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Shan YD, Yu ZF, Lv GG, Shan YL, Li BD, Zhao JY, Li XM, Gao WJ, Zhang LM. Activation of the hippocampal CA1 astrocyte Gq and Gi G protein-coupled receptors exerts a protective effect against attention deficit hyperactivity disorder. Int Immunopharmacol 2025; 152:114382. [PMID: 40049085 DOI: 10.1016/j.intimp.2025.114382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 02/26/2025] [Accepted: 02/26/2025] [Indexed: 03/24/2025]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is characterized by symptoms such as inattention, hyperactivity and impulsiveness, which significantly impact the healthy development of children. Our prior research demonstrated that exposure to S-Ketamine during pregnancy can lead to the development of ADHD, and existing studies have established a close association between astrocytes and the onset and progression of ADHD. The activation and inhibition of astrocytes are closely linked to neuropsychiatric dysfunction, and astrocytic NOD-like receptor protein 3 (NLRP3) has been reported to contribute to alterations in mental state and cognitive deficits. Thus, this study aims to investigate the role of astrocytes in ADHD by selectively modulating astrocyte function through Gq and Gi G protein-coupled receptors (GPCRs) and by specifically targeting the knockout of NLRP3. METHODS Pregnant C57BL/6 J mice or mice with a specific deletion of NLRP3 in astrocytes were administered intraperitoneal injections of 15 mg/kg of S-ketamine for 5 consecutive days from gestational day 14 to 18 to establish an ADHD model. To modulate astrocyte activity in the hippocampal CA1 region, we administered astrocyte-specific Gq-Adeno-associated virus (AAV) or Gi-AAV into the CA1 and maintained treatment with CNO. At 21 days postnatally, we conducted open field test (OFT), novel object recognition (NOR), elevated plus maze (EPM) and fear conditioning (FC) in the offspring mice. Additionally, on postnatal day 21, we implanted electrodes in the CA1 region of the offspring mice for neurophysiological monitoring and investigated local field potentials (LFP) during NOR on postnatal day 27. Lastly, pathological assessments were conducted after euthanasia. RESULTS Both the activation and inhibition of astrocytes in the hippocampal CA1 region improved impulsive-like behaviors and cognitive function in ADHD mice, reduced the power of theta (θ) oscillations during novel object exploration and decreased NLRP3-associated inflammatory factors, including cleaved caspase-1 and IL-18. Furthermore, compared to WT mice, astrocyte-specific NLRP3 conditional knockout mice demonstrated significantly reduced impulsive behavior and cognitive deficits, as well as a decrease in θ oscillation power and a reduction in NLRP3-associated inflammatory factors. CONCLUSIONS Our data provide compelling evidence that the activation of astrocytes alleviated impulsive-like behaviors and cognitive dysfunction, possibly by reducing NLRP3-associated pyroptosis following changes in calcium levels within the astrocytes. The activation of astrocytes can be a potential therapeutic target for ADHD.
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MESH Headings
- Animals
- Astrocytes/metabolism
- Astrocytes/drug effects
- Attention Deficit Disorder with Hyperactivity
- Mice, Inbred C57BL
- NLR Family, Pyrin Domain-Containing 3 Protein/metabolism
- NLR Family, Pyrin Domain-Containing 3 Protein/genetics
- Female
- Pregnancy
- Mice, Knockout
- Mice
- CA1 Region, Hippocampal/metabolism
- GTP-Binding Protein alpha Subunits, Gq-G11/metabolism
- GTP-Binding Protein alpha Subunits, Gq-G11/genetics
- Ketamine/pharmacology
- GTP-Binding Protein alpha Subunits, Gi-Go/metabolism
- GTP-Binding Protein alpha Subunits, Gi-Go/genetics
- Disease Models, Animal
- Male
- Prenatal Exposure Delayed Effects
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Affiliation(s)
- Yu-Dong Shan
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China
| | - Zhi-Fang Yu
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China
| | - Ge-Ge Lv
- The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yong-Lin Shan
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China
| | - Bao-Dong Li
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China
| | - Jian-Yong Zhao
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research, Cangzhou, China
| | - Xiao-Ming Li
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research, Cangzhou, China
| | - Wei-Juan Gao
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Li-Min Zhang
- Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou, China; Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China.
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Tarımtay Altun F, Yazıcı M, Ekinci Ö. The Role of Mothers' Psychiatric Symptoms, Practices of Emotion Socialization and Emotion Regulation among Children Diagnosed with Attention Deficit and Hyperactivity Disorder. Child Psychiatry Hum Dev 2025:10.1007/s10578-025-01808-4. [PMID: 40120040 DOI: 10.1007/s10578-025-01808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2025] [Indexed: 03/25/2025]
Abstract
This study investigates the mediating role of mothers' emotion socialization practices and emotion regulation difficulties in the relationship between maternal attention deficit and hyperactivity disorder (ADHD) and borderline personality disorder (BPD) symptom levels and their children's ADHD symptom levels. The study included 90 children (M = 9.71 years, SD = 1.33) diagnosed with ADHD and their mothers. Mothers completed Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale, Borderline Personality Inventory, DSM-IV Based Disruptive Behavior Disorders Rating Scale, Coping with Children's Negative Emotions Scale, Difficulties in Emotion Regulation Scale-Brief Form. Children filled out Cognitive Emotion Regulation Questionnaire for Children. The findings revealed that mothers' punitive and distress reactions mediated the relationship between mothers' and their children's ADHD symptom levels. Furthermore, all unsupportive emotion socialization strategies mediated the relationship between mothers' BPD symptoms and their children's ADHD symptoms. These results indicate that unsupportive maternal responses may contribute to the severity of children's ADHD symptoms.
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Affiliation(s)
- Feray Tarımtay Altun
- Department of Clinical Psychology, University of Health Sciences, Istanbul, Turkey.
| | - Medine Yazıcı
- Department of Psychiatry, University of Health Sciences, Erenkoy Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Özalp Ekinci
- School of Medicine, University of Health Sciences, Istanbul, Turkey
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Bob P, Privara M. ADHD, stress, and anxiety. Front Psychiatry 2025; 16:1536207. [PMID: 40171307 PMCID: PMC11959059 DOI: 10.3389/fpsyt.2025.1536207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 02/21/2025] [Indexed: 04/03/2025] Open
Abstract
Recent findings on stress and anxiety in attention deficit hyperactivity disorder (ADHD) suggest that specific processes related to brain developmental disorganization could create a vulnerable background that increases sensitivity to stress stimuli from the psychosocial environment. These basic neurodevelopmental processes are closely related to the developmental mechanisms of primitive functions and their integration or disintegration. In this context, the psychopathological processes that manifest in ADHD are linked to the mechanisms of disturbed inhibitory functions that may cause incongruent neural interactions ("neural interference") between the more primitive functions and the higher levels of attentional and cognitive neural processes. These disturbed developmental processes may also determine increased sensitivity to stressful experiences that, in ADHD cases, could lead to the manifestations of various psychopathological symptoms such as disturbed attentional and motor functions, anxiety, and depression, among other cognitive and affective disturbances. These findings, based on previous research, suggest novel framework and hypothesis on how this neurodevelopment-based increased sensitivity to stress stimuli could manifest in the etiopathogenesis of ADHD in its relationship with cognitive, affective, and motor deficits.
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Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, Charles University, Prague, Czechia
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4
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Lachance KA, Pelland-Goulet P, Gosselin N. Listening habits and subjective effects of background music in young adults with and without ADHD. Front Psychol 2025; 15:1508181. [PMID: 39911190 PMCID: PMC11797425 DOI: 10.3389/fpsyg.2024.1508181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 12/18/2024] [Indexed: 02/07/2025] Open
Abstract
Adults listen to an average of 20.7 hours of music per week, according to a study conducted across 26 countries. Numerous studies indicate that listening to music can have beneficial effects on cognitive performance and emotional well-being. Music listening habits may vary depending on individual needs and listening contexts. However, a limited number of studies have specifically examined the patterns of background music usage during various more or less cognitive activities, especially among individuals with attentional difficulties related to ADHD. This study primarily aimed to compare music listening habits during daily activities that are more and less cognitive (e.g., studying, problem-solving versus cleaning, engaging in sports) between neurotypical young adults and those screened for ADHD (respondents who were identified as likely having ADHD based on the number of self-reported symptoms). To achieve this, 434 young adults aged 17 to 30 responded to an online survey. The results indicate that certain listening habits differ significantly between the neurotypical and ADHD-screened groups. The ADHD-screened group reports significantly more background music listening during less cognitive activities and while studying, compared to the neurotypical group. The results also reveal a difference in the proportion of individuals preferring stimulating music between the groups: ADHD-screened individuals report significantly more frequent listening to stimulating music, regardless of the activity type (more or less cognitive). Other aspects of music listening are common to both groups. Regardless of the group, more respondents reported preferring to listen to relaxing, instrumental, familiar and self-chosen music during more cognitive activities, whereas for less cognitive activities, more individuals mentioned preferring to listen to music that is stimulating, with lyrics, familiar and self-chosen. Overall, the results confirm that most young adults listen to music during their daily activities and perceive positive effects from this listening.
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Affiliation(s)
- Kelly-Ann Lachance
- International Laboratory for Brain, Music and Sound Research (BRAMS), Center for Research on Brain, Language and Music (CRBLM), Laboratory for Music, Emotions and Cognition Research (MUSEC), Interdisciplinary Research Center on Brain and Learning (CIRCA), CerebrUM Research Center, Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Pénélope Pelland-Goulet
- International Laboratory for Brain, Music and Sound Research (BRAMS), Center for Research on Brain, Language and Music (CRBLM), Laboratory for Music, Emotions and Cognition Research (MUSEC), Interdisciplinary Research Center on Brain and Learning (CIRCA), CerebrUM Research Center, Department of Psychology, University of Montreal, Montreal, QC, Canada
- Alpha Neuro Center, Montmorency College, Montreal, QC, Canada
- Neurocognition Vision Laboratory, University of Montreal, Montreal, QC, Canada
| | - Nathalie Gosselin
- International Laboratory for Brain, Music and Sound Research (BRAMS), Center for Research on Brain, Language and Music (CRBLM), Laboratory for Music, Emotions and Cognition Research (MUSEC), Interdisciplinary Research Center on Brain and Learning (CIRCA), CerebrUM Research Center, Department of Psychology, University of Montreal, Montreal, QC, Canada
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Kao PH, Ho CH, Huang CLC. Sex differences in psychiatric comorbidities of attention-deficit/hyperactivity disorder among children, adolescents, and adults: A nationwide population-based cohort study. PLoS One 2025; 20:e0315587. [PMID: 39752340 PMCID: PMC11698318 DOI: 10.1371/journal.pone.0315587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 11/27/2024] [Indexed: 01/06/2025] Open
Abstract
This cross-sectional, nationwide, population-based study aimed to elucidate sex differences in psychiatric comorbidities of Attention-deficit/hyperactivity disorder (ADHD) across children, adolescents, and adults. We analyzed data from Taiwan's comprehensive healthcare database, including 112,225 individuals diagnosed with ADHD, categorized by age (0-12, 13-18, ≥18 years) and sex. Psychiatric comorbidities were assessed using ICD-9-CM codes, focusing on age and sex-specific prevalence. Among the cohort, 83.50% were children (0-12 years) presenting primarily with learning disabilities and tics, while adolescents (13-18 years; 11.88%) had higher instances of oppositional defiant and conduct disorders. In adults (≥18 years; 4.62%), the prevalence of anxiety, depression, bipolar disorder, and substance misuse was notably higher. Males under 18 predominantly had ADHD, whereas females exhibited increased vulnerability to emotional disorders. In adulthood, males showed greater susceptibility to most psychiatric comorbidities, except sleep disorders. The study highlights the evolving nature of ADHD-related psychiatric comorbidities across different life stages, with distinct sex-based patterns. The transition from childhood to adulthood sees an increased prevalence of various psychiatric conditions, particularly impacting adult males. These findings underscore the need for age- and sex-specific therapeutic approaches in ADHD management. The cultural context of the study necessitates further research in diverse populations for broader applicability of the findings.
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Affiliation(s)
- Pei-Hsin Kao
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Charles Lung-Cheng Huang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kim S, Kim MS, Kim J, Kim JS, Hong SB. Attention-deficit/hyperactivity disorder and subsequent diagnoses of major psychiatric disorders: a nationwide population-based study. Eur Child Adolesc Psychiatry 2025; 34:315-326. [PMID: 38958762 DOI: 10.1007/s00787-024-02497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
We evaluated the risk of being diagnosed with various psychiatric disorders after an attention-deficit/hyperactivity disorder (ADHD) diagnosis using data from South Korea's National Health Insurance Service from 2002 to 2019, which covers approximately 97% of the country's population. ADHD and control groups were selected after propensity score matching was performed for individuals diagnosed with ADHD and their age- and sex-matched counterparts from the general population. Comorbid psychiatric disorders included depressive disorder, bipolar disorder, tic disorder, and schizophrenia. The incidence of newly diagnosed psychiatric disorders was compared between the groups. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated and adjusted for ADHD medication prescription. After matching, 353,898 individuals were assigned to each of the two groups. Compared to the control group, the ADHD group showed a significantly higher risk of being subsequently diagnosed with depressive disorder, bipolar disorder, schizophrenia, and tic disorder. The onset age of depressive disorder, bipolar disorder, and schizophrenia in the ADHD group was 16-17 years, approximately 5 years earlier than that in the control group. The risk for depression was the highest in individuals with high income levels, and that for schizophrenia was the highest among rural patients. The median length of the follow-up time until the diagnosis of each comorbid psychiatric disorder was 7.53, 8.43, 8.53, and 8.34 years for depressive disorder, bipolar disorder, schizophrenia, and tic disorder, respectively. Individuals with ADHD had an overall higher risk of being diagnosed with subsequent psychiatric disorders than did the controls. Hence, they should be carefully screened for other psychiatric symptoms from an early age and followed up for an extended duration, along with appropriate interventions for ADHD symptoms, including psychosocial treatments and educational approaches.
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Affiliation(s)
- Sujin Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Mi-Sook Kim
- Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Korea
| | - Jinhee Kim
- Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Korea
| | - Jae Sung Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Soon-Beom Hong
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea.
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Maleki Z, Heidarabadi S, Mohammadi A, Azami-Aghdash S, Rosenbaum P, Cross A, Soper AK. Disseminating the F-Words for Child Development to Parents of Children With Developmental Disabilities in Iran: A Qualitative Pilot Feasibility Study. Child Care Health Dev 2024; 50:e13321. [PMID: 39169646 DOI: 10.1111/cch.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Attitudes toward childhood disability have historically focused on biomedical efforts on 'fixing'. The introduction of WHO's ICF framework for health and Canadian researchers' 'F-words' (functioning, fitness, fun, friends, family and future) have significantly changed the field. To explore whether the F-words ideas influenced parents' perspectives on their child's abilities and rehabilitation goals, this qualitative pilot study introduced the F-words to Iranian parents with a child with a developmental disability. METHODS This study was conducted in Tabriz, Iran, in 2023, using Iranian educational F-words materials built on ideas available on the CanChild F-words Knowledge Hub. Data were collected through semistructured interviews with five mothers of children <5 years old with a developmental disability before and after attending an 'F-words Awareness Session' and analysed using thematic analysis. RESULTS In the preinterviews, six themes (and 20 subthemes) were identified: (i) routines (5); (ii) challenges (4); (iii) parental concerns (3); (iv) child's needs and priorities (3); (v) the role of parents in satisfying needs and challenges (2); and (vi) expectations of rehabilitation (3). In the postinterview, the same six themes and four additional subthemes emerged. CONCLUSION Findings from the pilot study showed that the intervention had an impact on the attitudes and behaviours of participants. Specifically, teaching about the F-words reduced parents' emphasis on the concept of 'normality'. Families' positive response to the 'F-words Awareness Session' indicates their openness to incorporating this approach into their daily lives. These findings highlight the potential benefits of utilizing the F-words in rehabilitation in Iran. Studies like these can serve as a foundation for developing effective strategies for integrating the F-words into existing rehabilitation practices in Iran.
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Affiliation(s)
- Zahra Maleki
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seifollah Heidarabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Mohammadi
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Cross
- Department of Pediatrics, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alice Kelen Soper
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Mahrous NN, Albaqami A, Saleem RA, Khoja B, Khan MI, Hawsawi YM. The known and unknown about attention deficit hyperactivity disorder (ADHD) genetics: a special emphasis on Arab population. Front Genet 2024; 15:1405453. [PMID: 39165752 PMCID: PMC11333229 DOI: 10.3389/fgene.2024.1405453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a clinically and genetically heterogeneous neurodevelopmental syndrome characterized by behavioral appearances such as impulsivity, inattention, and hyperactivity. The prevalence of ADHD is high in childhood when compared to adults. ADHD has been significantly advanced by genetic research over the past 25 years. However, it is logically conceivable that both genetic and/or non-genetic factors, such as postnatal environmental and social influences, are associated with ADHD phenotype in Arab populations. While genetic influences are strongly linked with the etiology of ADHD, it remains obscure how consanguinity which is an underlying factor for many genetic diseases, contributes to ADHD subtypes. Arabian Gulf Nations have one the highest rates of consanguineous marriages, and consanguinity plays an important contributing factor in many genetic diseases that exist in higher percentages in Arabian Gulf Nations. Therefore, the current review aims to shed light on the genetic variants associated with ADHD subtypes in Arabian Gulf nations and Saudi Arabia in particular. It also focuses on the symptoms and the diagnosis of ADHD before turning to the neuropsychological pathways and subgroups of ADHD. The impact of a consanguinity-based understanding of the ADHD subtype will help to understand the genetic variability of the Arabian Gulf population in comparison with the other parts of the world and will provide novel information to develop new avenues for future research in ADHD.
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Affiliation(s)
- Nahed N. Mahrous
- Department of Biological Sciences, College of Science, University of Hafr Al-Batin, Hafr Al- Batin, Saudi Arabia
| | - Amirah Albaqami
- Department of Clinical Laboratory Sciences, Turbah University College, Taif University, Taif, Saudi Arabia
| | - Rimah A. Saleem
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Basmah Khoja
- Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed I. Khan
- Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Yousef M. Hawsawi
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
- Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Källstrand J, Niklasson K, Lindvall M, Claesdotter-Knutsson E. Reduced thalamic activity in ADHD under ABR forward masking conditions. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:222-228. [PMID: 36524942 DOI: 10.1080/21622965.2022.2155520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common chronic neurodevelopmental disorder characterized by symptoms of inattention, overactivity, and/or impulsiveness. The prevalence of ADHD varies in different settings and there have been voices raised to call for more objective measures in order to avoid over- and underdiagnosing of ADHD. Auditory Brainstem Response (ABR) is a method where click shaped sounds evoke potentials that are recorder from electrodes on the skull of a patient. The aim of this study was to explore possible alterations in the ABR of 29 patients with ADHD compared to 39 healthy controls. We used a forward masked sound. We found differences in ABR that correspond to the thalamic area. The thalamus seems to play an active role in regulation of activity level in ADHD. More research is needed to draw any further conclusions on using ABR as an objective measurement to detect ADHD.
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Affiliation(s)
| | - Katalin Niklasson
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
| | - Magnus Lindvall
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Auro K, Holopainen I, Perola M, Havulinna AS, Raevuori A. Attention-Deficit/Hyperactivity Disorder Diagnoses in Finland During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2418204. [PMID: 38935377 PMCID: PMC11211961 DOI: 10.1001/jamanetworkopen.2024.18204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/03/2024] [Indexed: 06/28/2024] Open
Abstract
Importance Several reports suggest an increase in attention-deficit/hyperactivity disorder (ADHD) symptoms during the COVID-19 pandemic. This nationwide study assessed new ADHD diagnoses and ADHD prevalence before and during the pandemic. Objective To investigate trends in new ADHD diagnoses, prevalence, and ADHD medication use from 2015 to 2022 in Finland. Design, Setting, and Participants This longitudinal cohort study comprised the entire Finnish population. ADHD diagnoses and medication use were obtained from nationwide registers and assessed at 3 time points: in 2015 and before (2020) and after (2022) the pandemic. Data were analyzed from January 2015 to June 2022. Main outcomes and Measures New ADHD diagnoses, ADHD lifetime prevalence, and ADHD medication use. Results The cohort comprised 5 572 420 individuals (2 819 645 women [50.6%]). Lifetime prevalence of ADHD increased by 2.7-fold during 2015 to 2022; prevalence was 1.02% in 2015 (95% CI, 1.01%-1.03%), 1.80% in 2020 (95% CI, 1.79%-1.81%), and 2.76% in 2022 (95% CI, 2.75%-2.77%). Young men aged 13 to 20 years had the highest lifetime prevalence of 11.68% (95% CI, 11.56%-11.81%) in 2022. New ADHD diagnoses doubled during the pandemic, from 238 per 100 000 in 2020 to 477 per 100 000 in 2022. The pandemic-associated incremental increase in new diagnoses was 18.60% (95% CI, 16.47%-20.49%; 9482 per 50 897 cases). Young women aged 13 to 20 years had a 2.6-fold increase in new diagnoses during the pandemic, from 577 per 100 000 in 2020 to 1488 per 100 000 in 2022, and women aged 21 to 30 years had a 3.0-fold increase, from 361 per 100 000 to 1100 per 100 000. New diagnoses increased by 2.9-fold among those older than 55 years (from 5 per 100 000 to 13 per 100 000 in women and from 5 per 100 000 to 14 per 100 000 in men). Boys younger than 13 years had the highest absolute rate of new ADHD diagnoses in 2022 (1745 per 100 000), but boys and young men younger than 21 years did not show a significant incremental increase in new diagnoses. Lifetime prevalence of ADHD medication purchases was 0.57% (95% CI, 0.56%-0.58%) in 2015 (31 771 [55.62%] of those with ADHD diagnosis), 1.15% (95% CI, 1.14%-1.16%) in 2020 (64 034 [63.83%]), and 1.69% (95% CI 1.68%-1.70%) in 2022 (92 557 [61.43%]), respectively. Conclusions and Relevance In this nationwide cohort study, new ADHD diagnoses and ADHD prevalence showed significant increase in Finland during the pandemic. ADHD medication use did not increase in relation to ADHD diagnoses. These results highlight potential adverse outcomes of pandemic-associated changes in living conditions.
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Affiliation(s)
- Kirsi Auro
- Division of Adolescent Psychiatry, Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Clinicum, Helsinki, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
| | - Ida Holopainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
| | - Markus Perola
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
| | - Aki S. Havulinna
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare-THL, Helsinki, Finland
- Institute for Molecular Medicine Finland, FIMM-HiLIFE, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Division of Adolescent Psychiatry, Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Clinicum, Helsinki, Finland
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Schein J, Cloutier M, Gauthier-Loiselle M, Catillon M, Xu C, Chan D, Childress A. Assessment of centanafadine in adults with attention-deficit/hyperactivity disorder: A matching-adjusted indirect comparison vs lisdexamfetamine dimesylate, atomoxetine hydrochloride, and viloxazine extended-release. J Manag Care Spec Pharm 2024; 30:528-540. [PMID: 38824626 PMCID: PMC11145007 DOI: 10.18553/jmcp.2024.30.6.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND Head-to-head trials comparing centanafadine, an investigational therapy for adults with attention-deficit/hyperactivity disorder (ADHD), with other treatment options are lacking. OBJECTIVE To compare safety and efficacy outcomes of centanafadine sustained-release vs lisdexamfetamine dimesylate (lisdexamfetamine), atomoxetine hydrochloride (atomoxetine), and viloxazine extended-release (viloxazine ER), respectively, using matching-adjusted indirect comparison (MAIC). METHODS This MAIC included patient-level data pooled from 2 centanafadine trials (NCT03605680 and NCT03605836) and published aggregate data from comparable trials of 3 comparators-lisdexamfetamine (NCT00334880), atomoxetine (NCT00190736), and viloxazine ER (NCT04016779)-in adult patients with ADHD. Propensity score weighting was used to match characteristics of individual patients from the centanafadine trials to aggregate baseline characteristics from the respective comparator trials. Safety outcomes were rates of adverse events for which information was available in the centanafadine and respective comparator trials. Efficacy outcome was mean change from baseline in the Adult ADHD Investigator Symptom Rating Scale (AISRS) score (ADHD Rating Scale [ADHD-RS] was used as proxy in the comparison with lisdexamfetamine). Anchored indirect comparisons were conducted across matched populations of the centanafadine and respective comparator trials. RESULTS After matching, baseline characteristics in the centanafadine trials were the same as those in the respective comparator trials. Compared with lisdexamfetamine, centanafadine was associated with a significantly lower risk of lack of appetite (risk difference [RD] in percentage points: 23.42), dry mouth (19.27), insomnia (15.35), anxiety (5.21), nausea (4.90), feeling jittery (3.70), and diarrhea (3.47) (all P < 0.05) but a smaller reduction in the AISRS/ADHD-RS score (6.58-point difference; P < 0.05). Compared with atomoxetine, centanafadine was associated with a significantly lower risk of nausea (RD in percentage points: 18.64), dry mouth (17.44), fatigue (9.21), erectile dysfunction (6.76), lack of appetite (6.71), and urinary hesitation (5.84) (all P < 0.05) and no statistically significant difference in the change in AISRS score. Compared with viloxazine ER, centanafadine was associated with a significantly lower risk of fatigue (RD in percentage points: 11.07), insomnia (10.67), nausea (7.57), and constipation (4.63) (all P < 0.05) and no statistically significant difference in the change in AISRS score. CONCLUSIONS In an anchored MAIC, centanafadine showed a significantly better short-term safety profile than lisdexamfetamine, atomoxetine, and viloxazine ER; efficacy was lower than with lisdexamfetamine and comparable (ie, nondifferent) with atomoxetine and viloxazine ER. This MAIC provides important insights on the relative safety and efficacy of common treatment options to help inform treatment decisions in adults with ADHD. Safety assessment was limited to rates of adverse events reported in both trials of a given comparison. STUDY REGISTRATION NUMBERS NCT03605680, NCT03605836, NCT00334880, NCT00190736, and NCT04016779.
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Affiliation(s)
- Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ
| | | | | | | | - Chunyi Xu
- Analysis Group, Inc., Montréal, QC, Canada
| | | | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, NV
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Bahraini S, Maisonneuve AR, Wu D, Huang M, Xu M, Yang L, Li F, Samson A, Li F, Robaey P. Barriers and facilitators to implementing a Canadian shared-care ADHD program in pediatric settings in Shanghai: a consolidated framework for implementation research approach. BMC Health Serv Res 2024; 24:564. [PMID: 38698381 PMCID: PMC11064246 DOI: 10.1186/s12913-024-10910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES The vast majority of children with Attention-Deficit Hyperactivity Disorder (ADHD) do not have access to proper diagnosis and treatment in China. The goal of this project is to identify the challenges and facilitators in implementing a Canadian ADHD Shared Care Pathways program in pediatric settings in Shanghai region. METHODS Purposive semi-structured focus groups were conducted on a total of 13 healthcare practitioners from the Shanghai Xinuha, Ninghai and Chongming hospitals. Two independent researchers conducted a thematic analysis of the data with themes emerging based on the Consolidated Framework for Implementation Research (CFIR). RESULTS Notable barriers identified by participants included: (1) lack of knowledge in the management of ADHD, primarily among general practitioners; (2) lack of resources such as lack of staff, time, and medication for ADHD; (3) challenges in implementing an international multicentre intervention (such as communication difficulties between teams and integration of resources available in different hospitals); and (4) mental health stigma, difficulties in identifying ADHD patients, and logistical problems related to medication procurement rules put in place by provincial governments. Notable facilitators included: (1) the strong motivation of stakeholders and their confidence in their ability to learn and subsequently execute action plans to achieve the implementation goal; (2) the compatibility between the values and goals of the stakeholders and those of the program despite some cultural tension, a positive learning climate, strong tensions for change, and the high interest of organization leaders in engaging in the program (3) the perceived benefits of the program, such as standardization of the diagnostic and treatment process, and engaging primary care providers in ADHD management; and (4) the strong relationship between participating institutions and schools as well as provincial health initiatives available to support collaborative models of care. Mixed factors to implementation were also explored. CONCLUSIONS Appropriate training of health care providers, cultural adaptation of the program, increase public awareness about ADHD to decrease stigma, as well as strong project management and guidelines that clearly describe the role and expectations of each team member appeared essential to successful implementation.
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Affiliation(s)
- Sayna Bahraini
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Alexander R Maisonneuve
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Danping Wu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minhui Huang
- Ninghai Maternity and Child Health Care Hospital, Ning Bo, China
| | - Mingyu Xu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Yang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Beijing, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Feng Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China.
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Philippe Robaey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- University of Ottawa, Ottawa, Canada.
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Dooley N, Healy C, Cotter D, Clarke M, Cannon M. Predicting childhood ADHD-linked symptoms from prenatal and perinatal data in the ABCD cohort. Dev Psychopathol 2024; 36:979-992. [PMID: 36946069 DOI: 10.1017/s0954579423000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
This study investigates the capacity of pre/perinatal factors to predict attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood. It also explores whether predictive accuracy of a pre/perinatal model varies for different groups in the population. We used the ABCD (Adolescent Brain Cognitive Development) cohort from the United States (N = 9975). Pre/perinatal information and the Child Behavior Checklist were reported by the parent when the child was aged 9-10. Forty variables which are generally known by birth were input as potential predictors including maternal substance-use, obstetric complications and child demographics. Elastic net regression with 5-fold validation was performed, and subsequently stratified by sex, race/ethnicity, household income and parental psychopathology. Seventeen pre/perinatal variables were identified as robust predictors of ADHD symptoms in this cohort. The model explained just 8.13% of the variance in ADHD symptoms on average (95% CI = 5.6%-11.5%). Predictive accuracy of the model varied significantly by subgroup, particularly across income groups, and several pre/perinatal factors appeared to be sex-specific. Results suggest we may be able to predict childhood ADHD symptoms with modest accuracy from birth. This study needs to be replicated using prospectively measured pre/perinatal data.
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Affiliation(s)
- Niamh Dooley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
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14
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Stern P, Kolodny T, Tsafrir S, Cohen G, Shalev L. Unique Patterns of Eye Movements Characterizing Inattentive Reading in ADHD. J Atten Disord 2024; 28:1008-1016. [PMID: 38327026 DOI: 10.1177/10870547231223728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE We aimed to identify unique patterns of eye-movements measures reflecting inattentive reading among adults with and without ADHD. METHOD & RESULTS We recorded eye-movements during uninterrupted text reading of typically developed (TD) and ADHD adults. First, we found significantly longer reading time for the ADHD group than the TD group. Further, we detected cases in which words were reread more than twice and found that such occasions were much more frequent in participants with ADHD than in TD participants. Moreover, we discovered that the first reading pass of these words was less sensitive to the length of the word than the first pass of words read only once, indicating a less meaningful reading. CONCLUSION We propose that high rate of words that were reread is a correlate of inattentive reading which is more pronounced among ADHD readers. Implications of the findings in the context of reading comprehension are discussed.
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15
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Mlodnicka A, Mansolf M, Chandran A, Aris IM, Calub CA, Ahmad S, Shapiro A, Cochran D, Restrepo B, Schmidt R, Hertz-Picciotto I, Bennett D, Gold DR, O'Shea TM, Leve L, Schweitzer JB. Prediction of internalizing and externalizing symptoms in late childhood from attention-deficit/hyperactivity disorder symptoms in early childhood. Dev Psychopathol 2024:1-10. [PMID: 38532736 PMCID: PMC11427612 DOI: 10.1017/s0954579424000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Limited analyses based on national samples have assessed whether early attention-deficit/hyperactivity disorder (ADHD) symptoms predict later internalizing and externalizing symptoms in youth and the influence of sex and pubertal timing on subsequent psychiatric symptoms. This study analyzed data (n = 2818) from the Environmental influences on Child Health Outcomes Program national cohort. Analyses used data from early childhood (mean age = 5.3 years) utilizing parent-reported ADHD symptoms to predict rates of internalizing and externalizing symptoms from late childhood/adolescence (mean age = 11.9 years). Within a subsample age at peak height velocity (APHV) acted as a proxy to assess pubertal timing from early childhood (mean age = 5.4 years) to adolescence (mean age = 12.3 years). Early-childhood ADHD symptoms predicted later psychiatric symptoms, including anxiety, depression, aggressive behavior, conduct problems, oppositional defiant disorder, and rule-breaking behavior. Earlier APHV was associated with increased Conduct Disorder symptoms from late childhood to adolescence for females only. A stronger relation between ADHD symptoms and later aggression was observed in females with earlier APHV, whereas this same pattern with aggression, conduct problems and depression was observed in males with later APHV. Clinicians should consider that both young girls and boys with elevated ADHD symptoms, particularly with off-set pubertal timing, may be at risk for later psychiatric symptoms.
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Affiliation(s)
- Agnieszka Mlodnicka
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
- MIND Institute, University of California Davis, Sacramento, CA, USA
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aruna Chandran
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Izzuddin M Aris
- Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Catrina A Calub
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
- MIND Institute, University of California Davis, Sacramento, CA, USA
| | - Shaikh Ahmad
- Division of Developmental Medicine University of California San Francisco, San Francisco, CA, USA
| | - Allison Shapiro
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - David Cochran
- Department of Psychiatry, Eunice Kennedy Shriver Center, UMass Chan Medical School, Worcester, MA, USA
| | - Bibiana Restrepo
- MIND Institute, University of California Davis, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Rebecca Schmidt
- MIND Institute, University of California Davis, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Irva Hertz-Picciotto
- MIND Institute, University of California Davis, Sacramento, CA, USA
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Deborah Bennett
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health. Boston, MA, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Leve
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
- MIND Institute, University of California Davis, Sacramento, CA, USA
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Garcia-Argibay M, Bürkner PC, Lichtenstein P, Zhang L, D’Onofrio BM, Andell P, Chang Z, Cortese S, Larsson H. Methylphenidate and Short-Term Cardiovascular Risk. JAMA Netw Open 2024; 7:e241349. [PMID: 38446477 PMCID: PMC10918505 DOI: 10.1001/jamanetworkopen.2024.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/17/2024] [Indexed: 03/07/2024] Open
Abstract
Importance There are concerns about the safety of medications for treatment of attention-deficit/hyperactivity disorder (ADHD), with mixed evidence on possible cardiovascular risk. Objective To assess whether short-term methylphenidate use is associated with risk of cardiovascular events. Design, Setting, and Participants This retrospective, population-based cohort study was based on national Swedish registry data. Participants were individuals with ADHD aged 12 to 60 years with dispensed prescriptions of methylphenidate between January 1, 2007, and June 30, 2012. Each person receiving methylphenidate (n = 26 710) was matched on birth date, sex, and county to up to 10 nonusers without ADHD (n = 225 672). Statistical analyses were performed from September 13, 2022, to May 16, 2023. Main Outcomes and Measures Rates of cardiovascular events, including ischemic heart disease, venous thromboembolism, heart failure, or tachyarrhythmias, 1 year before methylphenidate treatment and 6 months after treatment initiation were compared between individuals receiving methylphenidate and matched controls using a bayesian within-individual design. Analyses were stratified by history of cardiovascular events. Results The cohort included 252 382 individuals (15 442 [57.8% men]; median age, 20 (IQR, 15-31) years). The overall incidence of cardiovascular events was 1.51 per 10 000 person-weeks (95% highest density interval [HDI], 1.35-1.69) for individuals receiving methylphenidate and 0.77 (95% HDI, 0.73-0.82) for the matched controls. Individuals treated with methylphenidate had an 87% posterior probability of having a higher rate of cardiovascular events after treatment initiation (incidence rate ratio [IRR], 1.41; 95% HDI, 1.09-1.88) compared with matched controls (IRR, 1.18; 95% HDI, 1.02-1.37). The posterior probabilities were 70% for at least a 10% increased risk of cardiovascular events in individuals receiving methylphenidate vs 49% in matched controls. No difference was found in this risk between individuals with and without a history of cardiovascular disease (IRR, 1.11; 95% HDI, 0.58-2.13). Conclusions and Relevance In this cohort study, individuals receiving methylphenidate had a small increased cardiovascular risk vs matched controls in the 6 months after treatment initiation. However, there was little evidence for an increased risk of 20% or higher and for differences in risk increase between people with and without a history of cardiovascular disease. Therefore, before treatment initiation, careful consideration of the risk-benefit trade-off of methylphenidate would be useful, regardless of cardiovascular history.
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Affiliation(s)
- Miguel Garcia-Argibay
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- The Department of Psychological and Brain Sciences at Indiana University, Bloomington
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Solent NHS Trust, Southampton, United Kingdom
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari Aldo Moro, Bari, Italy
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Caselles-Pina L, del Amo PS, Aguado D, López-Castromán J, Sanjuán-Antúnez JDD, Delgado-Gómez D. A data science approach to optimize ADHD assessment with the BRIEF-2 questionnaire. Transl Neurosci 2024; 15:20220349. [PMID: 39380964 PMCID: PMC11459613 DOI: 10.1515/tnsci-2022-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/13/2024] [Accepted: 07/26/2024] [Indexed: 10/10/2024] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. A key challenge associated with this condition is achieving an early diagnosis. The current study seeks to anticipate and delineate the assessments offered by both parents and teachers concerning a child's behavior and overall functioning with the Behavior Rating Inventory of Executive Function-2 (BRIEF-2). Mothers, fathers, and teachers of 59 children diagnosed or in the process of being assessed for ADHD participated in this study. The responses provided by 59 mothers, 59 fathers, and 57 teachers to the BRIEF-2 questionnaire were collected. The performance of various feature selection techniques, including Lasso, decision trees, random forest, extreme gradient boosting, and forward stepwise regression, was evaluated. The results indicate that Lasso stands out as the optimal method for our dataset, striking an ideal balance between accuracy and interpretability. A repeated validation analysis reveals an average positive correlation exceeding 0.5 between the inattention/hyperactivity scores reported by informants (mother, father, or teacher) and the predictions derived from Lasso. This performance is achieved using only approximately 18% of the BRIEF-2 items. These findings underscore the usefulness of variable selection techniques in accurately characterizing a patient's condition while employing a small subset of assessment items. This efficiency is particularly valuable in time-constrained settings and contributes to improving the comprehension of ADHD.
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Affiliation(s)
- Lucía Caselles-Pina
- Department of Statistics, Universidad Carlos III de Madrid, Getafe, Spain
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - David Aguado
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge López-Castromán
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
- IGF, CNRS-INSERM, University of Montpellier, Montpellier, France
- Department of Signal Theory and Communications, Carlos III University, Madrid, Spain
- CIBERSAM, Madrid, Spain
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Rosenthal EA, Broos HC, Timpano KR, Johnson SL. Does Emotion-Related Impulsivity Relate to Specific ADHD Symptom Dimensions, and Do the Effects Generalize Across Comorbid Internalizing and Externalizing Syndromes? J Atten Disord 2024; 28:178-188. [PMID: 37961911 PMCID: PMC10751976 DOI: 10.1177/10870547231210283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Recent work highlights the role of emotion dysregulation in the pathology of Attention-Deficit/Hyperactivity Disorder (ADHD). As such, emotion-related impulsivity (ERI), the trait-like tendency toward disinhibited thoughts (Pervasive Influence of Feelings, PIF) and actions (Feelings Trigger Action, FTA) during heightened emotional states, may be particularly relevant. We explored whether Inattention (IN) and Hyperactivity/Impulsivity (HI), two core symptom dimensions of ADHD, would relate to distinct facets of ERI, and whether externalizing and internalizing symptoms would moderate these relations. METHOD Using structural equation modeling, we examined hypotheses among 364 adults recruited for high internalizing and externalizing symptoms. RESULTS We identified significant paths for FTA regressed on HI and PIF regressed on IN, supporting our hypotheses about main effects. Moderating paths were not significant. CONCLUSIONS IN and HI correlate with distinct forms of ERI, These effects appear to generalize across co-occurring internalizing and externalizing symptoms. Theoretical and clinical implications are discussed.
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Caselles‐Pina L, Sújar A, Quesada‐López A, Delgado‐Gómez D. Adherence, frequency, and long-term follow-up of video game-based treatments in patients with attention-deficit/hyperactivity disorder: A systematic review. Brain Behav 2023; 13:e3265. [PMID: 37743605 PMCID: PMC10636395 DOI: 10.1002/brb3.3265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents. Recent studies show that video games have great potential for the treatment and rehabilitation of ADHD patients. The aim of the present review is to systematically review the scientific literature on the relationship between video games and ADHD, focusing on adherence to treatment, frequency of the intervention, and the long-term follow-up of video games in children and adolescents with ADHD. METHODS The preferred reporting items for systematic reviews and meta-analyses guidelines were adopted. The review protocol was registered in PROSPERO database. We searched in three databases, PubMed, Medline, and Web of Science to identify studies examining the association between video game interventions in ADHD patients. RESULTS A total of 18 empirical studies met the established inclusion criteria. The results showed that video games-based interventions can be used to improve ADHD symptoms and display high adherence to treatment. In addition, in the studies reviewed, the most common intervention frequency is 30 min three to five times per week. However, there is little evidence from studies with video games showing long-term effects in patients with ADHD. CONCLUSION Video games are useful and effective interventions that can complement traditional treatments in patients with ADHD.
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Affiliation(s)
- Lucía Caselles‐Pina
- Department of StatisticsUniversidad Carlos III de MadridGetafeSpain
- Department of PsychologyUniversidad Autónoma de MadridMadridSpain
| | - Aaron Sújar
- School of Computer EngineeringUniversidad Rey Juan CarlosMóstolesSpain
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Hutt Vater C, Biederman J, DiSalvo M, O'Connor H, Parker H, Woodworth KY, Wozniak J, Faraone SV. Growth Trajectories in Stimulant Treated Children and Adolescents: A Qualitative Review of the Literature from Comprehensive Datasets and Registries. J Child Adolesc Psychopharmacol 2023; 33:344-355. [PMID: 37966364 PMCID: PMC10771885 DOI: 10.1089/cap.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Objective: Attention-deficit/hyperactivity disorder (ADHD) treatment with stimulant products has been shown to be safe and effective; however, there are remaining concerns about their possible adverse effects on growth trajectories. We conducted a systematic review of the extant literature derived from ecologically valid databases and registries to assess the body of knowledge about the effects of stimulants on growth trajectories in naturalistic samples. Methods: Using PubMed and PsycINFO, we searched for articles published before February 8, 2023 that focused on growth findings associated with stimulant treatment in pediatric ADHD from comprehensive datasets derived from naturalistic population studies. Results: Of the 1070 articles initially identified, 12 met all inclusion criteria. Sample sizes ranged from 157 to 163,820 youths. Seven of 10 articles examining height found significant decreases in height associated with chronic stimulant treatment that normalized over time in 2 studies. Three articles found no significant association between stimulant treatment and height. No clear associations were identified between cumulative duration and dose of stimulant treatment and adult height. All articles examining weight and six of eight articles examining body mass index (BMI) found significant initial decreases that tended to normalize then increase over time. Longer duration of stimulant medication use was predominantly associated with significant weight and BMI reductions. The effects of stimulant dose on weight and BMI were mostly weak and clinically insignificant. Most studies found no significant association between age at start of stimulant treatment and change in height, weight, or BMI. Most studies did not find significant sex effects in relation to growth parameters. Conclusions: This review of ecologically informative samples revealed that the effects of stimulant treatment on growth trajectories are mainly small and transient. These effects seem to be clinically insignificant for most youth with ADHD who receive stimulant treatment from childhood onto adolescence and adulthood.
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Affiliation(s)
- Chloe Hutt Vater
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah O'Connor
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Haley Parker
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K. Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen V. Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA
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21
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Claesdotter-Knutsson E, Källstrand J, Niklasson K, Andersson M, Lindvall M. The influence of methylphenidate on auditory brainstem response patients with attention deficit hyperactivity disorder; an exploratory study. J Public Health Res 2023; 12:22799036231204319. [PMID: 37841833 PMCID: PMC10568990 DOI: 10.1177/22799036231204319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/24/2023] [Indexed: 10/17/2023] Open
Abstract
Background Attention-deficit hyperactivity disorder (ADHD), characterized by periods of inattention, overactivity, and impulsiveness, is the most prevalent neurodevelopmental disorder among children. Auditory Brainstem Response (ABR) is a technique in which clickshaped sounds elicit potentials that are recorded from electrodes placed on a patient's skull. Extant research indicates that ABR is frequently affected in neurodevelopmental disorders such as ADHD. Methylphenidate (MPH), a psychostimulant, is often prescribed to children with ADHD as a first-line pharmacological treatment. The aim of this study was to explore the effects of Methylphenidate treatment on previously observed amplitude alterations in the ABR of patients with ADHD. Methods We recruited 32 drug-naïve children and adolescents (19 males and 13 females; mean age 11 years) diagnosed with ADHD and 35 health controls (15 males and 20 females; mean age 12 years). The ADHD group was treated with Methylphenidate, and ABR was recorded before treatment and at a steady state of medical treatment. Results Medicated ADHD patients exhibited increased activity in the right side ABR in Wave VI. Conclusions A significant increase in activity was found in a part of the ABR thought to correspond to the thalamic area in medicated ADHD patients compared to the same area of non-medicated ADHD patients. The results add to the growing body of research suggesting that specific ABR peaks correlate to certain psychiatric symptoms.
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Affiliation(s)
- Emma Claesdotter-Knutsson
- Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Katalin Niklasson
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Lund, Sweden
| | - Mitchell Andersson
- Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Lindvall
- Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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22
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Meisinger C, Freuer D. Understanding the causal relationships of attention-deficit/hyperactivity disorder with mental disorders and suicide attempt: a network Mendelian randomisation study. BMJ MENTAL HEALTH 2023; 26:e300642. [PMID: 37669871 PMCID: PMC11146378 DOI: 10.1136/bmjment-2022-300642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/09/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a lifespan neurodevelopmental condition resulting from complex interactions between genetic and environmental risk factors. There is evidence that ADHD is associated with other mental disorders, but it remains unclear whether and in what way a causal relationship exists. OBJECTIVE To investigate the direct and indirect causal paths between ADHD and seven common mental disorders. METHODS Two-sample network Mendelian randomisation analysis was performed to identify psychiatric disorders causally related to ADHD. Total and direct effects were estimated in an univariable and multivariable setting, respectively. Robustness of results was ensured in three ways: a range of pleiotropy-robust methods, an iterative approach identifying and excluding outliers, and use of up to two genome-wide association studies per outcome to replicate results and calculate subsequently pooled meta-estimates. RESULTS Genetic liability to ADHD was independently associated with the risk of anorexia nervosa (OR 1.28 (95% CI 1.11 to 1.47); p=0.001). A bidirectional association was found with major depressive disorder (OR 1.09 (95% CI 1.03 to 1.15); p=0.003 in the forward direction and OR 1.76 (95% CI 1.50 to 2.06); p=4×10-12 in the reverse direction). Moreover, after adjustment for major depression disorder, a direct association with both suicide attempt (OR 1.30 (95% CI 1.16 to 1.547); p=2×10-5) and post-traumatic stress disorder (OR 1.18 (95% CI 1.05 to 1.33); p=0.007) was observed. There was no evidence of a relationship with anxiety, bipolar disorder or schizophrenia. CONCLUSIONS This study suggests that ADHD is an independent risk factor for a number of common psychiatric disorders. CLINICAL IMPLICATIONS The risk of comorbid psychiatric disorders in individuals with ADHD needs to be considered both in diagnosis and treatment.
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Affiliation(s)
- Christa Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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23
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Teksin MG, Özalp E, Bal NB, Özer İ, Çayköylü A. Is co-occurrence of adult adhd with bipolar disorder a risk factor for violent behavior? Psychiatry Res 2023; 326:115302. [PMID: 37418777 DOI: 10.1016/j.psychres.2023.115302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/09/2023]
Abstract
Research has shown that individuals with psychiatric disorders such as bipolar disorder (BD) and attention deficit and hyperactivity disorder (ADHD) have a higher likelihood of violent behavior. This study investigated the frequency of comorbid BD and ADHD in adultpatients and the relationship between this comorbidity and violent behavior. We assessed 105 remitted patients diagnosed with BD I (n = 91) or BD II (n = 14). The patients were administered the Sociodemographic Data Scale, the Wender-Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (BPAQ), and theViolence Tendency Scale (VTS) as self-reports. The same clinician administered the Diagnostic Interview for ADHD in adults (DIVA 2.0) to patients who scored≥36 on the WURS. Comorbid ADHD was diagnosed in 15.2% of patients according to the DIVA 2.0. In the multiple linear regression analysis, there was a statistically significant positive effect of the ASRS total score on the VTS and the BPAQ total score. Furthermore, it was found that male gender had a statistically significant positive effect on VTS total score and young age had a statistically significant positive effect on BPQA total score. These findings demonstrate an association between BD, comorbid ADHD, and violent behavior.
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Affiliation(s)
- Meryem Gül Teksin
- Psychiatrist, Psychiatry Clinic, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul Turkey.
| | - Elvan Özalp
- Psychiatrist, Private Specialist, Ankara Turkey
| | - Neşe Burcu Bal
- Psychiatrist, Psychiatry Clinic, Ankara Oncology, Research and Training Hospital, Istanbul Turkey
| | - İbrahim Özer
- Psychiatrist, Psychiatry Clinic, Afyonkarahisar State Hospital, Afyon Turkey
| | - Ali Çayköylü
- Psychiatrist, Psychiatry Clinic, Ankara Oncology, Research and Training Hospital, Istanbul Turkey
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24
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Soman SM, Vijayakumar N, Ball G, Hyde C, Silk TJ. Longitudinal Changes of Resting-State Networks in Children With Attention-Deficit/Hyperactivity Disorder and Typically Developing Children. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:514-521. [PMID: 35033687 DOI: 10.1016/j.bpsc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a prevalent childhood neurodevelopmental disorder. Given the profound brain changes that occur across childhood and adolescence, it is important to identify functional networks that exhibit differential developmental patterns in children with ADHD. This study sought to examine whether children with ADHD exhibit differential developmental trajectories in functional connectivity compared with typically developing children using a network-based approach. METHODS This longitudinal neuroimaging study included 175 participants (91 children with ADHD and 84 control children without ADHD) between ages 9 and 14 and up to 3 waves (173 total resting-state scans in children with ADHD and 197 scans in control children). We adopted network-based statistics to identify connected components with trajectories of development that differed between groups. RESULTS Children with ADHD exhibited differential developmental trajectories compared with typically developing control children in networks connecting cortical and limbic regions as well as between visual and higher-order cognitive regions. A pattern of reduction in functional connectivity between corticolimbic networks was seen across development in the control group that was not present in the ADHD group. Conversely, the ADHD group showed a significant decrease in connectivity between predominantly visual and higher-order cognitive networks that was not displayed in the control group. CONCLUSIONS Our findings show that the developmental trajectories in children with ADHD are characterized by a subnetwork involving different trajectories predominantly between corticolimbic regions and between visual and higher-order cognitive network connections. These findings highlight the importance of examining the longitudinal maturational course to understand the development of functional connectivity networks in children with ADHD.
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Affiliation(s)
| | | | - Gareth Ball
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Christian Hyde
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Timothy J Silk
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Developmental Imaging, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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25
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Skymba HV, Shields AN, Rauch AA, Phillips MS, Bing-Canar H, Finley JCA, Khan H, Ovsiew GP, Durkin NM, Jennette KJ, Resch ZJ, Soble JR. Does comorbid depression impact executive functioning (EF) in adults diagnosed with ADHD?: a comparison of EF across diagnoses in clinically-referred individuals. J Clin Exp Neuropsychol 2023; 45:1-11. [PMID: 37083506 DOI: 10.1080/13803395.2023.2203464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Executive functioning (EF) is a salient factor in both ADHD as well as depressive disorders. However, sparse literature has examined whether depression severity impacts EF concurrently among adults with ADHD. The goal of this study was to examine differences in EF between adult patients diagnosed with ADHD and those diagnosed with a non-ADHD primary psychopathological condition, as a function of both ADHD presentation and depression severity in a diverse clinical sample. METHOD This crosssectional study included 404 adult patients clinically referred for neuropsychological evaluation to assist with differential diagnosis and/or treatment planning related to known or suspected ADHD. Various EF tasks and a measure of depression severity were administered. One-way MANOVA analyses were conducted to compare EF performance between individuals diagnosed with ADHD or a non-ADHD primary psychopathological condition, with additional analyses examining group differences based on ADHD presentation and depression severity. Regression analyses also examined the potential contribution of depression severity to each EF measure within each group. RESULTS No significant EF performance differences were found when comparing individuals diagnosed with ADHD and those with a non-ADHD primary psychopathological condition, nor based on ADHD presentation. When comparing across groups using cut-offs for high or low depression, only one EF measure showed significant differences between groups. Further, depression severity generally did not predict reduced EF performances with the exception of verbal fluency and working memory performances in select groups. CONCLUSIONS This study demonstrated that individuals with ADHD generally perform comparably on EF measures regardless of the presence or absence of comorbid depression. These results suggest further examination of EF deficits when they emerge for adults with ADHD, especially beyond comorbid depression severity.
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Affiliation(s)
- Haley V Skymba
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Allison N Shields
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Andrew A Rauch
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, Loyola University, Chicago, Illinois, USA
| | - Matthew S Phillips
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, The Chicago School of Professional Psychology, Chicago, Illinois, USA
| | - Hanaan Bing-Canar
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - John-Christopher A Finley
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Humza Khan
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Gabriel P Ovsiew
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
| | - Nicole M Durkin
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
| | - Kyle J Jennette
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
| | - Zachary J Resch
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Urbana, Illinois, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, Illinois, USA
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Liang X, Qiu H, Sit CHP. The mediating role of resilience in the association between MVPA and psychological ill-being in children with ADHD. Scand J Med Sci Sports 2023; 33:485-494. [PMID: 36514869 DOI: 10.1111/sms.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This study investigated the mediating role of resilience in the association between moderate-to-vigorous physical activity (MVPA) and psychological ill-being, as well as the moderating role of age in the direct and indirect relationship between MVPA and psychological ill-being in children with attention-deficit/hyperactivity disorder (ADHD). METHODS Eighty-five children aged 6-12 years (Mage = 8.41 ± 1.44 years) diagnosed with ADHD were recruited. Participants wore an accelerometer on their non-dominant wrist for seven consecutive days to record MVPA. Resilience and psychological ill-being were assessed using self-reported questionnaires. RESULTS MVPA was positively associated with resilience but negatively related to depression and stress. Resilience was negatively correlated with depression and stress. Using the bootstrapping method, the indirect effect of resilience was found between MVPA and depression (-0.006%, 95% confidence interval [CI] = [-0.060, -0.020]) in children with ADHD, supporting partial mediation. Moderated mediation analysis further demonstrated that the indirect effect of MVPA on depression via resilience was stronger in older children (-0.008, 95% CI = [-0.023, -0.001]) than in younger children with ADHD. CONCLUSION The findings may inform future empirical studies on designing exercise interventions with MVPA levels that help to improve resilience and depression in children with ADHD.
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Affiliation(s)
- Xiao Liang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong, China
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
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27
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Garcia-Argibay M, Zhang-James Y, Cortese S, Lichtenstein P, Larsson H, Faraone SV. Predicting childhood and adolescent attention-deficit/hyperactivity disorder onset: a nationwide deep learning approach. Mol Psychiatry 2023; 28:1232-1239. [PMID: 36536075 PMCID: PMC10005952 DOI: 10.1038/s41380-022-01918-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder with a high degree of psychiatric and physical comorbidity, which complicates its diagnosis in childhood and adolescence. We analyzed registry data from 238,696 persons born and living in Sweden between 1995 and 1999. Several machine learning techniques were used to assess the ability of registry data to inform the diagnosis of ADHD in childhood and adolescence: logistic regression, random Forest, gradient boosting, XGBoost, penalized logistic regression, deep neural network (DNN), and ensemble models. The best fitting model was the DNN, achieving an area under the receiver operating characteristic curve of 0.75, 95% CI (0.74-0.76) and balanced accuracy of 0.69. At the 0.45 probability threshold, sensitivity was 71.66% and specificity was 65.0%. There was an overall agreement in the feature importance among all models (τ > .5). The top 5 features contributing to classification were having a parent with criminal convictions, male sex, having a relative with ADHD, number of academic subjects failed, and speech/learning disabilities. A DNN model predicting childhood and adolescent ADHD trained exclusively on Swedish register data achieved good discrimination. If replicated and validated in an external sample, and proven to be cost-effective, this model could be used to alert clinicians to individuals who ought to be screened for ADHD and to aid clinicians' decision-making with the goal of decreasing misdiagnoses. Further research is needed to validate results in different populations and to incorporate new predictors.
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Affiliation(s)
- Miguel Garcia-Argibay
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Yanli Zhang-James
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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28
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Stern P, Kolodny T, Tsafrir S, Cohen G, Shalev L. Near and Far Transfer Effects of Computerized Progressive Attention Training (CPAT) Versus Mindfulness Based Stress Reduction (MBSR) Practice Among Adults With ADHD. J Atten Disord 2023; 27:757-776. [PMID: 36794845 PMCID: PMC10173353 DOI: 10.1177/10870547231155877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE The present study evaluated the near (attention) and far (reading, ADHD symptoms, learning, and quality of life) transfer effects of a Computerized Progressive Attention Training (CPAT) versus Mindfulness Based Stress Reduction (MBSR) practice among adults with ADHD compared to a passive group. METHOD Fifty-four adults participated in a non-fully randomized controlled trial. Participants in the intervention groups completed eight 2-hr weekly training sessions. Outcomes were assessed before, immediately after, and 4 months post-intervention, using objective tools: attention tests, eye-tracker, and subjective questionnaires. RESULTS Both interventions showed near-transfer to various attention functions. The CPAT produced far-transfer effects to reading, ADHD symptoms, and learning while the MBSR improved the self-perceived quality of life. At follow-up, all improvements except for ADHD symptoms were preserved in the CPAT group. The MBSR group showed mixed preservations. CONCLUSION Both interventions have beneficial effects, however only the CPAT group exhibited improvements compared to the passive group.
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29
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Uchida M, Bukhari Q, DiSalvo M, Green A, Serra G, Hutt Vater C, Ghosh SS, Faraone SV, Gabrieli JDE, Biederman J. Can machine learning identify childhood characteristics that predict future development of bipolar disorder a decade later? J Psychiatr Res 2022; 156:261-267. [PMID: 36274531 PMCID: PMC9999264 DOI: 10.1016/j.jpsychires.2022.09.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/26/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022]
Abstract
Early identification of bipolar disorder may provide appropriate support and treatment, however there is no current evidence for statistically predicting whether a child will develop bipolar disorder. Machine learning methods offer an opportunity for developing empirically-based predictors of bipolar disorder. This study examined whether bipolar disorder can be predicted using clinical data and machine learning algorithms. 492 children, ages 6-18 at baseline, were recruited from longitudinal case-control family studies. Participants were assessed at baseline, then followed-up after 10 years. In addition to sociodemographic data, children were assessed with psychometric scales, structured diagnostic interviews, and cognitive and social functioning assessments. Using the Balanced Random Forest algorithm, we examined whether the diagnostic outcome of full or subsyndromal bipolar disorder could be predicted from baseline data. 45 children (10%) developed bipolar disorder at follow-up. The model predicted subsequent bipolar disorder with 75% sensitivity, 76% specificity, and an Area Under the Receiver Operating Characteristics of 75%. Predictors best differentiating between children who did or did not develop bipolar disorder were the Child Behavioral Checklist Externalizing and Internalizing behaviors, the Child Behavioral Checklist Total t-score, problematic school functions indexed through the Child Behavioral Checklist School Competence scale, and the Child Behavioral Checklist Anxiety/Depression and Aggression scales. Our study provides the first quantitative model to predict bipolar disorder. Longitudinal prediction may help clinicians assess children with emergent psychopathology for future risk of bipolar disorder, an area of clinical and scientific importance. Machine learning algorithms could be implemented to alert clinicians to risk for bipolar disorder.
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Affiliation(s)
- Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Qasim Bukhari
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Giulia Serra
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Chloe Hutt Vater
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Satrajit S Ghosh
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - John D E Gabrieli
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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30
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Altun S, Alkan A, Altun H. Automatic Diagnosis of Attention Deficit Hyperactivity Disorder with Continuous Wavelet Transform and Convolutional Neural Network. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:715-724. [DOI: 10.9758/cpn.2022.20.4.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/13/2021] [Accepted: 10/30/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Sinan Altun
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ahmet Alkan
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Hatice Altun
- Department of Child and Adolescent Psychiatry, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Bock B, Guentsch A, Heinrich-Weltzien R, Filz C, Rudovsky M, Schüler IM. Effect of Individualized Oral Health Care Training Provided to 6-16-Year-Old Psychiatric In-Patients-Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15615. [PMID: 36497687 PMCID: PMC9740340 DOI: 10.3390/ijerph192315615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND To assess the effect of individualized oral health care training (IndOHCT) administered to 6-16-year-old psychiatric in-patients on dental plaque removal. METHODS 74 in-patients with mental health disorders (49 males) aged 6-16 years with a mean age of 10.4 ± 2.3 years, were randomly divided into two equal groups. At the start of hospitalization, one calibrated dentist assessed the oral health status in the hospital setting. In-patients of the intervention group (IG) received IndOHCT, while those of the control group (CG) got an information flyer. Dental plaque was assessed by the Turesky modified Quigley-Hein-Index (TI) at the start (t0) and at the end of hospitalization before (t1a) and after (t1b) autonomous tooth brushing. RESULTS During hospitalisation, the TI was reduced in both groups (t0→t1a: IG = -0.1; CG = -0.2, p = 0.71). However, in-patients receiving IndOHCT achieved significantly higher plaque reduction rates than the controls when plaque values before and after autonomous tooth brushing were compared (t1a→t1b: IG = -1.0; CG = -0.8; p = 0.02). The effect size (ES) demonstrates the efficacy of IndOHCT (ES = 0.53), especially in children with mixed dentition (ES = 0.89). CONCLUSIONS IndOHCT enabled hospitalized children and adolescents with mental health disorders to achieve a better plaque reduction by tooth brushing but failed to improve self-controlled routine oral hygiene.
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Affiliation(s)
- Benedikt Bock
- Section of Preventive and Paediatric Dentistry, Jena University Hospital, 07743 Jena, Germany
| | - Arndt Guentsch
- Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI 53201-1881, USA
| | | | - Christina Filz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Jena University Hospital, 07743 Jena, Germany
| | - Melanie Rudovsky
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Jena University Hospital, 07743 Jena, Germany
| | - Ina M. Schüler
- Section of Preventive and Paediatric Dentistry, Jena University Hospital, 07743 Jena, Germany
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François-Sévigny J, Pilon M, Gauthier LA. Differences in Parents and Teachers' Perceptions of Behavior Manifested by Gifted Children with ADHD Compared to Gifted Children without ADHD and Non-Gifted Children with ADHD Using the Conners 3 Scale. Brain Sci 2022; 12:1571. [PMID: 36421895 PMCID: PMC9688281 DOI: 10.3390/brainsci12111571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 09/08/2024] Open
Abstract
The potential for the misdiagnosis of giftedness as attention deficit/hyperactivity disorder (ADHD) has been well documented, as has the clinical diagnostic profile of individuals with both giftedness and ADHD. This study aimed to examine parents' and teachers' responses to the Conners 3 behavioral rating scale of gifted students with ADHD compared to gifted students without ADHD and non-gifted students with ADHD. Ninety-two children aged 6 to 16 years were included in the study. On the basis of clinical assessments utilizing the K-SADS, the WISC-V, and other neurocognitive tests, the students were split into three groups: gifted/ADHD (n = 35), ADHD (n = 35), and gifted (n = 22). The results revealed that mothers', fathers', and teachers' responses to the Conners 3 rating scale distinguished well between the gifted group and the other two groups, but not between the gifted/ADHD and ADHD groups. The learning difficulties observed by teachers was the most significant element that distinguished gifted/ADHD students from non-gifted ADHD students. Other results indicated that mothers and fathers reported more inattention problems in their gifted/ADHD children than teachers. Additionally, mothers tended to observe more learning and executive function problems in their gifted/ADHD children than teachers did. These findings highlight the importance of multiple informants complementing each other in the assessment process for ADHD in a gifted context to counteract the masking effect between giftedness and ADHD.
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Affiliation(s)
| | - Mathieu Pilon
- Department of Psychology, Université de Sherbrooke, Longueuil Campus, Longueuil, QC J4K 0A8, Canada
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Green A, Baroud E, DiSalvo M, Faraone SV, Biederman J. Examining the impact of ADHD polygenic risk scores on ADHD and associated outcomes: A systematic review and meta-analysis. J Psychiatr Res 2022; 155:49-67. [PMID: 35988304 DOI: 10.1016/j.jpsychires.2022.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
Early identification of attention-deficit/hyperactivity disorder (ADHD) is critical for mitigating the many negative functional outcomes associated with its diagnosis. Because of the strong genetic basis of ADHD, the use of polygenic risk scores (PRS) could potentially aid in the early identification of ADHD and associated outcomes. Therefore, a systematic search of the literature on the association between ADHD and PRS in pediatric populations was conducted. All articles were screened for a priori inclusion and exclusion criteria, and, after careful review, 33 studies were included in our systematic review and 16 studies with extractable data were included in our meta-analysis. The results of the review were categorized into three common themes: the associations between ADHD-PRS with 1) the diagnosis of ADHD and ADHD symptoms 2) comorbid psychopathology and 3) cognitive and educational outcomes. Higher ADHD-PRS were associated with increased odds of having a diagnosis (OR = 1.37; p<0.001) and more symptoms of ADHD (β = 0.06; p<0.001). While ADHD-PRS were associated with a persistent diagnostic trajectory over time in the systematic review, the meta-analysis did not confirm these findings (OR = 1.09; p = 0.62). Findings showed that ADHD-PRS were associated with increased odds for comorbid psychopathology such as anxiety/depression (OR = 1.16; p<0.001) and irritability/emotional dysregulation (OR = 1.14; p<0.001). Finally, while the systematic review showed that ADHD-PRS were associated with a variety of negative cognitive outcomes, the meta-analysis showed no significant association (β = 0.08; p = 0.07). Our review of the available literature suggests that ADHD-PRS, together with risk factors, may contribute to the early identification of children with suspected ADHD and associated disorders.
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Affiliation(s)
- Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Evelyne Baroud
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital and McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | | | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations. Encephale 2022; 48:555-559. [DOI: 10.1016/j.encep.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
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Haugan ALJ, Sund AM, Thomsen PH, Lydersen S, Nøvik TS. Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population. Front Psychiatry 2022; 13:834356. [PMID: 36172514 PMCID: PMC9510657 DOI: 10.3389/fpsyt.2022.834356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Attention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of anxiety disorders in children and adolescents. The reasons for this association are poorly understood. Preliminary findings with young adults have suggested that executive functions and functional impairment may mediate the relationship between symptoms of ADHD and mixed anxiety and depressive symptoms. The objective of this study was to explore whether ADHD symptoms, executive functions and functional impairment predict anxiety in a clinical adolescent population. In addition, we investigated the possible mediating role of executive functions and functional impairment in this relationship. Method One hundred adolescents with ADHD and their parents completed the ADHD Rating Scale IV (ADHD RS-IV), the Behavior Rating Inventory of Executive Function (BRIEF), and the Weiss Functional Impairment Rating Scale (WFIRS) in relation to an RCT study. The adolescents also completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Analyses were conducted using regression and a serial multiple mediator model. Results In the regression analyses, parent-rated ADHD symptoms were unable to predict anxiety, but ADHD inattention symptoms predicted anxiety in the self-ratings. Executive dysfunction and functional impairment predicted anxiety in both the parent- and self-reports. In the mediation analyses ADHD symptoms alone did not predict anxiety, but executive dysfunction mediated this relationship as expected. Functional impairment mediated this relationship indirectly through executive functions. The results were similar in the parent- and self- reports. Conclusion The results pinpoint executive dysfunction as an important treatment target for alleviating anxiety in adolescents with impairing ADHD symptoms.
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Affiliation(s)
- Anne-Lise Juul Haugan
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Mari Sund
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Per Hove Thomsen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torunn Stene Nøvik
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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Tuan WJ, Babinski DE, Rabago DP, Zgierska AE. Treatment with stimulants and the risk of COVID-19 complications in adults with ADHD. Brain Res Bull 2022; 187:155-161. [PMID: 35839903 PMCID: PMC9279163 DOI: 10.1016/j.brainresbull.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/15/2022]
Abstract
Adults with attention deficit hyperactivity disorder (ADHD) have shown higher infection rates and worse outcomes from COVID-19. Stimulant medications are prescribed as the first-line treatment for ADHD in adults and mitigate risk of negative ADHD-related health outcomes, but little is known about the association between stimulant medications and COVID-19 outcomes. The objective of this study was to assess the risks of severe COVID-19 outcomes among people with ADHD who were prescribed stimulant medications versus those who were not. This retrospective cohort study used electronic health records in the TriNetX research database. We assessed records of adults with ADHD diagnosed with COVID-19 between January 1, 2020 and June 30, 2021. The stimulant cohort consisted of 28,011 people with at least one stimulant prescription; the unmedicated cohort comprised 42,258 people without prescribed stimulants within 12 months prior to their COVID infection. Multiple logistic regression modeling was utilized to assess the presence of critical care services or death within 30 days after the onset of COVID diagnoses, controlling for patient demographics, and comorbid medical and mental health conditions. The stimulant cohort was less likely to utilize emergency department, hospital, and intensive care services than the unmedicated cohort, and had significantly lower 30-day mortality. Further research, including prospective studies, is needed to confirm and refine these findings.
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Affiliation(s)
- Wen-Jan Tuan
- Penn State College of Medicine, Departments of Family and Community Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA.
| | - Dara E Babinski
- Penn State College of Medicine, Department of Psychiatry and Behavioral Health, 700 HMC Crescent Rd, Hershey, PA 17033, USA
| | - David P Rabago
- Penn State College of Medicine, Departments of Family and Community Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA; Penn State College of Medicine, Department of Psychiatry and Behavioral Health, 700 HMC Crescent Rd, Hershey, PA 17033, USA; Penn State College of Medicine, Departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, 700 HMC Crescent Rd, Hershey, PA 17033, USA
| | - Aleksandra E Zgierska
- Penn State College of Medicine, Departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, 700 HMC Crescent Rd, Hershey, PA 17033, USA
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Marx I, Cortese S, Koelch MG, Hacker T. Meta-analysis: Altered Perceptual Timing Abilities in Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:866-880. [PMID: 34923055 DOI: 10.1016/j.jaac.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 11/19/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We meta-analyzed studies comparing perceptual timing abilities in the range of milliseconds to several seconds in persons with attention-deficit/hyperactivity disorder (ADHD) and neurotypical participants, using the well-established time discrimination, time estimation, time production, and time reproduction paradigms. METHOD We searched PubMed, OVID databases, and Web of Knowledge through September 17, 2020. From 2,266 records, 55 studies were retained and meta-analyzed with random effects models. We conducted meta-regression analyses to explore moderating effects of task parameters and neuropsychological measures of working memory, attention, and inhibition on timing performance. RESULTS Compared with persons without ADHD, those with ADHD had significantly more severe difficulties in discriminating stimuli of very brief durations, especially in the sub-second range. They also had more variability in estimating the duration of stimuli lasting several seconds. Moreover, they showed deficits in time estimation and time production accuracy, indicative of an accelerated internal clock. Additional deficits in persons with ADHD were also found in the time reproduction paradigm, involving attentional (slower counting at short time intervals due to distraction) and motivational (faster counting at long time intervals due to increased delay aversion) functions. CONCLUSION There is meta-analytic evidence of a broad range of timing deficits in persons with ADHD. Results have implications for advancing our knowledge in the field (eg, for refinement of recent timing models in ADHD) and clinical practice (eg, testing timing functions to characterize the clinical phenotype of the patient and implementation of interventions to improve timing abilities).
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Affiliation(s)
- Ivo Marx
- Rostock University Medical Center, Rostock, Germany.
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, United Kingdom; New York University Grossman School of Medicine, New York
| | | | - Thomas Hacker
- Rostock University Medical Center, Rostock, Germany; Helios Hanseklinikum Stralsund, Stralsund, Germany
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Khodaverdi Z, Moreau D, Garber CE. Is there an effective dose of aerobic exercise associated with better executive function in youth with attention deficit hyperactivity disorder? Child Neuropsychol 2022; 28:569-596. [PMID: 34711134 DOI: 10.1080/09297049.2021.1992378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder in children, and it's linked to a higher risk of academic failure, interpersonal issues, mental illness, and criminality. Despite several of the comparative and detailed reviews on the effects of ADHD interventions on core symptoms, there is no data summarizing the effects of aerobic exercise (AE) on executive functions (EFs). Therefore, this study aimed to systematically review and determine the relationship between AE (acute and chronic) dosage and EFs (attention, inhibition, set-shifting, and working memory) in youth with ADHD. The consideration of how AE dosage impacts aspects of EFs has not been investigated in detail previously. The study adhered to PRISMA guideline. Sixdatabases were searched without any date restrictions, up to February 2021, for articles relating to AE interventions to influence EFs in youth with ADHD≤ 18 years old. Quality assessment of the reviewed papers was addressed. Thirteen studies met the inclusion criteria. Improvements in all aspects of EFs were reported after children with ADHD engaged in acute AE lasting 20-30 minutes with at least moderate intensity (65% ≤ 80% HRmax).Furthermore, chronic exercise that lasts at least 45 minutes and in the range of moderate tohigh intensity (i.e., 60% ≤ 75% HRmax), 3 days/week for 6-12, elicits additional benefits in inhibition and set-shifting.Different dosage of AE might differently influence aspects of EFs; however, this finding rests on preliminary evidence at this stage and thus should be treated with caution.It is necessary to establish suitable interventions with regard to the dosage of AE types to improve EFs in young people with ADHD.
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Affiliation(s)
- Zeinab Khodaverdi
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - David Moreau
- School of Psychology and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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Serrallach BL, Groß C, Christiner M, Wildermuth S, Schneider P. Neuromorphological and Neurofunctional Correlates of ADHD and ADD in the Auditory Cortex of Adults. Front Neurosci 2022; 16:850529. [PMID: 35600622 PMCID: PMC9121124 DOI: 10.3389/fnins.2022.850529] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Attention deficit (hyperactivity) disorder (AD(H)D) is one of the most common neurodevelopmental disorders in children with up to 60% probability of prevailing into adulthood. AD(H)D has far-fetching negative impacts on various areas of life. Until today, no observer-independent diagnostic biomarker is available for AD(H)D, however recent research found evidence that AD(H)D is reflected in auditory dysfunctions. Furthermore, the official diagnostic classification systems, being mainly the ICD-10 in Europe and the DSM-5 in the United States, are not entirely consistent. The neuro-auditory profiles of 82 adults (27 ADHD, 30 ADD, 25 controls) were measured via structural magnetic resonance imaging (MRI) and magnetoencephalography (MEG) to determine gray matter volumes and activity of auditory subareas [Heschl’s gyrus (HG) and planum temporale (PT)]. All three groups (ADHD, ADD, and controls) revealed distinct neuro-auditory profiles. In the left hemisphere, both ADHD and ADD showed reduced gray matter volumes of the left HG, resulting in diminished left HG/PT ratios. In the right hemisphere, subjects with ADHD were characterized by lower right HG/PT ratios and ADD by a similar right HG/PT ratio compared to controls. Controls and ADD had well-balanced hemispheric response patterns, ADHD a left-right asynchrony. With this study, we present the structural and functional differences in the auditory cortex of adult patients with AD(H)D.
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Affiliation(s)
- Bettina L. Serrallach
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
- *Correspondence: Bettina L. Serrallach,
| | - Christine Groß
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
- Jazeps Vitols Latvian Academy of Music, Riga, Latvia
| | - Markus Christiner
- Jazeps Vitols Latvian Academy of Music, Riga, Latvia
- Center for Systematic Musicology, University of Graz, Graz, Austria
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Peter Schneider
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
- Jazeps Vitols Latvian Academy of Music, Riga, Latvia
- Center for Systematic Musicology, University of Graz, Graz, Austria
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Sex Differences in Substance Use, Prevalence, Pharmacological Therapy, and Mental Health in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Brain Sci 2022; 12:brainsci12050590. [PMID: 35624977 PMCID: PMC9139081 DOI: 10.3390/brainsci12050590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Sex differences are poorly studied within the field of mental health, even though there is evidence of disparities (with respect to brain anatomy, activation patterns, and neurochemistry, etc.) that can significantly influence the etiology and course of mental disorders. The objective of this work was to review sex differences in adolescents (aged 13–18 years) diagnosed with ADHD (according to the DSM-IV, DSM-IV-TR and DSM-5 criteria) in terms of substance use disorder (SUD), prevalence, pharmacological therapy and mental health. We searched three academic databases (PubMed, Web of Science, and Scopus) and performed a narrative review of a total of 21 articles. The main conclusions of this research were (1) girls with ADHD are more at risk of substance use than boys, although there was no consensus on the prevalence of dual disorders; (2) girls are less frequently treated because of underdiagnosis and because they are more often inattentive and thereby show less disruptive behavior; (3) together with increased impairment in cognitive and executive functioning in girls, the aforementioned could be related to greater substance use and poorer functioning, especially in terms of more self-injurious behavior; and (4) early diagnosis and treatment of ADHD, especially in adolescent girls, is essential to prevent early substance use, the development of SUD, and suicidal behavior.
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Cherkasova MV, Roy A, Molina BSG, Scott G, Weiss G, Barkley RA, Biederman J, Uchida M, Hinshaw SP, Owens EB, Hechtman L. Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood. J Am Acad Child Adolesc Psychiatry 2022; 61:378-391. [PMID: 34116167 DOI: 10.1016/j.jaac.2021.05.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA). METHOD All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes. RESULTS The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders. CONCLUSION Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.
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Affiliation(s)
| | | | | | | | - Gabrielle Weiss
- McGill University, Montreal, and the University of British Columbia, Vancouver, Canada
| | | | | | - Mai Uchida
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephen P Hinshaw
- University of California Berkeley and the University of California San Francisco, California
| | | | - Lily Hechtman
- McGill University Health Center, Montreal, Quebec, Canada; Division of Child Psychiatry, McGill University, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Hong JS, Lee YS, Hong M, Kim B, Joung YS, Yoo HK, Kim EJ, Lee SI, Bhang SY, Lee SY, Bahn GH, Han DH. Cognitive Developmental Trajectories in Adult ADHD Patients and Controls: A Comparative Study. J Atten Disord 2022; 26:391-407. [PMID: 33472514 DOI: 10.1177/1087054720978548] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is an updated conceptualization of whole-lifespan attention-deficit hyperactivity disorder (ADHD), promoted by awareness of probable persistence of impairment into adulthood. We investigated cognition trajectories from adolescence to mid-adulthood in ADHD. METHOD Data of 240 patients with ADHD and 244 healthy controls (HCs) were obtained; clinical symptoms and neuropsychological functions were assessed using the various tests. RESULTS Compared to HCs, patients with ADHD except 35 to 44 age interval showed lower full scale intelligence quotient. They showed decreased verbal comprehensive scores except in the 35 to 44 age interval and working memory scores in all intervals. In the Comprehensive Attention Test, patients with ADHD showed increased working memory error frequencies except in the 15 to 17 age interval and divided attention omission error in all intervals. CONCLUSION Adults with ADHD showed deficits not in simple attention but in complex attention, including divided attention and working memory.
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Affiliation(s)
- Ji Sun Hong
- Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Lee
- Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Minha Hong
- Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bongseog Kim
- Inje University College of Medicine, Seoul, Republic of Korea
| | - Yoo Sook Joung
- Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Hanik K Yoo
- Seoul Brain Research Institute, Seoul, Republic of Korea
| | - Eui-Jung Kim
- Ewha Womans University, Seoul, Republic of Korea
| | - Soyoung Irene Lee
- Soonchunhyang University College of Medicine, Buchun, Republic of Korea
| | - Soo Young Bhang
- Eulji University School of Medicine, Seoul, Republic of Korea
| | - Seung Yup Lee
- Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Geon Ho Bahn
- Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Doug Hyun Han
- Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Koyuncu A, Ayan T, Ince Guliyev E, Erbilgin S, Deveci E. ADHD and Anxiety Disorder Comorbidity in Children and Adults: Diagnostic and Therapeutic Challenges. Curr Psychiatry Rep 2022; 24:129-140. [PMID: 35076887 DOI: 10.1007/s11920-022-01324-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE REVIEW: In this review, we focus on overlapping features of ADHD and anxiety disorders, and will discuss how an anxiety disorder comorbidity leads to diagnostic and treatment challenges in patients with ADHD, in consideration of the accumulated available knowledge. RECENT FINDINGS: The presence of overlapping symptoms, changes in the diagnostic criteria, and the use of divergent diagnostic tools and informant effects can complicate the diagnosis of this comorbidity. Due to the ongoing debate about the etiology, psychopathology, and diagnostic features of the association between ADHD and anxiety disorders, choosing appropriate treatment options emerges as a challenge. A novel methodology, standardized interview tools, and new statistical analysis methods are needed to define the phenotype of this co-occurrence more clearly. It is important to uncover the developmental nature of this comorbidity with follow-up studies that may explain the etiology and underlying neurobiological basis, and ultimately lead to more effective treatment approaches.
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Affiliation(s)
- Ahmet Koyuncu
- Academy Social Phobia Center, Atatürk Mah, İkitelli Cad, No:126 A, Daire:6 Küçükçekmece, Istanbul, Turkey.
| | - Tuğba Ayan
- Department of Clinical Psychology, Boğaziçi University, Bebek, 34342, Beşiktaş, İstanbul, Turkey
| | - Ezgi Ince Guliyev
- Department of Psychiatry, University of Health Sciences Erenköy Training and Research Hospital for Mental and Neurological Disorders, 19 Mayıs, Sinan Ercan Cd. No:23, Kadıköy, İstanbul, 34736, Turkey
| | - Seda Erbilgin
- Department of Child Development, Istanbul Gelişim University, Istanbul, Turkey
| | - Erdem Deveci
- Department of Psychiatry, Medipol Mega University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No:, D:1, Bağcılar, İstanbul, Turkey
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Artificial Intelligence Enabled Personalised Assistive Tools to Enhance Education of Children with Neurodevelopmental Disorders-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031192. [PMID: 35162220 PMCID: PMC8835076 DOI: 10.3390/ijerph19031192] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
Mental disorders (MDs) with onset in childhood or adolescence include neurodevelopmental disorders (NDDs) (intellectual disability and specific learning disabilities, such as dyslexia, attention deficit disorder (ADHD), and autism spectrum disorders (ASD)), as well as a broad range of mental health disorders (MHDs), including anxiety, depressive, stress-related and psychotic disorders. There is a high co-morbidity of NDDs and MHDs. Globally, there have been dramatic increases in the diagnosis of childhood-onset mental disorders, with a 2- to 3-fold rise in prevalence for several MHDs in the US over the past 20 years. Depending on the type of MD, children often grapple with social and communication deficits and difficulties adapting to changes in their environment, which can impact their ability to learn effectively. To improve outcomes for children, it is important to provide timely and effective interventions. This review summarises the range and effectiveness of AI-assisted tools, developed using machine learning models, which have been applied to address learning challenges in students with a range of NDDs. Our review summarises the evidence that AI tools can be successfully used to improve social interaction and supportive education. Based on the limitations of existing AI tools, we provide recommendations for the development of future AI tools with a focus on providing personalised learning for individuals with NDDs.
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Koh JEW, Ooi CP, Lim-Ashworth NS, Vicnesh J, Tor HT, Lih OS, Tan RS, Acharya UR, Fung DSS. Automated classification of attention deficit hyperactivity disorder and conduct disorder using entropy features with ECG signals. Comput Biol Med 2022; 140:105120. [PMID: 34896884 DOI: 10.1016/j.compbiomed.2021.105120] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The most prevalent neuropsychiatric disorder among children is attention deficit hyperactivity disorder (ADHD). ADHD presents with a high prevalence of comorbid disorders such as conduct disorder (CD). The lack of definitive confirmatory diagnostic tests for ADHD and CD make diagnosis challenging. The distinction between ADHD, ADHD + CD and CD is important as the course and treatment are different. Electrocardiography (ECG) signals may become altered in behavioral disorders due to brain-heart autonomic interactions. We have developed a software tool to categorize ADHD, ADHD + CD and CD automatically on ECG signals. METHOD ECG signals from participants were decomposed using empirical wavelet transform into various modes, from which entropy features were extracted. Robust ten-fold cross-validation with adaptive synthetic sampling (ADASYN) and z-score normalization were performed at each fold. Analysis of variance (ANOVA) technique was employed to determine the variability within the three classes, and obtained the most discriminatory features. Highly significant entropy features were then fed to classifiers. RESULTS Our model yielded the best classification results with the bagged tree classifier: 87.19%, 87.71% and 86.29% for accuracy, sensitivity and specificity, respectively. CONCLUSION The proposed expert system can potentially assist mental health professionals in the stratification of the three classes, for appropriate intervention using accessible ECG signals.
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Affiliation(s)
- Joel E W Koh
- School of Engineering, Ngee Ann Polytechnic, Singapore
| | - Chui Ping Ooi
- School of Science and Technology, Singapore University of Social Sciences, Singapore
| | | | | | - Hui Tian Tor
- School of Science and Technology, Singapore University of Social Sciences, Singapore
| | - Oh Shu Lih
- School of Engineering, Ngee Ann Polytechnic, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore.
| | - U Rajendra Acharya
- School of Engineering, Ngee Ann Polytechnic, Singapore; School of Science and Technology, Singapore University of Social Sciences, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taiwan, ROC; School of Management and Enterprise University of Southern Queensland, Springfield, Australia.
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Katzenmajer-Pump L, Komáromy D, Balázs J. The importance of recognizing worthlessness for suicide prevention in adolescents with Attention-deficit/hyperactivity disorder. Front Psychiatry 2022; 13:969164. [PMID: 36458127 PMCID: PMC9705741 DOI: 10.3389/fpsyt.2022.969164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric diagnoses among children and adolescents. Depression and general anxiety disorder (GAD) are often co-occurring with ADHD among children and adolescents. Previous studies have found that ADHD, depression and GAD are all strongly correlated with suicidal thoughts and planning. AIM The current study aimed to further explore the association between ADHD, GAD and depressive symptoms as well as their association with suicidal thoughts and planning among adolescents. METHOD Adolescents with ADHD diagnosis were involved from child psychiatry outpatient clinics and adolescents without a psychiatric treatment or diagnosis were enrolled from high schools in Hungary. The Mini International Neuropsychiatric Interview for Children and Adolescents was used to evaluate psychiatric symptoms and disorders as well as suicidal thoughts and planning. Regularized psychological networks were used to investigate the associations. RESULTS Altogether 185 adolescents (58 females and 127 males; mean age 14.79 years, SD = 1.48), 89 with ADHD and 96 without ADHD were enrolled. Depression symptom worthlessness was directly related to suicidal thoughts and planning, CI95 of the logit B between worthlessness and suicidal thought (0.72, 1.66). Both ADHD and anxiety were indirectly related to suicidal thoughts and planning through depression: CI95 of the logit B between being disorganized and feeling worthless is (0.38, 3.02), and CI95 of the logit B between being distressed and feeling worthless is (0.57, 2.52). CONCLUSIONS This study draws the attention of clinicians to the importance of recognizing "worthlessness" for suicide prevention in adolescents with ADHD. Furthermore, the results support previous studies, whereby symptoms of depression and anxiety mediate the relationship between ADHD and suicidal thoughts and planning. These results highlight the importance of ADHD comorbidities with depression and GAD and their effect on suicidal thoughts and planning.
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Affiliation(s)
- Luca Katzenmajer-Pump
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Komáromy
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands.,Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Judit Balázs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Oslo New University College, Oslo, Norway
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Pérez-Gómez J, Amigo-Gamero H, Collado-Mateo D, Barrios-Fernandez S, Muñoz-Bermejo L, Garcia-Gordillo MÁ, Carlos-Vivas J, Adsuar JC. Equine-assisted activities and therapies in children with attention-deficit/hyperactivity disorder: A systematic review. J Psychiatr Ment Health Nurs 2021; 28:1079-1091. [PMID: 33171006 DOI: 10.1111/jpm.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems of inattention and impulsive hyperactivity in children. Equine-assisted activities and therapies (EAATs) have been used as alternative non-pharmacological intervention option in patients with ADHD. WHAT DOES THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nowadays, more studies of high methodological quality are needed to determine whether EAAT is an effective intervention for the treatment in children with ADHD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Between 15 and 40 min of rising horses, 8-32 total sessions, for 4-32 weeks, seem to be beneficial to reduce the symptoms of ADHD. ABSTRACT INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by problems of inattention and impulsive hyperactivity. Equine-assisted activities and therapies (EAATs) have become an emerging non-pharmacological intervention option in patients with ADHD. AIM To perform a systematic review of updated literature about EAAT in children with ADHD. METHOD A systematic review was performed until 28 November 2019, in four electronic databases: PubMed, Web of Science, Embase and Google Scholar. The inclusion criteria were as follows: (a) intervention programme, with pre- and post-data, based on EAAT, (b) children with ADHD and (c) articles written in English. RESULTS A total of 9 articles were found that meet the inclusion criteria. The evidence level was C for 7 studies and B for 2 studies. The level of conclusion was 3. DISCUSSION There are few studies with high methodological quality, and there is a high heterogeneity in the variables included, what make that the level of evidence and conclusion are low. CONCLUSION There is no account with enough studies of high methodological quality to determine whether EAAT is an effective intervention for the treatment in children with ADHD.
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Affiliation(s)
- Jorge Pérez-Gómez
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
| | - Helena Amigo-Gamero
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
| | | | | | | | | | - Jorge Carlos-Vivas
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
| | - José Carmelo Adsuar
- Health, Economy, Motricity and Education (HEME) Research Group, University of Extremadura, Cáceres, Spain
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Schein J, Adler LA, Childress A, Gagnon-Sanschagrin P, Davidson M, Kinkead F, Cloutier M, Guérin A, Lefebvre P. Economic burden of attention-deficit/hyperactivity disorder among adults in the United States: a societal perspective. J Manag Care Spec Pharm 2021; 28:168-179. [PMID: 34806909 DOI: 10.18553/jmcp.2021.21290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with substantial clinical burden as individuals transition to adulthood, including higher rates of comorbidities, mortality, incarceration, and psychiatric hospitalizations than in individuals without ADHD. These higher rates likely contribute to substantial economic burden as well. OBJECTIVE: To provide a comprehensive evaluation of the economic burden associated with ADHD in the US adult population. METHODS: Direct health care costs were obtained by using claims data from the IBM MarketScan Research Databases (January 1, 2017, through December 31, 2018). Direct non-health care costs and indirect costs were estimated on the basis of the literature and government publications. Excess costs incurred by adults with ADHD during 2018 were evaluated from a societal perspective; per-patient costs were extrapolated to the national level. RESULTS: An estimated 8.7 million adults live with ADHD in the United States, resulting in a total societal excess cost attributable to ADHD of $122.8 billion ($14,092 per adult). Excess costs of unemployment ($66.8 billion; 54.4%) comprised the largest proportion of the total, followed by productivity loss ($28.8 billion; 23.4%) and health care services ($14.3 billion; 11.6%). CONCLUSIONS: ADHD in adults is associated with substantial economic burden. DISCLOSURES: This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. (Otsuka). The study sponsor contributed to and approved the study design, participated in the interpretation of data, and reviewed and approved the manuscript. Schein is an employee of Otsuka. Gagnon-Sanschagrin, Davidson, Kinkead, Cloutier, Guérin, and Lefebvre are employees of Analysis Group, Inc., a consulting company that provided paid consulting services to Otsuka to develop and conduct this study and write the manuscript. Adler has received research support from Shire/Takeda, Sunovion, and Otsuka; consulting fees from Bracket, Shire/Takeda, Sunovion, Otsuka, the State University of New York (SUNY), the National Football League (NFL), and Major League Baseball (MLB); and royalty payments (as inventor) from New York University (NYU) for license of adult ADHD scales and training materials. Childress has received research support from Allergan, Takeda/Shire, Emalex, Akili, Ironshore, Arbor, Aevi Genomic Medicine, Neos Therapeutics, Otsuka, Pfizer, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, and the US Food and Drug Administration; was on the advisory board of Takeda/Shire, Akili, Arbor, Cingulate, Ironshore, Neos Therapeutics, Otsuka, Pfizer, Purdue, Adlon, Rhodes, Sunovion, Tris, Supernus, and Corium; received consulting fees from Arbor, Ironshore, Neos Therapeutics, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, Corium, Jazz, and Tulex Pharma; received speaker fees from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Tris, and Supernus; and received writing support from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Purdue, Rhodes, Sunovion, and Tris. Part of the material in this study was presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2021 Virtual Meeting; May 17-20, 2021.
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Affiliation(s)
- Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ
| | - Lenard A Adler
- New York University Grossman School of Medicine, New York, NY
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, NV
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Rocco I, Corso B, Bonati M, Minicuci N. Time of onset and/or diagnosis of ADHD in European children: a systematic review. BMC Psychiatry 2021; 21:575. [PMID: 34784913 PMCID: PMC8594188 DOI: 10.1186/s12888-021-03547-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Symptoms related to this disorder cause a significant impairment in school tasks and in the activities of children's daily lives; an early diagnosis and appropriate treatment could almost certainly help improve their outcomes. The current study, part of the Models Of Child Health Appraised (MOCHA) project, aims to explore the age at which children experience the onset or diagnosis of ADHD in European countries. METHODS A systematic review was done examining the studies reporting the age of onset/diagnosis (AO/AD) of ADHD in European countries (28 European Member States plus 2 European Economic Area countries), published between January 1, 2010 and December 31, 2019. Of the 2276 identified studies, 44 met all the predefined criteria and were included in the review. RESULTS The lowest mean AO in the children diagnosed with ADHD alone was 2.25 years and the highest was 7.5 years. It was 15.3 years in the children with ADHD and disruptive behaviour disorder. The mean AD ranges between 6.2 and 18.1 years. CONCLUSIONS Our findings indicate that there is a wide variability in both the AO and AD of ADHD, and a too large distance between AO and AD. Since studies in the literature suggest that an early identification of ADHD symptoms may facilitate early referral and treatment, it would be important to understand the underlying reasons behind the wide variability found. TRIAL REGISTRATION PROSPERO registration: CRD42017070631 .
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Affiliation(s)
- Ilaria Rocco
- grid.5326.20000 0001 1940 4177Neuroscience Institute, National Research Council, Padova, Italy
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy.
| | - Maurizio Bonati
- grid.4527.40000000106678902Laboratory for Mother and Child Health, Department of Public Health, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Nadia Minicuci
- grid.5326.20000 0001 1940 4177Neuroscience Institute, National Research Council, Padova, Italy
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Uchida M, Driscoll H, DiSalvo M, Rajalakshmim A, Maiello M, Spera V, Biederman J. Assessing the Magnitude of Risk for ADHD in Offspring of Parents with ADHD: A Systematic Literature Review and Meta-Analysis. J Atten Disord 2021; 25:1943-1948. [PMID: 32830611 PMCID: PMC8051515 DOI: 10.1177/1087054720950815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main aim of this study was to examine the body of knowledge on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in "high-risk" children whose parents are diagnosed with ADHD. This knowledge could aid early identification for children presenting with ADHD symptoms at a young age. We conducted a systematic search of the literature assessing high-risk children. Included were original articles published in English with the main aim to assess prevalence of ADHD in high risk children. In addition, a meta-analysis was conducted to examine this prevalence. Four articles met our inclusion and exclusion criteria all suggesting an increased prevalence of ADHD in children of parents with ADHD. The meta-analysis also confirmed the increased prevalence of ADHD in high-risk children. The literature indicates that children of ADHD parents have an increased risk of developing ADHD compared to control children.
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Affiliation(s)
- Mai Uchida
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Joseph Biederman
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
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