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Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD. Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis. Pediatrics 2015; 136:1144-53. [PMID: 26598454 DOI: 10.1542/peds.2015-1708] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Mixed findings exist on whether stimulant medications alter youth sleep. OBJECTIVE To determine the effect of stimulant medications on sleep. DATA STUDIES Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed. STUDY SELECTION Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded. DATA EXTRACTION Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models. RESULTS A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (-0.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (-0.59) was significant, such that stimulants led to shorter sleep duration. LIMITATIONS Limitations include few studies, limited methodologic variability, and lack of unpublished studies. CONCLUSIONS Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.
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Affiliation(s)
| | - Tori R Van Dyk
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Alyssa Lundahl
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
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Wang Y, Cottler LB, Striley CW. Differentiating patterns of prescription stimulant medical and nonmedical use among youth 10-18 years of age. Drug Alcohol Depend 2015; 157:83-9. [PMID: 26518254 DOI: 10.1016/j.drugalcdep.2015.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/02/2015] [Accepted: 10/03/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the past 30-day prevalence of prescription stimulant use, report different forms of nonmedical use, and investigate different characteristics associated with Medical Users Only, Nonmedical Users Only, and youth who reported both medical and nonmedical use (MU+NMU youth). METHODS The National Monitoring of Adolescent Prescription Stimulants Study recruited 11,048 youth aged 10-18 years from entertainment venues in 10 US cities. RESULTS In this study, 6.8% youth used prescription stimulants in the past 30 days, with 3.0% reporting Medical Use Only (MU Only), 1.1% reporting Both Medical and Nonmedical Use (MU+NMU), and 2.5% reporting Nonmedical Use Only (NMU Only). Use of other's stimulants was the most frequently reported form of nonmedical use (88.4%), followed by using more than prescribed (38.9%), and using outside of the prescribed route (32.2%). Medical Users Only and MU+NMU youth did not differ from Non-Users in cigarette, alcohol, and illicit drug use. MU+NMU youth tended to have more conduct problem behaviors compared to Medical Users Only (p=0.0011) and Nonmedical Users Only (p=0.0132). Compared to MU+NMU youth, Nonmedical Users Only were more likely to have close friends who tried Adderall (p=0.0123), endorse binge drinking (p=0.0118) and illicit drug use (p<0.0015). CONCLUSIONS Future research should investigate the sources of the nonmedically used prescription stimulants and how they were diverted. Intervention programs need to acknowledge the differences between MU+NMU youth and Nonmedical Users Only, and employ different strategies to prevent nonmedical use in these subgroups.
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Affiliation(s)
- Yanning Wang
- Department of Epidemiology, College of Public Health & Health Professions, College of Medicine, University of Florida, United States
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health & Health Professions, College of Medicine, University of Florida, United States.
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health & Health Professions, College of Medicine, University of Florida, United States
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Abstract
Small studies suggest that prescription stimulants can precipitate psychosis and mania. We conducted a population-based case-crossover study to examine whether hospitalization for psychosis or mania was associated with initiation of stimulant therapy. Between October 1, 1999 and March 31, 2013, we studied 12,856 young people who received a stimulant prescription and were subsequently hospitalized for psychosis or mania. Of these, 183 commenced treatment during 1 of 2 prespecified 60-day intervals (defined as the "risk interval" and "control interval," respectively) prior to admission. We found that stimulant initiation was associated with an increased risk of hospitalization for psychosis or mania in the subsequent 60 days (odds ratio, 1.86; 95% confidence interval, 1.39-2.56). The risk was marginally higher in patients treated with antipsychotic drugs (odds ratio, 2.06; 95% confidence interval, 1.38-3.28), but remained in patients with no such history (odds ratio, 1.66; 95% confidence interval, 1.09-2.66). One third of subjects received another stimulant prescription after hospital discharge. Of these, 45% were readmitted with psychosis or mania shortly thereafter. We conclude that initiation of prescription stimulants is associated with an increased risk of hospitalization for psychosis or mania. Resumption of therapy is common, which may reflect a lack of awareness of the potential causative role of these drugs.
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654
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Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira‐Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; 2015:CD009885. [PMID: 26599576 PMCID: PMC8763351 DOI: 10.1002/14651858.cd009885.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life. DATA COLLECTION AND ANALYSIS Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias. MAIN RESULTS The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2). SECONDARY OUTCOMES Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence). AUTHORS' CONCLUSIONS The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Helle B. Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | | | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | - Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Bente Forsbøl
- Psychiatric Department, Region ZealandChild and Adolescent Psychiatric ClinicHolbaekDenmark
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- Copenhagen UniversityInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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655
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Epstein-Ngo QM, McCabe SE, Veliz PT, Stoddard SA, Austic EA, Boyd CJ. Diversion of ADHD Stimulants and Victimization Among Adolescents. J Pediatr Psychol 2015; 41:786-98. [PMID: 26590265 DOI: 10.1093/jpepsy/jsv105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 10/11/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD). METHODS Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization. RESULTS Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert. CONCLUSIONS Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure.
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Affiliation(s)
- Quyen M Epstein-Ngo
- Institute for Research on Women and Gender, University of Michigan Institute for Clinical and Health Research, University of Michigan Injury Center, University of Michigan
| | | | - Philip T Veliz
- Institute for Research on Women and Gender, University of Michigan
| | - Sarah A Stoddard
- School of Nursing, University of Michigan School of Public Health, University of Michigan
| | - Elizabeth A Austic
- Institute for Clinical and Health Research, University of Michigan Injury Center, University of Michigan Department of Emergency Medicine, University of Michigan
| | - Carol J Boyd
- Institute for Research on Women and Gender, University of Michigan School of Nursing, University of Michigan Department of Psychiatry, Addiction Research Center, University of Michigan
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656
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Wilens TE, Robertson B, Sikirica V, Harper L, Young JL, Bloomfield R, Lyne A, Rynkowski G, Cutler AJ. A Randomized, Placebo-Controlled Trial of Guanfacine Extended Release in Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:916-25.e2. [PMID: 26506582 DOI: 10.1016/j.jaac.2015.08.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/24/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite the continuity of attention-deficit/hyperactivity disorder (ADHD) into adolescence, little is known regarding use of nonstimulants to treat ADHD in adolescents. This phase 3 trial evaluated the safety and efficacy of guanfacine extended release (GXR) in adolescents with ADHD. METHOD This 13-week, multicenter, randomized, double-blind, placebo-controlled trial evaluated once-daily GXR (1-7 mg per day) in adolescents with ADHD aged 13 to 17 years. The primary endpoint was the change from baseline in the ADHD Rating Scale-IV (ADHD-RS-IV) total score; key secondary endpoints included scores from the Clinical Global Impressions-Severity of Illness (CGI-S), and Learning and School domain and Family domain scores from the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) at week 13. RESULTS A total of 314 participants were randomized (GXR, n = 157; placebo, n = 157). The majority of participants received optimal doses of 3, 4, 5, or 6 mg (30 [22.9%], 26 [19.8%], 27 [20.6%], or 24 [18.3%] participants, respectively), with 46.5% of participants receiving an optimal dose above the currently approved maximum dose limit of 4 mg. Participants receiving GXR showed improvement in ADHD-RS-IV total score compared with placebo (least-squares mean score change, -24.55 [GXR] versus -18.53 [placebo]; effect size, 0.52; p <.001). More participants on GXR also showed significant improvement in CGI-S scores compared with placebo (50.6% versus 36.1%; p = .010). There was no statistically significant difference between treatments at week 13 in the 2 WFIRS-P domains. Most treatment-emergent adverse events were mild to moderate, with sedation-related events reported most commonly. CONCLUSION GXR was associated with statistically significant improvements in ADHD symptoms in adolescents. GXR was well tolerated, with no new safety signals reported. CLINICAL TRIAL REGISTRATION INFORMATION Dose-Optimization in Adolescents Aged 13-17 Diagnosed With Attention-Deficit/Hyperactivity Disorder (ADHD) Using Extended-Release Guanfacine HCl; http://ClinicalTrials.gov/; NCT01081132.
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Affiliation(s)
| | | | - Vanja Sikirica
- Former employees of Shire, Wayne, PA; GlaxoSmithKline, King of Prussia, PA
| | | | - Joel L Young
- Rochester Center for Behavioral Medicine, Rochester Hills, MI
| | - Ralph Bloomfield
- Former employees of Shire, Wayne, PA; AstraZeneca, Cambridge, UK
| | - Andrew Lyne
- Former employees of Shire, Wayne, PA; Independent statistician, Maidenhead, UK
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657
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Burcu M, Safer DJ, Zito JM. Antipsychotic prescribing for behavioral disorders in US youth: physician specialty, insurance coverage, and complex regimens. Pharmacoepidemiol Drug Saf 2015; 25:26-34. [PMID: 26507224 DOI: 10.1002/pds.3897] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/05/2015] [Accepted: 09/22/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE To assess antipsychotic prescribing patterns according to insurance coverage type and physician specialty in the outpatient treatment of behavioral disorders (BD) in US youth. METHODS We used 2003-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data to compare antipsychotic prescribing in the outpatient treatment of BD in youth (6-19 years) according to insurance coverage (public vs. private) and physician specialty (psychiatrist vs. non-psychiatrist) using population-weighted Chi-square and multivariable analyses. Also, we examined co-prescribing of antipsychotics with other psychotropic medication classes. Subgroup analyses were conducted in BD visits with no other clinician-reported psychiatric diagnosis (non-comorbid BD visits). RESULTS A large majority (71.0%) of BD visits were provided by non-psychiatrists. However, psychiatrists prescribed antipsychotics far more frequently than non-psychiatrists (24.2% vs. 4.6%; adjusted odds ratio (AOR) = 5.1 [95% confidence interval (CI), 2.8-9.2]) in total BD visits as well as in non-comorbid BD visits (18.6% vs. 3.6%; AOR = 5.8 [95% CI, 3.2-10.5]). Antipsychotic prescribing was nearly two-fold greater in visits by publicly insured 6-12 year olds (11.3% vs. 5.8%; AOR = 1.9 [95% CI, 1.1-3.5]) and 13-19 year olds (16.2% vs. 8.9%; AOR = 2.0 [95% CI, 1.1-3.6]) compared with their privately insured counterparts. In more than one-third of antipsychotic-prescribed BD visits, antipsychotics were prescribed concomitantly with ≥2 psychotropic medication classes regardless of age group, insurance coverage, or even in the absence of psychiatric comorbidities. CONCLUSION In outpatient visits by youth for BD, antipsychotics were primarily prescribed by psychiatrists, concomitantly, and for the publicly insured. These treatment patterns merit further investigation.
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Affiliation(s)
- Mehmet Burcu
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA
| | - Daniel J Safer
- Departments of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Julie M Zito
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA.,Department of Psychiatry, University of Maryland, Baltimore, MD, USA
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658
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Freedman DS, Kit BK, Ford ES. Are the Recent Secular Increases in Waist Circumference among Children and Adolescents Independent of Changes in BMI? PLoS One 2015; 10:e0141056. [PMID: 26506450 PMCID: PMC4624430 DOI: 10.1371/journal.pone.0141056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/06/2015] [Indexed: 12/28/2022] Open
Abstract
Background Several studies have shown that the waist circumference of children and adolescents has increased over the last 25 years. However, given the strong correlation between waist circumference and BMI, it is uncertain if the secular trends in waist circumference are independent of those in BMI. Methods We analyzed data from 6- to 19-year-olds who participated in the 1988–1994 through 2011–2012 cycles of the National Health and Nutrition Examination Survey to assess whether the trends in waist circumference were independent of changes in BMI, race-ethnicity and age. Results Mean, unadjusted levels of waist circumference increased by 3.7 cm (boys) and 6.0 cm (girls) from 1988–94 through 2011–12, while mean BMI levels increased by 1.1 kg/m2 (boys) and 1.6 kg/m2 (girls). Overall, the proportional changes in mean levels of both waist circumference and BMI were fairly similar among boys (5.3%, waist vs. 5.6%, BMI) and girls (8.7%, waist vs. 7.7%, BMI). As assessed by the area under the curve, adjustment for BMI reduced the secular increases in waist circumference by about 75% (boys) and 50% (girls) beyond that attributable to age and race-ethnicity. There was also a race-ethnicity interaction (p < 0.001). Adjustment for BMI reduced the secular trend in waist circumference among non-Hispanic (NH) black children (boys and girls) to a greater extent (about 90%) than among other children. Conclusions Our results indicate that among children in the U.S., about 75% (boys) and 50% (girls) of the secular increases in waist circumference since 1988–94 can be accounted for by changes in BMI. The reasons for the larger independent effects among girls and among NH blacks are uncertain.
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Affiliation(s)
- David S. Freedman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Brian K. Kit
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States of America
| | - Earl S. Ford
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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659
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Spiel CF, Evans SW, Langberg JM. Evaluating the content of Individualized Education Programs and 504 Plans of young adolescents with attention deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2015; 29:452-468. [PMID: 25485467 DOI: 10.1037/spq0000101] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to evaluate the degree with which Individualized Education Programs (IEPs) and 504 Plans prepared for middle school students with attention deficit/hyperactivity disorder (ADHD) conformed to best practices and included evidence-based services. Specifically, we examined the problem areas identified in the statement of students' present level of academic achievement and functional performance (PLAAFP) and targeted in the students' measurable annual goals and objectives (MAGOs). In addition, we compared services with lists of recommended services provided by the U.S. Department of Education (ED) and reviews of evidence-based practices. Participants were 97 middle school students with ADHD, 61.9% with an IEP, and 38.1% with a 504 Plan. Most (85%) IEP PLAAFP statements described nonacademic/behavior problems, but fewer than half had MAGOs targeting these areas of need. Services listed on IEPs and Section 504 Plans were frequently consistent with ED recommendations, but had little to no research supporting their effectiveness. In addition, services with evidence supporting benefit to students with ADHD were rarely included on IEPs or 504 Plans. Implications for special education policy and future directions are discussed.
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660
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Adolescent D-amphetamine treatment in a rodent model of ADHD: Pro-cognitive effects in adolescence without an impact on cocaine cue reactivity in adulthood. Behav Brain Res 2015; 297:165-79. [PMID: 26467602 DOI: 10.1016/j.bbr.2015.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is comorbid with cocaine abuse. Whereas initiating ADHD medication in childhood does not alter later cocaine abuse risk, initiating medication during adolescence may increase risk. Preclinical work in the Spontaneously Hypertensive Rat (SHR) model of ADHD found that adolescent methylphenidate increased cocaine self-administration in adulthood, suggesting a need to identify alternatively efficacious medications for teens with ADHD. We examined effects of adolescent d-amphetamine treatment on strategy set shifting performance during adolescence and on cocaine self-administration and reinstatement of cocaine-seeking behavior (cue reactivity) during adulthood in male SHR, Wistar-Kyoto (inbred control), and Wistar (outbred control) rats. During the set shift phase, adolescent SHR needed more trials and had a longer latency to reach criterion, made more regressive errors and trial omissions, and exhibited slower and more variable lever press reaction times. d-Amphetamine improved performance only in SHR by increasing choice accuracy and decreasing errors and latency to criterion. In adulthood, SHR self-administered more cocaine, made more cocaine-seeking responses, and took longer to extinguish lever responding than control strains. Adolescent d-amphetamine did not alter cocaine self-administration in adult rats of any strain, but reduced cocaine seeking during the first of seven reinstatement test sessions in adult SHR. These findings highlight utility of SHR in modeling cognitive dysfunction and comorbid cocaine abuse in ADHD. Unlike methylphenidate, d-amphetamine improved several aspects of flexible learning in adolescent SHR and did not increase cocaine intake or cue reactivity in adult SHR. Thus, adolescent d-amphetamine was superior to methylphenidate in this ADHD model.
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661
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Louik C, Kerr S, Kelley KE, Mitchell AA. Increasing use of ADHD medications in pregnancy. Pharmacoepidemiol Drug Saf 2015; 24:218-20. [PMID: 25630904 DOI: 10.1002/pds.3742] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Carol Louik
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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662
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Whitaker R. The triumph of American psychiatry: How it created the modern therapeutic state. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2015. [DOI: 10.1080/13642537.2015.1094501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Miodovnik A, Harstad E, Sideridis G, Huntington N. Timing of the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Pediatrics 2015; 136:e830-7. [PMID: 26371198 DOI: 10.1542/peds.2015-1502] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Symptoms of inattention, hyperactivity, and impulsivity are core features of attention-deficit/hyperactivity disorder (ADHD). However, children with autism spectrum disorder (ASD) often present with similar symptoms and may receive a diagnosis of ADHD first. We investigated the relationship between the timing of ADHD diagnosis in children with ASD and the age at ASD diagnosis. METHODS Data were drawn from the 2011-2012 National Survey of Children's Health, which asked parents to provide the age(s) at which their child received a diagnosis of ADHD and/or ASD. Using weighted prevalence estimates, we examined the association between a previous diagnosis of ADHD and the age at ASD diagnosis, while controlling for factors known to influence the timing of ASD diagnosis. RESULTS Our study consisted of 1496 children with a current diagnosis of ASD as reported by parents of children ages 2 to 17 years. Approximately 20% of these children had initially been diagnosed with ADHD. Children diagnosed with ADHD before ASD were diagnosed with ASD ∼3 years (95% confidence interval 2.3-3.5) after children in whom ADHD was diagnosed at the same time or after ASD. The children with ADHD diagnosed first were nearly 30 times more likely to receive their ASD diagnosis after age 6 (95% confidence interval 11.2-77.8). The delay in ASD diagnosis was consistent across childhood and independent of ASD severity. CONCLUSION To avoid potential delays in ASD diagnosis, clinicians should consider ASD in young children presenting with ADHD symptoms.
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Affiliation(s)
- Amir Miodovnik
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Harstad
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts
| | - Georgios Sideridis
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts; and
| | - Noelle Huntington
- Division of Developmental Medicine, and Harvard Medical School, Boston, Massachusetts
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664
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Casas M, Forns J, Martínez D, Avella-García C, Valvi D, Ballesteros-Gómez A, Luque N, Rubio S, Julvez J, Sunyer J, Vrijheid M. Exposure to bisphenol A during pregnancy and child neuropsychological development in the INMA-Sabadell cohort. ENVIRONMENTAL RESEARCH 2015; 142:671-9. [PMID: 26343751 DOI: 10.1016/j.envres.2015.07.024] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/16/2015] [Accepted: 07/31/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Bisphenol A (BPA) may be a neurodevelopmental toxicant, but evidence is not consistent in terms of the sex-specific patterns of the associations and the specific behavioral or cognitive domains most affected. OBJECTIVE To examine the effects of prenatal BPA exposure on cognitive, psychomotor, and behavioral development in 438 children at 1, 4 and 7 years of age. METHODS BPA was measured in spot urine samples collected in trimester 1 and 3 of pregnancy from women participating in the INMA-Sabadell birth cohort study. Cognitive and psychomotor development was assessed at 1 and 4 years using psychologist-based scales. Attention deficit hyperactivity disorder (ADHD) symptoms and other behavioral problems were assessed at 4 years by teachers and at 7 years by parents using questionnaire-based rating scales. RESULTS Geometric mean creatinine-adjusted BPA concentration of the averaged samples was 2.6 μg/g creatinine. BPA exposure was not associated with the cognitive scores or their subscales at 1 and 4 years of age. At 1 year of age, exposure in the highest tertile of BPA concentrations was associated with a reduction of psychomotor scores (T3 vs T1 β=-4.28 points, 95% CI: -8.15, -0.41), but there was no association with psychomotor outcomes at 4 years. At 4 years, BPA exposure was associated with an increased risk of ADHD-hyperactivity symptoms (Incidence Rate Ratio (IRR) per log10 μg BPA/g creatinine increase=1.72; 1.08, 2.73) and this association was stronger in boys than in girls. Further, boys had an increased risk of ADHD-inattention symptoms whereas girls showed a reduced risk (p for interaction <0.1). At 7 years, these associations were not statistically significant nor were any other behavioral problems. CONCLUSIONS These results suggest that prenatal BPA exposure does not affect cognitive development up to age 4 years. Associations are observed with psychomotor development and ADHD-related symptoms at early ages, but these do not appear to persist until later ages.
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Affiliation(s)
- Maribel Casas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - David Martínez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Claudia Avella-García
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Unitat Docent de Medicina Preventiva i Salut Publica H. Mar-UPF-ASPB, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Damaskini Valvi
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | | | - Noelia Luque
- Department of Analytical Chemistry, University of Cordoba, Cordoba, Spain
| | - Soledad Rubio
- Department of Analytical Chemistry, University of Cordoba, Cordoba, Spain
| | - Jordi Julvez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Martine Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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665
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Bleck J, DeBate R, Levin BL, Baldwin J. Underlying Mechanisms and Trajectory of Comorbid ADHD and Eating Disorders: Proposing an Innovative Systems Framework for Informing Research. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9593-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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666
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Austic E, McCabe SE, Stoddard SA, Ngo QE, Boyd C. Age and Cohort Patterns of Medical and Nonmedical Use of Controlled Medication Among Adolescents. J Addict Med 2015; 9:376-82. [PMID: 26291544 PMCID: PMC4592367 DOI: 10.1097/adm.0000000000000142] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We identified peak annual incidence rates for medical and nonmedical use of prescription opioid analgesics, stimulants, sedatives, and anxiolytics (controlled medication), and explored cohort effects on age of initiation. METHODS Data were gathered retrospectively between 2009 and 2012 from Detroit area students (n = 5185). Modal age at the last assessment was 17 years. A meta-analytic approach produced age-, year-, and cohort-specific risk estimates of first-time use of controlled medication. Cox regression models examined cohort patterns in age of initiation for medical and nonmedical use with any of 4 classes of controlled medication (opioid analgesics, stimulants, sedatives, or anxiolytics). RESULTS Peak annual incidence rates were observed at age 16 years, when 11.3% started medical use, and 3.4% started using another person's prescription for a controlled medication (ie, engaged in nonmedical use). In the more recent birth cohort group (1996-2000), 82% of medical users and 76% of nonmedical users reported initiating such use by age 12 years. In contrast, in the less recent birth cohort group (1991-1995), 42% of medical users and 35% of nonmedical users initiated such use by age 12 years. Time to initiation was 2.6 times less in the more recent birth cohort group (medical use: adjusted hazard ratio [aHR] = 2.57 [95% confidence interval {CI} = 2.32-2.85]; nonmedical use: aHR = 2.57 [95% CI = 2.17-3.03]). CONCLUSIONS Peak annual incidence rates were observed at age 16 years for medical and nonmedical use. More recent cohorts reported initiating both types of use at younger ages. Earlier interventions may be needed to prevent adolescent nonmedical use of controlled medication.
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Affiliation(s)
- Elizabeth Austic
- Department of Emergency Medicine (EA), University of Michigan, Ann Arbor, MI; Institute for Research on Women and Gender (SEM, QEN, CB), University of Michigan, Ann Arbor, MI; School of Nursing (SAS, CB), University of Michigan, Ann Arbor, MI; Injury Research Center and Michigan Institute for Clinical and Health Research (QEN), University of Michigan, Ann Arbor, MI; and Addiction Research Center (CB), University of Michigan, Ann Arbor, MI
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667
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Simon AE, Pastor PN, Reuben CA, Huang LN, Goldstrom ID. Use of Mental Health Services by Children Ages Six to 11 With Emotional or Behavioral Difficulties. Psychiatr Serv 2015; 66:930-7. [PMID: 25975889 PMCID: PMC4654459 DOI: 10.1176/appi.ps.201400342] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors reported use of mental health services among children in the United States between ages six and 11 who were described by their parents as having emotional or behavioral difficulties (EBDs). METHODS Using data from the 2010-2012 National Health Interview Survey, the authors estimated the national percentage of children ages six to 11 with serious or minor EBDs (N=2,500) who received treatment for their difficulties, including only mental health services other than medication (psychosocial services), only medication, both psychosocial services and medication, and neither type of service. They calculated the percentage of children who received school-based and non-school-based psychosocial services in 2011-2012 and who had unmet need for psychosocial services in 2010-2012. RESULTS In 2010-2012, 5.8% of U.S. children ages six to 11 had serious EBDs and 17.3% had minor EBDs. Among children with EBDs, 17.8% were receiving both medication and psychosocial services, 28.8% psychosocial services only, 6.8% medication only, and 46.6% neither medication nor psychosocial services. Among children with EBDs in 2011-2012, 18.6% received school-based psychosocial services only, 11.4% non-school-based psychosocial services only, and 17.3% both school- and non-school-based psychosocial services. In 2010-2012, 8.2% of children with EBDs had unmet need for psychosocial services. CONCLUSIONS School-age children with EBDs received a range of mental health services, but nearly half received neither medication nor psychosocial services. School-based providers played a role in delivering psychosocial services, but parents reported an unmet need for psychosocial services among some children.
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Affiliation(s)
- Alan E Simon
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Patricia N Pastor
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Cynthia A Reuben
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Larke N Huang
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
| | - Ingrid D Goldstrom
- Dr. Simon, Dr. Pastor, and Ms. Reuben are with the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland (e-mail: ). Dr. Huang is with the Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Ms. Goldstrom was a consultant to SAMHSA at the time that this research was completed
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668
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Liu S, Cai W, Liu S, Zhang F, Fulham M, Feng D, Pujol S, Kikinis R. Multimodal neuroimaging computing: a review of the applications in neuropsychiatric disorders. Brain Inform 2015; 2:167-180. [PMID: 27747507 PMCID: PMC4737664 DOI: 10.1007/s40708-015-0019-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/08/2015] [Indexed: 12/20/2022] Open
Abstract
Multimodal neuroimaging is increasingly used in neuroscience research, as it overcomes the limitations of individual modalities. One of the most important applications of multimodal neuroimaging is the provision of vital diagnostic data for neuropsychiatric disorders. Multimodal neuroimaging computing enables the visualization and quantitative analysis of the alterations in brain structure and function, and has reshaped how neuroscience research is carried out. Research in this area is growing exponentially, and so it is an appropriate time to review the current and future development of this emerging area. Hence, in this paper, we review the recent advances in multimodal neuroimaging (MRI, PET) and electrophysiological (EEG, MEG) technologies, and their applications to the neuropsychiatric disorders. We also outline some future directions for multimodal neuroimaging where researchers will design more advanced methods and models for neuropsychiatric research.
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Affiliation(s)
- Sidong Liu
- School of IT, The University of Sydney, Sydney, Australia.
| | - Weidong Cai
- School of IT, The University of Sydney, Sydney, Australia
| | - Siqi Liu
- School of IT, The University of Sydney, Sydney, Australia
| | - Fan Zhang
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Michael Fulham
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, and the Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Dagan Feng
- School of IT, The University of Sydney, Sydney, Australia
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Sonia Pujol
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
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669
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Fallesen P, Wildeman C. The Effect of Medical Treatment of Attention Deficit Hyperactivity Disorder (ADHD) on Foster Care Caseloads: Evidence from Danish Registry Data. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:398-414. [PMID: 26242740 DOI: 10.1177/0022146515595046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since the early 2000s, foster care caseloads have decreased in many wealthy democracies, yet the causes of these declines remain, for the most part, a mystery. This article uses administrative data on all Danish municipalities (N = 277) and a 10% randomly drawn sample of all Danish children (N = 157,938) in the period from 1998 to 2010 to show that increasing medical treatment of attention deficit hyperactivity disorder (ADHD) accounts for a substantial share of the decrease in foster care caseloads. According to our estimates, the decline in foster care caseloads during this period would have been 45% smaller absent increases in medical treatment of ADHD. These findings are especially provocative in light of recent research showing ambiguous effects of medical treatment of ADHD. Future research should be attentive to how medical treatment aimed at addressing children's acute behavioral problems could also have a powerful effect on foster care caseloads.
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Affiliation(s)
- Peter Fallesen
- The Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden Rockwool Foundation Research Unit, University of Copenhagen, Copenhagen C, Denmark
| | - Christopher Wildeman
- Rockwool Foundation Research Unit, University of Copenhagen, Copenhagen C, Denmark Cornell University, Ithaca, NY, USA
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670
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Lewis T, Schwebel DC, Elliott MN, Visser SN, Toomey SL, McLaughlin KA, Cuccaro P, Tortolero Emery S, Banspach SW, Schuster MA. The association between youth violence exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of fifth-graders. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2015; 85:504-13. [PMID: 26460708 DOI: 10.1037/ort0000081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the current study was to examine the association between violence exposures (no exposure, witness or victim only, and both witness and victim) and attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as the potential moderating role of gender. Data from 4,745 5th graders and their primary caregivers were drawn from the Healthy Passages study of adolescent health. Parent respondents completed the DISC Predictive Scales for ADHD, and youth provided information about exposure to violence. Results indicated that youth who reported both witnessing and victimization had more parent-reported ADHD symptoms and were more likely to meet predictive criteria for ADHD. Among those with both exposures, girls exhibited a steeper increase in ADHD symptoms and higher probability of meeting predictive criteria than did boys. Findings indicate that being both victim-of and witness-to violence is significantly associated with ADHD symptoms particularly among girls.
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Affiliation(s)
- Terri Lewis
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, School of Medicine
| | | | | | - Susanna N Visser
- National Center on Birth Defects and Disabilities, Centers for Disease Control and Prevention
| | - Sara L Toomey
- Division of General Pediatrics, Boston Children's Hospital
| | | | - Paula Cuccaro
- School of Public Health, University of Texas Health Science Center at Houston
| | | | - Stephen W Banspach
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
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671
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Schachar RJ, Park LS, Dennis M. Mental Health Implications of Traumatic Brain Injury (TBI) in Children and Youth. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2015; 24:100-108. [PMID: 26379721 PMCID: PMC4558980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is the most common cause of death and disability in children and adolescents. Psychopathology is an established risk factor for, and a frequent consequence of, TBI. This paper reviews the literature relating psychopathology and TBI. METHOD Selective literature review. RESULTS The risk of sustaining a TBI is increased by pre-existing psychopathology (particularly ADHD and aggression) and psychosocial adversity. Even among individuals with no psychopathology prior to the injury, TBI is frequently followed by mental illness especially ADHD, personality change, conduct disorder and, less frequently, by post-traumatic stress and anxiety disorders. The outcome of TBI can be partially predicted by pre-injury adjustment and injury severity, but less well by age at injury. Few individuals receive treatment for mental illness following TBI. CONCLUSION TBI has substantial relevance to mental health professionals and their clinical practice. Available evidence, while limited, indicates that the risk for TBI in children and adolescents is increased in the presence of several, potentially treatable mental health conditions and that the outcome of TBI involves a range of mental health problems, many of which are treatable. Prevention and management efforts targeting psychiatric risks and outcomes are an urgent priority. Child and adolescent mental health professionals can play a critical role in the prevention and treatment of TBI through advocacy, education, policy development and clinical practice.
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Affiliation(s)
- Russell James Schachar
- Senior Scientist, Program in Neurosciences and Mental Health, Research Institute, Staff Psychiatrist, Department of Psychiatry, The Hospital for Sick Children, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto Dominion Bank Financial Group Chair in Child and Adolescent Psychiatry, Toronto, Ontario
| | - Laura Seohyun Park
- Clinical Research Project Coordinator, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, Ontario
| | - Maureen Dennis
- Senior Scientist, Program Neurosciences and Mental Health, Research Institute, Department of Psychology, The Hospital for Sick Children, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario
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672
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Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, Rohde LA, Sonuga-Barke EJS, Tannock R, Franke B. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020. [PMID: 27189265 DOI: 10.1038/nrdp.2015.20] [Citation(s) in RCA: 818] [Impact Index Per Article: 90.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York 13210, USA
- K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, 5020 Bergen, Norway
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joseph Biederman
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil
| | - Edmund J S Sonuga-Barke
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Rosemary Tannock
- Neuroscience and Mental Health Research Program, Research Institute of The Hospital for Sick Children, Toronto, Canada
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Franke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Departments of Human Genetics and Psychiatry, Nijmegen, The Netherlands
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673
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Johansen ME, Matic K, McAlearney AS. Attention Deficit Hyperactivity Disorder Medication Use Among Teens and Young Adults. J Adolesc Health 2015; 57:192-7. [PMID: 26026476 DOI: 10.1016/j.jadohealth.2015.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine rates of stimulant/atomoxetine use among teens (aged 12-17 years) and young adults (aged 18-23 years) and to investigate associations in medication use before and after the transition from teen to young adult. METHODS Repeated cross-sectional analyses using the nationally representative Medical Expenditure Panel Survey. The sample included all teens and young adults between 2003 and 2012. Within this group, a staggered sample of individuals between 2006 and 2012 born during a 5-year range was used to minimize false positive findings due to temporal trends. The primary outcome was attention deficit hyperactivity disorder (ADHD) medication use (two or more prescriptions and ≥60 tablets). A multivariable logistic regression was utilized to determine associations between ADHD medication use and race/ethnicity and other sociodemographic factors. RESULTS A total of 62,699 individuals were included between 2003 and 2012. Rates of ADHD medication use increased for both teens (4.2%-6.0%) and young adults (1.2%-2.6%) between 2003-2004 and 2011-2012. In adjusted analysis, blacks, Hispanics, and Asians had lower rates of use compared with whites. The decrease in use among young adults was more pronounced among blacks compared with whites. A usual source of care and health insurance were less common among young adults, and both were associated with ADHD medication use. CONCLUSIONS Although there has been an increase in the use of ADHD medications in both teens and young adults, we found a drop-off in levels of ADHD treatment among young adults when compared with teens. A portion of this decrease appears to be related to race/ethnicity, usual source of care, and health insurance status.
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Affiliation(s)
- Michael E Johansen
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
| | - Kathleen Matic
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio; Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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674
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People with long QT syndrome who have attention deficit hyperactivity disorder deserve to be treated properly. Heart Rhythm 2015; 12:1813-4. [DOI: 10.1016/j.hrthm.2015.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Indexed: 12/20/2022]
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de Schipper E, Lundequist A, Wilteus AL, Coghill D, de Vries PJ, Granlund M, Holtmann M, Jonsson U, Karande S, Levy F, Al-Modayfer O, Rohde L, Tannock R, Tonge B, Bölte S. A comprehensive scoping review of ability and disability in ADHD using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). Eur Child Adolesc Psychiatry 2015; 24:859-72. [PMID: 26036861 DOI: 10.1007/s00787-015-0727-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/18/2015] [Indexed: 11/25/2022]
Abstract
This is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Attention Deficit Hyperactivity Disorder (ADHD). The objective here was to use a comprehensive scoping review approach to identify the concepts of functional ability and disability used in the scientific ADHD literature and link these to the nomenclature of the ICF-CY. Systematic searches were conducted using Medline/PubMed, PsycINFO, ERIC and Cinahl, to extract the relevant concepts of functional ability and disability from the identified outcome studies of ADHD. These concepts were then linked to ICF-CY by two independent researchers using a standardized linking procedure. Data from identified studies were analysed until saturation of ICF-CY categories was reached. Eighty studies were included in the final analysis. Concepts contained in these studies were linked to 128 ICF-CY categories. Of these categories, 68 were considered to be particularly relevant to ADHD (i.e., identified in at least 5 % of the studies). Of these, 32 were related to Activities and participation, 31 were related to Body functions, and five were related to environmental factors. The five most frequently identified categories were school education (53 %), energy and drive functions (50 %), psychomotor functions (50 %), attention functions (49 %), and emotional functions (45 %). The broad variety of ICF-CY categories identified in this study underlines the necessity to consider ability and disability in ADHD across all dimensions of life, for which the ICF-CY provides a valuable and universally applicable framework. These results, in combination with three additional preparatory studies (expert survey, focus groups, clinical study), will provide a scientific basis to define the ICF Core Sets for ADHD for multi-purpose use in basic and applied research, and every day clinical practice.
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Affiliation(s)
- Elles de Schipper
- Paediatric Neuropsychiatry Unit, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Stockholm, Sweden
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676
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Alhraiwil NJ, Ali A, Househ MS, Al-Shehri AM, El-Metwally AA. Systematic review of the epidemiology of attention deficit hyperactivity disorder in Arab countries. ACTA ACUST UNITED AC 2015; 20:137-44. [PMID: 25864066 PMCID: PMC4727626 DOI: 10.17712/nsj.2015.2.20140678] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: To assess the epidemiology of attention deficit hyperactivity disorder (ADHD) in Arab countries, and identify gaps for future research. Methods: We searched PubMed from July 1978 to July 2014 and reviewed local journals with cross-referencing. The keywords we used were ADHD, diagnosis, prevalence, incidence, factor, diagnosis, rate, risk, and each of the names of the 22 Arab countries (Jordan, Egypt, Lebanon, Saudi Arabia, and so on). Studies were eligible for inclusion if they investigated the epidemiology of ADHD in any Arab country, and were published in English. The search was conducted from 2nd to 5th August 2014 in King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Results: A total of 22 articles were included in the review. Twenty studies were cross-sectional and found the prevalence of ADHD ranged between 1.3-16%, prevalence of hyperactive type ADHD between 1.4-7.8%, and the prevalence of inattention type between 2.1-2.7%. Only 2 case-control studies investigated potential risk factors. Evidence extracted from these studies shows a significant association between ADHD and male gender, previous psychiatric illness in the family, vitamin D deficiency, poor school performance, sleep problems, and nocturnal enuresis. Conclusion: The prevalence of ADHD in Arab countries is comparable to reports in North America, Africa, and other countries of the Middle East. Longitudinal studies are needed to investigate the prognosis and determinants of this condition in the Arab world.
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Affiliation(s)
- Najla J Alhraiwil
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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677
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Krivitzky LS, Walsh KS, Fisher EL, Berl MM. Executive functioning profiles from the BRIEF across pediatric medical disorders: Age and diagnosis factors. Child Neuropsychol 2015; 22:870-88. [PMID: 26143938 DOI: 10.1080/09297049.2015.1054272] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of the study was to compare executive functioning (EF) profiles across several pediatric medical conditions and explore the influence of age of diagnosis and evaluation. A retrospective, cross-sectional study of 734 children aged 5 to 18 years was conducted across five medical groups (brain tumor, leukemia [ALL], epilepsy [EPI], neurofibromatosis type 1 [NF1], and ornithine transcarbamylase deficiency [OTC-D]), attention deficit hyperactivity disorder (ADHD) controls, and matched healthy controls. We compared groups across the scales of a parent-completed Behavior Rating Inventory of Executive Functioning (BRIEF) using a repeated measures analysis of variance (ANOVA). Separate ANOVAs were conducted to look at age factors. The results showed that the ADHD group differed from all other groups and had the highest level of reported EF problems. The NF1 and OTC-D groups differed significantly from the healthy comparison group for overall EF problems, while the EPI and cancer groups did not. Working memory was the most elevated scale across medical groups, followed by plan/organize. Children with medical disorders were two to four times more likely than healthy controls to have clinically significant problems in several EF domains. There was a main effect for age at diagnosis and age at evaluation. A subset of children with medical disorders were found to have parent-reported EF difficulties, with particular vulnerability noted in working memory and organizational/planning skills. This has relevance for the development of interventions that may be helpful across disorders. Children with particular diagnoses and earlier age of diagnosis and evaluation had greater reported EF problems.
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Affiliation(s)
- Lauren S Krivitzky
- a Children's Hospital of Philadelphia and Perelman School of Medicine , University of Pennsylvania , Philadelphia , USA
| | - Karin S Walsh
- b Children's National Health System , Washington , DC , USA.,c The George Washington University Medical Center , Washington , DC , USA
| | | | - Madison M Berl
- b Children's National Health System , Washington , DC , USA.,c The George Washington University Medical Center , Washington , DC , USA
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678
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Singh I, Wessely S. Childhood: a suitable case for treatment? Lancet Psychiatry 2015; 2:661-6. [PMID: 26303563 DOI: 10.1016/s2215-0366(15)00106-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 12/31/2022]
Abstract
We examine the contemporary debate on attention deficit hyperactivity disorder, in which concerns about medicalisation and overuse of drug treatments are paramount. We show medicalisation in attention deficit hyperactivity disorder to be a complex issue that requires systematic research to be properly understood. In particular, we suggest that the debate on this disorder might be more productive and less divisive if longitudinal, evidence-based understanding of the harms and benefits of psychiatric diagnosis and misdiagnosis existed, as well as better access to effective, non-drug treatments. If articulation of the values that should guide clinical practice in child psychiatry is encouraged, this might create greater trust and less division.
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Affiliation(s)
- Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry (IoP), King's College London, London, UK
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679
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Ronis SD, Baldwin CD, McIntosh S, McConnochie K, Szilagyi PG, Dolan J. Caregiver Preferences Regarding Personal Health Records in the Management of ADHD. Clin Pediatr (Phila) 2015; 54:765-74. [PMID: 25567294 PMCID: PMC4474750 DOI: 10.1177/0009922814565883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Personal health records (PHRs) may address the needs of children with attention deficit hyperactivity disorder. Among parents, we assessed acceptance, barriers, and intentions regarding use of PHR for their children with attention deficit hyperactivity disorder. METHODS Survey of parents from 3 practices in Rochester, NY. Stepwise logistic regression analysis explored factors predicting respondents' intentions for future use of PHR, accounting for care coordination needs, caregiver education, socioeconomic status, and satisfaction with providers. RESULTS Of 184 respondents, 23% had used the PHR for their child, 82% intended future use. No difference was observed between users and nonusers regarding gender, age, race, or education. Users were more likely than nonusers to reside in the suburbs (P = .03). Caregivers were more likely to plan future use of the PHR if they felt engaged as partners in their child's care (adjusted odds ratio = 2.3, 95% confidence interval = 1.2, 4.5). CONCLUSIONS Parents are enthusiastic about PHRs. Future work should focus on engaging them as members of the health care team.
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Affiliation(s)
- Sarah D Ronis
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Constance D Baldwin
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Scott McIntosh
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kenneth McConnochie
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Peter G Szilagyi
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - James Dolan
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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680
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Chen JY, Clark MJ, Chang YY, Liu YY. Anxiety, Decision Conflict, and Health in Caregivers of Children with ADHD: A Survey. J Pediatr Nurs 2015; 30:568-79. [PMID: 25797314 DOI: 10.1016/j.pedn.2015.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to test a theoretical model to determine the effect of caregiver anxiety and decision conflict on the health of caregivers of children with ADHD. Cross-sectional analyses were conducted on data derived from caregivers (aged 24-70). Participants completed the Decision Conflict Scale, the Zung Anxiety Scale, the Duke Health Profile, and a demographic form. A path model that fit well indicated that anxiety and decision conflict had direct and indirect effects on the caregivers' health. Future study is needed to clarify factors contributing to uncertainty and to decrease emotional symptoms for caregivers, thus promoting their mental health.
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Affiliation(s)
- Jih Yuan Chen
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan ROC.
| | - Mary Jo Clark
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA, USA
| | - Yong Yuan Chang
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung City, Taiwan ROC
| | - Yea Ying Liu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan ROC
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681
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Austic EA, Meier EAAFEA. Peak ages of risk for starting nonmedical use of prescription stimulants. Drug Alcohol Depend 2015; 152:224-9. [PMID: 25908322 PMCID: PMC4458195 DOI: 10.1016/j.drugalcdep.2015.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/23/2015] [Accepted: 03/28/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND To produce population-level, year- and age-specific risk estimates of first time nonmedical use of prescription stimulants among young people in the United States. METHODS Data are from the National Surveys on Drug Use and Health 2004-2012; a nationally representative probability sample survey administered each year. Subpopulations included youths aged 12 to 21 years (n=240,160) who had not used prescription stimulants nonmedically prior to their year of survey assessment. A meta-analytic approach was used to produce population-level age-, year-, and cohort-specific risk estimates of first time nonmedical use of prescription stimulants. RESULTS Peak risk of starting nonmedical use of prescription stimulants was concentrated between ages 16 and 19 years, when an estimated 0.7% to 0.8% of young people reported nonmedical use of these medicines for the first time in the past twelve months. Smaller risk estimates ranging from 0.1% to 0.6% were observed at ages 12 to 15 years and 20 to 21 years. Compared with males, females were more likely to have started nonmedical use of prescription stimulants (odds ratio=1.35; 95% CI, 1.13-1.62), particularly between the ages of 14 and 19. Females showed a peak annual incidence rate of 1% at age 18, while males the same age showed an incidence rate of 0.5%. CONCLUSIONS Peak annual incidence rates for nonmedical use of prescription stimulants were observed between the ages of 16 and 19 years. There is reason to initiate interventions during the earlier adolescent years to prevent youths from starting nonmedical use of prescription stimulants.
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Affiliation(s)
- E A Austic
- Injury Center, Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, United States.
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682
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Rivera HM, Christiansen KJ, Sullivan EL. The role of maternal obesity in the risk of neuropsychiatric disorders. Front Neurosci 2015; 9:194. [PMID: 26150767 PMCID: PMC4471351 DOI: 10.3389/fnins.2015.00194] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/16/2015] [Indexed: 12/22/2022] Open
Abstract
Recent evidence indicates that perinatal exposure to maternal obesity, metabolic disease, including diabetes and hypertension, and unhealthy maternal diet has a long-term impact on offspring behavior and physiology. During the past three decades, the prevalence of both obesity and neuropsychiatric disorders has rapidly increased. Epidemiologic studies provide evidence that maternal obesity and metabolic complications increase the risk of attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety, depression, schizophrenia, eating disorders (food addiction, anorexia nervosa, and bulimia nervosa), and impairments in cognition in offspring. Animal models of maternal high-fat diet (HFD) induced obesity also document persistent changes in offspring behavior and impairments in critical neural circuitry. Animals exposed to maternal obesity and HFD consumption display hyperactivity, impairments in social behavior, increased anxiety-like and depressive-like behaviors, substance addiction, food addiction, and diminished cognition. During development, these offspring are exposed to elevated levels of nutrients (fatty acids, glucose), hormones (leptin, insulin), and inflammatory factors (C-reactive protein, interleukin, and tumor necrosis factor). Such factors appear to permanently change neuroendocrine regulation and brain development in offspring. In addition, inflammation of the offspring brain during gestation impairs the development of neural pathways critical in the regulation of behavior, such as serotoninergic, dopaminergic, and melanocortinergic systems. Dysregulation of these circuits increases the risk of mental health disorders. Given the high rates of obesity in most developed nations, it is critical that the mechanisms by which maternal obesity programs offspring behavior are thoroughly characterized. Such knowledge will be critical in the development of preventative strategies and therapeutic interventions.
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Affiliation(s)
- Heidi M Rivera
- Division of Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center Beaverton, OR, USA
| | | | - Elinor L Sullivan
- Division of Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center Beaverton, OR, USA ; Department of Biology, University of Portland Portland, OR, USA
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683
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Arnett AB, Pennington BF, Willcutt EG, DeFries JC, Olson RK. Sex differences in ADHD symptom severity. J Child Psychol Psychiatry 2015; 56:632-9. [PMID: 25283790 PMCID: PMC4385512 DOI: 10.1111/jcpp.12337] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Males show higher rates of attention deficit hyperactivity disorder (ADHD) than do females. Potential explanations include genuine etiological differences or artifact. METHODS 2,332 twin and sibling youth participated in behavioral and cognitive testing. Partially competing models of symptom severity distribution differences, the mean difference, and variance difference models, were tested within a randomly selected subsample. The Delta method was used to test for mediation of sex differences in ADHD symptom severity by processing speed, inhibition and working memory. RESULTS The combined mean difference and variance difference models fully explained the sex difference in ADHD symptom severity. Cognitive endophenotypes mediated 14% of the sex difference effect. CONCLUSIONS The sex difference in ADHD symptom severity is valid and may be due to differing genetic and cognitive liabilities between the sexes.
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Affiliation(s)
- Anne B. Arnett
- Department of Psychology; University of Denver; Denver CO USA
| | | | - Erik G. Willcutt
- Psychology and Neuroscience; University of Colorado at Boulder; Boulder CO USA
| | - John C. DeFries
- Institute for Behavioral Genetics; University of Colorado at Boulder; Boulder CO USA
| | - Richard K. Olson
- Institute for Behavioral Genetics; University of Colorado at Boulder; Boulder CO USA
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684
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Childress AC, Brams M, Cutler AJ, Kollins SH, Northcutt J, Padilla A, Turnbow JM. The Efficacy and Safety of Evekeo, Racemic Amphetamine Sulfate, for Treatment of Attention-Deficit/Hyperactivity Disorder Symptoms: A Multicenter, Dose-Optimized, Double-Blind, Randomized, Placebo-Controlled Crossover Laboratory Classroom Study. J Child Adolesc Psychopharmacol 2015; 25:402-14. [PMID: 25692608 PMCID: PMC4491157 DOI: 10.1089/cap.2014.0176] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study goal was to determine the efficacy and safety of an optimal dose of Evekeo, racemic amphetamine sulfate, 1:1 d-amphetamine and l-amphetamine (R-AMPH), compared to placebo in treating children with attention-deficit/hyperactivity disorder (ADHD) in a laboratory classroom setting. METHODS A total of 107 children ages 6-12 years were enrolled in this multicenter, dose-optimized, randomized, double-blind, placebo-controlled crossover study. After 8 weeks of open-label dose optimization, 97 subjects were randomized to 2 weeks of double-blind treatment in the sequence of R-AMPH followed by placebo (n=47) or placebo followed by R-AMPH (n=50). Efficacy measures included the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Rating Scale and Permanent Product Measure of Performance (PERMP) administered predose and at 0.75, 2, 4, 6, 8, and 10 hours postdose on 2 laboratory classroom days. Safety assessments included physical examination, chemistry, hematology, vital signs, and treatment-emergent adverse events (TEAEs). RESULTS Compared to placebo, a single daily dose of R-AMPH significantly improved SKAMP-Combined scores (p<0.0001) at each time point tested throughout the laboratory classroom days, with effect onset 45 minutes postdose and extending through 10 hours. R-AMPH significantly improved PERMP number of problems attempted and correct (p<0.0001) throughout the laboratory classroom days. During the twice-daily dose-optimization open-label phase, improvements were observed with R-AMPH in scores of the ADHD-Rating Scale IV and Clinical Global Impressions Severity and Improvement Scales. TEAEs and changes in vital signs associated with R-AMPH were generally mild and not unexpected. The most common TEAEs in the open-label phase were decreased appetite (27.6%), upper abdominal pain (14.3%), irritability (14.3%), and headache (13.3%). CONCLUSIONS Compared to placebo, R-AMPH was effective in treating children aged 6-12 years with ADHD, beginning at 45 minutes and continuing through 10 hours postdose, and was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01986062. https://clinicaltrials.gov/ct2/show/NCT01986062.
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Affiliation(s)
- Ann C. Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada
| | | | - Andrew J. Cutler
- University of Florida and Florida Clinical Research Center, Bradenton, Florida
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina
| | - Jo Northcutt
- Florida Clinical Research Center, LLC, Maitland, Florida
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685
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Steinhausen HC. Recent international trends in psychotropic medication prescriptions for children and adolescents. Eur Child Adolesc Psychiatry 2015; 24:635-40. [PMID: 25378107 DOI: 10.1007/s00787-014-0631-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022]
Abstract
Prescriptions of psychotropic medications have become an important intervention for many children and adolescents with mental disorders, and the rise of these prescriptions is debated intensively both among experts and the public. This review reports some recent international findings on point prevalence rates, cross-country comparisons, and time trends in psychotropic medication prescriptions for children and adolescents. Besides the total prescription rates, figures for antidepressants, antipsychotics, stimulants, and anxiolytics prescriptions are provided. The overall prescription rates of psychotropics in general and the major medication subgroups prescribed to children and adolescents vary substantially between countries with the US consumption being markedly higher than the use in European countries. However, even among the latter there are marked variations in findings. Studies reporting on time trends clearly indicate that there was a marked increase in the use of psychotropics for children and adolescents in the recent past. However, only a single study adjusted prevalence rates for the increasing number of children and adolescents assessed and treated in institutions providing mental health care. Considering the increasing numbers of children and adolescents seen in psychiatric services, the increase of psychotropic medications is less strong though still pronounced enough to stimulate further reflections on the use of these interventions.
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Affiliation(s)
- Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark,
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686
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Treatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs. J Pediatr 2015; 166:1423-30.e1-2. [PMID: 25841538 PMCID: PMC4469986 DOI: 10.1016/j.jpeds.2015.02.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/02/2015] [Accepted: 02/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines. STUDY DESIGN Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described. RESULTS Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%). CONCLUSION These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group.
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687
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Abstract
The revision effort leading to the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was flawed in process, goals and outcome. The revision process suffered from lack of an adequate public record of the rationale for changes, thus shortchanging future scholarship. The goals, such as dimensionalising diagnosis, incorporating biomarkers and separating impairment from diagnosis, were ill-considered and mostly abandoned. However, DSM-5's greatest problem, and the target of the most vigorous and sustained criticism, was its failure to take seriously the false positives problem. By expanding diagnosis beyond plausible boundaries in ways inconsistent with DSM-5's own definition of disorder, DSM-5 threatened the validity of psychiatric research, including especially psychiatric epidemiology. I present four examples: increasing the symptom options while decreasing the diagnostic threshold for substance use disorder, elimination of the bereavement exclusion from major depression, allowing verbal arguments as evidence of intermittent explosive disorder and expanding attention-deficit/hyperactivity disorder to adults before addressing its manifest false positives problems.
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688
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Moorthy G, Sallee F, Gabbita P, Zemlan F, Sallans L, Desai PB. Safety, tolerability and pharmacokinetics of 2-pyridylacetic acid, a major metabolite of betahistine, in a phase 1 dose escalation study in subjects with ADHD. Biopharm Drug Dispos 2015; 36:429-39. [DOI: 10.1002/bdd.1955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/03/2015] [Accepted: 04/18/2015] [Indexed: 11/12/2022]
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689
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Heidbreder R. ADHD symptomatology is best conceptualized as a spectrum: a dimensional versus unitary approach to diagnosis. ACTA ACUST UNITED AC 2015; 7:249-69. [PMID: 25957598 DOI: 10.1007/s12402-015-0171-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/18/2015] [Indexed: 12/19/2022]
Abstract
The aim of this paper is to build a case for the utility of conceptualizing ADHD, not as a unitary disorder that contains several subtypes, but rather as a marker of impairment in attention and/or impulsivity that can be used to identify one of several disorders belonging to a spectrum. The literature will be reviewed to provide an overview of what is known about ADHD in terms of heterogeneity in symptomatology, neuropsychology, neurobiology, as well as comorbidity with other diseases and treatment options. The data from these areas of research will be critically analyzed to support the construct of a spectrum of disorders that can capture the great variability that exists between individuals with ADHD and can discriminate between separate disorders that manifest similar symptoms. The symptoms associated with ADHD can be viewed as dimensional markers that point to a spectrum of related disorders that have as part of their characteristics impairments of attention and impulsivity. The spectrum can accommodate symmetrically and asymmetrically comorbid psychiatric disorders associated with ADHD as well as the wide heterogeneity known to be a part of the ADHD disorder. Individuals presenting with impairments associated with ADHD should be treated as having a positive marker for a spectrum disorder that has as part of its characteristics impairments of attention and/or impulsivity. The identification of impairment in attention and/or impulsivity should be a starting point for further testing rather than being an endpoint of diagnosis that results in pharmacological treatment that may or may not be the optimal therapy. Rather than continuing to attribute a large amount of heterogeneity in symptom presentation as well as a high degree of symmetric and asymmetric comorbidity to a single disorder, clinical evaluation should turn to the diagnosis of the type of attentional deficit and/or impulsivity an individual has in order to colocate the individual's disorder on a spectrum that captures the heterogeneity in symptomatology, the symmetrical and asymmetrical comorbidity, as well as subthreshold presentation and other variants often worked into the disorder of ADHD. The spectrum model can accommodate not only the psychophysiological profiles of patients, but is also consistent with what is known about the functional heterogeneity of the prefrontal cortex as well as the construct that cognitive processes are supported by overlapping and collaborative networks.
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Affiliation(s)
- Rebeca Heidbreder
- PsychResearchCenter, LLC, 3669 Michaux Mill Drive, Powhatan, VA, 23139, USA.
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690
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Rohatgi RK, Bos JM, Ackerman MJ. Stimulant therapy in children with attention-deficit/hyperactivity disorder and concomitant long QT syndrome: A safe combination? Heart Rhythm 2015; 12:1807-12. [PMID: 25956966 DOI: 10.1016/j.hrthm.2015.04.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is prevalent in about 11% of children in the United States. As such, ADHD is expected to be present in patients with long QT syndrome (LQTS), a rare, potentially lethal but highly treatable cardiac channelopathy. ADHD-directed stimulant therapy is relatively contraindicated in patients with LQTS because of concern for LQTS-triggered events. OBJECTIVE The purpose of this study was to evaluate the ADHD-directed treatment, outcome, and frequency of LQTS-triggered events in patients with LQTS and concomitant ADHD. METHODS A retrospective electronic medical record review of 357 pediatric patients with LQTS evaluated between 1999 and 2014 was performed to determine the prevalence of concomitant ADHD and the incidence of LQTS-triggered events in patients with LQTS, with or without concomitant ADHD. RESULTS Overall, 28 patients (8%) were diagnosed with LQTS concomitant ADHD. There were no phenotypic differences between patients with LQTS and ADHD, and LQTS alone. ADHD-directed stimulant therapy was stopped or advised against in 19 patients (68%) at the time of first evaluation or after diagnosis. None of the 15 stimulant-treated patients experienced LQTS-triggered events in a combined 56 person-years of treatment. Perhaps paradoxically, there was a statistically lower LQTS-triggered event rate in the stimulant-treated ADHD group compared to the LQTS alone cohort. CONCLUSION Among patients with mild- to moderate-risk LQTS, we found a prevalence of ADHD similar to that in the general population, which can be treated effectively and safely with stimulant therapy. Physicians should find reassurance in the low adverse event rate and should weigh the potential effects of suboptimal treatment of ADHD with the theoretical proarrhythmic risk from stimulant medications.
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Affiliation(s)
- Ram K Rohatgi
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - J Martijn Bos
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota,; Department of Medicine/Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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691
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Schawo S, van der Kolk A, Bouwmans C, Annemans L, Postma M, Buitelaar J, van Agthoven M, Hakkaart-van Roijen L. Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed? PHARMACOECONOMICS 2015; 33:489-509. [PMID: 25715975 PMCID: PMC4544537 DOI: 10.1007/s40273-015-0259-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Incidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents has been increasing. The disorder results in high societal costs. Policymakers increasingly use health economic evaluations to inform decisions on competing treatments of ADHD. Yet, health economic evaluations of first-choice medication of ADHD in children and adolescents are scarce and generally do not include broader societal effects. OBJECTIVES This study presents a probabilistic model and analysis of methylphenidate osmotic-release oral system (OROS) versus methylphenidate immediate-release (IR). We investigate and include relevant societal aspects in the analysis so as to provide cost-effectiveness estimates based on a broad societal perspective. METHODS We enhanced an existing Markov model and determined the cost effectiveness of OROS versus IR for children and adolescents responding suboptimally to treatment with IR. Enhancements included screening of a broad literature base, updated utility values, inclusion of costs and effects on caregivers and a change of the model type from deterministic to probabilistic. RESULTS The base case scenario resulted in lower incremental costs (€-5815) of OROS compared with IR and higher incremental quality-adjusted life-year (QALY) gains (0.22). Scenario analyses were performed to determine sensitivity to changes in transition rates, utility of caregivers, medical costs of caregivers and daily medication dose. CONCLUSIONS The results indicate that, for children responding suboptimally to treatment with IR, the beneficial effect of OROS on compliance may be worth the additional costs of medication. The presented model adds to the health economic information available for policymakers and to considerations on a broader perspective in cost-effectiveness analyses.
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Affiliation(s)
- Saskia Schawo
- Institute for Medical Technology Assessment and Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands,
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692
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Adisetiyo V, Helpern JA. Brain iron: a promising noninvasive biomarker of attention-deficit/hyperactivity disorder that warrants further investigation. Biomark Med 2015; 9:403-6. [DOI: 10.2217/bmm.15.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Vitria Adisetiyo
- Center for Biomedical Imaging, Department of Radiology & Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street MSC 323, Charleston, SC 29425, USA
| | - Joseph A Helpern
- Center for Biomedical Imaging, Department of Radiology & Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street MSC 323, Charleston, SC 29425, USA
- Department of Neuroscience, Medical University of South Carolina, 96 Jonathan Lucas Street MSC 323, Charleston, SC 29425, USA
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693
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Richards JR, Albertson TE, Derlet RW, Lange RA, Olson KR, Horowitz BZ. Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review. Drug Alcohol Depend 2015; 150:1-13. [PMID: 25724076 DOI: 10.1016/j.drugalcdep.2015.01.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/24/2014] [Accepted: 01/28/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Overdose of amphetamine, related derivatives, and analogues (ARDA) continues to be a serious worldwide health problem. Patients frequently present to the hospital and require treatment for agitation, psychosis, and hyperadrenegic symptoms leading to pathologic sequelae and mortality. OBJECTIVE To review the pharmacologic treatment of agitation, psychosis, and the hyperadrenergic state resulting from ARDA toxicity. METHODS MEDLINE, PsycINFO, and the Cochrane Library were searched from inception to September 2014. Articles on pharmacologic treatment of ARDA-induced agitation, psychosis, and hyperadrenergic symptoms were selected. Evidence was graded using Oxford CEBM. Treatment recommendations were compared to current ACCF/AHA guidelines. RESULTS The search resulted in 6082 articles with 81 eligible treatment involving 835 human subjects. There were 6 high-quality studies supporting the use of antipsychotics and benzodiazepines for control of agitation and psychosis. There were several case reports detailing the successful use of dexmedetomidine for this indication. There were 9 high-quality studies reporting the overall safety and efficacy of β-blockers for control of hypertension and tachycardia associated with ARDA. There were 3 high-quality studies of calcium channel blockers. There were 2 level I studies of α-blockers and a small number of case reports for nitric oxide-mediated vasodilators. CONCLUSIONS High-quality evidence for pharmacologic treatment of overdose from ARDA is limited but can help guide management of acute agitation, psychosis, tachycardia, and hypertension. The use of butyrophenone and later-generation antipsychotics, benzodiazepines, and β-blockers is recommended based on existing evidence. Future randomized prospective trials are needed to evaluate new agents and further define treatment of these patients.
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Affiliation(s)
- John R Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, United States.
| | - Timothy E Albertson
- Department of Internal Medicine, Divisions of Toxicology, Pulmonary and Critical Care, University of California Davis Medical Center, Sacramento, CA, United States; Northern California VA Medical System, Sacramento, CA, United States
| | - Robert W Derlet
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, United States
| | - Richard A Lange
- Department of Medicine, Division of Cardiology, University of Texas Health Sciences Center, San Antonio, TX, United States
| | - Kent R Olson
- Department of Medicine, University of California, San Francisco, CA, United States; Department of Clinical Pharmacy, University of California, San Francisco, California Poison Control System, San Francisco Division, San Francisco, CA, United States
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health Sciences University, Oregon Poison Center, Portland, OR, United States
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694
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[Has the prevalence of parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD) in Germany increased between 2003-2006 and 2009-2012? Results of the KiGGS-study: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:820-9. [PMID: 24950831 DOI: 10.1007/s00103-014-1983-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent international studies have reported a considerable increase in the diagnosis of attention deficit hyperactivity disorder (ADHD). Data from German statutory health insurance companies suggest a comparable trend for Germany. Based on data from the nationally representative study KiGGS Wave 1 (2009-2012) it was the aim of this study to report on the prevalence rates of parent-reported ADHD diagnoses in children and adolescents aged 3-17 years as well as to report on time trends in comparison with the KiGGS baseline study (2003-2006). ADHD caseness was met if a parent reported that a physician or a psychologist diagnosed their child with ADHD. Participants without a reported ADHD diagnosis but who scored ≥ 7 (clinical range) on the parent-rated hyperactivity subscale of the Strengths and Difficulties Questionnaire (SDQ) were considered as potential ADHD cases. The prevalence of diagnosed ADHD was 5.0% (prevalence of potential ADHD cases 6.0%). An ADHD diagnosis was more than four and a half times more likely to be reported among boys than girls. Children from families with low socioeconomic status (SES) were more than two and a half times more likely to be diagnosed with ADHD than children from families with high SES. Among potential cases, boys were twice as common as girls, and children from families with low SES were approximately three times more common compared with those from high SES families. The proportion of lifetime ADHD diagnoses increased with age and was highest in 11- to 17-year-olds. In every fifth child with ADHD the initial diagnosis was made by the age of 6 years and in 1 out of 11 children with ADHD the initial diagnosis was made by the age of 5 years. In total, we observed no significant changes regarding the frequency of ADHD diagnosis compared to the KiGGS baseline study. Increases reported using data from German statuary health insurance companies were not reflected in the KiGGS data.
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695
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Snyder SM, Rugino TA, Hornig M, Stein MA. Integration of an EEG biomarker with a clinician's ADHD evaluation. Brain Behav 2015; 5:e00330. [PMID: 25798338 PMCID: PMC4356845 DOI: 10.1002/brb3.330] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/22/2015] [Accepted: 02/02/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study is the first to evaluate an assessment aid for attention-deficit/hyperactivity disorder (ADHD) according to both Class-I evidence standards of American Academy of Neurology and De Novo requirements of US Food and Drug Administration. The assessment aid involves a method to integrate an electroencephalographic (EEG) biomarker, theta/beta ratio (TBR), with a clinician's ADHD evaluation. The integration method is intended as a step to help improve certainty with criterion E (i.e., whether symptoms are better explained by another condition). METHODS To evaluate the assessment aid, investigators conducted a prospective, triple-blinded, 13-site, clinical cohort study. Comprehensive clinical evaluation data were obtained from 275 children and adolescents presenting with attentional and behavioral concerns. A qualified clinician at each site performed differential diagnosis. EEG was collected by separate teams. The reference standard was consensus diagnosis by an independent, multidisciplinary team (psychiatrist, psychologist, and neurodevelopmental pediatrician), which is well-suited to evaluate criterion E in a complex clinical population. RESULTS Of 209 patients meeting ADHD criteria per a site clinician's judgment, 93 were separately found by the multidisciplinary team to be less likely to meet criterion E, implying possible overdiagnosis by clinicians in 34% of the total clinical sample (93/275). Of those 93, 91% were also identified by EEG, showing a relatively lower TBR (85/93). Further, the integration method was in 97% agreement with the multidisciplinary team in the resolution of a clinician's uncertain cases (35/36). TBR showed statistical power specific to supporting certainty of criterion E per the multidisciplinary team (Cohen's d, 1.53). Patients with relatively lower TBR were more likely to have other conditions that could affect criterion E certainty (10 significant results; P ≤ 0.05). Integration of this information with a clinician's ADHD evaluation could help improve diagnostic accuracy from 61% to 88%. CONCLUSIONS The EEG-based assessment aid may help improve accuracy of ADHD diagnosis by supporting greater criterion E certainty.
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Affiliation(s)
- Steven M Snyder
- Department of Research and Development, NEBA Health Boulder, Colorado ; Department of Psychiatry and Health Behavior, Georgia Regents University Augusta, Georgia
| | - Thomas A Rugino
- Children's Specialized Hospital Toms River, New Jersey ; Robert Wood Johnson School of Medicine Piscataway, New Jersey
| | - Mady Hornig
- Department of Epidemiology, Mailman School of Public Health, Columbia University New York, New York
| | - Mark A Stein
- Department of Psychiatry and Behavioral Science, and Pediatrics, University of Washington Seattle, Washington ; Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital Seattle, Washington
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696
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PIERPONT ELIZABETHI, TWOROG-DUBE ERICA, ROBERTS AMYE. Attention skills and executive functioning in children with Noonan syndrome and their unaffected siblings. Dev Med Child Neurol 2015; 57:385-92. [PMID: 25366258 PMCID: PMC9979240 DOI: 10.1111/dmcn.12621] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2014] [Indexed: 11/29/2022]
Abstract
AIM Emerging research indicates that gene mutations within the RAS-MAPK signaling cascade, which cause Noonan syndrome and related disorders, affect neurophysiologic activity in brain regions underlying attention and executive functions. The present study examined whether children with Noonan syndrome are at heightened risk for symptoms of attention-deficit-hyperactivity disorder (ADHD) and executive dysfunction relative to an unaffected sibling comparison group, and investigated three key aspects of behavioral attention: auditory attention, sustained attention, and response inhibition. METHOD Children and adolescents with Noonan syndrome (n=32, 17 males, 15 females, mean age 11y 3mo, SD 3y) and their unaffected siblings (n=16, eight males, eight females, mean age 11y, SD 3y 6mo) were administered standardized tests of intellectual functioning and clinic-based measures of behavioral attention. Parent ratings of ADHD symptoms, executive functioning, and behavior were also obtained. RESULTS Children with Noonan syndrome demonstrated higher rates of past ADHD diagnosis, as well as reduced performance compared with unaffected siblings on behavioral attention measures. Parent-rated functional impairments in attention, social skills, working memory, and self-monitoring were more prevalent in the Noonan syndrome group. The relationship between attention regulation skills (sustained attention and inhibitory control) and intellectual test performance was significantly stronger in the Noonan syndrome group than the comparison group. INTERPRETATION Clinical screening/evaluation for ADHD and executive dysfunction in Noonan syndrome is recommended to facilitate appropriate intervention and to address functional impact on daily life activities.
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Affiliation(s)
- ELIZABETH I PIERPONT
- Department of Pediatrics, Division of Clinical Behavioral Neuroscience, University of Minnesota Medical School, Minneapolis, MN
| | - ERICA TWOROG-DUBE
- Department of Cardiology and Department of Medicine, Division of Genetics, Boston Children’s Hospital, Boston, MA, USA
| | - AMY E ROBERTS
- Department of Cardiology and Department of Medicine, Division of Genetics, Boston Children’s Hospital, Boston, MA, USA
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697
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Prosser B, Lambert MC, Reid R. Psychostimulant prescription for ADHD in new South Wales: a longitudinal perspective. J Atten Disord 2015; 19:284-92. [PMID: 25300816 DOI: 10.1177/1087054714553053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is a need for Australian studies of ADHD that utilize the individual child as the unit of analysis because they provide a more accurate picture of national patterns (in new prescriptions, start age, and duration). The aim of this study was to build toward a national picture of patterns in psychostimulant use for ADHD by undertaking a retrospective analysis of archival data on prescriptions within New South Wales (NSW), Australia's most populated state. METHOD A person-based data set was used to assess (a) rate of new prescriptions by age group, (b) demographic characteristics (age of start, male:female ratio), (c) duration of use, and (d) comparisons across the two decades. RESULTS Five findings were observed: (a) The prevalence of psychostimulant use was 1.24% in 2010, (b) there was significant variability in the rate of new prescriptions by age group after 2003, (c) start age declined over the 1990 to 2000 period, but began to increase from 2000 to 2010, (d) the male:female ratio declined, and (e) the duration of psychostimulant use declined consistently. CONCLUSION Results suggest disconnect between persistence across the life span and actual treatment patterns. A decline in medication treatment for more than 1 year and the growing proportion of discontinuous treatment suggests a need for strategies to assist families with the transition onto and off medications.
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698
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Carmona S, Hoekzema E, Castellanos FX, García-García D, Lage-Castellanos A, Van Dijk KRA, Navas-Sánchez FJ, Martínez K, Desco M, Sepulcre J. Sensation-to-cognition cortical streams in attention-deficit/hyperactivity disorder. Hum Brain Mapp 2015; 36:2544-57. [PMID: 25821110 DOI: 10.1002/hbm.22790] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
We sought to determine whether functional connectivity streams that link sensory, attentional, and higher-order cognitive circuits are atypical in attention-deficit/hyperactivity disorder (ADHD). We applied a graph-theory method to the resting-state functional magnetic resonance imaging data of 120 children with ADHD and 120 age-matched typically developing children (TDC). Starting in unimodal primary cortex-visual, auditory, and somatosensory-we used stepwise functional connectivity to calculate functional connectivity paths at discrete numbers of relay stations (or link-step distances). First, we characterized the functional connectivity streams that link sensory, attentional, and higher-order cognitive circuits in TDC and found that systems do not reach the level of integration achieved by adults. Second, we searched for stepwise functional connectivity differences between children with ADHD and TDC. We found that, at the initial steps of sensory functional connectivity streams, patients display significant enhancements of connectivity degree within neighboring areas of primary cortex, while connectivity to attention-regulatory areas is reduced. Third, at subsequent link-step distances from primary sensory cortex, children with ADHD show decreased connectivity to executive processing areas and increased degree of connections to default mode regions. Fourth, in examining medication histories in children with ADHD, we found that children medicated with psychostimulants present functional connectivity streams with higher degree of connectivity to regions subserving attentional and executive processes compared to medication-naïve children. We conclude that predominance of local sensory processing and lesser influx of information to attentional and executive regions may reduce the ability to organize and control the balance between external and internal sources of information in ADHD.
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Affiliation(s)
- Susana Carmona
- Department of Psychology, Harvard University, Center for Brain Science, Cambridge, Massachusetts.,Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Elseline Hoekzema
- Neuroendocrinology Bakker Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Francisco X Castellanos
- Center for Neurodevelopmental Disorders, The Child Study Center at NYU Langone Medical Center, New York, New York.,Division of Child and Adolescent Psychiatric Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - David García-García
- Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | | | - Koene R A Van Dijk
- Department of Psychology, Harvard University, Center for Brain Science, Cambridge, Massachusetts.,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - Francisco J Navas-Sánchez
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Kenia Martínez
- Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Manuel Desco
- Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Jorge Sepulcre
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts.,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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699
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Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015; 56:345-65. [PMID: 25649325 DOI: 10.1111/jcpp.12381] [Citation(s) in RCA: 2042] [Impact Index Per Article: 226.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates. METHODS We conducted a systematic review of the literature searching in PubMed, PsycINFO, and EMBASE for prevalence studies of mental disorders investigating probabilistic community samples of children and adolescents with standardized assessments methods that derive diagnoses according to the DSM or ICD. Meta-analytical techniques were used to estimate the prevalence rates of any mental disorder and individual diagnostic groups. A meta-regression analysis was performed to estimate the effect of population and sample characteristics, study methods, assessment procedures, and case definition in determining the heterogeneity of estimates. RESULTS We included 41 studies conducted in 27 countries from every world region. The worldwide-pooled prevalence of mental disorders was 13.4% (CI 95% 11.3-15.9). The worldwide prevalence of any anxiety disorder was 6.5% (CI 95% 4.7-9.1), any depressive disorder was 2.6% (CI 95% 1.7-3.9), attention-deficit hyperactivity disorder was 3.4% (CI 95% 2.6-4.5), and any disruptive disorder was 5.7% (CI 95% 4.0-8.1). Significant heterogeneity was detected for all pooled estimates. The multivariate metaregression analyses indicated that sample representativeness, sample frame, and diagnostic interview were significant moderators of prevalence estimates. Estimates did not vary as a function of geographic location of studies and year of data collection. The multivariate model explained 88.89% of prevalence heterogeneity, but residual heterogeneity was still significant. Additional meta-analysis detected significant pooled difference in prevalence rates according to requirement of funcional impairment for the diagnosis of mental disorders. CONCLUSIONS Our findings suggest that mental disorders affect a significant number of children and adolescents worldwide. The pooled prevalence estimates and the identification of sources of heterogeneity have important implications to service, training, and research planning around the world.
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Affiliation(s)
- Guilherme V Polanczyk
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Research Center on Neurodevelopment and Mental Health, University of São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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700
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Levy E, Traicu A, Iyer S, Malla A, Joober R. Psychotic disorders comorbid with attention-deficit hyperactivity disorder: an important knowledge gap. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:S48-52. [PMID: 25886680 PMCID: PMC4418622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 06/01/2014] [Indexed: 03/07/2023]
Abstract
Psychotic disorders (PDs) and attention-deficit hyperactivity disorder (ADHD) are frequently comorbid. Clinicians are often reticent to treat ADHD in patients with psychosis, fearing that psychostimulants will worsen psychotic symptoms. Advances in neurobiology have challenged the simplistic dichotomy where PD is considered a disorder of high dopamine (DA), treated by DA antagonists, and ADHD a disorder of low DA, treated by DA agonists. In our paper, we review the literature on comorbid ADHD and psychosis. Treating ADHD with psychostimulants may be considered in patients with PD who have been stabilized with antipsychotics (APs). Not treating ADHD may have consequences because ADHD may predispose patients to drug abuse, which further increases the risk of PD. Nevertheless, more systematic studies are needed as there remains some uncertainty on the combined use of APs and psychostimulants in comorbid PD and ADHD.
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Affiliation(s)
- Emmanuelle Levy
- Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Alexandru Traicu
- Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Srividya Iyer
- Associate Professor, Douglas Mental Health University Institute, Montreal, Quebec
| | - Ashok Malla
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Ridha Joober
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Psychiatrist, Douglas Mental Health University Institute, Montreal, Quebec
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