations.

Attention deficit hyperactivity disorder and drug addiction rehabilitation patients.

PubMed

Camargo, Carlos Henrique Ferreira; Dornelles, Tarcísio Fanha; Barszcz, Karin; Martins, Eduardo Antunes

2016-12-01

Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention or hyperactivity. This study aimed to investigate the relationship between ADHD and drug dependence. The presence and severity of ADHD and substance use were evaluated through questionnaires in 80 adult patients in therapeutic communities. No difference in drug use or dependence prevalence between ADHD and non-ADHD patients was found. However, ADHD patients had lower ages on admission (p = 0.004) and at first contact with cocaine (p = 0.033). In ADHD patients, there was a negative correlation between the age at first use of cannabis and the subsequent severity of cannabis use (p = 0.017) and cocaine use (p = 0.033). Though there was no difference in prevalence of drug use among groups, results show that ADHD in patients in therapeutic communities may cause different addiction patterns, such as earlier use of cocaine and admission, and a more severe use of cocaine correlated to earlier contact with cannabis.

Methylphenidate mediated change in prosody is specific to the performance of a cognitive task in female adult ADHD patients.

PubMed

Bloch, Yuval; Aviram, Shai; Neeman, Ronnie; Braw, Yoram; Nitzan, Uriel; Maoz, Hagai; Mimouni-Bloch, Aviva

2015-01-01

Prosody production is highly personalized, related to both the emotional and cognitive state of the speaker and to the task being performed. Fundamental frequency (F main) is a central measurable feature of prosody, associated with having an attention deficit hyperactive disorder (ADHD). Since methylphenidate is an effective therapy for ADHD, we hypothesized that it will affect the fundamental frequency of ADHD patients. The answers of 32 adult ADHD patients were recorded while performing two computerized tasks (cognitive and emotional). Evaluations were performed at baseline and an hour after patients received methylphenidate. A significant effect of methylphenidate was observed on the fundamental frequency, as opposed to other parameters, of prosody. This change was evident while patients performed a cognitive, as opposed to an emotional, task. This change was seen in the 14 female ADHD patients but not in the 18 male ADHD patients. The fundamental frequency while performing a cognitive task without methylphenidate was not different in the female ADHD group, from 22 female controls. This pilot study supports prosodic changes as possible objective and accessible dynamic biological marker of treatment responses specifically in female ADHD.

[Attention deficit-hyperactivity disorder (ADHD) and comorbid mental disorders : ADHD-specific self-rating scales in differential diagnostics].

PubMed

Paucke, M; Stark, T; Exner, C; Kallweit, C; Hegerl, U; Strauß, M

2018-06-18

It is still unclear how well the established attention deficit-hyperactive disorder (ADHD)-specific rating scales can differentiate between ADHD symptoms and symptoms of other mental disorders. A total of 274 patients with suspected adult ADHD were extensively examined clinically and guideline-conform in an ADHD outpatient clinic. In 190 patients the diagnosis of ADHD could be made with certainty. The patients were also subsequently assessed according to the DSM IV criteria by self-rating scales on current (ADHS-SB, ASRS, CAARS) and retrospective (WURS-K) complaints. A binary logistic regression analysis was performed in order to extract from the questionnaires, which could best distinguish the diagnosis of ADHD from other mental disorders. The results showed that two self-rating scales (WURS-K and ADHS-SB) were sufficient to correctly diagnose ADHD in 83% of the patients examined with a sensitivity of 94% and specificity of 56%. The ADHD-specific self-rating scales are additionally useful for the diagnostic differentiation between ADHD-specific and other psychiatric symptoms in the clinical practice and can improve the safety of the diagnosis.

Effect of Pycnogenol® on attention-deficit hyperactivity disorder (ADHD): study protocol for a randomised controlled trial.

PubMed

Verlaet, Annelies A J; Ceulemans, Berten; Verhelst, Helene; Van West, Dirk; De Bruyne, Tess; Pieters, Luc; Savelkoul, Huub F J; Hermans, Nina

2017-03-28

Methylphenidate (MPH), the first choice medication for attention-deficit hyperactivity disorder (ADHD), is associated with serious adverse effects like arrhythmia. Evidence on the association of ADHD with immune and oxidant-antioxidant imbalances offers potential for antioxidant and/or immunomodulatory nutritional supplements as ADHD therapy. One small randomised trial in ADHD suggests, despite various limitations, therapeutic benefit from Pycnogenol®, a herbal, polyphenol-rich extract. This phase III trial is a 10-week, randomised, double-blind, placebo and active treatment controlled multicentre trial with three parallel treatment arms to compare the effect of Pycnogenol® to MPH and placebo on the behaviour of 144 paediatric ADHD and attention-deficit disorder (ADD) patients. Evaluations of behaviour (measured by the ADHD-Rating Scale (primary endpoint) and the Social-emotional Questionnaire (SEQ)), immunity (plasma cytokine and antibody levels, white blood cell counts and faecal microbial composition), oxidative stress (erythrocyte glutathione, plasma lipid-soluble vitamins and malondialdehyde and urinary 8-OHdG levels, as well as antioxidant enzyme activity and gene expression), serum zinc and neuropeptide Y level, urinary catecholamines and physical complaints (Physical Complaints Questionnaire) will be performed in week 10 and compared to baseline. Acceptability evaluations will be based on adherence, dropouts and reports of adverse events. Dietary habits will be taken into account. This trial takes into account comorbid behavioural and physical symptoms, as well as a broad range of innovative immune and oxidative biomarkers, expected to provide fundamental knowledge on ADHD aetiology and therapy. Research on microbiota in ADHD is novel. Moreover, the active control arm is rather unseen in research on nutritional supplements, but of great importance, as patients and parents are often concerned with the side effects of MPH. Clinicaltrials.gov number: NCT02700685 . Registered on 18 January 2016. EudraCT 2016-000215-32 . Registered on 4 October 2016.

[Dietary patterns in patients with attention deficit hyperactivity disorder].

PubMed

Durá Travé, T; Diez Bayona, V; Yoldi Petri, M E; Aguilera Albesa, S

2014-04-01

To evaluate the dietary patterns in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) and under treatment with extended-release methylphenidate (MPH-ER). A nutrition survey (food intake recall for three consecutive days) was carried out on 100 patients diagnosed with ADHD and under treatment with MPH-ER, and in 150 healthy children (control group). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. The mean MPH-ER dose was 1.02 mg/kg/day. Nutritional status in the ADHD group was significantly lower (P < .05) than in control group. The consumption of cereals, meat, pulses and fruits in the control group was significantly higher (P < .05) than in ADHD group. Calorie intake in the mid-morning snack, lunch and afternoon snack was significantly higher (P < .05) in the control group. Calorie intake at supper was significantly higher (P < .05) in the ADHD group. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake in the control group was significantly higher than in ADHD group. Treatment with MPH-ER substantially modifies the percentage distribution of calorie intake of the different meals. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in the healthy population of a similar age. Nutrition education should be provided, along with multimodal treatment, to the patients and/or their families. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Neural dysfunction during temporal discounting in paediatric Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder.

PubMed

Norman, Luke J; Carlisi, Christina O; Christakou, Anastasia; Chantiluke, Kaylita; Murphy, Clodagh; Simmons, Andrew; Giampietro, Vincent; Brammer, Michael; Mataix-Cols, David; Rubia, Katya

2017-11-30

Both Attention-Deficit/Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD) are associated with choice impulsivity, i.e. the tendency to prefer smaller immediate rewards over larger delayed rewards. However, the extent to which this impulsivity is mediated by shared or distinct underlying neural mechanisms is unclear. Twenty-six boys with ADHD, 20 boys with OCD and 20 matched controls (aged 12-18) completed an fMRI version of an individually adjusted temporal discounting (TD) task which requires choosing between a variable amount of money now or £100 in one week, one month or one year. Activations to immediate and delayed reward choices were compared between groups using a three-way ANCOVA. ADHD patients had steeper discounting rates on the task relative to controls. OCD patients did not differ from controls or patients with ADHD. Patients with ADHD and OCD showed predominantly shared activation deficits during TD in fronto-striato-insular-cerebellar regions responsible for self-control and temporal foresight, suggesting that choice impulsivity is mediated by overlapping neural dysfunctions in both disorders. OCD patients alone showed dysfunction relative to controls in right orbitofrontal and rostrolateral prefrontal cortex, extending previous findings of abnormalities in these regions in OCD to the domain of choice impulsiveness. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Medications Do Not Necessarily Normalize Cognition in ADHD Patients

ERIC Educational Resources Information Center

Gualtieri, C. Thomas; Johnson, Lynda G.

2008-01-01

Objective: Although ADHD medications are effective for the behavioral components of the disorder, little information exists concerning their effects on cognition, especially in community samples. Method: A cross-sectional study of ADHD patients treated with three different ADHD drugs was conducted. Patients' performance on a computerized…

Comparing Dimensional Models Assessing Personality Traits and Personality Pathology Among Adult ADHD and Borderline Personality Disorder.

PubMed

Koerting, Johanna; Pukrop, Ralf; Klein, Philipp; Ritter, Kathrin; Knowles, Mark; Banzhaf, Anke; Gentschow, Laura; Vater, Aline; Heuser, Isabella; Colla, Michael; Roepke, Stefan

2016-08-01

This pilot study was a comparison of dimensional models assessing personality traits and personality pathology in a clinical sample of adults diagnosed with ADHD and adults diagnosed with borderline personality disorder (BPD), and a nonclinical control sample of healthy adults. Personality traits were assessed using the NEO-Personality Inventory-Revised (NEO-PI-R) and dimensional personality pathology with the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Adults with ADHD and BPD produced higher Emotional Dysregulation/Neuroticism and Dissocial Behavior scores than controls. For the Extraversion/Inhibitedness scale, adults with BPD produced significantly lower scores than adults with ADHD and controls. On the Conscientiousness/Compulsivity domains, Conscientiousness scores were lower for both disorders, whereas low Compulsivity values were specific to adult ADHD. Our results suggest that patients with adult ADHD and BPD have distinguishable profiles of personality traits and personality pathology. © The Author(s) 2012.

Early maladaptive schemas in adult patients with attention deficit hyperactivity disorder.

PubMed

Philipsen, Alexandra; Lam, Alexandra P; Breit, Sigrid; Lücke, Caroline; Müller, Helge H; Matthies, Swantje

2017-06-01

The main purpose of this study was to examine whether adult patients with attention deficit hyperactivity disorder (ADHD) demonstrate sets of dysfunctional cognitive beliefs and behavioural tendencies according to Jeffrey Young's schema-focused therapy model. Sets of dysfunctional beliefs (maladaptive schemas) were assessed with the Young Schema Questionnaire (YSQ-S2) in 78 adult ADHD patients and 80 control subjects. Patients with ADHD scored significantly higher than the control group on almost all maladaptive schemas. The 'Failure', 'Defectiveness/Shame', 'Subjugation' and 'Emotional Deprivation' schemas were most pronounced in adult ADHD patients, while only 'Vulnerability to Harm or Illness' did not differ between the two groups. The schemas which were most pronounced in adult patients with ADHD correspond well with their learning histories and core symptoms. By demonstrating the existence of early maladaptive schemas in adults suffering from ADHD, this study suggests that schema theory may usefully be applied to adult ADHD therapy.

Acupuncture for attention deficit hyperactivity disorder (ADHD): study protocol for a randomised controlled trial.

PubMed

Hong, Soon-Sang; Cho, Seung-Hun

2011-07-11

Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-psychiatric problem, affecting 7-9% of children. Pharmacological interventions are widely used with behavioral treatments in ADHD. Still, the origin of ADHD is unclear, limiting pharmacological effectiveness and making adverse effects common. The use of complementary and alternative medicine (CAM) has increased, especially for developmental and behavioral disorders, such as ADHD. CAM is used by 60-65% of parents of children with ADHD to relieve ADHD-associated symptoms and to avoid the side effects of conventional medication. Acupuncture has been widely used to treat patients with ADHD, but the available evidence of its effectiveness is insufficient. Our aim was to evaluate the effectiveness and safety of acupuncture in patients (both and each treatment naive and conventional therapy children) with ADHD (any subtype) compared to the waitlist control. This study is a waitlist controlled open trial. We used a computer generated randomization scheme. This randomised, controlled trial had two parallel arms (acupuncture, and waitlist group). Each arm consisted of 40 participants. The acupuncture group received acupuncture treatment two times per week for a total of 12 sessions over 6 weeks. Post-treatment follow-up was performed 3 weeks later to complement the 12 acupuncture sessions. Participants in the waitlist group did not receive acupuncture treatments during the first six weeks but were only required to be assessed. After 6 weeks, the same treatments given to the acupuncture group were provided to the waitlist group. The primary outcome of this trial included differences in Korean version of ADHD-Rating Scale (K-ADHD-RS) before randomization, 3 weeks and 6 weeks after randomization, and 3 weeks after completing the treatment. Subjective measurements, like K-ADHD-RS, are commonly used in ADHD. Although these measurements have adequate reliability and validity, lack of objective assessment in ADHD may lead to some disputes, like parental placebo effects. More objective measurements, like Computerized Neurocognitive function Test (CNT) in this study, are needed in ADHD trials. Furthermore, this trial will provide evidence for the effectiveness of acupuncture as a treatment for ADHD. Clinical Research Information Service (CRiS) KCT0000019.

Acupuncture for attention deficit hyperactivity disorder (ADHD): study protocol for a randomised controlled trial

PubMed Central

2011-01-01

Background Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-psychiatric problem, affecting 7-9% of children. Pharmacological interventions are widely used with behavioral treatments in ADHD. Still, the origin of ADHD is unclear, limiting pharmacological effectiveness and making adverse effects common. The use of complementary and alternative medicine (CAM) has increased, especially for developmental and behavioral disorders, such as ADHD. CAM is used by 60-65% of parents of children with ADHD to relieve ADHD-associated symptoms and to avoid the side effects of conventional medication. Acupuncture has been widely used to treat patients with ADHD, but the available evidence of its effectiveness is insufficient. Our aim was to evaluate the effectiveness and safety of acupuncture in patients (both and each treatment naive and conventional therapy children) with ADHD (any subtype) compared to the waitlist control. Methods/Design This study is a waitlist controlled open trial. We used a computer generated randomization scheme. This randomised, controlled trial had two parallel arms (acupuncture, and waitlist group). Each arm consisted of 40 participants. The acupuncture group received acupuncture treatment two times per week for a total of 12 sessions over 6 weeks. Post-treatment follow-up was performed 3 weeks later to complement the 12 acupuncture sessions. Participants in the waitlist group did not receive acupuncture treatments during the first six weeks but were only required to be assessed. After 6 weeks, the same treatments given to the acupuncture group were provided to the waitlist group. The primary outcome of this trial included differences in Korean version of ADHD-Rating Scale (K-ADHD-RS) before randomization, 3 weeks and 6 weeks after randomization, and 3 weeks after completing the treatment. Discussion Subjective measurements, like K-ADHD-RS, are commonly used in ADHD. Although these measurements have adequate reliability and validity, lack of objective assessment in ADHD may lead to some disputes, like parental placebo effects. More objective measurements, like Computerized Neurocognitive function Test (CNT) in this study, are needed in ADHD trials. Furthermore, this trial will provide evidence for the effectiveness of acupuncture as a treatment for ADHD. Trial Registration Clinical Research Information Service (CRiS) KCT0000019 PMID:21745388

Does adult ADHD interact with COMT val (158) met genotype to influence working memory performance?

PubMed

Biehl, Stefanie C; Gschwendtner, Kathrin M; Guhn, Anne; Müller, Laura D; Reichert, Susanne; Heupel, Julia; Reif, Andreas; Deckert, Jürgen; Herrmann, Martin J; Jacob, Christian P

2015-03-01

Both attention-deficit/hyperactivity disorder (ADHD) and catechol-O-methyltransferase (COMT) genotype have been linked to altered dopaminergic transmission and possible impairment in frontal lobe functioning. This study offers an investigation of a possible interaction between ADHD diagnosis and COMT genotype on measures of working memory and executive function. Thirty-five adults with ADHD, who were recruited from the ADHD outpatient clinic at the Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, and thirty-five matched healthy controls completed the Digit Span test and the Stroop Color Word Test. While there were no main effects of ADHD or COMT, the two factors interacted on both Digit Span subtests with the two groups' met/met carriers showing significantly different performance on the Digit Span Forward subtest and the val/val carriers showing significantly different performance on the Digit Span Backward subtest. Findings provide preliminary support for a differential impact of COMT genotype on working memory measures in adult patients with ADHD compared to healthy controls.

Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial.

PubMed

Philipsen, Alexandra; Jans, Thomas; Graf, Erika; Matthies, Swantje; Borel, Patricia; Colla, Michael; Gentschow, Laura; Langner, Daina; Jacob, Christian; Groß-Lesch, Silke; Sobanski, Esther; Alm, Barbara; Schumacher-Stien, Martina; Roesler, Michael; Retz, Wolfgang; Retz-Junginger, Petra; Kis, Bernhard; Abdel-Hamid, Mona; Heinrich, Viola; Huss, Michael; Kornmann, Catherine; Bürger, Arne; Perlov, Evgeniy; Ihorst, Gabriele; Schlander, Michael; Berger, Mathias; Tebartz van Elst, Ludger

2015-12-01

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high prevalence in adulthood. There is a recognized need to assess the efficacy of psychotherapy in adult ADHD. To evaluate the efficacy of cognitive behavioral group psychotherapy (GPT) compared with individual clinical management (CM) and that of methylphenidate hydrochloride compared with placebo. Prospective, multicenter, randomized clinical trial of 18- to 58-year-old outpatients with ADHD from 7 German study centers. Patients were recruited between January 2007 and August 2010, treatment was finalized in August 2011, and final follow-up assessments occurred in March 2013. Sessions of GPT and CM were held weekly for the first 12 weeks and monthly thereafter (9 months). Patients received either methylphenidate or placebo for 1 year. The primary outcome was the change in the ADHD Index of the Conners Adult ADHD Rating Scale from baseline to the end of the 3-month intensive treatment (blinded observer ratings). Secondary outcomes included ADHD ratings after 1 year, blinded observer ratings using the Clinical Global Impression Scale, and self-ratings of depression. Among 1480 prescreened patients, 518 were assessed for eligibility, 433 were centrally randomized, and 419 were analyzed as randomized. After 3 months, the ADHD Index all-group baseline mean of 20.6 improved to adjusted means of 17.6 for GPT and 16.5 for CM, with no significant difference between groups. Methylphenidate (adjusted mean, 16.2) was superior to placebo (adjusted mean, 17.9) (difference, -1.7; 97.5% CI, -3.0 to -0.4; P = .003). After 1 year, treatment effects remained essentially stable. Descriptive analyses showed that methylphenidate was superior to placebo in patients assigned to GPT (difference, -1.7; 95% CI, -3.2 to -0.1; P = .04) or CM (difference, -1.7; 95% CI, -3.3 to -0.2; P = .03). Regarding depression, no significant differences were found. In contrast, GPT was superior to CM for all visits in the Clinical Global Impression global assessment of effectiveness. Highly structured group intervention did not outperform individual CM with regard to the primary outcome. Psychological interventions resulted in better outcomes during a 1-year period when combined with methylphenidate as compared with placebo. isrctn.org Identifier: ISRCTN54096201.

[ADH/D and impulsiveness: Prevalence of impulse control disorders and other comorbidities, in 81 adults with attention deficit/hyperactivity disorder (ADH/D)].

PubMed

Porteret, R; Bouchez, J; Baylé, F J; Varescon, I

2016-04-01

Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patient's professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom. The aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D. We used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities. More than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence. ADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Neurochemical correlates of internet game play in adolescents with attention deficit hyperactivity disorder: A proton magnetic resonance spectroscopy (MRS) study.

PubMed

Bae, Sujin; Han, Doug Hyun; Kim, Sun Mi; Shi, Xianfeng; Renshaw, Perry F

2016-08-30

Previous studies have examined the relationship of brain metabolic changes in patients with attention deficit hyperactivity disorder (ADHD) and internet gaming disorder (IGD). However, these studies have been limited by a small number of subjects, a large variance in subject age, and different brain regions of interest. The present study assessed the effects of chronic internet game play in ADHD children. Twenty eight ADHD adolescents with IGD (IGD+ADHD), 27 ADHD adolescents without problematic internet game playing (ADHD only) and 42 healthy comparison adolescents (HC) were included in the study. Magnetic resonance spectroscopy (MRS) was performed on a 3T MRI scanner. Our results indicate that the levels of NAA in both ADHD groups were lower than those observed in the HC group. The levels of Glu+Gln in the ADHD only group were increased, compared to those observed in the control group. However, Glu+Gln was not increased in the IGD+ADHD group. In addition, the levels of Glu+Gln in the IGD+ADHD group were positively correlated with K-ARS total and inattention scores. ADHD and IGD subjects were both characterized by decreased NAA levels within the frontal lobe, consistent with hypofrontality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Intelligence profiles of Chinese school-aged boys with high-functioning ASD and ADHD

PubMed Central

Li, Gaizhi; Jiang, Wenqing; Du, Yasong; Rossbach, Kathryn

2017-01-01

Purpose This study aimed to explore the intelligence profiles of Chinese school-aged boys with high-functioning autism spectrum disorder (HFASD) and attention-deficit/hyperactivity disorder (ADHD). Additionally, differences in intelligence quotient (IQ) between the HFASD group and the ADHD group were examined. Patients and methods Thirty-two boys with HFASD, 58 boys with ADHD, and 39 typically developing (TD) boys aged 6–16 years participated in this study. The ADHD group was divided into subgroups: ADHD-I (predominantly inattentive) and ADHD-C (combined type). (The ADHD-H [hyperactive] group was excluded because of small sample size). The Wechsler Intelligence Scale for Children-IV Chinese version was administered to every participant, and the FSIQ (Full-Scale IQ) score was used as the measure of IQ. Results Both boys with HFASD and ADHD (ADHD-I and ADHD-C) showed impairments in Processing Speed Index and FSIQ, as compared to the TD group. Lower Verbal Comprehension Index scores were found in the ASD and ADHD-I groups. Interestingly, Working Memory Index was only impaired in children with ADHD. Additionally, equivalent Perceptual Reasoning Index (PRI) scores were found among the HFASD, ADHD, and TD groups. Conclusion Results indicated that both children with ADHD and HFASD have difficulty in processing speed, which may be explained by these children having neurodevelopmental disorders. These results also indicated that working memory appears to only be impacted by having ADHD. Children with ASD are known to have language difficulties while children with ADHD typically display working memory deficits; thus, these findings were expected. PMID:28670123

How 'core' are motor timing difficulties in ADHD? A latent class comparison of pure and comorbid ADHD classes.

PubMed

van der Meer, Jolanda M J; Hartman, Catharina A; Thissen, Andrieke J A M; Oerlemans, Anoek M; Luman, Marjolein; Buitelaar, Jan K; Rommelse, Nanda N J

2016-04-01

Children with attention-deficit/hyperactivity disorder (ADHD) have motor timing difficulties. This study examined whether affected motor timing accuracy and variability are specific for ADHD, or that comorbidity with autism spectrum disorders (ASD) contributes to these motor timing difficulties. An 80-trial motor timing task measuring accuracy (μ), variability (σ) and infrequent long response times (τ) in estimating a 1-s interval was administered to 283 children and adolescents (8-17 years) from both a clinic and population based sample. They were divided into four latent classes based on the SCQ and L data. These classes were: without behavioral problems 'Normal-class' (n = 154), with only ADHD symptoms 'ADHD-class' (n = 49), and two classes with both ASD and ADHD symptoms; ADHD(+ASD)-class (n = 39) and ASD(+ADHD)-class (n = 41). The pure ADHD-class did not deviate from the Normal class on any of the motor timing measures (mean RTs 916 and 925 ms, respectively). The comorbid ADHD(+ASD) and ASD(+ADHD) classes were significantly less accurate (more time underestimations) compared to the Normal class (mean RTs 847 and 870 ms, respectively). Variability in motor timing was reduced in the younger children in the ADHD(+ASD) class, which may reflect a tendency to rush the tedious task. Only patients with more severe behavioral symptoms show motor timing deficiencies. This cannot merely be explained by high ADHD severity with ASD playing no role, as ADHD symptom severity in the pure ADHD-class and the ASD(+ADHD) class was highly similar, with the former class showing no motor timing deficits.

OROS-methylphenidate efficacy on specific executive functioning deficits in adults with ADHD: a randomized, placebo-controlled cross-over study.

PubMed

Bron, Tannetje I; Bijlenga, Denise; Boonstra, A Marije; Breuk, Minda; Pardoen, Willem F H; Beekman, Aartjan T F; Kooij, J J Sandra

2014-04-01

Attention-deficit/hyperactivity disorder (ADHD) is linked to impaired executive functioning (EF). This is the first study to objectively investigate the effects of a long-acting methylphenidate on neurocognitive test performance of adults with ADHD. Twenty-two adults with ADHD participated in a 6-weeks study examining the effect of osmotic-release oral system methylphenidate (OROS-mph) on continuous performance tests (CPTs; objective measures), and on the self-reported ADHD rating scale (subjective measure) using a randomized, double-blind, placebo-controlled cross-over design. OROS-mph significantly improved reaction time variability (RTV), commission errors (CE) and d-prime (DP) as compared to baseline (Cohen's d>.50), but did not affect hit reaction time (HRT) or omission errors (OE). Compared to placebo, OROS-mph only significantly influenced RTV on one of two CPTs (p<.050). Linear regression analyses showed predictive ability of more beneficial OROS-mph effects in ADHD patients with higher EF severity (RTV: β=.670, t=2.097, p=.042; omission errors (OE): β=-.098, t=-4.759, p<.001), and with more severe ADHD symptoms (RTV: F=6.363, p=.019; HRT: F=3.914, p=.061). Side effects rates were substantially but non-significantly greater for OROS-mph compared to placebo (77% vs. 46%, p=.063). OROS-mph effects indicated RTV as the most sensitive parameter for measuring both neuropsychological and behavioral deficits in adults with ADHD. These findings suggest RTV as an endophenotypic parameter for ADHD symptomatology, and propose CPTs as an objective method for monitoring methylphenidate titration. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder.

PubMed

Garbazza, Corrado; Sauter, Cornelia; Paul, Juliane; Kollek, Jenny; Dujardin, Catharine; Hackethal, Sandra; Dorn, Hans; Peter, Anita; Hansen, Marie-Luise; Manconi, Mauro; Ferri, Raffaele; Danker-Hopfe, Heidi

2018-01-01

Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls. Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of "periodicity," i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires. Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients. Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

Hippocampal subfield volume changes in subtypes of attention deficit hyperactivity disorder.

PubMed

Al-Amin, Mamun; Zinchenko, Artyom; Geyer, Thomas

2018-04-15

Attention-deficit hyperactivity disorder (ADHD) is accompanied by reduction of total hippocampal volume. However, disorder-related fine-grained structural alterations of hippocampal subfields remain unclear. Here we compared hippocampal subfield volumes in a large sample of patients with ADHD and healthy controls. We used T1-weighted structural 3-Tesla MRI images of 880 individuals (7-21 years old) from the ADHD-200 database. The images were acquired from 553 healthy individuals and 327 children and adolescents with combined (N = 196) and inattentive (N = 131) ADHD subtypes. Hippocampal subfields were segmented into the cornu amonis regions (CA1, CA2/3, CA4), fimbria, hippocampal fissure, presubiculum, subiculum, hippocampal tail, parasubiculum, granule cell layers of the dentate gyrus, molecular layer within the subiculum and the CA fields, and the hippocampal-amygdala transition area using an automatic algorithm available in Freesurfer 6.0. We found a significant reduction of total hippocampal volume in the combined ADHD group compared to healthy controls. This reduction was due to the atrophy of CA1, CA4, molecular layer, granule cell layers of the dentate gyrus, presubiculum, subiculum, and hippocampal tail. These differences were exclusively driven by the corresponding brain volume reduction in the combined ADHD-subtype, while hippocampal volumes in inattentive ADHD showed no reliable differences relative to controls. Finally, there were negative correlations between the reduced hippocampal subfields and behavioral ADHD indices. The present results point to a clear dissociation between inattentive and combined subtypes of ADHD. Therefore, hippocampal subfields may contribute towards understanding the pathophysiology of ADHD. Copyright © 2018 Elsevier B.V. All rights reserved.

Care Provision and Prescribing Practices of Physicians Treating Children and Adolescents With ADHD.

PubMed

Patel, Ayush; Medhekar, Rohan; Ochoa-Perez, Melissa; Aparasu, Rajender R; Chan, Wenyaw; Sherer, Jeffrey T; Alonzo, Joy; Chen, Hua

2017-07-01

Care provision and prescribing practices of physicians treating children with attention-deficit hyperactivity disorder (ADHD) were compared. A retrospective cohort study was conducted with the 1995-2010 General Electric Centricity Electronic Medical Record database. The sample included children (≤18 years) with newly diagnosed ADHD (ICD-9-CM code 314.XX) who received a prescription for a stimulant or atomoxetine. Identification of comorbid psychiatric disorders, duration from initial ADHD diagnosis to treatment, prescription of other psychotropic medications, and follow-up care during the ten months after the ADHD treatment initiation were compared across provider type (primary care physicians [PCPs], child psychiatrists, and physicians with an unknown specialty). The associations between provider type and practice variations were further determined by multivariate logistic regression accounting for patient demographic characteristics, region, insurance type, and prior mental health care utilizations. Of the 66,719 children identified, 75.8% were diagnosed by PCPs, 2.6% by child psychiatrists, and 21.6% by physicians whose specialty was unknown. Child psychiatrists were less likely than PCPs to initiate ADHD medication immediately after the diagnosis. However, once the ADHD treatment was initiated, they were more likely to prescribe psychotropic polytherapy even after analyses accounted for the comorbid psychiatric disorders identified. Only one-third of ADHD cases identified by both PCPs and child psychiatrists have met the HEDIS quality measure for ADHD medication-related follow-up visits. Differences were found by physician type in care of children with ADHD. Additional studies are needed to understand clinical consequences of these differences and the implications for care coordination across provider specialties.

Is emotion recognition the only problem in ADHD? effects of pharmacotherapy on face and emotion recognition in children with ADHD.

PubMed

Demirci, Esra; Erdogan, Ayten

2016-12-01

The objectives of this study were to evaluate both face and emotion recognition, to detect differences among attention deficit and hyperactivity disorder (ADHD) subgroups, to identify effects of the gender and to assess the effects of methylphenidate and atomoxetine treatment on both face and emotion recognition in patients with ADHD. The study sample consisted of 41 male, 29 female patients, 8-15 years of age, who were diagnosed as having combined type ADHD (N = 26), hyperactive/impulsive type ADHD (N = 21) or inattentive type ADHD (N = 23) but had not previously used any medication for ADHD and 35 male, 25 female healthy individuals. Long-acting methylphenidate (OROS-MPH) was prescribed to 38 patients, whereas atomoxetine was prescribed to 32 patients. The reading the mind in the eyes test (RMET) and Benton face recognition test (BFRT) were applied to all participants before and after treatment. The patients with ADHD had a significantly lower number of correct answers in child and adolescent RMET and in BFRT than the healthy controls. Among the ADHD subtypes, the hyperactive/impulsive subtype had a lower number of correct answers in the RMET than the inattentive subtypes, and the hyperactive/impulsive subtype had a lower number of correct answers in short and long form of BFRT than the combined and inattentive subtypes. Male and female patients with ADHD did not differ significantly with respect to the number of correct answers on the RMET and BFRT. The patients showed significant improvement in RMET and BFRT after treatment with OROS-MPH or atomoxetine. Patients with ADHD have difficulties in face recognition as well as emotion recognition. Both OROS-MPH and atomoxetine affect emotion recognition. However, further studies on the face and emotion recognition are needed in ADHD.

Perseveration by NK1R-/- (‘knockout’) mice is blunted by doses of methylphenidate that affect neither other aspects of their cognitive performance nor the behaviour of wild-type mice in the 5-Choice Continuous Performance Test

PubMed Central

Pillidge, Katharine; Porter, Ashley J; Young, Jared W; Stanford, S Clare

2016-01-01

The underlying cause(s) of abnormalities expressed by patients with attention deficit hyperactivity disorder (ADHD) have yet to be delineated. One factor that has been associated with increased vulnerability to ADHD is polymorphism(s) of TACR1, which is the human equivalent of the rodent NK1 (substance P-preferring) receptor gene (Nk1r). We have reported previously that genetically altered mice, lacking functional NK1R (NK1R–/–), express locomotor hyperactivity, which was blunted by the first-line treatment for ADHD, methylphenidate. Here, we compared the effects of this psychostimulant (3, 10 and 30 mg/kg, intraperitoneally) on the behaviour of NK1R-/- mice and their wild types in the 5-Choice Continuous Performance Test, which emulates procedures used to study attention and response control in ADHD patients. Methylphenidate increased total trials (a measure of ‘productivity’) completed by wild types, but not by NK1R-/- mice. Conversely, this drug reduced perseveration by NK1R-/- mice, but not by wild types. Other drug-induced changes in key behaviours were not genotype dependent, especially at the highest dose: for example, % omissions (an index of inattentiveness) was increased, whereas % false alarms and % premature responses (measures of impulsivity) declined in both genotypes, indicating reduced overall response. These findings are discussed in the context of the efficacy of methylphenidate in the treatment of ADHD. Moreover, they lead to several testable proposals. First, methylphenidate does not improve attention in a subgroup of ADHD patients with a functional deficit of TACR1. Second, these patients do not express excessive false alarms when compared with other groups of subjects, but they do express excessive perseveration, which would be ameliorated by methylphenidate. PMID:27097734

Altered interregional molecular associations of the serotonin transporter in attention deficit/hyperactivity disorder assessed with PET.

PubMed

Vanicek, Thomas; Kutzelnigg, Alexandra; Philippe, Cecile; Sigurdardottir, Helen L; James, Gregory M; Hahn, Andreas; Kranz, Georg S; Höflich, Anna; Kautzky, Alexander; Traub-Weidinger, Tatjana; Hacker, Marcus; Wadsak, Wolfgang; Mitterhauser, Markus; Kasper, Siegfried; Lanzenberger, Rupert

2017-02-01

Altered serotonergic neurotransmission has been found to cause impulsive and aggressive behavior, as well as increased motor activity, all exemplifying key symptoms of ADHD. The main objectives of this positron emission tomography (PET) study were to investigate the serotonin transporter binding potential (SERT BP ND ) in patients with ADHD and to assess associations of SERT BP ND between the brain regions. 25 medication-free patients with ADHD (age ± SD; 32.39 ± 10.15; 10 females) without any psychiatric comorbidity and 25 age and sex matched healthy control subjects (33.74 ± 10.20) were measured once with PET and the highly selective and specific radioligand [ 11 C]DASB. SERT BP ND maps in nine a priori defined ROIs exhibiting high SERT binding were compared between groups by means of a linear mixed model. Finally, adopted from structural and functional connectivity analyses, we performed correlational analyses using regional SERT binding potentials to examine molecular interregional associations between all selected ROIs. We observed significant differences in the interregional correlations between the precuneus and the hippocampus in patients with ADHD compared to healthy controls, using SERT BP ND of the investigated ROIs (P < 0.05; Bonferroni corrected). When correlating SERT BP ND and age in the ADHD and the healthy control group, we confirmed an age-related decline in brain SERT binding in the thalamus and insula (R 2  = 0.284, R 2  = 0.167, Ps < 0.05; Bonferroni corrected). The results show significantly different interregional molecular associations of the SERT expression for the precuneus with hippocampus in patients with ADHD, indicating presumably altered functional coupling. Altered interregional coupling between brain regions might be a sensitive approach to demonstrate functional and molecular alterations in psychiatric conditions. Hum Brain Mapp 38:792-802, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

[Summary of the practice guideline for the diagnosis and treatment of ADHD in adolescents and adults with addictions].

PubMed

Matthys, Frieda; Joostens, Peter; van den Brink, Wim; Sabbe, Bernard

2013-01-01

Various guidelines are available for the diagnosis and treatment of ADHD in adults, but not for patients with ADHD and a comorbid substance use disorder (SUD). In 2010, the Addiction Medicine Working Party, a division of the VAD (Verenigingvoor Alcohol- en andere Drugproblemen/Association for Alcohol and other Drug Problems) developed a practice guideline on how, when and by whom ADHD can be diagnosed in patients with an addiction, and how these patients should be treated. Given the high prevalence of ADHD in treatment-seeking SUD patients and the availability of valid screening instruments, all SUD patients should be screened for ADHD as soon as their drug use has stabilized. Acquiring information from external sources as well as clinical observation and questionnaires are important tools for the establishment of the diagnosis of ADHD. Integrated treatment primarily includes psycho-education, coaching and cognitive behavioural therapy in addition to pharmacotherapy. Evidence-based treatments for addiction may also be effective in patients with concomitant ADHD, provided the methods are adapted to the limitations that are associated with this condition.

Internet addiction and attention-deficit-hyperactivity disorder: Effects of anxiety, depression and self-esteem.

PubMed

Kahraman, Özlem; Demirci, Esra Özdemir

2018-06-01

Attention-deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Behavioral disinhibition, poor neurocognitive skills and immediate reward preference in children with ADHD have been suggested as risk factors for Internet addiction (IA). The aim of the present study was therefore to investigate the relationship between IA and depression, anxiety, and self-esteem in adolescents with ADHD, and to identify the features of Internet use that predict IA. We studied 111 patients with ADHD aged 12-18 years, and 108 healthy controls. The ADHD patients and controls were asked to complete a sociodemographic data form, the Internet Addiction Scale (IAS), Children's Depression Inventory, Childhood Screening Scale for Anxiety in Children, and the Rosenberg Self-Esteem Scale. IAS total score in the adolescents with ADHD was significantly higher than in the control group. Compared with the control group, the ADHD group depression scale score was significantly higher, and self-esteem score significantly lower (P < 0.05 for both). There was no difference between the groups in anxiety score. IAS score had a positive correlation with depression and anxiety scores, and a negative correlation with self-esteem score. The relationship between IA scale score and depression, anxiety and self-esteem scale scores were similar in the ADHD and the control group. In addition, IAS subscale and total scores were significantly higher in the ADHD group than the control group, even after controlling for the effects of self-esteem, depression and anxiety scores. Thus, ADHD is thought to be an independent risk factor for depression, anxiety and self-esteem, and, hence, for IA. © 2018 Japan Pediatric Society.

Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)--Review of Recent Findings.

PubMed

Matthies, Swantje; Philipsen, Alexandra

2016-04-01

Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.

Head-to-Head Comparison of Aripiprazole and Risperidone in the Treatment of ADHD Symptoms in Children with Autistic Spectrum Disorder and ADHD: A Pilot, Open-Label, Randomized Controlled Study.

PubMed

Lamberti, Marco; Siracusano, Rosamaria; Italiano, Domenico; Alosi, Norma; Cucinotta, Francesca; Di Rosa, Gabriella; Germanò, Eva; Spina, Edoardo; Gagliano, Antonella

2016-08-01

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are frequently overlapping neurodevelopmental disorders. Individuals in whom the disorders are comorbid show more severe impairment because of deficits in the processing of social situations, adaptive functioning, and executive control than individuals with either disorder alone. This open-label pilot study aimed to evaluate and compare the efficacy and tolerability of risperidone and aripiprazole for treating ADHD symptoms in patients with both ASD and ADHD over the course of 24 weeks of treatment. Patients (n = 44) were randomly assigned to start treatment with risperidone (22 patients) or aripiprazole (22 patients). Children were evaluated before starting treatment (T0), and after 12 weeks (T1) and 24 weeks (T2) of treatment. At each visit, specific psychiatric clinical scales were administered to assess the efficacy of the two drugs. The mean age was 8.4 ± 2.9 years in the aripiprazole group and 7.8 ± 2.3 years in the risperidone group. A total of 37 children (29 boys and 8 girls) completed the study (18 in the aripiprazole group and 19 in the risperidone group). Aripiprazole and risperidone appeared to have similar benefits in terms of efficacy and tolerability, although there were slight differences between the two drugs. Both groups showed a significant improvement in ADHD symptoms after 24 weeks of treatment (ADHD Rating Scale, Conners Parent Rating Scale-Hyperactivity, and Clinical Global Improvement-Severity Scale). No significant difference between the two drugs on any parameters at 24 weeks were found. Prolactin levels were decreased in the aripiprazole group. Both drugs were well tolerated, with no serious adverse events detected. Our study confirms the efficacy of both aripiprazole and risperidone in ameliorating ADHD symptoms of children also presenting with ASD.

[Differential effects of attention deficit/hyperactivity disorder subtypes in event-related potentials].

PubMed

Tamayo-Orrego, Lukas; Osorio Forero, Alejandro; Quintero Giraldo, Lina Paola; Parra Sánchez, José Hernán; Varela, Vilma; Restrepo, Francia

2015-01-01

To better understand the neurophysiological substrates in attention deficit/hyperactivity disorder (ADHD), a study was performed on of event-related potentials (ERPs) in Colombian patients with inattentive and combined ADHD. A case-control, cross-sectional study was designed. The sample was composed of 180 subjects between 5 and 15 years of age (mean, 9.25±2.6), from local schools in Manizales. The sample was divided equally in ADHD or control groups and the subjects were paired by age and gender. The diagnosis was made using the DSM-IV-TR criteria, the Conners and WISC-III test, a psychiatric interview (MINIKID), and a medical evaluation. ERPs were recorded in a visual and auditory passive oddball paradigm. Latency and amplitude of N100, N200 and P300 components for common and rare stimuli were used for statistical comparisons. ADHD subjects show differences in the N200 amplitude and P300 latency in the auditory task. The N200 amplitude was reduced in response to visual stimuli. ADHD subjects with combined symptoms show a delayed P300 in response to auditory stimuli, whereas inattentive subjects exhibited differences in the amplitude of N100 and N200. Combined ADHD patients showed longer N100 latency and smaller N200-P300 amplitude compared to inattentive ADHD subjects. The results show differences in the event-related potentials between combined and inattentive ADHD subjects. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood.

PubMed

Dalteg, Arne; Zandelin, Anders; Tuninger, Eva; Levander, Sten

2014-11-01

Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. ADHD and CD were much more common among the patients than in the general population-the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.

Gender ratios of administrative prevalence and incidence of attention-deficit/hyperactivity disorder (ADHD) across the lifespan: A nationwide population-based study in Taiwan.

PubMed

Huang, Charles Lung-Cheng; Weng, Shih-Feng; Ho, Chung-Han

2016-10-30

To verify the hypothesis that there is different gender ratio of attention-deficit/hyperactivity disorder (ADHD) among adults compared to children and adolescents in the clinical setting among Asian population. The nationwide population-based database containing data on enrollees in the National Health Insurance program in Taiwan during 2000-2007 was used in this study, and we investigated the lifetime gender ratios of administrative prevalence and incidence in healthcare-seeking ADHD patients (n=228,029). The male-to-female ratios of diagnosed incidence and prevalence of child/adolescent ADHD (age <20 years) ranged from 3.39 to 4.07 and 3.87-4.31, respectively. The male-to-female ratios of diagnosed incidence and prevalence of ADHD in the adult group (age 20-65 years) ranged from 0.24 to 0.76 and 0.35-0.98, respectively. In conclusion, there was substantially increased female-to-male ratio in adults ADHD compared to children and adolescents in the clinical setting. Further researches on the management and mechanism are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

1H-Magnetic resonance spectroscopy study of stimulant medication effect on brain metabolites in French Canadian children with attention deficit hyperactivity disorder

PubMed Central

Benamor, Leila

2014-01-01

Background Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school aged children. Functional abnormalities have been reported in brain imaging studies in ADHD populations. Psychostimulants are considered as the first line treatment for ADHD. However, little is known of the effect of stimulants on brain metabolites in ADHD patients. Objectives To compare the brain metabolite concentrations in children with ADHD and on stimulants with those of drug naïve children with ADHD, versus typically developed children, in a homogenous genetic sample of French Canadians. Methods Children with ADHD on stimulants (n=57) and drug naïve children with ADHD (n=45) were recruited, as well as typically developed children (n=38). The presence or absence of ADHD diagnosis (Diagnostic and Statistical Manual of Mental Disorders IV criteria) was based on clinical evaluation and The Diagnostic Interview Schedule for Children IV. All children (n=140) underwent a proton magnetic resonance spectroscopy session to measure the ratio of N-acetyl-aspartate, choline, glutamate, and glutamate–glutamine to creatine, respectively, in the left and right prefrontal and striatal regions of the brain, as well as in the left cerebellum. Results When compared with drug naïve children with ADHD, children with ADHD on stimulants and children typically developed were found to have higher choline ratios in the left prefrontal region (P=0.04) and lower N-acetyl-aspartate ratios in the left striatum region (P=0.01), as well as lower glutamate–glutamine ratios in the left cerebellum (P=0.05). In these three regions, there was no difference between children with ADHD on stimulants and typically developed children. Conclusion Therapeutic psychostimulant effects in children with ADHD may be mediated by normalization of brain metabolite levels, particularly in the left fronto-striato-cerebellar regions. PMID:24476627

Experiences of adolescents and young adults with ADHD in Hong Kong: treatment services and clinical management.

PubMed

Cheung, Kerry K W; Wong, Ian C K; Ip, Patrick; Chan, Phyllis K L; Lin, Candy H Y; Wong, Lisa Y L; Chan, Esther W

2015-05-01

Specialist services for the treatment of attention deficit hyperactivity disorder (ADHD) in adulthood in Hong Kong are yet to be developed. This study aims to explore the experiences of adolescents and young adults with ADHD in accessing treatment and services, coping with ADHD-related impairment, and their expectations of future treatment in Hong Kong. Qualitative interviews were conducted with a semi-structured guide. Forty young adult patients aged between 16 and 23 were included in the study. The interview recordings were transcribed verbatim and anonymised. Data were analysed with a thematic approach based on key principles of Grounded Theory. Four meta-themes were developed: Accessing ADHD diagnosis and treatment services; ADHD-related impairment; Experience of ADHD treatments; and Attitudes and expectations of future ADHD treatment. The role of parents and schools were highly significant in accessing services for patients diagnosed with ADHD in childhood. In general, ADHD affected every aspect of patients' lives including academic outcome, employment, family and social relationships. Medications were the principal treatment for ADHD amongst the interviewees and were reported to be generally effective. Half of the patients received non-pharmacological treatments in childhood but these effects were reported to be temporary. There was general consensus that the needs of patients with ADHD could not be met by the current service. In particular, there is a lack of specialist service for adults with ADHD, follow-up by different clinicians, and insufficient provision of non-pharmacological treatments. The findings suggest that further development of specialist ADHD services and non-pharmacological options for young adults are essential to meet their diverse needs with a holistic approach.

Attention Deficit Hyperactivity Disorder in Children With Sickle Cell Disease Referred for an Evaluation.

PubMed

Acquazzino, Melissa A; Miller, Meghan; Myrvik, Matthew; Newby, Robert; Scott, John Paul

2017-07-01

Neuropsychological deficits, including difficulties with attention, are well described in children with sickle cell disease (SCD). Very little is known about attention deficit hyperactivity disorder (ADHD) in children with SCD. The objective of this study was to determine the proportion of ADHD in children with SCD referred for neuropsychological evaluation. This prospective, cross-sectional study included patients (age, 4 to 18 y) with SCD and completion of a neuropsychological evaluation between December 2013 and March 2016. Patients were referred for neuropsychological evaluation because of concern regarding school performance, development, and/or behavior. The diagnosis of ADHD was made by a neuropsychologist on the basis of the diagnostic criteria in the Diagnostic Statistical Manual-Fourth or Fifth Editions. ADHD medication usage rate was obtained by medical record review. Of the 89 patients with SCD referred for neuropsychological evaluation, 25% (95% confidence interval, 16%-35%) met diagnostic criteria for ADHD. Only 21% of the patients with SCD and ADHD were prescribed an ADHD medication. Our study supports routine ADHD screening in children with SCD who have poor school performance or behavioral concerns. Despite the benefits of pharmacologic treatment, the majority of patients with SCD and ADHD did not receive a medication for management of their ADHD.

Gray Matter Increase in Motor Cortex in Pediatric ADHD: A Voxel-Based Morphometry Study.

PubMed

Sutcubasi Kaya, Bernis; Metin, Baris; Tas, Zeynep Cubukcuoglu; Buyukaslan, Ayse; Soysal, Aysegul; Hatiloglu, Deniz; Tarhan, Nevzat

2018-05-01

Several studies report that ADHD is associated with reduced gray matter (GM), whereas others report no differences in GM volume between ADHD patients and controls, and some even report more GM volume in individuals with ADHD. These conflicting findings suggest that reduced GM is not a universal finding in ADHD, and that more research is needed to delineate with greater accuracy the range of GM alterations. The present study aimed to identify GM alterations in ADHD using pediatric templates. 19 drug-naïve ADHD patients and 18 controls, all aged 7 to 14 years, were scanned using magnetic resonance imaging. Relative to the controls, the ADHD patients had more GM, predominantly in the precentral and supplementary motor areas. Moreover, there were positive correlations between GM volume in these areas and ADHD scale scores. The clinical and pathophysiological significance of increased GM in the motor areas remains to be elucidated by additional research.

One-year prospective follow-up of pharmacological treatment in children with attention-deficit/hyperactivity disorder.

PubMed

Didoni, Anna; Sequi, Marco; Panei, Pietro; Bonati, Maurizio

2011-10-01

To delineate the safety and tolerability profile of methylphenidate and atomoxetine in children and adolescents with attention deficit hyperactivity disorder (ADHD) monitored for more than 1 year. A cohort study analyzing data from the national ADHD register on patients from the Lombardy Region treated with MPH or atomoxetine. A total of 229 children (median age 11 years, range 6-17), enrolled in 15 regional centers between June 2007 and May 2010. The prevalence rate of pharmacological treatment for ADHD was 0.23%, whereas the estimated ADHD prevalence in the population was 0.95%. In total, 73.8% of patients had been treated with atomoxetine (10-90 mg daily) or MPH (10-75 mg daily); 22% of patients also received an additional psychotropic drug. Of the treated children, 26.9% discontinued the drug prior to 1 year of treatment, mostly because of adverse effects (28.6%). No new or unexpected adverse events (rate 39.2%) were encountered. Decreased appetite, headache, and unstable mood were the leading events. The most severe events occurred in two boys: one experienced absence seizures for the first time with MPH, the other experienced hallucinations with atomoxetine. Therapy was discontinued in ten male patients (7.7%) because of adverse events. All patients with adverse effects recovered well. A very low rate of ADHD prevalence was estimated in Italian children compared to that reported in other countries. Although the medications for ADHD are generally well tolerated, with only mild or minor adverse effects in most cases, their rational use can only be guaranteed by disseminating and monitoring evidence-based practices and by monitoring the safety and efficacy of treatments in both the short and long terms with appropriate tools and approaches.

Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder.

PubMed

Walker, Daniel J; Mason, Oren; Clemow, David B; Day, Kathleen A

2015-01-01

Attention-deficit/hyperactivity disorder (ADHD) is a CNS disorder that has its onset in childhood, but often persists into adulthood. There is growing recognition that adult ADHD can result in multiple negative consequences for individuals. ADHD is also often associated with a number of comorbid psychiatric disorders. Atomoxetine (ATX), a nonstimulant, selective noradrenergic reuptake inhibitor, was approved in the United States in 2002 for the treatment of ADHD in children and adolescents, as well as adults. We review here the safety and efficacy of ATX in adults with ADHD, including data in special populations, functional outcomes, as well as provider and patient real-world perceptions. We searched the databases Embase, MEDLINE and PsycINFO using the terms 'ADHD' and 'adult' and 'ATX' capturing publications from January 1, 1998, to March 27, 2014. Only publications in English were considered. ATX demonstrated significantly greater improvement than placebo (PBO) on the Conners Adult ADHD Rating Scale-Investigator rated:Screening Version (CAARS-Inv:SV) in all trials (N = 6; total score difference ranged from -3.5 to -5.5). For long-term trials using the CAARS-Inv:SV, ATX demonstrated significantly greater improvement than PBO in three of four trials (total score differences ranged from -0.1 to -6.0). In short-term studies, ATX showed significantly greater improvement than PBO on the Adult ADHD Quality-of-Life scale total score in three of three studies, but results were mixed on the Sheehan Disability Scale. Three studies of ATX have reported statistically significant improvement (compared with PBO) on the Behavior Rating Inventory of Executive Function-Adult Version Self Report scale. The most common adverse events (occurring in ≥ 10% of patients taking ATX) were nausea, dry mouth, decreased appetite, insomnia and fatigue. ATX is an important treatment option for the right patient. ATX can provide long-term, consistent symptom relief and functional improvement for adults with ADHD.

ADHD Symptoms in Pathological and Problem Gamblers in Singapore.

PubMed

Mak, Charles; Tan, Kok Kah; Guo, Song

2018-06-22

Background : There is relatively little research examining the relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) and gambling addiction. This study seeks to explore for ADHD symptoms in adult gambling addiction patients and to evaluate their gambling-related cognitions. Materials and Methods : A cross-sectional survey was conducted at National Addictions Management Service, Institute of Mental Health, in Singapore. Patients presenting for gambling treatment were screened for ADHD symptoms and assessed for severity of gambling-related cognitions. The primary objective was to observe the rate of patients screening positive for ADHD. Results : 20% of the sample screened positive for ADHD. These individuals also had lower levels of gambling-related cognitions. No significant correlation was noted between ADHD symptoms and gambling-related cognition scores. Conclusions : Positive screening results for ADHD occurred frequently in our sample of Pathological Gambling (PG) and Problem Gambling patients and these affected individuals also exhibited lower levels of gambling-related cognitions. This finding may suggest that the gambling behavior in patients with ADHD-PG comorbidity is driven by impulsivity rather than gambling-related cognitions, which has implication on treatment considerations. Further research with a larger sample size is indicated.

Impulsivity in Alcohol-Dependent Patients with and without ADHD: The Role of Atomoxetine.

PubMed

Coppola, Maurizio; Mondola, Raffaella

2018-06-07

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of hyperactivity, inattention, and impulsivity. As shown in the literature, this disorder is frequently associated with alcohol and drug abuse. Patients affected by ADHD show high levels of impulsivity and sensation seeking. These characteristics can significantly increase the risk of alcohol abuse, which is itself a clinical condition associated with high levels of impulsivity. Clinical studies suggest that atomoxetine is effective and safe in patients affected by both ADHD and alcohol dependence; however, information focused specifically on impulsivity is very limited. In an open-label study, we evaluated the difference in impulsivity level between alcohol-dependent patients with and without a diagnosis of ADHD. Furthermore, we hypothesized that, in patients with ADHD, atomoxetine could reduce the impulsivity trait.

Does Comorbid Disruptive Behavior Modify the Effects of Atomoxetine on ADHD Symptoms as Measured by a Continuous Performance Test and a Motion Tracking Device?

PubMed

Wehmeier, Peter M; Kipp, Laura; Banaschewski, Tobias; Dittmann, Ralf W; Schacht, Alexander

2015-07-01

To compare the reduction of ADHD symptoms under atomoxetine in patients with and without comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) using a computer-based continuous performance test (cb-CPT) combined with an infrared motion tracking (MT) device. Secondary analysis of a placebo-controlled study in ADHD patients (6-12 years old) treated with atomoxetine (target dose: 1.2 mg/kg per day). Cb-CPT/MT scores were analyzed using ANCOVA (last observation carried forward [LOCF]). The data (N = 125) suggested a more pronounced atomoxetine effect in the group with comorbid ODD/CD as measured by all cb-CPT/MT parameters except for "normalized variation of reaction time" (nVRT). The results showed that atomoxetine reduced ADHD severity as measured by cb-CPT and MT parameters regardless of whether comorbid ODD/CD was present. The treatment effect of atomoxetine on hyperactivity appears to be more pronounced in the subgroup of patients with comorbid ODD/CD than in the subgroup without this comorbidity. © 2012 SAGE Publications.

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder.

PubMed

Aymamí, N; Jiménez-Murcia, S; Granero, R; Ramos-Quiroga, J A; Fernández-Aranda, F; Claes, L; Sauvaget, A; Grall-Bronnec, M; Gómez-Peña, M; Savvidou, L G; Fagundo, A B; del Pino-Gutierrez, A; Moragas, L; Casas, M; Penelo, E; Menchón, J M

2015-01-01

(1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18-35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.

Reduced emotional empathy in adults with subclinical ADHD: evidence from the empathy and systemizing quotient.

PubMed

Groen, Y; den Heijer, A E; Fuermaier, A B M; Althaus, M; Tucha, O

2018-06-01

Studies in children with ADHD suggest impairments in social cognitive functions, whereas studies in adults with ADHD are scarce and inconclusive. The aim of this study was to investigate the relationship between ADHD traits and self-reported social cognitive style in a sample of adults from the general population. For this purpose, a community sample of 685 adults filled out online self-report questionnaires about ADHD symptoms (ADHD Rating Scale, ARS), social cognitive functioning and friendships. The Empathy Quotient (EQ) with the subscales Cognitive Empathy (CE), Emotional Empathy (EE) and Social Skills (SS), and the Systemizing Quotient (SQ) were included for measuring social cognitive style and the Friendship Questionnaire (FQ) for the quality of friendships. Participants who met the DSM-5 criteria on the ARS ('subclinical ADHD'; n = 56) were compared regarding their social cognitive functioning scores with a control group (n = 56) that was matched for age, sex and student status. With small effect sizes, the subclinical ADHD group showed reduced EE scores on the EQ and a more male social cognitive profile. This result was not influenced by sex or ADHD subtype. This study points to a relationship between traits of ADHD and the emotional aspect of empathy, whereas more complex aspects of empathy were unrelated. These findings should be corroborated in clinical patients with ADHD, employing neuropsychological tests rather than self-report questionnaires.

Familiality of neural preparation and response control in childhood attention deficit-hyperactivity disorder.

PubMed

Albrecht, B; Brandeis, D; Uebel, H; Valko, L; Heinrich, H; Drechsler, R; Heise, A; Müller, U C; Steinhausen, H-C; Rothenberger, A; Banaschewski, T

2013-09-01

Patients with attention deficit-hyperactivity disorder (ADHD) exhibit difficulties in multiple attentional functions. Although high heritability rates suggest a strong genetic impact, aetiological pathways from genes and environmental factors to the ADHD phenotype are not well understood. Tracking the time course of deviant task processing using event-related electrophysiological brain activity should characterize the impact of familiality on the sequence of cognitive functions from preparation to response control in ADHD. Method Preparation and response control were assessed using behavioural and electrophysiological parameters of two versions of a cued continuous performance test with varying attentional load in boys with ADHD combined type (n = 97), their non-affected siblings (n = 27) and control children without a family history of ADHD (n = 43). Children with ADHD and non-affected siblings showed more variable performance and made more omission errors than controls. The preparatory Cue-P3 and contingent negative variation (CNV) following cues were reduced in both ADHD children and their non-affected siblings compared with controls. The NoGo-P3 was diminished in ADHD compared with controls whilst non-affected siblings were located intermediate but did not differ from both other groups. No clear familiality effects were found for the Go-P3. Better task performance was further associated with higher CNV and P3 amplitudes. Impairments in performance and electrophysiological parameters reflecting preparatory processes and to some extend also for inhibitory response control, especially under high attentional load, appeared to be familially driven in ADHD and may thus constitute functionally relevant endophenotypes for the disorder.

Estimated prevalence and incidence of diagnosed ADHD and health care utilization in adults in Sweden - a longitudinal population-based register study.

PubMed

Polyzoi, Maria; Ahnemark, Ewa; Medin, Emma; Ginsberg, Ylva

2018-01-01

Although the worldwide prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults is estimated to be between 2% and 5%, it is considered to be underdiagnosed. This register study explored the prevalence of diagnosed ADHD and incidence of newly diagnosed ADHD in Swedish adults over time, and assessed comorbidities and pharmacologic treatment. National Patient Register data were used to estimate the overall prevalence of adults (≥18 years) with a registered ADHD diagnosis from 2006 to 2011, and the incidence of newly registered diagnoses from 2007 to 2011. Data from the Prescribed Drug Register were used to estimate the mean dose of the most frequently prescribed ADHD medication. The estimated annual prevalence (N=44,364) of diagnosed ADHD increased from 0.58 per 1,000 persons in 2006 to 3.54 per 1,000 persons in 2011. The estimated annual incidence of newly diagnosed ADHD (N=24,921) increased from 0.39 per 1,000 persons to 0.90 per 1,000 persons between 2007 and 2011. At least one comorbidity was diagnosed in 52.6% of adults with ADHD (54.0% of newly diagnosed adults), with anxiety, substance use disorders, and depression being the most common. Among all adults with ADHD, 78.9% (65.7% of newly diagnosed adults) were prescribed ADHD medication and one-third were prescribed more than one add-on medication. Osmotic release oral system methylphenidate was the most commonly used medication. The mean daily dose was 51.5 mg, and was significantly higher in males, patients with substance use disorders, patients with drug holidays, and patients with at least one add-on medication. The most frequent concomitant medications were anxiolytics and hypnotics. In Sweden, the number of adults diagnosed with ADHD increased between 2006 and 2011, and the majority of patients were prescribed ADHD-specific medication. Over one-half of patients had psychiatric comorbidities; one-third were prescribed more than one add-on medication. Consumption of pharmacologic ADHD medication was high in specific patient subpopulations.

Estimated prevalence and incidence of diagnosed ADHD and health care utilization in adults in Sweden – a longitudinal population-based register study

PubMed Central

Polyzoi, Maria; Ahnemark, Ewa; Medin, Emma; Ginsberg, Ylva

2018-01-01

Background Although the worldwide prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults is estimated to be between 2% and 5%, it is considered to be underdiagnosed. This register study explored the prevalence of diagnosed ADHD and incidence of newly diagnosed ADHD in Swedish adults over time, and assessed comorbidities and pharmacologic treatment. Methods National Patient Register data were used to estimate the overall prevalence of adults (≥18 years) with a registered ADHD diagnosis from 2006 to 2011, and the incidence of newly registered diagnoses from 2007 to 2011. Data from the Prescribed Drug Register were used to estimate the mean dose of the most frequently prescribed ADHD medication. Results The estimated annual prevalence (N=44,364) of diagnosed ADHD increased from 0.58 per 1,000 persons in 2006 to 3.54 per 1,000 persons in 2011. The estimated annual incidence of newly diagnosed ADHD (N=24,921) increased from 0.39 per 1,000 persons to 0.90 per 1,000 persons between 2007 and 2011. At least one comorbidity was diagnosed in 52.6% of adults with ADHD (54.0% of newly diagnosed adults), with anxiety, substance use disorders, and depression being the most common. Among all adults with ADHD, 78.9% (65.7% of newly diagnosed adults) were prescribed ADHD medication and one-third were prescribed more than one add-on medication. Osmotic release oral system methylphenidate was the most commonly used medication. The mean daily dose was 51.5 mg, and was significantly higher in males, patients with substance use disorders, patients with drug holidays, and patients with at least one add-on medication. The most frequent concomitant medications were anxiolytics and hypnotics. Conclusion In Sweden, the number of adults diagnosed with ADHD increased between 2006 and 2011, and the majority of patients were prescribed ADHD-specific medication. Over one-half of patients had psychiatric comorbidities; one-third were prescribed more than one add-on medication. Consumption of pharmacologic ADHD medication was high in specific patient subpopulations. PMID:29765219

Understanding the treatment of attention deficit hyperactivity disorder in newly diagnosed adult patients in general practice: a UK database study

PubMed Central

Bushe, Christopher; Wilson, Bernard; Televantou, Foula; Belger, Mark; Watson, Louise

2015-01-01

Background Adult attention deficit hyperactivity disorder (ADHD) has been largely ignored in psychiatric and general practice guidance until recently. Adult ADHD has a high social and medical burden, but health care is not well described in the UK. The main study objective was to evaluate a primary care adult ADHD population in terms of prescribing and health care contact rates. Methods This was a retrospective observational study using data from the Clinical Practice Research Database from January 1, 2002 to July 31, 2011. Adult patients with an incident ADHD diagnosis or ADHD medication were identified as having been free of ADHD medication or diagnoses in the previous 2 years. Patients were followed for 12–24 months after diagnosis. Results Of the 663 patients with ADHD in the cohort, 54.1% were prescribed ADHD medication during the observation period. During the first 6 months, 34.2% of patients initiated methylphenidates and 14.0% atomoxetine. In total, 36.3% patients were referred to secondary care psychiatry during observation, with the remaining population (63.7%) never having a referral. Most of the referrals were before diagnosis in primary care. At the end of the observation period, 16.2% of patients were on antipsychotics, 17.3% hypnotics, and 34.8% antidepressants or anxiolytics; however, some patients appeared to be prescribed antipsychotic or antidepressant medications even if they did not have an observable diagnosis in their records. Health care contact rates (general practitioner or hospital) increased by 39.2% post-diagnosis (incidence rate ratio: 1.39; 95% confidence interval: 1.32, 1.47), which may be related to the need for medication monitoring and titration. Conclusion This study has shown in primary care that there is relatively low use of ADHD medication, low referrals into secondary care, high rates of usage of psychiatric non-ADHD medications for different indications, and an increasing burden in terms of health care contacts in adult ADHD patients post-diagnosis. PMID:27774030

No Clear Association between Impaired Short-Term or Working Memory Storage and Time Reproduction Capacity in Adult ADHD Patients.

PubMed

Mette, Christian; Grabemann, Marco; Zimmermann, Marco; Strunz, Laura; Scherbaum, Norbert; Wiltfang, Jens; Kis, Bernhard

2015-01-01

Altered time reproduction is exhibited by patients with adult attention deficit hyperactivity disorder (ADHD). It remains unclear whether memory capacity influences the ability of adults with ADHD to reproduce time intervals. We conducted a behavioral study on 30 ADHD patients who were medicated with methylphenidate, 29 unmedicated adult ADHD patients and 32 healthy controls (HCs). We assessed time reproduction using six time intervals (1 s, 4 s, 6 s, 10 s, 24 s and 60 s) and assessed memory performance using the Wechsler memory scale. The patients with ADHD exhibited lower memory performance scores than the HCs. No significant differences in the raw scores for any of the time intervals (p > .05), with the exception of the variability at the short time intervals (1 s, 4 s and 6 s) (p < .01), were found between the groups. The overall analyses failed to reveal any significant correlations between time reproduction at any of the time intervals examined in the time reproduction task and working memory performance (p > .05). We detected no findings indicating that working memory might influence time reproduction in adult patients with ADHD. Therefore, further studies concerning time reproduction and memory capacity among adult patients with ADHD must be performed to verify and replicate the present findings.

[Quality of life of patients with attention-deficit/hyperactivity disorder: systematic review of the past 5 years].

PubMed

Velő, Szabina; Keresztény, Ágnes; Szentiványi, Dóra; Balázs, Judit

2013-06-01

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent childhood disorders which continues into adulthood in 30-60%. Many studies are interested in the examination of the impact of ADHD on QoL. The aim of the current study is to provide a systematic review of QoL studies in both children and adults with ADHD published in the past five years focusing on three domains: 1. The impact of ADHD on QoL 2. The impact of ADHD on QoL regarding age 3. The impact of ADHD on QoL regarding gender. A systematic literature search was conducted using the following databases: sciencedirect.com and MEDLINE from 2008 to 2012. The following keywords were searched: quality of life, QoL, attention deficit/hyperactivity disorder, ADHD, gender differences, gender-related, age differences, age-related. We included studies into our review which investigated both adults and children. Papers in English, German and Hungarian were included. Fourteen relevant articles were identified, among them 13 articles were in English, one in German and there were no articles in Hungarian. All of the 14 articles confirmed the negative effects of ADHD on QoL. Four studies dealt with the effects of ADHD on QoL regarding age: one paper claimed that older people with ADHD have more impairments, but have better lefi-expectations than younger people with ADHD, one study claimed that increasing age raises the odds of poor QoL, while two studies did not find any changes on QoL of patients with ADHD regarding age. Three studies dealt with the effect of ADHD on QoL regarding the gender: two studies did not find difference on QoL of patients with ADHD, while one study found that women with ADHD have lower QoL. Based on the studies published in the last 5 years, patients with ADHD have lower QoL than healthy people; moreover, they have lower QoL in many areas than patients with several somatic or other mental illnesses. More studies are needed regarding the effects of ADHD on QoL by age and gender.

Methylphenidate Reduces State Anxiety During a Continuous Performance Test That Distinguishes Adult ADHD Patients From Controls.

PubMed

Bloch, Yuval; Aviram, Shai; Segev, Aviv; Nitzan, Uri; Levkovitz, Yechiel; Braw, Yoram; Mimouni Bloch, Aviva

2017-01-01

We hypothesized that patients with ADHD were typified by distress more than by functional difficulties. Thus, a decline in state anxiety while performing a cognitive task when taking methylphenidate would discriminate between ADHD patients and controls. State anxiety and cognitive performance on a continuous performance test were assessed in ADHD patients and controls with and without taking methylphenidate. State anxiety and cognitive performance improved from baseline in 36 ADHD adults after taking methylphenidate. In 25 controls, cognitive performance improved, but state anxiety did not abate after a recess. In two additional studies, 5 controls were evaluated at baseline and after receiving methylphenidate, and showed improvement in cognitive assessment but not in state anxiety. Five ADHD adults were assessed at baseline and after a recess, and showed no improvement. Our results support the hypothesis that adult ADHD patients are characterized by distress and the relief of this distress under effective therapy as expressed by a decline in state anxiety while they perform a cognitive task.

Managing Complexity: Exploring Decision Making on Medication by Young Adults with ADHD.

PubMed

Druedahl, Louise C; Kälvemark Sporrong, Sofia

2018-04-19

Attention-deficit hyperactivity disorder (ADHD) causes difficulties with hyperactivity, impulsivity and inattention. Treatment of ADHD includes both medication and non-pharmacological options. Knowledge of treatment preferences by young adults with ADHD is sparse. The objective of this study was to explore the beliefs and experiences of young adults with ADHD related to their medication treatment decisions. Data were collected in Denmark in 2016 through a focus group and individual in-depth interviews. Conventional content analysis was used. Ten young adults with ADHD (22-to 29-year-old) participated. Three major themes were identified: (1) the patient’s right to choose concerning ADHD medicine; (2) the patient’s decision of whether or not to treat ADHD with medication; and (3) factors affecting the patient’s decision on whether to take ADHD medication or not. The latter theme contained 15 factors, which were distributed across three levels: individual, between-individuals, and societal. The dominant factors were increasing quality of life and improving oneself e.g., improving social skills. For counselling at the pharmacy and by prescribers, it is important to be aware of the different factors that affect young adult patients’ decisions on whether to take ADHD medication or not. This knowledge will aid to understand reasons for non-adherence and to determine appropriate treatment for the individual patient.

ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate.

PubMed

Rheims, Sylvain; Herbillon, Vania; Villeneuve, Nathalie; Auvin, Stéphane; Napuri, Silvia; Cances, Claude; Berquin, Patrick; Castelneau, Pierre; Nguyen The Tich, Sylvie; Villega, Frédéric; Isnard, Hervé; Nabbout, Rima; Gaillard, Ségolène; Mercier, Catherine; Kassai, Behrouz; Arzimanoglou, Alexis

2016-07-01

Attention-deficit/hyperactivity disorder (ADHD) is commonly observed in children with epilepsy. However, factors associated with the development of ADHD and which might help to guide its therapeutic management, remain an issue of debate. We conducted a multicenter prospective observational study that included children, aged 6-16 years, with both epilepsy and ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. After inclusion, patients entered a 12-16 week follow-up period during which they were either treated with methylphenidate or they did not receive specific ADHD treatment. ADHD was evaluated with the ADHD Rating Scale-IV. One hundred sixty-seven patients were included, of which 91 were seizure-free during the preinclusion baseline period. At inclusion, the ADHD Rating Scale-IV total score was 30.4 ± (standard deviation) 9.2, the inattentive subscore was 17.3 ± 4.4, and the hyperactive subscore was 13.2 ± 6.6. We did not detect any difference of ADHD Rating Scale-IV scores across patients' age or gender, age at epilepsy onset, epilepsy syndrome, seizure frequency, or number of ongoing antiepileptic drugs. Methylphenidate was initiated in 61 patients, including 55 in whom a follow-up evaluation was available. At the last follow-up, 41 patients (75%) treated with methylphenidate and 39 (42%) of those who did not received ADHD therapy demonstrated ≥25% decrease of ADHD Rating Scale-IV total score (p < 0.001). Response to methylphenidate was greater in girls but was not influenced by any epilepsy-related variables. We did not detect any epilepsy-related factor associated with the severity of ADHD. Twenty-five percent of patients did not respond to methylphenidate. A better understanding of the pathologic process that underlies ADHD development in childhood epilepsy might be required to improve therapeutic strategies. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Association analysis of norepinephrine transporter polymorphisms and methylphenidate response in ADHD patients.

PubMed

Angyal, Nora; Horvath, Erzsebet Zsofia; Tarnok, Zsanett; Richman, Mara J; Bognar, Emese; Lakatos, Krisztina; Sasvari-Szekely, Maria; Nemoda, Zsofia

2018-06-08

Methylphenidate (MPH) is the most frequently prescribed drug in Attention Deficit Hyperactivity Disorder (ADHD). Hitherto mostly the dopamine transporter gene has been studied in MPH-response and only a few studies analyzed the norepinephrine transporter (NET, SLC6A2) gene, although MPH is a potent inhibitor of both dopamine and norepinephrine transporters. We aimed to analyze this monoamine transporter gene in relation to ADHD per se and MPH-response in particular to gain further knowledge in ADHD pharmacogenetics using a Caucasian sample. Six single nucleotide polymorphisms (rs28386840, rs2242446, rs3785143, rs3785157, rs5569, rs7194256 SNP) were studied across the NET gene in 163 ADHD children (age: 9.3±2.6; 86.5% male) using ADHD-RS hyperactivity-impulsivity and inattention scales. For case-control analysis 486 control subjects were also genotyped. At the MPH-response analysis responders had minimum 25% decrease of ADHD-RS total score after 2months of treatment, and chi-square test compared 90 responders and 32 non-responders, whereas ANOVA was used to assess symptom improvement after the first month among the 122 ADHD patients. The classical case-control analysis did not yield any association with ADHD diagnosis, which was supported by meta-analysis conducted on the available genetic data (combining previously published and the present studies). On the other hand, the intronic rs3785143 showed nominal association with inattention symptoms (p=0.01). The haplotype analysis supported this association, and indicated the importance of the first haploblock encompassing the intronic and 2 promoter SNPs. With MPH-response only the promoter rs28386840 showed nominal association: Those with at least one T-allele were overrepresented in the responder group (42% vs 19%, p=0.08), and they had better improvement on the hyperactivity-impulsivity scale compared to the AA genotype (p=0.04). Although none of our single SNP findings remained significant after correcting for multiple testing, our results from the MPH-response analysis indicate the potential importance of promoter variants in the NET gene. Copyright © 2018 Elsevier Inc. All rights reserved.

Lifespan persistence of ADHD: the life transition model and its application.

PubMed

Turgay, Atilla; Goodman, David W; Asherson, Philip; Lasser, Robert A; Babcock, Thomas F; Pucci, Michael L; Barkley, Russell

2012-02-01

The understanding that attention-deficit/hyperactivity disorder (ADHD) often persists throughout life has heightened interest of patients, families, advocates, and professionals in a longitudinal approach to management. Such an approach must recognize and address known patient- and systems-based challenges of long-term mental health treatment, shifting of clinical presentations of ADHD, and commonality of psychiatric comorbidity with ADHD. The ADHD Life Transition Model is a step toward developing criteria to optimize recognition and clinical management of ADHD (eg, response, remission) across an individual's lifespan and across diverse medical subspecialties. To support therapeutic efficiency and adaptability, our proposed model highlights periods when external resources for managing ADHD are reduced, cognitive and behavioral stressors are increased, and individuals may be reevaluating how they perceive, accept, and adhere to ADHD treatment. Such a model aims to support the clinical community by placing in context new findings, which suggest that the prevention of adult psychopathology in individuals with pediatric ADHD may be possible. The ADHD Life Transition Model seeks to improve care for individuals with ADHD by (1) underscoring that ADHD persists beyond childhood in at least two-thirds of patients, (2) raising awareness of the need to approach ADHD from a chronic illness standpoint, and (3) increasing mental health professionals' diligence in symptom recognition and management of ADHD across developmental phases from childhood through adulthood. © Copyright 2012 Physicians Postgraduate Press, Inc.

Connectomic disturbances in attention-deficit/hyperactivity disorder: a whole-brain tractography analysis.

PubMed

Hong, Soon-Beom; Zalesky, Andrew; Fornito, Alex; Park, Subin; Yang, Young-Hui; Park, Min-Hyeon; Song, In-Chan; Sohn, Chul-Ho; Shin, Min-Sup; Kim, Bung-Nyun; Cho, Soo-Churl; Han, Doug Hyun; Cheong, Jae Hoon; Kim, Jae-Won

2014-10-15

Few studies have sought to identify, in a regionally unbiased way, the precise cortical and subcortical regions that are affected by white matter abnormalities in attention-deficit/hyperactivity disorder (ADHD). This study aimed to derive a comprehensive, whole-brain characterization of connectomic disturbances in ADHD. Using diffusion tensor imaging, whole-brain tractography, and an imaging connectomics approach, we characterized altered white matter connectivity in 71 children and adolescents with ADHD compared with 26 healthy control subjects. White matter differences were further delineated between patients with (n = 40) and without (n = 26) the predominantly hyperactive/impulsive subtype of ADHD. A significant network comprising 25 distinct fiber bundles linking 23 different brain regions spanning frontal, striatal, and cerebellar brain regions showed altered white matter structure in ADHD patients (p < .05, family-wise error-corrected). Moreover, fractional anisotropy in some of these fiber bundles correlated with attentional disturbances. Attention-deficit/hyperactivity disorder subtypes were differentiated by a right-lateralized network (p < .05, family-wise error-corrected) predominantly linking frontal, cingulate, and supplementary motor areas. Fractional anisotropy in this network was also correlated with continuous performance test scores. Using an unbiased, whole-brain, data-driven approach, we demonstrated abnormal white matter connectivity in ADHD. The correlations observed with measures of attentional performance underscore the functional importance of these connectomic disturbances for the clinical phenotype of ADHD. A distributed pattern of white matter microstructural integrity separately involving frontal, striatal, and cerebellar brain regions, rather than direct frontostriatal connectivity, appears to be disrupted in children and adolescents with ADHD. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Psychotic Disorders Comorbid With Attention-Deficit Hyperactivity Disorder: An Important Knowledge Gap

PubMed Central

Levy, Emmanuelle; Traicu, Alexandru; Iyer, Srividya; Malla, Ashok; Joober, Ridha

2015-01-01

Psychotic disorders (PDs) and attention-deficit hyperactivity disorder (ADHD) are frequently comorbid. Clinicians are often reticent to treat ADHD in patients with psychosis, fearing that psychostimulants will worsen psychotic symptoms. Advances in neurobiology have challenged the simplistic dichotomy where PD is considered a disorder of high dopamine (DA), treated by DA antagonists, and ADHD a disorder of low DA, treated by DA agonists. In our paper, we review the literature on comorbid ADHD and psychosis. Treating ADHD with psychostimulants may be considered in patients with PD who have been stabilized with antipsychotics (APs). Not treating ADHD may have consequences because ADHD may predispose patients to drug abuse, which further increases the risk of PD. Nevertheless, more systematic studies are needed as there remains some uncertainty on the combined use of APs and psychostimulants in comorbid PD and ADHD. PMID:25886680

Neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD)--a controlled multicenter study of a non-pharmacological treatment approach.

PubMed

Holtmann, Martin; Pniewski, Benjamin; Wachtlin, Daniel; Wörz, Sonja; Strehl, Ute

2014-08-13

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and has often a chronic course persisting into adulthood. However, up to 30% of children treated with stimulants either fail to show an improvement or suffer adverse side effects, including decreased appetite, insomnia and irritability and there is no evidence of long term efficacy of stimulants for ADHD. A series of studies has shown that neurofeedback is an effective additional or alternative treatment for children with ADHD, leading to e.g. significant and stable improvement in behavior, attention and IQ. Significant treatment effects of neurofeedback have also been verified in meta-analyses. Most of the trials, however, have been criticized for methodological difficulties, particularly lacking appropriate control conditions and number of patients included. This randomized study examines the efficacy of slow cortical potentials (SCP) -neurofeedback, controlling unspecific effects of the setting by comparing two active treatment modalities. A total of 144 patients with ADHD, older than six and younger than ten years, in some cases with additional pharmacological treatment, are included in this trial. In five trial centres patients are treated either with SCP-feedback or electromyographic (EMG) -feedback in 25 sessions within 3 months. A comprehensive test battery is conducted before and after treatment and at follow-up 6 month later, to assess core symptoms of ADHD, general psychopathology, attentional performance, comorbid symptoms, intelligence, quality of life and cortical arousal. The efficacy of SCP-feedback training for children with ADHD is evaluated in this randomized controlled study. In addition to behavior ratings and psychometric tests neurophysiological parameters serve as dependent variables. Further, the choice of EMG-biofeedback as an active control condition is debated. Current Controlled Trials ISRCTN76187185. Registered 5 February 2009.

Difference between healthy children and ADHD based on wavelet spectral analysis of nuclear magnetic resonance images

NASA Astrophysics Data System (ADS)

González Gómez, Dulce I.; Moreno Barbosa, E.; Martínez Hernández, Mario Iván; Ramos Méndez, José; Hidalgo Tobón, Silvia; Dies Suarez, Pilar; Barragán Pérez, Eduardo; De Celis Alonso, Benito

2014-11-01

The main goal of this project was to create a computer algorithm based on wavelet analysis of region of homogeneity images obtained during resting state studies. Ideally it would automatically diagnose ADHD. Because the cerebellum is an area known to be affected by ADHD, this study specifically analysed this region. Male right handed volunteers (infants with ages between 7 and 11 years old) were studied and compared with age matched controls. Statistical differences between the values of the absolute integrated wavelet spectrum were found and showed significant differences (p<0.0015) between groups. This difference might help in the future to distinguish healthy from ADHD patients and therefore diagnose ADHD. Even if results were statistically significant, the small size of the sample limits the applicability of this methods as it is presented here, and further work with larger samples and using freely available datasets must be done.

Questioning the Specificity of ASRS-v1.1 to Accurately Detect ADHD in Substance Abusing Populations

ERIC Educational Resources Information Center

Chiasson, Jean-Pierre; Stavro, Katherine; Rizkallah, Elie; Lapierre, Luc; Dussault, Maxime; Legault, Louis; Potvin, Stephane

2012-01-01

Objective: To assess the specificity of the Adult ADHD Self-Report Scale (ASRS-v1.1) in detecting ADHD among individuals with substance use disorders (SUDs). Method: A chart review of 183 SUD patients was conducted. Patients were screened for ADHD with the ASRS-v1.1 and were later assessed by a psychiatrist specialized in ADHD. Results: Among SUD…

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder

PubMed Central

Aymamí, N.; Jiménez-Murcia, S.; Granero, R.; Ramos-Quiroga, J. A.; Fernández-Aranda, F.; Claes, L.; Sauvaget, A.; Grall-Bronnec, M.; Gómez-Peña, M.; Savvidou, L. G.; Fagundo, A. B.; del Pino-Gutierrez, A.; Moragas, L.; Casas, M.; Penelo, E.; Menchón, J. M.

2015-01-01

Objectives. (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. Method. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Results. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18–35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. Conclusion. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits. PMID:26229967

Heavy Metals' Effect on Susceptibility to Attention-Deficit/Hyperactivity Disorder: Implication of Lead, Cadmium, and Antimony.

PubMed

Lee, Min-Jing; Chou, Miao-Chun; Chou, Wen-Jiun; Huang, Chien-Wei; Kuo, Ho-Chang; Lee, Sheng-Yu; Wang, Liang-Jen

2018-06-10

Background: Heavy metals are known to be harmful for neurodevelopment and they may correlate to attention deficit/hyperactivity disorder (ADHD). In this study, we aim to explore the relationships between multiple heavy metals (manganese, lead, cadmium, mercury, antimony, and bismuth), neurocognitive function, and ADHD symptoms. Methods: We recruited 29 patients with ADHD inattentive type (ADHD-I), 47 patients with ADHD hyperactivity/impulsivity type (ADHD-H/I), and 46 healthy control children. Urine samples were obtained to measure the levels of the aforementioned heavy metals in each child. Participants’ cognitive function and clinical symptoms were assessed, respectively. Results: We found ADHD-H/I patients demonstrated the highest antimony levels ( p = 0.028), and ADHD-I patients demonstrated the highest cadmium levels ( p = 0.034). Antimony levels were positively correlated with the severity of ADHD symptoms that were rated by teachers, and cadmium levels were negatively correlated with the Full Scale Intelligence Quotient. Lead levels were negatively correlated with most indices of the Wechsler Intelligence Scale for Children⁻Fourth Edition (WISC-IV), but positively correlated with inattention and hyperactivity/impulsivity symptoms ( p < 0.05). Conclusion: Lead, cadmium and antimony were associated with susceptibility to ADHD and symptom severity in school-age children. Eliminating exposure to heavy metals may help to prevent neurodevelopmental disorders in children.

Associations of sleep disturbance with ADHD: implications for treatment.

PubMed

Hvolby, Allan

2015-03-01

Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also 'paradoxically' calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.

Estimation of utilities in attention-deficit hyperactivity disorder for economic evaluations.

PubMed

Lloyd, Andrew; Hodgkins, Paul; Sasane, Rahul; Akehurst, Ron; Sonuga-Barke, Edmund J S; Fitzgerald, Patrick; Nixon, Annabel; Erder, Haim; Brazier, John

2011-01-01

Attempts to estimate the cost effectiveness of attention-deficit hyperactivity disorder (ADHD) treatments in the past have relied on classifying ADHD patients as responders or non-responders to treatment. Responder status has been associated with a small gain in health-related quality of life (HR-QOL) [or utility, as measured using the generic QOL measure EQ-5D] of 0.06 (on a scale from 0 being dead to 1.0 being full health). The goal of the present study was to develop and validate several ADHD-related health states, and to estimate utility values measured amongst the general public for those states and to re-estimate utility values associated with responder status. Detailed qualitative interview data were collected from 20 young ADHD patients to characterize their HR-QOL. In addition, item-by-item clinical and HR-QOL data from a clinical trial were used to define and describe four health states (normal; borderline to mildly ill; moderately to markedly ill; and severely ill). ADHD experts assessed the content validity of the descriptions. The states were rated by 100 members of the UK general public using the time trade-off (TTO) interview and visual analog scale. Statistical mapping was also undertaken to estimate Clinical Global Impression-Improvement (CGI-I) utilities (i.e. response status) from Clinical Global Impression-Severity (CGI-S) defined states. The mapping work estimated changes in utilities from study baseline to last visit for patients with a CGI-I score of ≤ 2 or ≤ 3. The validity of the four health states developed in this study was supported by in-depth interviews with ADHD experts and patients, and clinical trial data. TTO-derived utilities for the four health states ranged from 0.839 (CGI-S state 'normal') to 0.444 (CGI-S state 'severely ill'). From the mapping work, the change in utility for treatment responders was 0.19 for patients with a CGI-I score of ≤ 2 and 0.15 for patients with a CGI-I score of ≤ 3. The present study provides utilities for different severity levels of ADHD estimated in a TTO study. This approach provides a more granular assessment of the impact of ADHD on HR-QOL than binary approaches employed in previous economic analyses. Change in utility for responders and non-responders at different levels of CGI-I was estimated, and thus these utilities may be used to compare health gains of different ADHD interventions.

Neurofibromatosis type 1 and attention deficit hyperactivity disorder: a case study and literature review

PubMed Central

Miguel, Carmen Sílvia; Chaim-Avancini, Tiffany M; Silva, Maria Aparecida; Louzã, Mario Rodrigues

2015-01-01

Background The cognitive profile of children with neurofibromatosis type 1 (NF1) and attention deficit hyperactivity disorder (ADHD) has been well characterized, but few studies have evaluated the cognitive abilities of adults with NF1 and ADHD. Objectives We investigated 1) the cognitive profile of an adult patient with NF1 and inattention problems, 2) changes in his cognition after 14 months of follow-up, and 3) whether the patient exhibited comorbid NF1 and ADHD or secondary ADHD-like symptoms. Methods We administered neuropsychological tests of executive function, attention, verbal and visual memory, visuospatial function, and language during two evaluations separated by 14 months. Results We found no changes in sustained attention, language, or verbal memory. Visual memory, verbal learning, selective attention inhibitory control, and problem solving declined over time, whereas visual search, psychomotor speed, visuospatial function, and mental flexibility improved. Conclusion Our patient exhibited a cognitive profile characteristic of both NF1 and ADHD, leading to the hypothesis that the patient had comorbid ADHD instead of secondary ADHD-like symptoms. More studies are necessary to characterize the cognition of patients with NF1 and ADHD. PMID:25848279

Clinical Impact of Epileptiform Discharge in Children With Attention-Deficit/Hyperactivity Disorder (ADHD).

PubMed

Lee, Eun Hye; Choi, Yong Sung; Yoon, Hoi Soo; Bahn, Geon Ho

2016-04-01

The aim of this study was to investigate the prevalence and clinical significance of epileptiform discharges in patients with attention-deficit/hyperactivity disorder (ADHD). The authors retrospectively reviewed 180 children who were diagnosed with ADHD and had an electroencephalography (EEG) recording. Epileptiform discharges were found in 29 (16.1%) of 180 patients with ADHD. Of these, 15 (8.3%) had generalized epileptiform discharges and 14 (7.7%) had focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the frontal (5/14) and rolandic area (5/14). Among the 29 patients with epileptiform discharges and ADHD, 5 patients had previous history of epilepsy and 4 patients developed epilepsy later, whereas none of the normal EEG group developed epilepsy. The authors suggest that interictal epileptiform discharges appear to be associated with seizure occurrence in children with ADHD and might reflect maturational pathophysiology overlapping with epilepsy. © The Author(s) 2015.

Clinical Management of ADHD in a Family Medicine Residency Program: Comparison with AAP Guidelines.

PubMed

Skelley, Jessica W; Carpenter, P Chase; Morehead, M Shawn; Murphy, Patrick L

2016-06-01

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Research has shown that even with the growing incidence of children diagnosed as having ADHD, physicians may find providing optimal care to these patients challenging. Our objective was to contrast existing clinical management of ADHD in a family medicine setting with published American Academy of Pediatrics guidelines and review the literature pertinent to differences. A report was generated for all visits with "ADHD" or "ADD" (attention-deficit disorder) as a current or past medical problem that had been addressed at the family medicine clinic from July 2012 to June 2014. A total of 60 pediatric patients were identified. A retrospective chart review of clinical practice and management patterns for these patients was completed using a standardized data collection form based on the 2011 ADHD treatment guidelines set by the American Academy of Pediatrics. Fifty-seven (95%) patients had documentation of at least one core symptom of ADHD, and 27 (45%) patients had documentation of these symptoms in more than one setting (clinic/school/home). Only 30 (50%) patients were assessed at the initial ADHD visit for coexisting conditions. Coexisting conditions were found to be present in 20 (33.3%) patients. Of these 20 patients, coexisting conditions were not addressed during the visit in 12 (60%) patients before drug therapy for ADHD was initially prescribed. Behavioral therapy was initiated as first-line monotherapy in one of the nine preschool-age patients (4-5 years old). Fifty-two (86.7%) patients received a preferred initial medication as identified by guidelines, and 41 (78.8%) of those patients received an appropriate initial dose. Fifty-one (85%) patients were assessed for improvement of symptoms, and 39 (65%) were assessed for adverse events. Of 62 documented medication adjustments, 54 (87.1%) adjustments coincided with current practice guidelines. Sixteen (26.7%) patients were referred to mental health specialists. This retrospective review identified areas of strength and weakness for attending physicians and medical residents in the diagnosis, evaluation, and treatment of children with ADHD. A significant need was identified for more physician-focused education on the evaluation of coexisting conditions and long-term management associated with ADHD therapy. Further training in the initiation of behavioral therapy as a first-line treatment above drug therapy and proper medication selection in children aged 4 to 5 years also are recommended.

Association between altered lipid profiles and attention deficit hyperactivity disorder in boys.

PubMed

Avcil, Sibelnur

2018-04-24

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, which is multifactorial, complex, and seen most commonly in childhood. The aim of this study was to examine the hypothesis that altered serum lipid profiles are associated with ADHD. The study inluded 32 boys diagnosed with ADHD according to DSM-IV-R criteria and a control group of 29 healthy subjects. All patients were assessed with The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Turgay DSM-IV-based Disruptive Behavior Disorders Child and Adolescent Rating and Screening Scale, the Conners Parent Rating Scale-Revised Long Form, and the Conners Teacher Rating Scale. Measurements were taken of fasting plasma total cholesterol (T-Chol), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and 1-day food intake levels, and the groups were compared. The mean TC, LDL, and HDL levels were significantly lower in the ADHD group than the control group (p = .005, p < .001, p = .002, respectively). There was no significant difference between the groups' TG levels (p = .295). No significant differences were determined between the combined-type ADHD patients and the predominantly inattentive subtype of ADHD in respect to the lipid profile. The results of this study add to the growing body of evidence indicating an association between serum cholesterol and ADHD in boys. Further genetic and molecular studies are required to elucidate the biochemical mechanisms underlying this relationship.

Transcranial direct current stimulation improves clinical symptoms in adolescents with attention deficit hyperactivity disorder.

PubMed

Soff, Cornelia; Sotnikova, Anna; Christiansen, Hanna; Becker, Katja; Siniatchkin, Michael

2017-01-01

Anodal transcranial direct current stimulation (tDCS) of the prefrontal cortex has repeatedly been shown to improve working memory. As patients with attention deficit hyperactivity disorder (ADHD) are characterized by both underactivation of the prefrontal cortex and deficits in working memory that correlate with clinical symptoms, it is hypothesized that the modulation of prefrontal activity with tDCS in patients with ADHD increases performance in working memory and reduces symptoms of ADHD. To test this hypothesis, fifteen adolescents with ADHD (12-16 years old, three girls and 12 boys) were treated according to the randomized, double-blinded, sham-controlled, crossover design with either 1 mA anodal tDCS over the left dorsolateral prefrontal cortex or with the sham protocol 5 days each with a 2 weeks pause between these conditions. Anodal tDCS caused a significant reduction in clinical symptoms of inattention and impulsivity in adolescents with ADHD compared to sham stimulation. The clinical effects were supported by a significant reduction in inattention and hyperactivity in a standardized working memory test (QbTest). The described effects were more pronounced 7 days after the end of stimulation, a fact which emphasizes the long-lasting clinical and neuropsychological changes after tDCS. This study provides the first evidence that tDCS may reduce symptoms of ADHD and improve neuropsychological functioning in adolescents and points on the potential of tDCS as a form of treatment for ADHD.

Hippocampus and amygdala morphology in adults with attention-deficit hyperactivity disorder

PubMed Central

Perlov, Evgeniy; Philipsen, Alexandra; Tebartz van Elst, Ludger; Ebert, Dieter; Henning, Juergen; Maier, Simon; Bubl, Emanuel; Hesslinger, Bernd

2008-01-01

Objective Attention-deficit hyperactivity disorder (ADHD) in adulthood is a serious health problem with a prevalence of up to 4%. Limbic structures have been implicated in the genesis of ADHD; it has been suggested that they mediate mood and cognitive disturbances in affected individuals. Recently, a large study involving children and adolescents with ADHD reported bilateral enlargement of the hippocampus and indirect evidence of amygdala volume loss in this patient sample. We sought to test the hypothesis that, like in pediatric patients, there might be hippocampus and amygdala volume abnormalities in adult patients with ADHD. Methods We studied 27 adult patients with ADHD and 27 group-matched healthy volunteers using a 1.5 T magnetic resonance imaging scanner. We manually obtained morphometric measurements of the regions mentioned. Results In contrast to previous findings in children and adolescents, we found no significant differences in hippocampus and amygdala volumes among adults with and without the disorder. Conclusion Findings of hippocampus enlargement and amygdala volume loss are not very stable across different samples of patients with ADHD. Contradictory findings may be related to the different locations of alterations along the complex circuits responsible for the different symptoms of ADHD. Further studies involving larger samples of adult patients with ADHD and using multimodal designs are needed. PMID:18982173

Disorder-specific functional abnormalities during temporal discounting in youth with Attention Deficit Hyperactivity Disorder (ADHD), Autism and comorbid ADHD and Autism.

PubMed

Chantiluke, Kaylita; Christakou, Anastasia; Murphy, Clodagh M; Giampietro, Vincent; Daly, Eileen M; Ecker, Christina; Brammer, Michael; Murphy, Declan G; Rubia, Katya

2014-08-30

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are often comorbid and share cognitive abnormalities in temporal foresight. A key question is whether shared cognitive phenotypes are based on common or different underlying pathophysiologies and whether comorbid patients have additive neurofunctional deficits, resemble one of the disorders or have a different pathophysiology. We compared age- and IQ-matched boys with non-comorbid ADHD (18), non-comorbid ASD (15), comorbid ADHD and ASD (13) and healthy controls (18) using functional magnetic resonance imaging (fMRI) during a temporal discounting task. Only the ASD and the comorbid groups discounted delayed rewards more steeply. The fMRI data showed both shared and disorder-specific abnormalities in the three groups relative to controls in their brain-behaviour associations. The comorbid group showed both unique and more severe brain-discounting associations than controls and the non-comorbid patient groups in temporal discounting areas of ventromedial and lateral prefrontal cortex, ventral striatum and anterior cingulate, suggesting that comorbidity is neither an endophenocopy of the two pure disorders nor an additive pathology. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

A systematic review and meta-analysis of tract-based spatial statistics studies regarding attention-deficit/hyperactivity disorder.

PubMed

Chen, Lizhou; Hu, Xinyu; Ouyang, Luo; He, Ning; Liao, Yi; Liu, Qi; Zhou, Ming; Wu, Min; Huang, Xiaoqi; Gong, Qiyong

2016-09-01

Diffusion tensor imaging (DTI) studies that use tract-based spatial statistics (TBSS) have demonstrated the microstructural abnormalities of white matter (WM) in patients with attention-deficit/hyperactivity disorder (ADHD); however, robust conclusions have not yet been drawn. The present study integrated the findings of previous TBSS studies to determine the most consistent WM alterations in ADHD via a narrative review and meta-analysis. The literature search was conducted through October 2015 to identify TBSS studies that compared fractional anisotropy (FA) between ADHD patients and healthy controls. FA reductions were identified in the splenium of the corpus callosum (CC) that extended to the right cingulum, right sagittal stratum, and left tapetum. The first two clusters retained significance in the sensitivity analysis and in all subgroup analyses. The FA reduction in the CC splenium was negatively associated with the mean age of the ADHD group. We hypothesize that, in addition to the fronto-striatal-cerebellar circuit, the disturbed WM matter tracts that integrate the bilateral hemispheres and posterior-brain circuitries play a crucial role in the pathophysiology of ADHD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Variability in ADHD care in community-based pediatrics.

PubMed

Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua

2014-12-01

Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined. Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatrician-delivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change. Copyright © 2014 by the American Academy of Pediatrics.

Methylphenidate does not improve interference control during a working memory task in young patients with attention-deficit hyperactivity disorder.

PubMed

Prehn-Kristensen, Alexander; Krauel, Kerstin; Hinrichs, Hermann; Fischer, Jochen; Malecki, Ulrike; Schuetze, Hartmut; Wolff, Stephan; Jansen, Olav; Duezel, Emrah; Baving, Lioba

2011-05-04

Patients with attention-deficit/hyperactivity disorder (ADHD) show deficits in working memory (WM) which may be related to prefrontal dysfunction. Methylphenidate (MPH) can restore WM deficits in ADHD by enhancing prefrontal activity. At the same time, changes in striatal activation could cause ADHD patients to be more interference-sensitive during working memory tasks. However, it is unclear whether MPH reduces WM distractibility in ADHD. In this fMRI study, 12 ADHD patients and 12 healthy controls participated on two separate days in a delayed-match-to-sample test. During the delay interval, a distractor stimulus was presented in half of the trials. Children and adolescents with ADHD received MPH only on one of the two sessions. Behavioral data analyses revealed that MPH normalized WM in ADHD. However, MPH did not improve WM performance when a distractor was presented during the delay interval. Functional images showed that MPH enhanced prefrontal activity during the delay in ADHD patients when no distractor was present. If the delay was interrupted by a distractor, only healthy controls showed activation of the caudate. In patients with ADHD, however, in line with behavioral data, MPH did not enhance caudate activity. In healthy youth, caudate activity is involved in interference control allowing the successful maintenance of information in working memory even in the presence of distraction. Our findings suggest that interference control, linked to caudate activity, is not adequately enhanced by MPH in ADHD. Copyright © 2011 Elsevier B.V. All rights reserved.

Concussion History in Adolescent Athletes with Attention-Deficit Hyperactivity Disorder.

PubMed

Iverson, Grant L; Atkins, Joseph E; Zafonte, Ross; Berkner, Paul D

2016-12-01

Little is known about the rate of concussions in adolescents with attention-deficit hyperactivity disorder (ADHD). We hypothesized that high school athletes with ADHD would report a greater history of concussion than students without ADHD. A total of 6529 adolescent and young adult student athletes, between the ages of 13 and 19 years (mean, 15.9; standard deviation, 1.3), completed a preseason health survey in 2010. Of those with ADHD, 26.1% reported a history of one or more concussions, compared to 17.1% of those without ADHD (p<0.00001; odds ratio [OR], 1.71). Stratified by gender, 27.0% of boys with ADHD reported a history of one or more concussions, compared to 20.0% of boys without ADHD (p<0.004; OR, 1.48), and 23.6% of girls with ADHD reported a history of one or more concussions, compared to 13.6% of girls without ADHD (p<0.003; OR, 1.97). Of those with ADHD, 9.8% reported a history of two or more concussions, compared to 5.5% of those without ADHD (p<0.0003; OR, 1.87). Stratified by gender, 10.0% of boys with ADHD reported a history of two or more concussions, compared to 6.7% of boys without ADHD (p<0.033; OR, 1.54), and 9.1% of girls with ADHD reported a history of two or more concussions, compared to 3.8% of girls without ADHD (p<0.006; OR, 2.51). In this large-scale, retrospective survey study, boys and girls with ADHD were significantly more likely to report a history of concussion. Additional research is needed to determine whether students with ADHD are more susceptible to injury (i.e., have a lower threshold) or have different recovery trajectories.

Are treatment results for eating disorders affected by ADHD symptoms? A one-year follow-up of adult females.

PubMed

Svedlund, Nils Erik; Norring, Claes; Ginsberg, Ylva; von Hausswolff-Juhlin, Yvonne

2018-05-02

To explore the influence of self-reported Attention Deficit Hyperactivity Disorder (ADHD) symptoms on recovery rate at 1-year follow-up in an unselected group of patients in a specialized eating disorder (ED) clinic. Four hundred forty-three adult females with an ED were assessed with the ADHD Self-Report Scale for Adults (ASRS-screener), and for demographic variables and ED symptoms. Recovery was registered at 1-year follow-up. A high degree of ADHD symptoms at baseline was predictive for nonrecovery of ED at 1-year follow-up in patients with loss of control over eating, bingeing, or purging. The presence of inattentive ADHD symptoms was stronger associated with nonrecovery than hyperactive/impulsive symptoms. A high degree of ADHD symptoms may have a negative impact on recovery in ED. Screening/diagnostic evaluation of ADHD in all loss of control over eating/bingeing/purging ED patients and studies of the effect of implementing ADHD-treatment strategies in this patient group are recommended. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

The effect of methylphenidate on anxiety and depression symptoms in patients with Asperger syndrome and comorbid attention deficit/hyperactivity disorder.

PubMed

Golubchik, Pavel; Rapaport, Michal; Weizman, Abraham

2017-09-01

The objective of this study was to assess the response of anxiety and depression symptoms to methylphenidate (MPH) treatment in patients with Asperger syndrome (AS) combined with attention deficit/hyperactivity disorder (ADHD). A group of 12 patients with AS/ADHD, aged 8-18 years, received 12 weeks of MPH treatment. The severities of ADHD, anxiety, and depression symptoms were assessed by means of the ADHD Rating Scale (ADHD-RS), Screen for Child Anxiety Related Emotional Disorders, and the Children's Depression Inventory. The severity of ADHD and depression symptoms was reduced significantly (P<0.0003 and P=0.046, respectively). No improvement in total anxiety symptoms was found, but a significant reduction was obtained in the school-related subscale of the Screen for Child Anxiety Related Emotional Disorders (P=0.0054). A positive correlation was found between the reductions in ADHD-RS and Children's Depression Inventory scores (r=0.59, P=0.039). MPH treatment may be safe, tolerable, and effective in alleviating depression and school-related anxiety symptoms in patients with AS and ADHD.

Towards Precision Addiction Treatment: New Findings in Co-morbid Substance Use and Attention-Deficit Hyperactivity Disorders.

PubMed

Luo, Sean X; Levin, Frances R

2017-03-01

Attention-deficit hyperactivity disorder (ADHD) and substance use disorders (SUDs) may have common etiologies. ADHD is more prevalent in patients with substance use disorders, and this pattern is consistent across different substances of abuse. Individuals with SUDs and ADHD exhibit significant variations in their clinical presentations. The developmental trajectory of ADHD to SUDs is complex: ADHD symptoms appear first in some patients but not in others. Many patients present with a heterogeneous collection of psychiatric and substance use co-morbidities, and these symptoms change over time. ADHD symptom severity is also highly variable, and more severe ADHD symptoms worsen co-morbid SUDs and complicate treatment. New longitudinal studies with innovative methods in high-risk populations and in community-based samples may clarify issues related to patient-treatment matching. When closely monitored, psychostimulant and other adjunct medications can be safely used to treat ADHD in this population, and such treatment may also improve outcome of SUDs. In particular, emerging evidence suggests individual-level tailoring ("precision medicine") approaches may represent a key pathway to improve clinical outcome.

Towards Precision Addiction Treatment: New Findings in Co-morbid Substance Use and Attention-Deficit Hyperactivity Disorders

PubMed Central

Levin, Frances R.

2017-01-01

Attention-deficit hyperactivity disorder (ADHD) and substance use disorders (SUDs) may have common etiologies. ADHD is more prevalent in patients with substance use disorders, and this pattern is consistent across different substances of abuse. Individuals with SUDs and ADHD exhibit significant variations in their clinical presentations. The developmental trajectory of ADHD to SUDs is complex: ADHD symptoms appear first in some patients but not in others. Many patients present with a heterogeneous collection of psychiatric and substance use co-morbidities, and these symptoms change over time. ADHD symptom severity is also highly variable, and more severe ADHD symptoms worsen co-morbid SUDs and complicate treatment. New longitudinal studies with innovative methods in high-risk populations and in community-based samples may clarify issues related to patient-treatment matching. When closely monitored, psychostimulant and other adjunct medications can be safely used to treat ADHD in this population, and such treatment may also improve outcome of SUDs. In particular, emerging evidence suggests individual-level tailoring (“precision medicine”) approaches may represent a key pathway to improve clinical outcome. PMID:28251590

Previously undiagnosed attention-deficit/hyperactivity disorder associated with poor metabolic control in adolescents with type 1 diabetes.

PubMed

Nylander, C; Lindström, K; Khalifa, N; Fernell, E

2018-06-01

Managing modern diabetes treatment requires efficient executive functions. Patients with attention-deficit/hyperactivity disorder (ADHD) and type 1 diabetes have poor metabolic control and present with ketoacidosis more often than patients without ADHD. To assess whether patients with type 1 diabetes and with indications of executive problems met criteria for ADHD, and to investigate whether these patients had difficulties achieving metabolic control. In a hospital-based study, including 3 pediatric departments at hospitals in Stockholm and Uppsala, Sweden, questionnaires regarding executive problems had been filled out by 12- to 18-year-old patients with type 1 diabetes and their parents. Out of 166 patients with completed questionnaires, 49 were selected for a clinical study due to reported executive problems/ADHD symptoms. However, 7 already had a diagnosis of ADHD, 21 denied follow-up, 8 did not respond, leaving 13 adolescents for the clinical assessment. Of the clinically assessed adolescents, 9 (6 girls) met criteria for ADHD. Patients who did not respond to the follow-up and patients who were diagnosed with ADHD within the study, showed to a larger extent than the other study groups high HbA1c levels (>70 mmol/mol, 8,6%). HbA1c >70 mmol/mol (8.6%) was associated with diagnosed ADHD (prior to or within the study), odds ratio 2.96 (95% confidence interval 1.02-8.60). Patients with type 1 diabetes and poor metabolic control should be assessed with regard to ADHD. There is a need for paying special attention to girls with poor metabolic control. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

No Clear Association between Impaired Short-Term or Working Memory Storage and Time Reproduction Capacity in Adult ADHD Patients

PubMed Central

Mette, Christian; Grabemann, Marco; Zimmermann, Marco; Strunz, Laura; Scherbaum, Norbert; Wiltfang, Jens; Kis, Bernhard

2015-01-01

Objective Altered time reproduction is exhibited by patients with adult attention deficit hyperactivity disorder (ADHD). It remains unclear whether memory capacity influences the ability of adults with ADHD to reproduce time intervals. Method We conducted a behavioral study on 30 ADHD patients who were medicated with methylphenidate, 29 unmedicated adult ADHD patients and 32 healthy controls (HCs). We assessed time reproduction using six time intervals (1 s, 4 s, 6 s, 10 s, 24 s and 60 s) and assessed memory performance using the Wechsler memory scale. Results The patients with ADHD exhibited lower memory performance scores than the HCs. No significant differences in the raw scores for any of the time intervals (p > .05), with the exception of the variability at the short time intervals (1 s, 4 s and 6 s) (p < .01), were found between the groups. The overall analyses failed to reveal any significant correlations between time reproduction at any of the time intervals examined in the time reproduction task and working memory performance (p > .05). Conclusion We detected no findings indicating that working memory might influence time reproduction in adult patients with ADHD. Therefore, further studies concerning time reproduction and memory capacity among adult patients with ADHD must be performed to verify and replicate the present findings. PMID:26221955

The influence of comorbid oppositional defiant disorder on white matter microstructure in attention-deficit/hyperactivity disorder.

PubMed

van Ewijk, Hanneke; Noordermeer, Siri D S; Heslenfeld, Dirk J; Luman, Marjolein; Hartman, Catharina A; Hoekstra, Pieter J; Faraone, Stephen V; Franke, Barbara; Buitelaar, Jan K; Oosterlaan, J

2016-07-01

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid disorders. ADHD has been associated with altered white matter (WM) microstructure, though the literature is inconsistent, which may be due to differences in the in- or exclusion of participants with comorbid ODD. WM abnormalities in ODD are still poorly understood, and it is unclear whether comorbid ODD in ADHD may have confounded the current ADHD literature. Diffusion Tensor Imaging (DTI) was used to compare fractional anisotropy (FA) and mean diffusivity (MD) between ADHD patients with (n = 42) and without (n = 117) comorbid ODD. All participants were between 8-25 years and groups did not differ in mean age or gender. Follow-up analyses were conducted to examine the role of antisocial behaviour (conduct problems) on FA and MD values in both groups. Comorbid ODD in ADHD was associated with lower FA in left frontotemporal WM, which appeared independent of ADHD symptoms. FA was negatively associated with antisocial behaviour in ADHD + ODD, but not in ADHD-only. Comorbid ODD is associated with WM abnormalities in individuals with ADHD, which appears to be independent of ADHD symptoms. Altered WM microstructure in comorbid ODD may play a role in inconsistencies in the current DTI literature in ADHD. Altered development of these tracts may contribute to social-emotional and cognitive problems in children with oppositional and antisocial behaviour.

Optimal management of ADHD in older adults.

PubMed

Torgersen, Terje; Gjervan, Bjorn; Lensing, Michael B; Rasmussen, Kirsten

2016-01-01

The manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed. A systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years. ADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70-80 years than the group 50-60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered. It is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk-benefit ratio when pharmacotherapy is considered to be a possible treatment.

Period prevalence of concomitant psychotropic medication usage among children and adolescents with attention-deficit/hyperactivity disorder during 2009.

PubMed

Betts, Keith A; Sikirica, Vanja; Hodgkins, Paul; Zhou, Zhou; Xie, Jipan; DeLeon, Anthony; Erder, M Haim; Wu, Eric Q

2014-06-01

Stimulants are recommended as a first-line treatment for attention- deficit/hyperactivity disorder (ADHD); however, a subset of the patient population augments their stimulant treatment with other medications. The objective of this study was to estimate the 1 year period prevalence of concomitant psychotropic medication use among children and adolescents with ADHD during 2009. Patients 6-17 years of age with one or more primary ADHD diagnoses between July 1, 2008 and December 31, 2009 and one or more stimulant prescription fills during 2009 were identified from a large United States commercial claims database. Concomitant psychotropic medication use, defined as 30 days of continuous medication supply overlap between the augmenting agent and stimulant, was evaluated for 14 distinct psychotropic medication categories (6 with a United States Food and Drug Administration (FDA) approved indication for ADHD, 8 without an indication for ADHD). The 1 year period prevalence of concomitant psychotropic medication use (both overall and within each medication category) was calculated and compared between patients with and without psychiatric or neurologic comorbidities. Children (6-12 years) and adolescents (13-17 years) were evaluated separately. A total of 71,201 children and 49,959 adolescents met the inclusion criteria. The 1 year period prevalence of concomitant psychotropic medication use among children and adolescents was 20.3% and 23.4%, with 5.7% and 6.7% augmenting with two or more medication categories, respectively. The most common concomitant medication categories were selective serotonin reuptake inhibitors (SSRIs) (children: 6.2%; adolescents: 11.4%), atypical antipsychotics (5.8%; 6.8%) and clonidine immediate release (5.4%; 2.9%). Children and adolescents with psychiatric or neurologic comorbidities had higher rates of augmentation than did those without comorbidities (all p<0.001). This epidemiologic study found that the prevalence of concomitant psychotropic medication use in children and adolescents ranged from 12.6% for noncomorbid ADHD to 41.7% for comorbid ADHD, in 2009. Future research is warranted to evaluate the rationale for, and clinical benefit of, concomitant psychotropic medication usage in patients with ADHD.

Pharmacological Treatment of ADHD in Addicted Patients: What Does the Literature Tell Us?

PubMed Central

Carpentier, Pieter-Jan; Levin, Frances R.

2017-01-01

Learning objectives After participating in this activity, learners should be better able to: Evaluate pharmacologic treatment of attention deficit/hyperactivity disorder (ADHD) in patients with substance use disorder (SUD)Assess the causes of the diminished efficacy of ADHD medication in patients with comorbid SUD Objective Substance use disorder (SUD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, and the presence of ADHD complicates the treatment of the addiction. Pharmacotherapy is a potent intervention in childhood and adult ADHD, but findings have been mixed in adolescent and adult ADHD patients with SUDs. This review focuses on several contributing factors and possible explanations, with implications both for future research and for clinical practice. Method This systematic review examined all randomized, placebo-controlled trials of pharmacotherapy for ADHD in adult and adolescent SUD patients. Results The number of studies is limited, and several studies are hampered by qualitative flaws. The results, in general, are inconclusive for most medications studied, but more recent trials using psychostimulants in robust dosing have demonstrated significantly positive results. Conclusion In reviewing these trials, possible explanations relating to the particular characteristics and problems of this complex patient group are discussed. Several factors, including ADHD symptom severity, psychiatric comorbidity, persistent drug use, choice of medication, and concomitant psychosocial intervention, influence study results. Taking these factors into account may improve the likelihood of detecting significant effects in future research, as the recent positive trials have indicated, and may help in the appropriate selection of pharmacotherapy in clinical practice. PMID:28272130

Distinct differences in striatal dysmorphology between attention deficit hyperactivity disorder boys with and without a comorbid reading disability.

PubMed

Goradia, Dhruman D; Vogel, Sherry; Mohl, Brianne; Khatib, Dalal; Zajac-Benitez, Caroline; Rajan, Usha; Robin, Arthur; Rosenberg, David R; Stanley, Jeffrey A

2016-12-30

There is evidence of greater cognitive deficits in attention deficit hyperactivity disorder with a comorbid reading disability (ADHD/+RD) compared to ADHD alone (ADHD/-RD). Additionally, the striatum has been consistently implicated in ADHD. However, the extent of morphological alterations in the striatum of ADHD/+RD is poorly understood, which is the main purpose of this study. Based on structural MRI images, the surface deformation of the caudate and putamen was assessed in 59 boys matching in age and IQ [19 ADHD/-RD, 15 ADHD/+RD and 25 typically developing controls (TDC)]. A vertex based analysis with multiple comparison correction was conducted to compare ADHD/-RD and ADHD/+RD to TDC. Compared to TDC, ADHD/+RD showed multiple bilateral significant clusters of surface compression. In contrast, ADHD/-RD showed fewer significant clusters of surface compression and restricted to the left side. Regarding the putamen, only ADHD/-RD showed significant clusters of surface compression. Results demonstrate for the first time a greater extent of morphological alterations in the caudate of ADHD/+RD than ADHD/-RD compared to TDC, which may suggest greater implicated cortical areas projecting to the caudate that are associated with the greater neuropsychological impairments observed in ADHD/+RD. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Temperament and characteristics related to attention deficit/hyperactivity disorder symptoms.

PubMed

Park, Hwanjin; Suh, Byung Seong; Lee, Hye-Kyung; Lee, Kounseok

2016-10-01

Adult attention deficit/hyperactivity disorder (ADHD) exhibits symptoms, such as attention deficit and impulsivity, that make it difficult for patients to manage social activities. In this study, we investigated the association of adult ADHD symptoms with temperament and character dimensions, taking into account possible sex interactions. A total of 2917 (1462 males and 1455 females) college students completed the 140 5-point Likert items on the Temperament and Character Inventory-Revised Short version (TCI-RS) and the Attention Deficit/Hyperactivity Disorder Self-Rated Scale (ASRS). According to the ASRS score, subjects were classified into the control group, the inattentive ADHD symptom (IA) group, or the hyperactive/impulsive ADHD symptom (HI) group. Additionally, the scores of the four temperament dimensions and the three character dimensions were compared. In the IA and HI groups, the NS and HA levels of the temperament dimension were high and the PS level was low compared with the control group. In the character dimension, the levels of SD and CO were significantly lower in the ADHD groups than in the control group (P<0.001). Meanwhile, the ST level in the HI group was significantly higher than in the control group. In the regression analysis after age and gender correction, NS and SD in the IA group and NS, CO, and ST in the HI group were associated with adult ADHD symptoms. The current findings suggest that high novelty seeking may be related to adult ADHD symptoms in the temperament dimension. Furthermore, some character dimensions were associated with adult ADHD symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

The Neural Basis of Decision-Making and Reward Processing in Adults with Euthymic Bipolar Disorder or Attention-Deficit/Hyperactivity Disorder (ADHD)

PubMed Central

Ibanez, Agustin; Cetkovich, Marcelo; Petroni, Agustin; Urquina, Hugo; Baez, Sandra; Gonzalez-Gadea, Maria Luz; Kamienkowski, Juan Esteban; Torralva, Teresa; Torrente, Fernando; Strejilevich, Sergio; Teitelbaum, Julia; Hurtado, Esteban; Guex, Raphael; Melloni, Margherita; Lischinsky, Alicia; Sigman, Mariano; Manes, Facundo

2012-01-01

Background Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) share DSM-IV criteria in adults and cause problems in decision-making. Nevertheless, no previous report has assessed a decision-making task that includes the examination of the neural correlates of reward and gambling in adults with ADHD and those with BD. Methodology/Principal Findings We used the Iowa gambling task (IGT), a task of rational decision-making under risk (RDMUR) and a rapid-decision gambling task (RDGT) which elicits behavioral measures as well as event-related potentials (ERPs: fERN and P3) in connection to the motivational impact of events. We did not observe between-group differences for decision-making under risk or ambiguity (RDMUR and IGT); however, there were significant differences for the ERP-assessed RDGT. Compared to controls, the ADHD group showed a pattern of impaired learning by feedback (fERN) and insensitivity to reward magnitude (P3). This ERP pattern (fERN and P3) was associated with impulsivity, hyperactivity, executive function and working memory. Compared to controls, the BD group showed fERN- and P3-enhanced responses to reward magnitude regardless of valence. This ERP pattern (fERN and P3) was associated with mood and inhibitory control. Consistent with the ERP findings, an analysis of source location revealed reduced responses of the cingulate cortex to the valence and magnitude of rewards in patients with ADHD and BD. Conclusions/Significance Our data suggest that neurophysiological (ERPs) paradigms such as the RDGT are well suited to assess subclinical decision-making processes in patients with ADHD and BD as well as for linking the cingulate cortex with action monitoring systems. PMID:22624011

The neural basis of decision-making and reward processing in adults with euthymic bipolar disorder or attention-deficit/hyperactivity disorder (ADHD).

PubMed

Ibanez, Agustin; Cetkovich, Marcelo; Petroni, Agustin; Urquina, Hugo; Baez, Sandra; Gonzalez-Gadea, Maria Luz; Kamienkowski, Juan Esteban; Torralva, Teresa; Torrente, Fernando; Strejilevich, Sergio; Teitelbaum, Julia; Hurtado, Esteban; Guex, Raphael; Melloni, Margherita; Lischinsky, Alicia; Sigman, Mariano; Manes, Facundo

2012-01-01

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) share DSM-IV criteria in adults and cause problems in decision-making. Nevertheless, no previous report has assessed a decision-making task that includes the examination of the neural correlates of reward and gambling in adults with ADHD and those with BD. We used the Iowa gambling task (IGT), a task of rational decision-making under risk (RDMUR) and a rapid-decision gambling task (RDGT) which elicits behavioral measures as well as event-related potentials (ERPs: fERN and P3) in connection to the motivational impact of events. We did not observe between-group differences for decision-making under risk or ambiguity (RDMUR and IGT); however, there were significant differences for the ERP-assessed RDGT. Compared to controls, the ADHD group showed a pattern of impaired learning by feedback (fERN) and insensitivity to reward magnitude (P3). This ERP pattern (fERN and P3) was associated with impulsivity, hyperactivity, executive function and working memory. Compared to controls, the BD group showed fERN- and P3-enhanced responses to reward magnitude regardless of valence. This ERP pattern (fERN and P3) was associated with mood and inhibitory control. Consistent with the ERP findings, an analysis of source location revealed reduced responses of the cingulate cortex to the valence and magnitude of rewards in patients with ADHD and BD. Our data suggest that neurophysiological (ERPs) paradigms such as the RDGT are well suited to assess subclinical decision-making processes in patients with ADHD and BD as well as for linking the cingulate cortex with action monitoring systems.

[Addiction from a developmental perspective: the role of conduct disorder and ADHD in the development of problematic substance use disorders].

PubMed

Carpentier, P J

2014-01-01

The externalising disorders conduct disorder (CD) and ADHD occur frequently in patients suffering from substance use disorders. These disorders play an important role in the onset and development of addiction. To examine the influence of CD and ADHD on the current problems and the psychiatric comorbidity of patients with a chronic addiction. A group of 193 opiate-addicted patients receiving methadone maintenance treatment were evaluated extensively in the following areas: functioning, quality of life, psychiatric comorbidity (including CD and ADHD) and comorbid addictions. Standardised interviews were used to check for the presence of CD and ADHD. A history of CD was demonstrated in the majority of participants (60.1%). Persistent ADHD was ascertained in 24.9%. Participants with CD and/or ADHD had a more severe addiction, characterised by more psychiatric comorbidity, more serious dysfunctioning and reduced quality of life. A history of CD predisposed patients particularly to antisocial behaviour and personality disorders. ADHD increased the risk of psychiatric comorbidity. Psychiatric comorbidity is part and parcel of addiction and reduces the quality of life of addicted patients. Behaviour problems in childhood play a major role in the development of severe addictions. Although CD is the biggest risk factor, the combination of ADHD with CD increases this risk, possibly through increased vulnerability to further psychiatric comorbidity.

Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers.

PubMed

Kutuk, Meryem Ozlem; Tufan, Ali Evren; Guler, Gulen; Yalin, Osman Ozgur; Altintas, Ebru; Bag, Harika Gozukara; Uluduz, Derya; Toros, Fevziye; Aytan, Nurgul; Kutuk, Ozgur; Ozge, Aynur

2018-06-16

Attention deficit and hyperactivity disorder (ADHD) is a neuro-developmental disorder related to internalizing and externalizing disorders as well as somatic complaints and disorders. This study was conducted to evaluate the prevalence of headache subtypes, epilepsy, atopic disorders, motion sickness and recurrent abdominal pain among children and adolescents with ADHD and their parents. In a multi-center, cross-sectional, familial association study using case-control design, treatment naïve children and adolescents between 6 and 18 years of age diagnosed with ADHD according to the DSM-5 criteria as well as age- and gender-matched healthy controls and their parents were evaluated by a neurologist and analyzed accordingly. 117 children and adolescents with ADHD and 111 controls were included. Headache disorder diagnosis was common for both patients and healthy controls (59.0% vs. 37.8%), with a significantly elevated rate in the ADHD group (p = 0.002). Migraine was found in 26.0% of ADHD patients and 9.9% of healthy controls. Tension headache was found in 32.4% of ADHD patients and 27.9% of healthy controls. Headache diagnosis was also found to be significantly more common in mothers of children with ADHD than control group mothers (90.5% vs. 36.6%, p < 0.001). Headache diagnoses and specifically migraines were significantly more common among children with ADHD and their mothers, while recurrent abdominal pain was elevated in both parents and ADHD patients. Migraine is an important part of ADHD comorbidity, not only for children but also for mothers. Motion sickness may be reduced among families of ADHD probands. Copyright © 2018. Published by Elsevier B.V.

Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate.

PubMed

Reimherr, Fred W; Marchant, Barrie K; Gift, Thomas E; Steans, Tammy A; Wender, Paul H

2015-06-01

Much recent research describes the importance of emotional symptoms in ADHD. While there is no accepted system for including emotionality in diagnosing ADHD, the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) provides a tool to facilitate this. It assesses a range of adult ADHD symptoms which load on two factors: inattentive and emotional dysregulation. The consistently high inattentive factor was used to define significant elevation on the more variable emotional dysregulation factor (which contains four WRAADDS domains: hyperactivity/restlessness, temper, affective lability, and emotional over-reactivity) allowing the definition of two ADHD diagnostic types. We compared these two types on a broad range of adult subject characteristics, including response to methylphenidate (MPH) treatment assessed during two clinical trials. Marked impairment in three of the four emotional domains reflected a symptom severity level equivalent to that of the inattentive factor. 59 % met this threshold, defining them as ADHD emotion dysregulation presentation, as opposed to 41 % with ADHD inattentive presentation. Cluster analysis validated these groups by generating similar clusters with 85 % agreement regarding membership. ADHD emotional dysregulation presentation subjects showed more childhood ADHD symptoms, adult symptoms of oppositional defiant disorder, and evidence of personality disorder. Both types showed similar improvement during the double-blind MPH arm of the trials and during a 6-month open-label phase. Based on the presence of symptoms of emotional dysregulation, ADHD in adults can be conceptualized as two types. Impairment and comorbidity in adults with ADHD are largely concentrated in ADHD emotional dysregulation presentation patients.

“ADHD Knowledge, Perceptions and Information Sources: Perspectives from a Community Sample of Adolescents and their Parents”

PubMed Central

Bussing, Regina; Zima, Bonnie T.; Mason, Dana M.; Meyer, Johanna.M.; White, Kimberly; Garvan, Cynthia W.

2012-01-01

PURPOSE The chronic illness model advocates for psychoeducation within a collaborative care model to enhance outcomes. To inform psychoeducational approaches for attention-deficit/hyperactivity disorder (ADHD), this study describes parent and adolescent knowledge, perceptions and information sources and explores how these vary by sociodemographic characteristics, ADHD risk, and past child mental health service use. METHODS Parents and adolescents were assessed 7.7 years after initial school district screening for ADHD risk. The study sample included 374 adolescents (56% high and 44% low ADHD risk), on average 15.4 (SD 1.8) years old, and 36% were African American. Survey questions assessed ADHD knowledge, perceptions, and cues to action, and elicited utilized and preferred information sources. Multiple logistic regression was used to determine potential independent predictors of ADHD knowledge. McNemar's tests compared information source utilization against preference. RESULTS Despite relatively high self-rated ADHD familiarity, misperceptions among parents and adolescents were common, including a sugar etiology (25% and 27%, respectively) and medication overuse (85% and 67%). African American respondents expressed lower ADHD awareness and greater belief in sugar etiology than Caucasians. Parents used a wide range of ADHD information sources while adolescents relied on social network members and teachers/school. However, parents and adolescents expressed similar strong preferences for the Internet (49% and 51%) and doctor (40% and 27%) as ADHD information sources. CONCLUSION Culturally appropriate psychoeducational strategies are needed that combine doctor-provided ADHD information with reputable Internet sources. Despite time limitations during patient visits, both parents and teens place high priority on receiving information from their doctor. PMID:23174470

Sleep complaints and psychiatric symptoms in children evaluated at a pediatric mental health clinic.

PubMed

Ivanenko, Anna; Crabtree, Valerie McLaughlin; Obrien, Louise Margaret; Gozal, David

2006-01-15

To examine the association of sleep problems with psychiatric symptoms in children evaluated at a university-based outpatient child psychiatry clinic. Parents of 174 children attending psychiatric services completed a 47-item Childhood Sleep Questionnaire and the Behavioral Assessment System for Children. Psychiatric diagnosis was obtained through retrospective chart review. Sleep characteristics were compared among 4 diagnostic subcategories: attention-deficit/hyperactivity disorder (ADHD) alone (n=29), ADHD with comorbid mood and anxiety disorders (ADHD+; n=50), mood and anxiety disorders alone (n=67), and other psychiatric disorders (n= 28). Data from sleep habits survey of 174 community children without reported psychiatric history served as controls. Children with psychiatric disorders had a significantly higher prevalence of sleep complaints compared with nonpsychiatric controls. Children with ADHD had frequent nocturnal awakenings, bad dreams, and bedtime struggles. In addition, the presence of leg jerks during sleep was particularly frequent in patients with ADHD compared with any other psychiatric disorder. More frequent nighttime awakenings were present in children with mood and anxiety disorders. Sleep duration and sleep latency strongly correlated with aggression, hyperactivity, and depression. Restless sleep scores highly correlated with all psychiatric symptoms. Sleep problems are highly prevalent among children with psychiatric disorders. Children with ADHD and comorbid anxiety or mood disorders are more likely to report sleep disturbances. Restless sleep, long sleep latency, short sleep duration, and frequent nocturnal awakenings correlate with the severity of psychiatric symptoms.

Impact of negative media publicity on attention-deficit/hyperactivity disorder medication in Taiwan.

PubMed

Wang, Liang-Jen; Lee, Sheng-Yu; Yuan, Shin-Sheng; Yang, Chun-Ju; Yang, Kang-Chung; Lee, Tung-Liang; Shyu, Yu-Chiau

2016-01-01

This study explores trends in attention-deficit/hyperactivity disorder (ADHD) medications in Taiwan from 2000 to 2011 and whether negative media coverage of Ritalin in January 2010 impacted ADHD prescriptions throughout the country. Patients throughout Taiwan who had been newly diagnosed with ADHD (n = 145,269) between January 2000 and December 2011 were selected from Taiwan's National Health Insurance database as subjects for this study. We analyzed monthly and yearly data on person-days of treatment with immediate-release methylphenidate (IR-MPH), osmotic controlled-release formulation of methylphenidate (OROS-MPH), and atomoxetine (ATX) using linear models of curve estimation and the time series expert modeler. Of our sample, 57.8%, 28.9%, and 4.3% had been prescribed one or more doses of IR-MPH, OROS-MPH, or ATX, respectively. The annual person-days of IR-MPH use increased regularly from 2000 to 2009, dropped abruptly in 2010, and then increased again the next year. Furthermore, the person-days of OROS-MPH prescriptions did not reach their expected goal in 2010; however, the person-days of ATX prescriptions have increased constantly since entering the market in 2007. Compared with patients newly diagnosed with ADHD in 2009, those newly diagnosed in 2010 were less likely to be treated with medication. These findings suggest that negative publicity affected the writing of stimulant prescriptions for ADHD patients throughout Taiwan. Media reporting has a vital role in influencing children with ADHD, their parents, and their willingness to accept pharmacotherapy as treatment. Copyright © 2015 John Wiley & Sons, Ltd.

A four-year follow-up controlled study of stress response and symptom persistence in Brazilian children and adolescents with attention deficit disorder and hyperactivity (ADHD).

PubMed

Palma, Sonia Maria Motta; Natale, Ana Carolina Motta Palma; Calil, Helena Maria

2015-12-15

This study evaluated children and adolescents with Attention Deficit Disorder andHyperactivity Disorder (ADHD), reassessing them at a four-year follow-up. Their cortisol response to a stress stimulus was measured twice. ADHD symptom persistence, development of comorbidities, and psychostimulant usage were also reassessed. The initial sample consisted of 38 ADHD patients and 38 healthy controls, age ranging 6-14. At the follow-up, there were 37 ADHD patients and 22 healthy controls, age ranging 10-18. ADHD was classified as persistent if the patients fulfilled all DSM IV criteria for syndromic or subthreshold or had functional impairment. Salivary cortisol samples were collected prior to the application of a cognitive stressor (Continuous Performance Test - CPT), and at three time intervals afterwards at baseline and at the follow-up. Their reassessment showed that 75% had persistent symptoms, psychiatric comorbidities (oppositional defiant and behavioral disorders), functional and academic impairement. Only seven patients were on medication. The ADHD group's cortisol levels were lower than those measured four years earlier, but cortisol concentrations were similar for both ADHD and control groups at the four-year follow-up. The cortisol results suggest that HPA axis reactivity could be a marker differentiating ADHD from ADHD with comorbidities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers.

PubMed

Schubiner, H; Tzelepis, A; Milberger, S; Lockhart, N; Kruger, M; Kelley, B J; Schoener, E P

2000-04-01

This cross-sectional study sought to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder among adults admitted to 2 chemical dependency treatment centers. It was hypothesized that ADHD alone or in combination with conduct disorder would be overrepresented in a population of patients with psychoactive substance use disorders. Two hundred one participants were selected randomly from 2 chemical dependency treatment centers. Standardized clinical interviews were conducted using the Structured Clinical Interview for DSM-IV, the Addiction Severity Index, and DSM-IV criteria for ADHD. Reliabilities for the diagnostic categories were established using the Cohen kappa, and the subgroups of individuals with and without ADHD and conduct disorder were compared. Forty-eight (24%) of the participants were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95; NS). Seventy-nine participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse. Individuals with conduct disorder (in comparison with those without conduct disorder) were younger, had a greater number of jobs as adults, and were more likely to repeat a grade in school, have a learning disability, be suspended or expelled from school, have an earlier age at onset of alcohol dependence, and have had a greater number of treatments for drug abuse. They were more likely to have a lifetime history of abuse of and/or dependence on cocaine, stimulants, hallucinogens, and/or cannabis. A significant overrepresentation of ADHD exists among inpatients with psychoactive substance use disorders. Over two thirds of those with ADHD in this sample also met criteria for conduct disorder. Our sample had a very large overlap between ADHD and conduct disorder, and the major comorbidities identified here were attributable largely to the presence of conduct disorder. Individuals who manifest conduct disorder and/or ADHD represent a significant proportion of those seeking treatment for psychoactive substance use disorders. They appear to have greater comorbidity and may benefit from a treatment approach that addresses these comorbidities specifically through medical and behavioral therapies.

Lower white matter microstructure in the superior longitudinal fasciculus is associated with increased response time variability in adults with attention-deficit/ hyperactivity disorder.

PubMed

Wolfers, Thomas; Onnink, A Marten H; Zwiers, Marcel P; Arias-Vasquez, Alejandro; Hoogman, Martine; Mostert, Jeanette C; Kan, Cornelis C; Slaats-Willemse, Dorine; Buitelaar, Jan K; Franke, Barbara

2015-09-01

Response time variability (RTV) is consistently increased in patients with attention-deficit/hyperactivity disorder (ADHD). A right-hemispheric frontoparietal attention network model has been implicated in these patients. The 3 main connecting fibre tracts in this network, the superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF) and the cingulum bundle (CB), show microstructural abnormalities in patients with ADHD. We hypothesized that the microstructural integrity of the 3 white matter tracts of this network are associated with ADHD and RTV. We examined RTV in adults with ADHD by modelling the reaction time distribution as an exponentially modified Gaussian (ex-Gaussian) function with the parameters μ, σ and τ, the latter of which has been attributed to lapses of attention. We assessed adults with ADHD and healthy controls using a sustained attention task. Diffusion tensor imaging-derived fractional anisotropy (FA) values were determined to quantify bilateral microstructural integrity of the tracts of interest. We included 100 adults with ADHD and 96 controls in our study. Increased τ was associated with ADHD diagnosis and was linked to symptoms of inattention. An inverse correlation of τ with mean FA was seen in the right SLF of patients with ADHD, but no direct association between the mean FA of the 6 regions of interest with ADHD could be observed. Regions of interest were defined a priori based on the attentional network model for ADHD and thus we might have missed effects in other networks. This study suggests that reduced microstructural integrity of the right SLF is associated with elevated τ in patients with ADHD.

Lower white matter microstructure in the superior longitudinal fasciculus is associated with increased response time variability in adults with attention-deficit/hyperactivity disorder

PubMed Central

Wolfers, Thomas; Onnink, A. Marten H.; Zwiers, Marcel P.; Arias-Vasquez, Alejandro; Hoogman, Martine; Mostert, Jeanette C.; Kan, Cornelis C.; Slaats-Willemse, Dorine; Buitelaar, Jan K.; Franke, Barbara

2015-01-01

Background Response time variability (RTV) is consistently increased in patients with attention-deficit/hyperactivity disorder (ADHD). A right-hemispheric frontoparietal attention network model has been implicated in these patients. The 3 main connecting fibre tracts in this network, the superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF) and the cingulum bundle (CB), show microstructural abnormalities in patients with ADHD. We hypothesized that the microstructural integrity of the 3 white matter tracts of this network are associated with ADHD and RTV. Methods We examined RTV in adults with ADHD by modelling the reaction time distribution as an exponentially modified Gaussian (ex-Gaussian) function with the parameters μ, σ and τ, the latter of which has been attributed to lapses of attention. We assessed adults with ADHD and healthy controls using a sustained attention task. Diffusion tensor imaging–derived fractional anisotropy (FA) values were determined to quantify bilateral microstructural integrity of the tracts of interest. Results We included 100 adults with ADHD and 96 controls in our study. Increased τ was associated with ADHD diagnosis and was linked to symptoms of inattention. An inverse correlation of τ with mean FA was seen in the right SLF of patients with ADHD, but no direct association between the mean FA of the 6 regions of interest with ADHD could be observed. Limitations Regions of interest were defined a priori based on the attentional network model for ADHD and thus we might have missed effects in other networks. Conclusion This study suggests that reduced microstructural integrity of the right SLF is associated with elevated τ in patients with ADHD. PMID:26079698

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients.

PubMed

Svedlund, Nils Erik; Norring, Claes; Ginsberg, Ylva; von Hausswolff-Juhlin, Yvonne

2017-01-17

Very little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic. In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables. Almost one third (31.3 %) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35-37 %) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1-4 and Binge Eating Disorder patients reported slightly below average (26-31 %), and Anorexia Nervosa restricting subtype patients even lower (18 %). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses. There is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group.

Everyday life consequences of substance use in adult patients with a substance use disorder (SUD) and co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD): a patient's perspective.

PubMed

Kronenberg, Linda M; Slager-Visscher, Karin; Goossens, Peter J J; van den Brink, Wim; van Achterberg, Theo

2014-09-19

Although the prevalence of substance use disorder (SUD) with co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) is relatively high in adult patients, there is hardly any knowledge about these dual diagnoses. A recent study reported met- and unmet needs for several life domains regarding these patient groups. To improve treatment, it is necessary to identify the everyday life consequences of SUD and co-occurring ADHD or ASD in adult patients. Qualitative study using in-depth interviews. 11 SUD + ADHD and 12 SUD + ASD patients participated in the study. The interview transcripts were coded and analysed according to the seven steps for descriptive phenomenology by Colaizzi. Both patients with ADHD and patients with ASD can get caught in a jumble of thoughts and emotions which can often lead to agitation and impulsivity in the case of ADHD or passivity and melancholia in the case of ASD with co-occurring SUD in both cases. Initially substance use ameliorates the symptoms and related problems, but both patient groups can later experience even greater problems: difficulties with the structuring of daily life due to a lack of planning (SUD + ADHD) or due to a lack of initiative (SUD + ASD). Both groups indicate that structure helps them function better. They also recognize that substance use disorganizes their lives and that an absence of structure contributes to substance use in what becomes a vicious circle which needs to be broken for effective treatment and care. This study provides insight into the daily life consequences of SUD with a co-occurring ADHD or ASD. Substance use is reported to solve some ADHD- or ASD-related problems in the short run but have negative consequences in the long run (i.e., contribute to already impaired cognitive functioning). Insight is provided into what clinicians can do to break this vicious circle and thus help ADHD patients to refrain from action and ASD patients to take action.

Pharmacology and pharmacogenetics of pediatric ADHD with associated aggression: a review.

PubMed

Patel, Bianca D; Barzman, Drew H

2013-12-01

Attention deficit hyperactivity disorder (ADHD) is often associated with symptoms of aggression in children and adolescents. Clinically, this is complex because aggression can be from hyperactivity and impulsivity, or could be a distinct symptom from a comorbid diagnosis. Past research has recommended first treating the primary disorder of ADHD. Stimulants are the most common treatment for pediatric ADHD, which can be helpful in decreasing aggressive behaviors. Alpha-adrenergic agonists and atomoxetine (ATX) are non-stimulant medications for ADHD and aggression, but more research is necessary to compare these drugs to stimulants. If aggressive symptoms do not improve from treating the primary disorder, aggression can be treated separately. Risperidone, lithium, valproic acid, clonidine, and guanfacine have shown positive results in reducing aggression, but studies including children with aggression and ADHD are limited. The variability in treatment tolerability in patients has stimulated research in pharmacogenetics for ADHD. Although this field is still emerging, research has found evidence supporting a link between the response rate of methylphenidate and the dopamine transporter (DAT1) and a link between the metabolism rate of atomoxetine and hepatic cytochrome 450 isozymes. Pharmacogenetics may be relevant to ADHD and associated aggression. Further research in pharmacogenetics will strive to identify patterns of genetic variations that can tailor individual treatments.

How do children with attention deficit hyperactivity disorder interact in a clinical dental examination? A video analysis.

PubMed

Blomqvist, My; Augustsson, Mikael; Bertlin, Christine; Holmberg, Kirsten; Fernell, Elisabeth; Dahllöf, Göran; Ek, Ulla

2005-06-01

Attention deficit hyperactivity disorder (ADHD) is currently the most common behavioural disorder in school-age children. The aim of this study was to perform a detailed analysis of behavioural interactions between the dentist and the child patient with ADHD. All children born in 1991 (n = 555) in one Swedish municipality were screened for attention and learning problems, and assessed for ADHD. Twenty-two children with ADHD, and a control group of 47 children without attention and learning problems, were included in the study. The dental recall visit was recorded on video. The interaction between the dentist and the child was analysed in detail and scored as verbal and non-verbal initiatives and responses. Compared to the children in the control group, the children with ADHD made significantly more initiatives, especially initiatives that did not focus on the examination or the dentist. The children with ADHD had fewer verbal responses and more missing responses. In conclusion, the problems in communication resulted in less two-way communication between the dentist and the children with ADHD than the interaction between the dentist and the children in the control group. The children with ADHD had particular difficulties staying focused on the examination. (c) Eur J Oral Sci, 2005

Attention Deficit Hyperactivity Disorder and Functional Defecation Disorders in Children.

PubMed

Kuizenga-Wessel, Sophie; Koppen, Ilan J N; Vriesman, Mana H; Di Lorenzo, Carlo; van Dijk, Marieke; Beelen, Maureen L R; Groeneweg, Michael; Stoffelsen, Reino J; Benninga, Marc A

2018-02-01

The aim of the study was to assess the prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with functional defecation disorders (FDDs) and to assess the prevalence of FDDs in children with ADHD. A cross-sectional cohort study was carried out between September 2014 and May 2016. Group 1: Parents of children with FDDs according to the Rome III criteria completed the Child Behavior Checklist and the VvGK (Dutch questionnaire based on the American Disruptive Behavior Disorder rating scale). Patients with ADHD subarea scores ≥70 on the Child Behavior Checklist and/or ≥16 on the VvGK were referred for further psychiatric evaluation. Group 2: Parents of children treated for ADHD at a specialized ADHD outpatient clinic completed a standardized questionnaire regarding their child's defecation pattern. In group 1 (282 children with FDDs), 10.3% (7.1%-13.5% bias-corrected and accelerate confidence interval) were diagnosed with ADHD. Group 2 consisted of 198 children with ADHD, 22.7% (17.6-28.8 bias-corrected and accelerate confidence interval) fulfilled the Rome III criteria for an FDD. Children with both an FDD and ADHD reported urinary incontinence significantly more often compared to children with an FDD or ADHD alone: 57.1% in FDD + ADHD versus 22.8% in FDD alone (P < 0.001) and 31.1% in ADHD + FDD versus 7.8% in ADHD alone (P < 0.001). Approximately 10.3% of children with FDDs had ADHD and 22.7% of children with a known diagnosis of ADHD fulfilled the Rome III criteria for an FDD. This observation suggests that screening for behavioral disorders and FDDs should be incorporated into the diagnostic workup of these groups of children.

White matter abnormalities and their impact on attentional performance in adult attention-deficit/hyperactivity disorder.

PubMed

Konrad, Andreas; Dielentheis, Thomas F; El Masri, Dschamil; Dellani, Paulo R; Stoeter, Peter; Vucurevic, Goran; Winterer, Georg

2012-06-01

Inattention is the most important behavioral feature of adult patients with attention-deficit/hyperactivity disorder (ADHD). Neuroimaging studies in ADHD have demonstrated abnormalities primarily in the frontostriatal circuitry and were mostly conducted in children. We investigated white matter (WM) integrity in adult ADHD patients and the correlation of WM microstructure and neuropsychological parameters in 37 (21 men) never-medicated adult ADHD patients and 34 age- and gender-matched healthy controls. All subjects underwent clinical interviews, rating scales, and neuropsychological tests of attentional performance. Diffusion tensor imaging (DTI) was acquired, and 12 WM regions-of-interest (ROIs) within the attentional network were chosen. Group differences of mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated for each ROI, and patients' DTI measures were then correlated with measures of attentional performance. FA values in ADHD patients were significantly reduced in the left inferior longitudinal fasciculus (ILF), while MD values were significantly increased in ADHD patients in the frontal portion of the left frontooccipital fasciculus (IFO). In ADHD patients, MD values were negatively correlated with attentional performance in the left ILF. Our findings provide further support for disturbed frontostriatal structural connectivity and also point to an involvement of the left temporal white matter with an impact on attentional performance.

Elucidating X chromosome influences on Attention Deficit Hyperactivity Disorder and executive function.

PubMed

Green, Tamar; Bade Shrestha, Sharon; Chromik, Lindsay C; Rutledge, Keetan; Pennington, Bruce F; Hong, David S; Reiss, Allan L

2015-09-01

To identify distinct behavioral and cognitive profiles associated with ADHD in Turner syndrome (TS), relative to idiopathic ADHD and neurotypical controls, in order to elucidate X-linked influences contributing to ADHD. We used a multilevel-model approach to compare 49 girls with TS to 37 neurotypical females, aged 5-12, on established measures of behavior (BASC-2) and neurocognitive function (NEPSY). We further compared girls with TS to BASC-2 and NEPSY age-matched reference data obtained from children with idiopathic ADHD. Within the TS group, 51% scored at or above the "at-risk" range for ADHD-associated behaviors on the BASC-2 (TS/+ADHD). The BASC-2 behavioral profile in this TS/+ADHD-subgroup was comparable to a reference group of boys with ADHD with respect to attentional problems and hyperactivity. However, the TS/+ADHD-subgroup had significantly higher hyperactivity scores relative to a reference sample of girls with ADHD (p = 0.016). The behavioral profile in TS was associated with significantly lower attention and executive function scores on the NEPSY relative to neurotypical controls (p = 0.015); but was comparable to scores from a reference sample of children with idiopathic ADHD. Deficits in attention and executive function were not observed in girls with TS having low levels of ADHD-associated behavior (TS/-ADHD). ADHD-associated behavioral and cognitive problems in TS are prevalent and comparable in severity to those found in children with idiopathic ADHD. The ADHD phenotype in TS also appears relatively independent of cognitive features typically associated with TS, like visuospatial weaknesses. These findings suggest that X-linked haploinsufficiency and downstream biological effects contribute to increased risk for ADHD. Copyright © 2015 Elsevier Ltd. All rights reserved.

Attention deficit hyperactivity disorder in children is found to be related to the occurrence of ADHD in siblings and the male gender, but not to birth order, when compared to healthy controls.

PubMed

Keshavarzi, Zahra; Bajoghli, Hafez; Mohamadi, Mohammad Reza; Holsboer-Trachsler, Edith; Brand, Serge

2014-10-01

The aim of the present study was to explore the extent to which the prevalence of attention deficit hyperactivity disorder (ADHD) in childhood is associated with birth order and gender, and the prevalence of ADHD and mental retardation (MR) in siblings, as compared to healthy controls. Methods. Data from 200 children diagnosed with ADHD (mean age: 11.13 years; 10.5% females) were compared to data from 200 healthy controls (mean age: 11.0 years; 27.5% females). The data were related to symptoms of ADHD, birth order, gender, family size, and the occurrence of ADHD and MR in siblings. Compared to controls, the occurrence of ADHD was found to be related to the male gender and to the occurrence of ADHD-related symptoms in siblings (odds ratio: 13.50). Birth order and MR were not associated with the occurrence of ADHD and ADHD-related symptoms. ADHD- related symptoms increased if a further sibling also suffered from ADHD. Conclusions. Among a sample of Iranian children suffering from ADHD, the ADHD and ADHD-related symptoms in childhood were found to be related to the male gender and to the occurrence of ADHD in siblings. Moreover, birth order was found to be unrelated. The fact that symptoms of ADHD-related symptoms increased if a further sibling was suffering from ADHD, and decreased if a further sibling was suffering from MR, is intriguing and needs further explanation.

Evaluation of sleep organization in patients with attention deficit hyperactivity disorder (ADHD) and ADHD as a comorbidity of epilepsy.

PubMed

Kalil Neto, Felipe; Nunes, Magda L

2017-05-01

Epilepsy or attention deficit hyperactivity disorder (ADHD) can influence sleep organization in different ways. The aim of this study was to evaluate sleep organization in children and adolescents with ADHD and epilepsy, and to analyze the influence of methylphenidate. This was an observational, cross-sectional study of children and adolescents with epilepsy, who were seizure free for at least three months, and were also diagnosed with ADHD. They were selected from the epilepsy and child neurology outpatient clinic of a university hospital in Brazil. After sample size calculation, patients were consecutively included into four different groups, with 21 patients each: epilepsy + ADHD using methylphenidate, epilepsy + ADHD not using methylphenidate, only ADHD, and a healthy control group. All participants were evaluated with the Sleep Disturbance Scale for Children (SDSC) and monitored with actigraphy for five nights/days. Actigraphic analysis showed a higher number of night awakenings in the epilepsy + ADHD groups; they were most prominent in the group without methylphenidate (p = 0.001). Parental reports demonstrated a higher risk for sleep disturbances in the epilepsy + ADHD without methylphenidate and the ADHD groups (p < 0.001). Primary ADHD as a comorbidity of epilepsy impairs sleep organization in children, and the use of short-acting methylphenidate seems to improve it. Both objective (actigraphic) and subjective (SDSC) measures showed significant sleep alterations between primary ADHD and ADHD as a comorbidity of epilepsy; this was most prominent in the group without methylphenidate. Copyright © 2016 Elsevier B.V. All rights reserved.

The impact of ADHD on the health and well-being of ADHD children and their siblings.

PubMed

Peasgood, Tessa; Bhardwaj, Anupam; Biggs, Katie; Brazier, John E; Coghill, David; Cooper, Cindy L; Daley, David; De Silva, Cyril; Harpin, Val; Hodgkins, Paul; Nadkarni, Amulya; Setyawan, Juliana; Sonuga-Barke, Edmund J S

2016-11-01

Childhood attention-deficit/hyperactivity disorder (ADHD) has been associated with reduced health and well-being of patients and their families. The authors undertook a large UK survey-based observational study of the burden associated with childhood ADHD. The impact of ADHD on both the patient (N = 476) and their siblings (N = 337) on health-related quality of life (HRQoL) and happiness was quantified using multiple standard measures [e.g. child health utility-9D (CHU-9D), EuroQol-5D-Youth]. In the analysis, careful statistical adjustments were made to ensure a like-for-like comparison of ADHD families with two different control groups. We controlled for carers' ADHD symptoms, their employment and relationship status and siblings' ADHD symptoms. ADHD was associated with a significant deficit in the patient's HRQoL (with a CHU-9D score of around 6 % lower). Children with ADHD also have less sleep and were less happy with their family and their lives overall. No consistent decrement to the HRQoL of the siblings was identified across the models, except that related to their own conduct problems. The siblings do, however, report lower happiness with life overall and with their family, even when controlling for the siblings own ADHD symptoms. We also find evidence of elevated bullying between siblings in families with a child with ADHD. Overall, the current results suggest that the reduction in quality of life caused by ADHD is experienced both by the child with ADHD and their siblings.

Regional brain network organization distinguishes the combined and inattentive subtypes of Attention Deficit Hyperactivity Disorder.

PubMed

Saad, Jacqueline F; Griffiths, Kristi R; Kohn, Michael R; Clarke, Simon; Williams, Leanne M; Korgaonkar, Mayuresh S

2017-01-01

Attention Deficit Hyperactivity Disorder (ADHD) is characterized clinically by hyperactive/impulsive and/or inattentive symptoms which determine diagnostic subtypes as Predominantly Hyperactive-Impulsive (ADHD-HI), Predominantly Inattentive (ADHD-I), and Combined (ADHD-C). Neuroanatomically though we do not yet know if these clinical subtypes reflect distinct aberrations in underlying brain organization. We imaged 34 ADHD participants defined using DSM-IV criteria as ADHD-I ( n  = 16) or as ADHD-C ( n  = 18) and 28 matched typically developing controls, aged 8-17 years, using high-resolution T1 MRI. To quantify neuroanatomical organization we used graph theoretical analysis to assess properties of structural covariance between ADHD subtypes and controls (global network measures: path length, clustering coefficient, and regional network measures: nodal degree). As a context for interpreting network organization differences, we also quantified gray matter volume using voxel-based morphometry. Each ADHD subtype was distinguished by a different organizational profile of the degree to which specific regions were anatomically connected with other regions (i.e., in "nodal degree"). For ADHD-I (compared to both ADHD-C and controls) the nodal degree was higher in the hippocampus. ADHD-I also had a higher nodal degree in the supramarginal gyrus, calcarine sulcus, and superior occipital cortex compared to ADHD-C and in the amygdala compared to controls. By contrast, the nodal degree was higher in the cerebellum for ADHD-C compared to ADHD-I and in the anterior cingulate, middle frontal gyrus and putamen compared to controls. ADHD-C also had reduced nodal degree in the rolandic operculum and middle temporal pole compared to controls. These regional profiles were observed in the context of no differences in gray matter volume or global network organization. Our results suggest that the clinical distinction between the Inattentive and Combined subtypes of ADHD may also be reflected in distinct aberrations in underlying brain organization.

Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder

PubMed Central

Wolfe, Elizabeth S.; Madden, Kelly J.

2016-01-01

Context: Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs. Objective: To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively. Data Sources: We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology. Study Selection: Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded. Data Extraction: Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review. Data Synthesis: We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting. Conclusions: Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome. PMID:27834506

Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder.

PubMed

Wolfe, Elizabeth S; Madden, Kelly J

2016-10-01

Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs. To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively. We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology. Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded. Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review. We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting. Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome.

Reading outcomes of children and adolescents with attention-deficit/hyperactivity disorder and dyslexia following atomoxetine treatment.

PubMed

Shaywitz, Bennett A; Williams, David W; Fox, Bethany K; Wietecha, Linda A

2014-10-01

Abstract Objective: This study assessed the efficacy of atomoxetine on attention-deficit/hyperactivity disorder (ADHD) symptoms in children and adolescents having ADHD with comorbid dyslexia (ADHD+D) and the effects of the treatment on reading measures. The analyses in this report used data from a study designed to examine the effects of a nonstimulant pharmacological agent, atomoxetine, on reading in children with ADHD+D. Patients ages 10-16 years with ADHD or ADHD+D received open-label atomoxetine for 16 weeks. The ADHD Rating Scale (ADHD-RS) and reading subtests of the Kaufman Test of Educational Achievement (K-TEA) were assessed. Changes in ADHD symptoms and reading scores were also analyzed by ADHD subtype. Treatment effect sizes and correlations between changes in ADHDRS and K-TEA scores were calculated. After atomoxetine treatment, both ADHD and ADHD+D patient groups showed significant reduction in ADHD symptom and improvements in K-TEA reading scores. The range of treatment effect sizes on K-TEA scores was 0.35-0.53 for the ADHD group and 0.50-0.62 for the ADHD+D group. Pearson's correlation coefficients revealed only a few weak correlations between changes in ADHD symptoms and reading scores, regardless of diagnostic group. ADHD symptoms and K-TEA reading scores improved for both the ADHD and ADHD+D groups following atomoxetine treatment. Correlation analyses indicate that improvements in reading outcomes cannot be explained by a reduction of ADHD symptoms alone. These findings support further exploration of the potential effects of atomoxetine on reading in children with ADHD and dyslexia or dyslexia alone.

Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices.

PubMed

Jacob, L; Kostev, K

2017-04-01

Two thousand eight hundred ninety-four children and adolescents treated by 243 pediatricians were analyzed. Patients receiving attention deficit hyperactivity disorder (ADHD) medications were at a lower risk of fractures than patients without ADHD medications. The strongest impact was in the age group of 6-9 years. Finally, there was a significant association between therapy duration and fracture risk. The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians. Children and adolescents initially diagnosed with ADHD and fractures between 2010 and 2015 were identified by 243 pediatricians. In this nested case-control study, each ADHD case with a fracture was matched (1:1) to an ADHD control without a fracture for age, gender, index year, and physician. In total, 2894 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of ADHD therapy. Multivariate logistic regression models were created to determine the effect of ADHD therapy on the risk of fracture in the entire population and in three age-specific subgroups. Patients receiving ADHD medications were at a lower risk of fracture than patients without ADHD medications (OR = 0.61). The impact of ADHD therapy on the risk of fracture was stronger in the age group of 6-9 years (OR = 0.41) than in the age groups of 10-13 years (OR = 0.68) and 14-17 years (OR = 0.74). Finally, a significant correlation was found between therapy duration and fracture risk (OR = 0.71 per month). ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.

Reappraisal of abnormal EEG findings in children with ADHD: on the relationship between ADHD and epileptiform discharges.

PubMed

Kanazawa, Osamu

2014-12-01

Attention-deficit hyperactivity disorder is suggested to be closely related to epilepsy. A recent large-scale study revealed that ADHD in children is often accompanied by epilepsy. In Japan, methylphenidate (MPH) as a sustained-action tablet and atomoxetine (ATX) became commercially available as medications for children recently. Since then, the number of prescriptions of both medicines has increased rapidly. Methylphenidate, as a psychostimulant, has been a source of concern because of the perceived lowered threshold for convulsions in children. Based on this background, reappraisal of EEG findings in children with ADHD is important in order to detect indications of potential comorbid epilepsy and to investigate the developmental mechanisms of the neurophysiological manifestations in patients with ADHD. EEG findings in children newly diagnosed with ADHD and their relationship with clinical findings were investigated. The author evaluated 208 patients with ADHD newly diagnosed between 2008 and 2013. Of these, there were 145 patients for whom EEG findings were obtained along with a clinical follow-up for at least three months. Patients with IQ<70 were excluded in order to obtain a homogenous group of patients with ADHD. The male-to-female ratio was 130:15, and the age range was between 5 years, 9 months and 19 years, 9 months, with mean age of 11 years, 4 months. The results revealed that about half (48.3%) of the children with ADHD had abnormal EEG findings and that 22.1% of them had epileptiform discharges. Patients without comorbidity of autism spectrum disorder (ore homogenous group with ADHD) were especially likely to show abnormal EEG findings (51.0%) including epileptiform discharges (24.5%). Afebrile seizures, that is, epileptic seizures, occurred in a boy three days after commencement of administration with MPH as a sustained-action tablet. In four patients with a past history of epilepsy, neither relapse of EEG abnormality nor epileptic seizures were observed during the follow-up period. There was to be a significantly close relationship between ADHD and epileptiform discharges. Therefore, in patients with ADHD, it is important to obtain more precise information about seizures and presence of epilepsy from the personal and family histories, as well as to undertake a thorough EEG examination. Copyright © 2014 Elsevier Inc. All rights reserved.

[Analysis of Applying Chinese Medical Clinical Pathway for Treating Attention-deficit Hyperactivity Disorder].

PubMed

Guo, Yu-qing; Han, Xin-min; Zhu, Xian-kang; Zhou, Zheng; Ma, Bing-xiang; Zhang, Bao-qing; Li, Yan-ning; Feng, Yu-lin; Xue, Zheng; Wang, Yong-hong; Li, Yi-min; Jiang, Zhi-mei; Xu, Jin-xing; Yue, Wei-zhen; Xiang, Xi-xiong

2015-12-01

To evaluate the application effect of Chinese medical clinical pathway for treating attention-deficit hyperactivity disorder (ADHD), and to provide evidence for further improving clinical pathways. Totally 270 ADHD children patients were recruited and treated at pediatrics clinics of 9 cooperative hospitals from December 2011 to December 2012. The treatment course for all was 3 months. Scores of attention deficit and hyperactivity rating scale, scores of behavior, Conners index of hyperactivity (CIH), and Chinese medical syndrome scores were compared between before and after treatment. The efficacy difference in various sexes, ages, and disease courses were evaluated by judging standards for Chinese medical syndrome and ADHD. Fifteen children patients who entered clinical pathway dropped out, and the rest 255 completed this trial. Compared with before treatment, total scores of attention deficit and hyperactivity rating scale, scores of attention deficit and hyperactivity rating scale, CIH, and Chinese medical syndrome scores obviously decreased (all P < 0.01). The total effective rate in disease efficacy was 87.8% (224/255 cases), and the total effective rate in Chinese medical syndrome curative effect was 87.5% (223/255 cases). The clinical curative effect was not influenced by age, gender, or course of disease when statistically analyzed from judging standards for Chinese medical syndrome or for disease efficacy. Intervention by Chinese medical clinical pathway could improve ADHD patients' symptoms, and its efficacy was not influenced by sex, age, or course of disease.

ADHD-related symptoms, emotional/behavioral problems, and physical conditions in Taiwanese children with epilepsy.

PubMed

Tsai, Fang-Ju; Liu, Shu-Tsen; Lee, Chi-Mei; Lee, Wang-Tso; Fan, Pi-Chuan; Lin, Wei-Sheng; Chiu, Yen-Nan; Gau, Susan Shur-Fen

2013-07-01

Little is known about whether Asian children with epilepsy have more attention-deficit hyperactivity disorder (ADHD)-related symptoms, emotional/ behavioral problems, and physical conditions compared with those described in Western studies. The authors investigated the rates of ADHD-related symptoms, emotional/behavioral problems, and physical conditions among pediatric patients with epilepsy. We recruited 61 patients with epilepsy, aged 6-16 years, and 122 age-, sex-, and parental education-matched school controls. Data on demographics, parental reports on the Child Behavior Checklist (CBCL) and Swanson, Nolan, and Pelham, version IV scale (SNAP-IV), and medical records were collected. The average full-scale intelligence quotient of the case group was 95.8. There were 11 (18.0%), 7 (11.5%), 26 (42.6%), and 26 (42.6%) of children with epilepsy ever clinically diagnosed with developmental delay, overt ADHD symptoms, allergies reported by physicians, and behavior problems measured by the CBCL, respectively. Those children with epilepsy had more severe ADHD-related symptoms and a wider range of emotional/behavioral problems than controls (Cohen's d 0.36-0.80). The rate of potential cases of ADHD among children with epilepsy was 24.6%. A history of developmental delay predicted ADHD- related symptoms and internalizing and externalizing problems. Among children with epilepsy, a longer duration of treatment with antiepileptic drugs predicted externalizing problems, and an earlier onset of epilepsy predicted inattention and hyperactivity/impulsivity. Our findings imply that clinicians should assess physical and emotional/behavioral problems among children with epilepsy in order to provide interventions to offset possible adverse psychiatric outcomes. Copyright © 2012. Published by Elsevier B.V.

Pharmacotherapy of attention deficit in neurofibromatosis type 1: effects on cognition.

PubMed

Lidzba, Karen; Granstroem, Sofia; Leark, Robert A; Kraegeloh-Mann, Inge; Mautner, Victor-Felix

2014-08-01

 Attention deficit with or without hyperactivity (AD[H]D) is a common comorbidity of neurofibromatosis type 1 (NF 1). We tested the hypothesis that permanent medication with methylphenidate can improve cognitive functioning in children with NF 1 and comorbid AD(H)D.  We retrospectively analyzed data of a clinical sample of patients with NF 1 with or without AD(H)D, who underwent standardized neuropsychological diagnostics twice (age range: T1, 6-14 years; T2, 7-16 years; mean interval, 49.09 months). A total of 16 children without AD(H)D (nine females) were compared with 14 unmedicated children with AD(H)D (eight females) and to 13 medicated children with AD(H)D (two females). Effects of medication and attention on cognitive outcome (IQ) were tested by repeated measures analysis of covariance (rmANCOVA).  Medicated children with NF 1 improved significantly in full-scale IQ from T1 to T2 (IQ[T1] = 80.38, IQ[T2] = 98.38, confidence interval [diff]: -25.59 to -10.40, p < 0.0001), this effect was not evident for the other groups. With attention measures as covariates, the effect remained marginally significant.  Children and adolescents with NF 1 and comorbid AD(H)D may profit from MPH medication regarding general cognition. This effect could be specific for the group of patients with NF 1, and cannot be explained solely by improvements in attention. Controlled, prospective studies are warranted to corroborate our findings. Georg Thieme Verlag KG Stuttgart · New York.

Attention deficit-hyperactivity disorder is associated with reduced blood pressure and serum vitamin D levels: results from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS).

PubMed

Meyer, Thomas; Becker, Andreas; Sundermann, Jessika; Rothenberger, Aribert; Herrmann-Lingen, Christoph

2017-02-01

Alterations in blood pressure in attention-deficit/hyperactivity disorder (ADHD), specifically during dopaminergic stimulant intake, are not fully understood. It has been reported that vitamin D deficiency might modify dopaminergic pathways and thus influence ADHD symptoms. Using data from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study, we compared blood pressure and vitamin D levels in healthy controls to both diagnosed ADHD patients and suspected ADHD subjects, as defined by a value of ≥7 on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire. In a total cohort of n = 6922 study participants aged 11-17 years, mean arterial blood pressure was significantly higher in controls (86.7 ± 8.2 mmHg) than in the two groups of confirmed (85.5 ± 7.8 mmHg, p = 0.004, n = 430) and suspected ADHD patients (84.6 ± 8.2, p < 0.001, n = 399). In addition, we found an inverse association between vitamin D and blood pressure in both ADHD groups (p < 0.003). Regression analyses adjusted for age, sex, body-mass index, psychotropic medication use, and serum vitamin D levels confirmed that low blood pressure was a significant and independent predictor of ADHD. Furthermore, we observed that vitamin D mediated the effect of systolic blood pressure on ADHD diagnosis (b = 0.007, 95 % confidence interval [CI] 0.001-0.013, p = 0.021, R 2  = 0.050). In a large and representative national sample of German adolescents, we found a significant association between low blood pressure and ADHD symptoms. In addition, we observed that circulating vitamin D mediated the inverse relation between blood pressure and ADHD, although the effect size was very low. These findings highlight the role of dysregulated pathways of the autonomic nervous system in ADHD.

Atomoxetine treatment of attention-deficit/hyperactivity disorder in young adults with assessment of functional outcomes: a randomized, double-blind, placebo-controlled clinical trial.

PubMed

Durell, Todd M; Adler, Lenard A; Williams, Dave W; Deldar, Ahmed; McGough, James J; Glaser, Paul E; Rubin, Richard L; Pigott, Teresa A; Sarkis, Elias H; Fox, Bethany K

2013-02-01

Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairment in multiple functional domains. This trial evaluated efficacy in ADHD symptoms and functional outcomes in young adults treated with atomoxetine. Young adults (18-30 years old) with ADHD were randomized to 12 weeks of double-blind treatment with atomoxetine (n = 220) or placebo (n = 225). The primary efficacy measure of ADHD symptom change was Conners' Adult ADHD Rating Scale (CAARS): Investigator-Rated: Screening Version Total ADHD Symptoms score with adult prompts. Secondary outcomes scales included the Adult ADHD Quality of Life-29, Clinical Global Impression-ADHD-Severity, Patient Global Impression-Improvement, CAARS Self-Report, Behavior Rating Inventory of Executive Function-Adult Version Self-Report, and assessments of depression, anxiety, sleepiness, driving behaviors, social adaptation, and substance use. Atomoxetine was superior to placebo on CAARS: Investigator-Rated: Screening Version (atomoxetine [least-squares mean ± SE, -13.6 ± 0.8] vs placebo [-9.3 ± 0.8], 95% confidence interval [-6.35 to -2.37], P < 0.001), Clinical Global Impression-ADHD-Severity (atomoxetine [-1.1 ± 0.1] vs placebo [-0.7 ± 0.1], 95% confidence interval [-0.63 to -0.24], P < 0.001), and CAARS Self-Report (atomoxetine [-11.9 ± 0.8] vs placebo [-7.8 ± 0.7], 95% confidence interval [-5.94 to -2.15], P < 0.001) but not on Patient Global Impression-Improvement. In addition, atomoxetine was superior to placebo on Adult ADHD Quality of Life-29 and Behavior Rating Inventory of Executive Function-Adult Version Self-Report. Additional assessments failed to detect significant differences (P ≥ 0.05) between atomoxetine and placebo. The adverse event profile was similar to that observed in other atomoxetine studies. Nausea, decreased appetite, insomnia, dry mouth, irritability, dizziness, and dyspepsia were reported significantly more often with atomoxetine than with placebo. Atomoxetine reduced ADHD symptoms and improved quality of life and executive functioning deficits in young adults compared with placebo. Atomoxetine was also generally well tolerated.

Self-esteem in adolescent patients with attention-deficit/hyperactivity disorder during open-label atomoxetine treatment: psychometric evaluation of the Rosenberg Self-Esteem Scale and clinical findings.

PubMed

Dittmann, Ralf W; Wehmeier, Peter M; Schacht, Alexander; Lehmann, Martin; Lehmkuhl, Gerd

2009-12-01

To report on (1) psychometric properties of the Rosenberg Self-Esteem Scale (SES) studied in adolescents with ADHD, (2) correlations of SES with ADHD scale scores, and (3) change in patient-reported self-esteem with atomoxetine treatment. ADHD patients (12-17 years), treated in an open-label study for 24 weeks. Secondary analyses on ADHD symptoms (assessed with ADHD-RS, CGI, GIPD scales) and self-esteem (SES) were performed. One hundred and fifty-nine patients were treated. A dichotomous structure of the SES could be confirmed. Reliability and internal consistency were moderate to excellent. Highest coefficients were found for the correlation between SES and GIPD scores. Self-esteem significantly increased over time, accompanied by an improvement of ADHD symptoms and related perceived difficulties. The Rosenberg SES was shown to be internally consistent, reliable, and sensitive to treatment-related changes of self-esteem. According to these findings, self-esteem may be an important individual patient outcome beyond the core symptoms of ADHD. © The Author(s) 2009. This article is published with open access at Springerlink.com

Behavioral and Neural Sustained Attention Deficits in Disruptive Mood Dysregulation Disorder and Attention-Deficit/Hyperactivity Disorder.

PubMed

Pagliaccio, David; Wiggins, Jillian Lee; Adleman, Nancy E; Curhan, Alexa; Zhang, Susan; Towbin, Kenneth E; Brotman, Melissa A; Pine, Daniel S; Leibenluft, Ellen

2017-05-01

Disruptive mood dysregulation disorder (DMDD), characterized by severe irritability, and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid. This is the first study to characterize neural and behavioral similarities and differences in attentional functioning across these disorders. Twenty-seven healthy volunteers, 31 patients with DMDD, and 25 patients with ADHD (8 to 18 years old) completed a functional magnetic resonance imaging attention task. Group differences in intra-subject variability in reaction time (RT) were examined. The present functional magnetic resonance imaging analytic approach precisely quantified trial-wise associations between RT and brain activity. Group differences manifested in the relation between RT and brain activity (all regions: p < .01, F > 2.54, partial eta-squared [η p 2 ] > 0.06). Patients with DMDD showed specific alterations in the right paracentral lobule, superior parietal lobule, fusiform gyrus, and cerebellar culmen. In contrast, patients with DMDD and those with ADHD exhibited blunted compensatory increases in activity on long RT trials. In addition, youth with DMDD exhibited increased activity in the postcentral gyrus, medial frontal gyrus, and cerebellar tonsil and declive (all regions: p < .05, F > 2.46, η p 2 > 0.06). Groups in the imaging sample did not differ significantly in intra-subject variability in RT (F 2,79  = 2.664, p = .076, η p 2  = 0.063), although intra-subject variability in RT was significantly increased in youth with DMDD and ADHD when including those not meeting strict motion and accuracy criteria for imaging analysis (F 2,96  = 4.283, p = .017, η p 2  = 0.083). Patients with DMDD exhibited specific alterations in the relation between pre-stimulus brain activity and RT. Patients with DMDD and those with ADHD exhibited similar blunting of compensatory neural activity in frontal, parietal, and other regions. In addition, patients with DMDD showed increased RT variability compared with healthy youth. This work is the first to identify common and unique behavioral and neural signatures of DMDD and ADHD. Published by Elsevier Inc.

Assessment of effects of atomoxetine in adult patients with ADHD: consistency among three geographic regions in a response maintenance study.

PubMed

Tanaka, Yoko; Escobar, Rodrigo; Upadhyaya, Himanshu P

2017-06-01

A previous study (Upadhyaya et al. in Eur J Psychiatry 2013b; 27:185-205) reported that adults with attention-deficit/hyperactivity disorder (ADHD) demonstrated maintenance of response for up to 25 weeks after initially responding to atomoxetine treatment. In the present report, the consistency of treatment effect across three geographic regions (Europe, United States/Canada [US/Can], and Latin America [Latin Am]) was explored. Data were analyzed from a phase 3, multicenter, randomized, double-blind, maintenance-of-response (randomized withdrawal) trial of atomoxetine versus placebo in adults with ADHD. Patients were randomized to atomoxetine (N = 266) or placebo (N = 258) for 25 weeks. Consistency assessments included the interaction test, pairwise t tests, noninferiority, and the criteria from Basic Principles on Global Clinical Trials (Ministry of Health, Labour and Welfare of Japan 2007). Atomoxetine-treated patients maintained the improved ADHD symptoms relative to placebo-treated patients on the Conners' Adult ADHD Rating Scale Investigator-Rated: Screening Version 18-Item (CAARS-Inv:SV) total score in all three regions (atomoxetine-placebo mean difference = -4.55, -3.18, and -0.07 for Europe, US/Can, and Latin Am, respectively). For the Latin Am region, the mean change in total score (0.41) was notably smaller for the placebo group than for Europe (5.87) and US/Can (4.39). Similar results were observed for the CAARS-Inv:SV hyperactivity/impulsivity and inattention subscale scores. Overall, patients maintained the response with atomoxetine treatment compared to placebo; however, the magnitude of treatment effect differed among the regions studied, being numerically higher in the EU and US/Can than Latin Am. Trial registration http://www.clinicaltrials.gov/(NCT00700427 ).

[Update on attention-deficit/hyperactive disorder treatment].

PubMed

Loro-López, M; Quintero, J; García-Campos, N; Jiménez-Gómez, B; Pando, F; Varela-Casal, P; Campos, J A; Correas-Lauffer, J

Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient's every day life. AIM. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment. As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal. The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient's family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders' patients.

Comparing ADHD in Velocardiofacial Syndrome to Idiopathic ADHD: A Preliminary Study

ERIC Educational Resources Information Center

Antshel, Kevin M.; Faraone, Stephen V.; Fremont, Wanda; Monuteaux, Michael C.; Kates, Wendy R.; Doyle, Alysa; Mick, Eric; Biederman, Joseph

2007-01-01

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…

Color Vision Deficiency and Functional Disorders Among Israeli Male Adolescents Between 2007 and 2013.

PubMed

Berger, Assaf; Findler, Michael; Maymon, Dror; Korach, Tzfanya; Yativ, Oshrat Fono; Gronovich, Yoav; Hassidim, Ayal

2016-09-01

Color vision deficiency has been associated with educational difficulties among male children, as well as attention-deficit hyperactivity disorder (ADHD). We examined the association of color vision deficiency with functional conditions, including ADHD, irritable bowel syndrome, enuresis and somatoform disorders, in a large population of male adolescents. We included all Israeli male adolescents that underwent medical and cognitive examinations during conscription between the years 2007 and 2013. The prevalence of ADHD, irritable bowel syndrome, enuresis, and somatoform disorders among color vision deficiency patients was compared to a control group. The study included 305 964 males aging 17 ± 0.6, of which 7584 (2.5%) had color vision deficiency. Using a multivariable analysis, the probability for irritable bowel syndrome, enuresis, and somatoform disorders among color vision deficiency patients was increased by 1.41, 1.94, and 3.87, respectively (P < .05). No significant association was found between ADHD and color vision deficiency. Color vision abnormalities are associated with functional disorders in male adolescents, including irritable bowel syndrome, enuresis, and somatoform disorders. © The Author(s) 2016.

ADHD knowledge, perceptions, and information sources: perspectives from a community sample of adolescents and their parents.

PubMed

Bussing, Regina; Zima, Bonnie T; Mason, Dana M; Meyer, Johanna M; White, Kimberly; Garvan, Cynthia W

2012-12-01

The chronic illness model advocates for psychoeducation within a collaborative care model to enhance outcomes. To inform psychoeducational approaches for ADHD, this study describes parent and adolescent knowledge, perceptions, and information sources and explores how these vary by sociodemographic characteristics, ADHD risk, and past child mental health service use. Parents and adolescents were assessed 7.7 years after initial school district screening for ADHD risk. The study sample included 374 adolescents (56% high and 44% low ADHD risk) aged, on average, 15.4 (standard deviation = 1.8) years, and 36% were African American. Survey questions assessed ADHD knowledge, perceptions, and cues to action and elicited used and preferred information sources. Multiple logistic regression was used to determine potential independent predictors of ADHD knowledge. McNemar tests compared information source utilization against preference. Despite relatively high self-rated ADHD familiarity, misperceptions among parents and adolescents were common, including a sugar etiology (25% and 27%, respectively) and medication overuse (85% and 67%, respectively). African American respondents expressed less ADHD awareness and greater belief in sugar etiology than Caucasians. Parents used a wide range of ADHD information sources, whereas adolescents relied on social network members and teachers/school. However, parents and adolescents expressed similar strong preferences for the Internet (49% and 51%, respectively) and doctor (40% and 27%, respectively) as ADHD information sources. Culturally appropriate psychoeducational strategies are needed that combine doctor-provided ADHD information with reputable Internet sources. Despite time limitations during patient visits, both parents and teens place high priority on receiving information from their doctor. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Informativeness of Self-Reports of ADHD Symptoms in Monitoring Response to Stimulant Treatment in Clinically Referred Adults With ADHD.

PubMed

Biederman, Joseph; Fitzgerald, Maura; Spencer, Thomas J; Adler, Lenard A; Abrams, Jessica; Biederman, Itai; Faraone, Stephen V

2018-05-01

To investigate the informativeness of self-reports of ADHD symptoms in adults with ADHD in the clinical setting. Subjects were clinically referred adults aged 19 years to 67 years of age of both sexes ( N = 54). All subjects were on stable doses of stimulant and were considered responders to treatment. ADHD symptoms were assessed using the ADHD Investigator Symptom Rating Scale (AISRS) and the ADHD Self-Report Scale (ASRS). Spearman's rank correlations were used to assess the correlations between clinician-assessed ADHD and patients' self-reports. Spearman's rank correlation analysis found evidence of a strong, positive association between total scores on the AISRS and the ASRS ( rs = .65, df = 52, p< .001). Results have important implications for the management and monitoring of treatment response in the clinical setting through patients' self-report.

Differences in methylphenidate abuse rates among methadone maintenance treatment patients in two clinics.

PubMed

Peles, Einat; Schreiber, Shaul; Linzy, Shirley; Domani, Yoav; Adelson, Miriam

2015-07-01

Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6 months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p = 0.01), had higher ADHD scores (p = 0.02), lower cognitive scores (p = 0.05), and a higher benzodiazepine (BDZ) abuse rate (p < 0.0005), with no difference in age, gender, duration in MMT, cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study. Copyright © 2015 Elsevier Inc. All rights reserved.

Nonpharmacologic Treatments for Attention-Deficit/Hyperactivity Disorder: A Systematic Review.

PubMed

Goode, Adam P; Coeytaux, Remy R; Maslow, Gary R; Davis, Naomi; Hill, Sherika; Namdari, Behrouz; LaPointe, Nancy M Allen; Befus, Deanna; Lallinger, Kathryn R; Bowen, Samantha E; Kosinski, Andrzej; McBroom, Amanda J; Sanders, Gillian D; Kemper, Alex R

2018-06-01

Nonpharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) encompass a range of care approaches from structured behavioral interventions to complementary medicines. To assess the comparative effectiveness of nonpharmacologic treatments for ADHD among individuals 17 years of age and younger. PubMed, Embase, PsycINFO, and Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2009 through November 7, 2016. We included studies that compared any ADHD nonpharmacologic treatment strategy with placebo, pharmacologic, or another nonpharmacologic treatment. Study design, patient characteristics, intervention approaches, follow-up times, and outcomes were abstracted. For comparisons with at least 3 similar studies, random-effects meta-analysis was used to generate pooled estimates. We identified 54 studies of nonpharmacologic treatments, including neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. No new guidance was identified regarding the comparative effectiveness of nonpharmacologic treatments. Pooled results for omega fatty acids found no significant effects for parent rating of ADHD total symptoms ( n = 411; standardized mean difference -0.32; 95% confidence interval -0.80 to 0.15; I 2 = 52.4%; P = .10) or teacher-rated total ADHD symptoms ( n = 287; standardized mean difference -0.08; 95% confidence interval -0.47 to 0.32; I 2 = 0.0%; P = .56). Studies often did not reflect the primary care setting and had short follow-up periods, small sample sizes, variations in outcomes, and inconsistent reporting of comparative statistical analyses. Despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments. Copyright © 2018 by the American Academy of Pediatrics.

Diminished central nervous 5-HT neurotransmission and mood self-ratings in children and adolescents with ADHD: no clear effect of rapid tryptophan depletion.

PubMed

Zepf, Florian Daniel; Holtmann, Martin; Stadler, Christina; Magnus, Sophie; Wöckel, Lars; Poustka, Fritz

2009-03-01

Research on 5-HT-functioning in adult patients and healthy subjects using rapid tryptophan depletion (RTD) has indicated weak but stable effects on mood ratings. Altered mood in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) can confound the differential diagnosis between severe ADHD and mood disorders such as pediatric bipolar disorder. The present study investigated the effects of RTD induced lowered central nervous 5-HT-levels on mood self-ratings in children with ADHD. Seventeen boys with ADHD participated in the study in a double-blind within-subject crossover-design. They were administered RTD within an amino acid drink lacking tryptophan, thus lowering central nervous 5-HT-synthesis. On another day they received a placebo. Self-rated mood was assessed on both days at baseline conditions and at three different post-drink time-points. RTD had no clear effect on mood within the whole sample. Low scorers on venturesomeness were more strongly affected by RTD in terms of feelings of inactivity and negative feelings compared to high venture patients. Our data did not show a significant effect of RTD on mood self-ratings. However, the findings must be considered as preliminary and require further replication, in particular as they could be due to sampling bias.

[Attention deficit hyperactivity disorder and its relation to social skills and leadership evaluated with an evaluation system of the behavior of children and adolescents (BASC)].

PubMed

Fernández-Jaén, Alberto; Fernández-Mayoralas, Daniel M; López-Arribas, Sonia; García-Savaté, Carolina; Muñiz-Borrega, Blanca; Pardos-Véglia, Alexandra; Prados-Parra, Baldomero; Calleja-Pérez, Beatriz; Muñoz-Jareño, Nuria

2011-01-01

Numerous studies have documented that children with attention deficit hyperactivity disorder (ADHD) show a low social competence. To compare the symptomatic severity of ADHD, as well as associations to different subtypes, sex and comorbidities, with social functioning ("ability" and "leadership") estimated through a Behavior Assessment System for Children (BASC) for parents and teachers. We have retrospectively analyzed 170 patients with ADHD, diagnosed between 2007 and 2010. Social "ability," "leadership," "hyperactivity" and "attention deficit" sections of BASC and cardinal symptoms of ADHD measured through a Spanish scale for de evaluation of DHD (E-DHD) were registered. Results of these variables are analyzed according to the normative data by age and sex, and processed in Z values. The ratings for social skills were significantly lower in patients with conduct disorder or oppositional defiant disorder as informed by parents (p<0.05). Symptomatic intensity of ADHD showed significant (p<0,001) and inverse relation with social "ability" as parents. "Attention-deficit" scores were related with social "ability" and "leadership" as parents and teachers. Intensity of attention deficit was the only variable that showed a significant relation with the social skills and leadership according to the BASC scores, independently of the informer.

The patient-centered medical home, practice patterns, and functional outcomes for children with attention deficit/hyperactivity disorder.

PubMed

Toomey, Sara L; Chan, Eugenia; Ratner, Jessica A; Schuster, Mark A

2011-01-01

To determine whether children with attention deficit/hyperactivity disorder (ADHD) receive care in a patient-centered medical home (PCMH) and how that relates to their ADHD treatment and functional outcomes. Cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91,642 parents. This analysis covers 5169 children with parent-reported ADHD ages 6-17. The independent variable is receiving care in a PCMH. Main outcome measures are receiving ADHD medication, mental health specialist involvement, and functional outcomes (difficulties with participation in activities, attending school, making friends; having problem behaviors; missed school days; and number of times parents contacted by school). Only 44% of children with ADHD received care in a PCMH. Children with ADHD receiving care in a PCMH compared with those who did not were more likely to receive medication for ADHD (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.9); less likely to have mental health specialist involvement (OR, 0.6; 95% CI, 0.4-0.7); less likely to have difficulties participating in activities (OR, 0.6; 95% CI 0.4-0.8), making friends (OR, 0.6; 95% CI, 0.5-0.9), and attending school (OR, 0.4; 95% CI, 0.3-06); less likely to have problem behaviors (OR 0.6; 95% CI 0.5-0.9); had fewer missed school days (β = -1.5, 95% CI -2.4 to -0.5); and parents were contacted by school less frequently (β = -0.2, 95% CI -0.3 to -0.1). For children with ADHD, receiving care in a PCMH is associated with practice pattern change and better outcomes. The PCMH may represent a promising opportunity to improve quality of care and outcomes for children with ADHD. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Cross-cultural reliability and validity of ADHD assessed by the ADHD Rating Scale in a pan-European study.

PubMed

Döpfner, Manfred; Steinhausen, Hans-Christoph; Coghill, David; Dalsgaard, Søren; Poole, Lynne; Ralston, Stephen J; Rothenberger, Aribert

2006-12-01

To provide psychometric information on the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-IV (ADHD-RS-IV) in a large population of children with ADHD. Patients aged 6-18 years (n=1,478 in baseline analysis) were rated by 244 physicians on the ADHD-RS-IV based on a semi-structured interview with the patient's parent. Physicians additionally rated functional impairment (CGAS) and health status (CGI-S), and parents rated their child's behavioural and emotional problems (SDQ) and quality of life (CHIP-CE). Inattention and hyperactivity-impulsivity as dimensions of ADHD were replicated. 3-factor solutions reflecting the ICD-10 definition, with hyperactivity, impulsivity and inattention as separate dimensions were extracted in some national sub-samples and in separate analyses for boys and younger children.Good internal consistencies, strong country effects and small effects of age were found. Based on ADHD-RS-IV, 88.5% of patients met the criteria for any ADHD diagnosis. Correlations between ADHD-RS-IV and measures of functional impairment were low but statistically significant. The correlations with SDQ and CHIP-CE scales confirm the convergent and divergent validity of ADHD-RS-IV. Impressive evidence for the cross-cultural factorial validity, internal consistency as well as convergent and divergent validity of ADHD-RS-IV was found. ADHD can be assessed reliably and validly in routine care across Europe. The ICD-10 3-factor model seems to be less robust than the DSM-IV 2-factor model, but may be a good description for special populations (boys, younger children).

[ADHD and addiction; application of the Belgian guideline with particular reference to comorbid affective disorders].

PubMed

Matthys, F; Joostens, P; Tremmery, S; Stes, S; Sabbe, B

2013-01-01

Two patients with a multi-substance use disorder and an apparent comorbid ADHD disorder were given psychiatric treatment for both illnesses. Each patient had a comorbid affective disorder. In both cases the approach was based on the Belgian guideline Good clinical practice in the recognition and treatment of young adults with addiction problems& squo. We use the case-reports to demonstrate the usefulness and relevance of the guideline in an outpatient setting compared to an inpatient setting and look particularly at the implications of other kinds of comorbidity encompassed by the guideline.

Cortical deficits of emotional face processing in adults with ADHD: its relation to social cognition and executive function.

PubMed

Ibáñez, Agustin; Petroni, Agustin; Urquina, Hugo; Torrente, Fernando; Torralva, Teresa; Hurtado, Esteban; Guex, Raphael; Blenkmann, Alejandro; Beltrachini, Leandro; Muravchik, Carlos; Baez, Sandra; Cetkovich, Marcelo; Sigman, Mariano; Lischinsky, Alicia; Manes, Facundo

2011-01-01

Although it has been shown that adults with attention-deficit hyperactivity disorder (ADHD) have impaired social cognition, no previous study has reported the brain correlates of face valence processing. This study looked for behavioral, neuropsychological, and electrophysiological markers of emotion processing for faces (N170) in adult ADHD compared to controls matched by age, gender, educational level, and handedness. We designed an event-related potential (ERP) study based on a dual valence task (DVT), in which faces and words were presented to test the effects of stimulus type (faces, words, or face-word stimuli) and valence (positive versus negative). Individual signatures of cognitive functioning in participants with ADHD and controls were assessed with a comprehensive neuropsychological evaluation, including executive functioning (EF) and theory of mind (ToM). Compared to controls, the adult ADHD group showed deficits in N170 emotion modulation for facial stimuli. These N170 impairments were observed in the absence of any deficit in facial structural processing, suggesting a specific ADHD impairment in early facial emotion modulation. The cortical current density mapping of N170 yielded a main neural source of N170 at posterior section of fusiform gyrus (maximum at left hemisphere for words and right hemisphere for faces and simultaneous stimuli). Neural generators of N170 (fusiform gyrus) were reduced in ADHD. In those patients, N170 emotion processing was associated with performance on an emotional inference ToM task, and N170 from simultaneous stimuli was associated with EF, especially working memory. This is the first report to reveal an adult ADHD-specific impairment in the cortical modulation of emotion for faces and an association between N170 cortical measures and ToM and EF.

Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder.

PubMed

Curry, Allison E; Metzger, Kristina B; Pfeiffer, Melissa R; Elliott, Michael R; Winston, Flaura K; Power, Thomas J

2017-08-01

Attention-deficit/hyperactivity disorder (ADHD) often persists into adolescence, when motor vehicle crash risk peaks. We know little about when adolescents with ADHD get licensed and, once they do, the extent to which they have increased crash risk compared with adolescents without ADHD. To examine the association between ADHD and both driver licensing and crash involvement and whether it varies by sex, licensing age, and/or being prescribed ADHD medication at licensure. This retrospective cohort study was conducted at 6 primary care practices of the Children's Hospital of Philadelphia, a large pediatric health care network in southeastern Pennsylvania and southern New Jersey. Using electronic health records, we defined a cohort of 2479 adolescents and young adults with ADHD and 15 865 without ADHD who were (1) born from 1987 to 1997; (2) residents of New Jersey and patients at 1 of 6 New Jersey primary care practices at age 12 years or older; and (3) age-eligible to obtain a driver's license from 2004 through 2014. Electronic health records data were then linked with New Jersey's statewide driver licensing and crash databases for 2004 through 2014. Acquisition of a driver's license and first involvement as a driver in a police-reported crash. Survival analysis was used to estimate adjusted hazard ratios for licensing and crash outcomes through age 25 years. The median age of individuals at the end of the study was 22.2 years (interquartile range, 19.7-24.8). Compared with individuals without ADHD, the licensing probability of individuals with ADHD 6 months after eligibility was 35% lower (for males: adjusted hazard ratio, 0.65; 95% CI, 0.61-0.70; females: adjusted hazard ratio, 0.64; 95% CI, 0.58-0.70). Among individuals with a driver's license, 764 of 1785 with ADHD (42.8%) and 4715 of 13 221 without ADHD (35.7%) crashed during the study period. The adjusted risk for first crash among licensed drivers with ADHD was 1.36 times higher than for those without ADHD (95% CI, 1.25-1.48) and did not vary by sex, licensing age, or over time. Only 129 individuals with ADHD (12.1%) were prescribed medication in the 30 days before licensure. Adolescents with ADHD get licensed less often and at an older age. Once licensed, this cohort has a greater risk of crashing. Additional research is needed to understand the specific mechanisms by which ADHD influences crash risk.

ADHD and behavioral disorders: Assessment, management, and an update from DSM-5.

PubMed

Austerman, Joseph

2015-11-01

Behavioral disorders in pediatric patients--primarily attention deficit hyperactivity disorder (ADHD)--pose a clinical challenge for health care providers to accurately assess, diagnose, and treat. In 2013, updated diagnostic criteria for behavioral disorders were published, including ADHD and a new diagnostic entity: disruptive mood dysregulation disorder. Revised criteria for ADHD includes oldest age for occurrence of symptoms, need for symptoms to be present in more than one setting, and requirement for number of symptoms in those aged 17 and older. Assessment of ADHD relies primarily on the clinical interview, including the medical and social history, along with the aid of objective measures. The clinical course of ADHD is chronic with symptom onset occurring well before adolescence. Most patients have symptoms that continue into adolescence, and some into adulthood. Many patients with ADHD have comorbid disorders such as depression, disruptive behavior disorders, or substance abuse, which need to be addressed first in the treatment plan. Treatment of ADHD relies on a combination of psychopharmacologic, academic, and behavioral interventions, which produce response rates up to 80%. Copyright © 2015 Cleveland Clinic.

[Awareness of adult attention-deficit/hyperactivity disorder (ADHD) in Greece].

PubMed

Pehlivanidis, A

2012-06-01

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopment disorder of childhood that persists into adulthood in the majority of cases. In adults, the clinical picture of ADHD is complex and comorbidity with other psychiatric disorders is the rule. The documentation that the disorder had a childhood onset and the various comorbid symptomatologies present both in childhood and adult life represent the most influential obstacles for the accurate clinical diagnosis of the disorder. In 75% of cases with adult ADHD there is at least one coexisting comorbid disorder, with anxiety and mood disorders as well as substance abuse and impulse control disorders being the most prevalent ones. Adult psychiatrists have limited experience in the diagnosis, treatment and overall management of the disorder. Greece is a member of the European Network Adult ADHD (ENAA), founded in 2003, aiming to increase awareness of the disorder and to improve knowledge and patient care for adults with ADHD across Europe. A clinic where diagnosis as well as treatment recommendations are given after a thorough assessment of adult ADHD patients, is hosted at the First Department of Psychiatry of the Athens National and Kapodistian University. The clinic is in close collaboration with ENAA. The diagnosis of ADHD is given after a detailed evaluation of the patient, based on history taken, self-administered questionnaires and a specific psychiatric interview. The reliable trace of the symptoms' onset back in early childhood, current symptomatology, as well as its impact on at least two major areas of functioning (school, home, work or personal relationships) are pivotal for the assessment procedure. Special attention should be paid in the distinction of symptoms often coexisting with the core symptoms of the ADHD, such as emotional liability, incessant mental activity, avoidance of situations like queuing, especially when there is also frustration, from those indicating a comorbid disorder, e.g. bipolar disorder, major depression, anxiety disorders or personality disorders. Its coexistence with substance abuse requires special attention, as ADHD is quite prevalent in this group. In order to treat an ADHD patient the rule is a multidimensional intervention. Comorbid psychiatric disorders must be treated first. Psychoeducation of the patient is needed in most of the cases as well as the admin istration of specific for the ADHD psychotropic medication. Coaching, Cognitive Therapy and family interventions are proved to be the most efficacious psychosocial treatments. In the context of our university outpatients' clinic an observation study for exploring the occurrence of ADHD among patients with anxiety and depressive disorders took place. 15% of patients with anxiety and depressive disorders received for the first time in their lives the diagnosis of ADHD. The above mentioned indicate the need for further training psychiatrists in the recognition and treatment of adult ADHD.

Orbitofrontal reward sensitivity and impulsivity in adult attention deficit hyperactivity disorder.

PubMed

Wilbertz, Gregor; van Elst, Ludger Tebartz; Delgado, Mauricio R; Maier, Simon; Feige, Bernd; Philipsen, Alexandra; Blechert, Jens

2012-03-01

Impulsivity symptoms of adult attention deficit hyperactivity disorder (ADHD) such as increased risk taking have been linked with impaired reward processing. Previous studies have focused on reward anticipation or on rewarded executive functioning tasks and have described a striatal hyporesponsiveness and orbitofrontal alterations in adult and adolescent ADHD. Passive reward delivery and its link to behavioral impulsivity are less well understood. To study this crucial aspect of reward processing we used functional magnetic resonance imaging (fMRI) combined with electrodermal assessment in male and female adult ADHD patients (N=28) and matched healthy control participants (N=28) during delivery of monetary and non-monetary rewards. Further, two behavioral tasks assessed risky decision making (game of dice task) and delay discounting. Results indicated that both groups activated ventral and dorsal striatum and the medial orbitofrontal cortex (mOFC) in response to high-incentive (i.e. monetary) rewards. A similar, albeit less strong activation pattern was found for low-incentive (i.e. non-monetary) rewards. Group differences emerged when comparing high and low incentive rewards directly: activation in the mOFC coded for the motivational change in reward delivery in healthy controls, but not ADHD patients. Additionally, this dysfunctional mOFC activity in patients correlated with risky decision making and delay discounting and was paralleled by physiological arousal. Together, these results suggest that the mOFC codes reward value and type in healthy individuals whereas this function is deficient in ADHD. The brain-behavior correlations suggest that this deficit might be related to behavioral impulsivity. Reward value processing difficulties in ADHD should be considered when assessing reward anticipation and emotional learning in research and applied settings. Copyright © 2011 Elsevier Inc. All rights reserved.

Economic Burden of Attention-Deficit/Hyperactivity Disorder among Pediatric Patients in the United States.

PubMed

Gupte-Singh, Komal; Singh, Rakesh R; Lawson, Kenneth A

2017-04-01

To determine the adjusted incremental total costs (direct and indirect) for patients (aged 3-17 years) with attention-deficit/hyperactivity disorder (ADHD) and the differences in the adjusted incremental direct expenditures with respect to age groups (preschoolers, 0-5 years; children, 6-11 years; and adolescents, 12-17 years). The 2011 Medical Expenditure Panel Survey was used as the data source. The ADHD cohort consisted of patients aged 0 to 17 years with a diagnosis of ADHD, whereas the non-ADHD cohort consisted of subjects in the same age range without a diagnosis of ADHD. The annual incremental total cost of ADHD is composed of the incremental direct expenditures and indirect costs. A two-part model with a logistic regression (first part) and a generalized linear model (second part) was used to estimate the incremental costs of ADHD while controlling for patient characteristics and access-to-care variables. The 2011 Medical Expenditure Panel Survey database included 9108 individuals aged 0 to 17 years, with 458 (5.0%) having an ADHD diagnosis. The ADHD cohort was 4.90 times more likely (95% confidence interval [CI] 2.97-8.08; P < 0.001) than the non-ADHD cohort to have an expenditure of at least $1, and among those with positive expenditures, the ADHD cohort had 58.4% higher expenditures than the non-ADHD cohort (P < 0.001). The estimated adjusted annual total incremental cost of ADHD was $949.24 (95% CI $593.30-$1305.18; P < 0.001). The adjusted annual incremental total direct expenditure for ADHD was higher among preschoolers ($989.34; 95% CI $402.70-$1575.98; P = 0.001) than among adolescents ($894.94; 95% CI $428.16-$1361.71; P < 0.001) or children ($682.71; 95% CI $347.94-$1017.48; P < 0.001). Early diagnosis and use of evidence-based treatments may address the substantial burden of ADHD. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Treatment of adult ADHD: a clinical perspective

PubMed Central

Geffen, Josh; Forster, Kieran

2017-01-01

Adult attention deficit/hyperactivity disorder (ADHD) has moved from the blurred edge of clinical focus to clear recognition as a prevalent and significant disorder in its own right. It is a relatively common comorbidity which if identified and treated may open the door to better outcomes for hard-to-treat patients. Conversely, failure to identify and treat adult ADHD is linked to negative outcomes. The recognition of the importance of adult ADHD in a subset of our patients challenges us to overcome our anxiety about this diagnosis and prevent the societal marginalization of vulnerable patients. Adult ADHD responds well to integrated pharmacological and psychotherapeutic intervention. Its treatment responsiveness reduces disability and allows the comorbidity which is typically present to be addressed. Mastering this challenge can make the diagnosis and treatment of adult ADHD a rewarding experience. PMID:29344341

Caloric and nutrient intake in children with attention deficit hyperactivity disorder treated with extended-release methylphenidate: analysis of a cross-sectional nutrition survey.

PubMed

Durá-Travé, Teodoro; Gallinas-Victoriano, Fidel

2014-02-01

To study calorie and nutrients intake in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) under treatment with extended-release methylphenidate (MPH-ER), and to analyse the need to design nutrition intervention strategies. Observational (case-control). Navarra Hospital Complex, Pamplona, Spain. A total of 100 patients diagnosed with ADHD under treatment with MPH-ER and 100 healthy children (control group). A nutrition survey was carried out (food intake registration of 3 consecutive school days). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. Nutritional status in ADHD group was significantly lower (p < 0.05) than in control group. Calorie intake in mid-morning snack, lunch and afternoon snack was significantly higher (p < 0.05) in the control group. Calorie intake in supper was significantly higher (p < 0.05) in the ADHD group. There were no significant differences in breakfast. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake, in control group was significantly higher than in ADHD group. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in healthy population of similar age. The need to impart programmes of nutrition education simultaneously with multimodal treatment in order to avoid the nutrition consequences of treatment with MPH should be considered.

Electrophysiological Correlates of Semantic Processing during Encoding of Neutral and Emotional Pictures in Patients with ADHD

ERIC Educational Resources Information Center

Krauel, Kerstin; Duzel, Emrah; Hinrichs, Hermann; Lenz, Daniel; Herrmann, Christoph S.; Santel, Stephanie; Rellum, Thomas; Baving, Lioba

2009-01-01

The current study investigated the relevance of semantic processing and stimulus salience for memory performance in young ADHD patients and healthy control participants. 18 male ADHD patients and 15 healthy control children and adolescents participated in an ERP study during a visual memory paradigm with two different encoding tasks requiring…

Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany.

PubMed

Greven, Peter; Sikirica, Vanja; Chen, Yaozhu J; Curtice, Tammy G; Makin, Charles

2017-09-01

Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families. A retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6-17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy. Patients received at least one prescription for their index medication (ATX/LA-MPH) during 2006-2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index. No significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients. These real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.

Experienced consequences of being diagnosed with ADHD as an adult - a qualitative study.

PubMed

Hansson Halleröd, Sara Lina; Anckarsäter, Henrik; Råstam, Maria; Hansson Scherman, Marianne

2015-02-26

Despite increasing knowledge of attention deficit hyperactivity disorder (ADHD) across the life span, there is still little research on adults' own experiences of being diagnosed with ADHD. The aim of the present study was to explore and describe patients' experiences and perceptions of being diagnosed with ADHD in adulthood. The study can be seen as an attempt to validate the diagnosis from a patient perspective. Twenty-one adults diagnosed with ADHD were individually interviewed. The interviews were open-ended and exploratory, analysed with a qualitative phenomenographical approach, and the results were described in categories. Positive experiences were dominant, but there was a complex intra- and inter-individual variation of experiences. Descriptions focused on the diagnosis, on identity, and on life. The diagnosis was described as explaining a previously inexplicable life history, but was also questioned, both as a phenomenon and in relation to the individual (the diagnosis in focus). It was experienced as providing self-knowledge and increased value, but could also cause devaluation and concern about identity (identity in focus). It meant help to achieve a better life, but was also perceived to restrict possibilities and cause disappointment over lack of professional help. It could lead to a wish for an earlier diagnosis that could have spared suffering, as well as to a changed view of the participants' relatives (life in focus). All but one of the interviewees expressed important positive consequences of being diagnosed with ADHD. About half of them acknowledged negative aspects of being diagnosed, but none regretted going through the neuropsychiatric evaluation. From a patient perspective, there are major positive consequences of being diagnosed with ADHD, compared to the undiagnosed situation. Knowledge of the individual's combination of experiences is important for professionals, as these experiences can affect well-being and interfere with treatment. Negative experiences in particular might need to be addressed in the treatment work.

A survey of adult referrals to specialist attention-deficit/hyperactivity disorder clinics in Canada

PubMed Central

Klassen, Larry J; Blackwood, C Matthew; Reaume, Christopher J; Schaffer, Samuel; Burns, James G

2018-01-01

Background Canadian guidelines encourage family physicians to diagnose/manage adults with uncomplicated attention-deficit/hyperactivity disorder (ADHD); specialist referral is recommended only for complex cases. This retrospective case review investigated adults referred to Canadian ADHD clinics. Methods Adult ADHD specialists reviewed referral letters/charts of patients (aged ≥18 years and no family history/known/expressed childhood ADHD) from family physicians/psychiatrists over 2 years. Results Data on 515 referrals (mean age 33 years, 60% males) were collected (December 2014 to September 2015); 472/515 (92%) were made by family physicians. No psychiatric comorbid symptoms were noted in 344/515 (67%) referrals. ADHD was confirmed by a specialist in 483/515 (94%) cases, whether comorbid symptoms were noted at referral (155/171 [91%]) or not (328/344 [95%]). ADHD was reported to impact “work” (251/317 [79%]), “school” (121/166 [73%]), “social/friends” (260/483 [54%]), and “spouse/family” (231/483 [48%]). Overall, 335/483 (69%) patients had more than or equal to one comorbid symptom (diagnosed by referring physician or specialist). Stimulant monotherapy was recommended for 383/483 (79%) patients, non-stimulant monotherapy for 41/483 (8%) patients, and stimulant plus non-stimulant monotherapy for 39/483 (8%) patients. Almost half of patients were returned for referring physician’s follow-up, either before treatment initiation (102/483 [21%]) or after treatment stabilization (99/483 [20%]). Follow-up was by a specialist for 282/483 (58%) patients. Conclusion ADHD diagnosis was specialist confirmed in most cases. Although most referrals (67%) noted no psychiatric comorbid symptoms, 69% of patients had ≥1 such symptom (diagnosed by a referring physician or specialist), so comorbid symptoms although not always noted at referral, may have contributed to the decision to refer. ADHD has a wide-ranging impact on patients’ daily lives. It is possible that greater confidence of family physicians to diagnose and treat adult ADHD could help to meet patients’ needs. PMID:29317844

A Systematic Review of Combination Therapy with Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder, Including Patient Characteristics, Treatment Strategies, Effectiveness, and Tolerability

PubMed Central

Gau, Susan Shur-Fen; Méndez, Luis; Montgomery, William; Monk, Julie A.; Altin, Murat; Wu, Shenghu; Lin, Chaucer C.H.; Dueñas, Héctor J.

2013-01-01

Abstract Objective The purpose of this article was to systematically review the literature on stimulant and atomoxetine combination therapy, in particular: 1) Characteristics of patients with attention-deficit/hyperactivity disorder (ADHD) given combination therapy, 2) treatment strategies used, 3) efficacy and effectiveness, and 4) safety and tolerability. Methods Literature databases (MEDLINE®, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, and SciVerse Scopus) were systematically searched using prespecified criteria. Publications describing stimulant and atomoxetine combination therapy in patients with ADHD or healthy volunteers were selected for review. Exclusion criteria were comorbid psychosis, bipolar disorder, epilepsy, or other psychiatric/neurologic diseases that could confound ADHD symptom assessment, or other concomitant medication(s) to treat ADHD symptoms. Results Of the 16 publications included for review, 14 reported findings from 3 prospective studies (4 publications), 7 retrospective studies, and 3 narrative reviews/medication algorithms of patients with ADHD. The other two publications reported findings from two prospective studies of healthy volunteers. The main reason for prescribing combination therapy was inadequate response to previous treatment. In the studies of patients with ADHD, if reported, 1) most patients were children/adolescents and male, and had a combined ADHD subtype; 2) methylphenidate was most often used in combination with atomoxetine for treatment augmentation or switch; 3) ADHD symptom control was improved in some, but not all, patients; and 4) there were no serious adverse events. Conclusions Published evidence of the off-label use of stimulant and atomoxetine combination therapy is limited because of the small number of publications, heterogeneous study designs (there was only one prospective, randomized controlled trial), small sample sizes, and geographic bias. Existing evidence suggests, but does not confirm, that this drug combination may benefit some, but not all, patients who have tried several ADHD medications without success. PMID:23560600

Symptom Profile of ADHD in Youth With High-Functioning Autism Spectrum Disorder: A Comparative Study in Psychiatrically Referred Populations.

PubMed

Joshi, Gagan; Faraone, Stephen V; Wozniak, Janet; Tarko, Laura; Fried, Ronna; Galdo, Maribel; Furtak, Stephannie L; Biederman, Joseph

2017-08-01

To compare the clinical presentation of ADHD between youth with autism spectrum disorder (ASD) and ADHD and a sample of youth with ADHD only. A psychiatrically referred sample of autism spectrum disorder (ASD) youth with ADHD attending a specialized ambulatory program for ASD ( n = 107) and a sample of youth with ADHD attending a general child psychiatry ambulatory clinic ( n = 74) were compared. Seventy-six percent of youth with ASD met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. The clinical presentation of ADHD in youth with ASD was predominantly similar to its typical presentation including age at onset (3.5 ± 1.7 vs. 4.0 ± 1.9; p = .12), distribution of diagnostic subtypes, the qualitative and quantitative symptom profile, and symptom severity. Combined subtype was the most frequent presentation of ADHD in ASD youth. Despite the robust presentation of ADHD, a significant majority of ASD youth with ADHD failed to receive appropriate ADHD treatment (41% vs. 24%; p = .02). A high rate of comorbidity with ADHD was observed in psychiatrically referred youth with ASD, with a clinical presentation typical of the disorder.

ADHD patients fail to maintain task goals in face of subliminally and consciously induced cognitive conflicts.

PubMed

Gohil, K; Bluschke, A; Roessner, V; Stock, A-K; Beste, C

2017-07-01

Attention deficit hyperactivity disorder (ADHD) patients have been reported to display deficits in action control processes. While it is known that subliminally and consciously induced conflicts interact and conjointly modulate action control in healthy subjects, this has never been investigated for ADHD. We investigated the (potential) interaction of subliminally and consciously triggered response conflicts in children with ADHD and matched healthy controls using neuropsychological methods (event-related potentials; ERPs) to identify the involved cognitive sub-processes. Unlike healthy controls, ADHD patients showed no interaction of subliminally and consciously triggered response conflicts. Instead, they only showed additive effects as their behavioural performance (accuracy) was equally impaired by each conflict and they showed no signs of task-goal shielding even in cases of low conflict load. Of note, this difference between ADHD and controls was not rooted in early bottom-up attentional stimulus processing as reflected by the P1 and N1 ERPs. Instead, ADHD showed either no or reversed modulations of conflict-related processes and response selection as reflected by the N2 and P3 ERPs. There are fundamental differences in the architecture of cognitive control which might be of use for future diagnostic procedures. Unlike healthy controls, ADHD patients do not seem to be endowed with a threshold which allows them to maintain high behavioural performance in the face of low conflict load. ADHD patients seem to lack sufficient top-down attentional resources to maintain correct response selection in the face of conflicts by shielding the response selection process from response tendencies evoked by any kind of distractor.

Risperidone Versus Methylphenidate in Treatment of Preschool Children With Attention-Deficit Hyperactivity Disorder.

PubMed

Arabgol, Fariba; Panaghi, Leily; Nikzad, Vahid

2015-02-01

Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric diagnosis among preschool children. The aim of this study was to examine the Risperidone treatment compared to Methylphenidate (MPH) in preschool children with ADHD. Thirty three outpatient preschool children, aged 3-6 years, diagnosed with ADHD (The diagnosis of ADHD was established by two child and adolescent psychiatrists according to the DSM-IV-TR criteria), participated in a 6-week, double-blind clinical trial with risperidone (0.5-1.5 mg/d) and methylphenidate (5-20 mg/d), in two divided doses. Treatment outcomes were assessed using the Parent ADHD Rating Scale and Conners Rating Scale. Patients were assessed by a child psychiatrist at baseline, 2, 4 and 6 weeks after the medication started. Side effects were also rated by side effects questionnaire. There were no significant differences between the two protocols on the Parent ADHD Rating Scale scores (P > 0.05) and Parent Conners Rating Scale scores (P > 0.05). Both groups showed a significant improvement in ADHD symptoms over the 6 weeks of treatment for parent ADHD Rating Scale (P < 0.001) and Parent Conners Rating Scale (P < 0.001). The most common adverse effects seen with risperidone were daytime drowsiness and anorexia (20%), and with methylphenidate it was anorexia (55%). Results of this study show that risperidone may be effective and well tolerated for ADHD in preschool children, but more researches are needed to clarify the potential benefits and adverse effects in long term use and comorbid conditions.

Emotional Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder-Validity, Predictability, Severity, and Comorbidity.

PubMed

Corbisiero, Salvatore; Mörstedt, Beatrice; Bitto, Hannes; Stieglitz, Rolf-Dieter

2017-01-01

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity. However, this triad might not be able to explain the complete spectrum of ADHD symptoms, as emotional dysregulation (ED) frequently seems to accompany the disorder. The aim of this study was to further understand the role of ED in adult ADHD. The sample comprised 393 adults with ADHD without or with comorbidity, and 121 adults without ADHD or any other mental disorder. Additionally, the sample focused on ED. The contribution of core symptoms and the effect of comorbidity on ED were tested and the predictive value of ED for the ADHD diagnosis itself analyzed. Finally, all subjects were categorized into groups-No ADHD, ADHD, and ADHD + ED-to analyze the differences in the severity of ADHD symptomatology in the three groups. ED levels were found to be elevated in patients with ADHD. The core symptoms affected ED, and the ADHD diagnosis was predicted by ED. The addition of ED to a regression model with the core symptoms was shown to improve the predictability of the ADHD diagnosis. The presence of ED proved to be an indicator of the severity of adult ADHD independent of a present comorbidity. ED is a significant symptom in adult patients with ADHD and appears to be associated with ADHD itself. Whilst the presence of other mental disorders intensifies symptoms of ED, ED seems not to manifest solely as a consequence of comorbidity. © 2016 Wiley Periodicals, Inc.

Attention-Deficit Hyperactivity Disorder (ADHD) in Epilepsy and Primary ADHD: Differences in Symptom Dimensions and Quality of Life.

PubMed

Ekinci, Ozalp; Okuyaz, Çetin; Erdoğan, Semra; Gunes, Serkan; Ekinci, Nuran; Kalınlı, Merve; Teke, Halenur; Direk, Meltem Çobanoğulları

2017-12-01

We aimed to (1) compare quality of life (QOL) among children with epilepsy, epilepsy and attention-deficit hyperactivity disorder (ADHD), and primary ADHD and (2) compare ADHD symptom dimensions and subtypes between children with epilepsy-ADHD and primary ADHD. A total of 140 children; 53 with epilepsy, 35 with epilepsy-ADHD, and 52 with primary ADHD were included. KINDL-R (quality of life measure), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Parent Rating Scale (CPRS) were completed. Neurology clinic charts were reviewed for epilepsy-related variables. Children with epilepsy-ADHD had the lowest (poorest) KINDL-R total scores. Epilepsy-ADHD group had more inattentiveness symptoms, whereas primary ADHD group had more hyperactivity/impulsivity symptoms. The frequencies of ADHD combined and inattentiveness subtypes were 60% and 40% in children with epilepsy-ADHD and 80.7% and 19.3% in children with primary ADHD, respectively ( P = .034). ADHD in epilepsy is associated with a significantly poor quality of life and predominantly inattentiveness symptoms.

Multiclass Classification for the Differential Diagnosis on the ADHD Subtypes Using Recursive Feature Elimination and Hierarchical Extreme Learning Machine: Structural MRI Study

PubMed Central

Qureshi, Muhammad Naveed Iqbal; Min, Beomjun; Jo, Hang Joon; Lee, Boreom

2016-01-01

The classification of neuroimaging data for the diagnosis of certain brain diseases is one of the main research goals of the neuroscience and clinical communities. In this study, we performed multiclass classification using a hierarchical extreme learning machine (H-ELM) classifier. We compared the performance of this classifier with that of a support vector machine (SVM) and basic extreme learning machine (ELM) for cortical MRI data from attention deficit/hyperactivity disorder (ADHD) patients. We used 159 structural MRI images of children from the publicly available ADHD-200 MRI dataset. The data consisted of three types, namely, typically developing (TDC), ADHD-inattentive (ADHD-I), and ADHD-combined (ADHD-C). We carried out feature selection by using standard SVM-based recursive feature elimination (RFE-SVM) that enabled us to achieve good classification accuracy (60.78%). In this study, we found the RFE-SVM feature selection approach in combination with H-ELM to effectively enable the acquisition of high multiclass classification accuracy rates for structural neuroimaging data. In addition, we found that the most important features for classification were the surface area of the superior frontal lobe, and the cortical thickness, volume, and mean surface area of the whole cortex. PMID:27500640

Multiclass Classification for the Differential Diagnosis on the ADHD Subtypes Using Recursive Feature Elimination and Hierarchical Extreme Learning Machine: Structural MRI Study.

PubMed

Qureshi, Muhammad Naveed Iqbal; Min, Beomjun; Jo, Hang Joon; Lee, Boreom

2016-01-01

The classification of neuroimaging data for the diagnosis of certain brain diseases is one of the main research goals of the neuroscience and clinical communities. In this study, we performed multiclass classification using a hierarchical extreme learning machine (H-ELM) classifier. We compared the performance of this classifier with that of a support vector machine (SVM) and basic extreme learning machine (ELM) for cortical MRI data from attention deficit/hyperactivity disorder (ADHD) patients. We used 159 structural MRI images of children from the publicly available ADHD-200 MRI dataset. The data consisted of three types, namely, typically developing (TDC), ADHD-inattentive (ADHD-I), and ADHD-combined (ADHD-C). We carried out feature selection by using standard SVM-based recursive feature elimination (RFE-SVM) that enabled us to achieve good classification accuracy (60.78%). In this study, we found the RFE-SVM feature selection approach in combination with H-ELM to effectively enable the acquisition of high multiclass classification accuracy rates for structural neuroimaging data. In addition, we found that the most important features for classification were the surface area of the superior frontal lobe, and the cortical thickness, volume, and mean surface area of the whole cortex.

Video game performances are preserved in ADHD children compared with controls.

PubMed

Bioulac, Stéphanie; Lallemand, Stéphanie; Fabrigoule, Colette; Thoumy, Anne-Laure; Philip, Pierre; Bouvard, Manuel Pierre

2014-08-01

Although ADHD and excessive video game playing have received some attention, few studies have explored the performances of ADHD children when playing video games. The authors hypothesized that performances of ADHD children would be as good as those of control children in motivating video games tasks but not in the Continuous Performance Test II (CPT II). The sample consisted of 26 ADHD children and 16 control children. Performances of ADHD and control children were compared on three commercially available games, on the repetition of every game, and on the CPT II. ADHD children had lower performances on the CPT II than did controls, but they exhibited equivalent performances to controls when playing video games at both sessions and on all three games. When playing video games, ADHD children present no difference in inhibitory performances compared with control children. This demonstrates that cognitive difficulties in ADHD are task dependent. © 2012 SAGE Publications.

Theory of Mind and Empathy in Children With ADHD.

PubMed

Maoz, Hagai; Gvirts, Hila Z; Sheffer, Maya; Bloch, Yuval

2017-05-01

The current study compared empathy and theory of mind (ToM) between children with ADHD and healthy controls, and assessed changes in ToM among children with ADHD following administration of methylphenidate (MPH). Twenty-four children with ADHD (mean age = 10.3 years) were compared with 36 healthy controls. All children completed the interpersonal reactivity index (IRI), a self-reported empathy questionnaire, and performed the "faux-pas" recognition task (FPR). Children with ADHD performed the task with and without MPH. Children with ADHD showed significantly lower levels of self-reported empathy on most IRI subscales. FPR scores were significantly lower in children with ADHD and were improved, following the administration of MPH, to a level equal to that found in healthy controls. Children with ADHD show impaired self-reported empathy and FPR when compared with healthy controls. Stimulants improve FPR in children with ADHD to a level equal to that in healthy controls.

The effects of patient characteristics on ADHD diagnosis and treatment: a factorial study of family physicians.

PubMed

Morley, Christopher P

2010-02-08

Attention Deficit Hyperactivity Disorder (ADHD) is a costly and prevalent disorder in the U.S., especially among youth. However, significant disparities in diagnosis and treatment appear to be predicted by the race and insurance status of patients. This study employed a web-based factorial survey with four ADHD cases derived from an ADHD clinic, two diagnosed with ADHD in actual evaluation, and two not. Randomized measures included race and insurance status of the patients. Participants N = (187) included clinician members of regional and national practice-based research networks and the U.S. clinical membership of the Society of Teachers of Family Medicine. The main outcomes were decisions to 1) diagnose and 2) treat the cases, based upon the information presented, analyzed via binary logistic regression of the randomized factors and case indicators on diagnosis and treatment. ADHD-positive cases were 8 times more likely to be diagnosed and 12 times more likely to be treated, and the male ADHD positive case was more likely to be diagnosed and treated than the female ADHD positive case. Uninsured cases were significantly more likely to be treated overall, but male cases that were uninsured were about half as likely to be diagnosed and treated with ADHD. Additionally, African-American race appears to increase the likelihood of medicinal treatment for ADHD and being both African-American and uninsured appears to cut the odds of medicinal treatment in half, but not significantly. Family physicians were competent at discerning between near-threshold ADHD-negative and ADHD positive cases. However, insurance status and race, as well as gender, appear to affect the likelihood of diagnosis and treatment for ADHD in Family Medicine settings.

Further Evidence that Severe Scores in the Aggression/Anxiety-Depression/Attention Subscales of Child Behavior Checklist (Severe Dysregulation Profile) Can Screen for Bipolar Disorder Symptomatology: A Conditional Probability Analysis

PubMed Central

Uchida, Mai; Faraone, Stephen V; Martelon, MaryKate; Kenworthy, Tara; Woodworth, K Yvonne; Spencer, Thomas; Wozniak, Janet; Biederman, Joseph

2014-01-01

Background Previous work shows that children with high scores (2 SD, combined score ≥ 210) on the Attention Problems, Aggressive Behavior, and Anxious-Depressed (A-A-A) subscales of the Child Behavior Checklist (CBCL) are more likely than other children to meet criteria for bipolar (BP)-I disorder. However, the utility of this profile as a screening tool has remained unclear. Methods We compared 140 patients with pediatric BP-I disorder, 83 with attention deficit hyperactivity disorder (ADHD), and 114 control subjects. We defined the CBCL-Severe Dysregulation profile as an aggregate cutoff score of ≥ 210 on the A-A-A scales. Patients were assessed with structured diagnostic interviews and functional measures. Results Patients with BP-I disorder were significantly more likely than both control subjects (Odds Ratio [OR]: 173.2; 95% Confidence Interval [CI], 21.2 to 1413.8; P < 0.001) and those with ADHD (OR: 14.6; 95% CI, 6.2 to 34.3; P < 0.001) to have a positive CBCL-Severe Dysregulation profile. Receiver Operating Characteristics analyses showed that the area under the curve for this profile comparing children with BP-I disorder against control subjects and those with ADHD was 99% and 85%, respectively. The corresponding positive predictive values for this profile were 99% and 92% with false positive rates of < 0.2% and 8% for the comparisons with control subjects and patients with ADHD, respectively. Limitations Non-clinician raters administered structured diagnostic interviews, and the sample was referred and largely Caucasian. Conclusions The CBCL-Severe Dysregulation profile can be useful as a screen for BP-I disorder in children in clinical practice. PMID:24882182

Testing for Neuropsychological Endophenotypes in Siblings Discordant for ADHD

PubMed Central

Bidwell, L. Cinnamon; Willcutt, Erik G.; DeFries, John C.; Pennington, Bruce F.

2007-01-01

Objective Neurocognitive deficits associated with attention deficit-hyperactivity disorder (ADHD) may be useful intermediate endophenotypes for determining specific genetic pathways that contribute to ADHD. Methods This study administered 17 measures from prominent neuropsychological theories of ADHD (executive function, processing speed, arousal regulation and motivation/delay aversion) in dizygotic (DZ) twin pairs discordant for ADHD and control twin pairs (ages 8–18) in order to compare performance between twins affected with ADHD (n = 266), their unaffected co-twins (n = 228), and control children from twin pairs without ADHD or learning difficulties (n = 332). Results ADHD subjects show significant impairment on executive function, processing speed, and response variability measures compared to control subjects. Unaffected cotwins of ADHD subjects are significantly impaired on nearly all the same measures as their ADHD siblings, even when subclinical symptoms of ADHD are controlled. Conclusion Executive function, processing speed, and response variability deficits may be useful endophenotypes for genetic studies of ADHD. PMID:17585884

Symptom and performance validity with veterans assessed for attention-deficit/hyperactivity disorder (ADHD).

PubMed

Shura, Robert D; Denning, John H; Miskey, Holly M; Rowland, Jared A

2017-12-01

Little is known about attention-deficit/hyperactivity disorder (ADHD) in veterans. Practice standards recommend the use of both symptom and performance validity measures in any assessment, and there are salient external incentives associated with ADHD evaluation (stimulant medication access and academic accommodations). The purpose of this study was to evaluate symptom and performance validity measures in a clinical sample of veterans presenting for specialty ADHD evaluation. Patients without a history of a neurocognitive disorder and for whom data were available on all measures (n = 114) completed a clinical interview structured on DSM-5 ADHD symptoms, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), and the Test of Memory Malingering Trial 1 (TOMM1) as part of a standardized ADHD diagnostic evaluation. Veterans meeting criteria for ADHD were not more likely to overreport symptoms on the MMPI-2-RF nor to fail TOMM1 (score ≤ 41) compared with those who did not meet criteria. Those who overreported symptoms did not endorse significantly more ADHD symptoms; however, those who failed TOMM1 did report significantly more ADHD symptoms (g = 0.90). In the total sample, 19.3% failed TOMM1, 44.7% overreported on the MMPI-2-RF, and 8.8% produced both an overreported MMPI-2-RF and invalid TOMM1. F-r had the highest correlation to TOMM1 scores (r = -.30). These results underscore the importance of assessing both symptom and performance validity in a clinical ADHD evaluation with veterans. In contrast to certain other conditions (e.g., mild traumatic brain injury), ADHD as a diagnosis is not related to higher rates of invalid report/performance in veterans. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

High IQ May "Mask" the Diagnosis of ADHD by Compensating for Deficits in Executive Functions in Treatment-Naïve Adults With ADHD.

PubMed

Milioni, Ana Luiza Vidal; Chaim, Tiffany Moukbel; Cavallet, Mikael; de Oliveira, Nathalya Moleda; Annes, Marco; Dos Santos, Bernardo; Louzã, Mario; da Silva, Maria Aparecida; Miguel, Carmen Silvia; Serpa, Mauricio Henriques; Zanetti, Marcus V; Busatto, Geraldo; Cunha, Paulo Jannuzzi

2017-04-01

To evaluate and compare the performance of adults with ADHD with high and standard IQ in executive functions (EF) tasks. We investigated the neuropsychological performance of 51 adults with ADHD, compared with 33 healthy controls (HC) while performing a wide battery of neuropsychological tests that measure executive functioning. Adults with clinical diagnosis of ADHD were divided into two groups according to their IQ level (IQ ≥ 110-ADHD group with more elevated IQ, and IQ < 110-ADHD group with standard IQ). The ADHD group with standard IQ presented a worse executive functioning compared with the HC group in the following measures: Stroop 2 ( p = .000) and 3 ( p = .000), Trail Making Test (TMT) B ( p = .005), Wisconsin Card-Sorting Test (WCST)-perseverative errors ( p = .022) and failures to maintain set ( p = .020), Continuous Performance Test (CPT)-omission errors ( p = .005) and commission errors ( p = .000), and Frontal Assessment Battery (FAB)-conceptualization ( p = .016). The ADHD group with more elevated IQ presented only impairments in the CPT-commission errors ( p = .019) when compared with the control group. Adults with ADHD and more elevated IQ show less evidence of executive functioning deficits compared with those with ADHD and standard IQ, suggesting that a higher degree of intellectual efficiency may compensate deficits in executive functions, leading to problems in establishing a precise clinical diagnosis.

Are names of children with attention deficit hyperactivity disorder more 'hyperactive'?

PubMed

Shoval, Gal; Manor, Iris; Nahshoni, Eitan; Weizman, Abraham; Zalsman, Gil

2012-01-01

The role of the meaning of given names has been noted in psychotherapy as well as in everyday life. This study aimed to investigate the possible association between the nature of given names of children and attention deficit hyperactivity disorder (ADHD) diagnosis. A total of 134 given names of children and adolescent patients diagnosed as having ADHD were compared with those of an age- and gender-matched randomly chosen control group from the general population. The first names of the two cohorts were compared with regard to the following: the literal meaning of their names, whether the name constitutes a verb, the prevalence of each name and their length (number of syllables). The meaning of first names of children and adolescents with ADHD combined type were rated by referees as expressing significantly more activity and containing less syllables than the names of controls. In addition, the prevalence of their names was significantly lower than that of names used in the general population. All findings remained significant following Bonferroni adjustment. Our findings demonstrate an intriguing relationship between children's given names and ADHD diagnosis. Given names may serve as a possible predictor of later diagnosis of ADHD. Clinicians should be more attentive to given names in the context of child psychiatric evaluation and therapy. Copyright © 2012 S. Karger AG, Basel.

Addiction severity pattern associated with adult and childhood Attention Deficit Hyperactivity Disorder (ADHD) in patients with addictions.

PubMed

Fatséas, Melina; Hurmic, Hortense; Serre, Fuschia; Debrabant, Romain; Daulouède, Jean-Pierre; Denis, Cécile; Auriacombe, Marc

2016-12-30

Attention Deficit Hyperactivity Disorder (ADHD) is highly prevalent among adults with addictive disorders, but little is known about addiction patterns associated with ADHD diagnosis. This study examined addiction severity in patients with co-occurring addictive disorders and ADHD controlling for the potential influence of associated psychiatric comorbidity. Data were collected in French outpatient addiction treatment centers. A total of 217 patients seeking treatment for substance or gambling addiction were included. At treatment entry, participants were interviewed with the Addiction Severity Index, the Conners Adult ADHD Diagnosis Interview for the DSM-IV (CAADID), the Mini International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV Axis II for borderline personality disorder (SCID II). History of ADHD was associated with an earlier onset of addiction, poly-dependence (defined by presence of at least two current substance dependence diagnoses in addition to tobacco dependence if present) and borderline personality disorder. Persistence of ADHD during adulthood was associated with a higher prevalence of poly-dependence. This study highlights the need for early implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the need to consider ADHD in the treatment of addictive disorders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparative efficacy and safety of methylphenidate and atomoxetine for attention-deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials.

PubMed

Liu, Qiang; Zhang, Hong; Fang, Qingqing; Qin, Lili

2017-11-01

Comparative efficacy and safety are important issues for appropriate drug selection for attention-deficit hyperactivity disorder (ADHD) treatment. Therefore we conducted a meta-analysis, where we compared atomoxetine (ATX) and methylphenidate (MPH) for ADHD treatment in children and adolescents. Literature retrieval was conducted in relevant databases from their inception to April 2016 to select head-to-head trials that compared ATX and MPH in children and adolescents. Outcomes like response rate, ADHD Rating Scale (ADHD-RS) score, and adverse events were compared between ATX and MPH treatments. The standardized mean difference (SMD) and risk ratio (RR) with their corresponding 95% confidence intervals (CIs) were used as the effect size for continuous data or dichotomous data, respectively. Eleven eligible randomized-controlled trials were included, and two of them were double-blind, while the remaining were open-label. Compared to ATX, MPH showed a higher response rate (RR = 1.14, 95% CI [1. 09, 1.20]), decreased inattention (SMD = -0.13, 95% CI [-0.25, -0.01]) and lower risk of adverse events (drowsiness: RR = 0.17, 95% CI [0.11, 0.26; nausea: RR = 0.49; 95% CI [0.29, 0.85; vomiting: RR = 0.41, 95% CI [0.27, 0.63]). However, MPH presented a higher risk of insomnia than ATX (RR = 2.27, 95% CI [1.63, 3.15], p < .01). Results of the meta-analysis add additional evidence of the effectiveness of both ATX and MPH and suggest that MPH should be a first treatment option in most patients with ADHD.

COMPARING STIMULANT EFFECTS IN YOUTH WITH ADHD SYMPTOMS AND EPILEPSY

PubMed Central

Gonzalez-Heydrich, Joseph; Hsin, Olivia; Gumlak, Sarah; Kimball, Kara; Rober, Ashley; Azeem, Muhammad W.; Hickory, Meredith; Mrakotsky, Christine; Torres, Alcy; Mezzacappa, Enrico; Bourgeois, Blaise; Biederman, Joseph

2014-01-01

To retrospectively examine response to stimulant treatment in patients with epilepsy and ADHD symptoms as predicted by seizure freedom for six months, use of methylphenidate (MPH) versus amphetamine (AMP) preparations, and cognitive level, medical records were searched for patients under age 18 with epilepsy and ADHD symptoms treated with MPH or AMP (n = 36, age 10.4±3.5; 67% male). “Responders” had a CGI-Improvement score of ≤2 and did not stop medication due to adverse effects. “Worsened” patients discontinued medication due to agitation/emotional lability. Seizure freedom did not predict treatment response. Lower cognitive level was associated with increased rate of worsening (p=0.048). No patients who were seizure-free at start of the medication trial experienced an increase in seizures. Of the patients having seizures at the start of trial, one patient on MPH and two on AMP had increased seizures during the trial. Seizures returned to baseline frequency or less after stimulant discontinuation or anticonvulsant adjustment. MPH was associated with a higher response rate, with 12 of 19 given MPH 0.62±0.28mg/kg/day compared to 4 of 17 given AMP 0.37±0.26mg/kg/day responding (p=0.03). MPH treatment and higher cognitive level were associated with improved treatment outcome while seizure freedom had no clear effect. Confidence in these findings is limited by the study’s small, open label, and uncontrolled nature. PMID:24907495

False Memory in Adults With ADHD: A Comparison Between Subtypes and Normal Controls.

PubMed

Soliman, Abdrabo Moghazy; Elfar, Rania Mohamed

2017-10-01

To examine the performance on the Deese-Roediger-McDermott task of adults divided into ADHD subtypes and compares their performance to that of healthy controls to examine whether adults with ADHD are more susceptible to the production of false memories under experimental conditions. A total of 128 adults with ADHD (50% females), classified into three Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV-TR) subtypes, were compared with 48 controls. The results indicated that the ADHD participants recalled and recognized fewer studied words than the controls, the ADHD groups produced more false memories than the control group, no differences in either the false positives or the false negatives. The ADHD-combined (ADHD-CT) group recognized significantly more critical words than the control, ADHD-predominantly inattentive (ADHD-IA), and ADHD-predominantly hyperactive-impulsive (ADHD-HI) groups. The ADHD groups recalled and recognized more false positives, were more confident in their false responses, and displayed more knowledge corruption than the controls. The ADHD-CT group recalled and recognized more false positives than the other ADHD groups. The adults with ADHD have more false memories than the controls and that false memory formation varied with the ADHD subtypes.

Improvement with Duloxetine in an Adult ADHD Patient

ERIC Educational Resources Information Center

Tourjman, Smadar Valerie; Bilodeau, Mathieu

2009-01-01

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common and disabling disorder among adults and is treated with stimulant and non stimulant medication. Objective: To report the case of a patient with ADHD showing good clinical response to duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Case…

A compound herbal preparation (CHP) in the treatment of children with ADHD: a randomized controlled trial.

PubMed

Katz, M; Levine, A Adar; Kol-Degani, H; Kav-Venaki, L

2010-11-01

Evaluation of the efficacy of a patented, compound herbal preparation (CHP) in improving attention, cognition, and impulse control in children with ADHD. A randomized, double-blind, placebo-controlled trial. University-affiliated tertiary medical center. 120 children newly diagnosed with ADHD, meeting DSM-IV criteria. Random assignment to the herbal treatment group (n = 80) or control group (placebo; n = 40); 73 patients in the treatment group (91%) and 19 in the control group (48%) completed the 4-month trial. Test of Variables of Attention (TOVA) administered before and after the treatment period; overall score and 4 subscales. The treatment group showed substantial, statistically significant improvement in the 4 subscales and overall TOVA scores, compared with no improvement in the control group, which persisted in an intention-to-treat analysis. The well-tolerated CHP demonstrated improved attention, cognition, and impulse control in the intervention group, indicating promise for ADHD treatment in children.

DOE Office of Scientific and Technical Information (OSTI.GOV)

González Gómez Dulce, I., E-mail: isabeldgg@hotmail.com, E-mail: emoreno@fcfm.buap.mx, E-mail: mim@fcfm.buap.mx, E-mail: joserm84@gmail.com; Moreno Barbosa, E., E-mail: isabeldgg@hotmail.com, E-mail: emoreno@fcfm.buap.mx, E-mail: mim@fcfm.buap.mx, E-mail: joserm84@gmail.com; Hernández, Mario Iván Martínez, E-mail: isabeldgg@hotmail.com, E-mail: emoreno@fcfm.buap.mx, E-mail: mim@fcfm.buap.mx, E-mail: joserm84@gmail.com

The main goal of this project was to create a computer algorithm based on wavelet analysis of region of homogeneity images obtained during resting state studies. Ideally it would automatically diagnose ADHD. Because the cerebellum is an area known to be affected by ADHD, this study specifically analysed this region. Male right handed volunteers (infants with ages between 7 and 11 years old) were studied and compared with age matched controls. Statistical differences between the values of the absolute integrated wavelet spectrum were found and showed significant differences (p<0.0015) between groups. This difference might help in the future to distinguishmore » healthy from ADHD patients and therefore diagnose ADHD. Even if results were statistically significant, the small size of the sample limits the applicability of this methods as it is presented here, and further work with larger samples and using freely available datasets must be done.« less

ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity?

PubMed Central

2013-01-01

Background Attention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits. Methods 191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R. Results The ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness. Conclusions Bingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology. PMID:23758944

Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder.

PubMed

Sonuga-Barke, Edmund; Bitsakou, Paraskevi; Thompson, Margaret

2010-04-01

The dual pathway model explains neuro-psychological heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) in terms of dissociable cognitive and motivational deficits each affecting some but not other patients. We explore whether deficits in temporal processing might constitute a third dissociable neuropsychological component of ADHD. Nine tasks designed to tap three domains (inhibitory control, delay aversion and temporal processing) were administered to ADHD probands (n=71; ages 6 to 17 years), their siblings (n=71; 65 unaffected by ADHD) and a group of non-ADHD controls (n=50). IQ and working memory were measured. Temporal processing, inhibitory control and delay-related deficits represented independent neuropsychological components. ADHD children differed from controls on all factors. For ADHD patients, the co-occurrence of inhibitory, temporal processing and delay-related deficits was no greater than expected by chance with substantial groups of patients showing only one problem. Domain-specific patterns of familial co-segregation provided evidence for the validity of neuropsychological subgroupings. The current results illustrate the neuropsychological heterogeneity in ADHD and initial support for a triple pathway model. The findings need to be replicated in larger samples.

Six months methylphenidate treatment improves emotion dysregulation in adolescents with attention deficit/hyperactivity disorder: a prospective study.

PubMed

Suzer Gamli, Ipek; Tahiroglu, Aysegul Yolga

2018-01-01

Individuals with attention deficit/hyperactivity disorder (ADHD) may suffer from emotional dysregulation (ED), although this symptom is not listed among the diagnostic criteria. Methylphenidate (MPH) is useful in reducing emotional symptoms in ADHD. The aim of the present study was to determine both psychosocial risk factors and presence of ED in adolescents with ADHD before and after MPH treatment. Eighty-two patients aged 12-18 years with ADHD were included as participants. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime, the Difficulties in Emotion Regulation Scale (DERS), sociodemographic form, and the Inventory of Statements About Self-Injury were administered. Results were compared before and after 6 months MPH treatment. A significant improvement was detected on DERS for impulsivity (15.9±6.8 initial vs 14.2±6.5 final test, p <0.01) and total score (88.4±23.3 initial vs 82.4±2.7 final test, p <0.05) across all patients taking MPH regardless of subtype and sex. Despite treatment, a significant difference remained for impulsivity, strategies, and total score in patients with comorbid oppositional defiant disorder (ODD) compared with those without ODD, but no difference was detected for conduct disorder comorbidity. In patients who self-harm, scores for goals, impulsivity, strategies, clarity, and total score were higher before treatment: furthermore, impulsivity and total score remained high after treatment. In maltreated patients, goals, impulsivity, strategies, and total scores were significantly higher before treatment; however, their symptoms were ameliorated after treatment with MPH. Individuals with severe ED may "self-medicate" by smoking and/or self-harming. MPH led to significant improvements in ED possibly owing, in part, to a decrease in impulsivity, so that individuals felt more able to supervise their emotions and engage in goal-directed behaviors. ED should be considered particularly in patients with additional psychosocial factors and ODD comorbidity, and included in the treatment plan.

Prevalence of sleep disorders in patients with neurofibromatosis type 1.

PubMed

Maraña Pérez, A I; Duat Rodríguez, A; Soto Insuga, V; Domínguez Carral, J; Puertas Martín, V; González Gutiérrez Solana, L

2015-01-01

Neurofibromatosis type 1 (NF1) is frequently associated with neurological disorders unrelated to neurofibromas, including sleep disorders. This article reviews the prevalence of sleep disorders in patients with NF1, compares rates to data reported in the literature, and analyses the relationship between cognitive disorder and attention deficit hyperactivity disorder (ADHD) in these patients. Comparative retrospective study reviewing data collected between January 2010 and January 2012 from patients diagnosed with NF1 in a tertiary hospital. We included 95 paediatric patients with NF1 who completed the Bruni Sleep Disturbance Scale in Children. The overall prevalence of sleep disorders was 6.3%, which was lower than in the general paediatric population. Patients with NF1 and ADHD had a higher prevalence of sleep onset and maintenance disorders (18% vs 6.3%), sleep-wake transition disorders (12.5% vs 6.3%), and daytime sleepiness (12.5% vs 7.9%); differences were not statistically significant. A statistically significant difference was found in the subdomain of nocturnal hyperhidrosis (21.9% vs 6.3%, P < 0.05). Patients with NF1 and IQ<85 showed higher prevalence rates of daytime sleepiness (20% vs 6.7%) and of sleep hyperhidrosis (11% vs 0%). The prevalence of sleep disorders in our cohort of patients with NF1 was no higher than in the general paediatric population, although some of these disorders are more common in cases with cognitive disorders or ADHD. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities

PubMed Central

Clemow, David B; Bushe, Chris; Mancini, Michele; Ossipov, Michael H; Upadhyaya, Himanshu

2017-01-01

Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that is often diagnosed during childhood, but has also increasingly been recognized to occur in adults. Importantly, up to 52% of children (including adolescents) and 87% of adults with ADHD also have a comorbid psychiatric disorder. The presence of a comorbid disorder has the potential to impact diagnosis and could affect treatment outcomes. Atomoxetine is a nonstimulant treatment for ADHD. Despite numerous published studies regarding efficacy of atomoxetine in the treatment of ADHD in patients with comorbid disorders, there is limited information about the impact of individual common comorbid disorders on the efficacy of atomoxetine for ADHD, especially with regard to adults. Moreover, a cumulative review and assessment of these studies has not been conducted. For this reason, we performed a literature review to find, identify, and cumulatively review clinical studies that examined the efficacy of atomoxetine in the treatment of patients with ADHD and comorbid psychiatric disorders. We found a total of 50 clinical studies (37 in children; 13 in adults) that examined the efficacy of atomoxetine in patients with ADHD and a comorbid disorder. The comorbidities that were studied in children or in adults included anxiety, depression, and substance use disorder. Overall, the presence of comorbidity did not adversely impact the efficacy of atomoxetine in treatment of ADHD symptoms in both patient populations. In the studies identified and assessed in this review, atomoxetine did not appear to exacerbate any of the comorbid conditions and could, therefore, be an important therapy choice for the treatment of ADHD in the presence of comorbid disorders. PMID:28223809

Comparative efficacy and tolerability of pharmacological interventions for attention-deficit/hyperactivity disorder in children, adolescents and adults: protocol for a systematic review and network meta-analysis.

PubMed

Cortese, Samuele; Adamo, Nicoletta; Mohr-Jensen, Christina; Hayes, Adrian J; Bhatti, Sahar; Carucci, Sara; Del Giovane, Cinzia; Atkinson, Lauren Z; Banaschewski, Tobias; Simonoff, Emily; Zuddas, Alessandro; Barbui, Corrado; Purgato, Marianna; Steinhausen, Hans-Christoph; Shokraneh, Farhad; Xia, Jun; Cipriani, Andrea; Coghill, David

2017-01-10

Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles. We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences. CRD42014008976. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Comparative efficacy and tolerability of pharmacological interventions for attention-deficit/hyperactivity disorder in children, adolescents and adults: protocol for a systematic review and network meta-analysis

PubMed Central

Cortese, Samuele; Adamo, Nicoletta; Mohr-Jensen, Christina; Hayes, Adrian J; Bhatti, Sahar; Carucci, Sara; Del Giovane, Cinzia; Atkinson, Lauren Z; Banaschewski, Tobias; Simonoff, Emily; Zuddas, Alessandro; Barbui, Corrado; Purgato, Marianna; Steinhausen, Hans-Christoph; Shokraneh, Farhad; Xia, Jun; Coghill, David

2017-01-01

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles. Methods and analysis We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences. Trial registration number CRD42014008976. PMID:28073796

Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria.

PubMed

van de Glind, Geurt; Konstenius, Maija; Koeter, Maarten W J; van Emmerik-van Oortmerssen, Katelijne; Carpentier, Pieter-Jan; Kaye, Sharlene; Degenhardt, Louisa; Skutle, Arvid; Franck, Johan; Bu, Eli-Torild; Moggi, Franz; Dom, Geert; Verspreet, Sofie; Demetrovics, Zsolt; Kapitány-Fövény, Máté; Fatséas, Melina; Auriacombe, Marc; Schillinger, Arild; Møller, Merete; Johnson, Brian; Faraone, Stephen V; Ramos-Quiroga, J Antoni; Casas, Miguel; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A; Wallhed, Sara; Barta, Csaba; Alleman, Peter; Levin, Frances R; van den Brink, Wim

2014-01-01

Available studies vary in their estimated prevalence of attention deficit/hyperactivity disorder (ADHD) in substance use disorder (SUD) patients, ranging from 2 to 83%. A better understanding of the possible reasons for this variability and the effect of the change from DSM-IV to DSM-5 is needed. A two stage international multi-center, cross-sectional study in 10 countries, among patients form inpatient and outpatient addiction treatment centers for alcohol and/or drug use disorder patients. A total of 3558 treatment seeking SUD patients were screened for adult ADHD. A subsample of 1276 subjects, both screen positive and screen negative patients, participated in a structured diagnostic interview. Prevalence of DSM-IV and DSM-5 adult ADHD varied for DSM-IV from 5.4% (CI 95%: 2.4-8.3) for Hungary to 31.3% (CI 95%:25.2-37.5) for Norway and for DSM-5 from 7.6% (CI 95%: 4.1-11.1) for Hungary to 32.6% (CI 95%: 26.4-38.8) for Norway. Using the same assessment procedures in all countries and centers resulted in substantial reduction of the variability in the prevalence of adult ADHD reported in previous studies among SUD patients (2-83%→5.4-31.3%). The remaining variability was partly explained by primary substance of abuse and by country (Nordic versus non-Nordic countries). Prevalence estimates for DSM-5 were slightly higher than for DSM-IV. Given the generally high prevalence of adult ADHD, all treatment seeking SUD patients should be screened and, after a confirmed diagnosis, treated for ADHD since the literature indicates poor prognoses of SUD in treatment seeking SUD patients with ADHD. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: Results from an international multi-center study exploring DSM-IV and DSM-5 criteria☆☆

PubMed Central

van de Glind, Geurt; Konstenius, Maija; Koeter, Maarten W.J.; van Emmerik-van Oortmerssen, Katelijne; Carpentier, Pieter-Jan; Kaye, Sharlene; Degenhardt, Louisa; Skutle, Arvid; Franck, Johan; Bu, Eli-Torild; Moggi, Franz; Dom, Geert; Verspreet, Sofie; Demetrovics, Zsolt; Kapitány-Fövény, Máté; Fatséas, Melina; Auriacombe, Marc; Schillinger, Arild; Møller, Merete; Johnson, Brian; Faraone, Stephen V.; Ramos-Quiroga, J. Antoni; Casas, Miguel; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A.; Wallhed, Sara; Barta, Csaba; Alleman, Peter; Levin, Frances R.; van den Brink, Wim

2014-01-01

Background Available studies vary in their estimated prevalence of attention deficit/hyperactivity disorder (ADHD) in substance use disorder (SUD) patients, ranging from 2 to 83%. A better understanding of the possible reasons for this variability and the effect of the change from DSM-IV to DSM-5 is needed. Methods A two stage international multi-center, cross-sectional study in 10 countries, among patients form inpatient and outpatient addiction treatment centers for alcohol and/or drug use disorder patients. A total of 3558 treatment seeking SUD patients were screened for adult ADHD. A subsample of 1276 subjects, both screen positive and screen negative patients, participated in a structured diagnostic interview. Results Prevalence of DSM-IV and DSM-5 adult ADHD varied for DSM-IV from 5.4% (CI 95%: 2.4–8.3) for Hungary to 31.3% (CI 95%:25.2–37.5) for Norway and for DSM-5 from 7.6% (CI 95%: 4.1–11.1) for Hungary to 32.6% (CI 95%: 26.4–38.8) for Norway. Using the same assessment procedures in all countries and centers resulted in substantial reduction of the variability in the prevalence of adult ADHD reported in previous studies among SUD patients (2–83%→ 5.4–31.3%). The remaining variability was partly explained by primary substance of abuse and by country (Nordic versus non-Nordic countries). Prevalence estimates for DSM-5 were slightly higher than for DSM-IV. Conclusions Given the generally high prevalence of adult ADHD, all treatment seeking SUD patients should be screened and, after a confirmed diagnosis, treated for ADHD since the literature indicates poor prognoses of SUD in treatment seeking SUD patients with ADHD. PMID:24156882

Attention-deficit/hyperactivity disorder during adulthood.

PubMed

Magnin, E; Maurs, C

Attention-Deficit/Hyperactivity Disorder (ADHD), although considered a childhood-onset neurodevelopmental condition, is nevertheless a frequent and disabling condition in adults. A proportion of such patients are not diagnosed during childhood or adolescence, as diagnosis of the syndrome is rather complex, especially when other psychiatric, neurological or other neurodevelopmental conditions are also associated, yet comorbidities and consequences of ADHD are frequently observed in adults and older populations. As ADHD patients present to memory clinics with attentional and executive disorders, neuropsychological examinations of undiagnosed ADHD patients may reveal atypical cognitive profiles that can complicate the usual diagnostic procedure and increase the risk of delayed diagnosis or misdiagnosis. Thus, explorations of cognitive and/or behavioral disorders in adult populations should systematically screen for this neurodevelopmental condition. Accurate diagnosis could lead to non-pharmaceutical and/or pharmaceutical treatments to improve symptoms and quality of life for adult ADHD patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD

PubMed Central

2010-01-01

Background Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. Methods The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. Results Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? Conclusions ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group. PMID:20815868

The fiscal consequences of ADHD in Germany: a quantitative analysis based on differences in educational attainment and lifetime earnings.

PubMed

Kotsopoulos, Nikolaos; Connolly, Mark P; Sobanski, Esther; Postma, Maarten J

2013-03-01

To estimate the long-term fiscal consequences of attention deficit hyperactivity disorder (ADHD) on the German government and social insurance system based on differences in educational attainment and the resulting differences in lifetime earnings compared with non-ADHD cohorts. Differences in educational attainment between ADHD and non-ADHD cohorts were linked to education-specific earnings data. Direct and indirect tax rates and social insurance contributions were linked to differences in lifetime, education-specific earnings to derive lost tax revenue in Germany associated with ADHD. For ADHD and non-ADHD cohorts we derived the age-specific discounted net taxes paid by deducting lifetime transfers from lifetime gross taxes paid. The lifetime net tax revenue for a non-ADHD individual was approximately EUR 80,000 higher compared to an untreated ADHD individual. The fiscal burden of untreated ADHD, based on a cohort of n=31,844 born in 2010, was estimated at EUR 2.5 billion in net tax revenue losses compared with an equally-sized non-ADHD cohort. ADHD interventions providing a small improvement in educational attainment resulted in fiscal benefits from increases in lifetime tax gains. ADHD results in long-term financial loss due to lower education attainment and lifetime reduced earnings and resulting lifetime taxes and social contributions paid. Investments in ADHD interventions allowing more children to achieve their educational potential may offer fiscal benefits generating a positive rate of return.

[Atomoxetine and piracetam in the treatment of attention deficit hyperactivity disorder in children].

PubMed

Zavadenko, N N; Suvorinova, N Iu

2008-01-01

Therapeutic effect of atomoxetine and piracetam has been assessed in the open controlled study included 42 patients with attention deficit hyperactivity disorder (ADHD), aged from 6 to 13 years. Group 1 (16 patients) received atomoxetine (strattera) in daily dosage 0,8-1,2 mg/kg as a monotherapy for 6 weeks. Patients of group 2 (14 children) received piracetam as a monotherapy in daily dosage 50-70 mg/kg for 6 weeks. No pharmacological therapy was conducted in group 3 (a control one) which included 12 patients with ADHD. The high effectiveness of both atomoxetine and piracetam has been shown. However, comparing to piracetam, the therapeutic effect of atomoxetine was reached earlier (two weeks after the beginning of therapy) and was more pronounced for all components of syndromes.

Are Patient-Administered Attention Deficit Hyperactivity Disorder Scales Suitable for Adults?

ERIC Educational Resources Information Center

Rogers, Edwin S.; Spalding, Steven L.; Eckard, Alexis A.; Wallace, Lorraine S.

2009-01-01

Objective: This primary purpose of this study was to examine cognitive complexity and readability of patient-administered ADHD scales. The secondary purpose was to estimate variation in readability of individual ADHD scale items. Method: Using comprehensive search strategies, we identified eight English-language ADHD scales for inclusion in our…

Low Dopamine Function in Attention Deficit/Hyperactivity Disorder: Should Genotyping Signify Early Diagnosis in Children?

PubMed Central

Gold, Mark S.; Blum, Kenneth; Oscar-Berman, Marlene; Braverman, Eric R.

2014-01-01

Attention deficit/hyperactivity disorder (ADHD) is present in 8% to 12% of children, and 4% of adults worldwide. Children with ADHD can have learning impairments, poor self-esteem, social dysfunction, and an increased risk of substance abuse, including cigarette smoking. Overall, the rate of treatment with medication for patients with ADHD has been increasing since 2008, with > 2 million children now being treated with stimulants. The rise of adolescent prescription ADHD medication abuse has occurred along with a concomitant increase of stimulant medication availability. Of adults presenting with a substance use disorder (SUD), 20% to 30% have concurrent ADHD, and 20% to 40% of adults with ADHD have a history of SUD. Following a brief review of the etiology of ADHD, its diagnosis and treatment, we focus on the benefits of early and appropriate testing for a predisposition to ADHD. We suggest that by genotyping patients for a number of known, associated dopaminergic polymorphisms, especially at an early age, misdiagnoses and/or over-diagnosis can be reduced. Ethical and legal issues of early genotyping are considered. As many as 30% of individuals with ADHD are estimated to either have secondary side-effects or are not responsive to stimulant medication. We also consider the benefits of non-stimulant medication and alternative treatment modalities, which include diet, herbal medications, iron supplementation, and neurofeedback. With the goals of improving treatment of patients with ADHD and SUD prevention, we encourage further work in both genetic diagnosis and novel treatment approaches. PMID:24393762

Low dopamine function in attention deficit/hyperactivity disorder: should genotyping signify early diagnosis in children?

PubMed

Gold, Mark S; Blum, Kenneth; Oscar-Berman, Marlene; Braverman, Eric R

2014-01-01

Attention deficit/hyperactivity disorder (ADHD) is present in 8% to 12% of children, and 4% of adults worldwide. Children with ADHD can have learning impairments, poor selfesteem, social dysfunction, and an increased risk of substance abuse, including cigarette smoking. Overall, the rate of treatment with medication for patients with ADHD has been increasing since 2008, with ≥ 2 million children now being treated with stimulants. The rise of adolescent prescription ADHD medication abuse has occurred along with a concomitant increase of stimulant medication availability. Of adults presenting with a substance use disorder (SUD), 20% to 30% have concurrent ADHD, and 20% to 40% of adults with ADHD have a history of SUD. Following a brief review of the etiology of ADHD, its diagnosis and treatment, we focus on the benefits of early and appropriate testing for a predisposition to ADHD. We suggest that by genotyping patients for a number of known, associated dopaminergic polymorphisms, especially at an early age, misdiagnoses and/or over-diagnosis can be reduced. Ethical and legal issues of early genotyping are considered. As many as 30% of individuals with ADHD are estimated to either have secondary side-effects or are not responsive to stimulant medication. We also consider the benefits of non-stimulant medication and alternative treatment modalities, which include diet, herbal medications, iron supplementation, and neurofeedback. With the goals of improving treatment of patients with ADHD and SUD prevention, we encourage further work in both genetic diagnosis and novel treatment approaches.

Impaired visuomotor adaptation in adults with ADHD.

PubMed

Kurdziel, Laura B F; Dempsey, Katherine; Zahara, Mackenzie; Valera, Eve; Spencer, Rebecca M C

2015-04-01

Attention-deficit hyperactivity disorder (ADHD) is a prevalent psychiatric disorder in children that often continues into adulthood. It has been suggested that motor impairments in ADHD are associated with underlying cerebellar pathology. If such is the case, individuals with ADHD should be impaired on motor tasks requiring healthy cerebellar function. To test this, we compared performance of individuals with ADHD and ADHD-like symptoms with non-ADHD controls on a visuomotor adaptation task known to be impaired following cerebellar lesions. Participants adapted reaching movements to a visual representation that was rotated by 30°. Individuals with ADHD and those with ADHD-like symptoms took longer to correct the angle of movement once the rotation was applied relative to controls. However, post-adaptation residual effect did not differ for individuals with ADHD and ADHD-like symptoms compared to the control group. These results are consistent with the hypothesis that mild cerebellar deficits are evident in the motor performance of adults with ADHD.

Reading Performance of Young Adults With ADHD Diagnosed in Childhood.

PubMed

Miranda, Ana; Mercader, Jessica; Fernández, M Inmaculada; Colomer, Carla

2017-02-01

To study reading performance of young adults with ADHD and its relation with executive functioning. Thirty young adults with a childhood diagnosis of ADHD and 30 with normal development (ND) were compared on reading accuracy, fluency, and comprehension. Furthermore, ADHD with reading disabilities (ADHD+RD) and ADHD without reading disabilities (ADHD-RD) subgroups were compared using self-report and informant-report versions of the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A). Adults with ADHD obtained significantly worse results than the ND adults on reading speed, responses to literal questions, and a cloze test. Although the comparison of the ADHD+RD and ADHD-RD groups did not show significant differences on the BRIEF-A subscales, the ADHD+RD group surpassed the critical percentile (85) on more subscales, with working memory and metacognition especially affected. The findings point out that reading should be assessed in individuals with ADHD as part of their evaluation to design effective early interventions.

Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: a pilot trial.

PubMed

Simone, Marta; Viterbo, Rosa Gemma; Margari, Lucia; Iaffaldano, Pietro

2018-06-08

The treatment of cognitive deficits is challenging in pediatric onset multiple sclerosis (POMS) and in patients with attention deficit hyperactivity disorder (ADHD). We performed a pilot double-blind RCT to evaluate the efficacy of a home-based computerized-program for retraining attention in two cohorts of POMS and ADHD patients. POMS and ADHD patients failing in at least 2/4 attention tests on a neuropsychological battery were randomized to specific or nonspecific computerized training (ST, nST), performed in one-hour sessions, twice/week for 3 months. The primary outcome was the effect of the training on global neuropsychological performances measured by the cognitive impairment index (CII). The efficacy of the intervention was evaluated in each disease group by using repeated measures ANOVA. Sixteen POMS (9 females, age 15.75 ± 1.74 years) and 20 ADHD (2 females, age 11.19 ± 2.49 years) patients were enrolled. In POMS patients the ST exposure was associated to a significantly more pronounced improvement of the CII (p < 0.0001) and on cognitive test exploring attention, concentration, planning strategies and visuo-spatial memory performances in comparison to nST exposure. In ADHD patients the difference between the ST and nST on the CII was not statistical significant (p = 0.06), but a greater effect of the ST was found only on cognitive test exploring attention and delayed recall of visuo-spatial memory performances. Our data suggest that a cognitive rehabilitation program that targets attention is a suitable tool for improving global cognitive functioning in POMS patients, whereas it has a less pronounced transfer effect in ADHD patients. ClinicalTrials.gov; NCT03190902 ; registration date: June 15, 2017; retrospectively registered.

Comparison of brain volume abnormalities between ADHD and conduct disorder in adolescence

PubMed Central

Stevens, Michael C.; Haney-Caron, Emily

2012-01-01

Background Previous studies of brain structure abnormalities in conduct disorder and attention-deficit/hyperactivity disorder (ADHD) samples have been limited owing to cross-comorbidity, preventing clear understanding of which structural brain abnormalities might be specific to or shared by each disorder. To our knowledge, this study was the first direct comparison of grey and white matter volumes in diagnostically “pure” (i.e., no comorbidities) conduct disorder and ADHD samples. Methods Groups of adolescents with noncormobid conduct disorder and with noncomorbid, combined-subtype ADHD were compared with age- and sex-matched controls using DARTEL voxel-based analysis of T1-weighted brain structure images. Analysis of variance with post hoc analyses compared whole brain grey and white matter volumes among the groups. Results We included 24 adolescents in each study group. There was an overall 13% reduction in grey matter volume in adolescents with conduct disorder, reflecting numerous frontal, temporal, parietal and subcortical deficits. The same grey matter regions typically were not abnormal in those with ADHD. Deficits in frontal lobe regions previously identified in studies of patients with ADHD either were not detected, or group differences from controls were not as strong as those between the conduct disorder and control groups. White matter volume measurements did not differentiate conduct disorder and ADHD. Limitations Our modest sample sizes prevented meaningful examination of individual features of ADHD or conduct disorder, such as aggression, callousness, or hyperactive versus inattentive symptom subtypes. Conclusion The evidence supports theories of frontotemporal abnormalities in adolescents with conduct disorder, but raises questions about the prominence of frontal lobe and striatal structural abnormalities in those with noncomorbid, combined-subtype ADHD. The latter point is clinically important, given the widely held belief that ADHD is associated with numerous frontal lobe structural deficits, a conclusion that is not strongly supported following direct comparison of diagnostically pure groups. The results are important for future etiological studies, particularly those seeking to identify how early expression of specific brain structure abnormalities could potentiate the risk for antisocial behaviour. PMID:22663946

The Influence of Methylphenidate on Hyperactivity and Attention Deficits in Children With ADHD: A Virtual Classroom Test.

PubMed

Mühlberger, A; Jekel, K; Probst, T; Schecklmann, M; Conzelmann, A; Andreatta, M; Rizzo, A A; Pauli, P; Romanos, M

2016-05-13

This study compares the performance in a continuous performance test within a virtual reality classroom (CPT-VRC) between medicated children with ADHD, unmedicated children with ADHD, and healthy children. N = 94 children with ADHD (n = 26 of them received methylphenidate and n = 68 were unmedicated) and n = 34 healthy children performed the CPT-VRC. Omission errors, reaction time/variability, commission errors, and body movements were assessed. Furthermore, ADHD questionnaires were administered and compared with the CPT-VRC measures. The unmedicated ADHD group exhibited more omission errors and showed slower reaction times than the healthy group. Reaction time variability was higher in the unmedicated ADHD group compared with both the healthy and the medicated ADHD group. Omission errors and reaction time variability were associated with inattentiveness ratings of experimenters. Head movements were correlated with hyperactivity ratings of parents and experimenters. Virtual reality is a promising technology to assess ADHD symptoms in an ecologically valid environment. © The Author(s) 2016.

Does Anxiety Modify the Risk for, or Severity of, Conduct Problems Among Children With Co-Occurring ADHD: Categorical and Dimensional and Analyses.

PubMed

Danforth, Jeffrey S; Doerfler, Leonard A; Connor, Daniel F

2017-08-01

The goal was to examine whether anxiety modifies the risk for, or severity of, conduct problems in children with ADHD. Assessment included both categorical and dimensional measures of ADHD, anxiety, and conduct problems. Analyses compared conduct problems between children with ADHD features alone versus children with co-occurring ADHD and anxiety features. When assessed by dimensional rating scales, results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety are at risk for more intense conduct problems. When assessment included a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosis via the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic Version (K-SADS), results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety neither had more intense conduct problems nor were they more likely to be diagnosed with oppositional defiant disorder or conduct disorder. Different methodological measures of ADHD, anxiety, and conduct problem features influenced the outcome of the analyses.

Knowledge of attention deficit hyperactivity disorder and its associated factors among teachers in 3 large primary schools in Phra Nakorn Sri Ayutthaya Province, Thailand.

PubMed

Muanprasart, Pongchanok; Traivaree, Chanchai; Arunyanart, Wirongrong; Teeranate, Chakriya

2014-02-01

Though attention deficit, hyperactivity disorder ADHD is a common problem in childhood. Thai teachers' knowledge regarding the disease has never been assessed. To identify knowledge of Thai teachers regardingADHD and its influencingfactors. Cross-sectional study was operated in three primary schools in Ayutthaya, Thailand. Standardized questionnaires comprised ofdemographic data, ADHD experiences and the Knowledge of Attention Deficit Disorder Scale, KADDS, were distributed to participating teachers. Results were reported using frequency, percent, mean, and standard deviation. Association between demographic and ADHD experiences and the KADDS score was identified by logistic regression analysis. Lack ofknowledge of ADHD among teachers was apparent. Only 19.4% of them passed the total scale of KADDS. Teachers under 31-years-old were more likely to pass general information and signs, symptoms & diagnosis subscales and total scale. In addition, familiarity with ADHD patients was associated with passing scores of general information subscale and total scale. Despite public awareness of ADHD, Thai teachers lacked knowledge concerning the disease. Young teachers were more acquainted with ADHD. Direct experience with ADHD patient might help teachers develop their knowledge on ADHD.

Clinical correlations of grey matter reductions in the caudate nucleus of adults with attention deficit hyperactivity disorder

PubMed Central

Montes, Luis Guillermo Almeida; Ricardo-Garcell, Josefina; De La Torre, Lázaro Barajas; Alcántara, Hugo Prado; García, Reyna Beatriz Martínez; Fernández-Bouzas, Antonio; Acosta, David Ávila

2010-01-01

Background Magnetic resonance imaging (MRI) studies have shown decreased caudate volumes in individuals with attention deficit hyperactivity disorder (ADHD). However, most of these studies have been carried out in male children. Very little research has been done in adults, and the results obtained in children are difficult to extrapolate to adults. We sought to compare the volume of the caudate of adults with ADHD with that of healthy controls; we also compared these volumes between men and women. Methods We performed an MRI scan on 20 adults with ADHD (10 men and 10 women) aged 25–35 years and 20 healthy controls matched by age and sex. We used voxel-based morphometry with the DARTEL algorithm for image analyses. We used the specifically designed Friederichsen, Almeida, Serrano, Cortes Test (FASCT) to measure the severity of ADHD; both the self-reported (FASCT-SR) and the observer (FASCT-O) versions were used. Results The statistical parametric map showed a smaller region with low grey matter volume and a smaller concentration of grey matter in this region of the right caudate in ADHD patients than in health controls, both in the entire sample and within each sex. There was a significant correlation between the volume of this region of the caudate with the number of DSM IV-TR criteria, as well as with the total scores and most of the factors of the FASCT-SR and FASCT-O scales. A separate correlation analysis by sex gave similar results. Limitations The study design was cross-sectional. Conclusion The region of the right caudate with low grey matter volume was smaller in adults with ADHD in both sexes and was correlated with ADHD severity. PMID:20569650

Meta-analysis of social cognition in attention-deficit/hyperactivity disorder (ADHD): comparison with healthy controls and autistic spectrum disorder.

PubMed

Bora, E; Pantelis, C

2016-03-01

Impairment in social cognition is an established finding in autism spectrum disorders (ASD). Emerging evidence suggests that attention-deficit/hyperactivity disorder (ADHD) might be also associated with deficits in theory of mind (ToM) and emotion recognition. However, there are inconsistent findings, and it has been debatable whether such deficits persist beyond childhood and how similar social cognitive deficits are in ADHD v. ASD. We conducted a meta-analysis of social cognition, including emotion recognition and ToM, studies in ADHD compared with healthy controls and ASD. The current meta-analysis involved 44 studies comparing ADHD (n = 1999) with healthy controls (n = 1725) and 17 studies comparing ADHD (n = 772) with ASD (n = 710). Facial and vocal emotion recognition (d = 0.40-0.44) and ToM (d = 0.43) abilities were significantly impaired in ADHD. The most robust facial emotion recognition deficits were evident in anger and fear. Social cognitive deficits were either very subtle (emotion recognition) or non-significant (ToM) in adults with ADHD. Deficits in social cognition, especially ToM, were significantly more pronounced in ASD compared with ADHD. General cognitive impairment has contributed to social cognitive deficits in ADHD. Performance of individuals with ADHD on social cognition lies intermediate between ASD and healthy controls. However, developmental trajectories of social cognition probably differ between ADHD and ASD as social cognitive deficits in ADHD might be improving with age in most individuals. There is a need for studies investigating a potential subtype of ADHD with persistent social cognitive deficits and exploring longitudinal changes in social cognition during development.

Combination use of atomoxetine hydrochloride and olanzapine in the treatment of attention-deficit/hyperactivity disorder with comorbid disruptive behavior disorder in children and adolescents 10-18 years of age.

PubMed

Holzer, Barry; Lopes, Vasco; Lehman, Robert

2013-08-01

The aim of this study was to assess the use of atomoxetine and olanzapine in combination to treat attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behaviors in children and adolescents 10-18 years of age. Eleven subjects ages 10-18 received open-label atomoxetine and olanzapine for a 10 week treatment period. Patients were assessed at baseline, 2 weeks, 4 weeks, 6 weeks, and 10 weeks (posttreatment). ADHD improvement was measured through the ADHD Rating Scale (ADHD-RS) (Investigator and Parent ratings). Aggression was measured through the Modified Overt Aggression Scale (MOAS). The combined use of atomoxetine and olanzapine resulted in statistically significant improvement in ADHD symptoms and overt aggression from baseline to posttreatment. As evidenced by a 33% reduction in symptoms on the ADHD-RS-I and the MOAS, 73% of patients were considered responders to ADHD treatment, whereas 55% responded to treatment for aggression. Both medications were generally well tolerated. Olanzapine treatment was associated with significant weight gain. Patients gained, on average, 3.9 kg. throughout the treatment period. These data provide initial evidence that combination use of atomoxetine and olanzapine for the treatment of ADHD and comorbid disruptive behaviors was effective in reducing ADHD symptoms and aggressive behavior in a 10 week treatment period.

Symptom Profile of Attention-Deficit/Hyperactivity Disorder in Youth with High-functioning Autism Spectrum Disorder: A Comparative Study in Psychiatrically Referred Populations

PubMed Central

Joshi, Gagan; Faraone, Stephen V.; Wozniak, Janet; Tarko, Laura; Fried, Ronna; Galdo, Maribel; Furtak, Stephannie L.; Biederman, Joseph

2014-01-01

Objective To compare the clinical presentation of ADHD between youth with autism spectrum disorder (ASD) and ADHD and a sample of youth with ADHD only. Method A psychiatrically referred sample of autism spectrum disorder (ASD) youth with ADHD attending a specialized ambulatory program for ASD (n = 107) and a sample of youth with ADHD attending a general child psychiatry ambulatory clinic (n = 74) were compared. Results Seventy-six percent of youth with ASD met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. The clinical presentation of ADHD in youth with ASD was predominantly similar to its typical presentation including age at onset (3.5 ± 1.7 vs. 4.0 ± 1.9; p = .12), distribution of diagnostic subtypes, the qualitative and quantitative symptom profile, and symptom severity. Combined subtype was the most frequent presentation of ADHD in ASD youth. Conclusion Despite the robust presentation of ADHD, a significant majority of ASD youth with ADHD failed to receive appropriate ADHD treatment (41% vs. 24%; p = .02). A high rate of comorbidity with ADHD was observed in psychiatrically referred youth with ASD, with a clinical presentation typical of the disorder. PMID:25085653

Association of the GRIN2B rs2284411 polymorphism with methylphenidate response in attention-deficit/hyperactivity disorder.

PubMed

Kim, Johanna I; Kim, Jae-Won; Park, Jong-Eun; Park, Subin; Hong, Soon-Beom; Han, Doug Hyun; Cheong, Jae Hoon; Choi, Jae-Won; Lee, Sumin; Kim, Bung-Nyun

2017-08-01

We investigated the possible association between two NMDA subunit gene polymorphisms (GRIN2B rs2284411 and GRIN2A rs2229193) and treatment response to methylphenidate (MPH) in attention-deficit/hyperactivity disorder (ADHD). A total of 75 ADHD patients aged 6-17 years underwent 6 months of MPH administration. Treatment response was defined by changes in scores of the ADHD-IV Rating Scale (ADHD-RS), clinician-rated Clinical Global Impression-Improvement (CGI-I), and Continuous Performance Test (CPT). The association of the GRIN2B and GRIN2A polymorphisms with treatment response was analyzed using logistic regression analyses. The GRIN2B rs2284411 C/C genotype showed significantly better treatment response as assessed by ADHD-RS inattention ( p=0.009) and CGI-I scores ( p=0.009), and there was a nominally significant association in regard to ADHD-RS hyperactivity-impulsivity ( p=0.028) and total ( p=0.023) scores, after adjusting for age, sex, IQ, baseline Clinical Global Impression-Severity (CGI-S) score, baseline ADHD-RS total score, and final MPH dose. The GRIN2B C/C genotype also showed greater improvement at the CPT response time variability ( p<0.001). The GRIN2A G/G genotype was associated with a greater improvement in commission errors of the CPT compared to the G/A genotype ( p=0.001). The results suggest that the GRIN2B rs2284411 genotype may be an important predictor of MPH response in ADHD.

Reduced prefrontal hemodynamic response in adult attention-deficit hyperactivity disorder as measured by near-infrared spectroscopy.

PubMed

Ueda, Shotaro; Ota, Toyosaku; Iida, Junzo; Yamamuro, Kazuhiko; Yoshino, Hiroki; Kishimoto, Naoko; Kishimoto, Toshifumi

2018-06-01

Recent developments in near-infrared spectroscopy (NIRS) have enabled non-invasive clarification of brain functions in psychiatric disorders. In pediatric attention-deficit hyperactivity disorder (ADHD), reduced prefrontal hemodynamic responses have been observed with NIRS repeatedly. However, there are few studies of adult ADHD by multi-channel NIRS. Therefore, in this study, we used multi-channel NIRS to examine the characteristics of prefrontal hemodynamic responses during the Stroop Color-Word Task (SCWT) in adult ADHD patients and in age- and sex-matched control subjects. Twelve treatment-naïve adults with ADHD and 12 age- and sex-matched healthy control subjects participated in the present study after giving consent. We used 24-channel NIRS to measure the oxygenated hemoglobin (oxy-Hb) changes at the frontal lobes of participants during the SCWT. We compared the oxy-Hb changes between adults with ADHD and control subjects by t-tests with Bonferroni correction. During the SCWT, the oxy-Hb changes observed in the ADHD group were significantly smaller than those in the control group in channels 11, 16, 18, 21, 22, 23, and 24, corresponding to the prefrontal cortex. At channels 16, 21, 23, and 24 of the ADHD group, there were negative correlations between the symptomatic severity and the oxy-Hb changes. The present study suggests that adults with ADHD have reduced prefrontal hemodynamic response as measured by NIRS. © 2018 The Authors. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.

Impact of emotional salience on episodic memory in attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study.

PubMed

Krauel, Kerstin; Duzel, Emrah; Hinrichs, Hermann; Santel, Stephanie; Rellum, Thomas; Baving, Lioba

2007-06-15

Patients with attention-deficit/hyperactivity disorder (ADHD) show episodic memory deficits especially in complex memory tasks. We investigated the neural correlates of memory formation in ADHD and their modulation by stimulus salience. We recorded event-related functional magnetic resonance imaging during an episodic memory paradigm with neutral and emotional pictures in 12 male ADHD subjects and 12 healthy adolescents. Emotional salience did significantly augment memory performance in ADHD patients. Successful encoding of neutral pictures was associated with activation of the anterior cingulate cortex (ACC) in healthy adolescents but with activation of the superior parietal lobe (SPL) and precuneus in ADHD patients. Successful encoding of emotional pictures was associated with prefrontal and inferior temporal cortex activation in both groups. Healthy adolescents, moreover, showed deactivation in the inferior parietal lobe. From a pathophysiological point of view, the most striking functional differences between healthy adolescents and ADHD patients were in the ACC and SPL. We suggest that increased SPL activation in ADHD reflected attentional compensation for low ACC activation during the encoding of neutral pictures. The higher salience of emotional stimuli, in contrast, regulated the interplay between ACC and SPL in conjunction with improving memory to the level of healthy adolescents.

Motor regulation problems and pain in adults diagnosed with ADHD

PubMed Central

2013-01-01

Background Most children who are diagnosed with attention deficit-hyperactivity disorder (ADHD) have moderate-to-severe motor problems using the Motor Function Neurological Assessment battery (MFNU). The MFNU focuses on specific muscle adjustment problems associated with ADHD, especially motor inhibition problems and high muscle tone. Here we investigated whether adults with ADHD/hyperkinetic disorder (HKD) have similar motor problems. In our clinical experience, adults with ADHD often complain about back, shoulder, hip, and leg pain. We also investigate reported pain in adults with ADHD. Methods Twenty-five adult outpatients diagnosed with ADHD/HKD who were responders to methylphenidate (MPH) were compared to 23 non-ADHD controls on 16 MFNU subtests and using a ‘total score’ (‘TS’) parameter. The MFNU test leader was blinded to group identity. The two groups were also compared using the Pain Drawing and Numerical Pain Rating Scale. Results The adult ADHD group had significantly (p < .001) more motor problems (higher TS) than controls. On the muscle regulation subtests, 36–96% of the ADHD group showed ‘moderate’ to ‘severe’ problems compared to 13–52% of the control group, and 80% of the ADHD group reported widespread pain. Highly significant differences were found between the ADHD and control groups for the variables ‘pain level’ (p < .001) and ‘pain location’ (p < .001). Significant correlations were found between TS and ‘pain location’ and between TS and ‘pain level’. Conclusions These findings suggest that similar to children with ADHD, adults diagnosed with ADHD also have motor inhibition problems and heightened muscle tone. The presence of significantly higher pain levels and more widespread pain in the ADHD group compared to non-ADHD controls might indicate that pain is a long-term secondary effect of heightened muscle tone and restricted movement that can be demonstrated in children and adults by the MFNU battery. PMID:23642255

Safety of Methylphenidate and Atomoxetine in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): Data from the Italian National ADHD Registry.

PubMed

Cortese, Samuele; Panei, Pietro; Arcieri, Romano; Germinario, Elena A P; Capuano, Annalisa; Margari, Lucia; Chiarotti, Flavia; Curatolo, Paolo

2015-01-01

The aim of this study was to assess the type and frequency of adverse events (AEs) in children with attention-deficit/hyperactivity disorder (ADHD) treated with methylphenidate or atomoxetine over a 5-year period in a large naturalistic study. We draw on data from the Italian ADHD Registry, a national database for postmarketing phase IV pharmacovigilance of ADHD medications across 90 centers. AEs were defined as severe or mild as per the classification of the Italian Medicines Agency. AE frequency in the two treatment groups was compared using incidence rates per 100 person-years (IR100PY) and incidence rate ratios (IRRs). Mantel-Haenszel adjusted IRRs were calculated to control for psychiatric comorbidity. A total of 1350 and 753 participants (aged 6-18 years, mean age 10.7 ± 2.8) were treated with methylphenidate and atomoxetine, respectively, from 2007 to 2012. Ninety participants (7 %) were switched from methylphenidate to atomoxetine, and 138 (18 %) from atomoxetine to methylphenidate. Thirty-seven children treated with atomoxetine and 12 with methylphenidate had their medication withdrawn. Overall, 645 patients (26.8 %) experienced at least one mild AE (including decreased appetite and irritability, for both drugs) and 95 patients (3.9 %) experienced at least one severe AE (including severe gastrointestinal events). IR100PY were significantly higher in the atomoxetine-treated group compared with the methylphenidate-treated group for a number of mild and severe AEs and for any severe or mild AEs. After controlling for comorbidities, IRR was still significantly higher in the atomoxetine group compared with the methylphenidate group for a number of mild (decreased appetite, weight loss, abdominal pain, dyspepsia, stomach ache, irritability, mood disorder and dizziness) and severe (gastrointestinal, neuropsychiatric, and cardiovascular) AEs. In this naturalistic study, methylphenidate had a better safety profile than atomoxetine.

The relationships among ADHD, self-esteem, and test anxiety in young adults.

PubMed

Dan, Orrie; Raz, Sivan

2015-03-01

The comorbidity of adult ADHD with test anxiety (TA) has not been previously reported. This comorbidity can potentially affect clinical and academic interventions among individuals with ADHD. The present study investigated the relationships among ADHD, self-esteem, and three subscales of TA among young adults: Cognitive Obstruction, Social Derogation, and Tenseness. A total of 25 female participants diagnosed with ADHD and 30 female controls without ADHD of comparable age and education completed an Online Continuous Performance Test, an ADHD questionnaire, a self-esteem inventory, and a TA questionnaire. Participants with ADHD exhibited significantly higher levels of TA on all three subscales and lower levels of self-esteem compared with controls. Self-esteem served as a partial mediator between ADHD and cognitive obstruction TA and as a full mediator between ADHD and social derogation TA, but had no mediation effect in the relationships between ADHD and tenseness TA. The findings of this study suggest that TA, well known to affect success on tests, is correlated with ADHD. Therefore, interventions for ADHD should include components aimed at reducing TA. © 2012 SAGE Publications.

Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced.

PubMed

Ptacek, Radek; Stefano, George B; Weissenberger, Simon; Akotia, Devang; Raboch, Jiri; Papezova, Hana; Domkarova, Lucie; Stepankova, Tereza; Goetz, Michal

2016-01-01

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists in adulthood. It is defined by inattention and/or hyperactivity-impulsivity. ADHD is associated with many comorbidities, including eating disorders (EDs). In the last decade, studies have reported that ADHD is linked with binge EDs, bulimia nervosa, and anorexia nervosa. Many postulates have been proposed to explain the association: 1) impulsive behavior in ADHD patients leads to disordered eating behavior; 2) other psychologic comorbidities present in ADHD patients account for eating behavior; 3) poor eating habits and resulting nutritional deficiencies contribute to ADHD symptoms; and 4) other risk factors common to both ADHD and EDs contribute to the coincidence of both diseases. Additionally, sex differences become a significant issue in the discussion of EDs and ADHD because of the higher incidence of bulimia nervosa and anorexia nervosa in females and the ability of females to mask the symptoms of ADHD. Interestingly, both EDs and ADHD rely on a common neural substrate, namely, dopaminergic signaling. Dopaminergic signaling is critical for motor activity and emotion, the latter enabling the former into a combined motivated movement like eating. This linkage aids in explaining the many comorbidities associated with ADHD. The interconnection of ADHD and EDs is discussed from both a historical perspective and the one based on the revealing nature of its comorbidities.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karen, Romero Sánchez, E-mail: alphacentauri-hp@hotmail.com, E-mail: marcos-vaquezr@hotmail.com, E-mail: isabeldgg@hotmail.com; Vásquez Reyes Marcos, A., E-mail: alphacentauri-hp@hotmail.com, E-mail: marcos-vaquezr@hotmail.com, E-mail: isabeldgg@hotmail.com; González Gómez Dulce, I., E-mail: alphacentauri-hp@hotmail.com, E-mail: marcos-vaquezr@hotmail.com, E-mail: isabeldgg@hotmail.com

The main goal of this project was to create a computer algorithm based on wavelet analysis of BOLD signals, which automatically diagnosed ADHD using information from resting state MR experiments. Male right handed volunteers (infants with ages between 7 and 11 years old) were studied and compared with age matched controls. Wavelet analysis, which is a mathematical tool used to decompose time series into elementary constituents and detect hidden information, was applied here to the BOLD signal obtained from the cerebellum 8 region of all our volunteers. Statistical differences between the values of the a parameters of wavelet analysis wasmore » found and showed significant differences (p<0.02) between groups. This difference might help in the future to distinguish healthy from ADHD patients and therefore diagnose ADHD.« less

Is ADHD a Risk Factor for High School Dropout? A Controlled Study.

PubMed

Fried, Ronna; Petty, Carter; Faraone, Stephen V; Hyder, Laran L; Day, Helen; Biederman, Joseph

2016-05-01

This study examined whether ADHD was an independent contributor to grade retention when adjusting for IQ, learning disorders, and social class. Outcome data was from participants in studies at Massachusetts General Hospital (n= 404 ADHD,n= 349 controls) who underwent psychiatric interviews, socioeconomic status measures, and IQ testing. 28% of individuals with ADHD repeated a grade compared with 7% of controls (p< .001). Among participants with ADHD, social class, and IQ were significant predictors of high school dropout or repeated grade. An interaction effect of ADHD and gender was also found with females with ADHD having a higher risk ratio for repeated grade/dropout compared with males with ADHD. Participants with ADHD were significantly more likely to repeat a grade, adjusting for all other variables indicating the critical importance of early identification of ADHD to help mitigate adverse educational outcomes. © The Author(s) 2013.

Maternal ADHD, parenting, and psychopathology among mothers of adolescents with ADHD

PubMed Central

Babinski, Dara E.; Pelham, William E.; Molina, Brooke S.G.; Gnagy, Elizabeth M.; Waschbusch, Daniel A.; Wymbs, Brian T.; Sibley, Margaret H.; Derefinko, Karen J.; Kuriyan, Aparajita B.

2012-01-01

Objective This study describes the parenting and psychopathology of mothers with ADHD of adolescents with ADHD (MCA), non-ADHD mothers of adolescents with ADHD (CA), and non-ADHD mothers of adolescents without ADHD (COMP). Method Two sets of pairwise comparisons: 1) COMP vs. CA and 2) CA vs. MCA were conducted. We hypothesized that CA would experience greater distress in parenting and psychopathology compared to COMP, and that MCA would experience even more impairment compared to CA. Results Few differences emerged in comparisons of CA and COMP, with the exception of CA reporting greater parent-adolescent conflict and internalizing problems. In contrast, differences consistently emerged in comparisons of MCA and CA showing more difficulty for MCA in parenting and psychopathology. Conclusion These findings underscore the need for treatments that address parental ADHD when adolescent ADHD is the intended target. PMID:23160485

Pilot Study of Droxidopa With Carbidopa in Adults With ADHD.

PubMed

Adler, Lenard A; Gorny, Stephen W

2015-04-23

We conducted a two-period (open-label and double-blind) pilot investigation of droxidopa, with and without carbidopa, for ADHD. Twenty adult ADHD patients received open-label droxidopa titrated from 200 to 600 mg 3 times per day (TID; Weeks 1-3), then open-label droxidopa plus carbidopa titrated from 25 or 50 mg TID (Weeks 4-6). In Weeks 7 to 8, patients were randomized to continued co-treatment or matching placebo substitution. Improvements in mean total Adult ADHD Investigator Symptom Report Scale (AISRS) scores were seen at Week 1 (p < .0001) and Week 3 (p < .0001). Improvements were maintained but not increased with carbidopa. Thirteen of 20 patients completed open-label treatment. In the double-blind period, mean total AISRS scores were similar between the co-treatment (n = 6) and placebo (n = 5) groups. No serious adverse events were reported. These preliminary findings indicate that droxidopa can improve adult ADHD symptoms. Further studies are warranted to examine the efficacy and safety of droxidopa in ADHD. © 2015 SAGE Publications.

Serum protein profiling and proteomics in autistic spectrum disorder using magnetic bead-assisted mass spectrometry.

PubMed

Taurines, Regina; Dudley, Edward; Conner, Alexander C; Grassl, Julia; Jans, Thomas; Guderian, Frank; Mehler-Wex, Claudia; Warnke, Andreas; Gerlach, Manfred; Thome, Johannes

2010-04-01

The pathophysiology of autistic spectrum disorder (ASD) is not fully understood and there are no diagnostic or predictive biomarkers. Proteomic profiling has been used in the past for biomarker research in several non-psychiatric and psychiatric disorders and could provide new insights, potentially presenting a useful tool for generating such biomarkers in autism. Serum protein pre-fractionation with C8-magnetic beads and protein profiling by matrix-assisted laser desorption/ionisation-time of flight-mass spectrometry (MALDI-ToF-MS) were used to identify possible differences in protein profiles in patients and controls. Serum was obtained from 16 patients (aged 8-18) and age-matched controls. Three peaks in the MALDI-ToF-MS significantly differentiated the ASD sample from the control group. Sub-grouping the ASD patients into children with and without comorbid Attention Deficit and Hyperactivity Disorder, ADHD (ASD/ADHD+ patients, n = 9; ASD/ADHD- patients, n = 7), one peak distinguished the ASD/ADHD+ patients from controls and ASD/ADHD- patients. Our results suggest that altered protein levels in peripheral blood of patients with ASD might represent useful biomarkers for this devastating psychiatric disorder.

Nutritional status and feeding problems in pediatric attention deficit-hyperactivity disorder.

PubMed

Sha'ari, Norsuhaila; Manaf, Zahara Abdul; Ahmad, Mahadir; Rahman, Fairuz Nazri Abd

2017-04-01

Children with attention deficit-hyperactivity disorder (ADHD) may be at risk of nutrient deficiency due to the inability to sit through meals. This comparative cross-sectional study was therefore carried out to determine the nutritional status and feeding problems of ADHD children aged 4-12 years. Sociodemographic data, anthropometric measurements and 3 day dietary intake record were collected from 54 ADHD children and 54 typical development (TD) children. The Behavioral Pediatrics Feeding Assessment Scale was used to assess feeding problems. Mean subject age was 8.6 ± 2.1 years. On anthropometric assessment, 11.1% of the ADHD children had wasting, while 1.9% had severe wasting. In contrast, none of the TD children had wasting. Approximately 5.6% of the ADHD children had stunting, as compared with 3.7% of the TD children, while none of the TD children had severe stunting compared with 3.7% of the ADHD children. More than half of the ADHD children had mid-upper arm circumference (MUAC) below the 5th percentile, indicating undernutrition, compared with only 35.2% of TD children. More than one-third of the ADHD children had feeding problems compared with 9.3% of TD children. There was a significant negative relationship between the ADHD children's feeding problems and bodyweight (r = -0338, P = 0.012), body mass index (r = -0322, P = 0.017) and MUAC (r = -0384, P = 0.004). Almost half of the ADHD children had suboptimal nutrition compared with 11.1% of the TD children. It is imperative to screen ADHD children for nutritional status and feeding problems to prevent negative health impacts later on. © 2016 Japan Pediatric Society.

Attention deficit hyperactivity disorder increases the risk of having abnormal eating behaviours in obese adults.

PubMed

Docet, M F; Larrañaga, A; Pérez Méndez, L F; García-Mayor, R V

2012-06-01

To determine the rate of abnormal eating behaviours in obese adult patients with attention deficit hyperactivity disorder (ADHD) in comparison with obese adult patients without ADHD. This case-control study includes: obese adult patients defined by a body mass index (BMI) ≥30 kg/m², screening positive in the adult ADHD self-report scale-V1.1. (ASRS-V1.1), attending the Nutrition Section, as cases; and obese adult patients screening negative, as controls. Weight, height and BMI were determined in all the participants. The rate of abnormal eating behaviours was determined using an eating pattern questionnaire. Forty-five out of 51 (88.2%) cases vs 127 out of 179 (70.9%) controls had abnormal eating behaviours (p=0.01). Eating between-meal snacks was found in 39 (76.5%) cases vs 107 (59.8%) controls (p=0.03), going on binge eating episodes in 28 (54.9%) vs 42 (23.5%) (p=0.00), waking up at night to eat in 11 (21.6%) vs 16 (8.9%) (p=0.01), eating large amounts of food in 13 (25.5%) vs 38 (21.2%) (p=0.52), and eating in secret in 11 (21.6%) vs 16 (8.9%) (p=0.01), respectively. This is the first study that determines the rate of these abnormal eating behaviours in obese adult patients with ADHD in comparison with obese adult patients without ADHD. A high rate of abnormal eating behaviours was observed in obese patients with ADHD. Our results suggest that ADHD is a risk factor for the development of these abnormal eating behaviours, which may be contributing factors of obesity and the unsuccessful treatment of obese patients.

Influence of gender on attention-deficit/hyperactivity disorder in Europe--ADORE.

PubMed

Nøvik, Torunn Stene; Hervas, Amaia; Ralston, Stephen J; Dalsgaard, Søren; Rodrigues Pereira, Rob; Lorenzo, Maria J

2006-12-01

Attention-deficit/hyperactivity disorder (ADHD) in girls in Europe is poorly understood; it is not known whether they exhibit similar symptom patterns or co-existing problems and receive the same type of treatment as boys. To examine gender differences for referral patterns, social demographic factors, ADHD core symptomatology, co-existing health problems, psychosocial functioning and treatment. Baseline data from the ADHD Observational Research in Europe (ADORE) study, a 24-month, naturalistic, longitudinal observational study in 10 European countries of children (aged 6-18 years) with hyperactive/inattentive/impulsive symptoms but no previous diagnosis of ADHD, were analysed by gender. Data from 1,478 children were analysed: 231 girls (15.7%) and 1,222 boys (84.3%) (gender data missing for 25 patients). Gender ratios (girl:boy) varied by country, ranging from 1:3 to 1:16. Comparisons showed few gender effects in core ADHD symptomatology and clinical correlates of ADHD. Compared with boys, girls had significantly more parent-rated emotional symptoms and prosocial behaviour and were more likely to be the victim of bullying and less likely to be the bully. Girls and boys had similar levels of co-existing psychiatric and physical health problems, and received the same type of treatment. Fewer girls than boys are referred for ADHD treatment, but they have a similar pattern of impairment and receive similar treatment.

Hyperfunctional Voice Disorder in Children With Attention Deficit Hyperactivity Disorder (ADHD). A Phenotypic Characteristic?

PubMed

Barona-Lleo, Luz; Fernandez, Secundino

2016-01-01

The purpose of this study was to detect specific vocal aerodynamic patterns in attention deficit hyperactivity disorder (ADHD) patients and to define a possible new phenotypic feature of this disorder that must be diagnosed and treated. This is a prospective study. Seventy-nine children aged 5-13 years were recruited: 44 children with ADHD diagnosis and 35 children, as a control group, matched according to age and gender. All children were evaluated in the voice laboratory. Each subject repeated sustained vowels, syllables, words, and sentences several times. Intraoral pressure, transglottal airflow, microphone, and electroglottograph results were recorded and analyzed. Children affected by ADHD, with adequate tolerance, were evaluated endoscopically and by the speech therapist. The aerodynamic analysis shows that the subglottal pressure is higher and transglottal airflow is lower in ADHD children compared with the children of the control group. Those differences are statistically significant. The endoscopic physical examination showed vocal nodules in 25 children (78.125%) and hyperfunctional vocal behavior in all ADHD children studied. We proposed that every child with ADHD disorder must be evaluated from a laryngeal point of view (otolaryngologist and speech therapist) as an important part of the diagnosis and global treatment. It could be considered as a new phenotypic characteristic of this disorder. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Correspondence and Disparity in the Self- and Other Ratings of Current and Childhood ADHD Symptoms and Impairment in Adults with ADHD

ERIC Educational Resources Information Center

Barkley, Russell A.; Knouse, Laura E.; Murphy, Kevin R.

2011-01-01

Experts recommend that clinicians evaluating adults for attention-deficit/hyperactivity disorder (ADHD) obtain information from others who know the patient well. The authors examined correspondence between the self- and other-ratings of ADHD symptoms and impairment using 3 groups of adults recruited on the basis of their severity of ADHD: ADHD…

Exploring Behavioral Sleep Problems in Children With ADHD and Comorbid Autism Spectrum Disorder.

PubMed

Thomas, Simone; Lycett, Kate; Papadopoulos, Nicole; Sciberras, Emma; Rinehart, Nicole

2015-12-04

This study (a) compared behavioral sleep problems in children with comorbid ADHD and autism spectrum disorder (ASD) with those with ADHD and (b) examined child/family factors associated with sleep problems. Cross-sectional study comparison of 392 children with a confirmed ADHD diagnosis (ADHD+ASD, n=93, ADHD, n=299) recruited from 21 peadiatric practises in Victoria, Australia. Data were collected from parents. Key measures included the Child Sleep Habits Questionnaire (CSHQ). Children with ADHD + ASD experienced similar levels and types of behavioral sleep problems compared with those with ADHD. In both groups, the presence of co-occurring internalizing and externalizing comorbidities was associated with sleep problems. Sleep problems were also associated with parent age in the ADHD + ASD group and poorer parent mental health in the ADHD group. Findings suggest comorbid ASD is not associated with increased behavioral sleep problems in children with ADHD and that co-occurring internalizing and externalizing comorbidities may flag children in these groups with sleep problems. © The Author(s) 2015.

Affect Recognition in Adults with ADHD

ERIC Educational Resources Information Center

Miller, Meghan; Hanford, Russell B.; Fassbender, Catherine; Duke, Marshall; Schweitzer, Julie B.

2011-01-01

Objective: This study compared affect recognition abilities between adults with and without ADHD. Method: The sample consisted of 51 participants (34 men, 17 women) divided into 3 groups: ADHD-combined type (ADHD-C; n = 17), ADHD-predominantly inattentive type (ADHD-I; n = 16), and controls (n = 18). The mean age was 34 years. Affect recognition…

Once-daily treatment of ADHD with guanfacine: patient implications

PubMed Central

Strange, Brandon C

2008-01-01

The standard of care for treating ADHD is to use a psychostimulant as the first line agent. Recent medical literature reports that approximately 70%–90% of patients with ADHD received some benefit from a stimulant medication. Even though psychostimulants have a high rate of efficacy, an estimated 30%–50% of children and adults may discontinue psychostimulants secondary to adverse effects or inadequate response. Guanfacine has been used for a number of years as an off label alternative to psychostimulants. This article reviews the current literature on the effectiveness of guanfacine in treating ADHD. It also introduces the preliminary data for guanfacine extended release and its effectiveness in decreasing the symptoms of ADHD. PMID:18830439

Psychological treatment of attention deficit hyperactivity disorder in adults: a systematic review.

PubMed

Vidal-Estrada, Raquel; Bosch-Munso, Rosa; Nogueira-Morais, Mariana; Casas-Brugue, Miquel; Ramos-Quiroga, Josep A

2012-01-01

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder of childhood onset. The disorder persists into adulthood in most cases, significantly affecting patient function. Although the firstline choice of treatment for ADHD is pharmacological, drug treatments are not always sufficient. All the published studies on the psychological treatment of ADHD were systematically reviewed for the present article. The MEDLINE and PsychINFO electronic databases were searched using the terms psychological treatment OR psychotherapy OR psychosocial treatment AND ADHD. Patient age was restricted to adults (all adult:19+ years). Eighteen published studies met inclusion criteria for the review. Fifteen efficacy studies of psychological treatment were selected (cognitive behavioral therapy, metacognitive therapy, dialectical behavior therapy, coaching, cognitive remediation) and three previous reviews. The results indicate that cognitive behavioral therapy is the most effective psychological treatment for ADHD symptoms in adults and the comorbid symptoms of anxiety and depression, which have an important functional impact on the daily life of patients. However, more research is needed to know the differential effects of each psychological approach in relation to improved ADHD symptoms in adults. Finally, future directions for the psychosocial treatment of ADHD problems of adults are suggested.

Functional Connectivity of Child and Adolescent Attention Deficit Hyperactivity Disorder Patients: Correlation with IQ.

PubMed

Park, Bo-Yong; Hong, Jisu; Lee, Seung-Hak; Park, Hyunjin

2016-01-01

Attention deficit hyperactivity disorder (ADHD) is a pervasive neuropsychological disorder that affects both children and adolescents. Child and adolescent ADHD patients exhibit different behavioral symptoms such as hyperactivity and impulsivity, but not much connectivity research exists to help explain these differences. We analyzed openly accessible resting-state functional magnetic resonance imaging (rs-fMRI) data on 112 patients (28 child ADHD, 28 adolescent ADHD, 28 child normal control (NC), and 28 adolescent NC). We used group independent component analysis (ICA) and weighted degree values to identify interaction effects of age (child and adolescent) and symptom (ADHD and NC) in brain networks. The frontoparietal network showed significant interaction effects ( p = 0.0068). The frontoparietal network is known to be related to hyperactive and impulsive behaviors. Intelligence quotient (IQ) is an important factor in ADHD, and we predicted IQ scores using the results of our connectivity analysis. IQ was predicted using degree centrality values of networks with significant interaction effects of age and symptom. Actual and predicted IQ scores demonstrated significant correlation values, with an error of about 10%. Our study might provide imaging biomarkers for future ADHD and intelligence studies.

A study of pathway of care in children and adolescents with attention deficit hyperactivity disorder.

PubMed

Arya, Amit; Agarwal, Vivek; Yadav, Suresh; Gupta, Pawan Kumar; Agarwal, Manu

2015-10-01

Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India. 57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma. The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%). Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents. Copyright © 2015 Elsevier B.V. All rights reserved.

Frontal brain asymmetry in adult attention-deficit/hyperactivity disorder (ADHD): extending the motivational dysfunction hypothesis.

PubMed

Keune, Philipp M; Wiedemann, Eva; Schneidt, Alexander; Schönenberg, Michael

2015-04-01

Attention-deficit/hyperactivity disorder (ADHD) involves motivational dysfunction, characterized by excessive behavioral approach tendencies. Frontal brain asymmetry in the alpha band (8-13 Hz) in resting-state electroencephalogram (EEG) represents a neural correlate of global motivational tendencies, and abnormal asymmetry, indicating elevated approach motivation, was observed in pediatric and adult patients. To date, the relation between ADHD symptoms, depression and alpha asymmetry, its temporal metric properties and putative gender-specificity remain to be explored. Adult ADHD patients (n=52) participated in two resting-state EEG recordings, two weeks apart. Asymmetry measures were aggregated across recordings to increase trait specificity. Putative region-specific associations between asymmetry, ADHD symptoms and depression, its gender-specificity and test-retest reliability were examined. ADHD symptoms were associated with approach-related asymmetry (stronger relative right-frontal alpha power). Approach-related asymmetry was pronounced in females, and also associated with depression. The latter association was mediated by ADHD symptoms. Test-retest reliability was sufficient. The association between reliably assessable alpha asymmetry and ADHD symptoms supports the motivational dysfunction hypothesis. ADHD symptoms mediating an atypical association between asymmetry and depression may be attributed to depression arising secondary to ADHD. Gender-specific findings require replication. Frontal alpha asymmetry may represent a new reliable marker of ADHD symptoms. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

[Visual perception of Kanji characters and complicated figures. Part 3. Visual P300 event-related potentials in patients with attention deficit/hyperactivity disorders].

PubMed

Shirane, Seiko; Inagaki, Masumi; Sata, Yoshimi; Kaga, Makiko

2004-07-01

In order to evaluate visual perception, the P300 event-related potentials (ERPs) for visual oddball tasks were recorded in 11 patients with attention deficit/hyperactivity disorders (AD/HD), 12 with mental retardation (MR) and 14 age-matched healthy controls. With the aim of revealing trial-to-trial variabilities which are neglected by investigating averaged ERPs, single sweep P300s (ss-P300s) were assessed in addition to averaged P300. There were no significant differences of averaged P300 latency and amplitude between controls and AD/HD patients. AD/HD patients showed an increased variability in the amplitude of ss-P300s, while MR patient showed an increased variability in latency. These findings suggest that in AD/HD patients general attention is impaired to a larger extent than selective attention and visual perception.

Do Stimulants Reduce the Risk for Alcohol and Substance Use in Youth With ADHD? A Secondary Analysis of a Prospective, 24-Month Open-Label Study of Osmotic-Release Methylphenidate.

PubMed

Hammerness, Paul; Petty, Carter; Faraone, Stephen V; Biederman, Joseph

2017-01-01

The purpose of this study was to examine the impact of stimulant treatment on risk for alcohol and illicit drug use in adolescents with ADHD. Analysis of data derived from a prospective open-label treatment study of adolescent ADHD ( n = 115, 76% male), and a historical, naturalistic sample of ADHD ( n = 44, 68% male) and non-ADHD youth ( n = 52, 73% male) of similar age and sex. Treatment consisted of extended-release methylphenidate in the clinical trial or naturalistic stimulant treatment. Self-report of alcohol and drug use was derived from a modified version of the Drug Use Screening Inventory. Rates of alcohol and drug use in the past year were significantly lower in the clinical trial compared with untreated and treated naturalistic ADHD comparators, and similar to rates in non-ADHD comparators. Well-monitored stimulant treatment may reduce the risk for alcohol and substance use in adolescent ADHD.

Atomoxetine ameliorates nocturnal enuresis with subclinical attention-deficit/hyperactivity disorder.

PubMed

Ohtomo, Yoshiyuki

2017-02-01

Recent studies have shown that incontinence and attention-deficit/hyperactivity disorder (ADHD) coexist and there is an interaction between them. The treatment for nocturnal enuresis (NE) and ADHD, however, has not been established. At the first visit to the outpatient clinic, physical examination and history taking were carried out in 265 new patients with NE. After excluding the possibility of comorbid ADHD and related disorders, patients with monosymptomatic NE (MNE) were treated with desmopressin and/or alarm, and those with non-monosymptomatic NE (NMNE) were treated with anti-cholinergics and/or alarm. This 12 week treatment did not work in 65 patients, and they were re-assessed for comorbid ADHD. A total of 24 were diagnosed with ADHD, and they were treated with atomoxetine (1.8 mg/kg/day) in addition to ongoing therapy for NE. After 8 weeks of atomoxetine, the average wet nights per months was significantly decreased: 18.5-4.6 in the MNE group (P = 0.001), and 22.1-12.4 in the NMNE group (P = 0.0251). Overall, atomoxetine was beneficial in 19 of 24 patients. Atomoxetine may be a suitable option for refractory NE with comorbid ADHD. © 2016 Japan Pediatric Society.

Circadian activity rhythm in adult attention-deficit hyperactivity disorder.

PubMed

Tonetti, Lorenzo; Conca, Andreas; Giupponi, Giancarlo; Filardi, Marco; Natale, Vincenzo

2018-05-06

The aim of the present study was to analyze the features of circadian motor activity rhythm of adult attention-deficit hyperactivity disorder (ADHD) patients, by means of functional linear modeling, within the theoretical framework of the two-process model of sleep regulation. Thirty-two ADHD patients and 32 healthy controls (HCs) participated the study. Actiwatch AW64 actigraph was used to quantify motor activity data in 1-min epochs. Participants wore the actigraph on the non-dominant wrist for seven consecutive days. Results show that ADHD patients had significantly higher motor activity than HCs from 4:00 to 7:00, with a peak around 5:00, and from 12:00 to 18:00, with another peak around 14:00. According to the two-process model of sleep regulation, the circadian activity rhythm of ADHD patients may indicate a lower homeostatic sleep pressure, as reflected by the absence of post-lunch dip, which could be considered a potential trait marker of adult ADHD. Copyright © 2018 Elsevier Ltd. All rights reserved.

Mindfulness Meditation Improves Mood, Quality of Life, and Attention in Adults with Attention Deficit Hyperactivity Disorder

PubMed Central

2015-01-01

Objective. Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention. Mood in ADHD can be improved by mindful awareness practices (MAP), but results are mixed regarding the enhancement of attentional performance. Here we evaluated MAP-induced changes in quality of life (QoL), mood, and attention in adult ADHD patients and controls using more measures of attention than prior studies. Methods. Twenty-one ADHD patients and 8 healthy controls underwent 8 weekly MAP sessions; 22 similar patients and 9 controls did not undergo the intervention. Mood and QoL were assessed using validated questionnaires, and attention was evaluated using the Attentional Network Test (ANT) and the Conners Continuous Performance Test (CPT II), before and after intervention. Results. MAP enhanced sustained attention (ANT) and detectability (CPT II) and improved mood and QoL of patients and controls. Conclusion. MAP is a complementary intervention that improves affect and attention of adults with ADHD and controls. PMID:26137496

Mindfulness Meditation Improves Mood, Quality of Life, and Attention in Adults with Attention Deficit Hyperactivity Disorder.

PubMed

Bueno, Viviane Freire; Kozasa, Elisa H; da Silva, Maria Aparecida; Alves, Tânia Maria; Louzã, Mario Rodrigues; Pompéia, Sabine

2015-01-01

Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention. Mood in ADHD can be improved by mindful awareness practices (MAP), but results are mixed regarding the enhancement of attentional performance. Here we evaluated MAP-induced changes in quality of life (QoL), mood, and attention in adult ADHD patients and controls using more measures of attention than prior studies. Twenty-one ADHD patients and 8 healthy controls underwent 8 weekly MAP sessions; 22 similar patients and 9 controls did not undergo the intervention. Mood and QoL were assessed using validated questionnaires, and attention was evaluated using the Attentional Network Test (ANT) and the Conners Continuous Performance Test (CPT II), before and after intervention. MAP enhanced sustained attention (ANT) and detectability (CPT II) and improved mood and QoL of patients and controls. MAP is a complementary intervention that improves affect and attention of adults with ADHD and controls.

Atomoxetine Treatment of ADHD in Children with Comorbid Tourette Syndrome

ERIC Educational Resources Information Center

Spencer, Thomas J.; Sallee, F. Randy; Gilbert, Donald L.; Dunn, David W.; McCracken, James T.; Coffey, Barbara J.; Budman, Cathy L.; Ricardi, Randall K.; Leonard, Henrietta L.; Allen, Albert J.; Milton, Denai R.; Feldman, Peter D.; Kelsey, Douglas K.; Geller, Daniel A.; Linder, Steven L.; Lewis, Donald W.; Winner, Paul K.; Kurlan, Roger M.; Mintz, Mark

2008-01-01

Objective: This study examines changes in severity of tics and ADHD during atomoxetine treatment in ADHD patients with Tourette syndrome (TS). Method: Subjects (7-17 years old) with ADHD ("Diagnostic and Statistical Manual of Mental Disorders, DSM-IV") and TS were randomly assigned to double-blind treatment with placebo (n = 56) or atomoxetine…

The Identification and Assessment of Late-Life ADHD in Memory Clinics

ERIC Educational Resources Information Center

Fischer, Barbara L.; Gunter-Hunt, Gail; Steinhafel, Courtney Holm; Howell, Timothy

2012-01-01

Objective: Little data exist about ADHD in late life. While evaluating patients' memory problems, the memory clinic staff has periodically identified ADHD in previously undiagnosed older adults. The authors conducted a survey to assess the extent to which other memory clinics view ADHD as a relevant clinical issue. Method: The authors developed…

Cognitive Deficits in Adults with ADHD Go beyond Comorbidity Effects

ERIC Educational Resources Information Center

Silva, Katiane L.; Guimaraes-da-Silva, Paula O.; Grevet, Eugenio H.; Victor, Marcelo M.; Salgado, Carlos A. I.; Vitola, Eduardo S.; Mota, Nina R.; Fischer, Aline G.; Contini, Veronica; Picon, Felipe A.; Karam, Rafael G.; Belmonte-de-Abreu, Paulo; Rohde, Luis A.; Bau, Claiton H. D.

2013-01-01

Objective: This study addresses if deficits in cognitive, attention, and inhibitory control performance in adults with ADHD are better explained by the disorder itself or by comorbid conditions. Method Adult patients with ADHD ("n" = 352) and controls ("n" = 94) were evaluated in the ADHD program of a tertiary hospital. The…

Working memory - not processing speed - mediates fluid intelligence deficits associated with attention deficit/hyperactivity disorder symptoms.

PubMed

Brydges, Christopher R; Ozolnieks, Krista L; Roberts, Gareth

2017-09-01

Attention deficit/hyperactivity disorder (ADHD) is a psychological condition characterized by inattention and hyperactivity. Cognitive deficits are commonly observed in ADHD patients, including impaired working memory, processing speed, and fluid intelligence, the three of which are theorized to be closely associated with one another. In this study, we aimed to determine if decreased fluid intelligence was associated with ADHD, and was mediated by deficits in working memory and processing speed. This study tested 142 young adults from the general population on a range of working memory, processing speed, and fluid intelligence tasks, and an ADHD self-report symptoms questionnaire. Results showed that total and hyperactive ADHD symptoms correlated significantly and negatively with fluid intelligence, but this association was fully mediated by working memory. However, inattentive symptoms were not associated with fluid intelligence. Additionally, processing speed was not associated with ADHD symptoms at all, and was not uniquely predictive of fluid intelligence. The results provide implications for working memory training programs for ADHD patients, and highlight potential differences between the neuropsychological profiles of ADHD subtypes. © 2015 The British Psychological Society.

Age-dependent effects of acute methylphenidate on amygdala reactivity in stimulant treatment-naive patients with Attention Deficit/Hyperactivity Disorder.

PubMed

Bottelier, Marco A; Schrantee, Anouk; Ferguson, Bart; Tamminga, Hyke G H; Bouziane, Cheima; Kooij, J J Sandra; de Ruiter, Michiel B; Reneman, Liesbeth

2017-11-30

In the present study, we investigate whether methylphenidate (MPH) affects emotional processing and whether this effect is modulated by age. We measured amygdala reactivity with functional Magnetic Resonance Imaging (fMRI) during processing of angry and fearful facial expressions in male stimulant treatment-naive patients with ADHD (N = 35 boys; N = 46 men) and 23 healthy control subjects (N = 11 boys; N = 12 men). In ADHD patients, we also measured amygdala reactivity 90min after an acute oral challenge with MPH (0.5mg/kg). Mean amygdala reactivity was analyzed for all subjects using a repeated measures analysis of variance (ANOVA). Whole-brain maps were analyzed for the patients only. At baseline, we found a age*diagnosis effect approaching significance (p = 0.05) in the right amygdala due to lower reactivity in children with Attention Deficit/Hyperactivity Disorder (ADHD) vs. controls (-31%), but higher reactivity in adults with ADHD vs. controls (+31%). MPH significantly reduced right amygdala reactivity in all patients, resulting in further reductions in children. In the left amygdala, reduction of amygdala reactivity was confined to adult ADHD patients whereas there was no change in children with ADHD. MPH-induced decrease of amygdala reactivity in adults might be a promising avenue for managing emotional dysregulation when replicated for chronic MPH treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Gently restless: association of ADHD-like traits with response inhibition and interference control.

PubMed

Polner, Bertalan; Aichert, Désirée; Macare, Christine; Costa, Anna; Ettinger, Ulrich

2015-12-01

Impairment of inhibition-related functions is one of the most pronounced cognitive deficits found in attention-deficit/hyperactivity disorder (ADHD). Compelling evidence from studies of unaffected relatives of patients with ADHD and of ADHD-like traits in healthy subjects suggest the continuous distribution of ADHD symptoms in the population. A more subtle inhibitory deficit can also be found in healthy relatives of patients and in subjects with high ADHD-like traits. Here, we examined the relationship between inhibitory performance and ADHD-like traits, for the first time, in a large sample of healthy adults by applying multiple, widely used tests of inhibition-related functions. ADHD-like traits, in general, were independently predicted by Stroop interference score and, at trend level, by go/no-go commission error rate while controlling for socio-demographic factors, verbal intelligence and neuroticism. Additionally, higher inattentive traits were related to worse Stroop performance at trend level, and higher hyperactive/impulsive traits were significantly associated with more go/no-go commission errors. ADHD-like traits were strongly related to neuroticism. The study shows that individual differences in ADHD-like traits are related to variance in fundamental inhibition-related functions over and above effects of negative affect regulation, but the relationships tend to be small. The results suggest the quasi-dimensionality of ADHD and raise further questions about the relationship between genetic factors and the deficit of inhibition-related functions in the ADHD spectrum.

The Reliability and Validity of Self- and Investigator Ratings of ADHD in Adults

ERIC Educational Resources Information Center

Adler, Lenard A.; Faraone, Stephen V.; Spencer, Thomas J.; Michelson, David; Reimherr, Frederick W.; Glatt, Stephen J.; Marchant, Barrie K.; Biederman, Joseph

2008-01-01

Objective: Little information is available comparing self- versus investigator ratings of symptoms in adult ADHD. The authors compared the reliability, validity, and utility in a sample of adults with ADHD and also as an index of clinical improvement during treatment of self- and investigator ratings of ADHD symptoms via the Conners Adult ADHD…

Parental efficacy and child behavior in a community sample of children with and without attention-deficit hyperactivity disorder (ADHD).

PubMed

Primack, Brian A; Hendricks, Kristy M; Longacre, Meghan R; Adachi-Mejia, Anna M; Weiss, Julia E; Titus, Linda J; Beach, Michael L; Dalton, Madeline A

2012-12-01

Most studies of attention-deficit hyperactivity disorder (ADHD) youth have obtained data from the perspective of either children or parents, but not both simultaneously. The purpose of this study was to examine child and parent perspectives on parenting in a large community-based sample of children with and without ADHD. We identified children in grades 4-6 and their parents through surveys administered to a random sample of public schools. We used multivariable logistic regression to determine independent associations between child and parent characteristics and the presence of ADHD while controlling for covariates and clustering by school. Sufficient data were achieved for 2,509 child/parent dyads. Ten percent of youths (n = 240) had been diagnosed with ADHD. Compared with those without ADHD, those with ADHD were more commonly male (67.9 vs. 48.0 %, p < .001) and age 12 or over (16.3 vs. 10.3 %). After adjusting for covariates and clustering, compared to children without ADHD, children with ADHD were significantly more likely to report lower self-regulation (OR = 0.68, 95 % CI = 0.53, 0.88) and higher levels of rebelliousness (OR = 2.00, 95 % CI = 1.52, 2.69). Compared with parents whose children did not have ADHD, parents of children with ADHD rated their overall parental efficacy substantially lower (OR = 0.23, 95 % CI = 0.15, 0.33). However, child assessment of parenting style was similar by ADHD. Despite the internal challenges community-based youth with ADHD face, many parents of ADHD youth exhibit valuable parental skills from the perspective of their children. Feedback of this information to parents may improve parental self-efficacy, which is known to be positively associated with improved ADHD outcomes.

Parental Efficacy and Child Behavior in a Community Sample of Children with and without Attention-Deficit Hyperactivity Disorder (ADHD)

PubMed Central

Primack, Brian A.; Hendricks, Kristy M.; Longacre, Meghan R.; Adachi-Mejia, Anna M.; Weiss, Julia E.; Titus, Linda J.; Beach, Michael L.; Dalton, Madeline A.

2013-01-01

Purpose Most studies of ADHD youth have obtained data from the perspective of either children or parents, but not both simultaneously. The purpose of this study was to examine child and parent perspectives on parenting in a large community-based sample of children with and without ADHD. Methods We identified children in grades 4-6 and their parents through surveys administered to a random sample of public schools. We used multivariable logistic regression to determine independent associations between child and parent characteristics and presence of ADHD while controlling for covariates and clustering by school. Results Sufficient data were achieved for 2509 child/parent dyads. Ten percent of youths (n=240) had been diagnosed with ADHD. Compared with those without ADHD, those with ADHD were more commonly male (67.9% vs. 48.0%, P<.001) and age 12 or over (16.3% vs. 10.3%). After adjusting for covariates and clustering, compared to children without ADHD, children with ADHD were significantly more likely to report lower self-regulation (OR= 0.68, 95% CI=0.53, 0.88) and higher levels of rebelliousness (OR= 2.00, 95% CI=1.52, 2.69). Compared with parents whose children did not have ADHD, parents of children with ADHD rated their overall parental efficacy substantially lower (OR=0.23, 95% CI=0.15, 0.33). However, child assessment of parenting style was similar by ADHD. Conclusions Despite the internal challenges community-based youth with ADHD face, many parents of ADHD youth exhibit valuable parental skills from the perspective of their children. Feedback of this information to parents may improve parental self-efficacy, which is known to be positively associated with improved ADHD outcomes. PMID:22886756

Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients.

PubMed

Sala, L; Martinotti, G; Carenti, M L; Romo, L; Oumaya, M; Pham-Scottez, A; Rouillon, F; Gorwood, P; Janiri, L

2017-05-22

There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics. The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10). Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD. In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.

Symptom Overlap and Screening for Symptoms of Attention-Deficit/Hyperactivity Disorder and Psychosis Risk in Help-Seeking Psychiatric Patients

PubMed Central

Corbisiero, Salvatore; Riecher-Rössler, Anita; Buchli-Kammermann, Jacqueline; Stieglitz, Rolf-Dieter

2017-01-01

Symptoms of attention-deficit/hyperactivity disorder (ADHD) and psychosis risk share features which might represent an early vulnerability marker for schizophrenia. Early detection of individuals with this symptomatic overlap is relevant and may assist clinicians in their decision making for diagnosis and treatment. This study sought to analyze the capability of different instruments in the screening of patients for ADHD symptoms or at psychosis risk, assess their classification accuracy, and describe the extent of symptoms overlap between them. 243 adult patients completed one instrument screening for ADHD and two instruments screening for psychosis risk symptoms [Adult ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1); Prodromal Questionnaire Brief Version (PQ-16); Self-Screen Prodrome (SPro)]. The ability of these instruments to distinguish between the symptomaticity of these patients appears modest. The most satisfactory scale to identify subjects at psychosis risk was SPro with its subscale psychosis risk. ASRS-v1.1 showed good reliability in assessing individuals as not having ADHD symptoms and had higher probability to achieve its own and the cut-off of another questionnaire. Subjects having symptoms of psychosis risk and ADHD showed elevated symptomatology. Reliable instruments capable of separating ADHD symptoms from those of psychosis risk are needed to better identify the symptomatic overlap of this two conditions. PMID:29163233

Is the Inattentive Subtype of ADHD Different from the Combined/Hyperactive Subtype?

ERIC Educational Resources Information Center

Grizenko, Natalie; Paci, Michael; Joober, Ridha

2010-01-01

Objective: To compare the ADHD combined/hyperactive subtype (ADHD/CH) to the ADHD inattentive subtype (ADHD/I) on the level of comorbidity, treatment response, and possible etiological factors. Method: A total of 371 clinically referred children diagnosed with ADHD aged between 6 and 12 years are recruited for a double-blind, placebo-controlled…

Ability of College Students to Simulate ADHD on Objective Measures of Attention

ERIC Educational Resources Information Center

Booksh, Randee Lee; Pella, Russell D.; Singh, Ashvind N.; Gouvier, William Drew

2010-01-01

Objective: The authors examined the ability of college students to simulate ADHD symptoms on objective and self-report measures and the relationship between knowledge of ADHD and ability to simulate ADHD. Method: Undergraduate students were assigned to a control or a simulated ADHD malingering condition and compared with a clinical AD/HD group.…

Comparative Study of Children with ADHD Only, Autism Spectrum Disorder + ADHD, and Chronic Multiple Tic Disorder + ADHD

ERIC Educational Resources Information Center

Gadow, Kenneth D.; DeVincent, Carla J.; Schneider, Jayne

2009-01-01

Objective: Identification of differences among children with ADHD only, autism spectrum disorder (ASD)+ADHD, and chronic multiple tic disorder (CMTD)+ADHD may lead to better understanding of clinical phenotypes. Method: Children were evaluated using the parent- and teacher-completed questionnaires. Results: All three groups were highly similar in…

[Voxel-Based Morphometry in Medicated-naive Boys with Attention-deficit/hyperactivity Disorder(ADHD)].

PubMed

Liu, Qi; Chen, Lizhou; Li, Fei; Chen, Ying; Guo, Lanting; Gong, Qiyong; Huang, Xiaoqi

2016-06-01

Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neuro-developmental disorders occurring in childhood,characterized by symptoms of age-inappropriate inattention,hyperactivity/impulsivity,and the prevalence is higher in boys.Although gray matter volume deficits have been frequently reported for ADHD children via structural magnetic resonance imaging,few of them had specifically focused on male patients.The present study aimed to explore the alterations of gray matter volumes in medicated-naive boys with ADHD via a relatively new voxel-based morphometry technique.According to the criteria of DSM-IV-TR,43medicated-naive ADHD boys and 44age-matched healthy boys were recruited.The magnetic resonance image(MRI)scan was performed via a 3T MRI system with three-dimensional(3D)spoiled gradient recalled echo(SPGR)sequence.Voxel-based morphometry with diffeomorphic anatomical registration through exponentiated lie algebra in SPM8 was used to preprocess the3DT1-weighted images.To identify gray matter volume differences between the ADHD and the controls,voxelbased analysis of whole brain gray matter volumes between two groups were done via two sample t-test in SPM8 with age as covariate,threshold at P<0.001.Finally,compared to the controls,significantly reduced gray matter volumes were identified in the right orbitofrontal cortex(peak coordinates[-2,52,-25],t=4.01),and bilateral hippocampus(Left:peak coordinates[14,0,-18],t=3.61;Right:peak coordinates[-14,15,-28],t=3.64)of ADHD boys.Our results demonstrated obvious reduction of whole brain gray matter volumes in right orbitofrontal cortex and bilateral hippocampus in boys with ADHD.This suggests that the abnormalities of prefrontal-hippocampus circuit may be the underlying cause of the cognitive dysfunction and abnormal behavioral inhibition in medicatednaive boys with ADHD.

Anomalous subcortical morphology in boys, but not girls, with ADHD compared to typically developing controls and correlates with emotion dysregulation

PubMed Central

Crocetti, Deana; Mostofsky, Stewart H.; Miller, Michael I.; Rosch, Keri S.

2017-01-01

There has been limited investigation of volume and shape difference in subcortical structures in children with ADHD and a paucity of examination of the influence of sex on these findings. The objective of this study was to examine morphology (volume and shape) of subcortical structures and their association with emotion dysregulation (ED) in girls and boys with ADHD as compared to their typically-developing (TD) counterparts. Participants included 218 children ages 8-12 years old with and without DSM-IV ADHD. Structural magnetic resonance images were obtained, and shape analyses were conducted using large deformation diffeomorphic metric mapping (LDDMM). Compared to TD boys, boys with ADHD showed reduced volumes in the bilateral globus pallidus and amygdala. There were no volumetric differences in any structure between ADHD and TD girls. Shape analysis revealed localized compressions within the globus pallidus, putamen and amygdala in ADHD boys relative to TD boys, as well as significant correlations between increased ED and unique subregion expansion in right globus pallidus, putamen, and right amygdala. Our findings suggest a sexually dimorphic pattern of differences in subcortical structures in children with ADHD compared to TD children, and a possible neurobiological mechanism by which boys with ADHD demonstrate increased difficulties with ED. PMID:28104573

Psychiatric Comorbidity at the Time of Diagnosis in Adults With ADHD: The CAT Study.

PubMed

Piñeiro-Dieguez, Benjamín; Balanzá-Martínez, Vicent; García-García, Pilar; Soler-López, Begoña

2016-12-01

The CAT (Comorbilidad en Adultos con TDAH) study aimed to quantify and characterize the psychiatric comorbidity at the time of diagnosis of ADHD in adult outpatients. Cross-sectional, multicenter, observational register of adults with ADHD diagnosed for the first time. In this large sample of adult ADHD (n = 367), psychiatric comorbidities were present in 66.2% of the sample, and were more prevalent in males and in the hyperactive-impulsive and combined subtypes. The most common comorbidities were substance use disorders (39.2%), anxiety disorders (23%), and mood disorders (18.1%). In all, 88.8% patients were prescribed pharmacological treatment for ADHD (in 93.4% of cases, modified release methylphenidate capsules 50:50). A high proportion of psychiatric comorbidity was observed when adult outpatients received a first-time diagnosis of ADHD. The systematic registering of patients and comorbidities in clinical practice may help to better understand and manage the prognostic determinants in adult ADHD. © The Author(s) 2014.

Language Delay in 3-Year-Old Children With ADHD Symptoms.

PubMed

Rohrer-Baumgartner, Nina; Zeiner, Pål; Eadie, Patricia; Egeland, Jens; Gustavson, Kristin; Reichborn-Kjennerud, Ted; Aase, Heidi

2016-10-01

Little is known about cognition in preschoolers with ADHD and language delay (LD). The objective was to investigate cognitive functions in preschoolers with ADHD symptoms and LD compared with children with ADHD symptoms only and to estimate the frequency of children with ADHD symptoms, co-occurring language delay, and delays on cognitive measures. Participants were recruited from the Norwegian Mother and Child Cohort Study. The teacher report of expressive language and the cognitive tests from 119 3-year-old children with parent reported ADHD symptoms and LD were compared with those of 258 children with ADHD symptoms only. The ADHD + LD group performed significantly worse than the ADHD group on most language-related measures. There were no differences between the groups on most nonverbal measures. Single measures had a limited potential of differentiating between the groups. ADHD symptoms and co-occurring LD in preschoolers were characterized by cognitive deficits associated with both disorders, not with global neurodevelopmental delay. © The Author(s) 2013.

Are Anxiety Disorders in Children and Adolescents Less Impairing Than ADHD and Autism Spectrum Disorders? Associations with Child Quality of Life and Parental Stress and Psychopathology.

PubMed

Telman, Liesbeth G E; van Steensel, Francisca J A; Maric, Marija; Bögels, Susan M

2017-12-01

We compared clinically referred children with anxiety disorders (AD; n = 63) to children with autism spectrum disorder (ASD; n = 39), ADHD Combined (ADHD-C; n = 62), ADHD Predominantly Inattentive (ADHD-I; n = 64), and typically developing children (n = 42) on child quality of life (QOL), paternal and maternal psychopathology and parental stress. Diagnoses were based on DSM-IV-TR criteria. Multilevel analyses showed that QOL in AD was higher on school and social functioning, compared to respectively ADHD and ASD, and lower compared to normal controls on all five domains. Fathers reported their AD children higher QOL than mothers. Also, AD appeared to be associated with less parental stress and parental psychopathology than other child psychopathology. Therefore, parental factors may need to be considered more in treatment of children with ADHD/ASD than AD.

Atomoxetine's Effect on Societal Costs in Sweden

ERIC Educational Resources Information Center

Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par

2010-01-01

Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization…

[Quality of life of newly diagnosed, treatment naive children and adolescents with attention-deficit hyperactivity disorder].

PubMed

Velö, Szabina; Keresztény, Ágnes; Miklósi, Mónika; Dallos, Gyöngyvér; Szentiványi, Dóra; Gádoros, Júlia; Balázs, Judit

2014-01-01

Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorder, it affects around 3-12% of the children. ADHD is associated with numerous social and emotional impairments. Quality of life (QoL) studies of children with ADHD established low QoL in the most cases. Our aim was to examine QoL of children with ADHD according to the following aspects: age, children's self-report and parentproxy report, and we also would like to compare them with healthy control group along several dimensions of QoL. The clinical group consist of a treatmant naive group of children with ADHD, who were just diagnosed in the Vadaskert Hospital. The healthy control group consist of children from elementary schools. The children of control group do not have ADHD and do not stand under psychological or psychiatrical treatment. In our study we applied Mini International Neuropsychiatric Interview Kid and Intervertat Lebensqualitat Kindern und Jugendlichen questionare. Compared children with ADHD to healthy control group they have significantly lower QoL at many areas (school, peer realtions, generally) due their self report. By parent's proxy report children with ADHD have lower QoL according to all of the QoL domains. Parents of children with ADHD reported significantly lower QoL for their children in the most areas (school, family, peer realtion, mental state, generally) then the affected children. Adolescent with ADHD have lower QoL in 3 domains (school, peer relations, generally) than children with ADHD, while children with ADHD have lower QoL in one dimension (being alone) compared with adolescents with ADHD. Based on our results children with ADHD compared to healthy control group have lower QoL in many dimensions and there are age-related differences in the assessment of QoL. Additionally, our study draw the attention to the differences of QoL assessment between children and parents.

Proposing an adaptive mutation to improve XCSF performance to classify ADHD and BMD patients

NASA Astrophysics Data System (ADS)

Sadatnezhad, Khadijeh; Boostani, Reza; Ghanizadeh, Ahmad

2010-12-01

There is extensive overlap of clinical symptoms observed among children with bipolar mood disorder (BMD) and those with attention deficit hyperactivity disorder (ADHD). Thus, diagnosis according to clinical symptoms cannot be very accurate. It is therefore desirable to develop quantitative criteria for automatic discrimination between these disorders. This study is aimed at designing an efficient decision maker to accurately classify ADHD and BMD patients by analyzing their electroencephalogram (EEG) signals. In this study, 22 channels of EEGs have been recorded from 21 subjects with ADHD and 22 individuals with BMD. Several informative features, such as fractal dimension, band power and autoregressive coefficients, were extracted from the recorded signals. Considering the multimodal overlapping distribution of the obtained features, linear discriminant analysis (LDA) was used to reduce the input dimension in a more separable space to make it more appropriate for the proposed classifier. A piecewise linear classifier based on the extended classifier system for function approximation (XCSF) was modified by developing an adaptive mutation rate, which was proportional to the genotypic content of best individuals and their fitness in each generation. The proposed operator controlled the trade-off between exploration and exploitation while maintaining the diversity in the classifier's population to avoid premature convergence. To assess the effectiveness of the proposed scheme, the extracted features were applied to support vector machine, LDA, nearest neighbor and XCSF classifiers. To evaluate the method, a noisy environment was simulated with different noise amplitudes. It is shown that the results of the proposed technique are more robust as compared to conventional classifiers. Statistical tests demonstrate that the proposed classifier is a promising method for discriminating between ADHD and BMD patients.

Proposing an adaptive mutation to improve XCSF performance to classify ADHD and BMD patients.

PubMed

Sadatnezhad, Khadijeh; Boostani, Reza; Ghanizadeh, Ahmad

2010-12-01

There is extensive overlap of clinical symptoms observed among children with bipolar mood disorder (BMD) and those with attention deficit hyperactivity disorder (ADHD). Thus, diagnosis according to clinical symptoms cannot be very accurate. It is therefore desirable to develop quantitative criteria for automatic discrimination between these disorders. This study is aimed at designing an efficient decision maker to accurately classify ADHD and BMD patients by analyzing their electroencephalogram (EEG) signals. In this study, 22 channels of EEGs have been recorded from 21 subjects with ADHD and 22 individuals with BMD. Several informative features, such as fractal dimension, band power and autoregressive coefficients, were extracted from the recorded signals. Considering the multimodal overlapping distribution of the obtained features, linear discriminant analysis (LDA) was used to reduce the input dimension in a more separable space to make it more appropriate for the proposed classifier. A piecewise linear classifier based on the extended classifier system for function approximation (XCSF) was modified by developing an adaptive mutation rate, which was proportional to the genotypic content of best individuals and their fitness in each generation. The proposed operator controlled the trade-off between exploration and exploitation while maintaining the diversity in the classifier's population to avoid premature convergence. To assess the effectiveness of the proposed scheme, the extracted features were applied to support vector machine, LDA, nearest neighbor and XCSF classifiers. To evaluate the method, a noisy environment was simulated with different noise amplitudes. It is shown that the results of the proposed technique are more robust as compared to conventional classifiers. Statistical tests demonstrate that the proposed classifier is a promising method for discriminating between ADHD and BMD patients.

Impact of co-morbid attention-deficit and hyperactivity disorder on cognitive function in male children with Tourette syndrome: A controlled study.

PubMed

Termine, Cristiano; Luoni, Chiara; Fontolan, Stefania; Selvini, Claudia; Perego, Livia; Pavone, Francesca; Rossi, Giorgio; Balottin, Umberto; Cavanna, Andrea E

2016-09-30

Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD) are co-morbid neurodevelopmental conditions affecting more commonly male patients. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study. Participants included four matched groups of unmedicated children (age range 6-15 years): TS (n=13), TS+ADHD (n=8), ADHD (n=39), healthy controls (n=66). Following clinical assessment, each participant completed a battery of tests from the Wechsler Intelligence Scale for Children-III, the Italian Battery for ADHD, the Tower of London test, the Corsi test, and the Digit Span test. All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. The TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group, particularly in the tests assessing planning ability, inhibitory function, working memory and visual attention, but not auditory attention. Problems in executive functions are more common in patients with neurodevelopmental disorders than controls. Deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms than core TS symptoms. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Mentalization in adults with attention deficit hyperactivity disorder: Comparison with controls and patients with borderline personality disorder.

PubMed

Perroud, Nader; Badoud, Deborah; Weibel, Sébastien; Nicastro, Rosetta; Hasler, Roland; Küng, Anne-Lise; Luyten, Patrick; Fonagy, Peter; Dayer, Alexandre; Aubry, Jean-Michel; Prada, Paco; Debbané, Martin

2017-10-01

Emotion dysregulation and interpersonal hardships constitute core features of borderline personality disorder (BPD). Research has established the link between these core dysregulations and fluctuations in the capacity to appreciate the mental states that underlie behavior (mentalizing, operationalized as reflective functioning (RF)). As emotion dysregulation and interpersonal hardships also characterize adults with attention deficit hyperactivity disorder (ADHD), this study sought to examine the potential RF impairments affecting this population. 101 adults with ADHD, 108 with BPD and 236 controls were assessed using the RF questionnaire (RFQ), evaluating how individuals employ information about mental states to better understand their own and others' behaviors. The RFQ comprises two dimensions, certainty (RF_c) and uncertainty (RF_u) about mental states. RF scores helped distinguish ADHD from controls, but also from BPD (F = 48.1 (2/441) ; p < 0.0001 for RF_c and F = 92.5 (2/441) ; p < 0.0001 for RF_u). The ADHD group showed intermediary RF scores compared to the controls (b = -0.70; p < 0.0001 and b = 0.89; p < 0.0001 for RF_c and RF_u) and BPD group (b = 0.44; p = 0.001 and b = -0.56; p = 0.001 for RF_c and RF_u). Lower RF scores correlated with poor anger control and high levels of impulsivity. Higher severity of ADHD (more attentional and hyperactive/impulsive symptoms) was correlated with RF impairments. In conclusion, RF may constitute an important process underlying attentional, hyperactive/impulsive as well as emotional symptoms in ADHD; it should therefore be considered in the assessment of these patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Light up ADHD: I. Cortical hemodynamic responses measured by functional Near Infrared Spectroscopy (fNIRS): Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summarise relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders.

PubMed

Mauri, Maddalena; Nobile, Maria; Bellina, Monica; Crippa, Alessandro; Brambilla, Paolo

2018-07-01

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by deficits in cognitive and emotional self-control. Optical technique acquisitions, such as near infrared spectroscopy (NIRS), seem to be very promising during developmental ages, as they are non- invasive techniques and less influenced by body movements than other neuroimaging methods. Recently, these new techniques are being widely used to measure neural correlates underlying neuropsychological deficits in children with ADHD. In a short series of articles, we will review the results of functional NIRS (fNIRS) studies in children with ADHD. The present brief review will focus on the results of the fNIRS studies that investigate cortical activity during neuropsychological and/or emotional tasks. According to the reviewed studies, children and adolescents with ADHD show peculiar cortical activation both during neurological and emotional tasks, and the majority of the reviewed studies revealed lower prefrontal cortex activation in patients compared to typically developmental controls. a consistent interpretation of these results is limited by the substantial methodological heterogeneity including patients' medication status and washout period, explored cerebral regions, neuropsychological tasks, number of channels and sampling temporal resolutions. fNIRS seems to be a promising tool for investigating neural substrates of emotional dysregulation and executive function deficits in individuals with ADHD during developmental ages. Copyright © 2017 Elsevier B.V. All rights reserved.

Reduced right frontal cortical thickness in children, adolescents and adults with ADHD and its correlation to clinical variables: a cross-sectional study.

PubMed

Almeida, Luis G; Ricardo-Garcell, Josefina; Prado, Hugo; Barajas, Lázaro; Fernández-Bouzas, Antonio; Avila, David; Martínez, Reyna B

2010-12-01

Some longitudinal magnetic resonance imaging (MRI) studies have shown reduced volume or cortical thickness (CT) in the frontal cortices of individuals with attention-deficit/hyperactivity disorder (ADHD). These studies indicated that the aforementioned anatomical abnormalities disappear during adolescence. In contrast, cross-sectional studies on adults with ADHD have shown anatomical abnormalities in the frontal lobe region. It is not known whether the anatomical abnormalities in ADHD are a delay or a deviation in the encephalic maturation. The aim of this study was to compare CT in the frontal lobe of children, adolescents and adults of both genders presenting ADHD with that in corresponding healthy controls and to explore its relationship with the severity of the illness. An MRI scan study was performed on never-medicated ADHD patients. Twenty-one children (6-10 year-olds), twenty adolescents (14-17 year-olds) and twenty adults (25-35 year-olds) were matched with healthy controls according to age and sex. CT measurements were performed using the Freesurfer image analysis suite. The data showed regions in the right superior frontal gyrus where CT was reduced in children, adolescents and adults with ADHD in contrast to their respective healthy controls. The CT of these regions correlated with the severity of the illness. In subjects with ADHD, there is a thinning of the cortical surface in the right frontal lobe, which is present in the children, adolescents and in adults. Copyright © 2010 Elsevier Ltd. All rights reserved.

Attention deficit hyperactivity disorder symptoms in adults with autism spectrum disorders.

PubMed

Johnston, Kate; Dittner, Antonia; Bramham, Jessica; Murphy, Clodagh; Knight, Anya; Russell, Ailsa

2013-08-01

Features of attention deficit hyperactivity disorder (ADHD) and impairments on neuropsychological, tests of attention have been documented in children with autism spectrum disorders (ASDs). To date, there has been a lack of research comparing attention in adults with ASD and adults with ADHD. In study 1, 31 adults with ASD and average intellectual function completed self-report measures of ADHD symptoms. These were compared with self-report measures of ADHD symptoms in 38 adults with ADHD and 29 general population controls. In study 2, 28 adults with a diagnosis of ASD were compared with an age- and intelligence quotient-matched sample of 28 adults with ADHD across a range of measures of attention. Study 1 showed that 36.7% of adults with ASD met Diagnostic and Statistical Manual-IV criteria for current ADHD "caseness" (Barkley Current self-report scores questionnaire). Those with a diagnosis of pervasive developmental disorder-not otherwise specified were most likely to describe ADHD symptoms. The ASD group differed significantly from both the ADHD and control groups on total and individual symptom self-report scores. On neuropsychological testing, adults with ASD and ADHD showed comparable performance on tests of selective attention. Significant group differences were seen on measures of attentional switching; adults with ADHD were significantly faster and more inaccurate, and individuals with Asperger's syndrome showed a significantly slower and more accurate response style. Self-reported rates of ADHD among adults with ASD are significantly higher than in the general adult population and may be underdiagnosed. Adults with ASD have attentional difficulties on some neuropsychological measures. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.

Atomoxetine hydrochloride in the treatment of children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder: A placebo-controlled Italian study.

PubMed

Dell'Agnello, Grazia; Maschietto, Dino; Bravaccio, Carmela; Calamoneri, Filippo; Masi, Gabriele; Curatolo, Paolo; Besana, Dante; Mancini, Francesca; Rossi, Andrea; Poole, Lynne; Escobar, Rodrigo; Zuddas, Alessandro

2009-11-01

The primary aim of this study was to assess the efficacy of atomoxetine in improving ADHD and ODD symptoms in paediatric patients with ADHD and comorbid oppositional defiant disorder (ODD), non-responders to previous psychological intervention with parent support. This was a multicentre, randomised, placebo-controlled trial conducted in patients aged 6-15 years, with ADHD and ODD diagnosed according to the DSM-IV criteria by a structured clinical interview (K-SADS-PL). Only subjects who are non-responders to a 6-week standardized parent training were randomised to atomoxetine (up to 1.2 mg/kg/day) or placebo (in a 3:1 ratio) for the following 8-week double blind phase. Only 2 of the 156 patients enrolled for the parent support phase (92.9% of males; mean age: 9.9 years), improved after the parent training program; 139 patients were randomised for entering in the study and 137 were eligible for efficacy analysis. At the end of the randomised double blind phase, the mean changes in the Swanson, Nolan and Pelham Rating Scale-Revised (SNAP-IV) ADHD subscale were -8.1+/-9.2 and -2.0+/-4.7, respectively in the atomoxetine and in the placebo group (p<0.001 between groups); changes in the ODD subscale were -2.7+/-4.1 and -0.3+/-2.6, respectively in the two groups (p=0.001 between groups). The CGI-ADHD-S score decreased in the atomoxetine group (median change at endpoint: -1.0) compared to no changes in the placebo group (p<0.001 between groups). Statistically significant differences between groups, in favour of atomoxetine, were found in the CHIP-CE scores for risk avoidance domain, emotional comfort and individual risk avoidance subdomains. An improvement in all the subscales of Conners Parents (CPRS-R:S) and Teacher (CTRS-R:S) subscales was observed with atomoxetine, except in the cognitive problems subscale in the CTRS-R:S. Only 3 patients treated with atomoxetine discontinued the study due to adverse events. No clinically significant changes of body weight, height and vital signs were observed in both groups. Treatment with atomoxetine of children and adolescents with ADHD and ODD, who did not initially respond to parental support, was associated with improvements in symptoms of ADHD and ODD, and general health status. Atomoxetine was well tolerated.

Wavelet analysis of MR functional data from the cerebellum

NASA Astrophysics Data System (ADS)

Romero Sánchez, Karen; Vásquez Reyes, Marcos A.; González Gómez, Dulce I.; Hidalgo Tobón, Silvia; Hernández López, Javier M.; Dies Suarez, Pilar; Barragán Pérez, Eduardo; De Celis Alonso, Benito

2014-11-01

The main goal of this project was to create a computer algorithm based on wavelet analysis of BOLD signals, which automatically diagnosed ADHD using information from resting state MR experiments. Male right handed volunteers (infants with ages between 7 and 11 years old) were studied and compared with age matched controls. Wavelet analysis, which is a mathematical tool used to decompose time series into elementary constituents and detect hidden information, was applied here to the BOLD signal obtained from the cerebellum 8 region of all our volunteers. Statistical differences between the values of the a parameters of wavelet analysis was found and showed significant differences (p<0.02) between groups. This difference might help in the future to distinguish healthy from ADHD patients and therefore diagnose ADHD.

Holistic Treatment Approaches to ADHD: Nutrition, Sleep,and Exercise, Part 7

ERIC Educational Resources Information Center

Lavoie, Theresa

2009-01-01

This article is part of a series exploring Attention Deficit Hyperactivity Disorder (ADHD). In this seventh installment, the author discusses three holistic treatments for children and adults with ADHD: diet and nutrition, sleep, and exercise. These approaches focus and improve the overall health of ADHD patients. (For Part 6 of this series, see…

Community survey of attention-deficit/hyperactivity disorder among primary school pupils in Benin City, Nigeria.

PubMed

Ambuabunos, E A; Ofovwe, E G; Ibadin, M O

2011-01-01

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neuro-developmental condition with early onset. ADHD affects children worldwide. However, there is a variation in the prevalence across different countries. In Nigeria, there is paucity of information on the prevalence. To provide the relevant information, a cross-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6-12 years selected systematically among pupils in Egor Local Government Area of Edo State. All the 1473 pupils were screened with the Disruptive Behavior Disorder (DBD) Rating Scale to identify children who had ADHD symptoms as contained in the DSM -IV. Such children were compared with randomly selected controls. The academic records of both the groups were also compared. The prevalence of ADHD was 7.6%. The prevalence was higher in boys (9.4%) when compared to girls (5.5%) (P = 0.003). Of the three different subtypes of ADHD, the predominantly inattentive subtype (ADHD-I) was the most prevalent (47.3% of the ADHD population) followed by the combined type (ADHD-C; 31.3%), while the least prevalent was the hyperactive/impulsive subtype (ADHD-HI; 21.4%). There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. The prevalence of ADHD was relatively high when compared to the figures available for other countries. For this reason, there is a need to pay increased attention to this condition in Nigeria. Community screening under the umbrella of the School Health Program could be of assistance.

Atypical Processing of Gaze Cues and Faces Explains Comorbidity between Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD).

PubMed

Groom, Madeleine J; Kochhar, Puja; Hamilton, Antonia; Liddle, Elizabeth B; Simeou, Marina; Hollis, Chris

2017-05-01

This study investigated the neurobiological basis of comorbidity between autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD). We compared children with ASD, ADHD or ADHD+ASD and typically developing controls (CTRL) on behavioural and electrophysiological correlates of gaze cue and face processing. We measured effects of ASD, ADHD and their interaction on the EDAN, an ERP marker of orienting visual attention towards a spatially cued location and the N170, a right-hemisphere lateralised ERP linked to face processing. We identified atypical gaze cue and face processing in children with ASD and ADHD+ASD compared with the ADHD and CTRL groups. The findings indicate a neurobiological basis for the presence of comorbid ASD symptoms in ADHD. Further research using larger samples is needed.

Inhibition, Reinforcement Sensitivity and Temporal Information Processing in ADHD and ADHD+ODD: Evidence of a Separate Entity?

ERIC Educational Resources Information Center

Luman, Marjolein; van Noesel, Steffen J. P.; Papanikolau, Alky; Van Oostenbruggen-Scheffer, Janneke; Veugelers, Diane; Sergeant, Joseph A.; Oosterlaan, Jaap

2009-01-01

This study compared children with ADHD-only, ADHD+ODD and normal controls (age 8-12) on three key neurocognitive functions: response inhibition, reinforcement sensitivity, and temporal information processing. The goal was twofold: (a) to investigate neurocognitive impairments in children with ADHD-only and children with ADHD+ODD, and (b) to test…

[Caffeine, cannabis and cocaine: from automedication to 'automutilation' in adults with ADHD].

PubMed

Pereira, R Rodrigues; van de Wetering, B J M

2004-12-25

Four patients whose automedication had attracted medical attention had signs compatible with adult attention deficit hyperactivity disorder (ADHD). Two of them, men aged 42 and 28, were seen with their hyperactive children in the outpatient department; they appeared to drink huge amounts of coffee, smoked heavily or used cannabis to facilitate sleep. The other two patients, a man aged 25 and a woman aged 35, were initially not diagnosed with ADHD; they had noticed that dopaminergic drugs like cocaine and an amphetamine-containing medication taken to lose weight made their behaviour much more 'normal', although the man was addicted. All experienced relief of their chaotic mental activity when they were treated with methylphenidate. Smoking and addiction due to undiagnosed ADHD may lead to 'automutilation'. Early recognition and awareness of the symptoms of ADHD is important; the clinical interview should also cover items like automedication and other ADHD symptoms in the family.

Attention profiles in autism spectrum disorder and subtypes of attention-deficit/hyperactivity disorder.

PubMed

Boxhoorn, Sara; Lopez, Eva; Schmidt, Catharina; Schulze, Diana; Hänig, Susann; Freitag, Christine M

2018-03-06

Attention problems are observed in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Most neuropsychological studies that compared both disorders focused on complex executive functions (EF), but missed to contrast basic attention functions, as well as ASD- and ADHD subtypes. The present study compared EF as well as basic attention functioning of children with the combined subtype (ADHD-C), the predominantly inattentive subtype (ADHD-I), and autism spectrum disorder without ADHD (ASD-) with typically developing controls (TD). Basic attention functions and EF profiles were analysed by testing the comprehensive attention function model of van Zomeren and Brouwer using profile analysis. Additionally, neurocognitive impairments in ASD- and ADHD were regressed on dimensional measures of attention- and hyperactive-impulsive symptoms across and within groups. ADHD-C revealed a strong impairment across measures of EF compared to ASD- and TD. The ADHD-C profile furthermore showed disorder specific impairments in interference control, whereas the ASD- profile showed a disorder specific impairment in basic attention component divided attention. Attention- and hyperactive-impulsive symptom severity did not predict neurocognitive impairments across- or within groups. Study findings thus support disorder and subtype specific attention/EF profiles, which refute the idea of a continuum of ADHD-I, ADHD-C, and ASD with increasing neurocognitive impairments.

Characteristics of internalizing and externalizing disorders in medication-naive, clinically referred children with attention deficit hyperactivity disorder, combined type and dysthymic disorder.

PubMed

Sanders, Michelle; Arduca, Yolanda; Karamitsios, Mary; Boots, Marilyn; Vance, Alasdair

2005-05-01

Internalizing and externalizing disorders are frequently comorbid with attention deficit hyperactivity disorder, combined type (ADHD-CT) and dysthymic disorder (DD) in referred primary school-age children, yet there has been relatively little systematic research of the nature of these comorbid disorders. We describe the characteristics of parent- and child-reported internalizing and externalizing disorders in primary school-age children with ADHD-CT and DD. A cross-sectional study of 45 clinically referred medication naive children with ADHD-CT and DD, examining parent and child reports of internalizing and externalizing disorders, defined categorically and dimensionally. Generalized anxiety disorder and separation anxiety disorder were increased in the DD groups, whether ADHD-CT was present or not. Major depressive disorder was increased in the ADHD-CT and DD group compared to the ADHD-CT alone and the DD alone groups. Conduct disorder was increased in the ADHD-CT alone group compared to the DD with and without ADHD-CT groups. Verbal and fullscale IQ were increased in the DD groups, whether ADHD-CT was present or not, compared to the ADHD-CT alone group. There is emerging evidence that DD and anxiety may represent a different phenotypic expression of a common underlying aetiological process, while the co-occurrence of ADHD-CT and anxiety disorders remains unclear. Only the ADHD-CT and DD group is significantly associated with major depressive disorder, which suggests an additive effect. In contrast, conduct disorder and decreased verbal and fullscale IQ are only associated with the ADHD-CT group, which may suggest a protective effect of DD when comorbid with ADHD-CT. From a research perspective, it is important to confirm these found associations in larger samples derived from epidemiological populations.

Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD).

PubMed

Janssen, Lotte; Kan, Cornelis C; Carpentier, Pieter J; Sizoo, Bram; Hepark, Sevket; Grutters, Janneke; Donders, Rogier; Buitelaar, Jan K; Speckens, Anne E M

2015-09-15

Adults with attention deficit hyperactivity disorder (ADHD) often present with a lifelong pattern of core symptoms that is associated with impairments of functioning in daily life. This has a substantial personal and economic impact. In clinical practice there is a high need for additional or alternative interventions for existing treatments, usually consisting of pharmacotherapy and/or psycho-education. Although previous studies show preliminary evidence for the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning, these studies have methodological limitations. This study will take account of these limitations and will examine the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) in further detail. A multi-centre, parallel-group, randomised controlled trial will be conducted in N = 120 adults with ADHD. Patients will be randomised to MBCT in addition to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline and at three, six and nine months after baseline. Primary outcome measure will be severity of ADHD symptoms rated by a blinded clinician. Secondary outcome measures will be self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. In addition, a cost-effectiveness analysis will be conducted. This trial will offer valuable information about the clinical and cost-effectiveness of MBCT in addition to TAU compared to TAU alone in adults swith ADHD. ClinicalTrials.gov NCT02463396. Registered 8 June 2015.

Investigating facets of personality in adult pathological gamblers with ADHD

PubMed Central

Davtian, Margarit; Reid, Rory C; Fong, Timothy W

2012-01-01

SUMMARY The present study explored facets of personality in a sample of pathological gamblers with ADHD (n = 52) and without ADHD (n = 43). Participants were assessed for psychopathology and gambling disorders using the Mini International Neuropsychiatric Interview, the National Opinion Research Center DSM Screen for Gambling Problems, and the Adult ADHD Self-Report Scale. Facets of personality were assessed using the NEO Personality Inventory–Revised. Group differences emerged across several facets of personality when analyzed using multivariate statistics. Although both groups experienced difficulties in several areas compared with norming data (e.g., greater depression, higher impulsivity, lower self-esteem and lower self-discipline), these facets of personality were more pronounced in pathological gamblers with ADHD. Most notable among these differences are tendencies for gamblers with ADHD to experience greater levels of emotional instability, interpersonal sensitivity and stress proneness. Pathological gamblers with ADHD also appear to experience lower self-esteem, greater difficulty being assertive and lower levels of self-discipline. Surprisingly, both groups were comparable on facets of impulsivity. These findings suggest that pathological gamblers diagnosed with adult ADHD may experience additional challenges compared with pathological gamblers without ADHD. PMID:22815658

Measuring impairment when diagnosing adolescent ADHD: Differentiating problems due to ADHD versus other sources.

PubMed

Vazquez, Alejandro L; H Sibley, Margaret; Campez, Mileini

2018-06-01

The DSM-5 requires clinicians to link ADHD symptoms to clinically meaningful impairments in daily life functioning. Measuring impairment during ADHD assessments may be particularly challenging in adolescence, when ADHD is often not the sole source of a youth's difficulties. Existing impairment rating scales are criticized for not specifying ADHD as the source of impairment in their instructions, leading to potential problems with rating scale specificity. The current study utilized a within subjects design (N = 107) to compare parent report of impairment on two versions of a global impairment measure: one that specified ADHD as the source of impairment (Impairment Rating Scale-ADHD) and a standard version that did not (Impairment Rating Scale). On the standard family impairment item, parents endorsed greater impairment as compared to the IRS-ADHD. This finding was particularly pronounced when parents reported high levels of parenting stress. More severe ADHD symptoms were associated with greater concordance between the two versions. Findings indicate that adolescent family related impairments reported during ADHD assessments may be due to sources other than ADHD symptoms, such as developmental maladjustment. To prevent false positive diagnoses, symptom-specific wording may optimize impairment measures when assessing family functioning in diagnostic assessments for adolescents with ADHD. Copyright © 2018 Elsevier B.V. All rights reserved.

Searching for a neurobiological basis for self-medication theory in ADHD comorbid with substance use disorders: an in vivo study of dopamine transporters using (99m)Tc-TRODAT-1 SPECT.

PubMed

Silva, Neivo; Szobot, Claudia M; Shih, Ming C; Hoexter, Marcelo Q; Anselmi, Carlos Eduardo; Pechansky, Flavio; Bressan, Rodrigo A; Rohde, Luis Augusto

2014-02-01

Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD) frequently co-occur. Although several studies have shown changes in striatal dopamine transporter (DAT) density in these disorders, little is known about the neurobiological basis of the comorbidity. The aim of this study was to evaluate striatal DAT density in treatment-naive ADHD adolescents with SUD (ADHD + SUD) and without SUD (ADHD), compared to SUD adolescents without ADHD (SUD) and healthy control subjects (HC). Sixty-two male age-matched subjects diagnosed with DSM-IV criteria were included: ADHD + SUD (n = 18), SUD (n = 14), HC (n = 19), and ADHD (n = 11). Urine tests confirmed participants' drug use. All subjects performed SPECT scans with Tc-TRODAT-1 to evaluate DAT density in the striatum. The mean right striatum specific binding were 1.68 (ADHD), 1.38 (ADHD + SUD), 1.19 (HC), 1.17 (SUD), and in left striatum 1.65 (ADHD), 1.39 (ADHD + SUD), 1.19 (HC), and 1.17 (SUD). The ADHD group presented significantly higher striatal DAT density compared with ADHD + SUD, SUD, and HC groups. Adolescents with ADHD + SUD had significantly lower DAT density than those with ADHD, but significantly higher DAT density than those with SUD only and no significant difference from the healthy control group. The ADHD + SUD group had lower striatal DAT density in comparison with ADHD without SUD. It is possible to speculate that the use of cannabis and cocaine is responsible for the lower striatal DAT density in this group which would help in understanding the neurobiological basis for the self-medication theory in ADHD adolescents.

Response time variability under slow and fast-incentive conditions in children with ASD, ADHD and ASD+ADHD.

PubMed

Tye, Charlotte; Johnson, Katherine A; Kelly, Simon P; Asherson, Philip; Kuntsi, Jonna; Ashwood, Karen L; Azadi, Bahare; Bolton, Patrick; McLoughlin, Gráinne

2016-12-01

Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) show significant behavioural and genetic overlap. Both ADHD and ASD are characterised by poor performance on a range of cognitive tasks. In particular, increased response time variability (RTV) is a promising indicator of risk for both ADHD and ASD. However, it is not clear whether different indices of RTV and changes to RTV according to task conditions are able to discriminate between the two disorders. Children with ASD (n = 19), ADHD (n = 18), ASD + ADHD (n = 29) and typically developing controls (TDC; n = 26) performed a four-choice RT task with slow-baseline and fast-incentive conditions. Performance was characterised by mean RT (MRT), standard deviation of RT (SD-RT), coefficient of variation (CV) and ex-Gaussian distribution measures of Mu, Sigma and Tau. In the slow-baseline condition, categorical diagnoses and trait measures converged to indicate that children with ADHD-only and ASD + ADHD demonstrated increased MRT, SD-RT, CV and Tau compared to TDC and ASD-only. Importantly, greater improvement in MRT, SD-RT and Tau was demonstrated in ADHD and ASD + ADHD from slow-baseline to fast-incentive conditions compared to TDC and ASD-only. Slower and more variable RTs are markers of ADHD compared to ASD and typically developing controls during slow and less rewarding conditions. Energetic factors and rewards improve task performance to a greater extent in children with ADHD compared to children with ASD. These findings suggest that RTV can be distinguished in ASD, ADHD and ASD + ADHD based on the indices of variability used and the conditions in which they are elicited. Further work identifying neural processes underlying increased RTV is warranted, in order to elucidate disorder-specific and disorder-convergent aetiological pathways. © 2016 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

Age-dependent and -independent changes in attention-deficit/hyperactivity disorder (ADHD) during spatial working memory performance.

PubMed

Bollmann, Steffen; Ghisleni, Carmen; Poil, Simon-Shlomo; Martin, Ernst; Ball, Juliane; Eich-Höchli, Dominique; Klaver, Peter; O'Gorman, Ruth L; Michels, Lars; Brandeis, Daniel

2017-06-01

Attention-deficit/hyperactivity disorder (ADHD) has been associated with spatial working memory as well as frontostriatal core deficits. However, it is still unclear how the link between these frontostriatal deficits and working memory function in ADHD differs in children and adults. This study examined spatial working memory in adults and children with ADHD, focussing on identifying regions demonstrating age-invariant or age-dependent abnormalities. We used functional magnetic resonance imaging to examine a group of 26 children and 35 adults to study load manipulated spatial working memory in patients and controls. In comparison to healthy controls, patients demonstrated reduced positive parietal and frontostriatal load effects, i.e., less increase in brain activity from low to high load, despite similar task performance. In addition, younger patients showed negative load effects, i.e., a decrease in brain activity from low to high load, in medial prefrontal regions. Load effect differences between ADHD and controls that differed between age groups were found predominantly in prefrontal regions. Age-invariant load effect differences occurred predominantly in frontostriatal regions. The age-dependent deviations support the role of prefrontal maturation and compensation in ADHD, while the age-invariant alterations observed in frontostriatal regions provide further evidence that these regions reflect a core pathophysiology in ADHD.

A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis

PubMed Central

Madhoo, Manisha

2014-01-01

Objective: To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment. Data Sources: A PubMed search was conducted in April 9, 2012 for English-language publications from the previous 10 years. Search terms included attention deficit hyperactivity disorder, attention deficit/hyperactivity disorder, ADHD, and AD/HD combined with gender, girls, females, women, continuity, discontinuity, gap, treatment, untreated, and lack of treatment. Study Selection/Data Extraction: A total of 41 articles were reviewed for relevance. Reference lists from relevant articles were reviewed for additional publications; sources known to the authors were also included. Results: Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual’s gender. The ADHD prevalence rates are higher among boys than girls. A low index of clinical suspicion exists for girls; their presentation is considered “subthreshold” because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls. Conclusions: Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis. PMID:25317366

A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis.

PubMed

Quinn, Patricia O; Madhoo, Manisha

2014-01-01

To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment. A PubMed search was conducted in April 9, 2012 for English-language publications from the previous 10 years. Search terms included attention deficit hyperactivity disorder, attention deficit/hyperactivity disorder, ADHD, and AD/HD combined with gender, girls, females, women, continuity, discontinuity, gap, treatment, untreated, and lack of treatment. A total of 41 articles were reviewed for relevance. Reference lists from relevant articles were reviewed for additional publications; sources known to the authors were also included. Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual's gender. The ADHD prevalence rates are higher among boys than girls. A low index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls. Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis.

Random matrix theory for analyzing the brain functional network in attention deficit hyperactivity disorder

NASA Astrophysics Data System (ADS)

Wang, Rong; Wang, Li; Yang, Yong; Li, Jiajia; Wu, Ying; Lin, Pan

2016-11-01

Attention deficit hyperactivity disorder (ADHD) is the most common childhood neuropsychiatric disorder and affects approximately 6 -7 % of children worldwide. Here, we investigate the statistical properties of undirected and directed brain functional networks in ADHD patients based on random matrix theory (RMT), in which the undirected functional connectivity is constructed based on correlation coefficient and the directed functional connectivity is measured based on cross-correlation coefficient and mutual information. We first analyze the functional connectivity and the eigenvalues of the brain functional network. We find that ADHD patients have increased undirected functional connectivity, reflecting a higher degree of linear dependence between regions, and increased directed functional connectivity, indicating stronger causality and more transmission of information among brain regions. More importantly, we explore the randomness of the undirected and directed functional networks using RMT. We find that for ADHD patients, the undirected functional network is more orderly than that for normal subjects, which indicates an abnormal increase in undirected functional connectivity. In addition, we find that the directed functional networks are more random, which reveals greater disorder in causality and more chaotic information flow among brain regions in ADHD patients. Our results not only further confirm the efficacy of RMT in characterizing the intrinsic properties of brain functional networks but also provide insights into the possibilities RMT offers for improving clinical diagnoses and treatment evaluations for ADHD patients.

Criterion validity and clinical usefulness of Attention Deficit Hyperactivity Disorder Rating Scale IV in attention deficit hyperactivity disorder (ADHD) as a function of method and age.

PubMed

López-Villalobos, José A; Andrés-De Llano, Jesús; López-Sánchez, María V; Rodríguez-Molinero, Luis; Garrido-Redondo, Mercedes; Sacristán-Martín, Ana M; Martínez-Rivera, María T; Alberola-López, Susana

2017-02-01

The aim of this research is to analyze Attention Deficit Hyperactivity Disorder Rating Scales IV (ADHD RS-IV) criteria validity and its clinical usefulness for the assessment of Attention Deficit Hyperactivity Disorder (ADHD) as a function of assessment method and age. A sample was obtained from an epidemiological study (n = 1095, 6-16 years). Clinical cases of ADHD  (ADHD-CL) were selected by dimensional ADHD RS-IV and later by clinical interview (DSM-IV). ADHD-CL cases were compared with four categorical results of ADHD RS-IV provided by parents (CATPA), teachers (CATPR), either parents or teachers (CATPAOPR) and both parents and teachers (CATPA&PR). Criterion validity and clinical usefulness of the answer modalities to ADHD RS-IV were studied. ADHD-CL rate was 6.9% in childhood, 6.2% in preadolescence and 6.9% in adolescence. Alternative methods to the clinical interview led to increased numbers of ADHD cases in all age groups analyzed, in the following sequence: CATPAOPR> CATPRO> CATPA> CATPA&PR> ADHD-CL. CATPA&PR was the procedure with the greatest validity, specificity and clinical usefulness in all three age groups, particularly in the childhood. Isolated use of ADHD RS-IV leads to an increase in ADHD cases compared to clinical interview, and varies depending on the procedure used.

Driving performance in adults with ADHD: results from a randomized, waiting list controlled trial with atomoxetine.

PubMed

Sobanski, E; Sabljic, D; Alm, B; Dittmann, R W; Wehmeier, P M; Skopp, G; Strohbeck-Kühner, P

2013-08-01

To investigate effects of a 12-week treatment with atomoxetine (ATX) on driving performance in real traffic, driving-related neuropsychological performance tests and self-evaluation of driving in adult patients with ADHD compared to an untreated control group with ADHD. Parallel group design with an ATX and a waiting list group. At baseline and endpoint patients were evaluated with a standardized on-road driving test (SDBO), a driving-related neuropsychological test battery (Act and React Test System [ART2020]), and subjective measures of driving performance (one-week driving diary, Driver Coping Questionnaire). Forty-three of the 64 included patients completed the study (n=22 ATX, n=21 controls). Mean intervention period was 11.9±3.0 weeks, mean daily ATX dosage was 71.6±14.9mg. At endpoint, 60.1% of patients treated with ATX and 0% of waiting list group had reduced ADHD symptoms by greater or equal to 30%. In SDBO, ATX group reduced driving errors in three of four driving performance categories (attention, P<0.05; risk-related self-control, P<0.005; driver skills, P<0.001), number of driving errors remained stable in control group. At endpoint, 47.6% of control group and 18.2% of ATX group (P<0.05) did not fulfil the driving fitness criteria according to German Guidelines (percentile rank less or equal to 16 in one or more subtests in ART2020). Total number of self-reported critical traffic situations decreased from 12.0 to 6.8 per week in ATX group (P<0.05) and remained stable in controls by 9.3 and 9.9 at baseline and endpoint (ns). Coping strategies with stressful traffic situations did not change within both groups. Our study provides first evidence that treatment with ATX improves driving performance in real traffic in adults with ADHD. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

The Prevalence of ADHD Patients among Pediatric Dentists in Israel and Knowledge of Dental and Behavioral Aspects of Treating Them.

PubMed

Blumer, Sigalit; Khoury, Rula Shehadi; Peretz, Benjamin

2018-01-01

There are no clear guidelines for managing the dental treatment of children with attention deficit hyperactivity disorder (ADHD). The use of sedation in combination with chronic ADHD medication use is also not well defined. This study surveyed the prevalence of ADHD children, management techniques and knowledge of pharmacologic therapies of these children among Israeli dentists. A specially designed questionnaire was distributed to all Israeli dentists attending a national conference in 2016. Of the 160 dentists who attended the conference, 96 completed the survey (60% response rate), and they included 46 (51%) pediatric dental specialists and 50 (49%) general dental practitioners. The medications Ritalin and Concerta were most familiar to the respondents (98.9%). Eighty-seven (91.1%) of the practitioners responded that their ADHD patients take their usual doses of any drug for treating ADHD symptoms, regardless of whether or not the dentists intended to use sedatives. The practitioners invented their own behavior management techniques with varying degrees of success. There are no specific guidelines for the most effective pharmacologic protocol (co-administration of ADHD drugs and dental sedatives) or behavior management techniques for the provision of optimal dental care to children with ADHD.

The risk of injury in adults with attention-deficit hyperactivity disorder: A nationwide, matched-cohort, population-based study in Taiwan.

PubMed

Chien, Wu-Chien; Chung, Chi-Hsiang; Lin, Fu-Huang; Yeh, Chin-Bin; Huang, San-Yuan; Lu, Ru-Band; Chang, Hsin-An; Kao, Yu-Chen; Chiang, Wei-Shan; Chou, Yu-Ching; Tsao, Chang-Huei; Wu, Yung-Fu; Tzeng, Nian-Sheng

2017-06-01

Few studies have investigated the risk of injuries associated with adults with attention-deficit hyperactivity disorder (ADHD), even though several studies have suggested a higher risk of injury in children and adolescents with ADHD. To investigate the risk of injury in adults with ADHD. We included 665 adults with ADHD from January 1, to December 31, 2000, and 1995 sex-, age- and index day-matched controls without ADHD from the Longitudinal Health Insurance Database (LHID) subset of the National Health Insurance Research Database in Taiwan. The Cox proportional hazard models were used to analyze the associations between the relevant demographics, and the psychiatric comorbidities and the risk of injury. The patients with ADHD had a 143% increased risk of overall injuries than the controls after considering all the confounding factors. In addition, the use of methylphenidate was associated with a 22.6% decrease in the risk of injuries in the patients with ADHD. Our findings strongly support that adults with ADHD are at an increased risk of injury, and imply that methylphenidate therapy may attenuate this risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Mathematical abilities and executive function in children with attention deficit hyperactivity disorder and learning disabilities in mathematics].

PubMed

Miranda Casas, Ana; Meliá de Alba, Amanda; Marco Taverner, Rafaela

2009-02-01

Mathematical abilities and executive function in children with attention deficit hyperactivity disorder and learning disabilities in mathematics. Even though 26% of children with attention deficit hyperactivity disorder (ADHD) show a specific mathematic learning difficulty (MLD), the studies have been scarce. The present study had the following goals: 1) to study the profile related to cognitive and metacognitive skills implied in calculation and problem-solving in children with ADHD+MLD, and to compare them in children with ADHD, children with MLD, and children without problems; 2) to study the severity of the deficit in executive function (EF) in children with ADHD+MLD. Comparing the groups MLD, ADHD, ADHD+MLD, and children without problems, the results highlighted that children with ADHD+MLD showed a cognitive and metacognitive deficit in mathematic achievement. Furthermore, results showed a more severe deficit in the EF in children with ADHD+MLD.

Comparison of Neuropsychological Functioning Between Adults With Early- and Late-Onset DSM-5 ADHD.

PubMed

Lin, Yu-Ju; Gau, Susan Shur-Fen

2017-09-01

We aimed to compare the visually dependent neuropsychological functioning among adults with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD who recalled symptom onset by and after age 7 and non-ADHD controls. We divided the participants, aged 17 to 40 years, into three groups-(a) ADHD, onset <7 years (early-onset, n = 142); (b) ADHD, onset between 7 and <12 years (late-onset, n = 41); (c) non-ADHD controls ( n = 148)-and compared their neuropsychological functioning, measured by the Cambridge Neuropsychological Testing Automated Battery. Both ADHD groups had deficits in attention and signal detectability, spatial working memory, and short-term spatial memory, but only the early-onset group showed deficits in alertness, set-shifting, and planning after controlling for age, sex, and psychiatric comorbidities. There was no statistical difference between the two ADHD groups in neuropsychological functioning. DSM-5 criteria for diagnosing adult ADHD are not too lax regarding neuropsychological functioning.

The Academic Experience of Male High School Students with ADHD

ERIC Educational Resources Information Center

Kent, Kristine M.; Pelham, William E.; Molina, Brooke S. G.; Sibley, Margaret H.; Waschbusch, Daniel A.; Yu, Jihnhee; Gnagy, Elizabeth M.; Biswas, Aparajita; Babinski, Dara E.; Karch, Kathryn M.

2011-01-01

This study compared the high school academic experience of adolescents with and without childhood ADHD using data from the Pittsburgh ADHD Longitudinal Study (PALS). Participants were 326 males with childhood ADHD and 213 demographically similar males without ADHD who were recruited at the start of the follow-up study. Data were collected yearly…

Cardiac Reactivity and Stimulant Use in Adolescents with Autism Spectrum Disorders with Comorbid ADHD Versus ADHD

ERIC Educational Resources Information Center

Bink, M.; Popma, A.; Bongers, I. L.; van Boxtel, G. J. M.; Denissen, A.; van Nieuwenhuizen, Ch.

2015-01-01

A large number of youngsters with autism spectrum disorders (ASD) display comorbid attention deficit/hyperactivity disorder (ADHD) symptoms. However, previous studies are not conclusive whether psychophysiological correlates, like cardiac reactivity, are different for ASD with comorbid ADHD (ASD+) compared to ADHD. Therefore, the current study…

An Investigation into the Psychosocial Functioning of Creative Children: The Impact of ADHD Symptomatology

ERIC Educational Resources Information Center

Healey, Dione; Rucklidge, Julia J.

2006-01-01

This study examined the relationship among creativity, ADHD symptomatology, temperament, and psychosocial functioning by comparing four groups of children aged 10-12 years: (1) 29 ADHD children without creativity, (2) 16 highly creative children displaying ADHD symptomatology, (3) 18 highly creative children without ADHD symptomatology, and (4) 30…

Sustained and Focused Attention Deficits in Adult ADHD

ERIC Educational Resources Information Center

Marchetta, Natalie D. J.; Hurks, Petra P. M.; De Sonneville, Leo M. J.; Krabbendam, Lydia; Jolles, Jelle

2008-01-01

Objective: To examine the specificity of deficits in focused attention and sustained attention in adults with ADHD and to evaluate the effect of comorbidity. Method: Twenty-eight adults with ADHD without comorbidity were compared with 28 ADHD outpatients with comorbidity. Two control groups were used: 68 adults referred for ADHD but with another…

Resting-State Neurophysiological Activity Patterns in Young People with ASD, ADHD, and ASD + ADHD

ERIC Educational Resources Information Center

Shephard, Elizabeth; Tye, Charlotte; Ashwood, Karen L.; Azadi, Bahar; Asherson, Philip; Bolton, Patrick F.; McLoughlin, Grainne

2018-01-01

Altered power of resting-state neurophysiological activity has been associated with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), which commonly co-occur. We compared resting-state neurophysiological power in children with ASD, ADHD, co-occurring ASD + ADHD, and typically developing controls. Children with ASD…

Characterizing adult attention-deficit/hyperactivity-disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors.

PubMed

O'Malley, G K; McHugh, L; Mac Giollabhui, N; Bramham, J

2016-01-01

To characterize adults with comorbid attention-deficit/hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) with regard to ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. A between-group design compared a group of individuals diagnosed with ADHD (n=40) with a group diagnosed with BPD and who also met the criteria for ADHD (ADHD+BPD) (n=20). Significant differences were observed for both childhood and current impulsivity symptoms, whereby ADHD+BPD exhibited increased impulsivity; no differences on self-report and cognitive measures of impulsivity were reported. The ADHD+BPD group scored significantly higher on measures of depression, anxiety and numerous other axis I and II conditions. The ADHD+BPD group scored significantly lower on most measures of intellectual functioning and attention, however largely not on those relating to response inhibition. Furthermore, group differences were observed for psychosocial factors, including education, substance use and criminal record. Comorbid ADHD and BPD is characterized by more symptoms of impulsivity, additional psychopathology, comparatively lower intellectual and attentional functioning and increased psychosocial difficulties. Copyright © 2015. Published by Elsevier Masson SAS.

Rate and predictors of divorce among parents of youths with ADHD.

PubMed

Wymbs, Brian T; Pelham, William E; Molina, Brooke S G; Gnagy, Elizabeth M; Wilson, Tracey K; Greenhouse, Joel B

2008-10-01

Numerous studies have asserted the prevalence of marital conflict among families of children with attention-deficit/hyperactivity disorder (ADHD), but evidence is surprisingly less convincing regarding whether parents of youths with ADHD are more at risk for divorce than are parents of children without ADHD. Using survival analyses, the authors compared the rate of marital dissolution between parents of adolescents and young adults with and without ADHD. Results indicated that parents of youths diagnosed with ADHD in childhood (n = 282) were more likely to divorce and had a shorter latency to divorce compared with parents of children without ADHD (n = 206). Among a subset of those families of youths with ADHD, prospective analyses indicated that maternal and paternal education level; paternal antisocial behavior; and child age, race/ethnicity, and oppositional-defiant/conduct problems each uniquely predicted the timing of divorce between parents of youths with ADHD. These data underscore how parent and child variables likely interact to exacerbate marital discord and, ultimately, dissolution among families of children diagnosed with ADHD. (c) 2008 APA, all rights reserved

A multicenter, open-label trial to evaluate the quality of life in adults with ADHD treated with long-acting methylphenidate (OROS MPH): Concerta Quality of Life (CONQoL) study.

PubMed

Mattos, Paulo; Louzã, Mário Rodrigues; Palmini, André Luís Fernandes; de Oliveira, Irismar Reis; Rocha, Fábio Lopes

2013-07-01

The available literature provides few studies on the effectiveness of methylphenidate in improving quality of life in individuals with ADHD. To assess the effectiveness of methylphenidate OROS formulation (OROS MPH) through QoL in adults with ADHD. A 12-week, multicenter, open-label trial involving 60 patients was used. The measures used were Adult Self-Rating Scale, Adult ADHD Quality of Life Scale (AAQoL), State and Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression (CGI), and safety measures. A significance statistic level of 5% was adopted. Analyses included 60 patients (66.7% male; M age = 31.1 years) for safety and 58 patients for effectiveness. All AAQoL subscales improved from baseline to Week 12 (p < .0001), as well as the Total AAQoL (p < .0001). A significant reduction on Clinical Global Impression-Improvement (CGI-I), HAM-D, STAI, and ASRS scores was observed (p < .0001). No serious adverse event was reported. Treatment of adult ADHD patients with OROS MPH improves QoL.

A systematic review of reboxetine for treating patients with attention deficit hyperactivity disorder.

PubMed

Ghanizadeh, Ahmad

2015-05-01

No published systematic review has ever assessed the efficacy and safety of reboxetine for treating of patients with attention deficit hyperactivity disorder (ADHD). This systematic review aimed to review the available evidence regarding the efficacy of reboxetine for treating ADHD. The databases of Pubmed/Medline, Google scholar, SCOPUS and Web of Science were searched using the Keywords: "reboxetine", "ADHD" and "attention deficit hyperactivity disorder". The reference lists of the included studies were screened to find any possible other relevant articles. All the non-controlled and controlled clinical trials were included. The current evidence mainly consists of un-controlled studies, such as case series. Only three of 33 studies were controlled clinical trials. They are from single sites and included a sub-sample of patients with ADHD. Non-controlled studies and controlled trials support the promising effect of reboxetine for treating ADHD in a sub-sample of patients that are without co-morbid psychiatric disorder and mental retardation. Reboxetine is tolerated well. However, more controlled trials are needed to reach any firm conclusion.

Open-label, dose-titration tolerability study of atomoxetine hydrochloride in Korean, Chinese, and Taiwanese adults with attention-deficit/hyperactivity disorder.

PubMed

Takahashi, Michihiro; Goto, Taro; Takita, Yasushi; Chung, Sang-Keun; Wang, Yufeng; Gau, Susan Shur-Fen

2014-03-01

The primary objective of this study was to assess the overall safety and tolerability of atomoxetine in Korean, Chinese, and Taiwanese adults with attention-deficit/hyperactivity disorder (ADHD). A total of 44 patients aged ≥18 years who met the Conners' Adult ADHD Diagnostic Interview for DSM-IV diagnostic criteria for ADHD were enrolled from China, Korea, and Taiwan. In this open-label, dose-escalation study, patients received atomoxetine orally once daily over a period of eight weeks, starting at 40 mg/day (one week) up to a maximum dosage of 120 mg/day. Tolerability was evaluated by rate of discontinuation due to adverse events. Safety was assessed by recording all adverse events, laboratory tests, vital signs, and electrocardiograms. ADHD symptoms were evaluated by the Conners' Adult ADHD Rating Scale-Investigator Rated: Screening Version (CAARS-Inv:SV) for efficacy assessment. Thirty-four patients (77.3%) completed the study. Atomoxetine was well tolerated with a discontinuation rate of 2.3% (1/44) due to adverse events. The most commonly reported adverse events were nausea, dizziness, and somnolence. The mean change from baseline to endpoint in CAARS-Inv:SV total ADHD symptom score was -12.5 (P < 0.001). A significant reduction in the CAARS-Inv:SV subscales (inattentive, hyperactive/impulsive, and ADHD index score, P < 0.001) was observed. This is the first atomoxetine clinical trial in adult patients with ADHD in China, Korea, and Taiwan. Atomoxetine was well tolerated in doses of up to 120 mg/day with no unknown safety concerns. Copyright © 2012 Blackwell Publishing Asia Pty Ltd.

Emotion Self-Regulation Moderates the Association Between Symptoms of ADHD and Weight Loss After Bariatric Surgery.

PubMed

Williamson, Tamara M; Campbell, Tavis S; Telfer, Jo Ann; Rash, Joshua A

2018-06-01

This study aimed to examine the combined effect of pre-surgical emotion self-regulation (ESR) and symptoms of attention deficit hyperactivity disorder (sADHD, i.e., inattention, impulsivity, and hyperactivity) on weight loss 12 months following bariatric surgery independent of psychological distress and eating pathology. Adults with obesity were recruited from a bariatric surgery specialty clinic in Canada. Patients completed measures of psychological distress (i.e., Beck Depression Inventory II and Beck Anxiety Inventory), eating pathology (i.e., Eating Disorder Examination Questionnaire), ESR (i.e., "Managing Own Emotions" subscale of the Schutte Emotional Intelligence Test), and sADHD (i.e., Adult ADHD Self-Report Scale) prior to surgery. Measures of height and weight were obtained and used to calculate percent excess weight loss (%EWL) of body mass index (BMI) pre- and 12 months post-surgery. Thirty-seven patients were recruited. The final sample consisted of 30 patients (80% female; mean age = 48 years; mean BMI = 49.32). Patients experienced significant weight loss and reported significant improvement in anxiety, depressed mood, and eating pathology from pre- to 12 months post-surgery. A significant sADHD by ESR interaction on %EWL (F(1, 21) = 6.43, p = .019) was observed and accounted for 13% of unique variance after adjusting for relevant covariates. Probing the interaction with the Johnson-Neyman technique indicated that there was a significant inverse association between sADHD and %EWL among individuals who scored ≤ 0.15 SD below the mean on ESR. ESR moderated the association between sADHD and %EWL, suggesting that sADHD may attenuate weight loss following bariatric surgery among individuals deficient in ESR. This finding has implications for bariatric surgery pre-surgical psychological assessment.

Stress levels in parents of children with and without attention deficit hyperactivity disorder during the back-to-school period: results of an international survey in Italy.

PubMed

Loprieno, Urania; Gagliano, Antonella

2016-10-01

The back-to-school stress survey was an international, non-clinical opinion survey, which aimed to compare stress levels in parents of children with/without attention deficit hyperactivity disorder (ADHD) during the back-to-school period. Here, we present results relating to the Italian sample, comparing them with European data. The questionnaire was built using a modified Holmes and Rahe stress scale. Parents of children with/without ADHD evaluated potentially stress-causing situations on a scale from 1 (low stress) to 10 (high stress). In Italy, 107 parents of children with ADHD (mean age ± SD 40.3±7.3 years) and 105 parents of children without ADHD (mean age 42.2±6.6 years) participated in the survey. The mean age of children with ADHD was 10.3±3.1 years; 77.6% were male, 72.9% had been diagnosed with at least one comorbid condition - in particular conduct disorder (24.3%), learning disorders/dyslexia (23.4%) and language/communication disorder (19.6%) - and 32.7% were receiving ADHD medication. Parents of children with ADHD showed significantly higher stress levels (p≤0.005) compared with the non-ADHD group in all areas analyzed that were related to the return to school. Significant differences between groups (P<0.05) were also observed in most standard areas evaluated (e.g. personal life). These results were in agreement with data obtained for the overall European sample. Parents of children with ADHD suffer significantly higher stress levels compared with parents of children without ADHD. Considering parental stress is important for the management of children with ADHD, as stress can affect the control of behavioral symptoms of children.

Attention-Deficit/Hyperactivity Disorder subtypes and substance use and use disorders in NESARC

PubMed Central

De Alwis, Duneesha; Lynskey, Michael T.; Reiersen, Angela M.; Agrawal, Arpana

2014-01-01

Background Attention-deficit /hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples. Methods Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N=33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N=17,009), the Combined (ADHD-C; N=361), Predominantly Inattentive (ADHD-I; N=325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N=279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined. Results After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups. Statistically significant differences were not evident across the three diagnostic groups. Hyperactive-impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms. Conclusions ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD. PMID:24821471

Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC.

PubMed

De Alwis, Duneesha; Lynskey, Michael T; Reiersen, Angela M; Agrawal, Arpana

2014-08-01

Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples. Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N = 33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N = 17,009), the Combined (ADHD-C; N = 361), Predominantly Inattentive (ADHD-I; N = 325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N = 279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined. After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups. Statistically significant differences were not evident across the three diagnostic groups. Hyperactive-impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms. ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction

PubMed Central

Pérez de los Cobos, José; Siñol, Núria; Pérez, Víctor; Trujols, Joan

2014-01-01

The present article reviews whether available efficacy and safety data support the pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD) in patients with concurrent substance use disorders (SUD). Arguments for and against treating adult ADHD with active SUD are discussed. Findings from 19 large open studies and controlled clinical trials show that the use of atomoxetine or extended-release methylphenidate formulations, together with psychological therapy, yield promising though inconclusive results about short term efficacy of these drugs in the treatment of adult ADHD in patients with SUD and no other severe mental disorders. However, the efficacy of these drugs is scant or lacking for treating concurrent SUD. No serious safety issues have been associated with these drugs in patients with co-morbid SUD-ADHD, given their low risk of abuse and favourable side effect and drug–drug interaction profile. The decision to treat adult ADHD in the context of active SUD depends on various factors, some directly related to SUD-ADHD co-morbidity (e.g. degree of diagnostic uncertainty for ADHD) and other factors related to the clinical expertise of the medical staff and availability of adequate resources (e.g. the means to monitor compliance with pharmacological treatment). Our recommendation is that clinical decisions be individualized and based on a careful analysis of the advantages and disadvantages of pharmacological treatment for ADHD on a case-by-case basis in the context of active SUD. PMID:23216449

Efficacy and Safety of Dexmethylphenidate Extended-Release Capsules in Children with Attention-Deficit/Hyperactivity Disorder

ERIC Educational Resources Information Center

Greenhill, Laurence L.; Muniz, Rafael; Ball, Roberta R.; Levine, Alan; Pestreich, Linda; Jiang, Hai

2006-01-01

Objective: The efficacy and safety of dexmethylphenidate extended release (d-MPH-ER) was compared to placebo in pediatric patients with attention-deficit/hyperactivity disorder (ADHD). Method: This multicenter, randomized, double-blind, placebo-controlled, parallel-group, two-phase study included 97 patients (ages 6-17 years) with…

Skills and compensation strategies in adult ADHD – A qualitative study

PubMed Central

Buadze, Anna; Dube, Anish; Eich, Dominique; Liebrenz, Michael

2017-01-01

Objective The primary objectives of this study were to investigate how adult patients with ADHD coped with their symptoms prior to diagnosis and treatment, what skills and compensation strategies they had developed and what their self-perceptions of these strategies were. Methods We used a qualitative approach to analyze interviews with 32 outpatients of a specialty care unit at a university hospital. Results Patients reported frequent use of diverse compensatory strategies with varying degrees of effectiveness. These were classified into five categories (organizational, motoric, attentional, social, psychopharmacological). In certain circumstances, ADHD symptoms were even perceived as useful. Conclusion Before diagnosis and treatment, patients with ADHD may develop a variety of skills to cope with their symptoms. Several of these skills are perceived as helpful. Knowledge of self-generated coping strategies may help better understand patients and their histories and thus facilitate patient cooperation. Moreover, knowing ways in which such patients cope with their symptoms may help elucidate reasons for late or under-diagnosing of the disorder. PMID:28953946

Skills and compensation strategies in adult ADHD - A qualitative study.

PubMed

Canela, Carlos; Buadze, Anna; Dube, Anish; Eich, Dominique; Liebrenz, Michael

2017-01-01

The primary objectives of this study were to investigate how adult patients with ADHD coped with their symptoms prior to diagnosis and treatment, what skills and compensation strategies they had developed and what their self-perceptions of these strategies were. We used a qualitative approach to analyze interviews with 32 outpatients of a specialty care unit at a university hospital. Patients reported frequent use of diverse compensatory strategies with varying degrees of effectiveness. These were classified into five categories (organizational, motoric, attentional, social, psychopharmacological). In certain circumstances, ADHD symptoms were even perceived as useful. Before diagnosis and treatment, patients with ADHD may develop a variety of skills to cope with their symptoms. Several of these skills are perceived as helpful. Knowledge of self-generated coping strategies may help better understand patients and their histories and thus facilitate patient cooperation. Moreover, knowing ways in which such patients cope with their symptoms may help elucidate reasons for late or under-diagnosing of the disorder.

Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis).

PubMed

Koyuncu, Ahmet; Alkın, Tunç; Tükel, Raşit

2018-04-01

Social anxiety disorder (SAD) may develop secondary to childhood attention deficit/hyperactivity (ADHD) in a subgroup of the patients with SAD. Patients pass through a number of identifiable stages of developmental pathways to SAD as they grow up. Patients with ADHD have maladaptive behaviours in social settings due to the symptoms of ADHD. These behaviours are criticized by their parents and social circle; they receive insults, humiliation and bullying. After each aversive incident, the individual feels shame and guilt. A vicious cycle emerges. The patients then develop social fears and a cognitive inhibition that occurs in social situations. The inhibition increases gradually as the fear persists and the individual becomes withdrawn. Patients start to monitor themselves and to focus on others' feedback. Finally, performative social situations become extremely stimulating for them and may trigger anxiety/panic attacks. If this hypothesis is proven, treatment of 'patients with SAD secondary to ADHD' should focus on the primary disease. © 2016 John Wiley & Sons Australia, Ltd.

Buspirone versus methylphenidate in the treatment of children with attention- deficit/ hyperactivity disorder: randomized double-blind study.

PubMed

Mohammadi, Mohammad-Reza; Hafezi, Poopak; Galeiha, Ali; Hajiaghaee, Reza; Akhondzadeh, Shahin

2012-01-01

A recent randomized clinical trial showed buspirone efficacy in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children. However, results from a recent multi-site controlled clinical trial of transdermal buspirone failed to separate it from placebo in a large sample of children with ADHD. Therefore, due to these inconsistent findings, this study was designed to assess the efficacy of buspirone in the treatment of children with ADHD compared to methylphenidate in a double blind randomized clinical trial. Forty outpatients with a DSM-IV-TR diagnosis of ADHD were study population of this trial. Subjects were recruited from an outpatient child and adolescent clinic for a 6 week double blind, randomized clinical trial. All study subjects were randomly assigned to receive treatment using tablet of buspirone at a dose of 20-30 mg/day depending on weight (20 mg/day for < 30kg and 30 mg/day for > 30kg) (group 1) or methylphenidate at a dose of 20-30 mg/day depending on weight (20 mg/day for < 30kg and 30 mg/day for > 30kg (group 2) for a 6 week double blind, randomized clinical trial. The principal measure of outcome was the Teacher and Parent ADHD Rating Scale IV. Patients were assessed at baseline and at 21 and 42 days after the medication started. Significant differences were observed between the two groups on the Parent and Teacher Rating Scale scores. The changes at the endpoint compared to baseline were: -8.95±8.73 (mean±SD) and -15.60±7.81 (mean±SD) for buspirone and methyphenidate, for Parent ADHD Rating Scale. The changes at the endpoint compared to baseline were: -9.80 ±7.06 (mean±SD) and -22.40±9.90 (mean±SD) for buspirone and methyphenidate, respectively for Teacher ADHD Rating Scale. The difference between the buspirone and methylphenidate groups in the frequency of side effects was not significant except for decreased appetite, headache and insomnia that were observed more frequently in the methylphenidate group. The results of this study suggest that administration of buspirone was less effective than methylphenidate in the treatment of ADHD.

Feedback-related negativity in children with two subtypes of attention deficit hyperactivity disorder.

PubMed

Gong, Jingbo; Yuan, Jiajin; Wang, Suhong; Shi, Lijuan; Cui, Xilong; Luo, Xuerong

2014-01-01

The current model of ADHD suggests abnormal reward and punishment sensitivity, although differences in ADHD subgroups are unclear. This study aimed to investigate the effect of feedback valence (reward or punishment) and punishment magnitude (small or large) on Feedback-Related Negativity (FRN) and Late Positive Potential (LPP) in two subtypes of ADHD (ADHD-C and ADHD-I) compared to typically developing children (TD) during a children's gambling task. Children with ADHD-C (n = 16), children with ADHD-I (n = 15) and typically developing children (n = 15) performed a children's gambling task under three feedback conditions: large losses, small losses and gains. FRN and LPP components in brain potentials were recorded and analyzed. In TD children and children with ADHD-C, large loss feedback evoked more negative FRN amplitudes than small loss feedback, suggesting that brain sensitivity to the punishment and its magnitude is not impaired in children with ADHD-C. In contrast to these two groups, the FRN effect was absent in children with ADHD-I. The LPP amplitudes were larger in children with ADHD-C in comparison with those with ADHD-I, regardless of feedback valence and magnitude. Children with ADHD-C exhibit intact brain sensitivity to punishment similar to TD children. In contrast, children with ADHD-I are significantly impaired in neural sensitivity to the feedback stimuli and in particular, to punishment, compared to TD and ADHD-C children. Thus, FRN, rather than LPP, is a reliable index of the difference in reward and punishment sensitivity across different ADHD-subcategories.

Group Independent Component Analysis (gICA) and Current Source Density (CSD) in the study of EEG in ADHD adults.

PubMed

Ponomarev, Valery A; Mueller, Andreas; Candrian, Gian; Grin-Yatsenko, Vera A; Kropotov, Juri D

2014-01-01

To investigate the performance of the spectral analysis of resting EEG, Current Source Density (CSD) and group independent components (gIC) in diagnosing ADHD adults. Power spectra of resting EEG, CSD and gIC (19 channels, linked ears reference, eyes open/closed) from 96 ADHD and 376 healthy adults were compared between eyes open and eyes closed conditions, and between groups of subjects. Pattern of differences in gIC and CSD spectral power between conditions was approximately similar, whereas it was more widely spatially distributed for EEG. Size effect (Cohen's d) of differences in gIC and CSD spectral power between groups of subjects was considerably greater than in the case of EEG. Significant reduction of gIC and CSD spectral power depending on conditions was found in ADHD patients. Reducing power in a wide frequency range in the fronto-central areas is a common phenomenon regardless of whether the eyes were open or closed. Spectral power of local EEG activity isolated by gICA or CSD in the fronto-central areas may be a suitable marker for discrimination of ADHD and healthy adults. Spectral analysis of gIC and CSD provides better sensitivity to discriminate ADHD and healthy adults. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Personality profiles in adults with attention deficit hyperactivity disorder (ADHD).

PubMed

Perroud, Nader; Hasler, Roland; Golay, Nicolas; Zimmermann, Julien; Prada, Paco; Nicastro, Rosetta; Aubry, Jean-Michel; Ardu, Stefano; Herrmann, François R; Giannakopoulos, Panteleimon; Baud, Patrick

2016-06-14

Previous studies suggested that the presence of ADHD in children and young adolescents may affect the development of personality. Whether or not the persistence of ADHD in adult life is associated with distinct personality patterns is still matter for debate. To address this issue, we compared the profiles of the Temperament and Character Inventory (TCI) that assesses personality dimensions in 119 adults ADHD and 403 controls. ANCOVA were used to examine group differences (controls vs. ADHD and ADHD inattentive type vs. ADHD combined + hyperactive/impulsive types) in Temperaments and Characters. Partial correlation coefficients were used to assess correlation between TCI and expression and severity of symptoms of ADHD. High novelty seeking (NS), harm avoidance (HA) and self-transcendence (ST) scores as well as low self-directedness (SD) and cooperativeness (C) scores were associated with ADHD diagnosis. Low SD was the strongest personality trait associated with adult ADHD. Cases with the ADHD inattentive type showed higher HA and lower SD scores compared to the combined and hyperactive/impulsive types. High HA scores correlated with inattention symptoms whereas high NS and ST scores were related to hyperactive symptoms. Finally low SD and high NS were associated with increased ADHD severity. Distinct temperaments were associated with inattentive versus hyperactive/impulsive symptoms supporting the heterogeneous nature of the disorder.

Prediction of methylphenidate treatment outcome in adults with attention-deficit/hyperactivity disorder (ADHD).

PubMed

Retz, Wolfgang; Retz-Junginger, Petra

2014-11-01

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent mental disorder of childhood, which often persists in adulthood. Methylphenidate (MPH) is one of the most effective medications to treat ADHD, but also few adult patients show no sufficient response to this drug. In this paper, we give an overview regarding genetic, neuroimaging, clinical and other studies which have tried to reveal the reasons for non-response in adults with ADHD, based on a systematic literature search. Although MPH is a well-established treatment for adults with ADHD, research regarding the prediction of treatment outcome is still limited and has resulted in inconsistent findings. No reliable neurobiological markers of treatment response have been identified so far. Some findings from clinical studies suggest that comorbidity with substance use disorders and personality disorders has an impact on treatment course and outcome. As MPH is widely used in the treatment of adults with ADHD, much more work is needed regarding positive and negative predictors of long-term treatment outcome in order to optimize the pharmacological treatment of adult ADHD patients.

Circadian Modulation of Dopamine Levels and Dopaminergic Neuron Development Contributes to Attention Deficiency and Hyperactive Behavior

PubMed Central

Huang, Jian; Zhong, Zhaomin; Wang, Mingyong; Chen, Xifeng; Tan, Yicheng; Zhang, Shuqing; He, Wei; He, Xiong; Huang, Guodong; Lu, Haiping; Wu, Ping; Che, Yi; Yan, Yi-Lin; Postlethwait, John H.; Chen, Wenbiao

2015-01-01

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and adults. While ADHD patients often display circadian abnormalities, the underlying mechanisms are unclear. Here we found that the zebrafish mutant for the circadian gene period1b (per1b) displays hyperactive, impulsive-like, and attention deficit-like behaviors and low levels of dopamine, reminiscent of human ADHD patients. We found that the circadian clock directly regulates dopamine-related genes monoamine oxidase and dopamine β hydroxylase, and acts via genes important for the development or maintenance of dopaminergic neurons to regulate their number and organization in the ventral diencephalic posterior tuberculum. We then found that Per1 knock-out mice also display ADHD-like symptoms and reduced levels of dopamine, thereby showing highly conserved roles of the circadian clock in ADHD. Our studies demonstrate that disruption of a circadian clock gene elicits ADHD-like syndrome. The circadian model for attention deficiency and hyperactive behavior sheds light on ADHD pathogenesis and opens avenues for exploring novel targets for diagnosis and therapy for this common psychiatric disorder. PMID:25673850

The clinical presentation of attention deficit-hyperactivity disorder (ADHD) in children with 22q11.2 deletion syndrome.

PubMed

Niarchou, Maria; Martin, Joanna; Thapar, Anita; Owen, Michael J; van den Bree, Marianne B M

2015-12-01

Although attention deficit-hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children with 22q11.2DS, it remains unclear whether its clinical presentation is similar to that in children with idiopathic ADHD. The aim of this study is to compare the ADHD phenotype in children with and without 22q11.2DS by examining ADHD symptom scores, patterns of psychiatric comorbidity, IQ and gender distribution. Forty-four children with 22q11.2DS and ADHD (mean age = 9.6), 600 clinic children (mean age = 10.8) and 77 children with ADHD from a population cohort (mean age = 10.8) participated in the study. Psychopathology was assessed using parent-report research diagnostic instruments. There was a higher proportion of females in the 22q11.2DS ADHD sample in relation to the clinical sample (χ(2)  = 18.2, P < 0.001). The 22q11.2DS group showed a higher rate of ADHD inattentive subtype (χ(2)  = 114.76, P < 0.001), and fewer hyperactive-impulsive symptoms compared to the clinical group (z = 8.43, P < 0.001). The 22q11.2DS ADHD group parents reported fewer oppositional defiant disorder/conduct disorder symptoms (z = 6.33, P < 0.001) and a higher rate of generalized anxiety disorder (χ(2)  = 4.56, P = 0.03) in relation to the clinical group. Two percent of the 22q11.2 DS ADHD sample had received ADHD treatment. The results were similar when the 22q11.2 ADHD group was compared to the population cohort ADHD group. The clinical presentation of ADHD and patterns of co-morbidity in 22q11.2DS is different from that in idiopathic ADHD. This could lead to clinical under-recognition of ADHD in this group. Examining psychopathology in 22q11.2DS can provide insights into the genetic origins of psychiatric problems with implications beyond the 22q11.2DS population. © 2015 Wiley Periodicals, Inc.

Controlled Social Interaction Tasks to Measure Self-Perceptions: No Evidence of Positive Illusions in Boys with ADHD.

PubMed

Jiang, Yuanyuan; Johnston, Charlotte

2017-08-01

Studies have suggested that children with Attention-Deficit/Hyperactivity Disorder (ADHD) possess a Positive Illusory Bias (PIB) where they have higher self-perceptions of competence than more objective measures of their competence. However, recent research calls into question the primary methodology of these studies, that is, difference scores. This study investigated the PIB in boys with ADHD within the social domain using a novel methodology that refrains from using difference scores. Eighty-one 8- to 12-year-old boys with and without ADHD completed social interaction tasks where their actual social performance was made comparable, allowing for tests of between-group differences in self-perceptions that do not rely on difference scores. In addition, to examine whether clarity of social feedback moderates the presence of the PIB, the social tasks presented unclear, clear positive, or clear negative feedback. Boys rated how well they performed in each social interaction task, and these ratings were compared between ADHD and non-ADHD groups. Compared to the non-ADHD group, boys with ADHD did not show a PIB in their ratings of performance on the social tasks. There also was no moderation of boys' ratings by type of feedback received. In contrast, when the PIB was calculated using difference scores based on child and parent ratings of child competence, boys with ADHD showed a PIB compared to boys without ADHD. These findings call attention to the need to re-examine the phenomenon of the PIB using methodologies outside of difference scores.

Resting state fMRI entropy probes complexity of brain activity in adults with ADHD.

PubMed

Sokunbi, Moses O; Fung, Wilson; Sawlani, Vijay; Choppin, Sabine; Linden, David E J; Thome, Johannes

2013-12-30

In patients with attention deficit hyperactivity disorder (ADHD), quantitative neuroimaging techniques have revealed abnormalities in various brain regions, including the frontal cortex, striatum, cerebellum, and occipital cortex. Nonlinear signal processing techniques such as sample entropy have been used to probe the regularity of brain magnetoencephalography signals in patients with ADHD. In the present study, we extend this technique to analyse the complex output patterns of the 4 dimensional resting state functional magnetic resonance imaging signals in adult patients with ADHD. After adjusting for the effect of age, we found whole brain entropy differences (P=0.002) between groups and negative correlation (r=-0.45) between symptom scores and mean whole brain entropy values, indicating lower complexity in patients. In the regional analysis, patients showed reduced entropy in frontal and occipital regions bilaterally and a significant negative correlation between the symptom scores and the entropy maps at a family-wise error corrected cluster level of P<0.05 (P=0.001, initial threshold). Our findings support the hypothesis of abnormal frontal-striatal-cerebellar circuits in ADHD and the suggestion that sample entropy is a useful tool in revealing abnormalities in the brain dynamics of patients with psychiatric disorders. © 2013 Elsevier Ireland Ltd. All rights reserved.

Novel subgroups of attention-deficit/hyperactivity disorder identified by topological data analysis and their functional network modular organizations

PubMed Central

Kyeong, Sunghyon; Kim, Jae-Jin; Kim, Eunjoo

2017-01-01

Attention-deficit/hyperactivity disorder (ADHD) is a clinically heterogeneous condition and identification of clinically meaningful subgroups would open up a new window for personalized medicine. Thus, we aimed to identify new clinical phenotypes in children and adolescents with ADHD and to investigate whether neuroimaging findings validate the identified phenotypes. Neuroimaging and clinical data from 67 children with ADHD and 62 typically developing controls (TDCs) from the ADHD-200 database were selected. Clinical measures of ADHD symptoms and intelligence quotient (IQ) were used as input features into a topological data analysis (TDA) to identify ADHD subgroups within our sample. As external validators, graph theoretical measures obtained from the functional connectome were compared to address the biological meaningfulness of the identified subtypes. The TDA identified two unique subgroups of ADHD, labelled as mild symptom ADHD (mADHD) and severe symptom ADHD (sADHD). The output topology shape was repeatedly observed in the independent validation dataset. The graph theoretical analysis showed a decrease in the degree centrality and PageRank in the bilateral posterior cingulate cortex in the sADHD group compared with the TDC group. The mADHD group showed similar patterns of intra- and inter-module connectivity to the sADHD group. Relative to the TDC group, the inter-module connectivity between the default mode network and executive control network were significantly increased in the sADHD group but not in the mADHD group. Taken together, our results show that the data-driven TDA is potentially useful in identifying objective and biologically relevant disease phenotypes in children and adolescents with ADHD. PMID:28829775

Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity.

PubMed

Brown, Nicole M; Brown, Suzette N; Briggs, Rahil D; Germán, Miguelina; Belamarich, Peter F; Oyeku, Suzette O

Although identifying adverse childhood experiences (ACEs) among children with behavioral disorders is an important step in providing targeted therapy and support, little is known about the burden of ACEs among children with attention deficit-hyperactivity disorder (ADHD). We described the prevalence of ACEs in children with and without ADHD, and examined associations between ACE type, ACE score, and ADHD diagnosis and severity. Using the 2011 to 2012 National Survey of Children's Health, we identified children aged 4 to 17 years whose parents indicated presence and severity of ADHD, and their child's exposure to 9 ACEs. Multivariate logistic regression was used to estimate associations between ACEs, ACE score, and parent-reported ADHD and ADHD severity, adjusted for sociodemographic characteristics. In our sample (N = 76,227, representing 58,029,495 children), children with ADHD had a higher prevalence of each ACE compared with children without ADHD. Children who experienced socioeconomic hardship (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.21-1.59), divorce (aOR, 1.34; 95% CI, 1.16-1.55), familial mental illness (aOR, 1.55; 95% CI, 1.26-1.90), neighborhood violence (aOR, 1.47; 95% CI, 1.23-1.75), and incarceration (aOR, 1.39; 95% CI, 1.12-1.72) were more likely to have ADHD. A graded relationship was observed between ACE score and ADHD. Children with ACE scores of 2, 3, and ≥4 were significantly more likely to have moderate to severe ADHD. Children with ADHD have higher ACE exposure compared with children without ADHD. There was a significant association between ACE score, ADHD, and moderate to severe ADHD. Efforts to improve ADHD assessment and management should consider routinely evaluating for ACEs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis.

PubMed

Cortese, Samuele; Moreira-Maia, Carlos Renato; St Fleur, Diane; Morcillo-Peñalver, Carmen; Rohde, Luis Augusto; Faraone, Stephen V

2016-01-01

Impulsivity and inattention related to attention deficit hyperactivity disorder (ADHD) may increase food intake and, consequently, weight gain. However, findings on the association between obesity/overweight and ADHD are mixed. The authors conducted a meta-analysis to estimate this association. A broad range of databases was searched through Aug. 31, 2014. Unpublished studies were also obtained. Study quality was rated with the Newcastle-Ottawa Scale. Random-effects models were used. Forty-two studies that included a total of 728,136 individuals (48,161 ADHD subjects; 679,975 comparison subjects) were retained. A significant association between obesity and ADHD was found for both children (odds ratio=1.20, 95% CI=1.05-1.37) and adults (odds ratio=1.55, 95% CI=1.32-1.81). The pooled prevalence of obesity was increased by about 70% in adults with ADHD (28.2%, 95% CI=22.8-34.4) compared with those without ADHD (16.4%, 95% CI=13.4-19.9), and by about 40% in children with ADHD (10.3%, 95% CI=7.9-13.3) compared with those without ADHD (7.4%, 95% CI=5.4-10.1). The significant association between ADHD and obesity remained when limited to studies 1) reporting odds ratios adjusted for possible confounding factors; 2) diagnosing ADHD by direct interview; and 3) using directly measured height and weight. Gender, study setting, study country, and study quality did not moderate the association between obesity and ADHD. ADHD was also significantly associated with overweight. Individuals medicated for ADHD were not at higher risk of obesity. This study provides meta-analytic evidence for a significant association between ADHD and obesity/overweight. Further research should address possible underlying mechanisms and the long-term effects of ADHD treatments on weight in individuals with both ADHD and obesity.

Differential effects of anxiety and depressive symptoms on working memory components in children and adolescents with ADHD combined type and ADHD inattentive type.

PubMed

Ferrin, Maite; Vance, Alasdair

2014-12-01

Working memory (WM) deficits have been shown to be associated with core ADHD symptoms, worse academic achievement and peer-relationship problems. Internalizing symptoms, such as anxiety and depression, have also been associated with impaired WM performance. However, the association of anxiety and depression and WM performance remains unclear for children and adolescents with ADHD. Further, it is unknown how these comorbid conditions might affect WM performance in the two main ADHD subtypes. The association of anxiety and depression and the specific components of spatial (SWM) and verbal working memory (VWM) were examined in 303 children and adolescents with ADHD, combined type (ADHD-CT) and 77 ADHD, inattentive type (ADHD-IA) compared to 128 age- and gender-matched typically developing participants. The relationship between anxiety and depression and WM was assessed using multiple linear regression analyses and separate simple regression analyses. Higher levels of anxiety/depression were associated with (1) increased between-search errors in the typically developing participants alone, (2) a better strategy performance in the ADHD-CT group, and (3) a better spatial span performance in the ADHD-IA group. VWM was equally impaired in the ADHD-CT and ADHD-IA groups, independent of the levels of anxiety and depression. The results suggest that the effects of internalizing symptoms on WM differ in typically developing children and adolescents compared to those with ADHD. Further, high levels of anxiety and depression modified WM performance differently according to the specific ADHD subtypes. This might help explain contradictory findings observed in previous studies of mixed samples of participants with ADHD-CT and ADHD-IA.

Iron and ADHD: Time to Move beyond Serum Ferritin Levels

ERIC Educational Resources Information Center

Donfrancesco, Renato; Parisi, Pasquale; Vanacore, Nicola; Martines, Francesca; Sargentini, Vittorio; Cortese, Samuele

2013-01-01

Objective: (a) To compare serum ferritin levels in a sample of stimulant-naive children with ADHD and matched controls and (b) to assess the association of serum ferritin to ADHD symptoms severity, ADHD subtypes, and IQ. Method: The ADHD and the control groups included 101 and 93 children, respectively. Serum ferritin levels were determined with…

Effects of Methylphenidate and Bupropion on DHEA-S and Cortisol Plasma Levels in Attention-Deficit Hyperactivity Disorder

ERIC Educational Resources Information Center

Lee, Moon-Soo; Yang, Jae-Won; Ko, Young-Hoon; Han, Changsu; Kim, Seung-Hyun; Lee, Min-Soo; Joe, Sook-Haeng; Jung, In-Kwa

2008-01-01

We evaluated plasma levels of DHEA-S and cortisol before and after treating ADHD patients with one of two medications: methylphenidate (n = 12) or bupropion (n = 10). Boys with ADHD (combined type) were evaluated with the Korean ADHD rating scale (K-ARS) and the computerized ADHD diagnostic system (ADS). All assessments were measured at baseline…

Virtual Patients for Virtual Sick Call Medical Training

DTIC Science & Technology

2010-11-01

2007). A controlled clinical comparison of attention performance in children with ADHD in a virtual reality classroom compared to standard...traditional approaches rely upon a combination of classroom learning and role-playing lnterservice/Jndusrry Training, Simularion, and Education

Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence.

PubMed

Roman-Urrestarazu, Andres; Lindholm, Päivi; Moilanen, Irma; Kiviniemi, Vesa; Miettunen, Jouko; Jääskeläinen, Erika; Mäki, Pirjo; Hurtig, Tuula; Ebeling, Hanna; Barnett, Jennifer H; Nikkinen, Juha; Suckling, John; Jones, Peter B; Veijola, Juha; Murray, Graham K

2016-05-01

When adolescents with ADHD enter adulthood, some no longer meet disorder diagnostic criteria but it is unknown if biological and cognitive abnorma lities persist. We tested the hypothesis that people diagnosed with ADHD during adolescence present residual brain abnormalities both in brain structure and in working memory brain function. 83 young adults (aged 20-24 years) from the Northern Finland 1986 Birth Cohort were classified as diagnosed with ADHD in adolescence (adolescence ADHD, n = 49) or a control group (n = 34). Only one patient had received medication for ADHD. T1-weighted brain scans were acquired and processed in a voxel-based analysis using permutation-based statistics. A sub-sample of both groups (ADHD, n = 21; controls n = 23) also performed a Sternberg working memory task whilst acquiring fMRI data. Areas of structural difference were used as a region of interest to evaluate the implications that structural abnormalities found in the ADHD group might have on working memory function. There was lower grey matter volume bilaterally in adolescence ADHD participants in the caudate (p < 0.05 FWE corrected across the whole brain) at age 20-24. Working memory was poorer in adolescence ADHD participants, with associated failure to show normal load-dependent caudate activation. Young adults diagnosed with ADHD in adolescence have structural and functional deficits in the caudate associated with abnormal working memory function. These findings are not secondary to stimulant treatment, and emphasise the importance of taking a wider perspective on ADHD outcomes than simply whether or not a particular patient meets diagnostic criteria at any given point in time.

Auditory brainstem response as a diagnostic tool for patients suffering from schizophrenia, attention deficit hyperactivity disorder, and bipolar disorder: protocol.

PubMed

Wahlström, Viktor; Åhlander, Fredrik; Wynn, Rolf

2015-02-12

Psychiatric disorders, such as schizophrenia, attention deficit hyperactivity disorder (ADHD), and bipolar disorder, may sometimes be difficult to diagnose. There is a great need for a valid and reliable diagnostic tool to aid clinicians in arriving at the diagnoses in a timely and accurate manner. Prior studies have suggested that patients suffering from schizophrenia and ADHD may process certain sound stimuli in the brainstem in an unusual manner. When these patient groups have been examined with the electrophysiological method of brainstem audiometry, some studies have found illness-specific aberrations. Such aberrations may also exist for patients suffering from bipolar disorder. In this study, we will examine whether the method of brainstem audiometry can be used as a diagnostic tool for patients suffering from schizophrenia, ADHD, and bipolar disorder. The method includes three steps: (1) auditory stimulation with specific sound stimuli, (2) simultaneous measurement of brainstem activity, and (3) automated interpretation of the resulting brain stem audiograms with data-based signal analysis. We will compare three groups of 12 individuals with confirmed diagnoses of schizophrenia, ADHD, or bipolar disorder with 12 healthy subjects under blinded conditions for a total of 48 participants. The extent to which the method can be used to reach the correct diagnosis will be investigated. The project is now in a recruiting phase. When all patients and controls have been recruited and the measurements have been performed, the data will be analyzed according to a previously arranged algorithm. We expect the recruiting phase and measurements to be completed in early 2015, the analyses to be performed in mid-2015, and the results of the study to be published in early 2016. If the results support previous findings, this will lend strength to the idea that brainstem audiometry can offer objective diagnostic support for patients suffering from schizophrenia, ADHD, and bipolar disorder. A positive result from the study could imply that brainstem audiometry could become an important supportive tool for clinicians in their efforts to diagnose patients with these disorders in a timely and accurate manner. ClinicalTrials.gov NCT01629355; https://clinicaltrials.gov/ct2/show/NCT01629355 (Archived by WebCite at http://www.webcitation.org/6VBfTwx5H).

Auditory brainstem response (ABR) profiling tests as diagnostic support for schizophrenia and adult attention-deficit hyperactivity disorder (ADHD).

PubMed

Juselius Baghdassarian, Eva; Nilsson Markhed, Maria; Lindström, Eva; Nilsson, Björn M; Lewander, Tommy

2018-06-01

To evaluate the performances of two auditory brainstem response (ABR) profiling tests as potential biomarkers and diagnostic support for schizophrenia and adult attention-deficit hyperactivity disorder (ADHD), respectively, in an investigator-initiated blinded study design. Male and female patients with schizophrenia (n=26) and adult ADHD (n=24) meeting Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) diagnostic criteria and healthy controls (n=58) comprised the analysis set (n=108) of the total number of study participants (n=119). Coded sets of randomized ABR recordings were analysed by an independent party blinded to clinical diagnoses before a joint code-breaking session. The ABR profiling test for schizophrenia identified schizophrenia patients versus controls with a sensitivity of 84.6% and a specificity of 93.1%. The ADHD test identified patients with adult ADHD versus controls with a sensitivity of 87.5% and a specificity of 91.4%. The ABR profiling tests discriminated schizophrenia and ADHD versus healthy controls with high sensitivity and specificity. The methods deserve to be further explored in larger clinical studies including a broad range of psychiatric disorders to determine their utility as potential diagnostic biomarkers.

Screening for attention-deficit/hyperactivity disorder in borderline personality disorder.

PubMed

Weibel, Sébastien; Nicastro, Rosetta; Prada, Paco; Cole, Pierre; Rüfenacht, Eva; Pham, Eléonore; Dayer, Alexandre; Perroud, Nader

2018-01-15

A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. Cross-sectional study on treatment-seeking patients. We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening. Copyright © 2017 Elsevier B.V. All rights reserved.

Cognitive endophenotypes of attention deficit/hyperactivity disorder and intra-subject variability in patients with autism spectrum disorder.

PubMed

Biscaldi, M; Bednorz, N; Weissbrodt, K; Saville, C W N; Feige, B; Bender, S; Klein, C

2016-07-01

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have previously been studied mainly in isolation from each other. However the two conditions may be aetiologically related and thus show overlap in aetiologically relevant functions. In order to address this question of potential aetiological overlap between ADHD and ASD, the present study set out to investigate putative endophenotypes of ADHD in N=33 typically developing (TD) children and N=28 patients with ASD that were (ASD+) or were not (ASD-) co-morbid for ADHD. With regard to both the cognitive endophenotype candidates (working memory, inhibition, temporal processing) and intra-subject variability (ISV) the pattern of abnormalities was inconsistent. Furthermore, the overall profile of ASD-TD differences was extremely similar to the pattern of differences between the ASD+ and ASD- sub-groups, suggesting that any abnormalities found were due to the comorbid ASD subgroup. This held in particular for ISV, which did not show in patients with ASD the task-general increase that is common in ADHD samples. Altogether, the present results do not support the hypothesis of aetiological overlap between ASD and ADHD. Copyright © 2016 Elsevier B.V. All rights reserved.

"The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment": Correction to Marshall et al. (2016).

PubMed

2016-10-01

Reports an error in "The Impact of Failing to Identify Suspect Effort in Patients Undergoing Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Assessment" by Paul S. Marshall, James B. Hoelzle, Danielle Heyerdahl and Nathaniel W. Nelson ( Psychological Assessment , Advanced Online Publication, Jan 11, 2016, np). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-00618-001.) This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (57%). This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations. PsycINFO Database Record (c) 2016 APA, all rights reserved

Event-Related Potentials during a Gambling Task in Young Adults with Attention-Deficit/Hyperactivity Disorder

PubMed Central

Mesrobian, Sarah K.; Villa, Alessandro E. P.; Bader, Michel; Götte, Lorenz; Lintas, Alessandra

2018-01-01

Attention-deficit hyperactivity disorder (ADHD) is characterized by deficits in executive functions and decision making during childhood and adolescence. Contradictory results exist whether altered event-related potentials (ERPs) in adults are associated with the tendency of ADHD patients toward risky behavior. Clinically diagnosed ADHD patients (n = 18) and healthy controls (n = 18), aged between 18 and 29 (median 22 Yo), were screened with the Conners' Adult ADHD Rating Scales and assessed by the Mini-International Neuropsychiatric Interview, adult ADHD Self-Report Scale, and by the 60-item HEXACO Personality Inventory. The characteristic personality traits of ADHD patients were the high level of impulsiveness associated with lower values of agreeableness. All participants performed a probability gambling task (PGT) with two frequencies of the feedback information of the outcome. For each trial, ERPs were triggered by the self-paced trial onset and by the gamble selection. After trial onset, N2-P3a ERP component associated with the attentional load peaked earlier in the ADHD group than in controls. An N500 component related to the feedback frequency condition after trial onset and an N400-like component after gamble selection suggest a large affective stake of the decision making and an emphasized post-decisional evaluation of the choice made by the ADHD participants. By combining ERPs, related to the emotions associated with the feedback frequency condition, and behavioral analyses during completion of PGT, this study provides new findings on the neural dynamics that differentiate controls and young ADHD adults. In the patients' group, we raise the hypothesis that the activity of frontocentral and centroparietal neural circuits drive the decision-making processes dictated by an impaired cognitive workload followed by the build-up of large emotional feelings generated by the conflict toward the outcome of the gambling choice. Our results can be used for new investigations aimed at studying the fine spatiotemporal distribution of cortical activity, and the neural circuits that underly the generation of that activity, associated with the behavioral deficits characteristic of ADHD. PMID:29535621

Event-Related Potentials during a Gambling Task in Young Adults with Attention-Deficit/Hyperactivity Disorder.

PubMed

Mesrobian, Sarah K; Villa, Alessandro E P; Bader, Michel; Götte, Lorenz; Lintas, Alessandra

2018-01-01

Attention-deficit hyperactivity disorder (ADHD) is characterized by deficits in executive functions and decision making during childhood and adolescence. Contradictory results exist whether altered event-related potentials (ERPs) in adults are associated with the tendency of ADHD patients toward risky behavior. Clinically diagnosed ADHD patients ( n = 18) and healthy controls ( n = 18), aged between 18 and 29 (median 22 Yo), were screened with the Conners' Adult ADHD Rating Scales and assessed by the Mini-International Neuropsychiatric Interview, adult ADHD Self-Report Scale, and by the 60-item HEXACO Personality Inventory. The characteristic personality traits of ADHD patients were the high level of impulsiveness associated with lower values of agreeableness. All participants performed a probability gambling task (PGT) with two frequencies of the feedback information of the outcome. For each trial, ERPs were triggered by the self-paced trial onset and by the gamble selection. After trial onset, N2-P3a ERP component associated with the attentional load peaked earlier in the ADHD group than in controls. An N500 component related to the feedback frequency condition after trial onset and an N400-like component after gamble selection suggest a large affective stake of the decision making and an emphasized post-decisional evaluation of the choice made by the ADHD participants. By combining ERPs, related to the emotions associated with the feedback frequency condition, and behavioral analyses during completion of PGT, this study provides new findings on the neural dynamics that differentiate controls and young ADHD adults. In the patients' group, we raise the hypothesis that the activity of frontocentral and centroparietal neural circuits drive the decision-making processes dictated by an impaired cognitive workload followed by the build-up of large emotional feelings generated by the conflict toward the outcome of the gambling choice. Our results can be used for new investigations aimed at studying the fine spatiotemporal distribution of cortical activity, and the neural circuits that underly the generation of that activity, associated with the behavioral deficits characteristic of ADHD.

The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment.

PubMed

Marshall, Paul S; Hoelzle, James B; Heyerdahl, Danielle; Nelson, Nathaniel W

2016-10-01

[Correction Notice: An Erratum for this article was reported in Vol 28(10) of Psychological Assessment (see record 2016-22725-001). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected.] This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%) [corrected]. This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations. PsycINFO Database Record (c) 2016 APA, all rights reserved

Methylphenidate in Adults with Attention Deficit Hyperactivity Disorder and Substance Use Disorders.

PubMed

Simon, Nicolas; Rolland, Benjamin; Karila, Laurent

2015-01-01

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopment disorder occurring during childhood. However, ADHD persists into adulthood in 45.7% of cases. The global prevalence of adult ADHD is estimated to 5.3%, with no difference between Europe and North America. ADHD is often comorbid with substance use disorder (SUD), with Odds Ratio ranges from 1.5 to 7.9, depending on the substance and the dependence level. Conversely, the prevalence of ADHD among patients with SUD is 10.8%, versus 3.8% for patients without SUD. Methylphenidate (MPH) alleviates ADHD symptoms and, as such, is currently considered as a first choice medication. MPH blocks the dopamine and norepinephrine transporters leading to an increase in extracellular dopamine. It should be noted that its subjective effects are highly dependent on the pharmacokinetic and especially on the rate of input, which highlights the importance of choosing a sustained-release formulation. Meanwhile, prescribing MPH to patients with comorbid SUD has always been challenging for clinicians. The aim of this review is to address the benefits and pitfalls of using MPH in adults with ADHD comorbid SUD, depending on each of the following types of SUD: amphetamine, cocaine, nicotine, alcohol, cannabis and opiates. Overall, due to the prevalence of ADHD in SUD and to the benefits of MPH observed in this population, and considering the mild or low side effects observed, the response to MPH treatment should be evaluated individually in adults with comorbid ADHD and SUD. The choice of the formulation should favor sustained- release MPH over immediate release MPH. Cardiovascular parameters also have to be monitored during long-term use.

The norepinephrine transporter in attention-deficit/hyperactivity disorder investigated with positron emission tomography.

PubMed

Vanicek, Thomas; Spies, Marie; Rami-Mark, Christina; Savli, Markus; Höflich, Anna; Kranz, Georg S; Hahn, Andreas; Kutzelnigg, Alexandra; Traub-Weidinger, Tatjana; Mitterhauser, Markus; Wadsak, Wolfgang; Hacker, Marcus; Volkow, Nora D; Kasper, Siegfried; Lanzenberger, Rupert

2014-12-01

Attention-deficit/hyperactivity disorder (ADHD) research has long focused on the dopaminergic system's contribution to pathogenesis, although the results have been inconclusive. However, a case has been made for the involvement of the noradrenergic system, which modulates cognitive processes, such as arousal, working memory, and response inhibition, all of which are typically affected in ADHD. Furthermore, the norepinephrine transporter (NET) is an important target for frequently prescribed medication in ADHD. Therefore, the NET is suggested to play a critical role in ADHD. To explore the differences in NET nondisplaceable binding potential (NET BPND) using positron emission tomography and the highly selective radioligand (S,S)-[18F]FMeNER-D2 [(S,S)-2-(α-(2-[18F]fluoro[2H2]methoxyphenoxy)benzyl)morpholine] between adults with ADHD and healthy volunteers serving as controls. Twenty-two medication-free patients with ADHD (mean [SD] age, 30.7 [10.4] years; 15 [68%] men) without psychiatric comorbidities and 22 age- and sex-matched healthy controls (30.9 [10.6] years; 15 [68%] men) underwent positron emission tomography once. A linear mixed model was used to compare NET BPND between groups. The NET BPND in selected regions of interest relevant for ADHD, including the hippocampus, putamen, pallidum, thalamus, midbrain with pons (comprising a region of interest that includes the locus coeruleus), and cerebellum. In addition, the NET BPND was evaluated in thalamic subnuclei (13 atlas-based regions of interest). We found no significant differences in NET availability or regional distribution between patients with ADHD and healthy controls in all investigated brain regions (F1,41<0.01; P=.96). Furthermore, we identified no significant association between ADHD symptom severity and regional NET availability. Neither sex nor smoking status influenced NET availability. We determined a significant negative correlation between age and NET availability in the thalamus (R2=0.29; P<.01 corrected) and midbrain with pons, including the locus coeruleus (R2=0.18; P<.01 corrected), which corroborates prior findings of a decrease in NET availability with aging in the human brain. Our results do not indicate involvement of changes in brain NET availability or distribution in the pathogenesis of ADHD. However, the noradrenergic transmitter system may be affected on a different level, such as in cortical regions, which cannot be reliably quantified with this positron emission tomography ligand. Alternatively, different key proteins of noradrenergic neurotransmission might be affected.

The Norepinephrine Transporter in Attention-Deficit/Hyperactivity Disorder Investigated With Positron Emission Tomography

PubMed Central

Rami-Mark, Christina; Savli, Markus; Höflich, Anna; Kranz, Georg S.; Hahn, Andreas; Kutzelnigg, Alexandra; Traub-Weidinger, Tatjana; Mitterhauser, Markus; Wadsak, Wolfgang; Hacker, Marcus; Volkow, Nora D.; Kasper, Siegfried; Lanzenberger, Rupert

2015-01-01

IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) research has long focused on the dopaminergic system’s contribution to pathogenesis, although the results have been inconclusive. However, a case has been made for the involvement of the noradrenergic system, which modulates cognitive processes, such as arousal, working memory, and response inhibition, all of which are typically affected in ADHD. Furthermore, the norepinephrine transporter (NET) is an important target for frequently prescribed medication in ADHD. Therefore, the NET is suggested to play a critical role in ADHD. OBJECTIVE To explore the differences in NET nondisplaceable binding potential (NET BPND) using positron emission tomography and the highly selective radioligand (S,S)-[18F]FMeNER-D2 [(S,S)-2-(α-(2-[18F]fluoro[2H2]methoxyphenoxy)benzyl)morpholine] between adults with ADHD and healthy volunteers serving as controls. DESIGN, SETTING, AND PARTICIPANTS Twenty-two medication-free patients with ADHD (mean [SD] age, 30.7 [10.4] years; 15 [68%] men) without psychiatric comorbidities and 22 age- and sex-matched healthy controls (30.9 [10.6] years; 15 [68%] men) underwent positron emission tomography once. A linear mixed model was used to compare NET BPND between groups. MAIN OUTCOMES AND MEASURES The NET BPND in selected regions of interest relevant for ADHD, including the hippocampus, putamen, pallidum, thalamus, midbrain with pons (comprising a region of interest that includes the locus coeruleus), and cerebellum. In addition, the NET BPND was evaluated in thalamic subnuclei (13 atlas-based regions of interest). RESULTS We found no significant differences in NET availability or regional distribution between patients with ADHD and healthy controls in all investigated brain regions (F1,41 < 0.01; P = .96). Furthermore, we identified no significant association between ADHD symptom severity and regional NET availability. Neither sex nor smoking status influenced NET availability. We determined a significant negative correlation between age and NET availability in the thalamus (R2 = 0.29; P < .01 corrected) and midbrain with pons, including the locus coeruleus (R2 = 0.18; P < .01 corrected), which corroborates prior findings of a decrease in NET availability with aging in the human brain. CONCLUSIONS AND RELEVANCE Our results do not indicate involvement of changes in brain NET availability or distribution in the pathogenesis of ADHD. However, the noradrenergic transmitter system may be affected on a different level, such as in cortical regions, which cannot be reliably quantified with this positron emission tomography ligand. Alternatively, different key proteins of noradrenergic neurotransmission might be affected. PMID:25338091

Attention Deficit Hyperactivity Disorder Symptoms, Sleepiness and Accidental Risk in 36140 Regularly Registered Highway Drivers

PubMed Central

Philip, Pierre; Micoulaud-Franchi, Jean-Arthur; Lagarde, Emmanuel; Taillard, Jacques; Canel, Annick; Sagaspe, Patricia; Bioulac, Stéphanie

2015-01-01

Background Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder that increases accidental risk. Recent studies show that some patients with ADHD can also suffer from excessive daytime sleepiness but there are no data assessing the role of sleepiness in road safety in patients with ADHD. We conducted an epidemiological study to explore sleep complaints, inattention and driving risks among automobile drivers. Methods and Findings From August to September 2014, 491186 regular highway users were invited to participate in an Internet survey on driving habits. 36140 drivers answered a questionnaire exploring driving risks, sleep complaints, sleepiness at the wheel, ADHD symptoms (Adult ADHD Self-Report Scale) and distraction at the wheel. 1.7% of all drivers reported inattention-related driving accidents and 0.3% sleep-related driving accidents in the previous year. 1543 drivers (4.3%) reported ADHD symptoms and were more likely to report accidents than drivers without ADHD symptoms (adjusted OR = 1.24, [1.03–1.51], p < .021). 14.2% of drivers with ADHD symptoms reported severe excessive daytime sleepiness (Epworth Sleepiness Scale >15) versus 3.2% of drivers without ADHD symptoms and 20.5% reported severe sleepiness at the wheel versus 7.3%. Drivers with ADHD symptoms reported significantly more sleep-related (adjusted OR = 1.4, [1.21–1.60], p < .0001) and inattention-related (adjusted OR = 1.9, [1.71–2.14], p<0001) near misses than drivers without ADHD symptoms. The fraction of near-misses attributable to severe sleepiness at the wheel was 4.24% for drivers without ADHD symptoms versus 10,35% for drivers with ADHD symptoms. Conclusion Our study shows that drivers with ADHD symptoms have more accidents and a higher level of sleepiness at the wheel than drivers without ADHD symptoms. Drivers with ADHD symptoms report more sleep-related and inattention-related near misses, thus confirming the clinical importance of exploring both attentional deficits and sleepiness at the wheel in these drivers. Road safety campaigns should be improved to better inform drivers of these accidental risks. PMID:26376078

Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters.

PubMed

Hamed, Alaa M; Kauer, Aaron J; Stevens, Hanna E

2015-01-01

Attention Deficit Hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD is known to negatively impact children, their families, and their community. About one-third to one-half of patients with ADHD will have persistent symptoms into adulthood. The prevalence in the United States is estimated at 5-11%, representing 6.4 million children nationwide. The variability in the prevalence of ADHD worldwide and within the US may be due to the wide range of factors that affect accurate assessment of children and youth. Because of these obstacles to assessment, ADHD is under-diagnosed, misdiagnosed, and undertreated. We examined factors associated with making and receiving the diagnosis of ADHD. We sought to review the consequences of a lack of diagnosis and treatment for ADHD on children's and adolescent's lives and how their families and the community may be involved in these consequences. We reviewed scientific articles looking for factors that impact the identification and diagnosis of ADHD and articles that demonstrate naturalistic outcomes of diagnosis and treatment. The data bases PubMed and Google scholar were searched from the year 1995 to 2015 using the search terms "ADHD, diagnosis, outcomes." We then reviewed abstracts and reference lists within those articles to rule out or rule in these or other articles. Multiple factors have significant impact in the identification and diagnosis of ADHD including parents, healthcare providers, teachers, and aspects of the environment. Only a few studies detailed the impact of not diagnosing ADHD, with unclear consequences independent of treatment. A more significant number of studies have examined the impact of untreated ADHD. The experience around receiving a diagnosis described by individuals with ADHD provides some additional insights. ADHD diagnosis is influenced by perceptions of many different members of a child's community. A lack of clear understanding of ADHD and the importance of its diagnosis and treatment still exists among many members of the community including parents, teachers, and healthcare providers. More basic and clinical research will improve methods of diagnosis and information dissemination. Even before further advancements in science, strong partnerships between clinicians and patients with ADHD may be the best way to reduce the negative impacts of this disorder.

Attention Deficit Hyperactivity Disorder Symptoms, Sleepiness and Accidental Risk in 36140 Regularly Registered Highway Drivers.

PubMed

Philip, Pierre; Micoulaud-Franchi, Jean-Arthur; Lagarde, Emmanuel; Taillard, Jacques; Canel, Annick; Sagaspe, Patricia; Bioulac, Stéphanie

2015-01-01

Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder that increases accidental risk. Recent studies show that some patients with ADHD can also suffer from excessive daytime sleepiness but there are no data assessing the role of sleepiness in road safety in patients with ADHD. We conducted an epidemiological study to explore sleep complaints, inattention and driving risks among automobile drivers. From August to September 2014, 491186 regular highway users were invited to participate in an Internet survey on driving habits. 36140 drivers answered a questionnaire exploring driving risks, sleep complaints, sleepiness at the wheel, ADHD symptoms (Adult ADHD Self-Report Scale) and distraction at the wheel. 1.7% of all drivers reported inattention-related driving accidents and 0.3% sleep-related driving accidents in the previous year. 1543 drivers (4.3%) reported ADHD symptoms and were more likely to report accidents than drivers without ADHD symptoms (adjusted OR = 1.24, [1.03-1.51], p < .021). 14.2% of drivers with ADHD symptoms reported severe excessive daytime sleepiness (Epworth Sleepiness Scale >15) versus 3.2% of drivers without ADHD symptoms and 20.5% reported severe sleepiness at the wheel versus 7.3%. Drivers with ADHD symptoms reported significantly more sleep-related (adjusted OR = 1.4, [1.21-1.60], p < .0001) and inattention-related (adjusted OR = 1.9, [1.71-2.14], p<0001) near misses than drivers without ADHD symptoms. The fraction of near-misses attributable to severe sleepiness at the wheel was 4.24% for drivers without ADHD symptoms versus 10,35% for drivers with ADHD symptoms. Our study shows that drivers with ADHD symptoms have more accidents and a higher level of sleepiness at the wheel than drivers without ADHD symptoms. Drivers with ADHD symptoms report more sleep-related and inattention-related near misses, thus confirming the clinical importance of exploring both attentional deficits and sleepiness at the wheel in these drivers. Road safety campaigns should be improved to better inform drivers of these accidental risks.

Effectiveness of symptom validity measures in identifying cognitive and behavioral symptom exaggeration in adult attention deficit hyperactivity disorder.

PubMed

Marshall, Paul; Schroeder, Ryan; O'Brien, Jeffrey; Fischer, Rebecca; Ries, Adam; Blesi, Brita; Barker, Jessica

2010-10-01

This study examines the effectiveness of symptom validity measures to detect suspect effort in cognitive testing and invalid completion of ADHD behavior rating scales in 268 adults referred for ADHD assessment. Patients were diagnosed with ADHD based on cognitive testing, behavior rating scales, and clinical interview. Suspect effort was diagnosed by at least two of the following: failure on embedded and free-standing SVT measures, a score > 2 SD below the ADD population average on tests, failure on an ADHD behavior rating scale validity scale, or a major discrepancy between reported and observed ADHD behaviors. A total of 22% of patients engaged in symptom exaggeration. The Word Memory test immediate recall and consistency score (both 64%), TOVA omission errors (63%) and reaction time variability (54%), CAT-A infrequency scale (58%), and b Test (47%) had good sensitivity as well as at least 90% specificity. Clearly, such measures should be used to help avoid making false positive diagnoses of ADHD.

Core ADHD Symptom Improvement with Atomoxetine versus Methylphenidate: A Direct Comparison Meta-Analysis

ERIC Educational Resources Information Center

Hazell, Philip L.; Kohn, Michael R.; Dickson, Ruth; Walton, Richard J.; Granger, Renee E.; van Wyk, Gregory W.

2011-01-01

Objective: Previous studies comparing atomoxetine and methylphenidate to treat ADHD symptoms have been equivocal. This noninferiority meta-analysis compared core ADHD symptom response between atomoxetine and methylphenidate in children and adolescents. Method: Selection criteria included randomized, controlled design; duration 6 weeks; and…

Analysis of the factors linked to a diagnosis of attention deficit hyperactivity disorder in children.

PubMed

Rivas-Juesas, C; de Dios, J G; Benac-Prefaci, M; Colomer-Revuelta, J

2017-09-01

Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder originating from multiple factors. The aim of this study is to determine the percentage of patients with ADHD out of all patients referred to our clinic for assessment, and to explore the epidemiological and clinical factors linked to this diagnosis. retrospective analytical study of a sample of patients under 15 years old sent to the paediatric neurology clinic for suspected ADHD. DSM-IV criteria were used for diagnosis. We completed a binary logistic regression analysis to determine which risk factors were associated with the diagnosis. Of the 280 selected patients, 224 were male (male/female ratio 4:1); mean age (SD) was 8.4 (3.08) years. Almost half (49%) of the patients were referred by their schools and 64.9% were born in the second half of the year, but this tendency was more marked in girls than in boys. Assessment according to DSM-IV criteria resulted in diagnosis of 139 subjects (49.7%). The risk factors linked to diagnosis were male sex, parents with ADHD, associated sleep disorders, tics, and absence of neurodevelopmental delay. Only half of the children referred for suspected ADHD were diagnosed with that condition, and most were among the youngest in their classes, which suggests that suspected ADHD is overestimated. An exhaustive clinical interview investigating the family's psychological disorders and the patient's sleep disorders and tics is needed to improve the diagnostic process. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Breastfeeding may protect from developing attention-deficit/hyperactivity disorder.

PubMed

Mimouni-Bloch, Aviva; Kachevanskaya, Anna; Mimouni, Francis Benjamin; Shuper, Avinoam; Raveh, Eyal; Linder, Nehama

2013-08-01

Breastfeeding has a positive influence on physical and mental development. Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with major social, familial, and academic influences. The present study aimed to evaluate whether ADHD is associated with a shorter duration of breastfeeding. In this retrospective matched study, children 6-12 years old diagnosed at Schneider's Children Medical Center (Petach Tikva, Israel) with ADHD between 2008 and 2009 were compared with two control groups. The first one consisted of healthy (no ADHD) siblings of ADHD children; the second control group consisted of children without ADHD who consulted at the otolaryngology clinic. A constructed questionnaire about demographic, medical, and perinatal findings, feeding history during the first year of life, and a validated adult ADHD screening questionnaire were given to both parents of every child in each group. In children later diagnosed as having ADHD, 43% were breastfed at 3 months of age compared with 69% in the siblings group and 73% in the control non-related group (p=0.002). By 6 months of age 29% of ADHD children were breastfed compared with 50% in the siblings group and 57% in the control non-related group (p=0.011). A stepwise logistic regression that included the variables found to be significant in univariate analysis demonstrated a significant association between ADHD and lack of breastfeeding at 3 months of age, maternal age at birth, male gender, and parental divorce. Children with ADHD were less likely to breastfeed at 3 months and 6 months of age than children in the two control groups. We speculate that breastfeeding may have a protective effect from developing ADHD later in childhood.

Unique white matter microstructural patterns in ADHD presentations-a diffusion tensor imaging study.

PubMed

Svatkova, Alena; Nestrasil, Igor; Rudser, Kyle; Goldenring Fine, Jodene; Bledsoe, Jesse; Semrud-Clikeman, Margaret

2016-09-01

Attention-deficit/hyperactivity disorder predominantly inattentive (ADHD-PI) and combined (ADHD-C) presentations are likely distinct disorders that differ neuroanatomically, neurochemically, and neuropsychologically. However, to date, little is known about specific white matter (WM) regions differentiating ADHD presentations. This study examined differences in WM microstructure using diffusion tensor imaging (DTI) data from 20 ADHD-PI, 18 ADHD-C, and 27 typically developed children. Voxel-wise analysis of DTI measurements in major fiber bundles was carried out using tract-based spatial statistics (TBSS). Clusters showing diffusivity abnormalities were used as regions of interest for regression analysis between fractional anisotropy (FA) and neuropsychological outcomes. Compared to neurotypicals, ADHD-PI children showed higher FA in the anterior thalamic radiations (ATR), bilateral inferior longitudinal fasciculus (ILF), and in the left corticospinal tract (CST). In contrast, the ADHD-C group exhibited higher FA in the bilateral cingulum bundle (CB). In the ADHD-PI group, differences in FA in the left ILF and ATR were accompanied by axial diffusivity (AD) abnormalities. In addition, the ADHD-PI group exhibited atypical mean diffusivity in the forceps minor (FMi) and left ATR and AD differences in right CB compared to healthy subjects. Direct comparison between ADHD presentations demonstrated radial diffusivity differences in FMi. WM clusters with FA irregularities in ADHD were associated with neurobehavioral performance across groups. In conclusion, differences in WM microstructure in ADHD presentations strengthen the theory that ADHD-PI and ADHD-C are two distinct disorders. Regions with WM irregularity seen in both ADHD presentations might serve as predictors of executive and behavioral functioning across groups. Hum Brain Mapp 37:3323-3336, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Time course of the development of depressive mood and oppositional defiant behavior among boys with attention deficit hyperactivity disorder: differences between subtypes.

PubMed

Ushijima, Hirokage; Usami, Masahide; Saito, Kazuhiko; Kodaira, Masaki; Ikeda, Manabu

2012-06-01

The aim of this research was to clarify the development of depression among boys with attention deficit hyperactivity disorder (ADHD) by examining the correlation between depressive mood, oppositional defiant behavior, and age for each ADHD subtype. The Birleson Depression Self-Rating Scale (DSRS) was used to evaluate depressive mood while the Oppositional Defiant Behavior Inventory (ODBI) was used to evaluate oppositional defiant behavior. The 90 subjects were divided into three groups: 22 boys (mean age, 12.4 ± 1.9 years) were placed in the ADHD predominantly inattentive type (ADHD-I) group; 45 boys (mean age, 10.4 ± 2.0 years) were placed in the ADHD combined type (ADHD-C) group; and 23 boys (mean age, 12.7 ± 2.4 years) were placed in the depressive disorder (DD) group. The DD group was included to highlight characteristics of depressive mood among boys with ADHD. The DSRS score was significantly higher in the DD group compared to the ADHD-I and ADHD-C groups. The ODBI score was significantly higher in the ADHD-C group compared to the ADHD-I (P = 0.043) and DD (P = 0.013) groups. In the DD group, ODBI was seen to decrease with increasing age. A certain degree of oppositional defiant behavior was seen in each ADHD subtype. The DSRS score correlated with the ODBI score in the ADHD-C group, while the DSRS score correlated with age in the ADHD-I group. The characteristics of developing depressive mood in childhood ADHD appeared to differ between subtypes and also differed from depression without ADHD. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

Methylenetetrahydrofolate Reductase Gene Polymorphisms in Children with Attention Deficit Hyperactivity Disorder

PubMed Central

Gokcen, Cem; Kocak, Nadir; Pekgor, Ahmet

2011-01-01

Objective: The purpose of this study was to evaluate the relationship between 5,10- methylenetetrahydrofolate reductase (MTHFR) polymorphisms and Attention Deficit Hyperactivity Disorder (ADHD) in a sample of Turkish children. Study Design: MTHFR gene polymorphisms were assessed in 40 patients with ADHD and 30 healty controls. Two mutations in the MTHFR gene were investigated using polymerase chain reactions and restriction fragment length polymorphisms. Results: Although there were no statistically significant differences in genotype distributions of the C677T alleles between the ADHD and the control groups (p=0,678) but the genotypic pattern of the distributions of the A1298C alleles was different between the ADHD patients and the controls (p=0,033). Conclusions: Preliminary data imply a possible relationship between A1298C MTHFR polymorphisms and the ADHD. PMID:21897766

Brief Report: Adaptive Functioning in Children with ASD, ADHD and ASD + ADHD

ERIC Educational Resources Information Center

Ashwood, Karen L.; Tye, Charlotte; Azadi, Bahare; Cartwright, Sally; Asherson, Philip; Bolton, Patrick

2015-01-01

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) often co-occur. Children with ASD and ADHD demonstrate deficits in adaptive functioning, yet pure and comorbid groups have not been directly compared. Vineland Adaptive Behaviour Scales (VABS-II) data were examined in boys with ASD (n = 17), ADHD (n = 31) and…

Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences

ERIC Educational Resources Information Center

Udal, Anne H.; Oygarden, Bjorg; Egeland, Jens; Malt, Ulrik F.; Groholt, Berit

2012-01-01

Differentiating between early-onset bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) can be difficult. Memory problems are commonly reported in BD, and forgetfulness is among the diagnostic criteria for ADHD. We compared children and adolescents with BD (n = 23), ADHD combined type (ADHD-C; n = 26), BD + ADHD-C (n = 15),…

Anxiety and Depression among College Students with Attention-Deficit/Hyperactivity Disorder (ADHD): Cross-Informant, Sex, and Subtype Differences

ERIC Educational Resources Information Center

Nelson, Jason M.; Liebel, Spencer W.

2018-01-01

Objective: This study examined symptoms of anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD). Participants: Data were collected between March 2011 and March 2016 from 150 college students with ADHD and 150 college students without ADHD. Method: Participants with ADHD were compared to a sex- and…

Knowledge of Attention Deficit Hyperactivity Disorder (ADHD) and Attitudes toward Teaching Children with ADHD: The Role of Teaching Experience

ERIC Educational Resources Information Center

Anderson, Donnah L.; Watt, Susan E.; Noble, William; Shanley, Dianne C.

2012-01-01

Knowledge of attention deficit hyperactivity disorder (ADHD) and attitudes toward teaching children with ADHD are compared across stages of Australian teachers' careers. Relative to pre-service teachers with (n = 218) and without (n = 109) teaching experience, in-service teachers (n = 127) show more overall knowledge of ADHD, more knowledge of…