Research Review: Language problems in children with Attention-Deficit Hyperactivity Disorder - a systematic meta-analytic review

Reading and writing difficulties and self-rated health among Danish adolescents: cross-sectional study from the FOCA cohort

BACKGROUND

People struggling with reading and writing difficulties may have poor odds of achieving a good and healthy life. Reading and writing difficulties are independent risk factors for not completing education and unemployment, which are essential in order to obtain a good and healthy life. Therefore, the purpose of this study was to investigate the association between reading and writing difficulties and self-rated health among adolescents, and to investigate how mental health mediates the association.

METHODS

A cross-sectional study was performed based on the FOCA cohort, a Danish population-based survey among 9th grade pupils, mainly aged 15- and 16-years old, gathered during the first months of 2017. The study population contained 9748 pupils. The dependent variable was a yes-or-no answer to experiencing limitations in every-day life due to reading and writing difficulties. The independent variable was measured with the SF-36 self-rated health question, dichotomised in high (very good, excellent) and low (good, fair, poor). A logistic regression model was applied.

RESULTS

Among the study population 953 (9.8%) pupils reported having reading and writing difficulties. The adjusted OR of having a low self-rated health was significantly higher among adolescents with reading and writing difficulties than without (1.37 (95% CI: 1.14-1.66)). Loneliness and perceived stress, explained a minor part of the association, OR attenuated from 1.77 (95% CI: 1.51-2.09) in the crude model to 1.47 (95% CI: 1.23-1.74) in a more adjusted model.

CONCLUSION

Adolescents with reading and writing difficulties are not only struggling with reading and writing difficulties but experiencing also low self-rated health. Mental health only explained a minor part of this association. To clarify whether causal relationship between reading and writing difficulties and self-rated health may exist, longitudinal studies are needed. If support for the hypothesised causality is found early identification of reading and writing difficulties is important, to prevent future health inequality in adolescents with reading and writing difficulties.

Estrutura e coerência da narrativa oral de crianças com transtorno de déficit de atenção e hiperatividade

RESUMO Objetivo O objetivo do estudo foi caracterizar e comparar o uso de elementos típicos da gramática de história e o nível de coerência global na narrativa oral de crianças com Transtorno de Déficit de Atenção e Hiperatividade à narrativa de crianças sem o transtorno e com desenvolvimento típico. Método Participaram 40 crianças com idade entre 5 e 10 anos, de ambos os sexos, que frequentavam o ensino fundamental, sendo 20 com diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade (Grupo TDAH) e 20 com desenvolvimento típico (Grupo TD). Os participantes de cada grupo eram semelhantes quanto ao sexo, idade cronológica, escolaridade e nível socioeconômico. O livro “Frog Where Are You?” foi utilizado para eliciar a narrativa oral de história, que foi analisada quanto à presença dos principais elementos típicos do esquema de história (personagem, tema/tópico, evento/trama e desfecho) e posteriormente classificada dentre quatro diferentes níveis crescentes de organização, correspondendo ao nível de coerência global da história. Resultados O grupo TDAH apresentou menor pontuação nos elementos estruturais “tema/tópico” e “desfecho” e narrativa com grau de coerência inferior quando comparado ao grupo TD. Conclusão As crianças com TDAH deste estudo apresentaram dificuldades no uso de elementos típicos da gramática de história, principalmente relacionados com a manutenção do tema central e desfecho da história. Tais elementos são considerados fundamentais para a construção do sentido da narrativa, o que justifica os níveis inferiores de coerência encontrados na narrativa oral do grupo TDAH.

Attention-deficit hyperactivity disorder in ancient Greece: The Obtuse Man of Theophrastus

We present an ancient Greek description written by the philosopher Theophrastus in his classic book ' Characters' comparable with modern attention-deficit hyperactivity disorder. The arguments are based in one chapter of this book-The Obtuse Man-presenting features of a character closely resembling the modern description of attention-deficit hyperactivity disorder. In a free comparative exercise, we compared Theophrastus descriptions with modern Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) attention-deficit hyperactivity disorder symptoms. The sentences describing The Obtuse Man written by Theophrastus are similar to several symptoms of attention-deficit hyperactivity disorder and he would probably be currently diagnosed with this disorder as an adult. To our knowledge, this is the oldest description compatible with the current conception of attention-deficit hyperactivity disorder in adults in the Western literature. Differently than the moralistic view of ancient Greece regarding those symptoms, the medical attention-deficit hyperactivity disorder conception may be advantageous to patients since it might reduce prejudice and allow individuals to seek treatment.

Neurodevelopmental disorders: prevalence and comorbidity in children referred to mental health services

BACKGROUND

Accurate prevalence rates of the neurodevelopmental disorders (ND) and comorbid conditions in child and adolescent mental health services (CAMHS) are essential for treatment planning and organization of health care. However, valid and reliable prevalence estimates from Nordic CAMHS populations are scarce, and the published findings vary.

AIMS

To report prevalence rates of ND (attention-deficit hyperactivity disorder: ADHD, tic disorder: TD or autism spectrum disorder: ASD) and comorbid disorders by a validated diagnostic instrument in children referred to CAMHS outpatient clinics.

METHODS

Parents of 407 consecutively referred children aged 7-13 years were interviewed with the semistructured interview schedule for affective disorders and schizophrenia, present and lifetime version (Kiddie-SADS-PL) at time of admittance.

RESULTS

One or more ND was diagnosed in 226 children (55.5%; 69.9% boys): ADHD (44.5%; 68.5% boys); TD (17.7%; 77.8% boys) and ASD (6.1%; 76% boys). Among children with ND 70 (31.0%) had only one ND with no comorbid disorder, 49 (21.7%) had more than one ND (homotypic comorbidity) and 131 (58%) had a non-ND psychiatric disorder (heterotypic comorbidity). Anxiety disorders were the most frequently occurring heterotypic comorbidity in all three ND. Comorbid depressive disorder was associated with older age, and comorbid anxiety disorder with female gender.

CONCLUSION

In children referred to CAMHS, ND constitute the most frequently occurring group of disorders, with high rates of both homotypic and heterotypic comorbidity. This needs to be taken into consideration in health service planning and treatment delivery.

Association of White Matter Structure With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

IMPORTANCE

Clinical overlap between autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) is increasingly appreciated, but the underlying brain mechanisms remain unknown to date.

OBJECTIVE

To examine associations between white matter organization and 2 commonly co-occurring neurodevelopmental conditions, ASD and ADHD, through both categorical and dimensional approaches.

DESIGN, SETTING, AND PARTICIPANTS

This investigation was a cross-sectional diffusion tensor imaging (DTI) study at an outpatient academic clinical and research center, the Department of Child and Adolescent Psychiatry at New York University Langone Medical Center. Participants were children with ASD, children with ADHD, or typically developing children. Data collection was ongoing from December 2008 to October 2015.

MAIN OUTCOMES AND MEASURES

The primary measure was voxelwise fractional anisotropy (FA) analyzed via tract-based spatial statistics. Additional voxelwise DTI metrics included radial diffusivity (RD), mean diffusivity (MD), axial diffusivity (AD), and mode of anisotropy (MA).

RESULTS

This cross-sectional DTI study analyzed data from 174 children (age range, 6.0-12.9 years), selected from a larger sample after quality assurance to be group matched on age and sex. After quality control, the study analyzed data from 69 children with ASD (mean [SD] age, 8.9 [1.7] years; 62 male), 55 children with ADHD (mean [SD] age, 9.5 [1.5] years; 41 male), and 50 typically developing children (mean [SD] age, 9.4 [1.5] years; 38 male). Categorical analyses revealed a significant influence of ASD diagnosis on several DTI metrics (FA, MD, RD, and AD), primarily in the corpus callosum. For example, FA analyses identified a cluster of 4179 voxels (TFCE FEW corrected P < .05) in posterior portions of the corpus callosum. Dimensional analyses revealed associations between ASD severity and FA, RD, and MD in more extended portions of the corpus callosum and beyond (eg, corona radiata and inferior longitudinal fasciculus) across all individuals, regardless of diagnosis. For example, FA analyses revealed clusters overall encompassing 12121 voxels (TFCE FWE corrected P < .05) with a significant association with parent ratings in the social responsiveness scale. Similar results were evident using an independent measure of ASD traits (ie, children communication checklist, second edition). Total severity of ADHD-traits was not significantly related to DTI metrics but inattention scores were related to AD in corpus callosum in a cluster sized 716 voxels. All these findings were robust to algorithmic correction of motion artifacts with the DTIPrep software.

CONCLUSIONS AND RELEVANCE

Dimensional analyses provided a more complete picture of associations between ASD traits and inattention and indexes of white matter organization, particularly in the corpus callosum. This transdiagnostic approach can reveal dimensional relationships linking white matter structure to neurodevelopmental symptoms.

The association between Mycoplasma pneumoniae infection and speech and language impairment: A nationwide population-based study in Taiwan

Manifestations of Mycoplasma pneumoniae infection can range from self-limiting upper respiratory symptoms to various neurological complications, including speech and language impairment. But an association between Mycoplasma pneumoniae infection and speech and language impairment has not been sufficiently explored. In this study, we aim to investigate the association between Mycoplasma pneumoniae infection and subsequent speech and language impairment in a nationwide population-based sample using Taiwan’s National Health Insurance Research Database. We identified 5,406 children with Mycoplasma pneumoniae infection (International Classification of Disease, Revision 9, Clinical Modification code 4830) and compared to 21,624 age-, sex-, urban- and income-matched controls on subsequent speech and language impairment. The mean follow-up interval for all subjects was 6.44 years (standard deviation = 2.42 years); the mean latency period between the initial Mycoplasma pneumoniae infection and presence of speech and language impairment was 1.96 years (standard deviation = 1.64 years). The results showed that Mycoplasma pneumoniae infection was significantly associated with greater incidence of speech and language impairment [hazard ratio (HR) = 1.49, 95% CI: 1.23–1.80]. In addition, significantly increased hazard ratio of subsequent speech and language impairment in the groups younger than 6 years old and no significant difference in the groups over the age of 6 years were found (HR = 1.43, 95% CI:1.09–1.88 for age 0–3 years group; HR = 1.67, 95% CI: 1.25–2.23 for age 4–5 years group; HR = 1.14, 95% CI: 0.54–2.39 for age 6–7 years group; and HR = 0.83, 95% CI:0.23–2.92 for age 8–18 years group). In conclusion, Mycoplasma pneumoniae infection is temporally associated with incident speech and language impairment.