551
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Altszuler AR, Page TF, Gnagy EM, Coxe S, Arrieta A, Molina BSG, Pelham WE. Financial Dependence of Young Adults with Childhood ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 44:1217-29. [PMID: 26542688 DOI: 10.1007/s10802-015-0093-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study used data from the Pittsburgh ADHD Longitudinal Study (PALS) to evaluate financial outcomes of young adults (YA) with ADHD relative to comparisons. Participants for this study included 309 individuals who had been diagnosed with ADHD (DSM-III-R or DSM-IV) in childhood and 208 comparison YA without childhood ADHD diagnoses (total N = 517) who were followed through age 25. Participants were predominately male (88 %) and Caucasian (84 %). Diagnostic interviews were conducted in childhood. Young adults and their parents reported on financial outcomes and a number of predictor variables. Young adults with ADHD experienced greater financial dependence on family members (p < 0.05) and the welfare system (p < 0.01) and had lower earnings (p < 0.05) than comparisons. ADHD diagnostic status, education attainment, and delinquency were significant predictors of financial outcomes. A projection of lifetime earnings indicated that ADHD group participants could expect to earn $543,000-$616,000 less over their lifetimes than comparisons. Due to the propensity of individuals with ADHD to underreport problems, the data are likely to be underestimates. These findings support the need for interventions to improve labor market outcomes as well as the development of interventions that target the management of personal finances for individuals with ADHD in young adulthood.
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Affiliation(s)
- Amy R Altszuler
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
| | - Timothy F Page
- Department of Health Policy and Management, Florida International University, 11200 SW 8th St., AHC5 447, Miami, FL, 33199, USA.
| | - Elizabeth M Gnagy
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
| | - Stefany Coxe
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
| | - Alejandro Arrieta
- Department of Health Policy and Management, Florida International University, 11200 SW 8th St., AHC5 447, Miami, FL, 33199, USA
| | - Brooke S G Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - William E Pelham
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
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552
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Bagot K. Making the Grade: Adolescent Prescription Stimulant Use. J Am Acad Child Adolesc Psychiatry 2017; 56:189-190. [PMID: 28219484 DOI: 10.1016/j.jaac.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
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553
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McCabe SE, Veliz P, Wilens TE, Schulenberg JE. Adolescents' Prescription Stimulant Use and Adult Functional Outcomes: A National Prospective Study. J Am Acad Child Adolesc Psychiatry 2017; 56:226-233.e4. [PMID: 28219488 PMCID: PMC5462599 DOI: 10.1016/j.jaac.2016.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/30/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the prospective 17-year relationship between the medical and nonmedical use of prescription stimulants during adolescence (age 18 years) and educational attainment and substance use disorder (SUD) symptoms in adulthood (age 35 years). METHOD A survey was self-administered by nationally representative probability samples of US high school seniors from the Monitoring the Future study; 8,362 of these individuals were followed longitudinally from adolescence (age 18, high school senior years 1976-1996) to adulthood (age 35, 1993-2013). RESULTS An estimated 8.1% reported medical use of prescription stimulants, and 16.7% reported nonmedical use of prescription stimulants by age 18 years. Approximately 43% of adolescent medical users of prescription stimulants had also engaged in nonmedical use of prescription stimulants during adolescence. Among past-year adolescent nonmedical users of prescription stimulants, 97.3% had used at least one other substance during the past year. Medical users of prescription stimulants without any history of nonmedical use during adolescence did not differ significantly from population controls (i.e., non-attention-deficit/hyperactivity disorder [ADHD] and non-stimulant-medicated ADHD during adolescence) in educational attainment and SUD symptoms in adulthood. In contrast, adolescent nonmedical users of prescription stimulants (with or without medical use) had lower educational attainment and more SUD symptoms in adulthood, compared to population controls and medical users of prescription stimulants without nonmedical use during adolescence. CONCLUSION Nonmedical use of prescription stimulants is common among adolescents prescribed these medications. The findings indicate youth should be carefully monitored for nonmedical use because this behavior is associated with lower educational attainment and more SUD symptoms in adulthood.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor; Substance Abuse Research Center, University of Michigan.
| | - Philip Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 48109
| | - Timothy E. Wilens
- Pediatric and Adult Psychopharmacology Units, Massachusetts General Hospital, Boston, MA 02114 and School of Medicine, Department of Psychiatry, Harvard University, Boston, MA 02115
| | - John E. Schulenberg
- Institute for Social Research and Department of Psychology, University of Michigan, Ann Arbor, MI, USA 48106-1248
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554
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Ramanathan T, Hulkower R, Holbrook J, Penn M. Legal Epidemiology: The Science of Law. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2017; 45:69-72. [PMID: 28661299 PMCID: PMC5690565 DOI: 10.1177/1073110517703329] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The importance of legal epidemiology in public health law research has undoubtedly grown over the last five years. Scholars and practitioners together have developed guidance on best practices for the field, including: placing emphasis on transdisciplinary collaborations; creating valid, reliable, and repeatable research; and publishing timely products for use in decision-making and change. Despite the energy and expertise researchers have brought to this important work, they name significant challenges in marshalling the diverse skill sets, quality controls, and funding to implement legal epidemiology activities. The Centers for Disease Control and Prevention (CDC) has worked to develop cross-cutting research and translation on issues of national priority in legal epidemiology, and has explored ways to overcome some of these challenges. As such, this article describes a case study of the use of law to characterize states' prior authorization policies regarding medication used to treat attention-deficit/hyperactivity disorder (ADHD), a central component of a broader effort to improve behavior therapy options for young children with ADHD. This article highlights the types of legal epidemiology work we have undertaken, the application of this work to an emerging public health problem, and the lessons learned in creating impactful research for the field.
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Affiliation(s)
- Tara Ramanathan
- Tara Ramanathan, J.D., M.P.H., is the Team Lead for Research and Translation at the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Rachel Hulkower, J.D., M.S.P.H., is a public health analyst through Chenega Professional & Technical Services with the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Joseph Holbrook, Ph.D., M.P.H., is an epidemiologist at the National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention. Matthew Penn, J.D., M.L.I.S., is the Direc¬tor of the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention
| | - Rachel Hulkower
- Tara Ramanathan, J.D., M.P.H., is the Team Lead for Research and Translation at the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Rachel Hulkower, J.D., M.S.P.H., is a public health analyst through Chenega Professional & Technical Services with the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Joseph Holbrook, Ph.D., M.P.H., is an epidemiologist at the National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention. Matthew Penn, J.D., M.L.I.S., is the Direc¬tor of the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention
| | - Joseph Holbrook
- Tara Ramanathan, J.D., M.P.H., is the Team Lead for Research and Translation at the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Rachel Hulkower, J.D., M.S.P.H., is a public health analyst through Chenega Professional & Technical Services with the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Joseph Holbrook, Ph.D., M.P.H., is an epidemiologist at the National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention. Matthew Penn, J.D., M.L.I.S., is the Direc¬tor of the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention
| | - Matthew Penn
- Tara Ramanathan, J.D., M.P.H., is the Team Lead for Research and Translation at the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Rachel Hulkower, J.D., M.S.P.H., is a public health analyst through Chenega Professional & Technical Services with the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention. Joseph Holbrook, Ph.D., M.P.H., is an epidemiologist at the National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention. Matthew Penn, J.D., M.L.I.S., is the Direc¬tor of the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support, U.S. Centers for Disease Control and Prevention
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555
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Colaneri N, Keim S, Adesman A. Physician practices to prevent ADHD stimulant diversion and misuse. J Subst Abuse Treat 2017; 74:26-34. [DOI: 10.1016/j.jsat.2016.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 11/28/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
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556
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Lawson GM, Nissley-Tsiopinis J, Nahmias A, McConaughy SH, Eiraldi R. Do Parent and Teacher Report of ADHD Symptoms in Children Differ by SES and Racial Status? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9591-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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557
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Lengvenyte A, Strumila R, Grikiniene J. Use of cognitive enhancers among medical students in Lithuania. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims The purpose of this study is to analyse the use of cognitive enhancers among medical students in Lithuania, determine the reasons for usage and evaluate the contributing factors such as socio-demographic characteristics, stress levels, sleep quality and knowing somebody who has used a neuro-enhancing drug. Design A cross-sectional survey study was performed by analysing a convenience sample of n=579 in the two universities offering medical education in Lithuania, Vilnius University and the Lithuanian University of Health Sciences. In 2014, students were asked to fill in anonymous paper questionnaires consisting of 13 items on prevalence of substance use to enhance cognitive performance, and on reasons and correlates (response rate 95%) during lecture time. Results Of the respondents, 8.1% indicated that they had used cognitive enhancers. Among those who had used these drugs, nootropics were the most frequently mentioned (59.6%), while psychostimulants, such as modafinil, methylphenidate and amphetamine-derived drugs were mentioned less frequently (38.3%). Other substances were indicated by 23.4% of the respondents. Improvement of concentration and increased studying time were predominant purposes (55.3% and 48.9% of users, respectively). Male students reported three times higher prevalence rates than females (14.6% vs. 5.1%, p<0.05). Prevalence was also higher in students who knew someone using these substances than among those who did not know such persons (17.3% vs. 5.1%, p< 0.05). This was the most associated factor with cognitive-enhancing drug-taking behaviour. No correlation between cognitive enhancement usage and sleep quality or stress levels was found, nor between usage and belonging to a student organisation or having a job. Conclusions In Lithuania, 1 of 12 medical students admits to having used neuro-enhancing drugs. Our study results provide an overview of the actual situation on correlates and reasons for taking performance-enhancing substances.
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558
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Gottfried MA, Sublett C. Does Applied STEM Course Taking Link to STEM Outcomes for High School Students With Learning Disabilities? JOURNAL OF LEARNING DISABILITIES 2017; 51:250-267. [PMID: 28170283 DOI: 10.1177/0022219417690356] [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: 06/06/2023]
Abstract
Over the most recent two decades, federal policy has urged high schools to embed applied science, technology, engineering, and mathematics (STEM) courses into the curriculum to reinforce concepts learned in traditional math and science classes as well as to motivate students' interests and long-term pursuits in STEM areas. While prior research has examined whether these courses link to STEM persistence for the general student population, no work has examined the role of these courses for students with learning disabilities (LDs). This is a critical lapse, as these courses have been supported as being one path by which STEM material can become more accessible for students with diverse learning needs. Hence, this descriptive study examines the landscape of applied STEM course taking for students with LDs. The findings suggest students with LDs are less likely to take applied STEM courses in high school compared to the general population. Additionally, while the general population does benefit from taking these courses, there is a unique association between applied STEM course taking and advanced math and science course taking or math achievement for students with LDs. Hence, there is no evidence that applied STEM course taking is related to any closure of the STEM achievement gap for students with LDs.
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559
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Momany AM, Kamradt JM, Ullsperger JM, Elmore AL, Nigg JT, Nikolas MA. Sex moderates the impact of birth weight on child externalizing psychopathology. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:244-256. [PMID: 27868421 PMCID: PMC5305621 DOI: 10.1037/abn0000238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Low birth weight (LBW) has consistently been associated with childhood attention deficit/hyperactivity disorder (ADHD), and a similar association has been found for childhood externalizing disorders, such as oppositional defiant disorder (ODD) and conduct disorder (CD), albeit to a lesser degree. Although the association between LBW and these disorders has been robustly replicated, few studies have adequately controlled for confounding variables, such as parental age at birth and prenatal tobacco use, examined the specificity of the risk of LBW for ADHD symptoms, or investigated potential nonlinear (i.e., quadratic) effects of birth weight (BW). Additionally, the extent to which LBW confers risk for these disorders depending on childhood sex has rarely been examined. The current study examined associations between BW and ADHD, ODD, and CD symptom dimensions as well as the extent to which such associations are moderated by child sex, while also controlling for confounding variables. Significant interactions between sex and BW emerged across all analyses predicting ADHD and externalizing psychopathology, such that associations were stronger in males relative to females. Results remained when controlling for a number of confounds, including parental age, prenatal tobacco use, comorbid psychopathology, as well as other indicators of maternal and child health during the pre- and perinatal period. Both linear and quadratic associations emerged between BW and both hyperactivity and CD symptoms, whereas BW predicted inattention and ODD symptoms in a linear fashion. Future research should continue to investigate the impact of BW on ADHD and externalizing psychopathology, in particular, the biological mechanisms underlying this association. (PsycINFO Database Record
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Affiliation(s)
- Allison M Momany
- Department of Psychological and Brain Sciences, University of Iowa
| | - Jaclyn M Kamradt
- Department of Psychological and Brain Sciences, University of Iowa
| | | | - Alexis L Elmore
- Department of Psychological and Brain Sciences, University of Iowa
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health and Sciences University
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa
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560
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Childress AC, Kollins SH, Cutler AJ, Marraffino A, Sikes CR. Efficacy, Safety, and Tolerability of an Extended-Release Orally Disintegrating Methylphenidate Tablet in Children 6-12 Years of Age with Attention-Deficit/Hyperactivity Disorder in the Laboratory Classroom Setting. J Child Adolesc Psychopharmacol 2017; 27:66-74. [PMID: 27183299 PMCID: PMC5326982 DOI: 10.1089/cap.2016.0002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Methylphenidate extended-release orally disintegrating tablets (MPH XR-ODTs) represent a new technology for MPH delivery. ODTs disintegrate in the mouth without water and provide a pharmacokinetic profile that is consistent with once-daily dosing. This study sought to determine the efficacy, safety, and tolerability of this novel MPH XR-ODT formulation in school-age children with attention-deficit/hyperactivity disorder (ADHD) in a laboratory classroom setting. METHODS Children aged 6-12 years with ADHD (n = 87) were enrolled in this randomized, multicenter, double-blind, placebo-controlled, parallel, laboratory classroom study. The MPH XR-ODT dose was titrated to an optimized dose during a 4-week open-label period and maintained on that dose for 1 week. Participants (n = 85) were then randomized to receive their optimized dose of MPH XR-ODT or placebo once daily for 1 week (double blind), culminating in a laboratory classroom testing day. Efficacy was evaluated using the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Attention, Deportment, and Combined scores along with Permanent Product Measure of Performance (PERMP; Attempted and Correct) assessments. Onset and duration of drug action were also evaluated as key secondary endpoints. Safety assessments included adverse events (AEs), physical examinations, electrocardiograms (ECGs), and the Columbia Suicide Severity Rating Scale (C-SSRS). RESULTS The average SKAMP-Combined score on the classroom study day was significantly better for the MPH XR-ODT group (n = 43) than for the placebo group (n = 39; p < 0.0001). The effect was evident at 1 hour and lasted through 12 hours postdose. The average SKAMP-Attention, SKAMP-Deportment, PERMP-A, and PERMP-C scores were indicative of significantly greater ADHD symptom control for the MPH XR-ODT group. The most common AEs reported were decreased appetite, upper abdominal pain, headache, insomnia, upper respiratory tract infection, affect lability, irritability, cough, and vomiting. CONCLUSIONS MPH XR-ODT was effective and well tolerated for the treatment of children with ADHD in a laboratory classroom setting. Clinical Trial Registry: NCT01835548 ( ClinicalTrials.gov ).
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Affiliation(s)
- Ann C. Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina
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561
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Colaneri N, Keim S, Adesman A. Adolescent Patient Education Regarding ADHD Stimulant Diversion And Misuse. PATIENT EDUCATION AND COUNSELING 2017; 100:289-296. [PMID: 27609322 DOI: 10.1016/j.pec.2016.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Recent studies report that adolescents misuse and divert ADHD stimulants. This study evaluates the extent to which physicians educate adolescents with ADHD about stimulant misuse and diversion (M/D). METHODS Child/adolescent psychiatrists (CAP), child neurologists (CN), and developmental-behavioral pediatricians (DBP) in the US completed a questionnaire. Descriptive statistics were performed on the final sample (n=826); multivariate regressions were performed to identify education practice differences. RESULTS Only 46% and 44% of physicians educate patients "often" or "very often" on health risks and legal consequences, respectively, of stimulant M/D. CAP are more likely to educate on health and legal consequences than CN, and more likely to educate on legal consequences than DBP. Compared to physicians who prescribe stimulants to 1-10 patients (low prescribers), medium prescribers (11-30 patients) and high prescribers (30+ patients) are more likely to educate about M/D. 60% of physicians counsel patients at least "often" about M/D in a pre-college appointment; 8% have written materials regarding M/D available. CONCLUSIONS Many physcians currently don't educate adolescent patients with ADHD often enough about M/D. CN and DBP, and low prescribers, are less likely to educate about M/D. PRACTICE IMPLICATIONS Physicians who prescribe stimulants must educate patients more often to prevent stimulant M/D.
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Affiliation(s)
- Natalie Colaneri
- Developmental and Behavioral Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, USA.
| | - Sarah Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, USA.
| | - Andrew Adesman
- Developmental and Behavioral Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, USA.
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562
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Merrill BM, Morrow AS, Altszuler AR, Macphee FL, Gnagy EM, Greiner AR, Coles EK, Raiker JS, Coxe S, Pelham WE. Improving homework performance among children with ADHD: A randomized clinical trial. J Consult Clin Psychol 2017; 85:111-122. [PMID: 27618639 PMCID: PMC5280087 DOI: 10.1037/ccp0000144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework. This study is the first to examine the effects of behavioral, psychostimulant, and combined treatments on homework problems, which have been shown to predict academic performance longitudinally. METHOD Children with ADHD (ages 5-12, N = 75, 71% male, 83% Hispanic/Latino) and their families were randomly assigned to either behavioral treatment (homework-focused parent training and a daily report card; BPT + DRC) or a waitlist control group. Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program. Children's objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills. RESULTS BPT + DRC had large effects on objective measures of homework completion and accuracy (Cohen's ds from 1.40 to 2.21, ps < .001). Other findings, including unimodal medication and incremental combined treatment benefits, were not significant. CONCLUSIONS Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance. (PsycINFO Database Record
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563
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Furu K, Karlstad Ø, Zoega H, Martikainen JE, Bahmanyar S, Kieler H, Pottegård A. Utilization of Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder among 5.4 Million Children Using Population-Based Longitudinal Data. Basic Clin Pharmacol Toxicol 2017; 120:373-379. [PMID: 27911044 DOI: 10.1111/bcpt.12724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/24/2016] [Indexed: 12/31/2022]
Abstract
Use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) has increased over the past two decades and varies substantially between countries. The objective of this multinational population-based study was to examine utilization of ADHD drugs (stimulants and atomoxetine) including comedication with other psychotropic drugs in the entire child population in the five Nordic countries. We included longitudinal data on dispensed ADHD drugs from five Nordic prescription registers during 2008-2012, which in 2012 comprised 48,296 individuals among 5.42 million inhabitants aged 0-17 years. Prevalence of filling ≥1 prescriptions of ADHD drugs among children aged 6-17 years increased during 2008-2012 from 5.9 to 11.2 and 19.4 to 31.0 per 1000 girls and boys, respectively. Prevalence by country showed that Iceland, Finland and Sweden had a steady increase during the study period, while in Norway the prevalence was quite stable and in Denmark it levelled off from 2010. Use in preschoolers (aged 0-5 years) was rare. Iceland had much higher prevalence and incidence than the other Nordic countries. The incidence of ADHD drug use increased during the study period, from 4.0 to 4.9 and from 1.5 to 2.3 per 1000 boys and girls, respectively. The increasing number of new users levelled off somewhat after 2010. Comedication with other psychotropic drugs was more common among girls (33.9%) than boys (27.0%) and was mainly melatonin, followed by antidepressants and antipsychotics. Overall prevalence of ADHD drug use increased among Nordic girls and boys aged 6-17 years, whereas the incidence increased slightly during 2008-2010 but levelled off through 2012. The substantial differences in ADHD drug use across the Nordic countries and high degree of comedication with other psychotropic drugs underscore the importance of close monitoring of treatment for ADHD among children.
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Affiliation(s)
- Kari Furu
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland Reykjavik, Reykjavik, Iceland
| | | | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Funen, Denmark
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564
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Gayleard JL, Mychailyszyn MP. Atomoxetine treatment for children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology. ACTA ACUST UNITED AC 2017; 9:149-160. [PMID: 28110366 DOI: 10.1007/s12402-017-0216-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 08/08/2015] [Indexed: 11/24/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) impacts a significant number of children and adolescents and often leads to deleterious functional impairment. Psychostimulant medication has historically been the first line of pharmacological intervention, though recent years have seen greater attention paid to non-stimulant alternatives. The objective of the present study was to conduct the most comprehensive meta-analysis to date evaluating the efficacy of atomoxetine in reducing core symptomatology of ADHD according to parent report. Selection criteria were applied, and studies were located by searching electronic databases, review of reference sections, and contact with expert researchers; article searching began on 10/01/2013, and the final search was conducted on 09/01/2014. A total of 42 studies met inclusion criteria-33 with control groups and 9 without-for a total sample of 8398 individuals. For those receiving atomoxetine, the summary pre-post (e.g., standardized mean gain) effect size estimate was 1.37 (95% CI [1.24, 1.51], p < .001); atomoxetine was found to statistically significantly outperform control conditions overall (Z = 4.07, p < .001), though results differed by the type of control group; for instance, when comparing atomoxetine to alternative medications as controls, significant differences were no longer present. The non-stimulant atomoxetine led to significant improvement in core ADHD symptomatology and should be considered as a viable pharmacological treatment option for ADHD.
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Affiliation(s)
- Jessica L Gayleard
- Department of Psychology, Towson University, 8000 York Road, Towson, MD, 21252, USA
| | - Matthew P Mychailyszyn
- Department of Psychology, Towson University, 8000 York Road, Towson, MD, 21252, USA. .,Division of Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA.
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565
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Adisetiyo V, Gray KM. Neuroimaging the neural correlates of increased risk for substance use disorders in attention-deficit/hyperactivity disorder-A systematic review. Am J Addict 2017; 26:99-111. [DOI: 10.1111/ajad.12500] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/02/2016] [Accepted: 12/23/2016] [Indexed: 01/18/2023] Open
Affiliation(s)
- Vitria Adisetiyo
- Department of Radiology and Radiological Science; Medical University of South Carolina; Charleston South Carolina
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston South Carolina
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566
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Altszuler AR, Morrow AS, Merrill BM, Bressler S, Macphee FL, Gnagy EM, Greiner AR, Coxe S, Raiker JS, Coles E, Pelham WE. The Effects of Stimulant Medication and Training on Sports Competence Among Children With ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 48:S155-S167. [PMID: 28103159 PMCID: PMC6141352 DOI: 10.1080/15374416.2016.1270829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children's observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities.
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Affiliation(s)
- Amy R Altszuler
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Anne S Morrow
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Brittany M Merrill
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Shannon Bressler
- b Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia
| | - Fiona L Macphee
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Elizabeth M Gnagy
- c Center for Children and Families , Florida International University
| | - Andrew R Greiner
- c Center for Children and Families , Florida International University
| | - Stefany Coxe
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Joseph S Raiker
- a Center for Children and Families and Department of Psychology , Florida International University
| | - Erika Coles
- a Center for Children and Families and Department of Psychology , Florida International University
| | - William E Pelham
- a Center for Children and Families and Department of Psychology , Florida International University
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567
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Parker J, Martyn-St James M, Green MA, Lewis-Hanna L, Dias R, Morris B, Shibib S, Chalhoub N. Physical activity for improving the symptoms of attention deficit hyperactivity disorder in children and adolescents. Hippokratia 2017. [DOI: 10.1002/14651858.cd012107.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jack Parker
- Sheffield Children's NHS Foundation Trust; Child and Adolescent Mental Health Service; Centenary House 55 Albert Terrace Road Sheffield South Yorkshire UK S6 3BR
| | - Marrissa Martyn-St James
- University of Sheffield; School of Health and Related Research (ScHARR); Regent Court, 30 Regent Street Sheffield South Yorkshire UK S1 4DA
| | - Mark A Green
- University of Sheffield; School of Health and Related Research (ScHARR); Regent Court, 30 Regent Street Sheffield South Yorkshire UK S1 4DA
| | - Lourence Lewis-Hanna
- South West Yorkshire NHS Foundation Trust; Barnsley Child and Adolescent Unit; New Street Health Centre Barnsley South Yorkshire UK S701LP
| | - Ryan Dias
- Sheffield Children's NHS Foundation Trust; Child and Adolescent Mental Health Service; Centenary House 55 Albert Terrace Road Sheffield South Yorkshire UK S6 3BR
| | - Bronwen Morris
- Sheffield Children's NHS Foundation Trust; Child and Adolescent Mental Health Service; Centenary House 55 Albert Terrace Road Sheffield South Yorkshire UK S6 3BR
| | - Shatha Shibib
- Sheffield Children's NHS Foundation Trust; Child and Adolescent Mental Health Service; Centenary House 55 Albert Terrace Road Sheffield South Yorkshire UK S6 3BR
| | - Nevyne Chalhoub
- Sheffield Children's NHS Foundation Trust; Child and Adolescent Mental Health Service; Centenary House 55 Albert Terrace Road Sheffield South Yorkshire UK S6 3BR
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568
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Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD. Matern Child Health J 2017; 20:915-24. [PMID: 26754346 DOI: 10.1007/s10995-015-1880-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES (1) To describe parents' report of special needs for children with ADHD on the Children with Special Health Care Needs (CSHCN) Screener; and (2) to assess the association between responses to Screener items and annual mental health and total health expenditures per child. METHODS In pooled 2002-2011 Medical Expenditure Panel Survey (MEPS) data, we identify children ages 4-17 years with ADHD. We use OLS and two-part regressions to model the relationship between CSHCN Screener items and mental health and total health expenditures. Based on these models we estimate adjusted, average total health expenditures for children with ADHD-both with and without a co-morbid mental health condition-and different combinations of endorsed Screener items. This research was conducted in accordance with prevailing ethical principles. RESULTS There were 3883 observations on 2591 children with ADHD. Without a co-morbid mental health condition, average total expenditures per year from adjusted, model-based estimates were $865 for those meeting no Screener items, $2664 for those meeting only the medication item, $3595 for those meeting the medication and counseling items, and $4203 for those meeting the medication, counseling, and use of more health services items. Children with a co-morbid mental health condition had greater total health expenditures for each combination of Screener items. The associations between Screener items and mental health expenditures were similar, but with a slightly lower marginal effect of the medication item (p < 0.001 for all comparisons). CONCLUSIONS Parents' responses on the CSHCN Screener are associated with meaningful variation in expenditures for children with ADHD. Though cross-sectional, this study suggests that the CSHCN Screener can be a useful categorization scheme for children with ADHD. It may be an efficient, standardized tool at the point of care for identifying children who need more resources and for targeting intensive interventions in the context of population health management.
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569
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Owens J, Jackson H. Attention-deficit/hyperactivity disorder severity, diagnosis, & later academic achievement in a national sample. SOCIAL SCIENCE RESEARCH 2017; 61:251-265. [PMID: 27886732 PMCID: PMC5292042 DOI: 10.1016/j.ssresearch.2016.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 05/27/2016] [Accepted: 06/09/2016] [Indexed: 05/06/2023]
Abstract
Although 11% (6.4 million) American children are diagnosed with attention deficit/hyperactivity disorder (ADHD), the role of ADHD severity in shaping the association between ADHD diagnosis and academic achievement is not understood. Using a nationally-representative sample of 7830 U.S. kindergartners from the Early Childhood Longitudinal Study-Kindergarten Cohort, we use regression and propensity score matching to compare diagnosed (N = 350) and undiagnosed children who are cognitively, behaviorally, and demographically similar. Diagnosed children with less severe ADHD-related behaviors on average scored lower in reading (-0.30 SD) and math (-0.22 SD) than their undiagnosed peers - a difference two times larger than that between diagnosed and undiagnosed children with more severe ADHD-related behaviors. Pharmacological treatment did not attenuate most of this "diagnostic labeling effect" among children with less severe ADHD-related behaviors. Negative factors associated with an ADHD diagnosis may outweigh potential benefits for achievement among children with less severe ADHD-related behaviors, even those receiving treatment.
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Affiliation(s)
- Jayanti Owens
- Department of Sociology and Watson Institute for International and Public Affairs, Brown University, Providence, RI, USA.
| | - Heide Jackson
- Center on Aging and Health, Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
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570
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Little LM, Dean E, Tomchek SD, Dunn W. Classifying sensory profiles of children in the general population. Child Care Health Dev 2017; 43:81-88. [PMID: 27545764 DOI: 10.1111/cch.12391] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/09/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to subtype groups of children in a community sample with and without developmental conditions, based on sensory processing patterns. METHODS We used latent profile analysis to determine the number of sensory subtypes in a sample of n = 1132 children aged 3-14 years with typical development and developmental conditions, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder and learning disabilities. RESULTS A five-subtype solution was found to best characterize the sample, which differed on overall degree and differential presentation of sensory processing patterns. Children with and without developmental conditions presented across subtypes, and one subtype was significantly younger in age than others (P < 0.05). CONCLUSIONS Our results show that sensory subtypes include both children with typical development and those with developmental conditions. Sensory subtypes have previously been investigated in ASD only, and our results suggest that similar sensory subtypes are present in a sample reflective of the general population of children including those largely with typical development. Elevated scores on sensory processing patterns are not unique to ASD but rather are reflections of children's abilities to respond to environmental demands.
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Affiliation(s)
- L M Little
- Department of Occupational Therapy, University of Kansas Medical Center, Kansas City, KS, USA
| | - E Dean
- Department of Occupational Therapy, University of Kansas Medical Center, Kansas City, KS, USA
| | - S D Tomchek
- Department of Occupational Therapy, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Pediatrics, University of Louisville, Weisskopf Child Evaluation Center, Louisville, KY, USA
| | - W Dunn
- Department of Occupational Therapy, University of Kansas Medical Center, Kansas City, KS, USA
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571
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LaKind JS, Anthony LG, Goodman M. Review of reviews on exposures to synthetic organic chemicals and children's neurodevelopment: Methodological and interpretation challenges. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2017; 20:390-422. [PMID: 28952888 DOI: 10.1080/10937404.2017.1370847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Environmental epidemiology data are becoming increasingly important in public health decision making, which commonly incorporates a systematic review of multiple studies. This review addresses two fundamental questions: What is the quality of available reviews on associations between exposure to synthetic organic chemicals and neurodevelopmental outcomes? What is the value (e.g., quality and consistency) of the underlying literature? Published reviews on associations between synthetic organic environmental chemical exposures and neurodevelopmental outcomes in children were systematically evaluated. Seventy-four relevant reviews were identified, and these were evaluated with respect to four methodological characteristics: (1) systematic inclusion/exclusion criteria and reproducible methods for search and retrieval of studies; (2) structured evaluation of underlying data quality; (3) systematic assessment of consistency across specific exposure-outcome associations; and (4) evaluation of reporting/publication bias. None of the 74 reviews fully met the criteria for all four methodological characteristics. Only four reviews met two criteria, and six reviews fulfilled only one criterion. Perhaps more importantly, the higher quality reviews were not able to meet all of the criteria owing to the shortcomings of underlying studies, which lacked comparability in terms of specific research question of interest, overall design, exposure assessment, outcome ascertainment, and analytic methods. Thus, even the most thoughtful and rigorous review may be of limited value if the underlying literature includes investigations that address different hypotheses and are beset by methodological inconsistencies and limitations. Issues identified in this review of reviews illustrate considerable challenges that are facing assessments of epidemiological evidence.
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Affiliation(s)
- Judy S LaKind
- a LaKind Associates , LLC , Catonsville , MD 21228 , USA
- b Department of Epidemiology and Public Health , University of Maryland School of Medicine , Baltimore , MD 21201 , USA
| | - Laura G Anthony
- c Center for Autism Spectrum Disorders, Children's National Health System , The George Washington University Medical Center , 15245 Shady Grove Road, Suite 350, Rockville , MD 20850 USA
| | - Michael Goodman
- d Department of Epidemiology, Rollins School of Public Health , Emory University , 1518 Clifton Rd, Atlanta , GA 30322 USA
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572
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Martinez AF, Abe Y, Hong S, Molyneux K, Yarnell D, Löhr H, Driever W, Acosta MT, Arcos-Burgos M, Muenke M. An Ultraconserved Brain-Specific Enhancer Within ADGRL3 (LPHN3) Underpins Attention-Deficit/Hyperactivity Disorder Susceptibility. Biol Psychiatry 2016; 80:943-954. [PMID: 27692237 PMCID: PMC5108697 DOI: 10.1016/j.biopsych.2016.06.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Genetic factors predispose individuals to attention-deficit/hyperactivity disorder (ADHD). Previous studies have reported linkage and association to ADHD of gene variants within ADGRL3. In this study, we functionally analyzed noncoding variants in this gene as likely pathological contributors. METHODS In silico, in vitro, and in vivo approaches were used to identify and characterize evolutionary conserved elements within the ADGRL3 linkage region (~207 Kb). Family-based genetic analyses of 838 individuals (372 affected and 466 unaffected patients) identified ADHD-associated single nucleotide polymorphisms harbored in some of these conserved elements. Luciferase assays and zebrafish green fluorescent protein transgenesis tested conserved elements for transcriptional enhancer activity. Electromobility shift assays were used to verify transcription factor-binding disruption by ADHD risk alleles. RESULTS An ultraconserved element was discovered (evolutionary conserved region 47) that functions as a transcriptional enhancer. A three-variant ADHD risk haplotype in evolutionary conserved region 47, formed by rs17226398, rs56038622, and rs2271338, reduced enhancer activity by 40% in neuroblastoma and astrocytoma cells (pBonferroni < .0001). This enhancer also drove green fluorescent protein expression in the zebrafish brain in a tissue-specific manner, sharing aspects of endogenous ADGRL3 expression. The rs2271338 risk allele disrupts binding of YY1 transcription factor, an important factor in the development and function of the central nervous system. Expression quantitative trait loci analysis of postmortem human brain tissues revealed an association between rs2271338 and reduced ADGRL3 expression in the thalamus. CONCLUSIONS These results uncover the first functional evidence of common noncoding variants with potential implications for the pathology of ADHD.
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573
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Childress A, Belchenko D, Lempa B. The use of modified-release methylphenidate in the treatment of attention-deficit/hyperactivity disorder. Expert Rev Neurother 2016; 17:113-121. [PMID: 27936986 DOI: 10.1080/14737175.2016.1271714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Since Ritalin® (Methylphenidate-Immediate release or MPH-IR) was introduced for the treatment of attention-deficit/hyperactivity disorder, multiple formulations of MPH have been developed. The specific formulation determines the pharmacokinetic (PK) profile and the onset and duration of action for the compound. Areas covered: Aptensio XR® is a multilayer-release MPH (MPH-MLR) consisting of an MPH-IR layer (40%) and an extended-release (ER) portion of 60% of MPH. It has an initial maximum MPH concentration at about two hours (h) and a second concentration peak at approximately 8 h. This formulation allows for a rapid onset of effect by 1 h and a duration of action through 12 h after dosing. The chemistry, PK, efficacy and adverse event profile of MPH-MLR will be reviewed. Expert commentary: Although the PK profile may prove beneficial to patients in the late afternoon and early evening, it is not clear if this is a significant advantage compared with other MPH-ER formulations.
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Affiliation(s)
- Ann Childress
- a Center for Psychiatry and Behavioral Medicine, Inc ., Las Vegas , NV , USA .,b Department of Family and Community Medicine , University of Nevada School of Medicine , Las Vegas , NV.,c Department of Psychiatry , Touro University Nevada , Henderson , NV , USA
| | - Dmitry Belchenko
- c Department of Psychiatry , Touro University Nevada , Henderson , NV , USA
| | - Brian Lempa
- c Department of Psychiatry , Touro University Nevada , Henderson , NV , USA
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574
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The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample. J Behav Health Serv Res 2016; 42:437-51. [PMID: 25007864 DOI: 10.1007/s11414-014-9422-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.
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575
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Mohammadpour N, Jazayeri S, Tehrani-Doost M, Djalali M, Hosseini M, Effatpanah M, Davari-Ashtiani R, Karami E. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutr Neurosci 2016; 21:202-209. [PMID: 27924679 DOI: 10.1080/1028415x.2016.1262097] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Previous studies have shown that serum levels of vitamin D were lower in attention deficit hyperactivity disorder (ADHD) children compared to healthy controls. The aim of the study was to determine the effect of vitamin D supplementation as adjunctive therapy to methylphenidate on symptoms of children with ADHD. METHODS Sixty-two children aged 5-12 years with a diagnosis of ADHD based on DSM-IV criteria were randomly assigned into two groups to receive either 2000IU vitamin D or placebo in addition to methylphenidate for 8 weeks. Symptoms severity was assessed by Conner's Parent Rating Scale-Revised[S] (CPRS), ADHD rating scale-IV (ADHD-RS), and Weekly Parent Ratings of Evening and Morning Behavior (WPREMB) at weeks 0, 4, and 8. Serum levels of 25(OH)D were measured at baseline and after 8 weeks. Anthropometric variables, dietary intake, physical activity, sun exposure, and side effects were assessed. RESULTS Fifty-four participants completed the trial. After 8 weeks of supplementation, serum levels of 25(OH)D significantly increased in the vitamin D group. ADHD symptoms decreased significantly in both groups (P < 0.05). Evening symptoms and total score of WPREMB scale were significantly different at weeks 4 and 8 between the two groups (P = 0.013, 0.016, respectively), but no differences were found in symptoms by CPRS and ADHD-RS scales. DISCUSSION Vitamin D supplementation as adjunctive therapy to methylphenidate improved ADHD evening symptoms. Future research is needed to clarify vitamin D effects as monotherapy in ADHD and its mechanism. The trial was registered in www.irct.ir is (IRCT201404222394N10).
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Affiliation(s)
- Nakisa Mohammadpour
- a Department of Clinical Nutrition , School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
| | - Shima Jazayeri
- b Pediatric Growth and Development Research Center , Institute of Endocrinology and Metabolism, Iran University of Medical Sciences , Tehran , Iran.,c Department of Nutrition , School of Public Health, Iran University of Medical Sciences , Tehran , Iran
| | - Mehdi Tehrani-Doost
- d Department of Psychiatry, Roozbeh Hospital , Tehran University of Medical Sciences , Iran
| | - Mahmoud Djalali
- e Department of Cellular and Molecular Nutrition , School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
| | - Mostafa Hosseini
- f Department of Epidemiology and Biostatistics , School of Public Health, Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Effatpanah
- g Ziaean Hospital, School of Medicine, International Campus , Tehran University of Medical Sciences , Tehran , Iran
| | - Rozita Davari-Ashtiani
- h Behavioral Sciences Research Center, Imam Hossein Hospital , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Elham Karami
- a Department of Clinical Nutrition , School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran
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576
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Hogue A, Lichvar E, Bobek M. Pilot Evaluation of the Medication Integration Protocol for Adolescents with ADHD in Behavioral Care: Treatment Fidelity and Medication Uptake. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2016; 24:223-234. [PMID: 34113069 PMCID: PMC8188877 DOI: 10.1177/1063426615611648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Although Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among adolescents in outpatient behavioral care, one of the few evidence-based treatment options, stimulant medication, is significantly underutilized. The Medication Integration Protocol (MIP) is a family-based intervention designed to help behavior therapists assume a lead role in educating clients about ADHD in adolescents, promoting family-centered decisions about medication initiation, and integrating medication management activities within behavioral treatment planning. This pilot study evaluated treatment fidelity and medication utilization for inner-city teens receiving MIP (n = 14) compared to a matched Historical Control (HC) group (n = 21) in a community clinic. Observational analyses revealed that in comparison to HC, MIP demonstrated basic protocol fidelity with regard to adherence to the MIP protocol, therapeutic alliance with the adolescent, and clinical focus on ADHD in session. MIP showed greater psychiatric evaluation completion and ADHD medication initiation than HC. Next steps in the ongoing development of MIP are outlined.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse at Columbia University
| | - Emily Lichvar
- The National Center on Addiction and Substance Abuse at Columbia University
| | - Molly Bobek
- The National Center on Addiction and Substance Abuse at Columbia University
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577
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Sayer GR, McGough JJ, Levitt J, Cowen J, Sturm A, Castelo E, McCracken JT. Acute and Long-Term Cardiovascular Effects of Stimulant, Guanfacine, and Combination Therapy for Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2016; 26:882-888. [PMID: 27483130 PMCID: PMC5178010 DOI: 10.1089/cap.2015.0264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study examines cardiovascular (CV) effects of guanfacine immediate-release (GUAN-IR), dexmethylphenidate extended-release (DMPH), and their combination (COMB) during acute and long-term treatment of youth with attention-deficit/hyperactivity disorder. METHODS Two hundred seven participants aged 7-14 years enrolled in an 8-week double-blind randomized trial of GUAN-IR (1-3 milligrams (mg)/day), DMPH (5-20 mg/day), or COMB with fixed-flexible dosing and titrated to optimal behavioral response. Heart rate, systolic blood pressure (BP), diastolic BP, and electrocardiograms were assessed at baseline, end of blinded optimization, and over a 1-year open-label maintenance phase. RESULTS During acute titration, GUAN-IR decreased heart rate, systolic BP, and diastolic BP; DMPH increased heart rate, systolic BP, diastolic BP, and corrected QT (QTc) interval; COMB increased diastolic BP, but had no effects on heart rate, systolic BP, or QTc. During maintenance, GUAN-IR-associated decreases in heart rate and DMPH-associated increases in systolic BP returned to baseline values. Other variables across the three groups remained unchanged from the end of blinded titration. There were no discontinuations due to CV adverse events. CONCLUSION GUAN-IR, DMPH, and COMB were well tolerated and safe. Expected changes in CV parameters during acute titration were seen in GUAN-IR and DMPH groups, with COMB values falling intermediately between the two other treatment groups. No serious CV events occurred in any participant. GUAN-IR- and DMPH-associated CV changes generally returned to baseline with sustained therapy. These data suggest that COMB treatment might attenuate long-term CV effects of GUAN-IR and stimulant monotherapy, possibly reducing risk of the small but statistically significant changes associated with either single treatment. Clinicaltrials.gov Identifier: NCT00429273.
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Affiliation(s)
- Gregory R. Sayer
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - James J. McGough
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Jennifer Levitt
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Jennifer Cowen
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Alexandra Sturm
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Edward Castelo
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - James T. McCracken
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
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578
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Visser SN, Deubler EL, Bitsko RH, Holbrook JR, Danielson ML. Demographic Differences Among a National Sample of US Youth With Behavioral Disorders. Clin Pediatr (Phila) 2016; 55:1358-1362. [PMID: 26701719 PMCID: PMC4970955 DOI: 10.1177/0009922815623229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Susanna N. Visser
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily L. Deubler
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H. Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph R. Holbrook
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa L. Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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579
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Jordan CJ, Lemay C, Dwoskin LP, Kantak KM. Adolescent d-amphetamine treatment in a rodent model of attention deficit/hyperactivity disorder: impact on cocaine abuse vulnerability in adulthood. Psychopharmacology (Berl) 2016; 233:3891-3903. [PMID: 27600990 PMCID: PMC5026317 DOI: 10.1007/s00213-016-4419-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/24/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE Stimulant medications for attention-deficit/hyperactivity disorder (ADHD) in adolescents remain controversial with respect to later development of cocaine abuse. Past research demonstrated that adolescent methylphenidate treatment increased several aspects of cocaine self-administration during adulthood using the spontaneously hypertensive rat (SHR) model of ADHD. Presently, we determined effects of the alternate stimulant medication, d-amphetamine, on cocaine self-administration. OBJECTIVES We tested the hypothesis that adolescent d-amphetamine would not increase cocaine self-administration in adult SHR, given that d-amphetamine has a different mechanism of action than methylphenidate. METHODS A pharmacologically relevant dose of d-amphetamine (0.5 mg/kg) or vehicle was administered throughout adolescence to SHR and two control strains, Wistar-Kyoto (WKY) and Wistar (WIS). Three aspects of cocaine abuse vulnerability were assessed in adulthood after discontinuing adolescent treatments: acquisition rate and dose-related responding under fixed (FR) and progressive (PR) ratio schedules. RESULTS Adult SHR acquired cocaine self-administration faster and self-administered more cocaine across multiple doses compared to WKY and WIS under FR and PR schedules, indicating that SHR is a reliable animal model of comorbid ADHD and cocaine abuse. Relative to vehicle, SHR and WIS with adolescent d-amphetamine treatment self-administered less cocaine upon reaching acquisition criteria, and WIS additionally acquired cocaine self-administration more slowly and had downward shifts in FR and PR cocaine dose-response curves. WKY with adolescent d-amphetamine treatment acquired cocaine self-administration more quickly relative to vehicle. CONCLUSIONS In contrast to methylphenidate, adolescent d-amphetamine did not augment cocaine self-administration in SHR. Adolescent d-amphetamine treatment actually protected against cocaine abuse vulnerability in adult SHR and WIS.
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Affiliation(s)
- Chloe J Jordan
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, USA
| | - Carley Lemay
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, USA
| | - Linda P Dwoskin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Kathleen M Kantak
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, USA.
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580
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Heins MJ, Bruggers I, Dijk LV, Korevaar JC. ADHD medication prescription: Effects of child, sibling, parent and general practice characteristics. J Child Health Care 2016; 20:483-493. [PMID: 27708116 DOI: 10.1177/1367493515620913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as 'hyperactive' were 16 times more likely to be prescribed ADHD medication than those with 'behavioural concerns'. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.
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Affiliation(s)
- Marianne J Heins
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Inge Bruggers
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Liset van Dijk
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joke C Korevaar
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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581
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Moody MD. "Us Against Them": Schools, Families, and the Diagnosis of ADHD Among Black Children. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0298-9. [PMID: 27800596 DOI: 10.1007/s40615-016-0298-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 11/26/2022]
Abstract
Prior research indicates that attention-deficit/hyperactivity disorder (ADHD) is underdiagnosed, or less likely to be diagnosed, among Black children relative to White children and children in other non-Black racial categories. Scholars have suggested that this may be a result of cultural biases or misconceptions that affect the ways classroom behavior is interpreted. The purpose of this pilot study was to engage a larger theoretical framework that explores the relationships between parents and teachers and to examine some of the ways in which common cultural misconceptions can lead to flawed behavioral ascriptions in the classroom, producing negative social outcomes for Black children. Findings from ethnography and interviews reveal that the most common barriers in this low-income neighborhood school setting included poor parent-teacher rapport, a general lack of basic understanding for how ADHD can affect classroom behavior, and faulty procedures in the school setting based on cultural stereotypes. These findings suggest that school officials' disinclination to recommend ADHD testing for Black children may be largely a result of the aforementioned obstacles. A larger study based on these results may produce more robust findings about the barriers that contribute to racial disparities in ADHD diagnoses.
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582
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Song I, Shin JY. Prescribing patterns for attention deficit hyperactivity disorder medications among children and adolescents in Korea, 2007-2011. Epidemiol Health 2016; 38:e2016045. [PMID: 27866408 PMCID: PMC5177798 DOI: 10.4178/epih.e2016045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/26/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study analyzed the prevalence of attention deficit hyperactivity disorder (ADHD) medication use among children and adolescents in Korea between January 1, 2007 and December 31, 2011. METHODS Using the Korea National Health Insurance claims database, we identified patients between one and 17 years of age who had at least one medical claim for the diagnosis of ADHD (International Classification of Diseases, 10th revision: F90.0). The annual prevalence of ADHD diagnoses was calculated, using national census data from Statistics Korea on the population aged between one and 17 years as the denominator. The prevalence was age-standardized using the 2010 population as the standard population. The number of patients who were treated with methylphenidate and/or atomoxetine and the prevalence of total patients with ADHD that were treated with either drug were also calculated for each year. All analyses were stratified according to gender and age group (1-5 years, 6-12 years, and 13-17 years). RESULTS The number of patients diagnosed with ADHD increased from 72,704 persons (0.71%) in 2007 to 85,468 persons (0.93%) in 2011. The annual age-standardized prevalence of ADHD diagnoses increased from 0.67% in 2007 to 0.94% in 2011. The prevalence of methylphenidate use among children and adolescents with ADHD decreased from 73.91% in 2007 to 70.33% in 2011, whereas that of atomoxetine use increased from 5.77% in 2009 to 13.09% in 2011. CONCLUSIONS While methylphenidate remains the most commonly prescribed ADHD drug, the use of atomoxetine has increased.
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Affiliation(s)
- Inmyung Song
- Division of Risk Assessment and International Cooperation, Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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583
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Jarrett MA, Meter AV, Youngstrom EA, Hilton DC, Ollendick TH. Evidence-Based Assessment of ADHD in Youth Using a Receiver Operating Characteristic Approach. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:808-820. [PMID: 27775429 DOI: 10.1080/15374416.2016.1225502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Guidelines exist for the assessment of attention deficit/hyperactivity disorder (ADHD), but they are often unclear as to how a clinician should consider multiple informants, methods, and co-occurring symptoms to reach an overall diagnostic probability for an individual patient. The current study used receiver operating characteristic analyses and evidence-based medicine methods to evaluate the Achenbach System of Empirically Based Assessment measures and the Conners' Continuous Performance Test for ADHD diagnosis in youth. Children (n = 379) and their parent(s) presented at an outpatient clinic for a psychoeducational assessment. Analyses examined the diagnostic efficiency and utility of study measures for predicting a best-estimate ADHD diagnosis. The Child Behavior Checklist Attention Problems construct, Teacher Report Form Attention Problems construct, and Hit Reaction Time Standard Error showed adequate diagnostic efficiency and unique contributions to the prediction of ADHD, Combined Type diagnosis. None of these measures showed good diagnostic efficiency or utility for the prediction of ADHD, Predominantly Inattentive Type. Child anxiety did not moderate the relations between predictors and ADHD diagnosis. Both the Child Behavior Checklist and Teacher Report Form Attention Problems constructs can discriminate youth with ADHD, Combined Type from other clinic-referred youth. Although Hit Reaction Time Standard Error also showed diagnostic utility, the decision to include a computerized measure should consider time and expense and be utilized in cases where diagnostic probability is unclear. Finally, anxiety may be associated with elevated attention problems, but it does not appear that anxiety affects diagnostic cutoffs for ADHD.
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Affiliation(s)
| | - Anna Van Meter
- b Ferkauf Graduate School of Psychology , Yeshiva University
| | - Eric A Youngstrom
- c Department of Psychology , University of North Carolina at Chapel Hill
| | | | - Thomas H Ollendick
- d Department of Psychology , Virginia Polytechnic Institute and State University
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584
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Litson K, Geiser C, Burns GL, Servera M. Examining Trait × Method Interactions Using Mixture Distribution Multitrait-Multimethod Models. STRUCTURAL EQUATION MODELING : A MULTIDISCIPLINARY JOURNAL 2016; 24:31-51. [PMID: 28983185 PMCID: PMC5624226 DOI: 10.1080/10705511.2016.1238307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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585
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Perrin JM, Anderson LE, Van Cleave J. The rise in chronic conditions among infants, children, and youth can be met with continued health system innovations. Health Aff (Millwood) 2016; 33:2099-105. [PMID: 25489027 DOI: 10.1377/hlthaff.2014.0832] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since the early twentieth century, medical and public health innovations have led to dramatic changes in the epidemiology of health conditions among infants, children, and youth. Infectious diseases have substantially diminished, and survival rates for children with cancer, congenital heart disease, leukemia, and other conditions have greatly improved. However, over the past fifty years chronic health conditions and disabilities among children and youth have steadily risen, primarily from four classes of common conditions: asthma, obesity, mental health conditions, and neurodevelopmental disorders. In this article we describe the epidemiological shift among infants, children, and youth and examine sociodemographic and other factors contributing to it. We describe how health systems are responding by reorganizing and innovating. For children with rare complex conditions, concentrating subspecialty care at regional centers has been effective. For the much larger numbers of children with common chronic conditions, primary care providers have expanded diagnosis, treatment, and management options in promising ways.
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Affiliation(s)
- James M Perrin
- James M. Perrin is a professor of pediatrics at Harvard Medical School and the John C. Robinson Professor and Associate Chair at MassGeneral Hospital for Children, in Boston, Massachusetts
| | - L Elizabeth Anderson
- L. Elizabeth Anderson is a medical student at the University of Tennessee College of Medicine, in Memphis
| | - Jeanne Van Cleave
- Jeanne Van Cleave is an assistant professor in general academic pediatrics at MassGeneral Hospital for Children
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586
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Faraone SV, Newcorn JH, Antshel KM, Adler L, Roots K, Heller M. The Groundskeeper Gaming Platform as a Diagnostic Tool for Attention-Deficit/Hyperactivity Disorder: Sensitivity, Specificity, and Relation to Other Measures. J Child Adolesc Psychopharmacol 2016; 26:672-685. [PMID: 27105181 PMCID: PMC5069710 DOI: 10.1089/cap.2015.0174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the relative accuracies of the Conners' Brief Rating Scale, Parent Version, the Conners' Continuous Performance Test II (CPT II), and a novel interactive game called "Groundskeeper" to discriminate child psychiatric patients with and without attention-deficit/hyperactivity disorder (ADHD). METHODS We administered the three assessments to 113 clinically referred ADHD and non-ADHD patients who had been diagnosed with the Kiddie-Schedule of Affective Disorders and Schizophrenia- Present and Lifetime (K-SADS-PL), Version 19. RESULTS As measured by the area under the curve (AUC) statistic from receiver operating characteristic (ROC) analysis, the diagnostic accuracy of Groundskeeper (0.79) was as high as the accuracy of the Conners' parent rating of inattention (0.76) and better than the CPT II percent correct (0.62). Combining the three tests produced an AUC of 0.87. Correlations among the three measures were small and, mostly, not significant. CONCLUSIONS Our finding of similar diagnostic accuracies between Groundskeeper and the Conners' inattention scale is especially remarkable given that the Conners' inattention scale shares method variance with the diagnostic process. Although our work is preliminary, it suggests that computer games may be useful in the diagnostic process. This provides an important direction for research, given the objectivity of such measures and the fact that computer games are well tolerated by youth.
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Affiliation(s)
- Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York
- K.G. Jebsen Center for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | | | - Kevin M. Antshel
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Lenard Adler
- Department of Psychiatry and Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York, New York
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587
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Tung I, Li JJ, Meza JI, Jezior KL, Kianmahd JS, Hentschel PG, O’Neil PM, Lee SS. Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis. Pediatrics 2016; 138:peds.2016-0430. [PMID: 27694280 PMCID: PMC9923580 DOI: 10.1542/peds.2016-0430] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls. OBJECTIVE To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD. DATA SOURCES Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD. STUDY SELECTION Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis. DATA EXTRACTION Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded. RESULTS Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus community-referred) girls; the effect of ADHD on ODD varied based on diagnostic informant. LIMITATIONS Findings were derived from cross-sectional studies, precluding causal inferences. CONCLUSIONS Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls.
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Affiliation(s)
- Irene Tung
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - James J. Li
- Department of Psychology, University of Wisconsin, Madison, Wisconsin; and
| | - Jocelyn I. Meza
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Kristen L. Jezior
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jessica S.V. Kianmahd
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Patrick G. Hentschel
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Paul M. O’Neil
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Steve S. Lee
- Department of Psychology, University of California, Los Angeles, Los Angeles, California;,Address correspondence to Steve S. Lee, PhD, Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095. E-mail:
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588
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Andrus CF. Attention-Deficit/Hyperactivity Disorder. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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589
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How psychoactive drugs shape human culture: A multi-disciplinary perspective. Brain Res Bull 2016; 126:138-151. [DOI: 10.1016/j.brainresbull.2016.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 12/23/2022]
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590
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Coker TR, Elliott MN, Toomey SL, Schwebel DC, Cuccaro P, Emery ST, Davies SL, Visser SN, Schuster MA. Racial and Ethnic Disparities in ADHD Diagnosis and Treatment. Pediatrics 2016; 138:peds.2016-0407. [PMID: 27553219 PMCID: PMC5684883 DOI: 10.1542/peds.2016-0407] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children. METHODS We used a population-based, multisite sample of 4297 children and parents surveyed over 3 waves (fifth, seventh, and 10th grades). Multivariate logistic regression examined disparities in parent-reported ADHD diagnosis and medication use in the following analyses: (1) using the total sample; (2) limited to children with an ADHD diagnosis or symptoms; and (3) limited to children without a diagnosis or symptoms. RESULTS Across all waves, African-American and Latino children, compared with white children, had lower odds of having an ADHD diagnosis and of taking ADHD medication, controlling for sociodemographics, ADHD symptoms, and other potential comorbid mental health symptoms. Among children with an ADHD diagnosis or symptoms, African-American children had lower odds of medication use at fifth, seventh, and 10th grades, and Latino children had lower odds at fifth and 10th grades. Among children who had neither ADHD symptoms nor ADHD diagnosis by fifth grade (and thus would not likely meet ADHD diagnostic criteria at any age), medication use did not vary by race/ethnicity in adjusted analysis. CONCLUSIONS Racial/ethnic disparities in parent-reported medication use for ADHD are robust, persisting from fifth grade to 10th grade. These findings suggest that disparities may be more likely related to underdiagnosis and undertreatment of African-American and Latino children as opposed to overdiagnosis or overtreatment of white children.
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Affiliation(s)
- Tumaini R. Coker
- Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California,RAND, Santa Monica, California
| | | | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula Cuccaro
- Center for Health Promotion and Prevention Research, University of Texas–Houston, School of Public Health, Houston, Texas
| | - Susan Tortolero Emery
- Center for Health Promotion and Prevention Research, University of Texas–Houston, School of Public Health, Houston, Texas
| | - Susan L. Davies
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Mark A. Schuster
- RAND, Santa Monica, California,Division of General Pediatrics, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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591
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Emerson ND, Morrell HER, Neece C. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity. J Autism Dev Disord 2016; 46:127-138. [PMID: 26280401 DOI: 10.1007/s10803-015-2555-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children.
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Affiliation(s)
- Natacha D Emerson
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA, 92354, USA.
| | - Holly E R Morrell
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA, 92354, USA
| | - Cameron Neece
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA, 92354, USA
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592
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Thongseiratch T, Worachotekamjorn J. Impact of the DSM-V Attention Deficit Hyperactivity Disorder Criteria for Diagnosing Children With High IQ. Psychol Rep 2016; 119:365-73. [PMID: 27502533 DOI: 10.1177/0033294116662662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study compared the number of attention deficit hyperactivity disorder (ADHD) cases defined by Diagnostic and Statistical Manual (DSM)-IV versus DSM-V criterion in children who have learning or behavioral problems with high IQ. The medical records of children ≤15 years of age who presented with learning or behavioral problems and underwent a Wechsler Intelligence Scale for Children (WISC)-III IQ test at the Pediatric Outpatient Clinic unit between 2010 and 2015 were reviewed. Information on DSM-IV and DSM-V criteria for ADHD were derived from computer-based medical records. Twenty-eight children who had learning or behavioral problems were identified to have a full-scale IQ ≥120. Sixteen of these high-IQ children met the DSM-IV criteria diagnosis for ADHD. Applying the extension of the age-of-onset criterion from 7 to 12 years in DSM-V led to an increase of three cases, all of which were the inattentive type ADHD. Including the pervasive developmental disorder criterion led to an increase of one case. The total number of ADHD cases also increased from 16 to 20 in this group. The data supported the hypothesis that applying the extension of the age-of-onset ADHD criterion and enabling the diagnosis of children with pervasive developmental disorders will increase the number of ADHD diagnoses among children with high IQ.
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593
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Castle IJP, Dong C, Haughwout SP, White AM. Emergency Department Visits for Adverse Drug Reactions Involving Alcohol: United States, 2005 to 2011. Alcohol Clin Exp Res 2016; 40:1913-25. [PMID: 27488763 DOI: 10.1111/acer.13167] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol consumption may interfere with absorption, distribution, metabolism, and excretion of medications and increase risk of adverse drug reactions (ADR). Studies report increasing prescription medication use over time, with many U.S. drinkers using alcohol-interactive medication. This study identified trends in incidence of U.S. emergency department (ED) visits for ADR with alcohol involvement (ADR-A), compared characteristics and disposition between ADR-A visits and ADR visits without alcohol involvement (ADR-NA), and examined frequency of implicated medications in such visits for 2005 to 2011. METHODS ADR visits were identified through the Drug Abuse Warning Network, a national surveillance system monitoring drug-related ED visits. Analysis accounted for sampling design effects and sampling weights. Estimates are presented for totals (ages 12+), age group, and/or sex. Trends were assessed by joinpoint log-linear regression. Differences between ADR-A and ADR-NA visits were compared using two-tailed Rao-Scott chi-square tests. RESULTS From 2005 to 2011, incidence of ADR-A visits increased for males and females ages 21 to 34 and females ages 55+. An average of 25,303 ADR-A visits ages 12+ occurred annually. Compared with ADR-NA visits, ADR-A visits were more likely to involve males, patients ages 21 to 54, and 2+ implicated drugs. Alcohol involvement increased odds of more serious outcomes from ADR visits. Central nervous system (CNS) agents were the most common medications in ADR-A visits (59.1%), with nearly half being analgesics (mainly opioid). About 13.8% of ADR-A visits involved psychotherapeutic agents, including antidepressants. Besides CNS and psychotherapeutic agents, ADR-A visits involved a higher percentage of genitourinary-tract agents (mainly for impotence) than ADR-NA visits. Sex and age variations were observed with certain implicated medications. CONCLUSIONS ED visits for alcohol-drug interactions can be prevented by avoiding alcohol when taking alcohol-interactive medications. Our results underscore the need for healthcare professionals to routinely ask patients about alcohol consumption and warn of ADR risks before prescribing and dispensing alcohol-interactive medications.
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Affiliation(s)
| | - Chuanhui Dong
- CSR, Incorporated, Arlington, Virginia.,Department of Neurology, University of Miami, Miami, Florida
| | | | - Aaron M White
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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594
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DuPaul GJ, Pinho TD, Pollack BL, Gormley MJ, Laracy SD. First-Year College Students With ADHD and/or LD. JOURNAL OF LEARNING DISABILITIES 2016; 50:238-251. [PMID: 26712797 DOI: 10.1177/0022219415617164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Students with attention-deficit/hyperactivity disorder (ADHD) and/or learning disabilities (LD) experience significant challenges in making the transition from high school to college. This study examined the ways first-year college students with ADHD, LD, ADHD+LD, and comparison peers differ in engagement, core self-evaluation, high school preparation behaviors, and goals/expectations. Participants were from the 2010 Cooperative Institutional Research Program Freshman Survey, including students with ADHD ( n = 5,511), LD ( n = 2,626), ADHD+LD ( n = 1,399), or neither disability ( n = 5,737). Controlling for SAT/ACT scores, family income, and parent education, students with ADHD, LD, or ADHD+LD differed from peers on self-ratings of academic and creative abilities and psychosocial functioning; school disengagement, substance use, and emotional difficulties during their last year of high school; reasons for attending college; and expectations for college activities. Several differences were found between disability groups. Implications for college support services and future research are discussed.
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Affiliation(s)
- George J DuPaul
- 1 College of Education, Lehigh University, Bethlehem, PA, USA
| | - Trevor D Pinho
- 1 College of Education, Lehigh University, Bethlehem, PA, USA
| | | | | | - Seth D Laracy
- 1 College of Education, Lehigh University, Bethlehem, PA, USA
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595
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Abstract
PURPOSE OF REVIEW The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of an infant#$#apos;s life, with continuation of breastfeeding for at least a year or as mutually desired by mother and child. A robust body of research literature documenting the short-term medical, developmental, and emotional benefits of breastfeeding for infants and toddlers supports this position. This article reviews the neurodevelopmental benefits of breastfeeding as it relates to preschool and school-age children, with particular emphasis on cognitive development, attention-deficit/hyperactivity disorder, and autism spectrum disorder. RECENT FINDINGS The majority of research studies examining breastfeeding and long-term neurodevelopmental outcomes suggest that children who breastfeed for longer than 6 months have better cognitive outcomes, lower risk of developing attention-deficit/hyperactivity disorder, and lower risk of being diagnosed with autism spectrum disorder. SUMMARY Pediatricians play a critical role in educating and counseling families about infant nutrition and feeding. Along with the many positive short-term medical effects that breastfeeding confers, physicians should be aware of the growing body of research suggesting that there are also significant long-term neurodevelopmental benefits of breastfeeding.
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596
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Rhodes JD, Pelham WE, Gnagy EM, Shiffman S, Derefinko KJ, Molina BSG. Cigarette smoking and ADHD: An examination of prognostically relevant smoking behaviors among adolescents and young adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:588-600. [PMID: 27824233 PMCID: PMC5117481 DOI: 10.1037/adb0000188] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with health risks in adolescence which includes the potential for smoking cigarettes, early smoking initiation, and rapid progression to daily smoking. Much less is known, however, about prognostically relevant smoking behaviors among individuals with childhood ADHD. Further research in this area is important for identifying individuals at pronounced risk for nicotine addiction, and for developing effective interventions for this population. This study examined initiation of cigarette smoking, progression to regular smoking, quantity of use, indicators of tobacco dependence, and quit rates among adolescents and young adults with (n = 364) and without (n = 240) childhood ADHD. Individuals with, versus without, ADHD histories were significantly more likely to become daily smokers independent of conduct disorder (CD). They were also more likely to initiate smoking at younger ages and to progress to regular smoking more quickly. There were no significant group differences in cigarettes smoked per day, Fagerström Test of Nicotine Dependence (FTND), or Nicotine Dependence Syndrome Scale (NDSS) scores or in smoking within 30 min of waking. However, smokers with ADHD reported more intense withdrawal and craving during periods of abstinence than non-ADHD smokers. There were no significant group differences in number of quit attempts. Lastly, there were no significant differences among symptom persisters and desisters in daily smoking and amount. Individuals with ADHD histories are at high risk for persistent smoking given their early onset, rapid course, and abstinence characteristics. Smoking cessation programs may need to be adapted or otherwise intensified for those with ADHD. (PsycINFO Database Record
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Affiliation(s)
| | - William E Pelham
- Center for Children and Families, Florida International University
| | | | | | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center
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597
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Sibley MH, Graziano PA, Kuriyan AB, Coxe S, Pelham WE, Rodriguez L, Sanchez F, Derefinko K, Helseth S, Ward A. Parent-teen behavior therapy + motivational interviewing for adolescents with ADHD. J Consult Clin Psychol 2016; 84:699-712. [PMID: 27077693 PMCID: PMC4949080 DOI: 10.1037/ccp0000106] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study evaluates a parent-teen skills-based therapy for attention deficit/hyperactivity disorder (ADHD) blended with motivational interviewing (MI) to enhance family engagement. Supporting Teens' Autonomy Daily (STAND) is an adolescent-specific treatment for ADHD that targets empirically identified adolescent (i.e., organization, time management, and planning, or OTP skills) and parent-based (i.e., monitoring and contingency management) mechanisms of long-term outcome through individual parent-teen sessions. METHOD The current randomized trial (N = 128) evaluates efficacy at posttreatment and 6-month follow-up. Participants were ethnically diverse teens (7.7% non-Hispanic White, 10.8% African American, 78.5% Hispanic, 3.0% other) randomly assigned to STAND or Treatment As Usual (TAU). RESULTS Primary findings were that (1) STAND was delivered in an MI-adherent fashion and most families fully engaged in treatment (85% completed); (2) STAND produced a range of significant acute effects on ADHD symptoms, OTP skills, homework behavior, parent-teen contracting, implementation of home privileges, parenting stress, and daily homework recording; and (3) 6 months after treatment ceased, effects on ADHD symptom severity, OTP skills, and parenting stress maintained, while parent use of contracting and privilege implementation strategies, as well as teen daily homework recording and homework behavior gains, were not maintained. CONCLUSION Skills-based behavior therapy blended with MI is an acutely efficacious treatment for adolescents with ADHD although more work is needed to establish the nature of long-term effects. (PsycINFO Database Record
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598
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Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review. J Adolesc Health 2016; 59:135-43. [PMID: 27209327 PMCID: PMC5576000 DOI: 10.1016/j.jadohealth.2016.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school-age children. This review is intended to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents. PubMed, PsychInfo, and Science Citation Index databases were searched from March 1990 to 2015 with the keywords: ADHD, primary care/pediatrics, and children/adolescents. Abstracts addressing diagnosis and/or treatment with 105 citations were identified including supplementary treatment guidelines/books. Adolescent ADHD presents with significant disturbances in attention, academic performance, and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis, and limited training and time for PCPs to conduct thorough evaluations. The evidence base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification, and treatment of conditions associated with ADHD that emerge during adolescence such as substance use disorders. Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care psychiatric models, to assist in determining the optimal care for patients at this critical period.
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599
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Fallu A, Dabouz F, Furtado M, Anand L, Katzman MA. A randomized, double-blind, cross-over, phase IV trial of oros-methylphenidate (CONCERTA(®)) and generic novo-methylphenidate ER-C (NOVO-generic). Ther Adv Psychopharmacol 2016; 6:237-51. [PMID: 27536342 PMCID: PMC4971598 DOI: 10.1177/2045125316643674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with onset during childhood. Multiple aspects of a child's development are hindered, in both home and school settings, with negative impacts on social, emotional, and cognitive functioning. If left untreated, ADHD is commonly associated with poor academic achievement and low occupational status, as well as increased risk of substance abuse and delinquency. The objective of this study was to evaluate adult ADHD subject reported outcomes when switched from a stable dose of CONCERTA(®) to the same dose of generic Novo-methylphenidate ER-C(®). METHODS Randomized, double-blind, cross-over, phase IV trial consisted of two phases in which participants with a primary diagnosis of ADHD were randomized in a 1:1 ratio to 3 weeks of treatment with CONCERTA or generic Novo-Methylphenidate ER-C. Following 3 weeks of treatment, participants were crossed-over to receive the other treatment for an additional 3 weeks. Primary efficacy was assessed through the use of the Treatment Satisfaction Questionnaire for Medication, Version II (TSQM-II). RESULTS Participants with ADHD treated with CONCERTA were more satisfied in terms of efficacy and side effects compared to those receiving an equivalent dose of generic Novo-Methylphenidate ER-C. All participants chose to continue with CONCERTA treatment at the conclusion of the study. CONCLUSION Although CONCERTA and generic Novo-Methylphenidate ER-C have been deemed bioequivalent, however the present findings demonstrate clinically and statistically significant differences between generic and branded CONCERTA. Further investigation of these differences is warranted.
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Affiliation(s)
- Angelo Fallu
- Clinique Woodward, 717, rue Woodward, DIEX Research Inc., Sherbrooke, QC, J1G 1W4, Canada
| | - Farida Dabouz
- FB2D Clinical Research Consulting, Montréal, Québec, Canada
| | - Melissa Furtado
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Leena Anand
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
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600
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, #200, 233-16th Avenue North West, Calgary, Alberta T2M 0H5, Canada.
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, China
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