701
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Logan AC, Katzman MA, Balanzá-Martínez V. Natural environments, ancestral diets, and microbial ecology: is there a modern "paleo-deficit disorder"? Part I. J Physiol Anthropol 2015; 34:1. [PMID: 25636731 PMCID: PMC4318214 DOI: 10.1186/s40101-015-0041-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/02/2015] [Indexed: 12/15/2022] Open
Abstract
Famed microbiologist René J. Dubos (1901-1982) was an early pioneer in the developmental origins of health and disease (DOHaD) construct. In the 1960s, he conducted groundbreaking experimental research concerning the ways in which early-life experience with nutrition, microbiota, stress, and other environmental variables could influence later-life health outcomes. He also wrote extensively on potential health consequences of a progressive loss of contact with natural environments (now referred to as green or blue space), arguing that Paleolithic experiences have created needs, particularly in the mental realm, that might not be met in the context of rapid global urbanization. He posited that humans would certainly adapt to modern urban landscapes and high technology, but there might be a toll to be paid in the form of higher psychological distress (symptoms of anxiety and depression) and diminished quality of life. In particular, there might be an erosion of humanness, exemplified by declines in altruism/empathy. Here in the first of a two-part review, we examine contemporary research related to natural environments and question to what extent Dubos might have been correct in some of his 50-year-old assertions.
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Affiliation(s)
- Alan C Logan
- CAMNR, 23679 Calabasas Road Suite 542, Calabasas, CA, 91302, USA.
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, 32 Park Road, Toronto, ON, M4W 2 N4, Canada.
| | - Vicent Balanzá-Martínez
- Department of Medicine, Section of Psychiatry and Psychological Medicine, University of Valencia Medical School, Avda. Blasco Ibáñez, 15, E46010, Valencia, Spain.
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702
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Elmore AL, Nigg JT, Friderici KH, Jernigan K, Nikolas MA. Does 5HTTLPR Genotype Moderate the Association of Family Environment With Child Attention-Deficit Hyperactivity Disorder Symptomatology? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:348-60. [PMID: 25602736 DOI: 10.1080/15374416.2014.979935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Problematic family dynamics are common among youth with attention-deficit hyperactivity disorder (ADHD). Multiple mechanisms, including diathesis-stress (vulnerability) and differential susceptibility Gene × Environment interaction effects (G × E), have been proposed to account for this association. G × E effects for ADHD were examined via interactions between a genetic marker hypothesized to influence sensitivity to the environment (the promoter polymorphism of the serotonin transporter gene -5HTTLPR) and family conflict and cohesion in predicting ADHD symptoms. There were 498 youth ages 6-17 years (251 ADHD, 213 non-ADHD) and their parents who completed a multistage, multi-informant assessment (including parent and youth reports on the Family Environment Scale), and saliva sample collection for genotyping. Linear regression analyses examined interactions between 5HTTLPR genotype and the Family Environment Scale scales of conflict and cohesion reported by parent and child. Criteria laid out by Roisman et al. ( 2012 ) were applied to evaluate diathesis stress versus differential susceptibility G × E mechanisms. Results demonstrated interactions between 5HTTLPR genotype and both conflict and cohesion in predicting inattention but not hyperactivity-impulsivity. Both interactions were highly consistent with differential susceptibility models of G × E effects. 5HTTLPR genotype appeared to moderate the relationship between family conflict/cohesion and inattentive symptoms. Interactions highlight the role of 5HTTLPR genotype as a potential marker of environmental sensitivity and provide support for differential susceptibility models of G × E effects for ADHD.
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Affiliation(s)
| | - Joel T Nigg
- b Department of Psychiatry , Oregon Health and Science University
| | - Karen H Friderici
- c Department of Microbiology and Molecular Genetics , Michigan State University
| | - Katherine Jernigan
- c Department of Microbiology and Molecular Genetics , Michigan State University
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703
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Dougherty LR, Leppert KA, Merwin SM, Smith VC, Bufferd SJ, Kushner MR. Advances and Directions in Preschool Mental Health Research. CHILD DEVELOPMENT PERSPECTIVES 2015. [DOI: 10.1111/cdep.12099] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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704
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Hansen TG. Anesthesia-related neurotoxicity and the developing animal brain is not a significant problem in children. Paediatr Anaesth 2015; 25:65-72. [PMID: 25266176 DOI: 10.1111/pan.12548] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/18/2022]
Abstract
A multitude of animal studies have shown that virtually all general anesthetics used in clinical practice possibly during a vulnerable period of brain development (i.e., brain growth spurt, peak of synaptogenesis) may lead to neurodegeneration (particularly apoptosis) and abnormal synaptic development with functional deficits in learning and behavior later in life. Initial studies were mainly performed in immature rodent pups, but more recent studies have included nonhumans primates (rhesus monkeys). Given the number of neonates, infants, and young children anesthetized annually worldwide, these findings could have significant public health implications. So far, relatively few human (cohort) studies focusing on this topic have been published with inconsistent results. While some studies have indicated an association between exposure to anesthesia and surgery, other studies have indicated no such association. Prospective studies are underway, but the result will not be available for several years. This paper reviews some of the preclinical background behind anesthesia-related neurotoxicity but focuses mainly on the human studies so far. It is concluded that although disturbing, the animal data lack verification in humans. Fortunately, the humans studies performed so far have been unable to confirm these animal data. A single brief anesthetic seems safe in infants. Multiple anesthetic and surgical exposures on the other hand are different. But there may be other reasons for this than merely the anesthetics. Currently, there is no need to change current anesthetic clinical practice or to postpone or cancel truly urgent surgeries in young children.
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Affiliation(s)
- Tom G Hansen
- Department of Anesthesiology and Intensive Care -Pediatric Section, Odense University Hospital, Odense C, Denmark; Clinical Institute - Anesthesiology, University of Southern Denmark, Odense C, Denmark
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705
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Neurobehavioral Concerns Among Males with Dystrophinopathy Using Population-Based Surveillance Data from the Muscular Dystrophy Surveillance, Tracking, and Research Network. J Dev Behav Pediatr 2015; 36:455-63. [PMID: 26020585 PMCID: PMC4497929 DOI: 10.1097/dbp.0000000000000177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the occurrence of selected neurobehavioral concerns among males with a dystrophinopathy and to explore the associations with corticosteroid or supportive device use. METHODS Medical record abstraction of neurobehavioral concerns was conducted for 857 affected males from 765 families, born since 1982 and followed through 2011, and enrolled in the population-based Muscular Dystrophy Surveillance, Tracking, and Research Network. Cumulative probabilities for attention-deficit hyperactivity disorder (ADHD), behavior problems, and depressed mood were calculated from Kaplan-Meier estimates for the subsample of oldest affected males (n = 765). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for corticosteroid and supportive device use were estimated from Cox regression models with time-dependent covariates. RESULTS Of the 857 affected males, 375 (44%) had at least 1 of the 3 selected neurobehavioral concerns; a similar percentage (45%) was found among the 765 oldest affected males. The estimated cumulative probabilities among these oldest affected males were 23% for ADHD, 43% for behavior problems, and 51% for depressed mood. Corticosteroid (HR = 2.35, 95% CI = 1.75-3.16) and mobility device (HR = 1.53, 95% CI = 1.06-2.21) use were associated with behavior problems. Use of a mobility device (HR = 3.53, 95% CI = 2.13-5.85), but not corticosteroids, was associated with depressed mood. ADHD was not significantly associated with corticosteroid or mobility device use. Respiratory assist device use was not examined due to low numbers of users before onset of neurobehavioral concerns. CONCLUSION Selected neurobehavioral concerns were common among males with a dystrophinopathy. Reported associations highlight the importance of increased monitoring of neurobehavioral concerns as interventions are implemented and disease progresses.
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706
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Meacham D. The Subject of Enhancement: Augmented Capacities, Extended Cognition, and Delicate Ecologies of the Mind. New Bioeth 2015; 21:5-19. [PMID: 29384341 DOI: 10.1179/2050287715z.00000000063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This paper argues for an inflationary and capacity-relative understanding of human enhancement technology. In doing so it echoes the approach followed by Buchanan (2011a, 2011b). Particular emphasis is placed on the point that capacities themselves are relative to demands placed on the organism by its environment. In the case of human beings, this environment is to a very large extent institutionally structured. On the basis of the inflationary and capacity-relative concept of enhancement, I argue that the subject of enhancement must be understood in terms of a bundle of capacities that is both extended (Clark 1998) and ecological. This consequence of the inflationary enhancement concept has some surprising upshots, namely that the subject itself must be considered as a technological enhancement and not a ‘platform’ or subjectum upon which the enhancement enterprise builds. This conclusion clashes, I argue, with some of the presuppositions of liberal philosophy, which starts by assuming a reflective subject. The paper ends with some reflection on the desirability of reflective subjectivity for human flourishing and addressing the ecological crisis.
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707
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McKeown RE, Holbrook JR, Danielson ML, Cuffe SP, Wolraich ML, Visser SN. The impact of case definition on attention-deficit/hyperactivity disorder prevalence estimates in community-based samples of school-aged children. J Am Acad Child Adolesc Psychiatry 2015; 54:53-61. [PMID: 25524790 PMCID: PMC4472453 DOI: 10.1016/j.jaac.2014.10.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/17/2014] [Accepted: 11/07/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the impact of varying attention-deficit/hyperactivity disorder (ADHD) diagnostic criteria, including new DSM-5 criteria, on prevalence estimates. METHOD Parent and teacher reports identified high- and low-screen children with ADHD from elementary schools in 2 states that produced a diverse overall sample. The parent interview stage included the Diagnostic Interview Schedule for Children-IV (DISC-IV), and up to 4 additional follow-up interviews. Weighted prevalence estimates, accounting for complex sampling, quantified the impact of varying ADHD criteria using baseline and the final follow-up interview data. RESULTS At baseline 1,060 caregivers were interviewed; 656 had at least 1 follow-up interview. Teachers and parents reported 6 or more ADHD symptoms for 20.5% (95% CI = 18.1%-23.2%) and 29.8% (CI = 24.5%-35.6%) of children respectively, with criteria for impairment and onset by age 7 years (DSM-IV) reducing these proportions to 16.3% (CI = 14.7%-18.0%) and 17.5% (CI = 13.3%-22.8%); requiring at least 4 teacher-reported symptoms reduced the parent-reported prevalence to 8.9% (CI = 7.4%-10.6%). Revising age of onset to 12 years per DSM-5 increased the 8.9% estimate to 11.3% (CI = 9.5%-13.3%), with a similar increase seen at follow-up: 8.2% with age 7 onset (CI = 5.9%-11.2%) versus 13.0% (CI = 7.6%-21.4%) with onset by age 12. Reducing the number of symptoms required for those aged 17 and older increased the overall estimate to 13.1% (CI = 7.7%-21.5%). CONCLUSION These findings quantify the impact on prevalence estimates of varying case definition criteria for ADHD. Further research of impairment ratings and data from multiple informants is required to better inform clinicians conducting diagnostic assessments. DSM-5 changes in age of onset and number of symptoms required for older adolescents appear to increase prevalence estimates, although the full impact is uncertain due to the age of our sample.
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Affiliation(s)
- Robert E McKeown
- University of South Carolina Arnold School of Public Health, Columbia, SC
| | - Joseph R Holbrook
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta
| | - Melissa L Danielson
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta
| | | | - Mark L Wolraich
- University of Oklahoma (OU) Health Sciences Center, OU Child Study Center, Oklahoma City
| | - Susanna N Visser
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta.
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708
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Does Guanfacine Extended Release Impact Functional Impairment in Children with Attention-Deficit/Hyperactivity Disorder? Results from a Randomized Controlled Trial. CNS Drugs 2015; 29:953-62. [PMID: 26547425 PMCID: PMC4653245 DOI: 10.1007/s40263-015-0291-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In clinical trials of medications to treat attention-deficit/hyperactivity disorder (ADHD) in children, effects on functional impairment have been less well-studied than changes in ADHD symptoms. OBJECTIVE Data regarding functional impairment were analyzed from a multicenter, double-blind, placebo-controlled study of guanfacine extended release (GXR) in children with ADHD, using the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P). The correspondence of changes in WFIRS-P scores with symptomatic and global response to GXR treatment was also examined, with treatment response defined by scores on both the ADHD Rating Scale IV (ADHD-RS-IV) and the Clinical Global Impressions-Improvement Scale (CGI-I). METHODS In this 8-week, double-blind, placebo-controlled, dose optimization study at 47 sites across the USA and Canada, children aged 6-12 years with a diagnosis of ADHD [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and an ADHD-RS-IV score ≥28 and CGI-Severity of Illness Scale score ≥4 at baseline], were randomized 1:1:1 into three groups: GXR AM [GXR (1-4 mg/day) in the morning, placebo in the evening], GXR PM [placebo in the morning, GXR (1-4 mg/day) in the evening], or twice-daily placebo. Parents rated their children on the WFIRS-P at screening, baseline, the end of dose optimization, and at the final on-treatment assessment. RESULTS The efficacy population was composed of 333 subjects (GXR AM: n = 107; GXR PM: n = 114; placebo: n = 112). At the final on-treatment assessment, there were significant improvements from baseline in the placebo-adjusted difference in least-squares (LS) mean (95 % confidence interval) WFIRS-P Total scores for both GXR treatment groups combined [GXR all-active: -0.16 (-0.25, -0.07), effect size (ES) = 0.448, P <0.001] and separately [GXR AM: -0.15 (-0.26, -0.05), ES = 0.417, P = 0.004; GXR PM: -0.18 (-0.28, -0.07), ES = 0.478, P = 0.001]. Significant improvements in WFIRS-P domain scores for Family, Learning and School (including Academic Performance and Behavior in School), Social, and Risky Behavior were found for both GXR cohorts compared with placebo. However, the Life Skills and Self-Concept domain scores of the WFIRS-P did not improve with GXR treatment. Post hoc stratification by responder status revealed that significant (P <0.001) improvements in WFIRS-P Total and all domain scores were associated with symptomatic treatment response in the GXR all-active group. CONCLUSIONS GXR treatment in children with ADHD was associated with reductions in WFIRS-P functional impairment scores compared with placebo, regardless of time of GXR administration. Changes in WFIRS-P scores were congruent with clinical response, as determined by both ADHD symptom reduction and CGI-I scores. CLINICALTRIALS. GOV IDENTIFIER NCT00997984.
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709
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Hinshaw SP, Arnold LE. ADHD, Multimodal Treatment, and Longitudinal Outcome: Evidence, Paradox, and Challenge. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2015; 6:39-52. [PMID: 25558298 PMCID: PMC4280855 DOI: 10.1002/wcs.1324] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/31/2014] [Accepted: 09/18/2014] [Indexed: 12/14/2022]
Abstract
Given major increases in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and in rates of medication for this condition, we carefully examine evidence for effects of single versus multimodal (i.e., combined medication and psychosocial/behavioral) interventions for ADHD. Our primary data source is the Multimodal Treatment Study of Children with ADHD (MTA), a 14-month, randomized clinical trial in which intensive behavioral, medication, and multimodal treatment arms were contrasted with one another and with community intervention (treatment-as-usual), regarding outcome domains of ADHD symptoms, comorbidities, and core functional impairments. Although initial reports emphasized the superiority of well-monitored medication for symptomatic improvement, reanalyses and reappraisals have highlighted (a) the superiority of combination treatment for composite outcomes and for domains of functional impairment (e.g., academic achievement, social skills, parenting practices); (b) the importance of considering moderator and mediator processes underlying differential patterns of outcome, including comorbid subgroups and improvements in family discipline style during the intervention period; (c) the emergence of side effects (e.g., mild growth suppression) in youth treated with long-term medication; and (d) the diminution of medication's initial superiority once the randomly assigned treatment phase turned into naturalistic follow-up. The key paradox is that whereas ADHD clearly responds to medication and behavioral treatment in the short term, evidence for long-term effectiveness remains elusive. We close with discussion of future directions and a call for greater understanding of relevant developmental processes in the attempt to promote optimal, generalized, and lasting treatments for this important and impairing neurodevelopmental disorder.
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Affiliation(s)
- Stephen P. Hinshaw
- Department of Psychology, Tolman Hall, University of California, Berkeley CA 94720
| | - L. Eugene Arnold
- Department of Psychiatry, 395E McCampbell Hall, 1581 Dodd Dr., Ohio State University, Columbus, OH 43210
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710
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Abstract
The authors apply a two-systems approach to demonstrate improved treatment possibilities and outcomes in this group of children and suggest that psychoanalysis can be defined as a multimodal strengths-based learning experience. Using clinical material from the analysis of an aggressive, "out-of-control" child, they discuss how these behaviors and symptoms are better understood as an actively constructed effort at self-regulation than as a deficiency in capacity or primitive, lagging development. They illustrate how a two-systems framework can allow for an expanded repertoire of techniques and reclaim psychoanalytic concepts that have fallen into disuse.
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711
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Tonnsen BL, Grefer ML, Hatton DD, Roberts JE. Developmental trajectories of attentional control in preschool males with fragile X syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:62-71. [PMID: 25462466 PMCID: PMC4397109 DOI: 10.1016/j.ridd.2014.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/22/2014] [Indexed: 05/31/2023]
Abstract
Attention problems are among the most impairing features associated with fragile X syndrome (FXS). However, few studies have examined behavioral development of inhibitory control in very young children with FXS. We examined attentional control in 3-6 year boys with FXS using both an experimental inhibitory control paradigm and parent-report of attention problems. Study 1 examined attentional control in FXS compared to comparison groups matched on chronological and mental age. To determine the stability of impairments over time in FXS, Study 2 examined patterns of developmental change in an expanded longitudinal sample. Across studies, males with FXS demonstrated persistent impairments in inhibitory control and parent-reported attention problems. Inhibitory control was related to, but not solely driven by, lower mental age. Although parent-rated attention problems remained stable across ages, inhibitory control improved with time. Children with more severe attention problems often displayed initially poorer inhibitory control. However, these trajectories also improved more rapidly with age. Our findings indicate that despite persistent deficits in attentional control in young children with FXS, multi-method assessment can be used to capture developmental growth that should be further supported through early, targeted intervention.
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Affiliation(s)
- Bridgette L Tonnsen
- University of South Carolina Department of Psychology, 1512 Pendleton Street, Columbia, SC 29208, USA(1)
| | - Marjorie L Grefer
- University of South Carolina Department of Psychology, 1512 Pendleton Street, Columbia, SC 29208, USA(1)
| | - Deborah D Hatton
- Vanderbilt University Department of Special Education, Peabody College, Nashville, TN 37203, USA(2)
| | - Jane E Roberts
- University of South Carolina Department of Psychology, 1512 Pendleton Street, Columbia, SC 29208, USA(1).
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712
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Inadera H. Neurological Effects of Bisphenol A and its Analogues. Int J Med Sci 2015; 12:926-36. [PMID: 26664253 PMCID: PMC4661290 DOI: 10.7150/ijms.13267] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Abstract
The endocrine disrupting chemical bisphenol A (BPA) is widely used in the production of polycarbonate plastics and epoxy resins. The use of BPA-containing products in daily life makes exposure ubiquitous, and the potential human health risks of this chemical are a major public health concern. Although numerous in vitro and in vivo studies have been published on the effects of BPA on biological systems, there is controversy as to whether ordinary levels of exposure can have adverse effects in humans. However, the increasing incidence of developmental disorders is of concern, and accumulating evidence indicates that BPA has detrimental effects on neurological development. Other bisphenol analogues, used as substitutes for BPA, are also suspected of having a broad range of biological actions. The objective of this review is to summarize our current understanding of the neurobiological effects of BPA and its analogues, and to discuss preventive strategies from a public health perspective.
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Affiliation(s)
- Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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713
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Hamed AM, Kauer AJ, Stevens HE. Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters. Front Psychiatry 2015; 6:168. [PMID: 26635643 PMCID: PMC4659921 DOI: 10.3389/fpsyt.2015.00168] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD is known to negatively impact children, their families, and their community. About one-third to one-half of patients with ADHD will have persistent symptoms into adulthood. The prevalence in the United States is estimated at 5-11%, representing 6.4 million children nationwide. The variability in the prevalence of ADHD worldwide and within the US may be due to the wide range of factors that affect accurate assessment of children and youth. Because of these obstacles to assessment, ADHD is under-diagnosed, misdiagnosed, and undertreated. OBJECTIVES We examined factors associated with making and receiving the diagnosis of ADHD. We sought to review the consequences of a lack of diagnosis and treatment for ADHD on children's and adolescent's lives and how their families and the community may be involved in these consequences. METHODS We reviewed scientific articles looking for factors that impact the identification and diagnosis of ADHD and articles that demonstrate naturalistic outcomes of diagnosis and treatment. The data bases PubMed and Google scholar were searched from the year 1995 to 2015 using the search terms "ADHD, diagnosis, outcomes." We then reviewed abstracts and reference lists within those articles to rule out or rule in these or other articles. RESULTS Multiple factors have significant impact in the identification and diagnosis of ADHD including parents, healthcare providers, teachers, and aspects of the environment. Only a few studies detailed the impact of not diagnosing ADHD, with unclear consequences independent of treatment. A more significant number of studies have examined the impact of untreated ADHD. The experience around receiving a diagnosis described by individuals with ADHD provides some additional insights. CONCLUSION ADHD diagnosis is influenced by perceptions of many different members of a child's community. A lack of clear understanding of ADHD and the importance of its diagnosis and treatment still exists among many members of the community including parents, teachers, and healthcare providers. More basic and clinical research will improve methods of diagnosis and information dissemination. Even before further advancements in science, strong partnerships between clinicians and patients with ADHD may be the best way to reduce the negative impacts of this disorder.
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Affiliation(s)
- Alaa M Hamed
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Aaron J Kauer
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Hanna E Stevens
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA , USA ; Neuroscience Program, Pappajohn Biomedical Institute, University of Iowa , Iowa City, IA , USA
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714
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McMartin SE, Kingsbury M, Dykxhoorn J, Colman I. Time trends in symptoms of mental illness in children and adolescents in Canada. CMAJ 2014; 186:E672-8. [PMID: 25367419 PMCID: PMC4259795 DOI: 10.1503/cmaj.140064] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Existing research and media reports convey conflicting impressions of trends in the prevalence of mental illness. We sought to investigate trends in the prevalence of symptoms of mental illness in a large population-based cohort of Canadian children and adolescents. METHODS We obtained population-based data from the National Longitudinal Survey of Children and Youth. Every 2 years, participants completed self-reported measures of mental illness indicators, including conduct disorder, hyperactivity, indirect aggression, suicidal behaviour, and depression and anxiety. We analyzed trends in mean scores over time using linear regression. RESULTS We evaluated 11 725 participants aged 10-11 years from cycles 1 (1994/95) through 6 (2004/05), 10 574 aged 12-13 years from cycles 2 (1996/97) through 7 (2006/07), and 9835 aged 14-15 years from cycles 3 (1998/99) through 8 (2008/09). The distribution of scores on depression and anxiety, conduct and indirect aggression scales remained stable or showed small decreases over time for participants of all ages. The mean hyperactivity score increased over time in participants aged 10-11 years (change per 2-year cycle: 0.16, 95% CI 0.02 to 0.12) and those aged 12-13 years (0.13, 95% CI 0.09 to 0.18). Over time, fewer participants aged 12-13 years (0.40% per cycle, 95% CI -0.78 to -0.07) and aged 14-15 years (0.56% per cycle, 95% CI -0.91 to -0.23) reported attempting suicide in the previous 12 months. INTERPRETATION With the exception of hyperactivity, the prevalence of symptoms of mental illness in Canadian children and adolescents has remained relatively stable from 1994/95 to 2008/09. Conflicting reports of escalating rates of mental illness in Canada may be explained by differing methodologies between studies, an increase in treatment-seeking behaviour, or changes in diagnostic criteria or practices.
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Affiliation(s)
- Seanna E McMartin
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont
| | - Mila Kingsbury
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont
| | - Jennifer Dykxhoorn
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont
| | - Ian Colman
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
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715
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Hodgkin D, Horgan CM, Quinn AE, Merrick EL, Stewart MT, Leslie LK. Management of newer medications for attention-deficit/hyperactivity disorder in commercial health plans. Clin Ther 2014; 36:2034-2046. [PMID: 25450473 DOI: 10.1016/j.clinthera.2014.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/02/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE In the United States, many individuals with attention-deficit/hyperactivity disorder (ADHD) pay for their medications using private health insurance coverage. As in other drug classes, private insurers are actively seeking to influence use and costs, particularly for newer and costlier medications. The approaches that insurers use may have important effects on patients' access to medications. This article examines approaches (eg, copayments, prior authorization, and step therapy) that commercial health plans are using to manage newer medications used to treat ADHD and changes in approaches since 2003. METHODS Data are from a nationally representative survey of commercial health plans in 60 market areas regarding alcohol, drug abuse, and mental health services in 2010. Responses were obtained from 389 plans (89% response rate), reporting on 925 insurance products. For each of 6 branded ADHD medications, respondents were asked whether the plan covered the medication and, if so, on what copayment tier each medication was placed and whether it was subject to prior authorization or step therapy. Measures of management approach were constructed for each medication and for the group of medications. Bivariate and multivariate analyses were used to test for association of the management approach with various health plan characteristics. FINDINGS There was considerable variation across these 6 medications in how tightly they were managed by health plans, with newer medications being subject to more stringent management. The proportion of insurance products relying solely on copayment tiering to manage new ADHD medications appears to have decreased since 2003. Less than half of insurance products (43%) managed these 6 medications solely by use of tier 3 or 4 placement, and most of the remainder (48%) used other restrictions (with or without tier 3 or 4 placement). The average insurance product restricted access to at least 3 of the 6 brand-only medications examined, whether through copayment tier placement or other approaches. More ADHD medications were left unrestricted in health maintenance organization products than in preferred provider organization ones, products with internal or hybrid-internal contracts for behavioral health, those not contracting with pharmacy benefits managers, and those with for-profit ownership. IMPLICATIONS Many plans have supplemented copayment tiering with other approaches, such as prior authorization and step therapy, to influence use and decrease costs. It may be that plans have found copayments to be less effective in redirecting use in this medication class. The effect on clinical outcomes was not examined in this study but should be prioritized using other data sources.
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Affiliation(s)
- Dominic Hodgkin
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Constance M Horgan
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Amity E Quinn
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Elizabeth L Merrick
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Maureen T Stewart
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Laurel K Leslie
- Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, Massachusetts
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716
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Evans SF, Kobrosly RW, Barrett ES, Thurston SW, Calafat AM, Weiss B, Stahlhut R, Yolton K, Swan SH. Prenatal bisphenol A exposure and maternally reported behavior in boys and girls. Neurotoxicology 2014; 45:91-9. [PMID: 25307304 PMCID: PMC4362616 DOI: 10.1016/j.neuro.2014.10.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/25/2014] [Accepted: 10/01/2014] [Indexed: 12/19/2022]
Abstract
Prenatal exposure to gonadal hormones plays a major role in the normal development of the male and female brain and sexually dimorphic behaviors. Hormone-dependent differences in brain structure and function suggest that exposure to exogenous endocrine disrupting chemicals may be associated with sex-specific alterations in behavior. Bisphenol A (BPA) is an environmental chemical that has been shown to alter estrogen, androgen, and thyroid hormone signaling pathways. Epidemiological and experimental studies suggest associations between prenatal exposure to BPA and child behavior, however data are inconsistent, and few studies have examined school age children. We examined BPA concentration in spot urine samples from women at mean 27 weeks of pregnancy in relation to child behavior assessed at age 6-10 years using the parent-completed Child Behavior Checklist (CBCL). We report associations between maternal BPA urinary concentrations and several CBCL scores in 153 children (77 boys and 76 girls). We observed a significant interaction between maternal urinary BPA and sex for several behaviors (externalizing, aggression, Anxiety Disorder, Oppositional/Defiant Disorder and Conduct Disorder traits), but no significant associations between BPA and scores on any CBCL scales. However in analyses restricted to children of mothers with detectable prenatal urinary BPA (n=125), BPA was associated with moderately increased internalizing and externalizing behaviors, withdrawn/depressed behavior, somatic problems, and Oppositional/Defiant Disorder traits in boys. In addition we observed a significant interaction between BPA and sex for several behaviors (externalizing, withdrawn/depressed, rule-breaking, Oppositional/Defiant Disorder traits, and Conduct Disorder traits). These results suggest that prenatal exposure to BPA may be related to increased behavior problems in school age boys, but not girls.
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Affiliation(s)
- Sarah F Evans
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Roni W Kobrosly
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily S Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Bernard Weiss
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Richard Stahlhut
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kimberly Yolton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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717
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Dunne EM, Hearn LE, Rose JJ, Latimer WW. ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: an accelerated gateway model. Addict Behav 2014; 39:1755-8. [PMID: 25123341 DOI: 10.1016/j.addbeh.2014.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/03/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
The primary aims of the present study were to assess ADHD history as a risk factor for earlier initiation and current use of licit and illicit substances among a sample of drug using adults. It was hypothesized that ADHD history would accelerate the Gateway Theory of drug use. Participants included 941 drug-using African American and Caucasian individuals in Baltimore, Maryland. The sample consisted of 124 (13.2%) participants who reported a history of ADHD and 817 (86.8%) who reported no history of ADHD. The accelerated gateway hypothesis was supported, as a history of self-reported ADHD was significantly associated with younger ages of initiation for alcohol, cigarettes, marijuana, and cocaine use. Participants with a history of ADHD were also more likely to engage in recent HIV-risk behavior, such as injection drug use and needle sharing. This study provides compelling data in support of an accelerated gateway model for substance use related to ADHD history and increased problem severity in adulthood. Targeted substance use prevention and intervention may be beneficial for those with ADHD.
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718
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Polanczyk GV. Identifying the gaps between science, policies, services, and the needs of youths affected by mental disorders. Eur Child Adolesc Psychiatry 2014; 23:1119-21. [PMID: 25416962 DOI: 10.1007/s00787-014-0650-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Guilherme V Polanczyk
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil,
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719
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How do clinicians actually use the Diagnostic and Statistical Manual of Mental Disorders in clinical practice and why we need to know more. J Nerv Ment Dis 2014; 202:841-4. [PMID: 25390931 DOI: 10.1097/nmd.0000000000000210] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The clinical use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is explicitly stated as a goal for both the DSM Fourth Edition and DSM Fifth Edition (DSM-5) revisions. Many uses assume a relatively faithful application of the DSM diagnostic definitions. However, studies demonstrate significant discrepancies between clinical psychiatric diagnoses with those made using structured interviews suggesting that clinicians do not systematically apply the diagnostic criteria. The limited information regarding how clinicians actually use the DSM raises important questions: a) How can the clinical use be improved without first having a baseline assessment? b) How can potentially significant shifts in practice patterns based on wording changes be assessed without knowing the extent to which the criteria are used as written? Given the American Psychiatric Association's plans for interim revisions to the DSM-5, the value of a detailed exploration of its actual use in clinical practice remains a significant ongoing concern and deserves further study including a number of survey and in vivo studies.
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720
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Abstract
Neurological and psychiatric disorders present an immediate and growing challenge. The scale and complexity of this unmet need calls for a concomitantly large and sophisticated response. Here the author discusses just one element of such a response, the power of collaboration, and presents a personal account of how a variety of collaborative structures can advance science.
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Affiliation(s)
- Adrian J Ivinson
- Harvard NeuroDiscovery Center, Harvard Medical School, Boston, MA 02081, USA.
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721
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Jonsson U, Alexanderson K, Kjeldgård L, Mittendorfer-Rutz E. Psychiatric diagnoses and risk of suicidal behaviour in young disability pensioners: prospective cohort studies of all 19-23 year olds in Sweden in 1995, 2000, and 2005, respectively. PLoS One 2014; 9:e111618. [PMID: 25365217 PMCID: PMC4218787 DOI: 10.1371/journal.pone.0111618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 10/04/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Increasing rates of disability pension (DP) have been observed among young adults. We studied specific psychiatric DP diagnoses and subsequent risk of suicidal behaviour in a series of three cohorts of young adult in Sweden. METHOD In a nationwide register study, we included all young adults who in 1995, 2000, and 2005, respectively, were 19-23 years old and lived in Sweden (n≈500,000 per cohort). Rates of DP and specific psychiatric DP diagnoses were recorded in each cohort. Hazard ratios (HRs) and 95% confidence intervals (CIs) for suicidal behaviour during the following five years, with the corresponding age group as reference, were calculated by Cox proportional hazard regression, adjusted for demographic variables and previous own and parental suicidal behaviour. RESULTS The overall proportion with DP in this age group increased from 0.92% in 1995 to 2.29% in 2005, with particularly large increases in psychiatric diagnoses such as hyperkinetic disorders, pervasive developmental disorders, and depression/anxiety. The overall proportion of young disability pensioners attempting suicide during the five-year follow-up increased from 2.21% in the 1995 cohort to 3.81% in the 2005 cohort. Within most psychiatric DP diagnoses, the risk of attempted suicide did not change significantly over time, whereas suicide attempts increased in the reference group. Accordingly, the HRs for suicide attempt decreased in some psychiatric DP diagnoses. The highest adjusted HRs were observed for depression/anxiety (16.41; CI: 9.06 to 29.74) and schizophrenia (9.37; 6.13 to 14.31) in the 1995 cohort. The rate of suicide among young disability pensioners during follow-up ranged from 0.19% in 1995 to 0.37% in 2005, mainly occurring in individuals with psychiatric diagnoses. CONCLUSION Suicidal behaviour has become more prevalent among young disability pensioners, which co-occurred with an increased tendency to grant DP in psychiatric diagnoses with a known high risk of suicidal behaviour. Preventive measures are warranted.
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Affiliation(s)
- Ulf Jonsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Kjeldgård
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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722
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Casey BJ, Durston S. The impact of stimulants on cognition and the brain in attention-deficit/hyperactivity disorder: what does age have to do with it? Biol Psychiatry 2014; 76:596-8. [PMID: 25262230 DOI: 10.1016/j.biopsych.2014.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 08/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- B J Casey
- Sackler Institute for Developmental Psychobiology, Department of Psychiatry, Weill Cornell Medical College, New York, New York.
| | - Sarah Durston
- Rudolf Magnus Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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723
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Shenton ME, Kubicki M, Makris N. Understanding alterations in brain connectivity in attention-deficit/hyperactivity disorder using imaging connectomics. Biol Psychiatry 2014; 76:601-2. [PMID: 25262232 DOI: 10.1016/j.biopsych.2014.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Martha E Shenton
- Departments of Psychiatry, Brigham and Women's Hospital, Boston.; Departments of Radiology, Brigham and Women's Hospital, Boston.; Harvard Medical School, Boston.; Department of Veterans Affairs Boston Healthcare System, Brockton Division, Brockton..
| | - Marek Kubicki
- Departments of Psychiatry, Brigham and Women's Hospital, Boston.; Departments of Radiology, Brigham and Women's Hospital, Boston.; Harvard Medical School, Boston
| | - Nikos Makris
- Departments of Radiology, Brigham and Women's Hospital, Boston.; Harvard Medical School, Boston.; Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, Massachusetts
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724
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DuPaul GJ, Gormley MJ, Laracy SD. School-based interventions for elementary school students with ADHD. Child Adolesc Psychiatr Clin N Am 2014; 23:687-97. [PMID: 25220080 DOI: 10.1016/j.chc.2014.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) experience significant difficulties with behavior, social functioning, and academic performance in elementary school classrooms. Although psychotropic medication may enhance classroom behavior, pharmacologic treatment is rarely sufficient in addressing the many challenges encountered by individuals with ADHD in school settings. This article describes 3 evidence-based strategies including behavioral, academic, and self-regulation interventions. Future directions for research on school-based interventions are discussed.
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Affiliation(s)
- George J DuPaul
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA.
| | - Matthew J Gormley
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA
| | - Seth D Laracy
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA
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725
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Villagomez A, Ramtekkar U. Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder. CHILDREN (BASEL, SWITZERLAND) 2014; 1:261-79. [PMID: 27417479 PMCID: PMC4928738 DOI: 10.3390/children1030261] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/12/2014] [Accepted: 08/21/2014] [Indexed: 12/31/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder increasing in prevalence. Although there is limited evidence to support treating ADHD with mineral/vitamin supplements, research does exist showing that patients with ADHD may have reduced levels of vitamin D, zinc, ferritin, and magnesium. These nutrients have important roles in neurologic function, including involvement in neurotransmitter synthesis. The aim of this paper is to discuss the role of each of these nutrients in the brain, the possible altered levels of these nutrients in patients with ADHD, possible reasons for a differential level in children with ADHD, and safety and effect of supplementation. With this knowledge, clinicians may choose in certain patients at high risk of deficiency, to screen for possible deficiencies of magnesium, vitamin D, zinc, and iron by checking RBC-magnesium, 25-OH vitamin D, serum/plasma zinc, and ferritin. Although children with ADHD may be more likely to have lower levels of vitamin D, zinc, magnesium, and iron, it cannot be stated that these lower levels caused ADHD. However, supplementing areas of deficiency may be a safe and justified intervention.
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Affiliation(s)
- Amelia Villagomez
- University of Arizona, 2800 E. Ajo Way Suite 300, Tucson, AZ 85713, USA.
| | - Ujjwal Ramtekkar
- Mercy Children's Hospital, 621 S. New Ballas Road, Suite 693A, Saint Louis, MO 63141, USA.
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726
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Bowers K, Wink LK, Pottenger A, McDougle CJ, Erickson C. Phenotypic differences in individuals with autism spectrum disorder born preterm and at term gestation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:758-63. [PMID: 25192860 DOI: 10.1177/1362361314547366] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the study was to characterize the phenotype of males and females with autism spectrum disorder born preterm versus those born at term. Descriptive statistical analyses identified differences between male and female autism spectrum disorder subjects born preterm compared to term for several phenotypic characteristics and comorbidities. Of the 115 (13.0% of 883) born preterm, a greater percentage of males had sleep apnea (13.8% vs. 2.5%, p < 0.0001), seizure disorders (17.0% vs. 8.5%, p = 0.01), and attention-deficit/hyperactivity disorder (14.9% vs. 6.6%, p = 0.005). Females born preterm were more likely to be nonverbal (22.2% vs. 4.6%, p = 0.001). In summary, phenotypic differences were observed, especially among males. The results may have implications for understanding the underpinnings of a subset of individuals with autism spectrum disorder and contribute to the development of focused treatments for autism spectrum disorder among children born preterm.
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Affiliation(s)
| | - Logan K Wink
- Cincinnati Children's Hospital Medical Center, USA
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727
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Yang X, Morris SM, Gearhart JM, Ruark CD, Paule MG, Slikker W, Mattison DR, Vitiello B, Twaddle NC, Doerge DR, Young JF, Fisher JW. Development of a physiologically based model to describe the pharmacokinetics of methylphenidate in juvenile and adult humans and nonhuman primates. PLoS One 2014; 9:e106101. [PMID: 25184666 PMCID: PMC4153582 DOI: 10.1371/journal.pone.0106101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
The widespread usage of methylphenidate (MPH) in the pediatric population has received considerable attention due to its potential effect on child development. For the first time a physiologically based pharmacokinetic (PBPK) model has been developed in juvenile and adult humans and nonhuman primates to quantitatively evaluate species- and age-dependent enantiomer specific pharmacokinetics of MPH and its primary metabolite ritalinic acid. The PBPK model was first calibrated in adult humans using in vitro enzyme kinetic data of MPH enantiomers, together with plasma and urine pharmacokinetic data with MPH in adult humans. Metabolism of MPH in the small intestine was assumed to account for the low oral bioavailability of MPH. Due to lack of information, model development for children and juvenile and adult nonhuman primates primarily relied on intra- and interspecies extrapolation using allometric scaling. The juvenile monkeys appear to metabolize MPH more rapidly than adult monkeys and humans, both adults and children. Model prediction performance is comparable between juvenile monkeys and children, with average root mean squared error values of 4.1 and 2.1, providing scientific basis for interspecies extrapolation of toxicity findings. Model estimated human equivalent doses in children that achieve similar internal dose metrics to those associated with pubertal delays in juvenile monkeys were found to be close to the therapeutic doses of MPH used in pediatric patients. This computational analysis suggests that continued pharmacovigilance assessment is prudent for the safe use of MPH.
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Affiliation(s)
- Xiaoxia Yang
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
- * E-mail:
| | - Suzanne M. Morris
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
| | - Jeffery M. Gearhart
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Wright-Patterson Air Force Base, Ohio, United States of America
| | - Christopher D. Ruark
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Wright-Patterson Air Force Base, Ohio, United States of America
| | - Merle G. Paule
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
| | - William Slikker
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
| | - Donald R. Mattison
- Risk Sciences International, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Benedetto Vitiello
- National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Nathan C. Twaddle
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
| | - Daniel R. Doerge
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
| | - John F. Young
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
| | - Jeffrey W. Fisher
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, United States of America
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728
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Ramasamy R, Dadhich P, Dhingra A, Lipshultz L. Case Report: Testicular failure possibly associated with chronic use of methylphenidate. F1000Res 2014; 3:207. [PMID: 25383187 PMCID: PMC4215747 DOI: 10.12688/f1000research.5163.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/25/2022] Open
Abstract
Methylphenidate is a commonly prescribed treatment for attention deficit hyperactivity disorder (ADHD). However, little is known about its adverse effects on the male reproductive system. We report a 20-year-old male patient whose chief complaint was of delayed puberty. He spoke in a high-pitched voice and complained of lack of body hair, impaired libido, inadequate erectile function, chronic fatigue, and low energy. He had been treated with methylphenidate as an infant and had continued treatment for 17 years. On examination, the patient was lean and visibly lacked facial or body hair. He further explained that he had never been able to grow underarm or facial hair and that he was often mistakenly considered a young teenager rather than a 20-year-old. The patient’s genitalia were categorized as Tanner Stage 2. Laboratory studies confirmed low serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels. The patient was given exogenous testosterone supplementation with pellets and human chorionic gonadotropin to maintain testicular size. After 4 months his symptoms improved and he demonstrated signs of puberty. Our goal is to further elucidate the possible impact of methylphenidate on the male reproductive system.
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Affiliation(s)
- Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Pranav Dadhich
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ashna Dhingra
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Larry Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
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729
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Cardiovascular Effects of Methylphenidate, Amphetamines and Atomoxetine in the Treatment of Attention-Deficit Hyperactivity Disorder: An Update. Drug Saf 2014; 37:661-76. [DOI: 10.1007/s40264-014-0201-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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730
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Kollins SH, Schoenfelder EN, English JS, Holdaway A, Van Voorhees E, O'Brien BR, Dew R, Chrisman AK. An exploratory study of the combined effects of orally administered methylphenidate and delta-9-tetrahydrocannabinol (THC) on cardiovascular function, subjective effects, and performance in healthy adults. J Subst Abuse Treat 2014; 48:96-103. [PMID: 25175495 DOI: 10.1016/j.jsat.2014.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/22/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023]
Abstract
Methylphenidate (MPH) is commonly prescribed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD), and is often used illicitly by young adults. Illicit users often coadminister MPH with marijuana. Little is known about physiologic and subjective effects of these substances used in combination. In this double-blind, cross-over experiment, sixteen healthy adult subjects free from psychiatric illness (including ADHD) and reporting modest levels of marijuana use participated in 6 experimental sessions wherein all combinations of placebo or 10mg oral doses of delta-9-tetrahydocannibinol (THC); and 0mg, 10mg and 40 mg of MPH were administered. Sessions were separated by at least 48 hours. Vital signs, subjective effects, and performance measure were collected. THC and MPH showed additive effects on heart rate and rate pressure product (e.g., peak heart rate for 10mg THC+0mg, 10mg, and 40 mg MPH=89.1, 95.9, 102.0 beats/min, respectively). Main effects of THC and MPH were also observed on a range of subjective measures of drug effects, and significant THC dose × MPH dose interactions were found on measures of "Feel Drug," "Good Effects," and "Take Drug Again." THC increased commission errors on a continuous performance test (CPT) and MPH reduced reaction time variability on this measure. Effects of THC, MPH, and their combination were variable on a measure of working memory (n-back task), though in general, MPH decreased reaction times and THC mitigated these effects. These results suggest that the combination of low to moderate doses of MPH and THC produces unique effects on cardiovascular function, subjective effects and performance measures.
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Affiliation(s)
- Scott H Kollins
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC.
| | | | - Joseph S English
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC
| | - Alex Holdaway
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC
| | | | - Benjamin R O'Brien
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC
| | - Rachel Dew
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC
| | - Allan K Chrisman
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC
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731
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Jago BJ. My sleep fest: an autoethnographic short story. HEALTH COMMUNICATION 2014; 30:96-99. [PMID: 25072670 DOI: 10.1080/10410236.2014.891453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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732
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Bourgeois FT, Kim JM, Mandl KD. Premarket safety and efficacy studies for ADHD medications in children. PLoS One 2014; 9:e102249. [PMID: 25007171 PMCID: PMC4090185 DOI: 10.1371/journal.pone.0102249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/16/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a chronic condition and pharmacotherapy is the mainstay of treatment, with a variety of ADHD medications available to patients. However, it is unclear to what extent the long-term safety and efficacy of ADHD drugs have been evaluated prior to their market authorization. We aimed to quantify the number of participants studied and their length of exposure in ADHD drug trials prior to marketing. METHODS We identified all ADHD medications approved by the Food and Drug Administration (FDA) and extracted data on clinical trials performed by the sponsor and used by the FDA to evaluate the drug's clinical efficacy and safety. For each ADHD medication, we measured the total number of participants studied and the length of participant exposure and identified any FDA requests for post-marketing trials. RESULTS A total of 32 clinical trials were conducted for the approval of 20 ADHD drugs. The median number of participants studied per drug was 75 (IQR 0, 419). Eleven drugs (55%) were approved after <100 participants were studied and 14 (70%) after <300 participants. The median trial length prior to approval was 4 weeks (IQR 2, 9), with 5 (38%) drugs approved after participants were studied <4 weeks and 10 (77%) after <6 months. Six drugs were approved with requests for specific additional post-marketing trials, of which 2 were performed. CONCLUSIONS Clinical trials conducted for the approval of many ADHD drugs have not been designed to assess rare adverse events or long-term safety and efficacy. While post-marketing studies can fill in some of the gaps, better assurance is needed that the proper trials are conducted either before or after a new medication is approved.
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Affiliation(s)
- Florence T. Bourgeois
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Boston, Massachusetts, United States of America
- Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Jeong Min Kim
- Faculty of Arts and Sciences, Wellesley College, Wellesley, Massachusetts, United States of America
| | - Kenneth D. Mandl
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Boston, Massachusetts, United States of America
- Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School Center for Biomedical Informatics, Boston, Massachusetts, United States of America
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733
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Lee WJ, Lee TA, Pickard AS, Caskey RN, Schumock GT. Drugs Associated with Adverse Events in Children and Adolescents. Pharmacotherapy 2014; 34:918-26. [DOI: 10.1002/phar.1455] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - A. Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Rachel N. Caskey
- Internal Medicine and Pediatrics; College of Medicine; University of Illinois at Chicago; Chicago Illinois
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
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734
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Identificación por padres y maestros de síntomas del trastorno por déficit de atención con hiperactividad. ACTA COLOMBIANA DE PSICOLOGIA 2014. [DOI: 10.14718/acp.2014.17.2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Con el fin de contribuir a la investigación epidemiológica del Trastorno por Déficit de Atención con Hiperactividad–TDAH se analizaron las semejanzas y diferencias en los cuestionarios contestados por padres y maestros para la identificación de síntomas del TDAH en niños que acuden a consulta psicológica al Hospital Civil Fray Antonio Alcalde en Guadalajara, México. Padres y maestros de 168 niños (46 niñas, 122 niños, edad promedio de 8.2 años) contestaron respectivamente un cuestionario de 18 preguntas, estructurado a partir de los criterios diagnósticos para el TDAH propuestos en el DSM-IV. Como resultados, el análisis estadístico arrojó una concordancia moderada entre padres y maestros, observando diferencias significativas (p < 0.05) en 6 de los 18 reactivos. Los criterios concordantes se refieren, en su mayoría, a síntomas de desatención, mientras que las diferencias observadas tienen que ver con conductas asociadas a hiperactividad e impulsividad, con puntuaciones más altas otorgadas por parte de los padres. También se observó que al analizar en forma separada a niños y niñas no se encuentran diferencias significativas en la mayoría de las puntuaciones otorgadas a las niñas, mientras que las discrepancias son observadas principalmente en los puntajes otorgados a los niños, tanto de los primeros como de los últimos grados escolares, con mayores puntuaciones asignadas por los padres de familia. Se concluye que, efectivamente, tanto padres como maestros dan diferente significación a la conducta de los menores, dependiendo de su edad y su género, principalmente por su capacidad de control atencional y de su actividad motora, tanto en casa, como en la escuela.
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735
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Batstra L, Nieweg EH, Hadders-Algra M. Exploring five common assumptions on Attention Deficit Hyperactivity Disorder. Acta Paediatr 2014; 103:696-700. [PMID: 24661108 DOI: 10.1111/apa.12642] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/20/2014] [Accepted: 03/20/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) and treated with medication is steadily increasing. The aim of this paper was to critically discuss five debatable assumptions on ADHD that may explain these trends to some extent. These are that ADHD (i) causes deviant behaviour, (ii) is a disease, (iii) is chronic and (iv) is best treated by medication and (v) that classification should precede treatment. CONCLUSION We argue that ADHD is not a disease, not the cause of deviant behaviour and in most cases not chronic. Treatment for attention and hyperactivity problems could start with psychosocial interventions and without a diagnostic label. A stepped diagnosis approach may reduce overdiagnosis without risking undertreatment.
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Affiliation(s)
- Laura Batstra
- Department of Special Needs Education and Child Care; University of Groningen; Groningen the Netherlands
| | - Edo H. Nieweg
- Jonx Department of Child and Adolescent Mental Health; Lentis Psychiatric Institute; Groningen the Netherlands
| | - Mijna Hadders-Algra
- Department of Paediatrics - Developmental Neurology; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
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736
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Mattfeld AT, Gabrieli JDE, Biederman J, Spencer T, Brown A, Kotte A, Kagan E, Whitfield-Gabrieli S. Brain differences between persistent and remitted attention deficit hyperactivity disorder. Brain 2014; 137:2423-8. [DOI: 10.1093/brain/awu137] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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737
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Campbell L, Allan C. The ADHD Clinic: a collaborative model of care. MISSOURI MEDICINE 2014; 111:199-201. [PMID: 25011340 PMCID: PMC6179555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hyperactivity Disorder (ADHD) is a common chronic and often life-persistent neurobehavioral disorder. At Children's Mercy Hospital, collaboration between a developmental-behavioral pediatrician and a behavioral psychologist, both of whom specialize in ADHD, allows the use of both medication and behavior modification which are recommended by the American Academy of Pediatrics and which are equally effective as stand-alone therapies. Children who receive both of these treatment modalities also fare better than those who receive only medication in a number of areas. This article will describe our collaborative clinic model and will address considerations of parent preference about these therapeutic approaches.
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738
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Graf WD, Miller G, Nagel SK. Addressing the problem of ADHD medication as neuroenhancements. Expert Rev Neurother 2014; 14:569-81. [PMID: 24738763 DOI: 10.1586/14737175.2014.908707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The prevalence of attention deficit hyperactivity disorder (ADHD) diagnoses is rising. ADHD is closely linked to its treatment with medications such as methylphenidate and amphetamines, which have popular appeal as neuroenhancement drugs by persons without a neurological disorder. The three main reasons for the increase in ADHD medication demand, production, and consumption are a) the inclusion of milder ADHD diagnoses; b) the vast marketing of ADHD medications by the pharmaceutical industry; and c) the illegal diversion of controlled ADHD medication to consumers seeking stimulants as neuroenhancements. Rapidly rising rates of any neurological disorder - especially a behaviorly-defined disorder closely linked to potent medications currently prescribed to more than 5% of the population - deserves ongoing scrutiny. Major social and ethical problems arise from vague-symptom medicalization, neurological disorder trivialization, medication overuse, and controlled substances diversion to healthy persons for nonmedical purposes. We argue against the 'spectrumization' of ADHD in an effort to curtail further diagnosis creep.
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Affiliation(s)
- William D Graf
- Departments of Pediatrics and Neurology, Yale University, PO Box 208064, 333 Cedar Street, New Haven, CT 06510, USA
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739
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Lee KM, Olenchak FR. Individuals with a gifted/attention deficit/hyperactivity disorder diagnosis. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/0261429414530712] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper reviews the current literature on twice-exceptional students who are dual diagnosed as having giftedness and attention deficit/hyperactivity disorder (ADHD). This area of research is warranted because giftedness and ADHD present similarly but have different ramifications for performance and outcomes. In addition, research inquiry and intervention can ease the frustration of those individuals who have both of these strengths and weaknesses. Giftedness and ADHD are examined in terms of identification of individual and dual diagnoses; performance of gifted students with ADHD, including underachievement and creativity; psychosocial outcomes; and interventions for students with giftedness/ADHD. Gaps in the literature and future directions are discussed.
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740
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Sibley MH, Kuriyan AB, Evans SW, Waxmonsky JG, Smith BH. Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature. Clin Psychol Rev 2014; 34:218-32. [PMID: 24632046 DOI: 10.1016/j.cpr.2014.02.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 01/08/2014] [Accepted: 02/13/2014] [Indexed: 01/19/2023]
Abstract
Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.
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Affiliation(s)
| | | | | | - James G Waxmonsky
- Pennsylvania State University Milton Hershey Medical Center, Hershey, PA, USA
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741
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ADHD and "eye problems". J AAPOS 2014; 18:2-3. [PMID: 24568973 DOI: 10.1016/j.jaapos.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
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742
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Walkup JT, Stossel L, Rendleman R. Beyond rising rates: personalized medicine and public health approaches to the diagnosis and treatment of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2014; 53:14-6. [PMID: 24342381 DOI: 10.1016/j.jaac.2013.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
| | - Lauren Stossel
- New York-Presbyterian Hospital and Weill Cornell Medical Center
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