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Spencer T, Noyes E, Biederman J. Telemedicine in the Management of ADHD: Literature Review of Telemedicine in ADHD. J Atten Disord 2020; 24:3-9. [PMID: 31257978 DOI: 10.1177/1087054719859081] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Telemedicine has been used successfully in several medical specialties with favorable patient outcomes, satisfaction, in a cost-effective manner. However, its use in the context of ADHD remains unclear. Our main aim was to investigate what is known about the use of telemedicine in ADHD. Method: We conducted a systematic search of the literature assessing telemedicine in ADHD in PubMed, PsycINFO, and Medline. Included were original articles published in English with the main aim to assess the use of telemedicine in ADHD. Results: Only 11 articles met our inclusion and exclusion criteria, coming from only three systematic trials of telemedicine in ADHD. The studies suggest that telemedicine is valued by its users, is well accepted, and is associated with improved outcomes. Conclusion: The limited research indicates that telemedicine has potential to expand the delivery of clinical services to patients with ADHD. More work is needed to further evaluate this finding.
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Affiliation(s)
- Thomas Spencer
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Joseph Biederman
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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52
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Insa Pineda I, Huguet Miguel A, Chamorro Fernández M, Espadas Tejerina M, González CLG, Alda JA. ADHD Symptoms, Academic and Social Difficulties in Parents of Children with ADHD. Psychiatry 2020; 83:231-243. [PMID: 32729785 DOI: 10.1080/00332747.2020.1762395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To evaluate the prevalence of ADHD in a group of parents of children with ADHD compared with the general population. To compare academic level, unemployment aid rate and marital separations/divorce of this parents sample. Methodology: The experimental group was formed by the parents of 60 children with ADHD. The control group was formed by the parents of 60 healthy children. To assess the retrospective and current ADHD symptomatology among the parents of the sample the Wender Utah Rating Scale (WURS) and the Attention Deficit Hyperactivity Disorder-rating scale (ADHD.rs) were used. Also, the Hollingshead Four-Factor Index of Socioeconomic status (SES-Child) was used. Results: 20.33% of the mothers in the case group met criteria for a retrospective diagnosis of ADHD, while none of the control group mothers met criteria (p < .01). Regarding fathers, there was a retrospective ADHD diagnosis in 25% of the case group compared to 10% in the control group (p < .01). In terms of the current symptoms, 25.42% of the mothers and 21.43% of fathers in the case group met diagnostic criteria for probable ADHD compared to 1.67% in the control group (p < .01 in both genders). Parents in the case group had a lower academic level (p < .01), received more unemployment aid (p = .02) and reported a higher rate of marital separation or divorce (p = .02). Conclusions: Parents of children with ADHD have a higher incidence of retrospective and current ADHD diagnosis and they also present worse socioeconomic factors.
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Buadze A, Friedl N, Schleifer R, Young S, Schneeberger A, Liebrenz M. Perceptions and Attitudes of Correctional Staff Toward ADHD-A Challenging Disorder in Everyday Prison Life. Front Psychiatry 2020; 11:600005. [PMID: 33633596 PMCID: PMC7901975 DOI: 10.3389/fpsyt.2020.600005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.
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Affiliation(s)
- Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nadine Friedl
- Hospital of Psychiatry Münsingen, Münsingen, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavík, Iceland
| | - Andres Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Psychiatrische Dienste Graubuenden, Chur, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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54
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Salla J, Galéra C, Guichard E, Tzourio C, Michel G. ADHD Symptomatology and Perceived Stress Among French College Students. J Atten Disord 2019; 23:1711-1718. [PMID: 28103763 DOI: 10.1177/1087054716685841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study was to examine the independent association between inattention and hyperactivity/impulsivity symptoms and perceived stress among French college students. Method: Participants (N = 6,951) completed self-report surveys assessing ADHD symptoms, perceived stress, and sociodemographic characteristics. Multinomial logistic regression models were used to evaluate the association between ADHD symptoms and perceived stress. Results: Participants had a mean age of 20.8 years, and 75.6% were female. We found significant associations between increasing levels of inattention and hyperactivity/impulsivity symptoms and high level of perceived stress after adjustment for confounding variables. The association was stronger for inattention (odds ratio [OR] = 4.58, 95% confidence interval [CI] = [4.02, 5.22]) than for hyperactivity/impulsivity symptoms (OR = 1.21, 95% CI = [1.05 to 1.39]). Conclusion: Higher levels of inattention and hyperactivity/impulsivity were independently associated with perceived stress in French college students. This association was mainly driven by inattention. Screenings to better detect ADHD symptoms should be implemented in universities.
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Affiliation(s)
| | | | | | - Christophe Tzourio
- University of Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, France
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55
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Andrillon T, Windt J, Silk T, Drummond SPA, Bellgrove MA, Tsuchiya N. Does the Mind Wander When the Brain Takes a Break? Local Sleep in Wakefulness, Attentional Lapses and Mind-Wandering. Front Neurosci 2019; 13:949. [PMID: 31572112 PMCID: PMC6753166 DOI: 10.3389/fnins.2019.00949] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/22/2019] [Indexed: 01/18/2023] Open
Abstract
Sleep has been classically described as an all-or-nothing global phenomenon. However, recent research strongly suggests that this view requires tempering. Invasive and non-invasive recordings in animals and humans show that neural activity typically associated with sleep can locally occur during wakefulness. Although local sleep is defined neuronally, it has been associated with impaired performance during cognitive tasks. Comparatively, the phenomenology of local sleep (i.e., what it feels like when your brain is partially asleep) has been less explored. Taking into account the literature on the neuronal and behavioral profile of local sleep intrusions in wakefulness, we propose that occurrences of local sleep could represent the neural mechanism underlying many attentional lapses. In particular, we argue that a unique physiological event such as local sleep could account for a diversity of behavioral outcomes from sluggish to impulsive responses. We further propose that local sleep intrusions could impact individuals' subjective experience. Specifically, we propose that the timing and anatomical sources of local sleep intrusions could be responsible for both the behavioral consequences and subjective content of attentional lapses and may underlie the difference between subjective experiences such as mind wandering and mind blanking. Our framework aims to build a parallel between spontaneous experiences in sleep and wakefulness by integrating evidence across neuronal, behavioral and experiential levels. We use the example of attention deficit hyperactivity disorder (ADHD) to illustrate how local sleep could explain complex cognitive profiles which include inattention, impulsivity, mind-wandering and mind-blanking.
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Affiliation(s)
- Thomas Andrillon
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Jennifer Windt
- School of Philosophical, Historical and International Studies, Monash University, Melbourne, VIC, Australia
| | - Tim Silk
- School of Psychology, Deakin University, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sean P. A. Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Mark A. Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Naotsugu Tsuchiya
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
- Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology (NICT), Osaka, Japan
- Advanced Telecommunications Research Computational Neuroscience Laboratories, Kyoto, Japan
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56
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Estévez-Lamorte N, Foster S, Eich-Höchli D, Moggi F, Gmel G, Mohler-Kuo M. Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men. Eur Arch Psychiatry Clin Neurosci 2019; 269:667-679. [PMID: 30483874 DOI: 10.1007/s00406-018-0958-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals.
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Affiliation(s)
- Natalia Estévez-Lamorte
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland. .,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland. .,Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland. .,Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland.
| | - Simon Foster
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.,Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | | | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of the West of England, Frenchay Campus Coldharbour Lane, Bristol, UK
| | - Meichun Mohler-Kuo
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.,Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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57
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Micoulaud-Franchi JA, Lopez R, Cermolacce M, Vaillant F, Péri P, Boyer L, Richieri R, Bioulac S, Sagaspe P, Philip P, Vion-Dury J, Lancon C. Sensory Gating Capacity and Attentional Function in Adults With ADHD: A Preliminary Neurophysiological and Neuropsychological Study. J Atten Disord 2019; 23:1199-1209. [PMID: 26896149 DOI: 10.1177/1087054716629716] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The inability to filter sensory input correctly may impair higher cognitive function in ADHD. However, this relationship remains largely elusive. The objectives of the present study is to investigate the relationship between sensory input processing and cognitive function in adult patients with ADHD. Method: This study investigated the relationship between deficit in sensory gating capacity (P50 amplitude changes in a double-click conditioning-testing paradigm and perceptual abnormalities related to sensory gating deficit with the Sensory Gating Inventory [SGI]) and attentional and executive function (P300 amplitude in an oddball paradigm and attentional and executive performances with a neuropsychological test) in 24 adult patients with ADHD. Results: The lower the sensory gating capacity of the brain and the higher the distractibility related to sensory gating inability that the patients reported, the lower the P300 amplitude. Conclusion: The capacity of the brain to gate the response to irrelevant incoming sensory input may be a fundamental protective mechanism that prevents the flooding of higher brain structures with irrelevant information in adult patients with ADHD.
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Affiliation(s)
| | - Régis Lopez
- 3 Unités des troubles du sommeil, Hôpital Gui-de-Chauliac Montpellier, France.,4 Inserm U1061, Montpellier, France
| | - Michel Cermolacce
- 5 Département de Psychiatrie, CHU de Marseille, France.,6 UMR CNRS 729 / Aix-Marseille Université, Marseille, France
| | | | - Pauline Péri
- 5 Département de Psychiatrie, CHU de Marseille, France
| | - Laurent Boyer
- 5 Département de Psychiatrie, CHU de Marseille, France.,7 EA 3279 / Aix-Marseille Université, Marseille, France
| | - Raphaëlle Richieri
- 5 Département de Psychiatrie, CHU de Marseille, France.,7 EA 3279 / Aix-Marseille Université, Marseille, France
| | - Stéphanie Bioulac
- 2 USR CNRS 3113 SANPSY / Université de Bordeaux, France.,8 Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France
| | | | - Pierre Philip
- 1 Clinique du sommeil, CHU de Bordeaux, France.,2 USR CNRS 3113 SANPSY / Université de Bordeaux, France
| | - Jean Vion-Dury
- 5 Département de Psychiatrie, CHU de Marseille, France.,6 UMR CNRS 729 / Aix-Marseille Université, Marseille, France
| | - Christophe Lancon
- 5 Département de Psychiatrie, CHU de Marseille, France.,7 EA 3279 / Aix-Marseille Université, Marseille, France
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58
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Faraone SV, Silverstein MJ, Antshel K, Biederman J, Goodman DW, Mason O, Nierenberg AA, Rostain A, Stein MA, Adler LA. The Adult ADHD Quality Measures Initiative. J Atten Disord 2019; 23:1063-1078. [PMID: 30511593 DOI: 10.1177/1087054718804354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Quality measures (QMs; also known as Quality Indicators) quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are relevant to the provision of high-quality health care. We describe the first phase of a project that has as its ultimate goal the creation and validation of QMs for tracking the screening, diagnosis, treatment, and clinical follow-up of adults with ADHD. This will fill an important gap in the field of Adult ADHD because QMs for adult ADHD do not exist. Method: We followed the guidelines of the U.S. Agency for Healthcare Research and Quality (AHRQ) for the development of QMs. These guidelines call for two phases: (1) Identify Candidate QMs and (2) Assess Candidate QMs. This article describes the results of our Phase 1 activities. To generate QMs for adult ADHD, we took the following steps: (a) searched the clinical/research literature for adult ADHD QMs; (b) convened a multidisciplinary panel comprising clinical and research experts and had them brainstorm potential QMs in the areas of screening, diagnosis, treatment, follow-up, care coordination, and patient experience; (c) compared these QMs with existing guidelines for adult ADHD to see if any potential QMs had been missed, this led to a draft list of 46 QMs; (d) had 28 ADHD experts rate the importance, reliability, validity, feasibility, and usability of the QMs. Results: The literature review found several QMs for ADHD in youth but none for ADHD in adults. The brainstorming session generated 52 QMs. The survey showed that all of these QMs were highly rated but that there was sufficient variability in ratings to prioritize some QMs over others. Conclusion: Based on these results, we prioritized QMs to carry forward into the next phase of the project. This work fills an important gap for the clinical care of adult patients with ADHD and helps to set a precedent for mental health, which has lagged behind other areas of medicine in developing QMs.
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Affiliation(s)
- Stephen V Faraone
- 1 State University of New York Upstate Medical University, Syracuse, NY, USA
| | | | | | - Joseph Biederman
- 4 Massachusetts General Hospital, Boston, MA, USA.,5 Harvard Medical School, Boston, MA, USA
| | | | - Oren Mason
- 7 Michigan State University, East Lansing, USA
| | - Andrew A Nierenberg
- 4 Massachusetts General Hospital, Boston, MA, USA.,5 Harvard Medical School, Boston, MA, USA
| | - Anthony Rostain
- 8 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.,9 University of Washington, Seattle, USA
| | | | - Lenard A Adler
- 10 New York University School of Medicine, New York City, USA
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Hamed SA, Attiah FA. Psychosis in adults with epilepsy and its relationship to demographic, clinical and treatment variables. Neurol Res 2019; 41:959-966. [PMID: 31280704 DOI: 10.1080/01616412.2019.1638017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives: Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors. Methods: The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging. Results: IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42.47% had frontal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic and 7.53% had generalized tonic-clonic seizures. Compared to patients without psychosis, patients with psychosis were older at age of examination, had earlier age at onset, frequent seizures, longer duration of epilepsy and long-term antiepileptic drugs therapy and many relatives with epilepsy. Nearly 76.71% had history of postictal psychosis (PIP). The mean age of onset of IIP was 30.45 years and its mean duration was 3.84 months. Approximately 22% of patients with IIP had family history of psychosis. Patients developed IIP 10 years or more after epilepsy onset. Multivariate logistic regression analyses showed that predictors for IIP were the age at onset and duration of epilepsy, number of seizures, family history of epilepsy or psychosis, history of PIP and different types of epilepsy. Conclusion: IIP is not infrequent with chronic epilepsy regardless to its type. These findings emphasize the importance of optimizing patients' treatment and early recognition and management of IIP. Abbreviations: IIP: interictal psychosis; PIP: post-ictal psychosis; TLE: temporal lobe epilepsy; FLE: frontal lobe epilepsy; GTC: generalized tonic clonic; AEDs: antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; LEV: levetiracetam; APDs: antipsychotic drugs.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
| | - Fadia Ahmed Attiah
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
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60
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Quintero J, Morales I, Vera R, Zuluaga P, Fernández A. The Impact of Adult ADHD in the Quality of Life Profile. J Atten Disord 2019; 23:1007-1016. [PMID: 28974134 DOI: 10.1177/1087054717733046] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In this multicenter, cross-sectional study, we aimed to investigate the quality of life (QoL) and the neuropsychological and clinical characteristics of adults with ADHD with different developmental pathways. METHOD Our study sample included 25 control (healthy) participants, 31 patients with newly diagnosed ADHD without comorbidities (ADHD-C-D), 31 with newly diagnosed ADHD with comorbidities (ADHD+C-D), and 29 with previously diagnosed ADHD with comorbidities (ADHD+C+D). RESULTS Compared with controls, ADHDs had little differences in the attentional performance but showed higher impulsivity, more severe symptoms of depression and anxiety, and lower QoL. The ADHD+C-D group showed more severe symptoms of depression and anxiety than the ADHD+C+D group ( p = .037 and p = .008, respectively), and poorer QoL in the psychological health sphere ( p = .003). CONCLUSION Differences between ADHD and control subjects were particularly remarkable in mood symptoms and QoL. Previous diagnosis might have a positive impact on mood symptoms and QoL in ADHD adults.
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Affiliation(s)
- Javier Quintero
- 1 Hospital Universitario Infanta Leonor, Madrid, Spain.,2 Complutense University of Madrid, Spain
| | | | - Rosa Vera
- 2 Complutense University of Madrid, Spain
| | | | - Alberto Fernández
- 2 Complutense University of Madrid, Spain.,4 Technical University of Madrid, Spain
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61
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Barranco-Ruiz Y, Etxabe BE, Ramírez-Vélez R, Villa-González E. Interventions Based on Mind-Body Therapies for the Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in Youth: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E325. [PMID: 31262094 PMCID: PMC6680862 DOI: 10.3390/medicina55070325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 12/24/2022]
Abstract
Background and objectives: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and adolescents. Mind-body therapies (MBTs) seem to be effective for improving health in different populations; however, whether a positive effect occurs in children and adolescents with ADHD is still controversial. The main aim of this systematic review was to analyse the interventions based on MBT aimed to improve the main ADHD symptoms in children and adolescents. Materials and Methods: A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify MBT studies on children and adolescents (4-18 years) with a clinical diagnosis of ADHD. Study quality was evaluated by the NIH quality tool (U.S. National Institute of Health). Results: There were positive results in eleven out of twelve included studies regarding the effect of the MBT interventions on ADHD symptoms. With respect to ADHD symptoms, we observed differences across studies. In relation to the studies' quality, eleven studies were rated "poor" and one was rated as "fair". Conclusions: MBTs, such as yoga or mindfulness, could be positive strategies to mitigate ADHD symptoms in children and adolescents. However, further research with high-quality designs, with randomization, greater sample sizes, and more intensive supervised practice programs are needed.
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Affiliation(s)
- Yaira Barranco-Ruiz
- Department of Physical and Sports Education, PROFITH "PROmoting FITness and Health through physical activity" Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla, Spain
| | - Bingen Esturo Etxabe
- Department of Physical and Sports Education, PROFITH "PROmoting FITness and Health through physical activity" Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla, Spain
| | - Robinson Ramírez-Vélez
- Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospitalario de Navarra (CHN), 31008 Pamplona, Spain
| | - Emilio Villa-González
- Department of Physical and Sports Education, PROFITH "PROmoting FITness and Health through physical activity" Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla, Spain.
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62
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Storebø OJ, Elmose Andersen M, Skoog M, Joost Hansen S, Simonsen E, Pedersen N, Tendal B, Callesen HE, Faltinsen E, Gluud C. Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2019; 6:CD008223. [PMID: 31222721 PMCID: PMC6587063 DOI: 10.1002/14651858.cd008223.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) in children is associated with hyperactivity and impulsivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate the symptoms of ADHD but this rarely solves difficulties with social interactions. Children with ADHD may benefit from interventions designed to improve their social skills. We examined the benefits and harms of social skills training on social skills, emotional competencies, general behaviour, ADHD symptoms, performance in school of children with ADHD, and adverse events. OBJECTIVES To assess the beneficial and harmful effects of social skills training in children and adolescents with ADHD. SEARCH METHODS In July 2018, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 4 other databases and two trials registers.We also searched online conference abstracts, and contacted experts in the field for information about unpublished or ongoing randomised clinical trials. We did not limit our searches by language, year of publication, or type or status of publication, and we sought translation of the relevant sections of non-English language articles. SELECTION CRITERIA Randomised clinical trials investigating social skills training versus either no intervention or waiting-list control, with or without pharmacological treatment of both comparison groups of children and adolescents with ADHD. DATA COLLECTION AND ANALYSIS We conducted the review in accordance with the Cochrane Handbook for Systematic Reviews of Intervention. We performed the analyses using Review Manager 5 software and Trial Sequential Analysis. We assessed bias according to domains for systematic errors. We assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 25 randomised clinical trials described in 45 reports. The trials included a total of 2690 participants aged between five and 17 years. In 17 trials, participants were also diagnosed with various comorbidities.The social skills interventions were described as: 1) social skills training, 2) cognitive behavioural therapy, 3) multimodal behavioural/psychosocial therapy, 4) child life and attention skills treatment, 5) life skills training, 6) the "challenging horizon programme", 7) verbal self-instruction, 8) meta-cognitive training, 9) behavioural therapy, 10) behavioural and social skills treatment, and 11) psychosocial treatment. The control interventions were no intervention or waiting list.The duration of the interventions ranged from five weeks to two years. We considered the content of the social skills interventions to be comparable and based on a cognitive-behavioural model. Most of the trials compared child social skills training or parent training combined with medication versus medication alone. Some of the experimental interventions also included teacher consultations.More than half of the trials were at high risk of bias for generation of the allocation sequence and allocation concealment. No trial reported on blinding of participants and personnel. Most of the trials did not report on differences between groups in medication for comorbid disorders. We used all eligible trials in the meta-analyses, but downgraded the certainty of the evidence to low or very low.We found no clinically relevant treatment effect of social skills interventions on the primary outcome measures: teacher-rated social skills at end of treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) 0.00 to 0.22; 11 trials, 1271 participants; I2 = 0%; P = 0.05); teacher-rated emotional competencies at end of treatment (SMD -0.02, 95% CI -0.72 to 0.68; two trials, 129 participants; I2 = 74%; P = 0.96); or on teacher-rated general behaviour (SMD -0.06 (negative value better), 95% CI -0.19 to 0.06; eight trials, 1002 participants; I2 = 0%; P = 0.33). The effect on the primary outcome, teacher-rated social skills at end of treatment, corresponds to a MD of 1.22 points on the social skills rating system (SSRS) scale (95% CI 0.09 to 2.36). The minimal clinical relevant difference (10%) on the SSRS is 10.0 points (range 0 to 102 points on SSRS).We found evidence in favour of social skills training on teacher-rated core ADHD symptoms at end of treatment for all eligible trials (SMD -0.26, 95% CI -0.47 to -0.05; 14 trials, 1379 participants; I2= 69%; P = 0.02), but the finding is questionable due to lack of support from sensitivity analyses, high risk of bias, lack of clinical significance, high heterogeneity, and low certainty.The studies did not report any serious or non-serious adverse events. AUTHORS' CONCLUSIONS The review suggests that there is little evidence to support or refute social skills training for children and adolescents with ADHD. We may need more trials that are at low risk of bias and a sufficient number of participants to determine the efficacy of social skills training versus no training for ADHD. The evidence base regarding adolescents is especially weak.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of Southern DenmarkDepartment of PsychologyCampusvej 55OdenseDenmark5230
| | | | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Signe Joost Hansen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of Southern DenmarkDepartment of PsychologyCampusvej 55OdenseDenmark5230
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of CopenhagenInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
| | - Britta Tendal
- RigshospitaletThe Nordic Cochrane Centre9 Blegdamsvej, 3343CopenhagenDenmark2100
- Danish Health AuthorityIslands Brygge 67CopenhagenDenmark
| | | | - Erlend Faltinsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Regan SL, Hufgard JR, Pitzer EM, Sugimoto C, Hu YC, Williams MT, Vorhees CV. Knockout of latrophilin-3 in Sprague-Dawley rats causes hyperactivity, hyper-reactivity, under-response to amphetamine, and disrupted dopamine markers. Neurobiol Dis 2019; 130:104494. [PMID: 31176715 DOI: 10.1016/j.nbd.2019.104494] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/03/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022] Open
Abstract
Attention deficit hyperactivity disorder is a pervasive developmental disorder characterized by inattention, impulsivity, and hyperactivity and is 75-90% heritable. Latrophilin-3 (LPHN3; or ADGRL(3)) is associated with a subtype of ADHD, but how it translates to symptoms is unknown. LPHN3 is a synaptic adhesion G protein coupled receptor that binds to fibronectin leucine rich transmembrane protein 3 and teneurin-3 (FLRT3 and TEN-3). We created a null mutation of Lphn3 (KO) in Sprague-Dawley rats using CRISPR/Cas9 to delete exon-3. The KO rats had no effects on reproduction or survival but reduced growth. KO females showed catch-up weight gain whereas KO males did not. We tested WT and KO littermates for home-cage activity, anxiety-like behavior, acoustic startle response, and activity after amphetamine challenge. Expression of Lphn3-related genes, monoamines, and receptors were determined. Lphn3 KO rats showed persistent hyperactivity, increased acoustic startle, reduced activity in response to amphetamine relative to baseline, and female-specific reduced anxiety-like behavior. Expression of Lphn1, Lphn2, and Flrt3 by qPCR and their protein products by western-blot analysis showed no compensatory upregulation. Striatal tyrosine hydroxylase, aromatic L-amino acid decarboxylase (AADC), and the dopamine transporter were increased and dopamine D1 receptor (DRD1) and dopamine- and cAMP-regulated neuronal phosphoprotein (DARPP-32) decreased with no changes in DRD2, DRD4, vesicular monoamine transporter-2, N-methyl-d-aspartate (NMDA)-NR1, -NR2A, or -NR2B. LPHN3 is expressed in many brain regions but its function is largely unknown. Data from human, mouse, zebrafish, Drosophila and our new Lphn3 KO rat data collectively show that its disruption is significantly correlated with hyperactivity and associated striatal changes in dopamine markers.
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Affiliation(s)
- Samantha L Regan
- Neuroscience Graduate Program, University of Cincinnati, United States of America
| | - Jillian R Hufgard
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, United States of America
| | - Emily M Pitzer
- Neuroscience Graduate Program, University of Cincinnati, United States of America
| | - Chiho Sugimoto
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Neurology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Yueh-Chiang Hu
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States of America
| | - Michael T Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Neurology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Charles V Vorhees
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Neurology, Cincinnati Children's Hospital Medical Center, United States of America.
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Abstract
OBJECTIVES There is limited evidence of the unmet needs and experiences of adults with attention deficit hyperactivity disorder (ADHD). Previous research in this area is predominantly quantitative by nature, few studies employing qualitative approaches. This study seeks to provide a deeper insight into the lived experiences of adults with ADHD within Western Ireland. METHODS A qualitative design, consisting of semi-structured face-to-face interviews with a clinical sample in the Sligo/Leitrim area. Participants were eligible for this study if they screened positive for symptoms of ADHD, and diagnosed with ADHD with the Conners' Adult ADHD Diagnostic Interview for DSM-IV. In total, 11 participants completed this research. The interviews were open ended and exploratory, adopting a phenomenological approach. RESULTS Thematic analysis was used to explore three main themes; The Burden of symptoms of ADHD, Perceived Positive and Negative Effects of ADHD and Challenge of Accessing Services, each with several subthemes. CONCLUSION This research highlights the experiences of adults with ADHD. It is important for practitioners to be aware of the perceived positive and negative effects of the disorder, and how it can impact on their patient's lives. In addition, becoming aware of the stigma associated with ADHD can help clinicians improve upon individual treatment plans to meet their patient's needs. It is important to note that this sample experienced co-morbid diagnoses and so this may limit the interpretation of the findings. Further research in this area could explore patient's attitudes towards receiving a formal diagnosis of ADHD.
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Varela Casal P, Lorena Esposito F, Morata Martínez I, Capdevila A, Solé Puig M, de la Osa N, Ezpeleta L, Perera I Lluna A, Faraone SV, Ramos-Quiroga JA, Supèr H, Cañete J. Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children. J Atten Disord 2019; 23:599-614. [PMID: 29357741 DOI: 10.1177/1087054717749931] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. METHOD To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30). RESULTS We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). CONCLUSION In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.
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Affiliation(s)
- Paloma Varela Casal
- 1 Departament of Psychiatry, Hospital de Mataró, Barcelona, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | | | | | - Alba Capdevila
- 1 Departament of Psychiatry, Hospital de Mataró, Barcelona, Spain
| | | | - Núria de la Osa
- 6 Departament de Psicologia Clínica i de la Salud, Universitat Autònoma de Barcelona, Spain
| | - Lourdes Ezpeleta
- 6 Departament de Psicologia Clínica i de la Salud, Universitat Autònoma de Barcelona, Spain
| | | | | | - Josep Antoni Ramos-Quiroga
- 2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain.,8 Hospital Universitari Vall d'Hebron, Barcelona, Spain.,9 Biomedical Network Research Centre on Mental Health, Barcelona, Spain
| | - Hans Supèr
- 3 University of Barcelona, Spain.,4 Braingaze SL, Mataró, Spain.,10 Institut de Neurociències, Universitat de Barcelona, Spain ( www.ir3c.ub.edu ).,12 Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jose Cañete
- 1 Departament of Psychiatry, Hospital de Mataró, Barcelona, Spain
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Surman C, Ceranoglu A, Vaudreuil C, Albright B, Uchida M, Yule A, Spencer A, Boland H, Grossman R, Rhodewalt L, Fitzgerald M, Biederman J. Does L-Methylfolate Supplement Methylphenidate Pharmacotherapy in Attention-Deficit/Hyperactivity Disorder?: Evidence of Lack of Benefit From a Double-Blind, Placebo-Controlled, Randomized Clinical Trial. J Clin Psychopharmacol 2019; 39:28-38. [PMID: 30566416 PMCID: PMC6750952 DOI: 10.1097/jcp.0000000000000990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Interventions for attention-deficit/hyperactivity disorder (ADHD) may be inadequate for some patients. There is evidence that supplementation with L-methylfolate augments antidepressant agent effects and thus might also augment ADHD treatment effects by a common catecholaminergic mechanism. METHODS Forty-four adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ADHD participated in a randomized, double-blind, placebo-controlled, 12-week trial of 15 mg of L-methylfolate in combination with osmotic-release oral system methylphenidate. Osmotic-release oral system methylphenidate was dose optimized over the first 6 weeks. We evaluated the effects on ADHD symptoms, self-report on the Behavior Rating Inventory of Executive Function of executive function, methylphenidate dosing, neuropsychological test measures, the Adult ADHD Self-report scale, emotional dysregulation, social adjustment, and work productivity, as well as moderating effects of body mass index, autoantibodies to folate receptors, and select genetic polymorphisms. RESULTS L-Methylfolate was well tolerated, with no significant effect over placebo except improvement from abnormal measures on the mean adaptive dimension of the ASR scale (χ = 4.36, P = 0.04). Methylphenidate dosing was significantly higher in individuals on L-methylfolate over time (χ = 7.35, P = 0.007). Exploratory analyses suggested that variation in a guanosine triphosphate cyclohydrolase gene predicted association with higher doses of methylphenidate (P < 0.001). CONCLUSIONS L-Methylfolate was associated with no change in efficacy on measures relevant to neuropsychiatric function in adults with ADHD, other than suggestion of reduced efficacy of methylphenidate. Further investigation would be required to confirm this effect and its mechanism and the genotype prediction of effects on dosing.
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Affiliation(s)
- Craig Surman
- From the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
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Kadkhoda Mezerji F, Moharreri F, Mohammadpour AH, Elyasi S. Preventive effect of cyproheptadine on sleep and appetite disorders induced by methylphenidate: an exploratory randomised, double-blinded, placebo-controlled clinical trial. Int J Psychiatry Clin Pract 2019; 23:72-79. [PMID: 30261781 DOI: 10.1080/13651501.2018.1509095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Insomnia and loss of appetite are the most common side effects of methylphenidate in patients with attention deficit/hyperactivity disorder (ADHD). The adverse effects may limit optimal dosing and patients' compliance with treatment leading to the discontinuation of treatment. This research evaluates the preventive effects of cyproheptadine on sleeping and appetite disorders induced by methylphenidate in ADHD children. METHODS During this exploratory, randomised, double-blinded, placebo-controlled clinical trial, forty patients with ADHD diagnosis who had received methylphenidate randomly were assigned to participate in the cyproheptadine or the placebo group. Patients' weight and Pittsburgh Sleep Quality Index (PSQI) score were recorded at baseline, after four, six and eight weeks of treatment. The ADHD Parent Rating Scale-V score was also defined at the beginning and the end of study for each patient. RESULTS There was no significant difference between the cyproheptadine and the placebo groups regarding their weight, rate of growth and PSQI score in the monthly assessment. In addition, there was no significant difference in response to the therapy between the two groups. CONCLUSIONS Based on our findings, cyproheptadine does not have any considerable preventive effect on sleeping and appetite disorders induced by methylphenidate in ADHD children.
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Affiliation(s)
- Faezeh Kadkhoda Mezerji
- a Department of Clinical Pharmacy, School of Pharmacy , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Fatemeh Moharreri
- b Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences , Mashhad , Iran
| | | | - Sepideh Elyasi
- a Department of Clinical Pharmacy, School of Pharmacy , Mashhad University of Medical Sciences , Mashhad , Iran
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Mazor-Karsenty T, Shalev L, Parush S, Bonneh Y. Perception of Aversive Auditory Stimuli Is Different in Sensory Modulation Disorder and Attention Deficit Hyperactivity Disorder. Am J Occup Ther 2018; 72:7206205020p1-7206205020p8. [DOI: 10.5014/ajot.2018.022327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tal Mazor-Karsenty
- Tal Mazor-Karsenty, PhD, OT, is Teaching Fellow, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel;
| | - Lilach Shalev
- Lilach Shalev, PhD, is Professor, School of Education and School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Shula Parush
- Shula Parush, PhD, OT, is Professor Emeritus, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoram Bonneh
- Yoram Bonneh, PhD, is Visiting Scientist, Department of Optometry and Vision Science, Bar-Ilan University, Tel Aviv, Israel
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Checa-Ros A, Haro-García A, Seiquer I, Molina-Carballo A, Uberos-Fernández J, Muñoz-Hoyos A. Early monitoring of fatty acid profile in children with attention deficit and/or hyperactivity disorder under treatment with omega-3 polyunsaturated fatty acids. Minerva Pediatr 2018; 71:313-325. [PMID: 30419741 DOI: 10.23736/s0026-4946.18.04975-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cognitive effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) might make them helpful in attention deficit/hyperactivity disorder (ADHD). However, the results derived from supplementation studies in children depend on the respective combinations and the study period. We aimed to investigate the serum fatty acid profile, attention scores and the tolerability in a group of ADHD children after receiving methylphenidate (MPH) and ω-3 PUFAs for 1 month. METHODS A combination of MPH (1 mg/kg/day) and eicosapentaenoic (EPA, 70 mg/day) + docosahexaenoic acids (DHA, 250 mg/day) was administered to 40 ADHD children (7-15 years). An analysis of serum fatty acids by gas chromatography and an assessment of attention by using the Magallanes Scale of Visual Attention (MSVA) were carried out before and after 1 month of treatment. RESULTS Our data revealed significant decreases of several ω-6 PUFAs, like arachidonic acid (P<0.0259). EPA and DHA concentrations increased by 27% and 3% respectively, and the ω-6/ω-3 index slightly decreased. The quality of attention significantly increased (P<0.026) and an improvement of ADHD core symptoms was reported both by parents and by teachers. No severe side effects occurred. CONCLUSIONS Results demonstrate that the combination of MPH and EPA+DHA at the tested doses has positive clinical effects and an adequate safety profile. Therefore, our study suggests that ω-3 PUFAs may represent a feasible and a safe adjuvant therapy in children with ADHD and might enhance the effects of MPH. Further long-term follow-up studies are required to confirm these initial findings.
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Affiliation(s)
- Ana Checa-Ros
- Department of Pediatrics, School of Medicine, San Cecilio University Hospital, University of Granada, Granada, Spain - .,Aston Brain Centre, Aston University, Birmingham, UK -
| | - Ana Haro-García
- Department of Physiology and Biochemistry of Animal Nutrition (EEZ-CSIC), Estación Experimental del Zaidín (CSIC), Granada, Spain
| | - Isabel Seiquer
- Department of Physiology and Biochemistry of Animal Nutrition (EEZ-CSIC), Estación Experimental del Zaidín (CSIC), Granada, Spain
| | - Antonio Molina-Carballo
- Department of Pediatrics, School of Medicine, San Cecilio University Hospital, University of Granada, Granada, Spain
| | - José Uberos-Fernández
- Department of Pediatrics, School of Medicine, San Cecilio University Hospital, University of Granada, Granada, Spain
| | - Antonio Muñoz-Hoyos
- Department of Pediatrics, School of Medicine, San Cecilio University Hospital, University of Granada, Granada, Spain
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Lowry LS, Schatz NK, Fabiano GA. Exploring Parent Beliefs and Behavior: The Contribution of ADHD Symptomology Within Mothers and Fathers. J Atten Disord 2018; 22:1255-1265. [PMID: 25555630 DOI: 10.1177/1087054714562587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To use a multi-method approach to examine the association of parental ADHD and gender with observed and self-reported parenting beliefs and behaviors. METHOD Seventy-nine mother-father dyads completed measures of child behavior and impairment, parenting beliefs and behaviors, and self- and partner ratings of ADHD symptoms and functional impairment. Forty-five parents also completed structured parent-child interactions. RESULTS A hierarchical linear model suggests impairment in functional domains may be associated with negative emotions about parenting and less effective parenting strategies. For fathers, greater severity of partner-reported symptoms of ADHD may be associated with greater frequency of negative talk during parent-child interactions. CONCLUSION Findings suggest that higher levels of parental ADHD symptoms and functional impairment may be associated with reported beliefs and behaviors related to parenting. Differences emerged among mothers' and fathers' use of parenting strategies when self- and other-report of ADHD symptoms and impairment were assessed.
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Cerrillo-Urbina AJ, García-Hermoso A, Pardo-Guijarro MJ, Sánchez-López M, Santos-Gómez JL, Martínez-Vizcaíno V. The Effects of Long-Acting Stimulant and Nonstimulant Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials. J Child Adolesc Psychopharmacol 2018; 28:494-507. [PMID: 29897263 DOI: 10.1089/cap.2017.0151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of stimulant and nonstimulant medications in children and adolescents using as an outcome measure the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV), and to examine the effect of medications in different ADHD subtypes (i.e., inattention and hyperactivity/impulsivity). METHODS MEDLINE, Scopus, EMBASE, EBSCO (E-journal, CINAHL and SportDiscus), PUBMED, and The Cochrane Central Register of Controlled Trials databases were searched. Randomized controlled trials (RCTs) with parallel group or placebo-controlled studies comparing the effect of medications (stimulants or nonstimulants) in children and adolescents with ADHD were included. The main outcomes were the ADHD-RS-IV total score and subtypes (inattention and hyperactivity/impulsivity). Treatment-emergent adverse events (TEAEs) and secondary outcomes such as systolic and diastolic blood pressure, and pulse rate were considered. RESULTS The search strategy identified 15 RCTs, including a total of 4648 children and/or adolescents diagnosed with ADHD aged 6 to 17 years old. Overall, both stimulant and nonstimulant medications reduce the ADHD-RS-IV score with a standardized mean difference (SMD) of -0.70 (confidence interval [95% CI], -0.85 to -0.55); in subgroup analyses, the SMD was -0.83 (95% CI, -1.11 to -0.54) for stimulant medications and -0.58 (95% CI, -0.69 to -0.46) for nonstimulant medications. Similar results were observed in inattention and hyperactivity/impulsivity subtypes. The placebo group also showed a medium effect SMD of -0.68 (95% CI, -0.82 to -0.54). The most frequent TEAEs for stimulant and nonstimulant medications, respectively, were decreased appetite (28.6% and 14.2%) and somnolence (4.4% and 34.1%). CONCLUSIONS These results suggest that both stimulant and nonstimulant medications mitigate ADHD symptoms in children and adolescents, although subgroup analyses suggest a greater effectiveness of stimulant medications.
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Affiliation(s)
| | - Antonio García-Hermoso
- 2 Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile , USACH, Santiago, Chile
| | - María Jesús Pardo-Guijarro
- 1 Social and Health Care Research Center , Universidad de Castilla-La Mancha, Cuenca, Spain .,3 Faculty of Education, Universidad de Castilla-La Mancha , Cuenca, Spain
| | - Mairena Sánchez-López
- 1 Social and Health Care Research Center , Universidad de Castilla-La Mancha, Cuenca, Spain .,4 Faculty of Education, Universidad de Castilla-La Mancha , Ciudad Real, Spain
| | | | - Vicente Martínez-Vizcaíno
- 1 Social and Health Care Research Center , Universidad de Castilla-La Mancha, Cuenca, Spain .,6 Facultad de Ciencias de la Salud, Universidad Autónoma de Chile , Talca, Chile
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Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira‐Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies. Cochrane Database Syst Rev 2018; 5:CD012069. [PMID: 29744873 PMCID: PMC6494554 DOI: 10.1002/14651858.cd012069.pub2] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [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 a common neurodevelopmental disorder in childhood. The psychostimulant methylphenidate is the most frequently used medication to treat it. Several studies have investigated the benefits of methylphenidate, showing possible favourable effects on ADHD symptoms, but the true magnitude of the effect is unknown. Concerning adverse events associated with the treatment, our systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events. OBJECTIVES To assess the adverse events associated with methylphenidate treatment for children and adolescents with ADHD in non-randomised studies. SEARCH METHODS In January 2016, we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 12 other databases and two trials registers. We also checked reference lists and contacted authors and pharmaceutical companies to identify additional studies. SELECTION CRITERIA We included non-randomised study designs. These comprised comparative and non-comparative cohort studies, patient-control studies, patient reports/series and cross-sectional studies of methylphenidate administered at any dosage or formulation. We also included methylphenidate groups from RCTs assessing methylphenidate versus other interventions for ADHD as well as data from follow-up periods in RCTs. Participants had to have an ADHD diagnosis (from the 3rd to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or the 9th or 10th edition of theInternational Classification of Diseases, with or without comorbid diagnoses. We required that at least 75% of participants had a normal intellectual capacity (intelligence quotient of more than 70 points) and were aged below 20 years. We excluded studies that used another ADHD drug as a co-intervention. DATA COLLECTION AND ANALYSIS Fourteen review authors selected studies independently. Two review authors assessed risk of bias independently using the ROBINS-I tool for assessing risk of bias in non-randomised studies of interventions. All review authors extracted data. We defined serious adverse events according to the International Committee of Harmonization as any lethal, life-threatening or life-changing event. We considered all other adverse events to be non-serious adverse events and conducted meta-analyses of data from comparative studies. We calculated meta-analytic estimates of prevalence from non-comparative cohorts studies and synthesised data from patient reports/series qualitatively. We investigated heterogeneity by conducting subgroup analyses, and we also conducted sensitivity analyses. MAIN RESULTS We included a total of 260 studies: 7 comparative cohort studies, 6 of which compared 968 patients who were exposed to methylphenidate to 166 controls, and 1 which assessed 1224 patients that were exposed or not exposed to methylphenidate during different time periods; 4 patient-control studies (53,192 exposed to methylphenidate and 19,906 controls); 177 non-comparative cohort studies (2,207,751 participants); 2 cross-sectional studies (96 participants) and 70 patient reports/series (206 participants). Participants' ages ranged from 3 years to 20 years. Risk of bias in the included comparative studies ranged from moderate to critical, with most studies showing critical risk of bias. We evaluated all non-comparative studies at critical risk of bias. The GRADE quality rating of the evidence was very low.Primary outcomesIn the comparative studies, methylphenidate increased the risk ratio (RR) of serious adverse events (RR 1.36, 95% confidence interval (CI) 1.17 to 1.57; 2 studies, 72,005 participants); any psychotic disorder (RR 1.36, 95% CI 1.17 to 1.57; 1 study, 71,771 participants); and arrhythmia (RR 1.61, 95% CI 1.48 to 1.74; 1 study, 1224 participants) compared to no intervention.In the non-comparative cohort studies, the proportion of participants on methylphenidate experiencing any serious adverse event was 1.20% (95% CI 0.70% to 2.00%; 50 studies, 162,422 participants). Withdrawal from methylphenidate due to any serious adverse events occurred in 1.20% (95% CI 0.60% to 2.30%; 7 studies, 1173 participants) and adverse events of unknown severity led to withdrawal in 7.30% of participants (95% CI 5.30% to 10.0%; 22 studies, 3708 participants).Secondary outcomesIn the comparative studies, methylphenidate, compared to no intervention, increased the RR of insomnia and sleep problems (RR 2.58, 95% CI 1.24 to 5.34; 3 studies, 425 participants) and decreased appetite (RR 15.06, 95% CI 2.12 to 106.83; 1 study, 335 participants).With non-comparative cohort studies, the proportion of participants on methylphenidate with any non-serious adverse events was 51.2% (95% CI 41.2% to 61.1%; 49 studies, 13,978 participants). These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants); and decreased appetite, 31.1% (95% CI 26.5% to 36.2%; 84 studies, 11,594 participants). Withdrawal of methylphenidate due to non-serious adverse events occurred in 6.20% (95% CI 4.80% to 7.90%; 37 studies, 7142 participants), and 16.2% were withdrawn for unknown reasons (95% CI 13.0% to 19.9%; 57 studies, 8340 participants). AUTHORS' CONCLUSIONS Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake large-scale, high-quality RCTs, along with studies aimed at identifying responders and non-responders.
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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
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - 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
| | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | | | | | - Trine Gerner
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | | | - 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 Centre for Evidence‐Informed Healthcare and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreIndia632002
| | - Sasja J Håkonsen
- Aalborg UniversityDepartment of Health Science and TechnologyNiels Jernes Vej 14AalborgDenmark9220
| | | | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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Kolla NJ, van der Maas M, Erickson PG, Mann RE, Seeley J, Vingilis E. Attention deficit hyperactivity disorder and arrest history: Differential association of clinical characteristics by sex. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:150-156. [PMID: 29853005 DOI: 10.1016/j.ijlp.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is often cited as a risk factor for criminality. However, many studies do not take other criminogenic variables into account when reporting on this relationship. It is even less clear whether models that include ADHD as a potential risk factor for criminality consider the importance of sex differences. To answer this question, we collected data from a telephone population survey sampling adults over the age of 18 years in the province of Ontario, Canada (final sample size = 5196). Respondents were screened for ADHD using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four extra items. Problematic drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT), while cannabis misuse was evaluated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview provided a measure of previous conduct disorder symptoms and the 12-item General Health Questionnaire screening procedure was used to gauge general distress. History of arrest was self-reported. Three separate logistic regression analyses (entire sample, male only, and female only) were applied to estimate the association of the foregoing variables with arrest history. In the combined sample, conduct disorder symptoms, problem alcohol use, and problem cannabis use all predicted history of arrest. With regard to the male sample, conduct disorder symptoms, elevated AUDIT and ASSIST scores, and general distress were associated with an arrest history. For the female subsample, only conduct disorder symptoms and problematic cannabis use showed a relationship with criminality. To summarize, ADHD did not predict history of arrest for either subsample or the combined sample. When comparing males and females, conduct disorder symptoms and cannabis misuse exerted stronger effects on history of arrest for females than males. These results suggest that the relative importance and type of clinical risk factors for arrest may differ according to sex. Such information could be useful for crime prevention policies and correctional programs that take into account differences in experience by sex.
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Affiliation(s)
- Nathan J Kolla
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Violence Prevention Neurobiological Research Unit (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.
| | - Mark van der Maas
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | | | - Robert E Mann
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Jane Seeley
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
| | - Evelyn Vingilis
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
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Yep R, Soncin S, Brien DC, Coe BC, Marin A, Munoz DP. Using an emotional saccade task to characterize executive functioning and emotion processing in attention-deficit hyperactivity disorder and bipolar disorder. Brain Cogn 2018; 124:1-13. [PMID: 29698907 DOI: 10.1016/j.bandc.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 01/02/2023]
Abstract
Despite distinct diagnostic criteria, attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) share cognitive and emotion processing deficits that complicate diagnoses. The goal of this study was to use an emotional saccade task to characterize executive functioning and emotion processing in adult ADHD and BD. Participants (21 control, 20 ADHD, 20 BD) performed an interleaved pro/antisaccade task (look toward vs. look away from a visual target, respectively) in which the sex of emotional face stimuli acted as the cue to perform either the pro- or antisaccade. Both patient groups made more direction (erroneous prosaccades on antisaccade trials) and anticipatory (saccades made before cue processing) errors than controls. Controls exhibited lower microsaccade rates preceding correct anti- vs. prosaccade initiation, but this task-related modulation was absent in both patient groups. Regarding emotion processing, the ADHD group performed worse than controls on neutral face trials, while the BD group performed worse than controls on trials presenting faces of all valence. These findings support the role of fronto-striatal circuitry in mediating response inhibition deficits in both ADHD and BD, and suggest that such deficits are exacerbated in BD during emotion processing, presumably via dysregulated limbic system circuitry involving the anterior cingulate and orbitofrontal cortex.
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Affiliation(s)
- Rachel Yep
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Stephen Soncin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Donald C Brien
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Brian C Coe
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Alina Marin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Department of Psychiatry, Hotel Dieu Hospital, Kingston, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
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Jones HA, Eddy LD, Rabinovitch AE, Snipes DJ, Wilson SA, Parks AM, Karjane NW, Svikis DS. Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women. J Clin Psychol 2018; 74:665-679. [PMID: 28945932 DOI: 10.1002/jclp.22538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). METHOD A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. RESULTS Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. CONCLUSION As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.
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Reale L, Costantino MA, Sequi M, Bonati M. Transition to Adult Mental Health Services for Young People With ADHD. J Atten Disord 2018; 22:601-608. [PMID: 25525158 DOI: 10.1177/1087054714560823] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the care management and continuity from child to adult mental health service for young adults with ADHD. METHOD A questionnaire survey from 18 Regional ADHD Pediatric Centers (RAPC) in Lombardy, Italy, was used to collect data on transition protocols and population served, and to track the pathway of care of ADHD patients once they reached adulthood. RESULTS Twenty-eight percent of RAPC had transition protocols and 3% of the population annually served were potential referrals to adult service. Of 52 patients who turned 18 years, just over 70% were monitored by the general practitioner, of those 5 with RAPC support. One fifth of patients continued to use mental health services, the majority was still monitored by the RAPC, and only three by services for adult. CONCLUSION Managing the process of transition to adult services in mental health care remains a need to be prioritized and better defined for ADHD patients.
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Affiliation(s)
- Laura Reale
- 1 Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
| | - Maria Antonella Costantino
- 2 Child and Adolescent Neuropsychiatry Unit, IRCCS Foundation Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Sequi
- 1 Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
| | - Maurizio Bonati
- 1 Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
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Lopez PL, Torrente FM, Ciapponi A, Lischinsky AG, Cetkovich‐Bakmas M, Rojas JI, Romano M, Manes FF. Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev 2018; 3:CD010840. [PMID: 29566425 PMCID: PMC6494390 DOI: 10.1002/14651858.cd010840.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a developmental condition characterised by symptoms of inattention, hyperactivity and impulsivity, along with deficits in executive function, emotional regulation and motivation. The persistence of ADHD in adulthood is a serious clinical problem.ADHD significantly affects social interactions, study and employment performance.Previous studies suggest that cognitive-behavioural therapy (CBT) could be effective in treating adults with ADHD, especially when combined with pharmacological treatment. CBT aims to change the thoughts and behaviours that reinforce harmful effects of the disorder by teaching people techniques to control the core symptoms. CBT also aims to help people cope with emotions, such as anxiety and depression, and to improve self-esteem. OBJECTIVES To assess the effects of cognitive-behavioural-based therapy for ADHD in adults. SEARCH METHODS In June 2017, we searched CENTRAL, MEDLINE, Embase, seven other databases and three trials registries. We also checked reference lists, handsearched congress abstracts, and contacted experts and researchers in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating any form of CBT for adults with ADHD, either as a monotherapy or in conjunction with another treatment, versus one of the following: unspecific control conditions (comprising supportive psychotherapies, no treatment or waiting list) or other specific interventions. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures suggested by Cochrane. MAIN RESULTS We included 14 RCTs (700 participants), 13 of which were conducted in the northern hemisphere and 1 in Australia.Primary outcomes: ADHD symptomsCBT versus unspecific control conditions (supportive psychotherapies, waiting list or no treatment)- CBT versus supportive psychotherapies: CBT was more effective than supportive therapy for improving clinician-reported ADHD symptoms (1 study, 81 participants; low-quality evidence) but not for self-reported ADHD symptoms (SMD -0.16, 95% CI -0.52 to 0.19; 2 studies, 122 participants; low-quality evidence; small effect size).- CBT versus waiting list: CBT led to a larger benefit in clinician-reported ADHD symptoms (SMD -1.22, 95% CI -2.03 to -0.41; 2 studies, 126 participants; very low-quality evidence; large effect size). We also found significant differences in favour of CBT for self-reported ADHD symptoms (SMD -0.84, 95% CI -1.18 to -0.50; 5 studies, 251 participants; moderate-quality evidence; large effect size).CBT plus pharmacotherapy versus pharmacotherapy alone: CBT with pharmacotherapy was more effective than pharmacotherapy alone for clinician-reported core symptoms (SMD -0.80, 95% CI -1.31 to -0.30; 2 studies, 65 participants; very low-quality evidence; large effect size), self-reported core symptoms (MD -7.42 points, 95% CI -11.63 points to -3.22 points; 2 studies, 66 participants low-quality evidence) and self-reported inattention (1 study, 35 participants).CBT versus other interventions that included therapeutic ingredients specifically targeted to ADHD: we found a significant difference in favour of CBT for clinician-reported ADHD symptoms (SMD -0.58, 95% CI -0.98 to -0.17; 2 studies, 97 participants; low-quality evidence; moderate effect size) and for self-reported ADHD symptom severity (SMD -0.44, 95% CI -0.88 to -0.01; 4 studies, 156 participants; low-quality evidence; small effect size).Secondary outcomesCBT versus unspecific control conditions: we found differences in favour of CBT compared with waiting-list control for self-reported depression (SMD -0.36, 95% CI -0.60 to -0.11; 5 studies, 258 participants; small effect size) and for self-reported anxiety (SMD -0.45, 95% CI -0.71 to -0.19; 4 studies, 239 participants; small effect size). We also observed differences in favour of CBT for self-reported state anger (1 study, 43 participants) and self-reported self-esteem (1 study 43 participants) compared to waiting list. We found no differences between CBT and supportive therapy (1 study, 81 participants) for self-rated depression, clinician-rated anxiety or self-rated self-esteem. Additionally, there were no differences between CBT and the waiting list for self-reported trait anger (1 study, 43 participants) or self-reported quality of life (SMD 0.21, 95% CI -0.29 to 0.71; 2 studies, 64 participants; small effect size).CBT plus pharmacotherapy versus pharmacotherapy alone: we found differences in favour of CBT plus pharmacotherapy for the Clinical Global Impression score (MD -0.75 points, 95% CI -1.21 points to -0.30 points; 2 studies, 65 participants), self-reported depression (MD -6.09 points, 95% CI -9.55 points to -2.63 points; 2 studies, 66 participants) and self-reported anxiety (SMD -0.58, 95% CI -1.08 to -0.08; 2 studies, 66 participants; moderate effect size). We also observed differences favouring CBT plus pharmacotherapy (1 study, 31 participants) for clinician-reported depression and clinician-reported anxiety.CBT versus other specific interventions: we found no differences for any of the secondary outcomes, such as self-reported depression and anxiety, and findings on self-reported quality of life varied across different studies. AUTHORS' CONCLUSIONS There is low-quality evidence that cognitive-behavioural-based treatments may be beneficial for treating adults with ADHD in the short term. Reductions in core symptoms of ADHD were fairly consistent across the different comparisons: in CBT plus pharmacotherapy versus pharmacotherapy alone and in CBT versus waiting list. There is low-quality evidence that CBT may also improve common secondary disturbances in adults with ADHD, such as depression and anxiety. However, the paucity of long-term follow-up data, the heterogeneous nature of the measured outcomes, and the limited geographical location (northern hemisphere and Australia) limit the generalisability of the results. None of the included studies reported severe adverse events, but five participants receiving different modalities of CBT described some type of adverse event, such as distress and anxiety.
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Affiliation(s)
- Pablo Luis Lopez
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro UniversityLaboratory of Psychopathology ResearchPacheco de Melo1854/60Buenos AiresCapital FederalArgentinaC1078AAI
| | - Fernando Manuel Torrente
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro UniversityLaboratory of Psychopathology ResearchPacheco de Melo1854/60Buenos AiresCapital FederalArgentinaC1078AAI
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Alicia Graciela Lischinsky
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro UniversityLaboratory of Psychopathology ResearchPacheco de Melo1854/60Buenos AiresCapital FederalArgentinaC1078AAI
| | - Marcelo Cetkovich‐Bakmas
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro UniversityLaboratory of Psychopathology ResearchPacheco de Melo1854/60Buenos AiresCapital FederalArgentinaC1078AAI
| | - Juan Ignacio Rojas
- Hospital Italiano Buenos AiresNeurology DepartmentGascon 450Buenos AiresBuenos AiresArgentina1411
| | - Marina Romano
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Facundo F Manes
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro UniversityLaboratory of Psychopathology ResearchPacheco de Melo1854/60Buenos AiresCapital FederalArgentinaC1078AAI
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Cerrillo-Urbina AJ, García-Hermoso A, Martínez-Vizcaíno V, Pardo-Guijarro MJ, Ruiz-Hermosa A, Sánchez-López M. Prevalence of probable Attention-Deficit/Hyperactivity Disorder symptoms: result from a Spanish sample of children. BMC Pediatr 2018; 18:111. [PMID: 29544457 PMCID: PMC5853084 DOI: 10.1186/s12887-018-1083-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/27/2018] [Indexed: 11/26/2022] Open
Abstract
Background The aims of our study were to: (i) determine the prevalence of children aged 4 to 6 years with probable Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in the Spanish population; and (ii) analyse the association of probable ADHD symptoms with sex, age, type of school, origin (native or foreign) and socio-economic status in these children. Methods This cross-sectional study included 1189 children (4 to 6 years-old) from 21 primary schools in 19 towns from the Ciudad Real and Cuenca provinces, Castilla-La Mancha region, Spain. The ADHD Rating Scales IV for parents and teachers was administered to determine the probability of ADHD. The 90th percentile cut-off was used to establish the prevalence of inattention, hyperactivity/impulsivity and combined subtype. Results The prevalence of children with probable ADHD symptoms was 5.4% (2.6% inattention subtype symptoms, 1.5% hyperactivity/impulsivity subtype symptoms, and 1.3% combined subtype symptoms). Children aged 4 to 5 years showed a higher prevalence of probable ADHD in the inattention subtype symptoms and in total of all subtypes than children aged 6 years, and children with low socio-economic status reported a higher prevalence of probable ADHD symptoms (each subtype and total of all of them) than those with medium and high socio-economic status. Conclusions Early diagnosis and an understanding of the predictors of being probable ADHD are needed to direct appropriate identification and intervention efforts. These screening efforts should be especially addressed to vulnerable groups, particularly low socio-economic status families and younger children.
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Affiliation(s)
| | - Antonio García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago de Chile, Chile
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain.,Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - María Jesús Pardo-Guijarro
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain. .,Universidad de Castilla-La Mancha, Faculty of Education, Cuenca, Spain. .,Universidad de Castilla-La Mancha, Edificio Melchor Cano, Centro de Estudios Socio-Sanitarios, Santa Teresa Jornet s/n, 16071, Cuenca, Spain.
| | - Abel Ruiz-Hermosa
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain
| | - Mairena Sánchez-López
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain.,Universidad de Castilla-La Mancha, Faculty of Education, Ciudad Real, Spain
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Nomanbhoy A, Hawkins R. Parenting practices of Singaporean mothers of children with ADHD. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105817714805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: We wanted to determine: (1) whether ADHD symptoms were more common in mothers of children with ADHD; (2) whether mothers of children with ADHD differed in their parenting strategies; and (3) whether there was a difference in care-giving arrangements for children with ADHD and without ADHD. This was done by comparing mothers of children with ADHD with mothers of children without ADHD in Singapore. Methods: Mothers of children with ADHD ( n=46) and mothers of children without ADHD ( n=45) completed the Conners’ Parent Rating Scale-Revised, the Conners’ Adult ADHD Rating Scale-Self Report and the Alabama Parenting Questionnaire. Results: Mothers of children with ADHD did not report higher levels of current ADHD symptoms compared with the control group. However, they did use less adaptive parenting strategies. There were also no differences in the reported behaviours of children cared for by a paid worker and those cared for by mothers. Conclusions: Data support the Singapore Clinical Guidelines recommendations for the promotion of parenting skills, and referral to parenting programmes for parents of children with ADHD. The promotion of parenting skills and referral to parenting programmes for mothers of children with ADHD might include the option of electronic forms of programme delivery. The model of using paid help in the home, which is commonplace in Singapore, does not seem to disadvantage children with ADHD.
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Affiliation(s)
- Alefiya Nomanbhoy
- School of Education, University of Nottingham Malaysia Campus, Semenyih, Malaysia
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Strauß M, Ulke C, Paucke M, Huang J, Mauche N, Sander C, Stark T, Hegerl U. Brain arousal regulation in adults with attention-deficit/hyperactivity disorder (ADHD). Psychiatry Res 2018; 261:102-108. [PMID: 29291475 DOI: 10.1016/j.psychres.2017.12.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022]
Abstract
The main aim of the current study was to test the hypothesis that adult patients with attention-deficit/hyperactivity disorder (ADHD) have less stable brain arousal regulation than healthy controls. We objectively assessed brain arousal regulation using the Vigilance Algorithm Leipzig (VIGALL 2.1) to analyze 15-min resting EEG data of thirty-three ADHD patients and thirty-five matched controls. Based on automatically classified 1-s segments we computed mean EEG-vigilance (indexing arousal level) and arousal stability score (indexing arousal regulation). Adult ADHD patients showed significantly lower arousal levels and significantly less stable brain arousal regulation than controls. Multiple regression analysis indicated that arousal regulation (i.e., arousal stability score) predicted the retrospectively-assessed severity of childhood ADHD symptoms, supporting the trait aspect of brain arousal regulation. Our findings support the arousal regulation model of ADHD, which interprets hyperactivity and sensation seeking as an autoregulatory reaction to an unstable regulation of brain arousal. EEG-based arousal parameters may be candidate biomarkers for adult ADHD.
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Affiliation(s)
- Maria Strauß
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany; Depression Research Center, German Depression Foundation, Leipzig, Germany.
| | - Madlen Paucke
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany
| | - Jue Huang
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany
| | - Nicole Mauche
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany; Depression Research Center, German Depression Foundation, Leipzig, Germany
| | - Tetyana Stark
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany; Depression Research Center, German Depression Foundation, Leipzig, Germany
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Hall CL, James M, Brown S, Martin JL, Brown N, Selby K, Clarke J, Vijayan H, Guo B, Sayal K, Hollis C, Groom MJ. Protocol investigating the clinical utility of an objective measure of attention, impulsivity and activity (QbTest) for optimising medication management in children and young people with ADHD 'QbTest Utility for Optimising Treatment in ADHD' (QUOTA): a feasibility randomised controlled trial. BMJ Open 2018; 8:e021104. [PMID: 29453304 PMCID: PMC5829926 DOI: 10.1136/bmjopen-2017-021104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement. These sources can be unreliable and difficult to obtain. The addition of an objective test of attention and activity (QbTest) may improve the objectivity, reliability and speed of clinical decision-making and so reduce the time to identify the optimal medication dose. This study aims to assess the feasibility and acceptability of a QbTest medication management protocol delivered in routine healthcare services for children with ADHD. METHOD AND ANALYSIS This multisite feasibility randomised controlled trial (RCT) will recruit 60 young people (aged 6-17 years old), diagnosed with ADHD, and starting stimulant medication who are seen by Child and Adolescent Mental Health Services or Community Paediatric services. Participants will be randomised into one of two arms. In the experimental arm (QbTest protocol), the participant will complete a QbTest at baseline (prior to medication initiation), and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later). In the control arm, participants will receive treatment as usual, with at least two follow-up consultations. Measures of parent-, teacher- and clinician-rated symptoms and global functioning will be completed at each time point. Health economic measures will be completed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure completion rates. Qualitative interviews will be conducted. ETHICS AND DISSEMINATION The findings will be used to inform the development of a fully powered RCT. The results will be submitted for publication in peer-reviewed journals. The study has ethical approval. TRIAL REGISTRATION NUMBER NCT03368573; Pre-results.
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Affiliation(s)
- Charlotte L Hall
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sue Brown
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer L Martin
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Nikki Brown
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Julie Clarke
- Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, Grantham, UK
| | - Hena Vijayan
- North East London NHS Foundation Trust, Acorn Centre, Romford, UK
| | - Boliang Guo
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
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Abstract
Most child and adolescent mental health services recognise the existence of, and need for treatment in, attention-deficit hyperactivity disorder (ADHD). Many specialist multidisciplinary ADHD clinics have been developed in recent years, and many paediatricians have included the treatment of ADHD as an important part of their clinical activity. A good deal of the justification for this increase in therapeutic activity has been the demonstration that ADHD is indeed a predictor of adult mental health problems. General adult psychiatry, however, has not followed suit in identifying and treating substantial numbers of affected people. It is likely none the less that an increasing load in adult psychiatry will develop. A rising number of young people will enter adult life still receiving stimulant medication or other treatment for ADHD, and adult psychiatrists are likely to be consulted. Furthermore, an increasing number of adults are likely to recognise themselves as having been disabled by ADHD and therefore to seek assistance. In many cases, individuals with adult ADHD who require specific treatment for the condition will have been treated unsuccessfully for disorders with overlapping symptom profiles such as anxiety, depression, bipolar disorder and antisocial personality disorder.
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83
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Abstract
That Zwi & York (2004) have opened the discussion on adult attention-deficit hyperactivity disorder (ADHD) is to be applauded. Their main conclusion is that the diagnostic validity of adult ADHD remains uncertain and that further study is needed. This is based on a review of the ADHD concept in childhood and the longitudinal studies that have followed children with ADHD into adulthood.
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84
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Imagawa H, Nagar SP, Montgomery W, Nakamura T, Sato M, Davis KL. Treatment patterns, health care resource utilization, and costs in Japanese adults with attention-deficit hyperactivity disorder treated with atomoxetine. Neuropsychiatr Dis Treat 2018; 14:611-621. [PMID: 29503545 PMCID: PMC5825992 DOI: 10.2147/ndt.s150261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To describe the characteristics and medication treatment patterns of adult patients with attention-deficit/hyperactivity disorder (ADHD) prescribed atomoxetine in Japan. MATERIALS AND METHODS A retrospective analysis of insurance claims data was conducted using the Japan Medical Data Center database. Adults (≥18 years) with ADHD who had ≥1 atomoxetine claim from January 1, 2013 to December 31, 2014, and ≥180 to ≤900 days of follow-up were included. First atomoxetine claim defined the index date. Patient characteristics included age, gender, and comorbid conditions. Treatment patterns assessed included rates of atomoxetine discontinuation, switching, persistence, adherence (assessed via the medication possession ratio), and use of concomitant medications. RESULTS A total of 457 adults met all the inclusion criteria. Mean (SD) age was 32.7 (10.4) years, and 61.0% of patients were male. Nearly 72.0% of the patients had at least one comorbid mental health condition in the baseline period; depression (43.8%) and insomnia (40.7%) were the most common mental health comorbidities. Most common physical comorbidities were chronic obstructive pulmonary disease (14.4%) and diabetes (12.9%). Non-ADHD-specific psychotropics were prescribed to 59.7% of patients during the baseline period and to 65.9% during the follow-up period; 6.6% were prescribed non-ADHD-specific psychotropics concomitantly with atomoxetine. Overall, 40.0% of adults discontinued atomoxetine during the entire follow-up period and 65.9% were persistent with atomoxetine therapy at 3 months post-index date. Mean (SD) atomoxetine medication possession ratio was 0.57 (0.25), and 25.4% switched to an alternative ADHD therapy; methylphenidate (22.4%) and non-ADHD-specific psychotropics (77.6%) were the most common medication alternatives. Nearly 8% augmented atomoxetine with methylphenidates, non-stimulants, or non-ADHD-specific psychotropics. CONCLUSION In this observational study, a majority of adults with ADHD treated with atomoxetine were still persistent with therapy at 3 months post-index date, with one quarter switching to alternative ADHD therapy. High proportions of mental health comorbidities, along with high use of non-ADHD-specific psychotropic medications in both the baseline and follow-up periods, were observed among patients with ADHD prescribed atomoxetine.
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Affiliation(s)
- Hideyuki Imagawa
- Medical Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | | | - William Montgomery
- Global Patient Outcomes and Real World Evidence, Eli Lilly Australia, NSW, Australia
| | - Tomomi Nakamura
- Medical Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Masayo Sato
- Medical Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Keith L Davis
- RTI Health Solutions, Research Triangle Park, NC, USA
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85
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Time and psychostimulants: Opposing long-term structural effects in the adult ADHD brain. A longitudinal MR study. Eur Neuropsychopharmacol 2017; 27:1238-1247. [PMID: 29129558 DOI: 10.1016/j.euroneuro.2017.10.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/08/2017] [Accepted: 10/22/2017] [Indexed: 11/20/2022]
Abstract
Long-term effects of psychostimulants such as methylphenidate on ADHD patients have been proved to be difficult to capture in cross-sectional studies comparing medicated and non-medicated samples and in longitudinal studies with children, with age-related maturational processes possibly confounding independent effects of medication. However, chronic psychostimulant administration at therapeutic doses has been proven to yield profound neuroadaptive changes in rodent models. Here, we present for the first time the effect of psychostimulant treatment on brain volumes in a sample of medication-naïve adult ADHD patients. We investigated grey matter volume changes in a sample of 41 medication-naïve adult ADHD patients before and after three years of psychostimulant treatment (N = 25) or no treatment (N = 16) compared to healthy adults (N = 25). We found a significant group x time interaction effect on left putamen grey matter volumes, with a decrease in left putamen volumes in the non-medicated group compared to both the medicated group and controls, and no differences between the medicated group and controls. Our results suggest a normalizing effect of psychostimulant treatment on the left putamen volume loss detected in non-medicated ADHD patients.
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86
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Geng Y, Yang Z, Zhang R, Fan W, Yan F, Sai X, Liu Y. Relations between Machiavellianism, internalizing and externalizing behavior problems in adolescents: A one-year longitudinal study. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Surman CBH, Fried R, Rhodewalt L, Boland H. Do Pharmaceuticals Improve Driving in Individuals with ADHD? A Review of the Literature and Evidence for Clinical Practice. CNS Drugs 2017; 31:857-866. [PMID: 29052031 DOI: 10.1007/s40263-017-0465-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is defined as a disorder of impaired attention and/or behavioral control. Studies suggest that the condition can dispose individuals to a higher risk of automobile accidents. ADHD symptoms respond to pharmacotherapy in a majority of uncomplicated cases. Evidence on how pharmacotherapies for ADHD impact driving behavior or outcomes could allow clinicians to support on-road safety rationally. We therefore undertook a review to identify the evidence base to date indicating positive or negative effects of pharmacotherapies on driving behavior in individuals with ADHD. Further, we evaluated the level of evidence for these effects, their specificity to ADHD, and how they may inform clinical care. We identified studies involving pharmacotherapy for ADHD that evaluated driving-related activities or outcomes. We then categorized these studies by the mode of measurement used and by the ADHD specificity of the driving behaviors measured. Finally, we extracted themes of interest to clinical practice in pharmacologic intervention. In total, 14 studies, involving 2-61 subjects diagnosed with ADHD, looked at computer-measured, observer-measured, or self-reported driving behavior correlates of pharmacotherapy during simulation or on-road driving. Of these studies, 13 involved psychostimulant agents and two used atomoxetine. All but three investigations (one of methylphenidate, one of mixed amphetamine salts, and one of atomoxetine) found favorable changes in measures such as steering and braking behaviors or reaction to unexpected events. One study found adverse effects on driving at hour 17 following mixed amphetamine salt administration. Four studies compared two pharmacotherapies, and each found differences in measured driving behavior between the therapies. One study explored impact on ADHD-specific driving impairments, and the same study was the only one to explore correlation of clinical measures (ADHD symptoms and self-reported driving behavior) with medication-associated changes-finding dissociation between changes in ADHD symptoms and changes in measured driving measures. While data to date are limited on the ADHD-specific effects of pharmacotherapies used for ADHD on driving, it is clear from our review that these agents have effects on driving-relevant behaviors. Further research is urgently needed to develop an evidence base for clinically predictable effects of pharmacotherapy on driving safety in individuals with ADHD. If possible, clinicians should evaluate the positive and negative effects of pharmacotherapy on driving in their clients.
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Affiliation(s)
- Craig B H Surman
- Harvard Medical School, Boston, USA. .,Adult ADHD Research Program, Massachusetts General Hospital, 55 Fruit Street, Warren 625, Boston, MA, 02114, USA.
| | - Ronna Fried
- Clinical and Research Programs for Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, Warren, Boston, MA, 02114, USA
| | - Lauren Rhodewalt
- Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, Warren 628, Boston, MA, 02114, USA
| | - Heidi Boland
- Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, Warren 628, Boston, MA, 02114, USA
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88
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Canela C, Buadze A, Dube A, Eich D, Liebrenz M. Skills and compensation strategies in adult ADHD - A qualitative study. PLoS One 2017; 12:e0184964. [PMID: 28953946 PMCID: PMC5617155 DOI: 10.1371/journal.pone.0184964] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/04/2017] [Indexed: 12/31/2022] Open
Abstract
Objective The primary objectives of this study were to investigate how adult patients with ADHD coped with their symptoms prior to diagnosis and treatment, what skills and compensation strategies they had developed and what their self-perceptions of these strategies were. Methods We used a qualitative approach to analyze interviews with 32 outpatients of a specialty care unit at a university hospital. Results Patients reported frequent use of diverse compensatory strategies with varying degrees of effectiveness. These were classified into five categories (organizational, motoric, attentional, social, psychopharmacological). In certain circumstances, ADHD symptoms were even perceived as useful. Conclusion Before diagnosis and treatment, patients with ADHD may develop a variety of skills to cope with their symptoms. Several of these skills are perceived as helpful. Knowledge of self-generated coping strategies may help better understand patients and their histories and thus facilitate patient cooperation. Moreover, knowing ways in which such patients cope with their symptoms may help elucidate reasons for late or under-diagnosing of the disorder.
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Affiliation(s)
- Carlos Canela
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- * E-mail:
| | - Anna Buadze
- Division of ADHD Research, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Anish Dube
- Santa Barbara Child & Family Services, Santa Barbara, County of Santa Barbara, California
| | - Dominique Eich
- Division of ADHD Research, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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89
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Auerbach JG, Zilberman-Hayun Y, Atzaba-Poria N, Berger A. The Contribution of Maternal ADHD Symptomatology, Maternal DAT1, and Home Atmosphere to Child ADHD Symptomatology at 7 Years of Age. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:415-427. [PMID: 27873141 DOI: 10.1007/s10802-016-0230-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Children of mothers with attention-deficit/hyperactivity disorder (ADHD) have an increased genetic and environmental risk for ADHD. The unique and interactive contributions of a maternal dopamine receptor gene (DAT1), maternal ADHD symptoms (hyperactive- impulsive, inattentive), and home atmosphere to the prediction of ADHD symptoms (hyperactive- impulsive, inattentive) in 7- year-old boys (N = 96) were examined using data from a longitudinal study of familial risk for ADHD. During the first 6 months of the study, mothers and their spouses completed a questionnaire about the mother's ADHD symptoms. Home atmosphere questionnaire data were collected 4 years later. At the 7-year assessment, mothers reported on their child's ADHD symptoms. Negative home atmosphere was significantly associated with child hyperactive-impulsive and inattentive symptoms. Maternal inattentive symptoms were significantly correlated with both child symptom dimensions. Regression models, with child genotype and maternal education controlled, showed main effects for maternal inattentive symptoms, maternal DAT1 10/10 genotype, and home atmosphere in the prediction of child inattentive symptoms. Only home atmosphere predicted child hyperactive-impulsive symptoms. There was a significant home atmosphere x maternal hyperactive-impulsive symptoms interaction in the prediction of child hyperactive-impulsive symptoms. Boys with higher levels of symptoms came from homes characterized by higher levels of negative atmosphere and had mothers with higher levels of hyperactive-impulsive symptoms. There was also a trend (p = 0.075) for a maternal DAT1 x home atmosphere interaction. Boys with higher levels of inattentive symptoms came from homes with higher levels of negative atmosphere and had mothers with the homozygous 10/10 genotype. The maternal heterozygous 9/10 genotype did not predict child symptoms.
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Affiliation(s)
- Judith G Auerbach
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel, 8410501.
| | - Yael Zilberman-Hayun
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel, 8410501
| | - Naama Atzaba-Poria
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel, 8410501
| | - Andrea Berger
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel, 8410501
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90
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Bueno VF, da Silva MA, Alves TM, Louzã MR, Pompéia S. Fractionating Executive Functions of Adults With ADHD. J Atten Disord 2017; 21:944-955. [PMID: 25104788 DOI: 10.1177/1087054714545537] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the performance of adults with ADHD considering the fractionation of executive functions into six different domains. METHOD Participants were adult ADHD patients who were not under the acute effects of medication ( n = 48). Their performance was compared with that of a healthy control group ( n = 20) of comparable age, education, and nonverbal intelligence quotient. The cognitive domains assessed were executive shifting, updating, inhibition of prepotent responses, dual-task performance, planning, and access to long-term memory. We also assessed the symptoms of inattention, hyperactivity/impulsivity, anxiety, and depression by validated questionnaires. RESULTS Compared with controls, patients reported more symptoms related to ADHD, anxiety and depression symptoms and were impaired in the shifting cost measure and phonemic fluency (measure of access to long-term memory). CONCLUSION ADHD in adults selectively impaired executive shifting and access to long-term memory, domains that may alter performance in a wide range of daily tasks.
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91
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Howard AL, Pritchard TR. Heavy Drinking in University Students With and Without Attention-Deficit/Hyperactivity Disorder: Contributions of Drinking Motives and Protective Behavioral Strategies. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817723318. [PMID: 28814878 PMCID: PMC5546638 DOI: 10.1177/1178221817723318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
This study examined rates of heavy drinking and alcohol problems in relation to drinking motives and protective behavioral strategies in university students with a documented current diagnosis of attention-deficit/hyperactivity disorder (ADHD; n = 31) compared with students with no history of ADHD (n = 146). Participants completed a Web-based questionnaire, and logistic regression models tested interactions between ADHD/comparison group membership and motives and protective strategies. Group differences in rates of heavy drinking and alcohol problems were not statistically significant, but medium-sized risk ratios showed that students without ADHD reported heavy drinking at a rate 1.44 times higher than students with ADHD and met screening criteria for problematic alcohol use at a rate of 1.54 times higher than students with ADHD. Other key findings were, first, that drinking to enhance positive affect (e.g., drinking because it is exciting), but not to cope with negative affect (e.g., drinking to forget your worries), predicted both heavy drinking and alcohol problems. Second, only protective behavioral strategies that emphasize alcohol avoidance predicted both heavy drinking and alcohol problems. Contrary to expectations, we found no ADHD-related moderation of effects of motives or protective strategies on our alcohol outcomes. Results of this study are limited by the small sample of students with ADHD but highlight tentative similarities and differences in effects of motives and strategies on drinking behaviors and alcohol problems reported by students with and without ADHD.
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Affiliation(s)
- Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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92
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Bravender T. Attention-Deficit/Hyperactivity Disorder and Disordered Eating. J Adolesc Health 2017; 61:125-126. [PMID: 28734319 DOI: 10.1016/j.jadohealth.2017.05.018] [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: 05/19/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Terrill Bravender
- Division of Adolescent Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan
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93
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Subclinical symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with specific creative processes. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.03.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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94
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Magnin E, Maurs C. Attention-deficit/hyperactivity disorder during adulthood. Rev Neurol (Paris) 2017; 173:506-515. [DOI: 10.1016/j.neurol.2017.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/14/2022]
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95
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Tucha O. Supporting patients with ADHD: Missed opportunities? ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2017; 9:69-71. [PMID: 28523492 DOI: 10.1007/s12402-017-0233-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.
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96
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Abstract
PURPOSE OF REVIEW Impulsivity is a multifaceted construct and an important personality trait in various mental health conditions. Among personality disorders (PDs), especially cluster B PDs are affected. The aims of this review are to summarize the relevant findings of the past 3 years concerning impulsivity in cluster B PDs and to identify those subcomponents of self-reported impulsivity and experimentally measured impulse control that are most affected in these disorders. RECENT FINDINGS All studies referred to antisocial (ASPD) or borderline PD (BPD), and none were found for narcissistic or histrionic PD. In ASPD as well as BPD, self-report scales primarily revealed heightened impulsivity compared to healthy controls. In experimental tasks, ASPD patients showed impairments in response inhibition, while fewer deficits were found in delay discounting. BPD patients showed specific impairments in delay discounting and proactive interference, while response inhibition was less affected. However, after inducing high levels of stress, deficits in response inhibition could also be observed in BPD patients. Furthermore, negative affect led to altered brain activation patterns in BPD patients during impulse control tasks, but no behavioral impairments were found. As proposed by the DSM-5 alternative model for personality disorders, heightened impulsivity is a core personality trait in BPD and ASPD, which is in line with current research findings. However, different components of experimentally measured impulse control are affected in BPD and ASPD, and impulsivity occurring in negative emotional states or increased distress seems to be specific for BPD. Future research could be focused on measures that assess impulsive behaviors on a momentary basis as this is a promising approach especially for further ecological validation and transfer into clinical practice.
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97
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Caballero-Puntiverio M, Fitzpatrick CM, Woldbye DP, Andreasen JT. Effects of amphetamine and methylphenidate on attentional performance and impulsivity in the mouse 5-Choice Serial Reaction Time Task. J Psychopharmacol 2017; 31:272-283. [PMID: 28093027 DOI: 10.1177/0269881116684339] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies have investigated the effects of conventional attention deficit-hyperactivity disorder (ADHD) medication in the mouse 5-choice serial reaction time task (5-CSRTT), and rat studies have yielded inconsistent results. OBJECTIVE We aimed to examine the effects of acute methylphenidate (MPH) and amphetamine (AMPH) treatment in the mouse 5-CSRTT. METHODS Trained male C57Bl/6J mice were tested in a variable stimulus duration schedule. Effects of AMPH (0.25, 0.5, and 1 mg/kg) and MPH (0.5, 1.0, and 2.0 mg/kg) on discriminative accuracy, omissions, and premature responses were assessed. Saline treatment data determined high- and low-attentive (LA), and high- and low-impulsive (LI) subgroups according to the upper and lower 30th percentiles, respectively. RESULTS In the LA subgroup accuracy was improved by 0.5 mg/kg AMPH and 2 mg/kg MPH, while no effect was found in the high-attentive (HA) subgroup. Premature responses were increased by 1 mg/kg AMPH and 0.5 mg/kg MPH for all animals, and by 1 mg/kg AMPH for the LI subgroup. CONCLUSIONS The use of variable stimulus duration, along with the division into high- and LA, and high-and LI subgroups, may improve the sensitivity of the 5-CSRTT when investigating drug effects on attention and impulsivity.
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Affiliation(s)
| | | | - David Pd Woldbye
- 2 Laboratory of Neural Plasticity, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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98
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Abstract
OBJECTIVE Memory problems are a frequently reported symptom in adult ADHD, and it is well-documented that adults with ADHD perform poorly on long-term memory tests. However, the cause of this effect is still controversial. The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD. METHOD We performed separate meta-analyses of measures of memory acquisition and long-term memory using both verbal and visual memory tests. In addition, the influence of potential moderator variables was examined. RESULTS Adults with ADHD performed significantly worse than controls on verbal but not on visual long-term memory and memory acquisition subtests. The long-term memory deficit was strongly statistically related to the memory acquisition deficit. In contrast, no retrieval problems were observable. CONCLUSION Our results suggest that memory deficits in adult ADHD reflect a learning deficit induced at the stage of encoding. Implications for clinical and research settings are presented.
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Diagnosis of developmental learning and attention disorders in adults: A review of clinical modalities. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.npbr.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tanaka Y, Escobar R, Upadhyaya HP. Assessment of effects of atomoxetine in adult patients with ADHD: consistency among three geographic regions in a response maintenance study. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2017; 9:113-120. [PMID: 28058589 DOI: 10.1007/s12402-016-0212-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
Abstract
A previous study (Upadhyaya et al. in Eur J Psychiatry 2013b; 27:185-205) reported that adults with attention-deficit/hyperactivity disorder (ADHD) demonstrated maintenance of response for up to 25 weeks after initially responding to atomoxetine treatment. In the present report, the consistency of treatment effect across three geographic regions (Europe, United States/Canada [US/Can], and Latin America [Latin Am]) was explored. Data were analyzed from a phase 3, multicenter, randomized, double-blind, maintenance-of-response (randomized withdrawal) trial of atomoxetine versus placebo in adults with ADHD. Patients were randomized to atomoxetine (N = 266) or placebo (N = 258) for 25 weeks. Consistency assessments included the interaction test, pairwise t tests, noninferiority, and the criteria from Basic Principles on Global Clinical Trials (Ministry of Health, Labour and Welfare of Japan 2007). Atomoxetine-treated patients maintained the improved ADHD symptoms relative to placebo-treated patients on the Conners' Adult ADHD Rating Scale Investigator-Rated: Screening Version 18-Item (CAARS-Inv:SV) total score in all three regions (atomoxetine-placebo mean difference = -4.55, -3.18, and -0.07 for Europe, US/Can, and Latin Am, respectively). For the Latin Am region, the mean change in total score (0.41) was notably smaller for the placebo group than for Europe (5.87) and US/Can (4.39). Similar results were observed for the CAARS-Inv:SV hyperactivity/impulsivity and inattention subscale scores. Overall, patients maintained the response with atomoxetine treatment compared to placebo; however, the magnitude of treatment effect differed among the regions studied, being numerically higher in the EU and US/Can than Latin Am. Trial registration http://www.clinicaltrials.gov/(NCT00700427 ).
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Affiliation(s)
- Yoko Tanaka
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, 46285, USA.
| | - Rodrigo Escobar
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Himanshu P Upadhyaya
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, 46285, USA
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