151
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Dvorsky MR, Langberg JM. Predicting Impairment in College Students With ADHD: The Role of Executive Functions. J Atten Disord 2019; 23:1624-1636. [PMID: 25234039 DOI: 10.1177/1087054714548037] [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: 11/15/2022]
Abstract
OBJECTIVE This study longitudinally evaluated whether parent-ratings and self-ratings of executive function (EF) predicted the academic and overall functioning of college students with ADHD and whether EF deficits mediated the relationship between ADHD symptoms and functioning. METHOD A prospective longitudinal study of 59 college students comprehensively diagnosed with ADHD and their parents who completed ratings at the beginning and end of the school year. RESULTS Student-rated motivation and parent-rated emotion regulation significantly predicted overall impairment above and beyond symptoms of ADHD. Student-rated EF motivation mediated the relationship between ADHD symptoms and overall impairment. Student-rated EF organization mediated the relationship between ADHD symptoms and end of the year grades. CONCLUSION Motivation and organization aspects of EF appear particularly important for functioning. However, given the study's modest sample size, additional longitudinal research is needed to confirm these findings and to develop best-practice assessment and treatment recommendations for college students with ADHD.
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Johnstone JM, Leung B, Gracious B, Perez L, Tost G, Savoy A, Hatsu I, Hughes A, Bruton A, Arnold LE. Rationale and design of an international randomized placebo-controlled trial of a 36-ingredient micronutrient supplement for children with ADHD and irritable mood: The Micronutrients for ADHD in Youth (MADDY) study. Contemp Clin Trials Commun 2019; 16:100478. [PMID: 31763491 PMCID: PMC6859218 DOI: 10.1016/j.conctc.2019.100478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder affecting up to 9% of children and substantial numbers of adults. Existing pharmacologic treatments often improve symptoms, but concerns exist over side effects, stigma, potential long-term health effects, and residual irritability, often treated with adjunctive antipsychotics. To address public and clinician demand for non-pharmacologic evidence-based treatments, this study will examine efficacy of a 36-ingredient micronutrient (vitamin/mineral) supplement as treatment for children with ADHD and irritability. Methods An international team of experts in ADHD, mood dysregulation, nutrition, epidemiology, and clinical trials conferred to develop/refine a protocol powered to detect a medium effect. The study will employ a fully-blind randomized controlled trial (RCT) design, comparing the micronutrient supplement to matched placebo in 135 children aged 6-12 with ADHD symptoms and irritability, based on the parent-rated Child and Adolescent Symptom Inventory-5 (CASI-5). Irritability will be measured by at least one symptom of oppositional defiant disorder (ODD) or disruptive mood dysregulation disorder (DMDD). Based on research suggesting an irritable ADHD subtype, the primary outcome will be a composite score comprised of the CASI-5 subscales: ADHD, ODD, DMDD, and the Peer Conflict Scale, which assesses anger and aggression perpetrated towards peers. Participants will provide biological samples (blood, urine, saliva, hair and stool) to explore the micronutrients' mechanisms of action. Discussion This study is the first adequately powered RCT in North America to examine both behavioral responses to, and biological mechanisms of, micronutrients for ADHD and irritability in children. If found efficacious, broad-spectrum micronutrients, given at therapeutic doses, may provide an evidence-based alternative to prescription medications for ADHD and associated irritability. Trial registration NCT03252522. Registered 26 July 2017.
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Affiliation(s)
- Jeanette M Johnstone
- National University of Natural Medicine, Helfgott Research Institute, Portland, OR, USA.,Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Brenda Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Barbara Gracious
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, USA.,Orange Park Medical Center, Orange Park, FL, USA
| | - Leanna Perez
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Gabriella Tost
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Andrew Savoy
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Irene Hatsu
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Andrew Hughes
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Alisha Bruton
- National University of Natural Medicine, Helfgott Research Institute, Portland, OR, USA.,Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - L Eugene Arnold
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, USA
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153
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Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2019; 144:e20192528. [PMID: 31570648 PMCID: PMC7067282 DOI: 10.1542/peds.2019-2528] [Citation(s) in RCA: 567] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.
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Affiliation(s)
- Mark L. Wolraich
- Section of Developmental and Behavioral Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma
| | - Joseph F. Hagan
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont, Burlington, Vermont
- Hagan, Rinehart, and Connolly Pediatricians, PLLC, Burlington, Vermont
| | - Carla Allan
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Dale Davison
- Children and Adults with Attention-Deficit/Hyperactivity Disorder, Lanham, Maryland
- Dale Davison, LLC, Skokie, Illinois
| | - Marian Earls
- Community Care of North Carolina, Raleigh, North Carolina
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio
- Center for Intervention Research in Schools, Ohio University, Athens, Ohio
| | | | - Tanya Froehlich
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Frost
- Swope Health Services, Kansas City, Kansas
- American Academy of Family Physicians, Leawood, Kansas
| | - Joseph R. Holbrook
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christoph Ulrich Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee
| | | | | | - Karen L. Pierce
- American Academy of Child and Adolescent Psychiatry, Washington, District of Columbia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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154
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Krinzinger H, Hall CL, Groom MJ, Ansari MT, Banaschewski T, Buitelaar JK, Carucci S, Coghill D, Danckaerts M, Dittmann RW, Falissard B, Garas P, Inglis SK, Kovshoff H, Kochhar P, McCarthy S, Nagy P, Neubert A, Roberts S, Sayal K, Sonuga-Barke E, Wong ICK, Xia J, Zuddas A, Hollis C, Konrad K, Liddle EB. Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neurosci Biobehav Rev 2019; 107:945-968. [PMID: 31545988 DOI: 10.1016/j.neubiorev.2019.09.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes. We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a "traffic light" system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as "Unclear". Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse. We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention.
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Affiliation(s)
- Helga Krinzinger
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany
| | - Charlotte L Hall
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Madeleine J Groom
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Tobias Banaschewski
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Sara Carucci
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bruno Falissard
- University Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
| | - Peter Garas
- Semmelweis University, Károly Rácz School of PhD Studies, Mental Health Sciences Phd School, Budapest, Hungary
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Puja Kochhar
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | | | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jun Xia
- The Nottingham Ningbo GRADE Center, Nottingham China Health Institute, The University of Nottingham Ningbo, China
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; National Institute of Health Research (NIHR) MindTech MedTech Cooperative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Kerstin Konrad
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany; JARA-BRAIN Institute II, Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK.
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155
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Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019; 7:2420-2426. [PMID: 31559278 PMCID: PMC6745333 DOI: 10.12998/wjcc.v7.i17.2420] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood. It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents. This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders, learning disorders, externalising and internalising disorders. Challenges in screening for, diagnosing and managing comorbidity with ADHD are summarised. Also, methodological challenges and future directions in research in this interesting field are highlighted.
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Affiliation(s)
- Sundar Gnanavel
- Child Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham DH1 4LW, United Kingdom
| | - Pawan Sharma
- Department of Psychiatry, Patan Academy of Health Sciences, Patan 44700, Nepal
| | - Pulkit Kaushal
- Northumberland, Tyne and Wear NHS foundation Trust, Newcastle NE3 3XT, United Kingdom
| | - Sharafat Hussain
- Northumberland, Tyne and Wear NHS foundation Trust, Newcastle NE3 3XT, United Kingdom
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156
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Conjoint Behavioral Consultation for Students Exhibiting Symptoms of ADHD: Effects at Post-treatment and One-Year Follow-Up. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09342-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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157
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Abstract
Objective: The current study compared empathy and theory of mind (ToM) between children with ADHD and healthy controls, and assessed changes in ToM among children with ADHD following administration of methylphenidate (MPH). Method: Twenty-four children with ADHD (mean age = 10.3 years) were compared with 36 healthy controls. All children completed the interpersonal reactivity index (IRI), a self-reported empathy questionnaire, and performed the "faux-pas" recognition task (FPR). Children with ADHD performed the task with and without MPH. Results: Children with ADHD showed significantly lower levels of self-reported empathy on most IRI subscales. FPR scores were significantly lower in children with ADHD and were improved, following the administration of MPH, to a level equal to that found in healthy controls. Conclusion: Children with ADHD show impaired self-reported empathy and FPR when compared with healthy controls. Stimulants improve FPR in children with ADHD to a level equal to that in healthy controls.
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Affiliation(s)
- Hagai Maoz
- 1 Shalvata Mental Health Care Center, Hod Hasharon, Israel.,2 Tel Aviv University, Israel
| | - Hila Z Gvirts
- 1 Shalvata Mental Health Care Center, Hod Hasharon, Israel.,3 University of Haifa, Israel
| | - Maya Sheffer
- 1 Shalvata Mental Health Care Center, Hod Hasharon, Israel
| | - Yuval Bloch
- 1 Shalvata Mental Health Care Center, Hod Hasharon, Israel.,2 Tel Aviv University, Israel
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158
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Chang Z, Ghirardi L, Quinn PD, Asherson P, D’Onofrio BM, Larsson H. Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases. Biol Psychiatry 2019; 86:335-343. [PMID: 31155139 PMCID: PMC6697582 DOI: 10.1016/j.biopsych.2019.04.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 12/24/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry, and its use is increasing rapidly in adult psychiatry. However, major questions and concerns remain regarding the benefits and risks of ADHD medication, especially in real-world settings. We conducted a qualitative systematic review of studies that investigated the effects of ADHD medication on behavioral and neuropsychiatric outcomes using linked prescription databases from the last 10 years and identified 40 studies from Europe, North America, and Asia. Among them, 18 used within-individual designs to account for confounding by indication. These studies suggested short-term beneficial effects of ADHD medication on several behavioral or neuropsychiatric outcomes (i.e., injuries, motor vehicle accidents, education, substance use disorder), with estimates suggesting relative risk reduction of 9% to 58% for these outcomes. The within-individual studies found no evidence of increased risks for suicidality and seizures. Replication studies are needed for several other important outcomes (i.e., criminality, depression, mania, psychosis). The available evidence from pharmacoepidemiology studies on long-term effects of ADHD medication was less clear. We discuss time-varying confounding and other limitations that should be considered when interpreting results from pharmacoepidemiology studies. Furthermore, we highlight several knowledge gaps to be addressed in future research and implications for research on mechanisms of outcomes of ADHD medications.
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Affiliation(s)
- Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Laura Ghirardi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
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159
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A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with attention-deficit/hyperactivity disorder (ADHD). Psychiatry Res 2019; 279:23-33. [PMID: 31280035 DOI: 10.1016/j.psychres.2019.06.040] [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] [Received: 03/30/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/11/2022]
Abstract
The study aimed to explore whether cognitive behavioral therapy (CBT) combined with medication is superior to CBT alone in core symptoms, emotional symptoms, self-esteem as well as social and cognitive functions of adult attention-deficit/hyperactivity disorder (ADHD) patients. Samples from a previous RCT study and outpatient participants were all included. A total of 124 patients received 12 weeks of manualized CBT sessions, either with (n = 57) or without (n = 67) medication. Efficacy variables were evaluated at baseline and each week. Mixed linear models (MLM) were used to compare differences between the two groups in all of the above domains. Within-group comparisons showed that both groups had robust improvements in core ADHD symptoms, emotional symptoms and social functional outcomes. The CBT + M group presented more domains of improvement in executive functions than the CBT group. However, comparisons between groups didn't indicate the superiority of CBT + M in core symptoms, emotional symptoms and self-esteem. Instead, the CBT group showed a greater improvement in the physical domain of the WHOQOL-BREF than the CBT + M group. This study further indicated that CBT is an effective treatment for adults with ADHD. A combination of CBT and medication presented broader improvements in executive functions, but not in clinical symptoms, than CBT alone.
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160
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Freriks RD, Mierau JO, van der Schans J, Groenman AP, Hoekstra PJ, Postma MJ, Buskens E, Cao Q. Cost-Effectiveness of Treatments in Children With Attention-Deficit/Hyperactivity Disorder: A Continuous-Time Markov Modeling Approach. MDM Policy Pract 2019; 4:2381468319867629. [PMID: 31453364 PMCID: PMC6699005 DOI: 10.1177/2381468319867629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 07/05/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives. This study aimed to assess the cost-effectiveness of
treatments for attention-deficit/hyperactivity disorder (ADHD) in children
through prevention of serious delinquent behavior. Cost-effectiveness was
assessed in net-monetary benefit (NMB). Methods. To evaluate the
three major forms of ADHD treatment (medication management, behavioral
treatment, and the combination thereof) relative to community-delivered
treatment (control condition), we used data from 448 children, aged 7 to 10, who
participated in the National Institute of Mental Health’s Multimodal Treatment
Study of Children with ADHD. We developed a three-state continuous-time Markov
model (no delinquency, minor to moderate delinquency, serious delinquency) to
extrapolate the results 10 years beyond the 14-month trial period at a 3%
discount rate. Serious delinquency was considered an absorbing state to enable
assessment in life-years (LYs) of serious delinquent behavior prevented. The
willingness-to-pay (WTP) threshold was set equal to the annual cost associated
with serious delinquency in children with ADHD of $12,370. Results.
Modeled and observed outcomes matched closely with a mean difference of 6.9% in
LYs of serious delinquent behavior prevented. The economic evaluation revealed a
NMB of $95,449, $88,553, $90,536 and $98,660 for medication management,
behavioral treatment, combined treatment, and routine community care,
respectively. Estimates remained stable after linearly increasing the WTP
threshold between $0 and $50,000 in the deterministic sensitivity analyses.
Conclusions. This study assessed the cost-effectiveness of
treatments for ADHD in children using continuous-time Markov modeling. We show
that treatment evaluation in broader societal outcomes is essential for policy
makers, as the three major forms of ADHD treatment turned out to be inferior to
the control condition.
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Affiliation(s)
- Roel D Freriks
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Jochen O Mierau
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Jurjen van der Schans
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Erik Buskens
- Department of Operations, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Qi Cao
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
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161
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School Dropout and Associated Factors Among Omani Children with Attention-Deficit Hyperactivity Disorder: A Cross-Sectional Study. J Dev Behav Pediatr 2019; 39:109-115. [PMID: 29084072 DOI: 10.1097/dbp.0000000000000522] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the rising incidence of attention-deficit hyperactivity disorder (ADHD), there is a dearth of studies examining the rate of school dropout and its correlates in non-Western populations. METHODS Medical records were scrutinized to identify Omani children diagnosed with ADHD from 2006 to 2014 in a tertiary care hospital in Oman. The persistence of ADHD symptoms, school performance and dropout, as well as sociodemographic characteristics were examined. RESULTS Three hundred sixty-seven children fulfilled the diagnosis of ADHD based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria and 16.6% of them had dropped out of school. School dropout was associated with poor school performance, comorbid conduct disorder, and parental divorce. CONCLUSION This study from Oman concurs with existing literature that school dropout is common among children with ADHD. Concerted efforts are needed to mitigate this trend. Management strategies should incorporate the treatment of comorbid conduct disorder.
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162
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Carter-Pokras OD, Bugbee BA, Gold RS, Lauver PE, Aiken R, Arria AM. Utilizing Student Health and Academic Data: A County-Level Demonstration Project. Health Promot Pract 2019; 22:193-203. [PMID: 31394957 DOI: 10.1177/1524839919862796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Students with chronic health conditions miss more school days than their peers and are at increased risk for performing worse on standardized tests and not completing a high school degree. University-based researchers, state government leaders, and a local county school system collaborated to use existing health and academic data to (1) evaluate the strength of the relationship between health status and school performance (absenteeism, grades) and (2) describe the health status of students who are chronically absent. Analyses included descriptive statistics, chi-square tests, negative binomial regression models, and estimated marginal means. The most common health conditions among the 3,663 kindergarten through Grade 12 students were ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder), asthma, migraine headaches, mental health conditions, and eczema/psoriasis/skin disorders. After controlling for covariates, having asthma or a mental health diagnosis was positively associated with absences; and having an ADD/ADHD or mental health diagnosis was negatively associated with GPA (grade point average). Chronically absent students had significantly lower GPAs, and a higher number of health conditions than other students. The success of this demonstration project encourages strengthening existing collaborations and establishing new multidisciplinary partnerships to analyze existing data sources to learn more about the relationship between student health and academic achievement. Moreover, connecting health status to academic achievement might be a chief tactic for advocating for additional resources to improve the care and management of chronic disease conditions among students.
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Affiliation(s)
| | - Brittany A Bugbee
- University of Maryland School of Public Health, College Park, MD, USA
| | - Robert S Gold
- University of Maryland School of Public Health, College Park, MD, USA
| | | | | | - Amelia M Arria
- University of Maryland School of Public Health, College Park, MD, USA
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Kamimura-Nishimura KI, Brinkman WB, Froehlich TE. Strategies for improving ADHD medication adherence. CURRENT PSYCHIATRY 2019; 18:25-38. [PMID: 33867872 PMCID: PMC8049396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To maximize outcomes, understand and address the factors that affect adherence.
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Affiliation(s)
| | | | - Tanya E Froehlich
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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164
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Gilbert DL, Huddleston DA, Wu SW, Pedapati EV, Horn PS, Hirabayashi K, Crocetti D, Wassermann EM, Mostofsky SH. Motor cortex inhibition and modulation in children with ADHD. Neurology 2019; 93:e599-e610. [PMID: 31315973 DOI: 10.1212/wnl.0000000000007899] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/20/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Compared to typically developing (TD) peers, children with attention-deficit/hyperactivity disorder (ADHD) consistently demonstrate impaired transcranial magnetic stimulation (TMS)-evoked short interval cortical inhibition (SICI) of motor evoked potentials (MEPs) in resting motor cortex (M1). To determine whether perturbed M1 physiology also reflects clinically relevant behavioral dysfunction, we evaluated M1 physiology during a cognitive control task taxing motor response selection/inhibition. METHODS In this case-control study, behavioral ratings, motor skill (assessed using standardized examination), and left M1 physiology were evaluated in 131 right-handed, 8- to 12-year-old children (66 ADHD: mean 10.5 years, 43 male; 65 TD: mean 10.6 years, 42 male). The primary outcomes were MEP amplitudes and SICI, evaluated during rest and during a modified "racecar" Slater-Hammel stop signal reaction task, with TMS pulses administered 150 ms prior to the target go action and after the dynamic stop cue. RESULTS Go responses were significantly slower (p = 0.01) and more variable (p = 0.002) in ADHD. Children with ADHD showed less M1 SICI at rest (p = 0.02) and during go (p = 0.03) and stop trials (p = 0.02). Rest M1 excitability increased during response inhibition task engagement (p < 0.0001). This Task-Related Up-Modulation (TRUM) was less robust across and within groups, with diminished task upmodulation associated with significantly more severe ADHD behavioral ratings and slower stop signal reaction times. CONCLUSION Children with ADHD show anomalous motor cortex physiology, with deficient SICI across behavioral states and less TRUM from rest to action selection. Associations of these physiologic measures with ADHD symptoms and cognitive control measures support further investigation into biological mechanisms.
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Affiliation(s)
- Donald L Gilbert
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - David A Huddleston
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steve W Wu
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ernest V Pedapati
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul S Horn
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn Hirabayashi
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deanna Crocetti
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric M Wassermann
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stewart H Mostofsky
- From the Division of Neurology (D.L.G., D.A.H., S.W.W., E.V.P., P.S.H.) and Department of Psychiatry (E.V.P.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Center for Neurodevelopmental and Imaging Research (K.H., D.C., S.H.M.), Kennedy Krieger Institute, Baltimore; Behavioral Neurology Unit (E.M.W.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; and Departments of Neurology and Psychiatry (S.H.M.), Johns Hopkins University School of Medicine, Baltimore, MD
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Sluiter MN, Wienen AW, Thoutenhoofd ED, Doornenbal JM, Batstra L. Teachers’ role and attitudes concerning ADHD medication: A qualitative analysis. PSYCHOLOGY IN THE SCHOOLS 2019. [DOI: 10.1002/pits.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maruschka N. Sluiter
- Department of Developmental PsychologyUniversity of GroningenGroningen The Netherlands
- Professorship Youth, Education and SocietyHanze University of Applied Sciences GroningenGroningen The Netherlands
| | - Albert W. Wienen
- Department of Developmental PsychologyUniversity of GroningenGroningen The Netherlands
| | | | - Jeannette M. Doornenbal
- Professorship Youth, Education and SocietyHanze University of Applied Sciences GroningenGroningen The Netherlands
| | - Laura Batstra
- Department of Special Needs Education and Child CareUniversity of GroningenGroningen The Netherlands
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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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Friedman LM, Rapport MD, Orban SA, Eckrich SJ, Calub CA. Applied Problem Solving in Children with ADHD: The Mediating Roles of Working Memory and Mathematical Calculation. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:491-504. [PMID: 28597131 DOI: 10.1007/s10802-017-0312-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The difficulties children with ADHD experience solving applied math problems are well documented; however, the independent and/or interactive contributions of cognitive processes underlying these difficulties are not fully understood and warrant scrutiny. The current study examines two primary cognitive processes integral to children's ability to solve applied math problems: working memory (WM) and math calculation skills (i.e., the ability to utilize specific facts, skills, or processes related to basic math operations stored in long-term memory). Thirty-six boys with ADHD-combined presentation and 33 typically developing (TD) boys aged 8-12 years old were administered multiple counterbalanced tasks to assess upper (central executive [CE]) and lower level (phonological [PH STM] and visuospatial [VS STM] short-term memory) WM processes, and standardized measures of mathematical abilities. Bias-corrected, bootstrapped mediation analyses revealed that CE ability fully mediated between-group differences in applied problem solving whereas math calculation ability partially mediated the relation. Neither PH STM nor VS STM was a significant mediator. When modeled together via serial mediation analysis, CE in tandem with math calculation ability fully mediated the relation, explained 79% of the variance, and provided a more parsimonious explication of applied mathematical problem solving differences among children with ADHD. Results suggest that interventions designed to address applied math difficulties in children with ADHD will likely benefit from targeting basic knowledge of math facts and skills while simultaneously promoting the active interplay of these skills with CE processes.
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Affiliation(s)
- Lauren M Friedman
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Mark D Rapport
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA.
| | - Sarah A Orban
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Catrina A Calub
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
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Inattentive Behavior in Boys with ADHD during Classroom Instruction: the Mediating Role of Working Memory Processes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:713-727. [PMID: 28825170 DOI: 10.1007/s10802-017-0338-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children with ADHD exhibit clinically impairing inattentive behavior during classroom instruction and in other cognitively demanding contexts. However, there have been surprisingly few attempts to validate anecdotal parent/teacher reports of intact sustained attention during 'preferred' activities such as watching movies. The current investigation addresses this omission, and provides an initial test of how ADHD-related working memory deficits contribute to inattentive behavior during classroom instruction. Boys ages 8-12 (M = 9.62, SD = 1.22) with ADHD (n = 32) and typically developing boys (TD; n = 30) completed a counterbalanced series of working memory tests and watched two videos on separate assessment days: an analogue math instructional video, and a non-instructional video selected to match the content and cognitive demands of parent/teacher-described 'preferred' activities. Objective, reliable observations of attentive behavior revealed no between-group differences during the non-instructional video (d = -0.02), and attentive behavior during the non-instructional video was unrelated to all working memory variables (r = -0.11 to 0.19, ns). In contrast, the ADHD group showed disproportionate attentive behavior decrements during analogue classroom instruction (d = -0.71). Bias-corrected, bootstrapped, serial mediation revealed that 59% of this between-group difference was attributable to ADHD-related impairments in central executive working memory, both directly (ER = 41%) and indirectly via its role in coordinating phonological short-term memory (ER = 15%). Between-group attentive behavior differences were no longer detectable after accounting for ADHD-related working memory impairments (d = -0.29, ns). Results confirm anecdotal reports of intact sustained attention during activities that place minimal demands on working memory, and indicate that ADHD children's inattention during analogue classroom instruction is related, in large part, to their underdeveloped working memory abilities.
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169
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Smith ZR, Langberg JM. Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes. Clin Child Fam Psychol Rev 2019; 21:500-526. [PMID: 30141121 DOI: 10.1007/s10567-018-0268-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Preeminent theories of attention-deficit/hyperactivity disorder (ADHD) suggest that motivation deficits are core underlying features of the disorder. However, it is currently unclear whether empirical evidence supports the assertion that significant group (ADHD v. comparison) differences in motivation exist or that problems with motivation contribute to the functional impairments that youth with ADHD experience. Accordingly, this review focused on evaluating and summarizing the empirical literature on the presence of motivation deficits and their association with functional outcomes in samples of youth with ADHD. Twenty studies met the review inclusion criteria. Results support the assertion that youth with ADHD have lower academic-related motivation in comparison to their peers and that motivation plays an important role in academic outcomes, with the strongest evidence to date for reading achievement. However, the available evidence is limited, and few existing studies are aligned with the much larger theoretical and empirical motivation literature in typically developing youth. Given preliminary evidence that motivation plays a role in the academic impairments of youth with ADHD, the review concludes with a discussion of whether current ADHD interventions adequately target motivation and highlights important future directions.
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Affiliation(s)
- Zoe R Smith
- Virginia Commonwealth University, 806 W. Franklin St., Box 842018, Richmond, VA, 23284, USA
| | - Joshua M Langberg
- Virginia Commonwealth University, 806 W. Franklin St., Box 842018, Richmond, VA, 23284, USA.
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Curry AE, Yerys BE, Metzger KB, Carey ME, Power TJ. Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD. Pediatrics 2019; 143:e20182305. [PMID: 31110164 PMCID: PMC6564068 DOI: 10.1542/peds.2018-2305] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare monthly rates of specific types of crashes, violations, and license suspensions over the first years of licensure for drivers with and without attention-deficit/hyperactivity disorder (ADHD). METHODS We identified patients of New Jersey primary care locations of the Children's Hospital of Philadelphia who were born in 1987-1997, were New Jersey residents, had their last primary care visit at age ≥12 years, and acquired a driver's license (N = 14 936). Electronic health records were linked to New Jersey's licensing, crash, and violation databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. We calculated monthly per-driver rates of crashes (at fault, alcohol related, nighttime, and with peers), violations, and suspensions. Adjusted rate ratios were estimated by using repeated-measures Poisson regression. RESULTS Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18-2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD. CONCLUSIONS Adolescents with ADHD are at particularly high crash risk in their initial months of licensure, and engagement in preventable risky driving behaviors may contribute to this elevated risk. Comprehensive preventive approaches that extend beyond current recommendations are critically needed.
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Affiliation(s)
- Allison E Curry
- Centers for Injury Research and Prevention and
- Departments of Pediatrics and
| | - Benjamin E Yerys
- Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
- Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Thomas J Power
- Departments of Pediatrics and
- Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Aduen PA, Cox DJ, Fabiano GA, Garner AA, Kofler MJ. Expert Recommendations for Improving Driving Safety for Teens and Adult Drivers with ADHD. ACTA ACUST UNITED AC 2019; 27:8-14. [PMID: 31431797 DOI: 10.1521/adhd.2019.27.4.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paula A Aduen
- Harvard Partners Neuropsychology Consortium, Brigham and Women's Hospital, 60 Fenwood Road., Boston, MA 02115
| | - Daniel J Cox
- University of Virginia Health Sciences Center, Virginia Driving Safety Laboratory, Box 800-223, Charlottesville, VA 22908
| | - Gregory A Fabiano
- University at Buffalo, 334 Diefendorf Hall, University at Buffalo, Buffalo NY 14214
| | - Annie A Garner
- Saint Louis University, Department of Psychology, 3700 Lindell Boulevard, Room 2323, St. Louis, MO 63108
| | - Michael J Kofler
- Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306
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Eckernäs D, Hieronymus F, Carlsson T, Bergquist F. Acoustic white noise ameliorates reduced regional brain expression of CaMKII and ΔFosB in the spontaneously hypertensive rat model of ADHD. IBRO Rep 2019; 6:31-39. [PMID: 30656238 PMCID: PMC6302041 DOI: 10.1016/j.ibror.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022] Open
Abstract
ΔFosB was reduced in the DL-PFC, DLS and nAc in SH rats. Acoustic noise normalized ΔFosB expression in the DL-PFC and nAc of SH rats. CaMKII expression was reduced in the TMN in SH rats. Acoustic noise increased CaMKII expression in the TMN in both strains.
Loud (≥70dBA) acoustic white noise improves cognitive performance in children with ADHD as well as skilled reach and rotarod performance in the spontaneously hypertensive (SH) rat model of ADHD. To investigate how acoustic noise influences the brain activity in the SH rat model of ADHD, immunohistochemical staining of two neuronal activity and plasticity markers, Ca2+/Calmodulin dependent protein kinase II (CaMKII) and ΔFosB, was evaluated in Wistar (n = 24) and SH (n = 16) rats after repeated exposure to acoustic noise or ambient silence. Other SH rats (n = 6) were treated with repeated methylphenidate (MPH). Expression of CaMKII was reduced in the tuberomammillary nucleus (TMN) of the SH rat compared to Wistar but not in the nucleus accumbens (nAc) or the dorsolateral prefrontal cortex (DL-PFC). In the TMN, the expression of CaMKII was increased by noise in both strains. ΔFosB expression was reduced in nAc, DL-PFC and the dorsolateral striatum (DLS) of the SH rat compared to Wistar. Exposure to acoustic white noise significantly increased ΔFosB expression in the nAc and DL-PFC but not in the DLS of SH rats. The results indicate that acoustic noise shifts a reduced neuronal activity in the nAc, TMN and DL-PFC in SH rats toward the normal levels of activity in outbred rats. This may explain why noise has benefit selectively in ADHD.
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Affiliation(s)
- Daniel Eckernäs
- Corresponding author at: University of Gothenburg, Institute of Neuroscience and Physiology, Department of Pharmacology, Box 431, 405 30, Gothenburg, Sweden.
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Sibley MH, Coxe SJ, Campez M, Morley C, Olson S, Hidalgo-Gato N, Gnagy E, Greiner A, Coles EK, Page T, Pelham WE. High versus Low Intensity Summer Treatment for ADHD Delivered at Secondary School Transitions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 47:248-265. [PMID: 29498550 DOI: 10.1080/15374416.2018.1426005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spikes in symptom severity are noted for adolescents with attention deficit/hyperactivity disorder (ADHD) at the transitions to middle and high school that are attributed to developmental maladjustment. This study evaluated the effectiveness of high-intensity (HI; 412 hr, $4,373 per participant) versus low-intensity (LI; 24 hr, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD by local school district staff. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to HI versus LI (n = 218) or recruited into an untreated comparison group (n = 107). Group × Time 1-year outcome trajectories were compared using linear mixed models. Both interventions possessed high fidelity and were viewed by families as enjoyable and beneficial. Youth attendance was higher for HI (~80%) versus LI (~45%). Parent training attendance was uniform across groups (~50%). Parent and student attendance did not impact trajectories. Primary benefits of HI over LI were to note taking (d = .50), parent contingency management (d = .43), and parent-rated ADHD symptoms (d = .40-.46; ninth grade only). Secondary analyses suggested that HI may produce additional benefits compared to no treatment for home organization skills (HI vs. untreated d = .54), parent-teen conflict (HI vs. untreated d = .39), and grade point average (HI vs. untreated d = .47, ninth grade only). Summer HI treatment was superior to LI in engagement and uptake of certain skills. However, the extent to which these medium benefits on a limited number of outcomes justify high costs compared to LI remains an open question. Delivering treatment during the summer instead of school year may limit generalizability.
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Affiliation(s)
- Margaret H Sibley
- a Department of Psychiatry & Behavioral Health , Florida International University
| | - Stefany J Coxe
- b Department of Psychology, Florida International University
| | - Mileini Campez
- b Department of Psychology, Florida International University
| | - Candance Morley
- c Center for Children and Families, Florida International University
| | - Sandra Olson
- c Center for Children and Families, Florida International University
| | - Nick Hidalgo-Gato
- c Center for Children and Families, Florida International University
| | - Elizabeth Gnagy
- c Center for Children and Families, Florida International University
| | - Andrew Greiner
- c Center for Children and Families, Florida International University
| | - Erika K Coles
- b Department of Psychology, Florida International University
| | - Timothy Page
- d Department of Health Policy and Management, Florida International University
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174
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A randomized controlled trial of a brain-computer interface based attention training program for ADHD. PLoS One 2019; 14:e0216225. [PMID: 31112554 PMCID: PMC6528992 DOI: 10.1371/journal.pone.0216225] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/16/2019] [Indexed: 12/03/2022] Open
Abstract
Objective The use of brain-computer interface in neurofeedback therapy for attention deficit hyperactivity disorder (ADHD) is a relatively new approach. We conducted a randomized controlled trial (RCT) to determine whether an 8-week brain computer interface (BCI)-based attention training program improved inattentive symptoms in children with ADHD compared to a waitlist-control group, and the effects of a subsequent 12-week lower-intensity training. Study design We randomized 172 children aged 6–12 attending an outpatient child psychiatry clinic diagnosed with inattentive or combined subtypes of ADHD and not receiving concurrent pharmacotherapy or behavioral intervention to either the intervention or waitlist-control group. Intervention involved 3 sessions of BCI-based training for 8 weeks, followed by 3 training sessions per month over the subsequent 12 weeks. The waitlist-control group received similar 20-week intervention after a wait-time of 8 weeks. Results The participants’ mean age was 8.6 years (SD = 1.51), with 147 males (85.5%) and 25 females (14.5%). Modified intention to treat analyzes conducted on 163 participants with at least one follow-up rating showed that at 8 weeks, clinician-rated inattentive symptoms on the ADHD-Rating Scale (ADHD-RS) was reduced by 3.5 (SD 3.97) in the intervention group compared to 1.9 (SD 4.42) in the waitlist-control group (between-group difference of 1.6; 95% CI 0.3 to 2.9 p = 0.0177). At the end of the full 20-week treatment, the mean reduction (pre-post BCI) of the pooled group was 3.2 (95% CI 2.4 to 4.1). Conclusion The results suggest that the BCI-based attention training program can improve ADHD symptoms after a minimum of 24 sessions and maintenance training may sustain this improvement. This intervention may be an option for treating milder cases or as an adjunctive treatment.
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175
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Taylor E. ADHD Medication in the Longer Term. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:542-546. [PMID: 31012801 DOI: 10.1024/1422-4917/a000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review starts from the finding that there is strong persistence of ADHD problems into adult life, despite the availability of effective treatment with stimulants and other drugs. Short-term trials in adults reveal that those drugs can still be efficacious in adults. Pharmacoepidemiology studies, on the other hand, clearly show that most young people discontinue medication during adolescence. Neuropharmacology research suggests a waning of stimulant effects after a few years. Longitudinal studies are scarce but provide some evidence that prognosis is often determined by factors other than the core symptoms of inattentiveness and impulsive overactivity. The implications for clinical practice are discussed. Continuing care, especially during the follow-up after initial therapy, needs further development.
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Affiliation(s)
- Eric Taylor
- Institute of Psychiatry, Psychology and NeuroScience, King's College London, UK
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176
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Sibley MH, Rodriguez L, Coxe S, Page T, Espinal K. Parent-Teen Group versus Dyadic Treatment for Adolescent ADHD: What Works for Whom? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:476-492. [PMID: 30990088 DOI: 10.1080/15374416.2019.1585257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The goal of this study was to evaluate the comparative efficacy of 2 clinic-based psychosocial treatment modalities for adolescent attention deficit/hyperactivity disorder (ADHD) and identify characteristics that facilitate patient-modality matching. Culturally diverse adolescents with ADHD (N = 123) were randomized to 1 of 2 versions of a parent-teen psychosocial treatment for ADHD (Supporting Teens' Autonomy Daily [STAND]): (a) group parent and adolescent skills training or (b) dyadic skills training blended with motivational interviewing. Participants were assessed at baseline, posttreatment, and 6-month follow-up on ADHD symptom severity and functional treatment targets. Differences in therapy process and cost were documented. Modality differences in outcome were examined using linear mixed and general linear models. Each modality successfully engaged the proposed therapy processes. Dyadic and group STAND produced equivalent overall outcomes. However, the dyadic modality demonstrated superior efficacy when parents had elevated ADHD or depression symptoms or high conflict with the teen. Families with lower parent education level and higher parental depression showed lower overall attendance; married parents were more likely to attend dyadic STAND (vs. group). Naturalistic stimulant medication did not influence treatment outcome. At less than one third of the cost of dyadic treatment, group models may be an economical option for treating parents and adolescents with ADHD. Screening adolescents with ADHD for parental psychopathology and parent-teen conflict may allow clinics to match higher risk patients to more personalized approaches that can enhance efficacy.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Health, Florida International University
| | | | - Stefany Coxe
- Department of Psychology, Florida International University
| | - Timothy Page
- Health Policy and Management, Florida International University
| | - Kisbel Espinal
- Center for Children and Families, Florida International University
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177
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Salehinejad MA, Wischnewski M, Nejati V, Vicario CM, Nitsche MA. Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits. PLoS One 2019; 14:e0215095. [PMID: 30978259 PMCID: PMC6461252 DOI: 10.1371/journal.pone.0215095] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 02/02/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications in neuropsychiatric diseases. Its application in neurodevelopmental disorders especially attention-deficit hyperactivity disorder (ADHD), is in early stage and promising but its effectiveness has not been systematically examined yet. We conducted a meta-analysis on the effectiveness of tDCS on the most studied neuropsychological symptoms of ADHD, which is the first reported meta-analysis of tDCS studies on ADHD. Data from 10 randomized controlled studies (including 11 separate experiments) targeting inhibitory control, and/or working memory (WM) in ADHD were included. Results show that overall tDCS significantly improved inhibitory control. Sub-analyses further show that dorsolateral prefrontal cortex (dlPFC) (but not right inferior frontal gyrus) tDCS and anodal (but not cathodal) tDCS significantly improved inhibitory control with a small effect size. Anodal dlPFC-tDCS had the largest significant effect on inhibitory control with a small-to-medium effect size. Additionally, a significant improving effect of tDCS on inhibitory control accuracy (but not response time) and WM speed (but not accuracy) were found. Overall, this meta-analysis supports a beneficial effect of tDCS on inhibitory control and WM in ADHD with a small-to-medium effect size. TDCS seems to be a promising method for improving neuropsychological and cognitive deficits in ADHD. However, there might be a dissociation between neuropsychological deficits and clinical symptoms of ADHD and therefore, the significance of this meta-analysis for clinical purposes is limited. Future studies should systematically evaluate the role of inter-individual factors (i.e., ADHD subtype, types of the deficit) and stimulation parameters (i.e., site, polarity, intensity, duration, repetition rate) on tDCS efficacy in ADHD population and examine whether benefits are long-term.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Ruhr-University Bochum, International Graduate School of Neuroscience, Bochum, Germany
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
- * E-mail:
| | - Miles Wischnewski
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, The Netherlands
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Carmelo M. Vicario
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
- University of Messina, Department of Scienze Cognitive della Formazione e degli Studi Culturali, Messina, Italy
| | - Michael A. Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
- University Medical Hospital Bergmannsheil, Department of Neurology, Bochum, Germany
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178
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Jangmo A, Stålhandske A, Chang Z, Chen Q, Almqvist C, Feldman I, Bulik CM, Lichtenstein P, D'Onofrio B, Kuja-Halkola R, Larsson H. Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication. J Am Acad Child Adolesc Psychiatry 2019; 58:423-432. [PMID: 30768391 PMCID: PMC6541488 DOI: 10.1016/j.jaac.2018.11.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/01/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for poor school performance, and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance. METHOD A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum. RESULTS ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio = 0.80, 95% confidence interval (CI) = 0.76-0.84, and a higher grade point sum (range, 0.0-320.0) of 9.35 points, 95% CI = 7.88-10.82; standardized coefficient = 0.20. CONCLUSION ADHD has a substantial negative impact on school performance, whereas pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.
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Affiliation(s)
| | - Amanda Stålhandske
- Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Clinic, Stockholm County Council, Stockholm, Sweden
| | | | - Qi Chen
- Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Cynthia M Bulik
- Karolinska Institutet, Stockholm, Sweden; University of North Carolina at Chapel Hill, NC
| | | | - Brian D'Onofrio
- Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington, IN
| | | | - Henrik Larsson
- Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
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179
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Raiker JS, Friedman LM, Orban SA, Kofler MJ, Sarver DE, Rapport MD. Phonological Working Memory Deficits in ADHD Revisited: The Role of Lower Level Information-Processing Deficits in Impaired Working Memory Performance. J Atten Disord 2019; 23:570-583. [PMID: 28077012 DOI: 10.1177/1087054716686182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study dissociates lower level information-processing abilities (visual registration/encoding, visual-to-phonological conversion, and response output) and examines their contribution to ADHD-related phonological working memory (PHWM) deficits. METHOD Twenty children with ADHD and 15 typically developing (TD) children completed tasks assessing PHWM, visual registration/encoding, visual-to-phonological conversion, and response output. RESULTS Relative to TD children, children with ADHD exhibited deficient visual registration/encoding ( d = 0.60), visual-to-phonological conversion ( d = 0.56), and PHWM ( d = 0.72) but faster response output ( d = -0.66). Bias-corrected, bootstrapped mediation analyses revealed that visual registration/encoding, but not visual-to-phonological conversion, partially mediated ADHD-related PHWM impairments. In contrast, faster response output in children with ADHD served as a suppressor variable, such that greater PHWM deficits were observed in children with ADHD after controlling for their faster response output ( d = 0.72 vs. 0.85). CONCLUSION Results implicate both lower level (visual registration/encoding) and higher order (PHWM) impairments in ADHD. Implications for designing educationally relevant cognitive interventions are discussed.
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180
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Attention-deficit/hyperactivity disorder: An integrated developmental psychopathology and Research Domain Criteria (RDoC) approach. Compr Psychiatry 2019; 90:65-72. [PMID: 30743139 PMCID: PMC6913174 DOI: 10.1016/j.comppsych.2018.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by heterogeneous behaviors and symptoms, developmental trajectories, and treatment response. Isolating intermediate phenotypes that are superior to current DSM-based nosology in order to explain such heterogeneity is integral to enhancing etiological theory, improving clinical assessment, predicting treatment response, and developing tailored treatments. To this end, this review provides an integrated developmental psychopathology and National Institute of Mental Health Research Domain Criteria (RDoC) approach to ADHD. In particular, associations between ADHD and RDoC domains of cognition (specifically working memory) and positive valence (reward anticipation/delay/receipt) are discussed. These domains are examined across behavioral and neurocircuitry levels of analysis and placed within a developmental context via examining associations among RDoC domains, relevant features of ADHD, and environmental correlates implicated across development. Limitations of the existing literature and proposed future directions are explored. Importantly, future work should focus on novel approaches that account for developmental shifts in functioning of relevant RDoC domains over time, as well as further examination of the interaction across RDoC domains and levels of analysis.
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181
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Arnold LE, Roy A, Taylor E, Hechtman L, Sibley M, Swanson JM, Mitchell JT, Molina BSG, Rohde LA. Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult outcomes in the MTA and effect of comorbidity. Eur Child Adolesc Psychiatry 2019; 28:557-570. [PMID: 30232561 DOI: 10.1007/s00787-018-1222-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/03/2018] [Indexed: 01/20/2023]
Abstract
Diagnostic guidelines differ between DSM attention-deficit/hyperactivity disorder (ADHD) and ICD hyperkinetic disorder (HKD). Only 145 of 579 children age 7-9 in the Multimodal Treatment Study of ADHD (the MTA) with combined-type DSM-IV ADHD met criteria for ICD-10 HKD, because major internalizing comorbidities and more stringent symptom count/pervasiveness requirements excluded most. The 145 HKD had significantly better 14-month medication response than the rest. We explored whether HKD had greater adult symptom persistence and/or impairment than other ADHD. Multi-informant assessments were done for 16 years. We used the 12/14/16-year assessments, in young adulthood. The post-attrition 109 with baseline HKD had no greater adult persistence of ADHD symptoms/impairment than 367 without HKD, but had more cumulative stimulant use, more job losses, lower emotional lability, and fewer car crashes. However, those excluded for internalizing comorbidity but otherwise meeting HKD criteria had significantly more persistence. Only 6 of the 109 (5.5%) with baseline HKD met ICD-10 criteria for HKD in adulthood, compared to 25 of 367 (6.8%) without a childhood HKD diagnosis. Despite greater initial symptom severity, HKD had no worse 16-year young adult outcome than others, except for job losses, balanced by less emotional lability and fewer crashes. Comorbid internalizing disorder seems to have worse prognosis than initial severity/pervasiveness of ADHD symptoms.
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Affiliation(s)
- L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, 395E McCampbell Hall, 1581 Dodd Dr, Columbus, OH, 43210, USA.
| | - Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg, Würzburg, Germany
| | - Eric Taylor
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Lily Hechtman
- McGill University, Montreal Children's Hospital, Montreal, Canada
| | - Margaret Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, USA
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, USA
| | - John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA
| | - Brooke S G Molina
- Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Luis A Rohde
- Division of Child and Adolescent Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul and National Institute of Developmental Psychiatry for Children and Adolescents, Porto Alegre, Brazil
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182
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Waxmonsky JG, Baweja R. Editorial: Does an Attention-Deficit/Hyperactivity Disorder Pill a Day Keep Failing Grades Away? J Am Acad Child Adolesc Psychiatry 2019; 58:395-397. [PMID: 30849502 DOI: 10.1016/j.jaac.2019.01.014] [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] [Received: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Numerous studies have found that attention-deficit/hyperactivity disorder (ADHD) significantly impairs academic functioning. Observed impairments span diverse outcomes, from grade point average (GPA) and standardized test scores to grade retention and dropout. The impact of treating ADHD on academic functioning has received appreciable attention but remains a topic of debate because of the mixed and somewhat underwhelming results to date. The best evidence for effect is the capacity of central nervous system (CNS) stimulants to decrease problematic behaviors in the classroom.1 However, it is not clear whether improved behavior translates into better academic functioning. In fact, there is evidence that parents might be less likely to follow through on behavioral interventions after medication has been initiated, even when parents report persistent impairment from ADHD.2.
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183
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Hammond DC. Integrating Clinical Hypnosis and Neurofeedback. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:302-321. [PMID: 31017552 DOI: 10.1080/00029157.2018.1501550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hypnosis and neurofeedback each provide unique therapeutic strengths and opportunities. This article provides an overview of some of the research on neurofeedback and hypnosis. The author's perspective and recommendations are provided on the relative clinical utility of using either neurofeedback or hypnosis as the initial treatment of choice with various clinical conditions.
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184
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Vergunst F, Tremblay RE, Nagin D, Algan Y, Beasley E, Park J, Galera C, Vitaro F, Côté SM. Association of Behavior in Boys From Low Socioeconomic Neighborhoods With Employment Earnings in Adulthood. JAMA Pediatr 2019; 173:334-341. [PMID: 30742199 PMCID: PMC6450268 DOI: 10.1001/jamapediatrics.2018.5375] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/03/2018] [Indexed: 12/24/2022]
Abstract
Importance Identifying early childhood behavioral problems associated with economic success/failure is essential for the development of targeted interventions that enhance economic prosperity through improved educational attainment and social integration. Objective To test the association between kindergarten teacher-rated assessments of inattention, hyperactivity, opposition, aggression, and prosociality in boys with their employment earnings at age 35 to 36 years as measured by government tax return data. Design, Setting, and Participants A 30-year prospective follow-up study analyzing low socioeconomic neighborhoods in Montreal, Quebec, Canada. Boys aged 5 to 6 years attending kindergarten in low socioeconomic neighborhoods were recruited. Teacher-rated behavioral assessments were obtained for 1040 boys. Data were collected from April 1984 to December 2015. Analysis began January 2017. Main Outcomes and Measures Mixed-effects linear regression models were used to examine the association between teacher ratings of inattention, hyperactivity, opposition, aggression, and prosociality at age 6 years and individual earnings obtained from government tax returns at age 35 to 36 years. The IQ of the child and family adversity were adjusted for in the analysis. Results Complete data were available for 920 study participants (mean age at follow-up was 36.3 years). Mean (SD) personal earnings at follow-up were $28 865.53 ($24 103.45) (range, $0-$142 267.84). A 1-unit increase in inattention (mean [SD], 2.66 [2.34]; range, 0-8) at age 6 years was associated with decrease in earnings at age 35 to 36 years of $1295.13 (95% CI, -$2051.65 to -$538.62), while a unit increase in prosociality (mean [SD], 8.0 [4.96]; range, 0-20) was associated with an increase in earnings of $406.15 (95% CI, $172.54-$639.77). Hyperactivity, opposition, and aggression were not significantly associated with earnings. Child IQ was associated with higher earnings and family adversity with lower earnings in all models. A 1-SD reduction in inattention at age 6 years was associated with a theoretical increase in annual earnings of $3040.41, a similar magnitude to an equivalent increase in IQ. Conclusions and Relevance Teacher ratings of inattention and prosociality in kindergarten boys from low socioeconomic neighborhoods are associated with earnings in adulthood after adjustment for hyperactivity, aggression, and opposition, which were not associated with earnings. Interventions beginning in kindergarten that target boys' inattention and enhance prosociality could positively impact workforce integration and earnings.
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Affiliation(s)
- Francis Vergunst
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montreal, Quebec, Canada
| | - Richard E. Tremblay
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montreal, Quebec, Canada
- Department of Pediatrics and Psychology, University of Montreal, Montreal, Quebec, Canada
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
- Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Daniel Nagin
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Yann Algan
- Sciences Po Economic Department, L’Observatoire Français des Conjonctures Économiques (OFCE), Paris, France
| | - Elizabeth Beasley
- Centre pour la recherche économique et ses applications (CEPREMAP), Paris, France
| | | | - Cedric Galera
- Université de Bordeaux, INSERM U1219, Centre Hospitalier Perrens, Bordeaux, France
| | - Frank Vitaro
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montreal, Quebec, Canada
- Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
- School of Psycho-Education, University of Montreal, Montreal, Canada
| | - Sylvana M. Côté
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montreal, Quebec, Canada
- Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
- Université de Bordeaux, INSERM U1219, Centre Hospitalier Perrens, Bordeaux, France
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185
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Leaberry KD, Rosen PJ, Slaughter KE, Reese J, Fogleman ND. Temperamental negative affect, emotion-specific regulation, and concurrent internalizing and externalizing pathology among children with ADHD. ACTA ACUST UNITED AC 2019; 11:311-324. [PMID: 30905024 DOI: 10.1007/s12402-019-00294-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) experience high rates of temperamental negative affect and comorbid internalizing and externalizing pathology. The current study explored the role of emotion-specific regulation in accounting for the link between temperamental negative affect and psychopathology among children with ADHD. Forty parents of children ages 8-11 (N =29 males, N =11 females) completed measures of child temperament, emotion-specific dysregulation (i.e., anger dysregulation, sadness dysregulation), and psychopathology. Children completed a measure of emotion-specific dysregulation. Results revealed that anger dysregulation fully statistically accounted for the relationship between temperamental negative affect and concurrent externalizing problems. Sadness dysregulation did not account for the relationship between temperamental negative affect and internalizing problems. These novel findings implicate the robust role of anger dysregulation in explaining the link between temperamental negative affect and concurrent externalizing pathology. The results of this study have significant implications for the treatment of emotionally driven externalizing behavior among children with ADHD.
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Affiliation(s)
- Kirsten D Leaberry
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Room 317, Louisville, KY, 40292, USA.
| | - Paul J Rosen
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Room 317, Louisville, KY, 40292, USA
| | - Kelly E Slaughter
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Room 317, Louisville, KY, 40292, USA
| | - Joseph Reese
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Room 317, Louisville, KY, 40292, USA
| | - Nicholas D Fogleman
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Room 317, Louisville, KY, 40292, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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186
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IQ and Academic Achievement in Children with ADHD: the Differential Effects of Specific Cognitive Functions. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09728-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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187
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Rucklidge JJ, Eggleston MJF, Darling KA, Stevens AJ, Kennedy MA, Frampton CM. Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:181-192. [PMID: 30217770 DOI: 10.1016/j.pnpbp.2018.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intent-to-treat analyses from a randomized controlled trial showed significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement, but no group differences on clinician, parent and teacher ratings of overall ADHD symptoms. There was an advantage of micronutrients over placebo in improving overall function, emotional regulation, aggression, and reducing impairment as well as improving inattention based on clinician but not parent observation. No group differences were observed on hyperactive-impulsive symptoms. We investigated predictors of response defined by pre-treatment variables. METHOD We conducted analyses of data from a clinical trial of children (7-12 years) with ADHD, whereby participants were randomized to receive micronutrients or placebo for 10 weeks followed by a 10 week open-label (OL) phase. We included only children who had been exposed to micronutrients for a full 10 week period and demonstrated satisfactory adherence, either in RCT phase (n = 40) or OL phase (those who received placebo during RCT phase; n = 31). Seven outcomes were examined: change in ADHD symptoms (clinician/parent), ADHD responder, overall responder, change in mood, change in functioning, and change in aggression. Demographic, developmental variables, current clinical and physical characteristics, MTHFR genotype at two common variants, and pre-treatment serum/plasma levels (vitamin D, B12, folate, zinc, copper, iron, ferritin, potassium, calcium, magnesium, and homocysteine) were all considered as putative predictors. RESULTS Substantial nutrient deficiencies pre-treatment were observed only for vitamin D (13%) and copper (15%), otherwise most children entered the trial with nutrient levels falling within expected ranges. Regression analyses showed varying predictors across outcomes with no one predictor being consistently identified across different variables. Lower pre-treatment folate and B12 levels, being female, greater severity of symptoms and co-occurring disorders pre-treatment, more pregnancy complications and fewer birth problems were identified as possible predictors of greater improvement for some but not all outcome measures although predictive values were weak. Lower IQ and higher BMI predicted greater improvement in aggression. CONCLUSIONS This study replicates Rucklidge et al. (2014b) showing the limited value of using serum nutrient levels to predict treatment response although we cannot rule out that other non-assayed nutrient levels may be more valuable. Additionally, no specific demographic or clinical characteristics, including MTHFR genetic status, were identified that would preclude children with ADHD from trying this treatment approach.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand.
| | | | - Kathryn A Darling
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Aaron J Stevens
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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188
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Schrantee A, Bouziane C, Bron EE, Klein S, Bottelier MA, Kooij JJS, Rombouts SARB, Reneman L. Long-term effects of stimulant exposure on cerebral blood flow response to methylphenidate and behavior in attention-deficit hyperactivity disorder. Brain Imaging Behav 2019; 12:402-410. [PMID: 28321605 PMCID: PMC5880865 DOI: 10.1007/s11682-017-9707-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stimulant prescription rates for attention deficit hyperactivity disorder (ADHD) are increasing, even though potential long-term effects on the developing brain have not been well-studied. A previous randomized clinical trial showed short-term age-dependent effects of stimulants on the DA system. We here assessed the long-term modifying effects of age-of-first-stimulant treatment on the human brain and behavior. 81 male adult ADHD patients were stratified into three groups: 1) early stimulant treatment (EST; <16 years of age) 2) late stimulant treatment (LST: ≥23 years of age) and 3) stimulant treatment naive (STN; no history of stimulant treatment). We used pharmacological magnetic resonance imaging (phMRI) to assess the cerebral blood flow (CBF) response to an oral methylphenidate challenge (MPH, 0.5 mg/kg), as an indirect measure of dopamine function in fronto-striatal areas. In addition, mood and anxiety scores, and recreational drug use were assessed. Baseline ACC CBF was lower in the EST than the STN group (p = 0.03), although CBF response to MPH was similar between the three groups (p = 0.23). ADHD symptom severity was higher in the STN group compared to the other groups (p < 0.01). In addition, the EST group reported more depressive symptoms (p = 0.04), but not anxiety (p = 0.26), and less recreational drug use (p = 0.04). In line with extensive pre-clinical data, our data suggest that early, but not late, stimulant treatment long-lastingly affects the human brain and behavior, possibly indicating fundamental changes in the dopamine system.
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Affiliation(s)
- Anouk Schrantee
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1105, AZ, Amsterdam, the Netherlands.
| | - C Bouziane
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1105, AZ, Amsterdam, the Netherlands
| | - E E Bron
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - S Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - M A Bottelier
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1105, AZ, Amsterdam, the Netherlands.,Department of Child- and Adolescent Psychiatry, Triversum, Kees Boekestraat 5, 1817, EZ, Alkmaar, The Netherlands
| | - J J S Kooij
- Expertise Center Adult ADHD, PsyQ, Psycho-Medical Programs, Carel Reinierszkade 197, 2593, HR, The Hague, The Netherlands
| | - S A R B Rombouts
- Institute of Psychology, Leiden University, P.O. Box 9555, 2300, RB, Leiden, The Netherlands.,Department of Radiology, LUMC, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - L Reneman
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1105, AZ, Amsterdam, the Netherlands
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189
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Van Doren J, Arns M, Heinrich H, Vollebregt MA, Strehl U, K Loo S. Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2019; 28:293-305. [PMID: 29445867 PMCID: PMC6404655 DOI: 10.1007/s00787-018-1121-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
Neurofeedback (NF) has gained increasing interest in the treatment of attention-deficit/hyperactivity disorder (ADHD). Given learning principles underlie NF, lasting clinical treatment effects may be expected. This systematic review and meta-analysis addresses the sustainability of neurofeedback and control treatment effects by considering randomized controlled studies that conducted follow-up (FU; 2-12 months) assessments among children with ADHD. PubMed and Scopus databases were searched through November 2017. Within-group and between-group standardized mean differences (SMD) of parent behavior ratings were calculated and analyzed. Ten studies met inclusion criteria (NF: ten studies, N = 256; control: nine studies, N = 250). Within-group NF effects on inattention were of medium effect size (ES) (SMD = 0.64) at post-treatment and increased to a large ES (SMD = 0.80) at FU. Regarding hyperactivity/impulsivity, NF ES were medium at post-treatment (SMD = 0.50) and FU (SMD = 0.61). Non-active control conditions yielded a small significant ES on inattention at post-treatment (SMD = 0.28) but no significant ES at FU. Active treatments (mainly methylphenidate), had large ES for inattention (post: SMD = 1.08; FU: SMD = 1.06) and medium ES for hyperactivity/impulsivity (post: SMD = 0.74; FU: SMD = 0.67). Between-group analyses also revealed an advantage of NF over non-active controls [inattention (post: SMD = 0.38; FU: SMD = 0.57); hyperactivity-impulsivity (post: SMD = 0.25; FU: SMD = 0.39)], and favored active controls for inattention only at pre-post (SMD = - 0.44). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment. More studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.
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Affiliation(s)
- Jessica Van Doren
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Erlangen, Germany
| | - Martijn Arns
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.
- neuroCare Group, Munich, Germany.
- Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD, Nijmegen, The Netherlands.
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Erlangen, Germany
- kbo-Heckscher-Klinikum, Munich, Germany
| | - Madelon A Vollebregt
- Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ute Strehl
- Institute for Medical Psychology, University of Tuebingen, Tuebingen, Germany
| | - Sandra K Loo
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, USA
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190
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Garic D, Broce I, Graziano P, Mattfeld A, Dick AS. Laterality of the frontal aslant tract (FAT) explains externalizing behaviors through its association with executive function. Dev Sci 2019; 22:e12744. [PMID: 30159951 PMCID: PMC9828516 DOI: 10.1111/desc.12744] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 08/25/2018] [Indexed: 01/12/2023]
Abstract
We investigated the development of a recently identified white matter pathway, the frontal aslant tract (FAT) and its association with executive function and externalizing behaviors in a sample of 129 neurotypical male and female human children ranging in age from 7 months to 19 years. We found that the FAT could be tracked in 92% of those children, and that the pathway showed age-related differences into adulthood. The change in white matter microstructure was very rapid until about 6 years, and then plateaued, only to show age-related increases again after the age of 11 years. In a subset of those children (5-18 years; n = 70), left laterality of the microstructural properties of the FAT was associated with greater attention problems as measured by the Child Behavior Checklist (CBCL). However, this relationship was fully mediated by higher executive dysfunction as measured by the Behavior Rating Inventory of Executive Function (BRIEF). This relationship was specific to the FAT-we found no relationship between laterality of a control pathway, or of the white matter of the brain in general, and attention and executive function. These findings suggest that the degree to which the developing brain favors a right lateralized structural dominance of the FAT is directly associated with executive function and attention. This novel finding provides a new potential structural biomarker to assess attention deficit hyperactivity disorder (ADHD) and associated executive dysfunction during development.
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Affiliation(s)
- Dea Garic
- Department of Psychology, Florida International University, Miami, FL, 33199
| | - Iris Broce
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94143
| | - Paulo Graziano
- Department of Psychology, Florida International University, Miami, FL, 33199
| | - Aaron Mattfeld
- Department of Psychology, Florida International University, Miami, FL, 33199
| | - Anthony Steven Dick
- Department of Psychology, Florida International University, Miami, FL, 33199
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191
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Rubia K, Criaud M, Wulff M, Alegria A, Brinson H, Barker G, Stahl D, Giampietro V. Functional connectivity changes associated with fMRI neurofeedback of right inferior frontal cortex in adolescents with ADHD. Neuroimage 2019; 188:43-58. [PMID: 30513395 PMCID: PMC6414400 DOI: 10.1016/j.neuroimage.2018.11.055] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/21/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. We showed previously that 18 ADHD adolescents over 11 runs of 8.5 min of real-time functional magnetic resonance neurofeedback of the right inferior frontal cortex (rIFC) progressively increased activation in 2 regions of the rIFC which was associated with clinical symptom improvement. In this study, we used functional connectivity analyses to investigate whether fMRI-Neurofeedback of rIFC resulted in dynamic functional connectivity changes in underlying neural networks. Whole-brain seed-based functional connectivity analyses were conducted using the two clusters showing progressively increased activation in rIFC as seed regions to test for changes in functional connectivity before and after 11 fMRI-Neurofeedback runs. Furthermore, we tested whether the resulting functional connectivity changes were associated with clinical symptom improvements and whether they were specific to fMRI-Neurofeedback of rIFC when compared to a control group who had to self-regulate another region. rIFC showed increased positive functional connectivity after relative to before fMRI-Neurofeedback with dorsal caudate and anterior cingulate and increased negative functional connectivity with regions of the default mode network (DMN) such as posterior cingulate and precuneus. Furthermore, the functional connectivity changes were correlated with clinical improvements and the functional connectivity and correlation findings were specific to the rIFC-Neurofeedback group. The findings show for the first time that fMRI-Neurofeedback of a typically dysfunctional frontal region in ADHD adolescents leads to strengthening within fronto-cingulo-striatal networks and to weakening of functional connectivity with posterior DMN regions and that this may be underlying clinical improvement.
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Affiliation(s)
- K Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - M Criaud
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Wulff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - A Alegria
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - H Brinson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - G Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - D Stahl
- Department of Biostatistics & Health Informatics, King's College London, UK
| | - V Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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192
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Luo Y, Weibman D, Halperin JM, Li X. A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD). Front Hum Neurosci 2019; 13:42. [PMID: 30804772 PMCID: PMC6378275 DOI: 10.3389/fnhum.2019.00042] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/25/2019] [Indexed: 12/24/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects approximately 8%–12% of children worldwide. Throughout an individual’s lifetime, ADHD can significantly increase risk for other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. The multifactorial causation of ADHD is reflected in the heterogeneity of this disorder, as indicated by its diversity of psychiatric comorbidities, varied clinical profiles, patterns of neurocognitive impairment and developmental trajectories, and the wide range of structural and functional brain anomalies. Although evidence-based treatments can reduce ADHD symptoms in a substantial portion of affected individuals, there is yet no curative treatment for ADHD. A number of theoretical models of the emergence and developmental trajectories of ADHD have been proposed, aimed at providing systematic guides for clinical research and practice. We conducted a comprehensive review of the current status of research in understanding the heterogeneity of ADHD in terms of etiology, clinical profiles and trajectories, and neurobiological mechanisms. We suggest that further research focus on investigating the impact of the etiological risk factors and their interactions with developmental neural mechanisms and clinical profiles in ADHD. Such research would have heuristic value for identifying biologically homogeneous subgroups and could facilitate the development of novel and more tailored interventions that target underlying neural anomalies characteristic of more homogeneous subgroups.
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Affiliation(s)
- Yuyang Luo
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Dana Weibman
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Jeffrey M Halperin
- Department of Psychology, Queens College of the City University of New York, Flushing, NY, United States
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States.,Department of Electric and Computer Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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193
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Tsai FJ, Tseng WL, Yang LK, Gau SSF. Psychiatric comorbid patterns in adults with attention-deficit hyperactivity disorder: Treatment effect and subtypes. PLoS One 2019; 14:e0211873. [PMID: 30730956 PMCID: PMC6366698 DOI: 10.1371/journal.pone.0211873] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
Psychiatric comorbidities are common in individuals with attention-deficit/hyperactivity disorder (ADHD). In this study, we sought to evaluate the effects of medication and childhood ADHD subtypes on psychiatric comorbidities among adults with ADHD as compared to healthy adult controls. We assessed 121 drug-naïve adults with ADHD, 93 treated adults with ADHD, and 145 healthy controls (age 18-36 years) using semi-structured psychiatric interviews, intelligence tests, and medical records. Drug-naïve adults with ADHD had more comorbidities than treated adults with ADHD and controls. Childhood ADHD-combined subtype, relative to ADHD-inattentive subtype, was associated with higher risks of comorbidities. Current medication treatment was associate with a higher risk for anxiety disorders, and longer treatment duration was associated with lower risks of mood disorders and sleep disorders. Our results indicate that no medication treatment, short treatment duration, and childhood ADHD-combined subtype are associated with increased risks for psychiatric comorbidities among adults with ADHD.
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Affiliation(s)
- Fang-Ju Tsai
- Department of Psychiatry, National Taiwan University and College of Medicine, Taipei, Taiwan
- Department of Psychiatry, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Wan-Ling Tseng
- Emotion and Development Branch, National Institute of Mental Heath, National Institutes of Health, Department of Health and Human Sevices, Bethesda, MD, United States of America
| | - Li-Kuang Yang
- Department of Psychiatry, National Taiwan University and College of Medicine, Taipei, Taiwan
- Beitou Branch, Tri-Service General Hospital, National Medical Defense Center, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University and College of Medicine, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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194
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Arcos-Burgos M, Vélez JI, Martinez AF, Ribasés M, Ramos-Quiroga JA, Sánchez-Mora C, Richarte V, Roncero C, Cormand B, Fernández-Castillo N, Casas M, Lopera F, Pineda DA, Palacio JD, Acosta-López JE, Cervantes-Henriquez ML, Sánchez-Rojas MG, Puentes-Rozo PJ, Molina BSG, Boden MT, Wallis D, Lidbury B, Newman S, Easteal S, Swanson J, Patel H, Volkow N, Acosta MT, Castellanos FX, de Leon J, Mastronardi CA, Muenke M. ADGRL3 (LPHN3) variants predict substance use disorder. Transl Psychiatry 2019; 9:42. [PMID: 30696812 PMCID: PMC6351584 DOI: 10.1038/s41398-019-0396-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/02/2022] Open
Abstract
Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world (n = 2698), recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we assembled recursive-partitioning frameworks (classification tree analyses) with clinical, demographic, and ADGRL3 genetic information to predict SUD susceptibility. Our results indicate that SUD can be efficiently and robustly predicted in ADHD participants. The genetic models used remained highly efficient in predicting SUD in a large sample of individuals with severe SUD from a psychiatric institution that were not ascertained on the basis of ADHD diagnosis, thus identifying ADGRL3 as a risk gene for SUD. Recursive-partitioning analyses revealed that rs4860437 was the predominant predictive variant. This new methodological approach offers novel insights into higher order predictive interactions and offers a unique opportunity for translational application in the clinical assessment of patients at high risk for SUD.
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Affiliation(s)
- Mauricio Arcos-Burgos
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
- INPAC Research Group, Fundación Universitaria Sanitas, Bogotá, Colombia.
- Instituto de Investigaciones Médicas (IIM), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Jorge I Vélez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
- Universidad del Norte, Barranquilla, Colombia
| | - Ariel F Martinez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Josep A Ramos-Quiroga
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Sánchez-Mora
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Vanesa Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Roncero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Addiction and Dual Diagnosis Unit, Departament of Psychiatry, Hospital Universitari Vall d'Hebron-Public Health Agency, Barcelona, Spain
| | - Bru Cormand
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, CAT, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, CAT, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues, CAT, Spain
| | - Noelia Fernández-Castillo
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, CAT, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, CAT, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues, CAT, Spain
| | - Miguel Casas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Lopera
- Neuroscience Research Group, Universidad de Antioquia, Medellín, Colombia
| | - David A Pineda
- Neuroscience Research Group, Universidad de Antioquia, Medellín, Colombia
| | - Juan D Palacio
- Neuroscience Research Group, Universidad de Antioquia, Medellín, Colombia
| | - Johan E Acosta-López
- Grupo de Neurociencias del Caribe, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Martha L Cervantes-Henriquez
- Universidad del Norte, Barranquilla, Colombia
- Grupo de Neurociencias del Caribe, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Manuel G Sánchez-Rojas
- Grupo de Neurociencias del Caribe, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Pedro J Puentes-Rozo
- Grupo de Neurociencias del Caribe, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Barranquilla, Colombia
- Grupo de Neurociencias del Caribe, Universidad del Atlántico, Barranquilla, Colombia
| | - Brooke S G Molina
- Departments of Psychiatry and Psychology, University of Pittsburg, Pittsburg, PA, USA
| | - Margaret T Boden
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
| | - Deeann Wallis
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, USA
| | - Brett Lidbury
- National Center for Indigenous Genomics, Genome Biology Department, John Curtin School of Medical Research, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
| | - Saul Newman
- National Center for Indigenous Genomics, Genome Biology Department, John Curtin School of Medical Research, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
| | - Simon Easteal
- National Center for Indigenous Genomics, Genome Biology Department, John Curtin School of Medical Research, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
| | - James Swanson
- Department of Psychiatry, Florida International University, Miami, FL, USA
- Child Development Center, University of California at Irvine, Irvine, CA, USA
| | - Hardip Patel
- Genome Discovery Unit, Genome Biology Department, John Curtin School of Medical Research, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia
| | - Nora Volkow
- Office of the Director, National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, USA
| | - Maria T Acosta
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Francisco X Castellanos
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
| | - Claudio A Mastronardi
- INPAC Research Group, Fundación Universitaria Sanitas, Bogotá, Colombia
- Center for Research in Genetics and Genomics, Institute of Translational Medicine, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
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195
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Merrill BM, Molina BSG, Coxe S, Gnagy EM, Altszuler AR, Macphee FL, Morrow AS, Trucco EM, Pelham WE. Functional Outcomes of Young Adults with Childhood ADHD: A Latent Profile Analysis. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:215-228. [PMID: 30689405 DOI: 10.1080/15374416.2018.1547968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adults with childhood attention-deficit hyperactivity disorder (ADHD) experience impairment in core functional domains (e.g., educational attainment, occupational status, social relationships, substance abuse, and criminal behavior), but it is currently unclear which impairments co-occur and whether subgroups experience differentiable patterns, none, or all aforementioned functional domains. Latent profile analysis (LPA) was used to characterize patterns of impairment. Data from the Pittsburgh ADHD Longitudinal Study were used. The 317 participants were 25 years old and had childhood ADHD. LPA characterized the variability across substance use (alcohol consumption, cigarette smoking, marijuana use), criminal behavior, peer impairment, educational attainment, maternal relationship, financial dependence, and sexual activity among young adults with childhood ADHD. Childhood predictors of profiles were examined, and ADHD profiles were compared to a matched comparison group without ADHD also followed longitudinally (n = 217). Five profiles were found: prototypic impairment group (54%), high binge-drinking group (17%), high marijuana use group (10%), high criminal activity group (3%), and high cross-domain impairment group (17%). All profiles were impaired compared to non-ADHD young adults. Childhood variables rarely significantly predicted profiles. Young adults with childhood ADHD have differentiable impairment patterns that vary based on substance use, criminal behavior, and number of clinically impaired domains. Nearly all young adult ADHD profiles were impaired in peer, educational, and financial domains, and there was not a nonimpaired ADHD profile. Use of specific substances was elevated among subgroups of, but not all, young adults with ADHD histories. Finally, the high cross-domain impairment profile was impaired in all domains.
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Affiliation(s)
| | | | - Stefany Coxe
- Department of Psychology, Florida International University
| | | | | | | | - Anne S Morrow
- Department of Psychology, Florida International University
| | - Elisa M Trucco
- Department of Psychology, Florida International University
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196
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Estrada-Plana V, Esquerda M, Mangues R, March-Llanes J, Moya-Higueras J. A Pilot Study of the Efficacy of a Cognitive Training Based on Board Games in Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial. Games Health J 2019; 8:265-274. [PMID: 30653355 DOI: 10.1089/g4h.2018.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective: The main aim of this study was to prove the efficacy of an intervention based on board games on executive functions (EFs) and clinical symptoms in children with attention-deficit/hyperactivity disorder (ADHD). Materials and Methods: A nonblinded randomized controlled trial was conducted with a sample of children with a diagnosis of ADHD (diagnosed by psychiatrists and clinical psychologists in a mental health center). Children were randomly allocated by matching age and sex, into two groups: experimental EF training group (n = 13; mean [M]age = 9.46, standard deviation [SD] = 1.20; boys = 53.8%) or a wait-list control group (n = 14; Mage = 9.50, SD = 1.09; boys = 71.4%). Measures assessed individually at pretest, posttest, and follow-up intervention included EFs and clinical symptoms. Results: Analysis of covariance repeated measures analysis showed that linguistic short-term memory, F(1,28) = 7.45, p = 0.02, and conduct problems, F(1,28) = 12.51, p = 0.00, significantly improved with larger effects in the board games training group after intervention when compared to the wait-list group. Although nonsignificant effects were reported at the follow-up, large effect sizes were actually found. Conclusion: Although future studies are needed, the results of this study highlight the importance of board games and its efficacy as a possible therapeutic and/or preventive intervention on ADHD.
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Affiliation(s)
- Verónica Estrada-Plana
- 1Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain
| | - Montserrat Esquerda
- 2Sant Joan de Deu Childhood and Adolescence Mental Health Center, Lleida, Spain
| | - Rocío Mangues
- 2Sant Joan de Deu Childhood and Adolescence Mental Health Center, Lleida, Spain
| | - Jaume March-Llanes
- 1Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain
| | - Jorge Moya-Higueras
- 1Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain.,3Centre of Biomedical Research Network on Mental Health (CIBERSAM), Barcelona, Spain
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197
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Abstract
PURPOSE OF REVIEW Current traditional treatments for ADHD present serious limitations in terms of long-term maintenance of symptom remission and side effects. Here, we provide an overview of the rationale and scientific evidence of the efficacy of neurofeedback in regulating the brain functions in ADHD. We also review the institutional and professional regulation of clinical neurofeedback implementations. RECENT FINDINGS Based on meta-analyses and (large multicenter) randomized controlled trials, three standard neurofeedback training protocols, namely theta/beta (TBR), sensori-motor rhythm (SMR), and slow cortical potential (SCP), turn out to be efficacious and specific. However, the practical implementation of neurofeedback as a clinical treatment is currently not regulated. We conclude that neurofeedback based on standard protocols in ADHD should be considered as a viable treatment alternative and suggest that further research is needed to understand how specific neurofeedback protocols work. Eventually, we emphasize the need for standard neurofeedback training for practitioners and binding standards for use in clinical practice.
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Affiliation(s)
- Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
- Department of Biomedical Sciences of Cells & Systems, Section of Cognitive Neuropsychiatry, University of Groningen, Groningen, The Netherlands.
| | - Diede Smit
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Miguel Garcia Pimenta
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Martijn Arns
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
- neuroCare Group, Munich, Germany
- Research Institute Brainclinics, Nijmegen, The Netherlands
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198
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Safer DJ, Zito JM. Short- and Long-Term Antidepressant Clinical Trials for Major Depressive Disorder in Youth: Findings and Concerns. Front Psychiatry 2019; 10:705. [PMID: 31681028 PMCID: PMC6797591 DOI: 10.3389/fpsyt.2019.00705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/02/2019] [Indexed: 01/20/2023] Open
Abstract
The diagnosis of major depressive disorder (MDD) in U.S. youth is increasing as is the rate of antidepressant medication (ADM) treatment for the disorder. Fluoxetine and escitalopram are FDA approved for the short term and maintenance treatment of MDD in youth. Placebo-controlled short-term ADM trials represent the basis for Food and Drug Administration (FDA) approval. Meta-analyses in 2007 and 2016 revealed that short-term ADM treatment of youth diagnosed with MDD resulted in no meaningful benefit for children and only marginal benefit for adolescents. Placebo substitution trials of ADM short-term responders represent the basis for FDA approval of ADM maintenance treatment. These ADM placebo substitution maintenance trials for youth with MDD are characterized by high dropout rates, a rapid withdrawal that often can follow the switch to placebo, and relapse rates that are not dissimilar from those in the natural course of the disorder. Without the evidence from problematic ADM placebo substitution trials, there is no acceptable support for the inclusion of ADM in maintenance treatment for MDD in youth.
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Affiliation(s)
- Daniel J Safer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julie Magno Zito
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, United States.,Department of Psychiatry, University of Maryland, Baltimore, Baltimore, MD, United States
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199
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Schweren L, Hoekstra P, van Lieshout M, Oosterlaan J, Lambregts-Rommelse N, Buitelaar J, Franke B, Hartman C. Long-term effects of stimulant treatment on ADHD symptoms, social-emotional functioning, and cognition. Psychol Med 2019; 49:217-223. [PMID: 29530108 DOI: 10.1017/s0033291718000545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Methodological and ethical constraints have hampered studies into long-term lasting outcomes of stimulant treatment in individuals with attention-deficit/hyperactivity disorder (ADHD). Lasting effects may be beneficial (i.e. improved functioning even when treatment is temporarily ceased) or detrimental (i.e. worse functioning while off medication), but both hypotheses currently lack empirical support. Here we investigate whether stimulant treatment history predicts long-term development of ADHD symptoms, social-emotional functioning or cognition, measured after medication wash-out. METHODS ADHD symptoms, social-emotional functioning and cognitive test performance were measured twice, 6 years apart, in two ADHD groups (stimulant-treated versus not stimulant-treated between baseline and follow-up). Groups were closely matched on baseline clinical and demographic variables (n = 148, 58% male, age = 11.1). A matched healthy control group was included for reference. RESULTS All but two outcome measures (emotional problems and prosocial behaviour) improved between baseline and follow-up. Improvement over time in the stimulant-treated group did not differ from improvement in the not stimulant-treated group on any outcome measure. CONCLUSIONS Stimulant treatment is not associated with the long-term developmental course of ADHD symptoms, social-emotional functioning, motor control, timing or verbal working memory. Adolescence is characterised by clinical improvement regardless of stimulant treatment during that time. These findings are an important source to inform the scientific and public debate.
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Affiliation(s)
- Lizanne Schweren
- Department of Psychiatry,University Medical Center Groningen,Groningen,The Netherlands
| | - Pieter Hoekstra
- Department of Psychiatry,University Medical Center Groningen,Groningen,The Netherlands
| | | | | | - Nanda Lambregts-Rommelse
- Radboud University Medical Center, Donders Institute for Brain,Cognition and Behaviour,Nijmegen,The Netherlands
| | - Jan Buitelaar
- Radboud University Medical Center, Donders Institute for Brain,Cognition and Behaviour,Nijmegen,The Netherlands
| | - Barbara Franke
- Radboud University Medical Center, Donders Institute for Brain,Cognition and Behaviour,Nijmegen,The Netherlands
| | - Catharina Hartman
- Department of Psychiatry,University Medical Center Groningen,Groningen,The Netherlands
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200
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Kim B. Pharmacotherapy for attention-deficit/hyperactivity disorder. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.1.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Bongseog Kim
- Department of Psychiatry, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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