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Walter NM, Yde Ohki CM, Ruhstaller S, Del Campana L, Salazar Campos JM, Smigielski L, Rubio B, Walitza S, Grünblatt E. Neurodevelopmental effects of omega-3 fatty acids and its combination with Methylphenidate in iPSC models of ADHD. J Psychiatr Res 2025; 184:78-90. [PMID: 40043588 DOI: 10.1016/j.jpsychires.2025.02.035] [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] [Received: 09/05/2024] [Revised: 11/07/2024] [Accepted: 02/20/2025] [Indexed: 04/09/2025]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) has been linked to altered neurodevelopmental processes, including proliferation and differentiation of neural stem cells (NSC). We aimed to investigate the role of Wnt signaling, a pathway critical for brain development, in ADHD and to determine if modulation of this pathway using ω-3/6 polyunsaturated fatty acids (PUFAs) may provide a beneficial treatment approach. Given the symptom heterogeneity in ADHD and the limited response to conventional therapies for some patients, we examined the effects of ω-3/6 PUFA treatment combined with Methylphenidate (MPH) on neurodevelopmental mechanisms using induced pluripotent stem cell (iPSC)-derived NSCs, comparing controls to ADHD patients. Our results show that ω-3/6 PUFAs differentially regulate Wnt activity in NSCs depending on the patient's condition and the composition of the treatments. These findings highlight the potential of ω-3 PUFA treatment as personalized support for neurodevelopmental processes in ADHD. They also emphasize the importance of investigating ADHD subgroups, including those unresponsive to stimulant treatments, as they may exhibit distinct phenotypes.
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Affiliation(s)
- Natalie M Walter
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland; ZNZ PhD Program, University of Zurich, Winterthurerstrasse 11, 8057, Zurich, Switzerland
| | - Cristine M Yde Ohki
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Sina Ruhstaller
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Letizia Del Campana
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - José Maria Salazar Campos
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Lukasz Smigielski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Belén Rubio
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland; Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Winterthurerstrasse 11, 8057, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 11, 8057, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Translational Molecular Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland; Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Winterthurerstrasse 11, 8057, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 11, 8057, Zurich, Switzerland.
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Aydın H, Şahin M. Examining the Impact of a Developed Family Intervention Program on Children with ADHD. Psychol Rep 2025:332941251329785. [PMID: 40165033 DOI: 10.1177/00332941251329785] [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: 04/02/2025]
Abstract
ADHD is a brain development disorder that typically starts in early childhood, making it difficult for children to function effectively in daily life. The course of ADHD is negatively influenced by a dysfunctional family environment. Since ADHD affects development early on, involving parents in treatment is crucial for helping children with this condition. This study aims to explore how a group program designed to help families function better can improve the lives of children with ADHD and their parents. The correlational, causal-comparative, and quasi-experimental designs were utilized within the quantitative research approach in this study. The sample comprised 181 participants who have children with ADHD (Female = 131, Male = 48, Unspecified = 2). The Family Assessment Device, the Pediatric Quality of Life Inventory, and the Demographic Information Form were used to gather data. Experimental (7 couples) and control (7 couples) groups were formed for application of the research. A weekly intervention program designed to improve family functioning was applied to the experimental group. Both the group receiving the intervention program and a control group underwent assessments of family functioning at three points: before (pretest), after (posttest), and again later (follow-up). The results suggest that the group intervention program increased the scores for the family functioning. Moreover, the study revealed that this program indirectly improved children's quality of life. This finding suggests that parents who have a better family functioning are better at dealing with the challenges brought on by their children's ADHD symptoms. Accordingly, it is recommended that professionals should consider working with families as well as children with ADHD.
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Affiliation(s)
- Hanife Aydın
- Department of Psychological Counseling and Guidance, Trabzon University, Trabzon, Turkey
| | - Mustafa Şahin
- Psychology, İzmir Katip Çelebi University, İzmir, Turkey
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Gao Z, Duberg K, Warren SL, Zheng L, Hinshaw SP, Menon V, Cai W. Reduced temporal and spatial stability of neural activity patterns predict cognitive control deficits in children with ADHD. Nat Commun 2025; 16:2346. [PMID: 40057478 PMCID: PMC11890578 DOI: 10.1038/s41467-025-57685-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 02/26/2025] [Indexed: 05/13/2025] Open
Abstract
This study investigates the neural underpinnings of cognitive control deficits in attention-deficit/hyperactivity disorder (ADHD), focusing on trial-level variability of neural coding. Using fMRI, we apply a computational approach to single-trial neural decoding on a cued stop-signal task, probing proactive and reactive control within the dual control model. Reactive control involves suppressing an automatic response when interference is detected, and proactive control involves implementing preparatory strategies based on prior information. In contrast to typically developing children (TD), children with ADHD show disrupted neural coding during both proactive and reactive control, characterized by increased temporal variability and diminished spatial stability in neural responses in salience and frontal-parietal network regions. This variability correlates with fluctuating task performance and ADHD symptoms. Additionally, children with ADHD exhibit more heterogeneous neural response patterns across individuals compared to TD children. Our findings underscore the significance of modeling trial-wise neural variability in understanding cognitive control deficits in ADHD.
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Affiliation(s)
- Zhiyao Gao
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Katherine Duberg
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stacie L Warren
- Department of Psychology, University of Texas, Dallas, TX, USA
| | - Li Zheng
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, CA, USA
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Vinod Menon
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, USA.
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Maternal & Child Health Research Institute, Stanford, CA, USA.
| | - Weidong Cai
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, USA.
- Maternal & Child Health Research Institute, Stanford, CA, USA.
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Hornsey SJ, Gosling CJ, Jurek L, Nourredine M, Telesia L, Solmi M, Butt I, Greenwell K, Muller I, Hill CM, Cortese S. Umbrella Review and Meta-Analysis: The Efficacy of Nonpharmacological Interventions for Sleep Disturbances in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2025; 64:329-345. [PMID: 39608635 DOI: 10.1016/j.jaac.2024.10.015] [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] [Received: 07/20/2024] [Revised: 10/12/2024] [Accepted: 11/19/2024] [Indexed: 11/30/2024]
Abstract
OBJECTIVE We conducted an umbrella review of systematic reviews (SRs), with or without meta-analysis (MA), of randomized controlled trials (RCTs) assessing nonpharmacological sleep interventions for children and adolescents across various clinical populations. METHOD We searched multiple electronic databases up to January 24, 2024. Meta-analyzable data from RCTs in the retrieved SRs/MAs were pooled using Metaumbrella. Primary outcomes were subjective/objective child sleep parameters. Additional outcomes included child health/functioning and parental sleep/health. The quality of the MAs/SRs was assessed with Assessment of Multiple Systematic Reviews (AMSTAR-2), and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS We included 93 SRs/MAs covering 393 RCTs, with 25 (17%, 39%, and 30%: high, moderate, and low quality) providing data for quantitative synthesis. Behavioral interventions, usually multicomponent including parent training, psychoeducation, and/or specific sleep therapy/strategies, showed beneficial effects on night waking, sleep duration, overall sleep disturbance, mood/depression, and maternal sleep quality (standardized mean difference [SMD] = 0.10-0.80) in participants with sleep problems without a formal sleep disorder diagnosis. For those with a formal diagnosis (mainly insomnia), benefits were found for night waking, sleep efficiency (subjective/actigraphically measured), and sleep onset latency (mean SMD = 0.49-0.97). Those with attention-deficit/hyperactivity disorder (ADHD) improved in bedtime resistance, night waking, parasomnias, sleep anxiety, ADHD symptoms, sleep disturbance, and quality of life (mean SMD = 0.18-0.49). For those with autism, sleep disturbance improved (mean SMD = 0.70). However, all findings were of low to very low certainty of evidence. CONCLUSION Among nonpharmacological interventions for sleep difficulties in youth, only behavioral interventions are supported by meta-analytic evidence, yet with small-to-moderate effect sizes and limited certainty of evidence. PLAIN LANGUAGE SUMMARY This "umbrella review" (a review of reviews) analyzed 93 systematic reviews and meta-analyses of randomized controlled trials examining nonmedication sleep interventions for children and adolescents. The authors found that behavioral interventions, including parent training and psychoeducation, had positive effects on sleep issues like night waking, with effect sizes ranging from small to moderate. Improvements were also seen in children with ADHD and autism. However, the quality of the evidence for these benefits was rated as low to very low. This suggests that while behavioral approaches may help, more robust evidence is needed to confirm their benefits. STUDY PREREGISTRATION INFORMATION The efficacy and tolerability of nonpharmacological interventions for sleep problems in children and adolescents: protocol for an umbrella review of systematic reviews and meta-analyses of randomised controlled trials. https://osf.io; j9qna/.
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Affiliation(s)
| | - Corentin J Gosling
- University of Southampton, Southampton, United Kingdom; Université Paris Nanterre, DysCo Lab, Nanterre, France; Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt, France
| | - Lucie Jurek
- University of Southampton, Southampton, United Kingdom
| | - Mikail Nourredine
- University of Southampton, Southampton, United Kingdom; Service de biostatistiques de Lyon, Hospices Civil de Lyon, Lyon, France
| | - Laurence Telesia
- Laboratoire de biométrie et biologie évolutive UMR CNRS 5558, Lyon, France; King's College London, United Kingdom
| | - Marco Solmi
- University of Ottawa, Ontario, Canada; Charité Universitätsmedizin, Berlin, Germany
| | - Isabel Butt
- University of Southampton, Southampton, United Kingdom
| | | | - Ingrid Muller
- University of Southampton, Southampton, United Kingdom
| | - Catherine M Hill
- University of Southampton, Southampton, United Kingdom; University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Samuele Cortese
- University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; Hassenfeld Children's Hospital at NYU Langone, New York University, New York City, New York, USA; University of Bari "Aldo Moro", Bari, Italy
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Higgs S, Aarts K, Adan RAH, Buitelaar JK, Cirulli F, Cryan JF, Dickson SL, Korosi A, van der Beek EM, Dye L. Policy Actions Required to Improve Nutrition for Brain Health. Nutr Rev 2025; 83:586-592. [PMID: 39471498 DOI: 10.1093/nutrit/nuae160] [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] [Indexed: 11/01/2024] Open
Abstract
Brain health is a pressing global concern. Poor diet quality is a recognized major environmental risk factor for brain disorders and one of the few that is modifiable. There is substantial evidence that nutrition impacts brain development and brain health across the life course. So why then is the full potential of nutrition not utilized to improve brain function? This commentary, which is based on discussions of the European Brain Research Area BRAINFOOD cluster, aims to highlight the most urgent research priorities concerning the evidence base in the area of nutrition and brain health and identifies 3 major issues that need to be addressed: (1) increase causal and mechanistic evidence on the link between nutrition and brain health, (2) produce effective messages/education concerning the role of food for brain health, and (3) provide funding to support collaborative working across diverse stakeholders.
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Affiliation(s)
- Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham B152TT, United Kingdom
| | | | - Roger A H Adan
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht 3584 CG, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen 6500HB, The Netherlands
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome 00161, Italy
| | - John F Cryan
- Department of Anatomy & Neuroscience and APC Microbiome Ireland, University College Cork, Cork T12YT20, Ireland
| | - Suzanne L Dickson
- European Brain Council, Brussels 1000, Belgium
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg 41135, Sweden
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, Center for Neuroscience, Brain Plasticity Group, University of Amsterdam, Amsterdam 1090, The Netherlands
| | - Eline M van der Beek
- Department of Pediatrics, University Medical Centre Groningen, University of Groningen, Groningen 9700, The Netherlands
| | - Louise Dye
- Institute for Sustainable Food, School of Psychology, University of Sheffield, Sheffield S1 4DP, United Kingdom
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Lunsford-Avery JR, Wu JQ, French A, Davis NO. Topical review: sleep regulation as a novel target for treating preschool-aged children with attention-deficit/hyperactivity disorder symptoms. J Pediatr Psychol 2025; 50:266-271. [PMID: 39774675 PMCID: PMC11981054 DOI: 10.1093/jpepsy/jsae107] [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: 07/17/2024] [Revised: 12/04/2024] [Accepted: 12/08/2024] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVE Elevated attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers are a risk factor for poorer psychiatric health, cognitive deficits, and social and academic impairment across the lifespan. The first-line treatment for these preschoolers, behavioral parent training (BPT), reduces children's disruptive behaviors and parenting stress, yet its impact on core ADHD symptoms is inconsistent. Early interventions targeting biological mechanisms linked to core ADHD pathophysiology are critically needed. METHODS This topical review explores sleep dysregulation as a potential key target for early intervention for ADHD symptoms among preschoolers. RESULTS Sleep dysregulation is common in school-aged children with ADHD, and treating sleep improves core ADHD symptoms in older children. Cross-sectional and prospective research with preschoolers offers compelling evidence that sleep dysregulation and ADHD symptoms are closely linked over the course of early development. BPT and behavioral sleep medicine (BSM) interventions share an underlying theoretical framework and could be streamlined to target sleep in addition to daytime behaviors. CONCLUSIONS Novel early interventions targeting underlying biological mechanisms linked to core ADHD pathophysiology are critically needed to improve the trajectories of ADHD symptoms, comorbidity, and functional deficits for preschoolers with elevated ADHD symptoms. Sleep regulation is a promising mechanistic treatment target for this population, and future interventions may draw from the shared behavioral principles of BPT and BSM to target behaviors across the 24-hr period and employ scalable formats to optimize the number of families who can benefit from parent-based interventions targeting ADHD symptoms and sleep in early development.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Jade Q Wu
- Behavioral Sleep Medicine Program, Durham VA Medical Center, Durham, NC, United States
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Naomi O Davis
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Psyllou C, Luman M, van den Hoofdakker BJ, Van der Oord S, Aghebati A, Boyer B, Buitelaar J, Chronis-Tuscano A, Daley D, Dekkers TJ, DuPaul GJ, Fabiano GA, Ferrin M, Franke N, Tsahor NG, Harvey E, Hennig T, Herbert S, Hoekstra PJ, Kern L, Mautone JA, Mikami AY, Normand S, Pfiffner LJ, Shimabukuro S, Schramm SA, Schweitzer JB, Sibley MH, Sonuga-Barke E, Thompson C, Thompson MJ, Tripp G, Webster-Stratton C, Xie Y, Leijten P, Groenman AP. Research Review: Mechanisms of change and between-family differences in parenting interventions for children with ADHD - an individual participant data meta-analysis. J Child Psychol Psychiatry 2025. [PMID: 39910778 DOI: 10.1111/jcpp.14120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2024] [Indexed: 02/07/2025]
Abstract
BACKGROUND Understanding the mechanisms of change and between-family differences in behavioural parenting interventions for children with attention-deficit/hyperactivity disorder (ADHD) may help personalise interventions. Therefore, we examined whether improvements in parenting are associated with changes in child behaviour and functional outcomes, and how these associations vary based on parents' baseline parenting levels. METHODS We collected individual participant data including 19 randomised controlled trials focusing on children with ADHD (n = 1,720). Immediate post-intervention measures of child ADHD and oppositional behaviour severity, reported by parents and functional impairment reported by either the parent or probably masked clinicians, were treated as outcomes. We estimated pathways from intervention (vs. control) to child outcomes, via immediate post-intervention parent reports of constructive parenting (e.g. praise), non-constructive parenting (e.g. physical punishment) and parent-child affection (e.g. warmth), while controlling for baseline values of both child outcomes and parenting levels. Baseline values of each parenting variable were used as moderators of the mediated pathways. RESULTS Improvements in parenting behaviours and parent-child affection immediately following the intervention jointly explained concurrent improvements in children's ADHD severity, oppositional behaviour and functional impairment. Furthermore, when reversing the direction of the pathways, improvements in all child outcomes jointly explained improvements in each aspect of parenting. Improvements in non-constructive parenting and parent-child affection uniquely accounted for intervention effects on functional impairment, especially for families with higher baseline levels of non-constructive parenting. CONCLUSIONS Our findings might indicate that improvements in both the behavioural and affective aspects of parenting are associated with concurrent reductions in child behaviour problems and functional impairment. However, more research is necessary to explore the potential causal directionality between parenting and child outcomes. Nonetheless, supporting families with poorer parenting skills may be especially important, as reductions in non-constructive parenting in these families are linked to stronger treatment effects on child functional impairment.
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Affiliation(s)
- Constantina Psyllou
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Neuro and Developmental Psychology, Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Barbara J van den Hoofdakker
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Saskia Van der Oord
- Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Asma Aghebati
- School of Behavioural Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Bianca Boyer
- Developmental & Educational Psychology, Leiden University, Leiden, The Netherlands
- Praktijk Kuin, Haarlem, The Netherlands
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboudumc, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | | | - David Daley
- NTU Psychology, School of Social Science, Nottingham Trent University, Nottingham, UK
| | - Tycho J Dekkers
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers (AUMC), Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - George J DuPaul
- Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA
| | - Gregory A Fabiano
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Maite Ferrin
- Department of Child and Adolescent Mental Health, Barnet Enfield and Haringey NHS Trust, London, UK
| | - Nike Franke
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Elizabeth Harvey
- Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Timo Hennig
- Department of Inclusive Education, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Sharonne Herbert
- Department of Advocacy and Public Policy, Children's Hospital of Orange County, Orange, CA, USA
| | - Pieter J Hoekstra
- Accare Child Study Center, Groningen, The Netherlands
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lee Kern
- Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA
| | - Jennifer A Mautone
- Department of Child & Adolescent Psychiatry & Behavioural Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Amori Yee Mikami
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Sébastien Normand
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Institut du Savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada
| | - Linda J Pfiffner
- Department of Psychiatry and Behavioural Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Shizuka Shimabukuro
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology (OIST) Graduate University, Okinawa, Japan
| | - Satyam Antonio Schramm
- Department of Inclusive Education, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioural Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Margaret H Sibley
- Department of Psychiatry & Behavioural Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Edmund Sonuga-Barke
- Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, China
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
| | | | | | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology (OIST) Graduate University, Okinawa, Japan
| | - Carolyn Webster-Stratton
- Department of Psychiatry & Behavioural Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Yuhuan Xie
- Specialty Mental Health Program of Asian Health Service, Oakland, California, USA
| | - Patty Leijten
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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Dos Santos RM, Marinho V, de Araújo Val SN, Teles AS, Sousa DL, do Vale Bastos VH, de Souza LP, de Sousa AKC, de Moraes GSF, Teixeira S. Breaking boundaries: A systematic review of the application of non-invasive brain stimulation symptoms and sleep parameters in people with ADHD. Int J Dev Neurosci 2025; 85:e10401. [PMID: 39658854 DOI: 10.1002/jdn.10401] [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: 09/23/2024] [Revised: 11/14/2024] [Accepted: 11/22/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Studies of non-invasive treatments such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) can contribute in an alternative way to the symptoms treatment and changes in sleep patterns in attention deficit hyperactivity disorder (ADHD), due to some scientific evidence of action on cognition and clinical characteristics. AIM The aim of this systematic review was to evaluate studies of non-invasive brain stimulation using rTMS and tDCS on symptoms and sleep parameters in people with ADHD, in order to synthesize the main findings on intervention effects. METHODOLOGY A systematic review was carried out using the PRISMA protocol in the PubMed/Medline, Embase, PsycInfo, CINAHL, PEDro and Central-Cochrane library databases were initially carried out on 14 March 2024 and repeated until September 2024. Randomized clinical trials evaluating the effect of rTMS and tDCS on symptoms and changes in sleep pattern in people with ADHD were included. Primary outcomes were total severity of ADHD symptoms and sleep quality assessed by questionnaires and instrument measures. RESULTS The review evidenced only positive findings in five studies for tDCS in some cognitive functions, ADHD symptoms and improvement in sleep parameters, being results with reduced efficacy due to the high heterogeneity in the experimental protocols. CONCLUSION The findings show limited evidence; however, it is suggested that the combined use of non-invasive stimulation with other approaches, such as cognitive training, may improve the intervention effect. It is also important to consider limitations such as heterogeneity in clinical protocols, selection of participants with ADHD, including dosage and frequency. These factors should be explored in future research to optimize the application of these therapies.
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Affiliation(s)
- Renato Mendes Dos Santos
- Neuroinnovation Technology & Brain Mapping Laboratory (NITLab), Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- Graduate Program in Biotechnology, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
| | - Victor Marinho
- Neuroinnovation Technology & Brain Mapping Laboratory (NITLab), Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- The Northeast Biotechnology Network, Federal University of Piauí (UFPI), Teresina, Piauí, Brazil
- Laboratory of Brain Mapping and Functionality, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
| | - Sabrina Nayara de Araújo Val
- Neuroinnovation Technology & Brain Mapping Laboratory (NITLab), Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- Graduate Program in Biotechnology, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- Laboratory of Brain Mapping and Functionality, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
| | - Ariel Soares Teles
- Neuroinnovation Technology & Brain Mapping Laboratory (NITLab), Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
| | - Daniel Lima Sousa
- Neuroinnovation Technology & Brain Mapping Laboratory (NITLab), Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- Graduate Program in Biotechnology, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
| | - Victor Hugo do Vale Bastos
- Laboratory of Brain Mapping and Functionality, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
| | - Leonardo Peres de Souza
- Laboratory of Histological Analysis and Preparation, Federal University of Delta do Parnaíba (UFDPar), Parnaiba, Piauí, Brazil
| | | | | | - Silmar Teixeira
- Neuroinnovation Technology & Brain Mapping Laboratory (NITLab), Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- Graduate Program in Biotechnology, Federal University of Delta do Parnaíba (UFDPar), Parnaíba, Piauí, Brazil
- The Northeast Biotechnology Network, Federal University of Piauí (UFPI), Teresina, Piauí, Brazil
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Westwood SJ, Aggensteiner PM, Kaiser A, Nagy P, Donno F, Merkl D, Balia C, Goujon A, Bousquet E, Capodiferro AM, Derks L, Purper-Ouakil D, Carucci S, Holtmann M, Brandeis D, Cortese S, Sonuga-Barke EJS. Neurofeedback for Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2025; 82:118-129. [PMID: 39661381 PMCID: PMC11800020 DOI: 10.1001/jamapsychiatry.2024.3702] [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: 05/03/2024] [Accepted: 09/12/2024] [Indexed: 12/12/2024]
Abstract
Importance Neurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear. Objective To conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes. Data Sources PubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits. Study Selection Parallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included. Data Extraction and Synthesis Standardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes. Main Outcomes and Measures The primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0. Results A total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, -0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate. Conclusions and Relevance Overall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.
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Affiliation(s)
- Samuel J. Westwood
- Department of Psychology, Institute of Psychiatry, Psychology, Neuroscience, King’s College London, London, United Kingdom
| | - Pascal-M. Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Anna Kaiser
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Peter Nagy
- Bethesda Children’s Hospital, Budapest, Hungary
| | - Federica Donno
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, A. Cao Paediatric Hospital, Cagliari, Italy
| | - Dóra Merkl
- Bethesda Children’s Hospital, Budapest, Hungary
| | - Carla Balia
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, A. Cao Paediatric Hospital, Cagliari, Italy
| | - Allison Goujon
- Unit of Child and Adolescent Psychiatry, Hospital Center University Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Elisa Bousquet
- Unit of Child and Adolescent Psychiatry, Hospital Center University Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Agata Maria Capodiferro
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, A. Cao Paediatric Hospital, Cagliari, Italy
| | - Laura Derks
- Department for Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Landeswohlfahrtsverband Westfalen-Lippe University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Diane Purper-Ouakil
- Unit of Child and Adolescent Psychiatry, Hospital Center University Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- National Institute of Health and Medical Research Centre for Research in Epidemiology and Population Health, Psychiatry Development and Trajectories, Villejuif, France
| | - Sara Carucci
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatry Unit, A. Cao Paediatric Hospital, Cagliari, Italy
| | - Martin Holtmann
- Department for Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Landeswohlfahrtsverband Westfalen-Lippe University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Samuele Cortese
- Hassenfeld Children’s Hospital at New York University Langone, New York University Child Center, New York
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Solent National Health Service Trust, Southampton, United Kingdom
- Department of Precision and Regenerative Medicine-Jonic Area, University of Bari Aldo Moro, Baro, Italy
| | - Edmund J. S. Sonuga-Barke
- Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Yang X, Zhang L, Yu J, Wang M. Short-term and long-term effect of non-pharmacotherapy for adults with ADHD: a systematic review and network meta-analysis. Front Psychiatry 2025; 16:1516878. [PMID: 39958157 PMCID: PMC11825462 DOI: 10.3389/fpsyt.2025.1516878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 01/07/2025] [Indexed: 02/18/2025] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) is a lifelong neurodevelopmental condition with a global prevalence of 2.5% to 6.7% among adults. Non-pharmacological interventions have demonstrated effectiveness both as standalone treatments and adjuncts to pharmacotherapy in managing adult ADHD. Nevertheless, the comparative efficacy of these interventions, particularly with respect to diverse ADHD-related outcomes and their long-term impacts, remains insufficiently investigated. Objective This study aims to evaluate and compare the short-term and long-term effects of various non-pharmacological therapies on core ADHD symptoms (inattention, hyperactivity, and impulsivity) and emotional disorders (depression and anxiety) in adults with ADHD and to rank these therapies accordingly. Methods A systematic search was conducted for relevant randomized controlled trials (RCTs) in the Web of Science, PubMed, Cochrane Library, and EMBASE databases from inception to Sep 2024. Researchers independently screened and extracted data, and the analysis was performed using R version 4.3.2. Cochrane Risk of Bias tool version 2 (ROB2) and Confidence in Network Meta-Analysis (CINeMA) were used to assess the risk of bias and the certainty of the evidence. Standardized mean differences were estimated using network meta-analyses with random effects. Results A total of 37 RCTs involving 2,289 participants and 10 non-pharmacological therapies were included. The risk of bias was classified as low in 24.3%, unclear in 27%, and high in 48.6%, while the CINeMA assessment indicated that confidence in the evidence was "very low" or "low" for most of the remaining treatments. Cognitive behavioral therapy (CBT) showed significantly greater effectiveness than the control group/condition in both the short-term (SMD: -4.43, 95%CI: -5.50 to -3.37) and long-term (SMD: -3.61, 95%CI: -4.66 to -2.56) core symptoms. Additionally, CBT shows both short-term and long-term efficacy for depression (SMD: -4.16, 95%CI: -5.51 to -2.81; SMD: -3.89, 95%CI: -5.95 to -1.83) and anxiety (SMD: -2.12, 95%CI: -3.18 to -1.07; SMD: -7.25, 95%CI: -10.57 to -3.94). Conclusion CBT may be the most effective intervention for adults with ADHD and associated emotional disorders, while Mindfulness-based Cognitive Therapy (MC) is recommended as a preferable option for those without comorbidities. Caution is needed in interpreting our results, and high-quality RCTs are urgently required for more reliable insights. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42024432912.
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Affiliation(s)
- Xinyue Yang
- College of Sports Science, Shenyang Normal University, Shenyang, China
| | - Lin Zhang
- Department of Rehabilitation, West China Hospital Sichuan University Jintang Hospital, Chengdu, China
| | - Jing Yu
- College of Sports Science, Shenyang Normal University, Shenyang, China
| | - Meng Wang
- College of Sports Science, Shenyang Normal University, Shenyang, China
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Chen SC, Wu TMS, Li H, Shou JW, Qin J, Wu GT, Cheng WY, Yeung WF. Parental Perspectives on Eating Disorders of Their School-Age Children with ADHD in Hong Kong: A Qualitative Study. Nutrients 2025; 17:513. [PMID: 39940371 PMCID: PMC11820254 DOI: 10.3390/nu17030513] [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: 01/09/2025] [Revised: 01/28/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Children with attention deficit hyperactivity disorder (ADHD) frequently encounter eating problems. However, qualitative research on the eating problems of these children and the strategies employed by their parents to manage these issues remains limited. This study aimed to explore the eating problems of school-age children with ADHD and the coping strategies used by parents in urban settings like Hong Kong. Methods: A descriptive qualitative design was utilized, employing semi-structured focus group interviews. Purposive sampling was used to recruit 12 parents who voluntarily participated in five focus group sessions. The interviews were conducted in Cantonese, audio-recorded, and transcribed verbatim. Data were analyzed using template thematic analysis to identify key themes and subthemes. Results: Two major themes emerged: challenges affecting ADHD children's eating behaviors and parental coping strategies in Hong Kong. Children's eating difficulties stemmed from ADHD-specific behaviors, compounded by Hong Kong's demanding educational system and urban environmental constraints. In response, parents developed multifaceted coping approaches, ranging from dietary modifications and behavioral management strategies to healthcare resource utilization, while adapting their urban lifestyle to accommodate their children's needs. Conclusions: Children with ADHD face eating challenges that intersect with Hong Kong's sociocultural environment, where educational pressure, limited living spaces, and parents' work schedules influence their eating patterns. Parents adopt integrated Eastern-Western approaches, supported by Hong Kong's comprehensive healthcare resources spanning professional networks and community programs. Evidence-based dietary guidelines are essential to address ADHD-related nutritional misconceptions.
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Affiliation(s)
- Shu-Cheng Chen
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (S.-C.C.)
| | - To Ming Stanley Wu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Han Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jia-Wen Shou
- Li Dak Sum Yip Yio Chin R&D Centre for Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jing Qin
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; (S.-C.C.)
| | - Guo-Tao Wu
- Psychology Department, Southwest University, Chongqing 400715, China
| | - Wai-Yin Cheng
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
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12
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Martin-Moratinos M, Bella-Fernández M, Rodrigo-Yanguas M, González-Tardón C, Li C, Wang P, Royuela A, Lopez-Garcia P, Blasco-Fontecilla H. Effectiveness of a Virtual Reality Serious Video Game (The Secret Trail of Moon) for Emotional Regulation in Children With Attention-Deficit/Hyperactivity Disorder: Randomized Clinical Trial. JMIR Serious Games 2025; 13:e59124. [PMID: 39773848 PMCID: PMC11754979 DOI: 10.2196/59124] [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: 04/02/2024] [Revised: 10/09/2024] [Accepted: 10/25/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Difficulties in emotional regulation are often observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. The Secret Trail of Moon (MOON) is a serious video game developed by a multidisciplinary team featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire. OBJECTIVE We hypothesize that patients with ADHD using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group; additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to the web) will not affect emotional regulation scores; and (6) the video game will not cause any clinically significant side effects. METHODS This was a prospective, unicentric, randomized, unblinded, pre- and postintervention study with block-randomized sequence masking. Participants included individuals aged between 7 and 18 years who had a clinical diagnosis of ADHD and were receiving pharmacological treatment. They were randomized into 2 groups using an electronic case report form: the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game, and the control group, receiving standard pharmacological treatment. We provided both the groups with psychoeducational support on ADHD. Analysis was conducted using the Student 2-tailed t test and 2-factor ANOVA. An independent monitor supervised the study. RESULTS A total of 76 patients with ADHD participated in the trial, with an equal randomization (MOON: n=38, 50% and control: n=38, 50%) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global Strengths and Difficulties Questionnaire score, was not met. However, significant improvements were observed in material organization (P=.03), working memory (P=.04), and inhibition (P=.05), particularly among patients more engaged with the MOON treatment. CONCLUSIONS Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD. TRIAL REGISTRATION ClinicalTrials.gov NCT06006871; https://clinicaltrials.gov/study/NCT06006871. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/53191.
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Affiliation(s)
- Marina Martin-Moratinos
- Department of Psychiatry, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia de Arana University Hospital (IDIPHISA), Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Marcos Bella-Fernández
- Department of Psychiatry, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia de Arana University Hospital (IDIPHISA), Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Faculty of Psychology, Autonoma University of Madrid, Madrid, Spain
- Department of Psychology, Pontifical University of Comillas, Madrid, Spain
- Faculty of Health, International Business University, Madrid, Spain
| | | | | | - Chao Li
- Department of Psychiatry, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia de Arana University Hospital (IDIPHISA), Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Ping Wang
- Department of Psychiatry, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia de Arana University Hospital (IDIPHISA), Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
- Sichuan Provincial Center for Mental Health, University of Electronic Science and Technology of China, Chengdu, China
| | - Ana Royuela
- Clinical Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Consortium for Biomedical Research Network in Epidemiology and Public Health, Madrid, Spain
| | - Pilar Lopez-Garcia
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
- Spain Biomedical Research Networking Center for Mental Health Network, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Spain Biomedical Research Networking Center for Mental Health Network, Madrid, Spain
- Health Sciences and School of Doctoral Programs, International University of La Rioja, Logroño, Spain
- Emooti, Institute for Mental Health and Wellness, Madrid, Spain
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13
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Berchio C, Kumar SS, Narzisi A, Fabbri-Destro M. EEG Microstates in the Study of Attention-Deficit Hyperactivity Disorder: A Review of Preliminary Evidence. Psychophysiology 2025; 62:e14762. [PMID: 39775802 DOI: 10.1111/psyp.14762] [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: 10/24/2024] [Revised: 12/22/2024] [Accepted: 12/24/2024] [Indexed: 01/11/2025]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurobiological condition that affects both children and adults. Microstate (MS) analyses, a data-driven approach that identifies stable patterns in EEG signals, offer valuable insights into the neurophysiological characteristics of ADHD. This review summarizes findings from 13 studies that applied MS analyses to resting-state and task-based brain activity in individuals with ADHD. Relevant research articles were retrieved from electronic databases, including PubMed, Google Scholar, Web of Science, PsychInfo, and Scopus. The reviewed studies applied MS analyses to explore brain activity differences in ADHD populations. Resting-state studies consistently reported alterations in MS organization, with increased duration (MS-D) and changes in temporal dynamics (MS-C), potentially reflecting executive dysfunctions and delayed maturation of the default mode network. Additionally, MS B demonstrated promise in distinguishing between ADHD subtypes based on differences in visual network function. Task-based and event-related potential (ERP) studies, using paradigms like the continuous performance task (CPT) or Go-NoGo Task, identified MS abnormalities (i.e., N2, P2, P3, CNV) linked to inhibition and attentional resource allocation. Preliminary evidence suggests that MS analyses hold potential for distinguishing individuals with ADHD from control groups. The integration of machine learning techniques holds promise for improving diagnostic accuracy and identifying ADHD subtypes, while MS analyses may also help monitor the effects of stimulant medications like methylphenidate by tracking neurophysiological changes. However, this review highlights the need for more standardized methodologies to enhance the generalizability and replicability of findings. These efforts will ultimately contribute to a deeper understanding of the neurobiological mechanisms that underlie ADHD.
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Affiliation(s)
- Cristina Berchio
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Samika S Kumar
- Department of Psychology, University of Cambridge, Cambridge, UK
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Antonio Narzisi
- Department of Child Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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14
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Sibley MH, Flores S, Murphy M, Basu H, Stein MA, Evans SW, Zhao X, Manzano M, van Dreel S. Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature. J Child Psychol Psychiatry 2025; 66:132-149. [PMID: 39370392 DOI: 10.1111/jcpp.14056] [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] [Accepted: 07/05/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered. METHOD We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots. RESULTS Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment. CONCLUSIONS The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.
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Affiliation(s)
- Margaret H Sibley
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Hana Basu
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Mark A Stein
- University of Washington School of Medicine, Seattle, WA, USA
| | - Steven W Evans
- Center for Intervention Research in Schools, Ohio University, Athens, OH, USA
| | - Xin Zhao
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
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15
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Peng J, Wang W, Wang Y, Hu F, Jia M. Effects of mind-body exercise on individuals with ADHD: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1490708. [PMID: 39717371 PMCID: PMC11663905 DOI: 10.3389/fpsyt.2024.1490708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 11/19/2024] [Indexed: 12/25/2024] Open
Abstract
Objective To explore the effects of mind-body exercise (MBE) on ADHD through a systematic review and meta-analysis. Methods After identifying relevant search keywords based on the study's technical terminology, research articles were retrieved from five databases. Two researchers independently screened the results to select studies that met the inclusion criteria. A random-effects model was used to conduct a meta-analysis on the included studies. Results The findings indicate that MBE interventions significantly improved attention in individuals with ADHD [SMD=-0.97, 95% CI (-1.56, -0.39), P < 0.05]. However, the meta-analysis found no evidence that MBE improved executive function, emotional issues, or hyperactivity/impulsivity in ADHD patients. Conclusions MBE is beneficial for attention improvement in ADHD patients. However, further evidence is needed to support its efficacy as an adjunctive treatment for other symptoms. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42023447510.
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Affiliation(s)
- Jin Peng
- Department of Physical Education, Dong-A University, Busan, Republic of Korea
| | - Weiran Wang
- Department of Physical Education, Dong-A University, Busan, Republic of Korea
| | - Yiting Wang
- Department of Physical Education, College of Art and Physical Education, Hanyang University, Seoul, Republic of Korea
| | - Fengting Hu
- Department of Physical Education, Dong-A University, Busan, Republic of Korea
| | - Mingyuan Jia
- Department of Physical Education, Dong-A University, Busan, Republic of Korea
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Zheng Q, Kei KTL, Chiu KY, Shum KKM. Study protocol of a randomised controlled trial of the effects of near-infrared spectroscopy neurofeedback training coupled with virtual reality technology in children with ADHD. BMJ Open 2024; 14:e093183. [PMID: 39645257 PMCID: PMC11629003 DOI: 10.1136/bmjopen-2024-093183] [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: 09/02/2024] [Accepted: 11/19/2024] [Indexed: 12/09/2024] Open
Abstract
BACKGROUND The rise in the number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) highlights the need for effective interventions targeting attentional control. Although recent research has demonstrated the potential of neurofeedback training (NFT) for children with ADHD, most studies have been conducted in laboratory settings, raising questions about their real-world applicability. To address this issue, virtual reality (VR) may offer a solution to the ecological validity challenges encountered in NFT. By coupling NFT with VR, individuals can engage in self-regulating brain activity within a simulated, realistic environment. This study aims to investigate the efficacy of near-infrared spectroscopy (NIRS)-based NFT combined with VR in alleviating ADHD symptoms among children, addressing the need for interventions with practical relevance and effectiveness. METHODS This study aims to recruit 138 children aged 7-12 diagnosed with ADHD. Following baseline assessment, participants will be randomly assigned to one of three conditions: (1) NIRS-based NFT in a VR classroom setting; (2) conventional computerised cognitive training (active control) or (3) a waitlist control group. On completion of intervention sessions in the two training groups, all groups will undergo an assessment at time 2, with a follow-up assessment scheduled 2 months post-training for all participants. Primary outcomes will include measures of executive function, such as attentional control, response inhibition and working memory, along with changes in oxygenated and deoxygenated haemoglobin levels monitored by functional NIRS. Secondary outcome measures will comprise ratings of children's ADHD symptoms and executive function behaviours in daily life, reported by parents and teachers. DISCUSSION The three-arm randomised controlled trial will address research gaps regarding the effectiveness of NIRS-based NFT for children with ADHD, particularly when integrated with immersive VR technology. By combining NFT and VR, this study aims to simulate a real-world environment, potentially amplifying intervention effects. The findings from the study will provide evidence for the efficacy of this innovative intervention in improving executive function and alleviating ADHD symptoms. ETHICS AND DISSEMINATION Ethical approval was obtained from the Human Research Ethics Committee at the University of Hong Kong (Reference: EA200247). Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT05906485.
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Affiliation(s)
- Que Zheng
- Department of Psychology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ka Yu Chiu
- Department of Psychology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kathy Kar-man Shum
- Department of Psychology, The University of Hong Kong, Hong Kong, Hong Kong
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17
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Tost G, Srikanth P, Bruton A, Hatsu IE, Leung BM, Ast HK, Eiterman LP, Robinette LM, Williams C, Gracious B, Eugene Arnold L, Johnstone JM. Problems most concerning to parents of children with ADHD and emotional dysregulation in a randomized controlled trial of multinutrients: MADDY secondary analysis. Eur Child Adolesc Psychiatry 2024; 33:4335-4347. [PMID: 38819662 PMCID: PMC11607173 DOI: 10.1007/s00787-024-02463-1] [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: 06/09/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE With dual focus on structured, objective quantification of parent observations of child's behavior and identifying behaviors most amenable to change, this report examines Parent Target Problems (PTP) as a secondary outcome in a randomized clinical trial (RCT) of children with attention-deficit/ hyperactivity disorder (ADHD) in which one primary outcome, Clinical Global Impression-Improvement, showed a significant advantage of multinutrients over placebo and the other, Likert-type parent ratings, showed significant improvement in both groups, without significant difference between them. METHOD In a multisite 8-week RCT of broad-spectrum micronutrients ("multinutrients"), parents of children ages 6-12 (N = 126, 73% male, 88% white) with ADHD and emotional dysregulation nominated their child's most concerning problem(s) at baseline and quantified them by frequency, duration, impairment, and consequences. At subsequent visits, parents re-quantified the problem(s). Blinded child psychiatrists independently reviewed the PTPs and rated change at two timepoints compared to baseline. PTPs were grouped into 9 categories. Mean ratings were compared between active and placebo groups and explored by category. RESULTS By week 8, a significant separation favored multinutrients: 38% of the multinutrient group were "definitely improved" or better, compared to 25% of the placebo group, and ratings of "no change" or "worse" occurred in 35% with placebo versus 23% with multinutrients (p = 0.04). Inattention (72.2%) and emotional dysregulation (69.1%) were the most frequently reported PTP categories. Inattention and internalizing symptoms improved more with multinutrients than placebo (p = 0.01, d = 0.55; p = 0.03, d = 0.80, respectively). The multinutrient advantage was not significant for 7 other symptoms, including hyperactivity/impulsivity, aggression, autistic symptoms, or emotional dysregulation/irritable oppositionality. CONCLUSIONS This secondary analysis found that the multinutrients, compared to placebo, were associated with improvements in parental concerns overall, and in two domains specifically: inattention and internalizing symptoms (anxiety/depression), but not in seven domains: hyperactivity/impulsivity, aggression, autistic symptoms or physiological symptoms, peer relationships or emotional dysregulation/irritable oppositionality.
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Affiliation(s)
- Gabriella Tost
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | - Priya Srikanth
- OHSU-Portland State University School of Public Health, Portland, Oregon, United States
| | - Alisha Bruton
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | - Irene E Hatsu
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
- The Ohio State University, Columbus, Ohio, United States
| | | | - Hayleigh K Ast
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | | | | | - Craig Williams
- The Ohio State University, Columbus, Ohio, United States
| | - Barbara Gracious
- The Ohio State University, Columbus, Ohio, United States
- Orange Park Medical Center, Florida, Florida, United States
- Edward Via College of Osteopathic Medicine, Auburn, Alabama, United States
| | | | - Jeanette M Johnstone
- National University of Natural Medicine, Helfgott Research Institute, Portland, Oregon, United States.
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18
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Trinczer IL, Shalev L. Computerised Attention Functions Training Versus Computerised Executive Functions Training for Children with Attention Deficit/Hyperactivity Disorder: A Randomised Controlled Trial. J Clin Med 2024; 13:7239. [PMID: 39685698 DOI: 10.3390/jcm13237239] [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] [Received: 10/21/2024] [Revised: 11/20/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by deficits in attention, hyperactivity, and impulsivity. Current treatments, such as stimulant medication and behavioural therapy, ameliorate symptoms but do not address the core cognitive dysfunctions. This study aimed to investigate the effects of two computerised neurocognitive training programs, attention functions training and executive functions training, in children with ADHD. Methods: Eighty children with ADHD (ages 8-13) were randomly assigned to one of three groups: Attention functions training (AFT), targeting sustained, selective-spatial, orienting, and executive attention; executive functions training (EFT), focusing on working memory, cognitive flexibility, and problem solving; or a passive control group. Training sessions were administered in small groups twice a week for nine weeks. Participants underwent comprehensive assessments of attention (Continuous Performance Test, Conjunctive Visual Search Task), executive functions (Corsi Block-Tapping Tasks), nonverbal reasoning (Raven's Colored Progressive Matrices), parent-rated behavioural symptoms, and arithmetic performance at baseline, post-intervention, and follow-up. Results: The AFT group demonstrated significant improvements in sustained and selective-spatial attention, nonverbal reasoning, inattentive symptoms, and arithmetic performance, and most improvements persisted at follow-up. The EFT group showed gains in nonverbal reasoning and inattentive symptoms, although no improvements were documented in working memory or in parent ratings of executive functions. Conclusions: The AFT program that addressed core attentional functions in children with ADHD produced robust cognitive and behavioural benefits, whereas the EFT program yielded behavioural benefits and a limited improvement in executive functions. Future research should explore different training protocols for broader gains in executive functions. These findings support the potential of theory-driven, structured neurocognitive training targeting basic cognitive functions as an effective small-group intervention for ADHD.
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Affiliation(s)
- Inbar Lucia Trinczer
- Attention Lab, School of Education, Tel-Aviv University, Tel Aviv 67017, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv 67017, Israel
| | - Lilach Shalev
- Attention Lab, School of Education, Tel-Aviv University, Tel Aviv 67017, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv 67017, Israel
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19
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Haijen ECHM, Hurks PPM, Kuypers KPC. Self-rated costs and benefits of conventional and alternative adult ADHD treatments. Sci Rep 2024; 14:28046. [PMID: 39543226 PMCID: PMC11564691 DOI: 10.1038/s41598-024-79025-7] [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: 03/22/2024] [Accepted: 11/05/2024] [Indexed: 11/17/2024] Open
Abstract
Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments.
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Affiliation(s)
- E C H M Haijen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - P P M Hurks
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - K P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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20
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Bousquet E, Kerbage H, Purper-Ouakil D, Fongaro E. Experience of neurofeedback and methylphenidate in children with ADHD. L'ENCEPHALE 2024:S0013-7006(24)00202-1. [PMID: 39510871 DOI: 10.1016/j.encep.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 11/15/2024]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD is commonly treated with medication, such as methylphenidate, but some families and practitioners prefer psychosocial interventions as first line treatments. Many studies have investigated neurofeedback as a potential non-pharmacological treatment for ADHD yielding contradictory findings regarding its efficiency. Qualitative research on neurofeedback in ADHD is limited and can add valuable information on the acceptability and perceived efficacy among service users. This study aimed to explore the perceptions and experiences of children and adolescents with ADHD regarding the use of neurofeedback and methylphenidate. Eleven interviews with children and their parents explored their subjective experiences and perceived changes. Overall, neurofeedback was negatively experienced by those families: the intervention did not meet their expectations, and they reported minimal observed changes. The treatment with methylphenidate, however, was more manageable for families and was perceived to be more efficient despite its side effects.
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Affiliation(s)
- Elisa Bousquet
- Saint-Eloi Hospital, centre hospitalier universitaire de Montpellier, Hérault, France.
| | - Hala Kerbage
- Saint-Eloi Hospital, centre hospitalier universitaire de Montpellier, Hérault, France; CESP Inserm U 1018 UVSQ Psychiatry Development and Trajectories, Villejuif, France.
| | - Diane Purper-Ouakil
- Saint-Eloi Hospital, centre hospitalier universitaire de Montpellier, Hérault, France; CESP Inserm U 1018 UVSQ Psychiatry Development and Trajectories, Villejuif, France.
| | - Erica Fongaro
- Saint-Eloi Hospital, centre hospitalier universitaire de Montpellier, Hérault, France; CESP Inserm U 1018 UVSQ Psychiatry Development and Trajectories, Villejuif, France.
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21
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Lenartowicz A, DeSchepper B, Simpson GV. Training of Awareness in ADHD: Leveraging Metacognition. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2024; 9:e240006. [PMID: 39493272 PMCID: PMC11529823 DOI: 10.20900/jpbs.20240006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder that is prevalent in children and adults, with significant impact on life outcomes. Common treatment strategies include a combination of pharmacological and psychosocial interventions which have recognized limits to their effectiveness. Consequently, there exists interest in additional non-pharmacological interventions. In the current minireview we aim to complement existing surveys by focusing on a complementary approach, namely rooted in metacognition or the training of awareness. We review programs that incorporate metacognitive training of awareness in skill-training, psychosocial interventions, and mindfulness, and discuss existing assessments of metacognitive ability in ADHD. Existing data suggest that metacognitive approaches have potential in supporting symptom management in ADHD, with gains in objective assessments in near and far transfer tasks in educational research and high satisfaction from parents. Further research is warranted in assessment of the relative contribution of metacognitive elements relative to other treatment components, objective assessments of outcomes in psychosocial interventions, and efficacy in adult interventions.
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Affiliation(s)
- Agatha Lenartowicz
- Department of Psychiatry & Biobehavioral Sciences, OneMind Staglin Center for Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA
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22
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Pokorna N, Palmer M, Pearson O, Beckley-Hoelscher N, Shearer J, Kostyrka-Allchorne K, Robertson O, Koch M, Slovak P, Day C, Byford S, Waite P, Creswell C, Sonuga-Barke EJS, Goldsmith K. Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial. JMIR Pediatr Parent 2024; 7:e53864. [PMID: 39378100 PMCID: PMC11496916 DOI: 10.2196/53864] [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: 10/23/2023] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. OBJECTIVE This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up. METHODS This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. RESULTS Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. CONCLUSIONS This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. TRIAL REGISTRATION ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.
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Affiliation(s)
- Nikola Pokorna
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Melanie Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Oliver Pearson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - James Shearer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Katarzyna Kostyrka-Allchorne
- Department of Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom
| | - Olly Robertson
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Marta Koch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Petr Slovak
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Crispin Day
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Polly Waite
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Edmund J S Sonuga-Barke
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kimberley Goldsmith
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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23
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Ishii-Takahashi A, Hamada J, Yamaguchi R, Kawahara T, Mukai T, Gustavo S, Shaw P, Ashida S, Koehly L, Tsujimoto K, Yoshimaru Y, Kano Y. Efficacy of behavioural parent training on attachment security in children with attention deficit hyperactivity disorder: a randomised controlled trial. Trials 2024; 25:656. [PMID: 39367489 PMCID: PMC11451210 DOI: 10.1186/s13063-024-08431-z] [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: 08/09/2024] [Accepted: 08/27/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Behavioural parent training (BPT) is a psychosocial intervention designed for children with attention deficit hyperactivity disorder (ADHD). BPT programs teach parents to use effective commands or rules whilst encouraging them to pay careful attention to their child's appropriate behaviour. In this study, we will investigate the efficacy of BPT on parental stress, mothers' sense of emotional closeness to their children, and children's attachment security to their mothers. We will also examine the effects of BPT on children's internalising and externalising symptoms, ADHD symptoms, and sensitivity to rewards and punishments compared to usual care alone. The use of bias-prone assessment tools limits the ability of previous studies to assess effectiveness. Therefore, in this study, the child's attachment security will be assessed in a structured interview conducted by assessors blinded to group allocation, and brain changes will be assessed using magnetic resonance imaging. METHODS This randomised controlled clinical trial will aim to compare the efficacy of BPT to routine clinical care for 60 children with ADHD. Participants will be randomised, with stratification by medication status for ADHD (medicated or non-medicated). The BPT intervention group will receive parent training weekly for 10 weeks in a group of six or less. The primary outcome measure will be changes in parental stress. Furthermore, the key secondary outcome measure will be the child's attachment security, which will be assessed in an interview conducted by assessors blinded to group allocation. We will also evaluate changes in neural connectivity in both children and mothers using magnetic resonance imaging. Other secondary outcomes will include child behavioural problems, ADHD symptoms, emotional regulation, child sensitivity to rewards and punishments, parental behaviour, and the child and parent's social support network following the completion of 10 sessions. DISCUSSION This study represents the first randomised controlled trial exploring the efficacy of BPT on child attachment security and mothers' sense of emotional closeness to their children. It aims to provide robust evidence to assist parents of children with ADHD in making appropriate treatment decisions. TRIAL REGISTRATION UMIN000038693. Registered on November 9, 2019.
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Affiliation(s)
- Ayaka Ishii-Takahashi
- Department of Developmental Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
- Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan.
| | - Junko Hamada
- Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Rio Yamaguchi
- Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Takayo Mukai
- School of Arts and Sciences, The University of the Sacred Heart, Shibuya, Tokyo, Japan
| | - Sudre Gustavo
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philip Shaw
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Laura Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kengo Tsujimoto
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yuzu Yoshimaru
- Department of Developmental Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan
- Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Yukiko Kano
- Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
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24
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Caterfino A, Krishna S, Chen V. Novel and complementary treatment approaches in attention-deficit/hyperactivity disorder. Curr Opin Pediatr 2024; 36:562-569. [PMID: 38957089 DOI: 10.1097/mop.0000000000001378] [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] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder. RECENT FINDINGS The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks. SUMMARY There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.
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Affiliation(s)
- Andrew Caterfino
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Shruthi Krishna
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
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25
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Veronesi GF, Gabellone A, Tomlinson A, Solmi M, Correll CU, Cortese S. Treatments in the pipeline for attention-deficit/hyperactivity disorder (ADHD) in adults. Neurosci Biobehav Rev 2024; 163:105774. [PMID: 38914177 DOI: 10.1016/j.neubiorev.2024.105774] [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: 04/06/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024]
Abstract
To provide an overview of treatments in the pipeline for adults with attention-deficit/hyperactivity disorder (ADHD), we searched https://clinicaltrials.gov/and and https://www.clinicaltrialsregister.eu/ from 01/01/2010-10/18/2023 for ongoing or completed phase 2 or 3 randomised controlled trials (RCTs), assessing pharmacological or non-pharmacological interventions for adults with ADHD with no current regulatory approval. We found 90 eligible RCTs. Of these, 24 (27 %) reported results with statistical analysis for primary efficacy endpoints. While several pharmacological and non-pharmacological interventions had evidence of superiority compared to the control condition from a single RCT, centanafadine (norepinephrine, dopamine, and serotonin re-uptake inhibitor) was the only treatment with evidence of efficacy on ADHD core symptoms (small effect size=0.28-0.40) replicated in at least one additional RCT, alongside reasonable tolerability. Overall, the body of ongoing RCTs in adults with ADHD is insufficient, without any intervention on the horizon to match the efficacy of stimulant treatment or atomoxetine and with better tolerability profile. Additional effective and well tolerated treatments for adults with ADHD require development and testing.
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Affiliation(s)
| | - Alessandra Gabellone
- DiBraiN-Department of Translational Biomedicine Neurosciences, University of Bari "Aldo Moro", Bari, Italy
| | - Anneka Tomlinson
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; The Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; German Center for Mental Health (DZPG), partner site Berlin, Germany; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, 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, NY, USA; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy.
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Talib M, Rachdi M, Papazova A, Nicolis H. The Role of Dietary Patterns and Nutritional Supplements in the Management of Mental Disorders in Children and Adolescents: An Umbrella Review of Meta-Analyses: Le rôle des habitudes alimentaires et des suppléments nutritionnels dans la prise en charge des troubles mentaux chez les enfants et les adolescents : une méta-revue de méta-analyses. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:567-589. [PMID: 38689430 PMCID: PMC11298093 DOI: 10.1177/07067437241248070] [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: 05/02/2024]
Abstract
OBJECTIVE In recent years, the relationship between nutrition and mental health has gained considerable interest. We identified, synthesized, and appraised all meta--analyses of randomized controlled trials (RCTs) and observational studies reporting on the efficacy of dietary patterns and nutrient supplements in the prevention and treatment of mental disorders in children and adolescents. METHODS Systematic research in MEDLINE, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews was completed on 8 January 2024. RESULTS Our research found 24 meta-analyses: 14 on RCTs, 8 on observational studies, and 2 combining both. Emerging evidence suggests that omega-3, in particular eicosapentaenoic acid, and Vitamin D may have adjunctive benefits in the treatment of attention deficit hyperactivity disorder (ADHD), while no evidence was found for autism spectrum disorder (ASD). Observational data also indicated that prenatal folic acid supplementation (>400 μg daily) was associated with a reduced risk of ASD in offspring. In terms of dietary habits, several meta-analyses of observational data revealed that healthy dietary patterns (rich in fruits, vegetables, and fibre, low in saturated fats) during the prenatal period, childhood, and adolescence were linked to a significantly reduced risk of internalizing disorders and externalizing disorders. Conversely, unhealthy dietary habits (high in sugars, saturated animal fats, and industrial foods, low in fruits, vegetables, and fibre) are associated with an elevated risk of these mental health issues. However, the number of available studies on dietary interventions for the treatment of depression, ASD, and ADHD was limited, and the results obtained were either nonsignificant or contradictory. CONCLUSION Our findings emphasize the need to establish clear causal relationships between dietary habits and the risk of mental illness in children and adolescents. Moreover, further investigation of the benefits observed with some nutrient supplements (such as omega-3 and vitamin D for ADHD) through larger-scale RCTs is imperative to establish more robust conclusions.
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Affiliation(s)
- Maria Talib
- Child and Adolescent Psychiatry Department, Erasme Hospital, Brussels, Belgium
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Majda Rachdi
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anna Papazova
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hélène Nicolis
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Mental Health Service, Université Libre de Bruxelles, Brussels, Belgium
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Zimmermann-Rösner A, Prehn-Kristensen A. The Microbiome in Child and Adolescent Psychiatry. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:213-226. [PMID: 38240707 DOI: 10.1024/1422-4917/a000965] [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: 07/06/2024]
Abstract
Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.
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Affiliation(s)
| | - Alexander Prehn-Kristensen
- Institute for Child and Adolescent Psychiatry, Center of Integrative Psychiatry GmbH, Kiel, Germany
- Department of Psychology, Faculty of Human Sciences, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Hamburg, Germany
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Chacón-Candia JA, Ponce R, Marotta A. The reverse congruency effect elicited by eye-gaze as a function of attention-deficit/hyperactivity disorder symptoms. Front Psychol 2024; 15:1377379. [PMID: 38947900 PMCID: PMC11212038 DOI: 10.3389/fpsyg.2024.1377379] [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: 01/27/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Individuals diagnosed with attention deficit/hyperactivity disorder (ADHD) have been found to have impairments in multiple aspects of social cognition, thus including the attentional processing of socially relevant stimuli such as eye-gaze. However, to date, it remains unclear whether only the social-specific but not the domain-general directional components, elicited by eye-gaze are affected by ADHD symptomatology. To address this issue, the present study aimed to investigate the impact of ADHD-like traits on the social-specific attentional processing of eye-gaze. To this purpose, we conducted an online experiment with a sample of 140 healthy undergraduate participants who completed two self-reported questionnaires designed to assess ADHD-like traits, and a social variant of an interference spatial task known to effectively isolate the social-specific component of eye-gaze. To make our research plan transparent, our hypotheses, together with the plans of analyses, were registered before data exploration. Results showed that while the social-specific component of eye-gaze was evident in the sample, no significant correlation was found between this component and the measured ADHD-like traits. These results appear to contradict the intuition that the attentional processing of the social-specific components of eye-gaze may be impaired by ADHD symptomatology. However, further research involving children and clinical populations is needed in order to clarify this matter.
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Affiliation(s)
- Jeanette A. Chacón-Candia
- Department of Experimental Psychology, and Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Renato Ponce
- Department of Experimental Psychology, and Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Marotta
- Department of Experimental Psychology, and Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
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Qiu C, Zhai Q, Chen S. Effects of Practicing Closed- vs. Open-Skill Exercises on Executive Functions in Individuals with Attention Deficit Hyperactivity Disorder (ADHD)-A Meta-Analysis and Systematic Review. Behav Sci (Basel) 2024; 14:499. [PMID: 38920831 PMCID: PMC11200859 DOI: 10.3390/bs14060499] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Previous studies have identified discrepancies in improvements in executive functioning in typically developing children when comparing closed- and open-skill exercise interventions. However, there is limited research on executive functioning in attention deficit hyperactivity disorder (ADHD). This study aims to conduct a systematic review and meta-analysis to explore the impact of closed- and open-skill exercises on ADHD populations. (2) Methods: The PRISMA guidelines for systematic reviews were followed to search seven databases to evaluate and analyze studies published from 2013 to 2023. Prospero: CRD42023460452. (3) Results: A meta-analysis of 578 subjects with ADHD in 11 RCTs (Randomized control trial) and 3 NRS (Non-randomized studies) revealed that closed-skill exercise significantly improved executive function subdomains, including inhibitory control (standardized mean differences (SMD) = -1.00), cognitive flexibility (SMD = -1.33), and working memory (SMD = -0.85). Furthermore, open-skill exercise was found to have a positive effect on inhibitory control (SMD = -1.98) and cognitive flexibility (SMD = -0.97) in ADHD patients. Both types of exercise interventions demonstrated an improvement in executive function compared to controls, with open-skill exercises exhibiting superior effects (Qb = 6.26). (4) Conclusions: The review recommends a 12-week intervention cycle with exercise at least twice a week of moderate or higher intensity as suitable for ADHD individuals. This review also encourages individuals with ADHD to engage in exercises involving multiple motor skill types.
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Affiliation(s)
| | - Qun Zhai
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China; (C.Q.); (S.C.)
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Sadeghi M, Abraham E, McAuley T. Assessing adherence and clinical utility of modified goal management training for adolescents with ADHD: A pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-11. [PMID: 38859564 DOI: 10.1080/21622965.2024.2353828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Many adolescents with attention-deficit hyperactivity disorder (ADHD) have executive functioning (EF) difficulties that contribute to academic and social-emotional challenges. This pilot explored adherence to and effectiveness of modified Goal Management Training (GMT), an EF intervention, with ADHD youth. Six adolescents with ADHD (14-17 years, 2 female) participated in a 6-session online group. Adherence was tracked via attendance and homework. Reliable change scores gaged pre-post differences on measures before and after training (primary: everyday EF and goal attainment; secondary: EF task performance, functional impairment, emotional adjustment, and self-concept). All youth attended at least 4 sessions, though homework completion was mixed. Four youth achieved their goal, some demonstrated reliable change on outcome measures, and all evidenced a reduction in impairment. Results support the feasibility of modified GMT in adolescents with ADHD and suggest that youth may benefit from this more personalized and holistic approach to EF intervention.
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Affiliation(s)
- Mahsa Sadeghi
- Department of Psychology & Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON, Canada
| | - Eleenor Abraham
- Department of Psychology & Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON, Canada
| | - Tara McAuley
- Department of Psychology & Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON, Canada
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31
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Hood M, Baumann O. Could Nature Contribute to the Management of ADHD in Children? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:736. [PMID: 38928982 PMCID: PMC11203786 DOI: 10.3390/ijerph21060736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that is typically managed with pharmacological and psychotherapeutic interventions. In the general population, exposure to nature has been found to have robust beneficial effects on cognitive performance, including attention. With inattention being a factor of the symptomatology of individuals with ADHD, this provides a rationale to investigate the potential benefits of exposure to nature for this population. Four electronic databases (PubMED, PsycINFO, Embase, and Web of Science) were searched for empirical studies investigating the effects of nature on ADHD prevalence and/or symptom severity in populations of school-aged children. Key characteristics, methodologies, and outcomes of included studies were extracted and evaluated. Out of the 458 studies identified, 7 met the inclusion criteria. Despite the large heterogeneity in methodological approaches, the included articles consistently reported that exposure to nature is associated with reduced ADHD diagnoses and symptom severity. Furthermore, when several covariates, such as age, gender, annual household income, parental income, and education level, as well as several pre-natal factors, were controlled for, the relationship between nature and ADHD remained significant. The reviewed literature provides strong support for the benefits of exposure to nature on ADHD in school-aged children.
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Affiliation(s)
| | - Oliver Baumann
- School of Psychology, Bond University, Robina, QLD 4226, Australia;
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Dentz A, Soelch CM, Fahim C, Torsello A, Parent V, Ponsioen A, Guay MC, Bioulac-Rogier S, Clément C, Bader M, Romo L. Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD. L'ENCEPHALE 2024; 50:309-328. [PMID: 38326137 DOI: 10.1016/j.encep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 02/09/2024]
Abstract
Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.
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Affiliation(s)
- Amélie Dentz
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland.
| | - Chantal Martin Soelch
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Cherine Fahim
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Alexandra Torsello
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | | | | | | | | | - Céline Clément
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication (EA 2310), Université de Strasbourg, Strasbourg, France
| | - Michel Bader
- Unité de Recherche, Service de Psychiatrie de l'Enfant et de l'adolescent (SUPEA - DP CHUV), Lausanne, Switzerland
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre Université, Nanterre, France
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Nahidi M, Soleimanpour S, Emadzadeh M. Probiotics as a Promising Therapy in Improvement of Symptoms in Children With ADHD: A Systematic Review. J Atten Disord 2024; 28:1163-1172. [PMID: 38369739 DOI: 10.1177/10870547241228828] [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: 02/20/2024]
Abstract
BACKGROUND ADHD is widely recognized as the most prevalent neurodevelopmental disorder in children. Recently, the potential role of gut microbiota as an etiological factor in ADHD has gained attention. This systematic review aims to investigate the potential impact of probiotic supplements on alleviating ADHD symptoms and influencing behavior. METHODS PubMed, Web of Science, Cochrane Library, and SCOPUS were searched from inception to May 2023. Only randomized controlled trials that have suitable data of the effects of probiotics/synbiotics on children with ADHD were enrolled. The risk of bias of the included studies was assessed by Cochrane Collaboration risk of bias tool. RESULTS Five related randomized controlled trial were evaluated in the current review. Types of interventions ranged from single/multi strain probiotics to synbiotic. The duration of intervention in all of the studies were 2 to 3 months. The assessed outcomes were very diverse and different tools were used to report the symptoms in children. Among those which used Conners' Parent Rating Scale, a decrease in the total score occurred in the probiotic group, compared to the placebo group. An improvement in both intervention and control groups was seen in one study which used ADHD-Rating Scale. CONCLUSION In summary, the combined findings from the reviewed studies suggest that probiotic supplements might potentially serve as a complementary intervention for ADHD. However, given the small number of studies, limited sample sizes, and the diversity of probiotic strains, further research is needed to clarify the effects of probiotics in children with ADHD. The observed tolerability of probiotics is noteworthy as none of the studies report adverse effects.
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Affiliation(s)
- Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Soleimanpour
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Gao Z, Duberg K, Warren SL, Zheng L, Hinshaw SP, Menon V, Cai W. Reduced temporal and spatial stability of neural activity patterns predict cognitive control deficits in children with ADHD. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.29.596493. [PMID: 38854066 PMCID: PMC11160739 DOI: 10.1101/2024.05.29.596493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
This study explores the neural underpinnings of cognitive control deficits in ADHD, focusing on overlooked aspects of trial-level variability of neural coding. We employed a novel computational approach to neural decoding on a single-trial basis alongside a cued stop-signal task which allowed us to distinctly probe both proactive and reactive cognitive control. Typically developing (TD) children exhibited stable neural response patterns for efficient proactive and reactive dual control mechanisms. However, neural coding was compromised in children with ADHD. Children with ADHD showed increased temporal variability and diminished spatial stability in neural responses in salience and frontal-parietal network regions, indicating disrupted neural coding during both proactive and reactive control. Moreover, this variability correlated with fluctuating task performance and with more severe symptoms of ADHD. These findings underscore the significance of modeling single-trial variability and representational similarity in understanding distinct components of cognitive control in ADHD, highlighting new perspectives on neurocognitive dysfunction in psychiatric disorders.
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Affiliation(s)
- Zhiyao Gao
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Duberg
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stacie L Warren
- Department of Psychology, University of Texas, Dallas, TX, USA
| | - Li Zheng
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | - Vinod Menon
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, USA
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Maternal & Child Health Research Institute, Stanford, CA, USA
| | - Weidong Cai
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, USA
- Maternal & Child Health Research Institute, Stanford, CA, USA
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Brewerton TD, Dennis K, Wiss DA. Dismantling the myth of "all foods fit" in eating disorder treatment. J Eat Disord 2024; 12:60. [PMID: 38760858 PMCID: PMC11102136 DOI: 10.1186/s40337-024-01017-9] [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: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Kim Dennis
- SunCloud Health, Chicago, IL, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
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Wider W, Mutang JA, Chua BS, Pang NTP, Jiang L, Fauzi MA, Udang LN. Mapping the evolution of neurofeedback research: a bibliometric analysis of trends and future directions. Front Hum Neurosci 2024; 18:1339444. [PMID: 38799297 PMCID: PMC11116792 DOI: 10.3389/fnhum.2024.1339444] [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: 11/22/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments. Methods It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods. Results The co-citation analysis identified three major clusters: "Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity," "EEG Neurofeedback and Cognitive Performance Enhancement," and "Treatment of ADHD Using Neurofeedback." The co-word analysis highlighted four key clusters: "Neurofeedback in Mental Health Research," "Brain-Computer Interfaces for Stroke Rehabilitation," "Neurofeedback for ADHD in Youth," and "Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging. Discussion This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.
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Affiliation(s)
- Walton Wider
- Faculty of Business and Communications, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Jasmine Adela Mutang
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Bee Seok Chua
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Leilei Jiang
- Faculty of Education and Liberal Arts, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Muhammad Ashraf Fauzi
- Faculty of Industrial Management, Universiti Malaysia Pahang Al-Sultan Abdullah, Pekan, Pahang, Malaysia
| | - Lester Naces Udang
- Faculty of Liberal Arts, Shinawatra University, Pathumthani, Thailand
- College of Education, University of the Philippines, Diliman, Philippines
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37
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Huberts-Bosch A, Bierens M, Ly V, van der Velde J, de Boer H, van Beek G, Appelman D, Visser S, Bos LHP, Reijmers L, van der Meer J, Kamphuis N, Draaisma JMT, Donders R, van de Loo-Neus GHH, Hoekstra PJ, Bottelier M, Arias-Vasquez A, Klip H, Buitelaar JK, van den Berg SW, Rommelse NN. Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial. Eur Child Adolesc Psychiatry 2024; 33:1503-1516. [PMID: 37430148 PMCID: PMC11098970 DOI: 10.1007/s00787-023-02256-y] [Citation(s) in RCA: 1] [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: 11/22/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).
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Affiliation(s)
- Annick Huberts-Bosch
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.
| | - Margreet Bierens
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Verena Ly
- Institute of Psychology, Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Jessica van der Velde
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Heleen de Boer
- Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Gerry van Beek
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Danielle Appelman
- Triversum-GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, The Netherlands
| | | | - Lisa H P Bos
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Lisa Reijmers
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | | | - Niki Kamphuis
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gigi H H van de Loo-Neus
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry and Accare Child Study Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Bottelier
- Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Alejandro Arias-Vasquez
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia W van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Utrecht, The Netherlands
| | - Nanda N Rommelse
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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Bedawi RM, Al-Farsi Y, Mirza H, Al-Huseini S, Al-Mahrouqi T, Al-Kiyumi O, Al-Azri M, Al-Adawi S. Prevalence and Clinical Profile of Adults with ADHD Attending a Tertiary Care Hospital for Five Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:566. [PMID: 38791781 PMCID: PMC11121453 DOI: 10.3390/ijerph21050566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
(1) Objectives: This study aimed to assess the 5-year prevalence and clinical profile of attention deficit hyperactive disorder (ADHD) among adult patients seeking care in a tertiary care hospital in Oman. (2) Methods: The data were analysed using descriptive and inferential statistics and standardised prevalence estimates were calculated. (3) Results: Of the 39,881 hospital visits, 1.77% were made by adults with ADHD. This is equivalent to 17.8 visits per 1000 outpatients. The year 2021 saw the highest prevalence among the five years considered, while 2020 had the lowest prevalence. Although the age distribution indicated that the age group 'under 20' had the highest prevalence, the gender distribution showed that ADHD was more common among adult men. Among the various subtypes of ADHD, inattention was the most common. (4) Conclusions: This study specifically compared the prevalence and associated factors between an adult cohort with ADHD and those other psychiatric clinic attendees during the same period. The study offers important information on the prevalence and clinical profile of adults with ADHD in the population under consideration.
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Affiliation(s)
- Rabab Mohammed Bedawi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (R.M.B.); (Y.A.-F.); (M.A.-A.)
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (R.M.B.); (Y.A.-F.); (M.A.-A.)
| | - Hassan Mirza
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Salim Al-Huseini
- Department of Psychiatry, Al Masarra Hospital, Ministry of Health, Muscat 113, Oman;
| | - Tamadhir Al-Mahrouqi
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat 130, Oman (O.A.-K.)
| | - Omaima Al-Kiyumi
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat 130, Oman (O.A.-K.)
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (R.M.B.); (Y.A.-F.); (M.A.-A.)
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
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Schmidt KL, Kowalski A, Schweda A, Dörrie N, Skoda EM, Bäuerle A, Teufel M. Evaluation of a manualised neurofeedback training in psychosomatic-psychotherapeutic outpatient treatment (Neuro-pp-out): study protocol for a clinical mixed-methods pilot study. BMJ Open 2024; 14:e079098. [PMID: 38631828 PMCID: PMC11029405 DOI: 10.1136/bmjopen-2023-079098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Electroencephalographic neurofeedback (NFB), as a non-invasive form of brainwave training, has been shown to be effective in the treatment of various mental health disorders. However, only few results regarding manualised and standardised NFB trainings exist. This makes comparison as well as replication of studies difficult. Therefore, we developed a standard manual for NFB training in patients with mental health disorders attending a psychosomatic outpatient clinic. The current study aims at investigating the conduction of a standardised manual for NFB training in patients with mental health disorders. If successful, the study provides new opportunities to investigate NFB in a more controlled and comparable manner in clinical practice. METHODS AND ANALYSIS 30 patients diagnosed with a mental health disorder will be included. After the educational interview, patients will undergo baseline diagnostics (T0). The subsequent intervention consists of 10 sessions of NFB training aiming at increasing sensorimotor rhythm and alpha-frequency amplitudes and decreasing theta-frequency and high beta-frequency amplitudes to induce relaxation and decrease subjective stress. All patients will undergo a post-treatment diagnostic assessment (T1) and a follow-up assessment 8 weeks following the closing session (T2). Changes in amplitude bands (primary outcome) will be recorded with electroencephalography during pre-assessments, post-assessments and follow-up assessments and during NFB sessions. Physiological (respiratory rate, blood volume pulse, muscle tension) and psychometric parameters (distress, perceived stress, relaxation ability, depressive and anxiety symptoms, insomnia, self-efficacy and quality of life) will be assessed at T0, T1 and T2. Moreover, satisfaction, acceptance and usability will be assessed at T1 after NFB training. Further, qualitative interviews about the experiences with the intervention will be conducted with NFB practitioners 6 months after the study starts. Quantitative data will be analysed using repeated measures analysis of variance as well as mediation analyses on mixed linear models. Qualitative data will be analysed using Mayring's content analysis. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Medical Faculty of the University of Duisburg-Essen (23-11140-BO) and patient enrolment began in April 2023. Before participation, written informed consent by each participant will be required. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Prospectively registered on 28 March 2023 in the German clinical trials register, DRKS00031497.
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Affiliation(s)
- Kira Leandra Schmidt
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | | | - Adam Schweda
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Nora Dörrie
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva Maria Skoda
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Peterson BS, Trampush J, Maglione M, Bolshakova M, Rozelle M, Miles J, Pakdaman S, Brown M, Yagyu S, Motala A, Hempel S. Treatments for ADHD in Children and Adolescents: A Systematic Review. Pediatrics 2024; 153:e2024065787. [PMID: 38523592 DOI: 10.1542/peds.2024-065787] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
CONTEXT Effective treatment of attention-deficit/hyperactivity disorder (ADHD) is essential to improving youth outcomes. OBJECTIVES This systematic review provides an overview of the available treatment options. DATA SOURCES We identified controlled treatment evaluations in 12 databases published from 1980 to June 2023; treatments were not restricted by intervention content. STUDY SELECTION Studies in children and adolescents with clinically diagnosed ADHD, reporting patient health and psychosocial outcomes, were eligible. Publications were screened by trained reviewers, supported by machine learning. DATA EXTRACTION Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Data were pooled using random-effects models. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards. RESULTS In total, 312 studies reported in 540 publications were included. We grouped evidence for medication, psychosocial interventions, parent support, nutrition and supplements, neurofeedback, neurostimulation, physical exercise, complementary medicine, school interventions, and provider approaches. Several treatments improved ADHD symptoms. Medications had the strongest evidence base for improving outcomes, including disruptive behaviors and broadband measures, but were associated with adverse events. LIMITATIONS We found limited evidence of studies comparing alternative treatments directly and indirect analyses identified few systematic differences across stimulants and nonstimulants. Identified combination of medication with youth-directed psychosocial interventions did not systematically produce better results than monotherapy, though few combinations have been evaluated. CONCLUSIONS A growing number of treatments are available that improve ADHD symptoms and other outcomes, in particular for school-aged youth. Medication therapies remain important treatment options but are associated with adverse events.
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Affiliation(s)
- Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, California
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Joey Trampush
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | | | - Maria Bolshakova
- Southern California Evidence Review Center, Los Angeles, California
| | - Mary Rozelle
- Southern California Evidence Review Center, Los Angeles, California
| | - Jeremy Miles
- Southern California Evidence Review Center, Los Angeles, California
| | - Sheila Pakdaman
- Southern California Evidence Review Center, Los Angeles, California
| | - Morah Brown
- Southern California Evidence Review Center, Los Angeles, California
| | - Sachi Yagyu
- Southern California Evidence Review Center, Los Angeles, California
| | - Aneesa Motala
- Southern California Evidence Review Center, Los Angeles, California
| | - Susanne Hempel
- Southern California Evidence Review Center, Los Angeles, California
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Byrne MK, Cook R, Murta JCD, Bressington D, Meyer BJ. Dietary Intakes of Long-Chain Polyunsaturated Fatty Acids and Impulsivity: Comparing Non-Restricted, Vegetarian, and Vegan Diets. Nutrients 2024; 16:875. [PMID: 38542786 PMCID: PMC10975088 DOI: 10.3390/nu16060875] [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: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Research suggests a link between deficiencies in omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and impulsivity among psychiatric populations. However, this association is less evident in non-clinical populations. As omega-3 LCPUFAs are predominantly sourced through fish consumption, non-fish dieters may be more vulnerable to higher impulsivity. METHODS This cross-sectional observational study explored the association between lower intakes of omega-3 LCPUFA food sources and higher self-reported measures of impulsivity among healthy adults consuming non-restricted, vegetarian, and vegan diets. RESULTS The results from the validated Food Frequency Questionnaire showed significantly lower estimated omega-3 LCPUFA intakes among vegans and vegetarians when compared with people consuming non-restricted diets. Furthermore, although all groups scored within the normal range of impulsivity measures, vegans scored comparatively higher. Vegans also scored significantly higher in impulsivity control relating to attention than those consuming non-restricted diets. CONCLUSIONS The significantly lower omega-3 LCPUFA dietary intakes in the vegan diets were associated with higher scores in the second-order attentional aspect of self-reported impulsiveness.
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Affiliation(s)
- Mitchell K. Byrne
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Rebecca Cook
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Janina C. D. Murta
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Daniel Bressington
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai 50200, Thailand
| | - Barbara J. Meyer
- School of Medical, Indigenous and Health Sciences, Lipid Research Centre, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
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Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, Newcorn JH, Philipsen A, Polanczyk GV, Rubia K, Sibley MH, Buitelaar JK. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10:11. [PMID: 38388701 DOI: 10.1038/s41572-024-00495-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Mark A Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, 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, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chris Hollis
- National Institute for Health and Care Research (NIHR) MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Transcampus Professor KCL-Dresden, Technical University, Dresden, Germany
| | | | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
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Cheng F, Shi L, Xie H, Wang B, Hu C, Zhang W, Hu Z, Yu H, Wang Y. A study of the interactive mediating effect of ADHD and NSSI caused by co-disease mechanisms in males and females. PeerJ 2024; 12:e16895. [PMID: 38348102 PMCID: PMC10860553 DOI: 10.7717/peerj.16895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Background Non-suicidal self-injury (NSSI), of which the predisposing factors are complex and diverse, profoundly affects the physical and mental health of young people. Therefore, this work established an NSSI intermediary network model considering the interaction of multiple factors. A mediating effect between attention-deficit/hyperactivity disorder (ADHD) and NSSI, considering the influence of comorbidities, such as depression, anxiety, and impulsive personality, was proposed based on sex differences. Methods A total of 2,689 middle school students in Ningbo City, Zhejiang Province, China, were randomly sampled and participated in this study. Data regarding their demographic characteristics, attention deficit, hyperactivity/impulsivity, NSSI, anxiety, depression, internet addiction, and other comorbid symptoms were collected and analyzed. After initially screening the data, variables were assessed for significance using a single-factor inter-group difference analytic method, and a binary logistic regression analysis was performed. The intermediary effect of factors influencing NSSI in males and females was also analyzed. Results The overall NSSI rate was 15.16%. The results showed that the impact of individual impulsivity characteristics (impulsiveness, the ADHD with hyperactivity/impulsivity subtype) on NSSI behavior was not significant (regression results, P > 0.05). The degree of association between ADHD with attention deficit and ADHD with comprehension deficit subtypes, and other comorbid symptoms (depression, anxiety, and internet addiction disorder) and NSSI, with odds ratios (ORs) of 7.6/6.42/436.68/3.82/1.86, and 95% bootstrap confidence intervals (CIs) of 4.64, 12.87/3.46, 12.67/137.42, 2659.13/2.32, 6.37/1.31, 2.82, respectively. The results also showed significant effects of ADHD subtypes on comorbid symptoms and the path effects of NSSI (P < 0.01). Among them, the mediating effect was the strongest when anxiety was the mediating variable, and the mediating effect of girls was higher than that of boys. Conclusion The results of this work demonstrated the influence of ADHD symptoms on NSSI behavior. Among patients with ADHD, patients with subtypes with obvious attention deficit characteristics were more likely to exhibit NSSI behavior, whereas the hyperactive impulse subtype had no direct impact on NSSI. We conclude that adolescent impulsivity may not be directly related to NSSI behavior and that impulsive characteristics jointly affect NSSI behavior through a series of NSSI comorbid symptoms. Notably, the probability of symptom onset and the degree of comorbidity was significantly higher in girls than in boys of the same age, and girls were more prone to NSSI behavior. These findings provide effective theoretical support for the prevention and treatment of adolescent NSSI behavior.
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Affiliation(s)
- Fang Cheng
- The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | | | - Huabing Xie
- People’s Hospital of Wuhan University, Wuhan, China
| | - Beini Wang
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Changzhou Hu
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Wenwu Zhang
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Zhenyu Hu
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Haihang Yu
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Yiming Wang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Psychiatry, Affiliated Hospital to Guizhou Medical University, Guizhou, China
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Badia-Aguarón T, Royuela-Colomer E, Pera-Guardiola V, Vergés-Balasch P, Cebolla A, Luciano JV, Soler J, Feliu-Soler A, Huguet Miguel A. Combining mindfulness and cognitive training in children with attention deficit hyperactivity disorder: study protocol of a pilot randomized controlled trial (the NeuroMind study). Front Psychol 2024; 15:1291198. [PMID: 38384348 PMCID: PMC10879620 DOI: 10.3389/fpsyg.2024.1291198] [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: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) has a global mean prevalence of 5%. Cognitive Training (CT) and Mindfulness-Based Interventions (MBIs) have shown promising results in managing ADHD symptoms, but they are not its Treatment-As-Usual (TAU). The NeuroMind Study aims to evaluate the preliminary effectiveness and feasibility of three interventions: Mindfulness for Health (M4H), CT using the NeuronUP® platform (CT), and a combination of both, Mindfulness Cognitive Training (MCT). There is empirical evidence supporting the effectiveness of the M4H and NeuronUP® platform; however, this study explores for the first time the effectiveness of MCT and CT, as well as the integration of M4H into TAU. The objectives of this 5-month Randomized Controlled Trial (RCT) are: (1) To analyze the preliminary effectiveness and feasibility of M4H, CT or a combination of both (MCT) added to TAU for children with ADHD; (2) To evaluate the role of psychological process variables (mindfulness and emotional regulation) as mediators of 5-month follow-up clinical outcomes; (3) To preliminarily explore whether specific sociodemographic and clinical characteristics can predict the short-and medium-term clinical response to the specific treatments. Methods and analysis Participants will be 120 children (7 to 12 years) with ADHD recruited at Child and Adolescent Mental Health Service (CAMHS) Sant Joan de Déu Terres de Lleida (Spain) randomly allocated to one of the four study arms: TAU vs. TAU + CT vs. TAU + M4H vs. TAU + MCT. An assessment to collect ADHD symptoms, Executive Functions (EF), comorbid symptoms and global functioning will be conducted pre-intervention, post-intervention (2 months after baseline) and at the 5-month follow-up. Linear mixed models and mediational models will be computed. Discussion If the preliminary effectiveness and feasibility of the MCT are demonstrated, this study could be a preliminary basis to do a full RCT with a larger sample to definitively validate the intervention. The MCT could be applied in clinical practice if it is definitively validated.Clinical trial registration:ClinicalTrials.gov, identifier, NCT05937347. https://clinicaltrials.gov/study/NCT05937347?locStr=Spain&country=Spain&cond=ADHD&intr=Mindfulness&rank=1.
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Affiliation(s)
- Tania Badia-Aguarón
- Department of Basic, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Estíbaliz Royuela-Colomer
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Vanessa Pera-Guardiola
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
- Department of Psychology, University of Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Pere Vergés-Balasch
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
| | - Ausiàs Cebolla
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Juan V. Luciano
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquim Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
- CIBER of Mental Health (CIBERSAM), Madrid, Spain
| | - Albert Feliu-Soler
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Huguet Miguel
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
- Sant Joan de Déu Research Institute (IRSJD), Esplugues de Llobregat, Spain
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Marquet-Doléac J, Biotteau M, Chaix Y. Behavioral Parent Training for School-Aged Children With ADHD: A Systematic Review of Randomized Control Trials. J Atten Disord 2024; 28:377-393. [PMID: 38083879 DOI: 10.1177/10870547231211595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND All guidelines for the treatment of ADHD in children include behavioral parent training in combination with other strategies. In the past, several systematic reviews have been carried out that were either outdated or not sufficiently specific to ADHD. We wanted to conduct a new review focusing on a specific ADHD population of school age (4-12 years) and on behavioral and cognitive programs. We aimed to test our hypothesis that behavioral parent training would improve parents' difficulties, children's symptomatology, and the quality of life of families with ADHD. METHODS PUBMED, PsychInfo, Web of Science, ERIC, and Cochrane databases were searched for original articles on randomized control trials on behavioral parent training group for children with ADHD aged from 4 to 12 years until July 2023. RESULTS A total of 20 studies were included in the systematic review. The results were divided into four categories: parent data, child data collected by parents, teachers, or researchers. A qualitative analysis revealed for parents, effects on parental stress, feelings of parental efficacy, and negative parental educational behavior. As regard children, only effects are noted for parental assessment, on ADHD symptomatology, externalized disorders, and social skills. CONCLUSION Despite the heterogeneity or small number of studies in some categories, BPTs have positive effects on both parents and children. There are no convincing results to support the generalization of progress. This would seem to indicate that it remains essential to consider actions specific to each problematic environment for the child.
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Affiliation(s)
- Jerome Marquet-Doléac
- University of Toulouse, INSERM, UPS, France
- University of Toulouse 3 Paul Sabatier, France
| | - Maëlle Biotteau
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
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Kaiser A, Aggensteiner PM, Blasco Fontecilla H, Ros T, Acquaviva E, Attal Y, Banaschewski T, Baumeister S, Bousquet E, Bussalb A, Delhaye M, Delorme R, Drechsler R, Goujon A, Häge A, Mayaud L, Mechler K, Menache C, Revol O, Tagwerker F, Walitza S, Werling AM, Bioulac S, Purper-Ouakil D, Brandeis D. Limited usefulness of neurocognitive functioning indices as predictive markers for treatment response to methylphenidate or neurofeedback@home in children and adolescents with ADHD. Front Psychiatry 2024; 14:1331004. [PMID: 38312916 PMCID: PMC10836215 DOI: 10.3389/fpsyt.2023.1331004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Earlier studies exploring the value of executive functioning (EF) indices for assessing treatment effectiveness and predicting treatment response in attention-deficit/hyperactivity disorder (ADHD) mainly focused on pharmacological treatment options and revealed rather heterogeneous results. Envisioning the long-term goal of personalized treatment selection and intervention planning, this study comparing methylphenidate treatment (MPH) and a home-based neurofeedback intervention (NF@Home) aimed to expand previous findings by assessing objective as well as subjectively reported EF indices and by analyzing their value as treatment and predictive markers. Methods Children and adolescents (n = 146 in the per protocol sample) aged 7-13 years with a formal diagnosis of an inattentive or combined presentation of ADHD were examined. We explored the EF performance profile using the Conners Continuous Performance Task (CPT) and the BRIEF self-report questionnaire within our prospective, multicenter, randomized, reference drug-controlled NEWROFEED study with sites in five European countries (France, Spain, Switzerland, Germany, and Belgium). As primary outcome for treatment response, the clinician-rated ADHD Rating Scale-IV was used. Patients participating in this non-inferiority trial were randomized to either NF@home (34-40 sessions of TBR or SMR NF depending on the pre-assessed individual alpha peak frequency) or MPH treatment (ratio: 3:2). Within a mixed-effects model framework, analyses of change were calculated to explore the predictive value of neurocognitive indices for ADHD symptom-related treatment response. Results For a variety of neurocognitive indices, we found a significant pre-post change during treatment, mainly in the MPH group. However, the results of the current study reveal a rather limited prognostic value of neurocognitive indices for treatment response to either NF@Home or MPH treatment. Some significant effects emerged for parent-ratings only. Discussion Current findings indicate a potential value of self-report (BRIEF global score) and some objectively measured neurocognitive indices (CPT commission errors and hit reaction time variability) as treatment markers (of change) for MPH. However, we found a rather limited prognostic value with regard to predicting treatment response not (yet) allowing recommendation for clinical use. Baseline symptom severity was revealed as the most relevant predictor, replicating robust findings from previous studies.
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Affiliation(s)
- Anna Kaiser
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Pascal M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Tomas Ros
- Department of Neuroscience, Campus Biotech CISA-Université de Genève, Genève, Switzerland
| | - Eric Acquaviva
- Child and Adolescent Psychiatry Department and Child Brain Institute, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris and Universite Paris Cite, Paris, France
| | | | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Elisa Bousquet
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | | | - Marie Delhaye
- Child and Adolescent Psychiatry, Erasme Academic Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Richard Delorme
- Child and Adolescent Psychiatry Department and Child Brain Institute, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris and Universite Paris Cite, Paris, France
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Allison Goujon
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Konstantin Mechler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Olivier Revol
- Unit of Child and Adolescent Psychiatry, Hospices civils de Lyon, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Friederike Tagwerker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Maria Werling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Stéphanie Bioulac
- SANPSY, USR 3413, CNRS, Bordeaux, France
- Clinique du Sommeil, CHU Pellegrin, Bordeaux Cedex, France
| | - Diane Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
- Development and Trajectories, INSERM CESP U 1018 Psychiatry, Montpellier, France
- CESP, INSERM U 1018, Paul Brousse Hospital, Villejuif, France
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Bikic A, Dalsgaard S, Pittman B, Leckman JF, Wexler B. Cognitive training for children with ADHD: composite cognitive score outcome in a randomized controlled trial. Nord J Psychiatry 2024; 78:87-91. [PMID: 37905332 DOI: 10.1080/08039488.2023.2270954] [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] [Received: 10/25/2022] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE OF THE ARTICLE Cognitive training for Attention Deficit/Hyperactivity Disorder (ADHD) has shown promising, although mixed results. In post-hoc analyses, we evaluate effects of cognitive training using a novel composite cognition score as the outcome for children attending at least 16 sessions of training, dose-response of training and associations between symptoms and cognitive functioning. MATERIALS AND METHODS Children (age 6-13) with ADHD were randomized to intervention (n = 26) or control (n = 34). For the current analysis, we restricted the intervention group to children, who completed at least 16 sessions of cognitive training (n = 26) and examined a dose response within that group. RESULTS Cognition improved significantly in the intervention, but not control group. Amount of the completed training sessions correlated significantly with the amount of cognitive improvement. CONCLUSION Variations in dose and frequency of training may be an important source of the variance in previous studies.
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Affiliation(s)
- Aida Bikic
- Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Aabenraa, Denmark
| | - Søren Dalsgaard
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Bruce Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Zhang DW, Johnstone SJ, Sauce B, Arns M, Sun L, Jiang H. Remote neurocognitive interventions for attention-deficit/hyperactivity disorder - Opportunities and challenges. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110802. [PMID: 37257770 DOI: 10.1016/j.pnpbp.2023.110802] [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] [Received: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology/Center for Place-Based Education, Yangzhou University, Yangzhou, China; Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong, Australia; Brain & Behaviour Research Institute, University of Wollongong, Australia
| | - Bruno Sauce
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands; NeuroCare Group, Nijmegen, Netherlands
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Han Jiang
- College of Special Education, Zhejiang Normal University, Hangzhou, China
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Lawrence K, Fibert P, Hobbs J, Myrissa K, Toribio-Mateas MA, Quadt F, Cotter PD, Gregory AM. Randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: a study protocol. BMJ Open 2023; 13:e071063. [PMID: 38149413 PMCID: PMC10711914 DOI: 10.1136/bmjopen-2022-071063] [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: 12/16/2022] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Current interventions for children with attention-deficit/hyperactivity disorder (ADHD) are primarily medication, behavioural therapy and parent training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD, and therefore, manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD. METHODS AND ANALYSIS A 6-week randomised, double-blind, placebo-controlled trial in 70 children aged 8-13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for 6 weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using 7-day actigraphy recordings, The Child's Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (preintervention/postintervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances. ETHICS AND DISSEMINATION Ethical approval for the study was granted by St Mary's University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups. TRIAL REGISTRATION NUMBER NCT05155696.
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Affiliation(s)
- Kate Lawrence
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Philippa Fibert
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Jemima Hobbs
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Kyriaki Myrissa
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | | | - Frits Quadt
- Quadt Consultancy B.V, Oostvoorne, The Netherlands
| | - Paul D Cotter
- SeqBiome Ltd, Cork, Ireland
- University College Cork APC Microbiome Institute, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
| | - Alice M Gregory
- Department of Psychology, Goldsmiths University of London, London, UK
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50
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [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] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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