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Tamir S, Dye TJ, Witt RM. Sleep and Circadian Disturbances in Children With Neurodevelopmental Disorders. Semin Pediatr Neurol 2023; 48:101090. [PMID: 38065637 DOI: 10.1016/j.spen.2023.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023]
Abstract
Sleep problems are highly prevalent in those with neurodevelopmental disorders (NDDs). We propose this is secondary to multiple factors that directly and indirectly negatively impact sleep and circadian processes in those with NDDs, which in turn, further perturbs development, resulting in a "developmental and sleep/circadian-related encephalopathy." In this review, we discuss select NDDs with known or suspected sleep and circadian phenotypes. We also highlight important considerations when evaluating and treating sleep and circadian disorders in these populations.
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Affiliation(s)
- Sharon Tamir
- University of Cincinnati College of Medicine, Cincinnati, OH; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas J Dye
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rochelle M Witt
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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2
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Giambersio D, Marzulli L, Margari L, Matera E, Nobili L, De Grandis E, Cordani R, Barbieri A, Peschechera A, Margari A, Petruzzelli MG. Correlations between Sleep Features and Iron Status in Children with Neurodevelopmental Disorders: A Cross-Sectional Study. J Clin Med 2023; 12:4949. [PMID: 37568350 PMCID: PMC10420017 DOI: 10.3390/jcm12154949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
A high prevalence of sleep disturbances has been reported in children with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability (ID). The etiology of sleep disorders in these children is heterogeneous and, recently, iron deficiency has received increasing attention. This study aims to investigate sleep features in children with NDDs and to explore a possible correlation between serum iron status biomarkers and qualitative features of sleep. We included 4- to 12-year-old children with a diagnosis of ASD, ADHD, or ID and assessed their sleep features through the children's sleep habits questionnaire (CSHQ). Venous blood samples were collected to investigate ferritin, transferrin, and iron levels. The mean CSHQ total score exceeds the cut-off in all groups of children. In the ASD group, the Parasomnias subscale negatively correlated with serum ferritin levels (Rho = 0.354; p = 0.029). Our findings may suggest the existence of an association between iron status, sleep quality, and neurodevelopmental processes. In clinical practice, sleep assessment should be included in the routine assessment for patients with NDDs. Furthermore, a routine assessment of iron status biomarkers should be recommended for children with NDDs who have sleep disturbances.
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Affiliation(s)
- Donatella Giambersio
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (D.G.); (E.D.G.); (R.C.)
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Lucia Marzulli
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy (M.G.P.)
| | - Lucia Margari
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Emilia Matera
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (D.G.); (E.D.G.); (R.C.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa De Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (D.G.); (E.D.G.); (R.C.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (D.G.); (E.D.G.); (R.C.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonella Barbieri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (D.G.); (E.D.G.); (R.C.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonia Peschechera
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Anna Margari
- Interdisciplinary Department of Medicine (DIM), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Maria Giuseppina Petruzzelli
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Studies of Bari “Aldo Moro”, 70124 Bari, Italy (M.G.P.)
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Hoshino K. Problems in the Development of the Sleep-Wake Rhythm Influence Neurodevelopmental Disorders in Children. Diagnostics (Basel) 2023; 13:diagnostics13111859. [PMID: 37296711 DOI: 10.3390/diagnostics13111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Development of the sleep-wake rhythm has a significant effect on the physical and mental development of children. The sleep-wake rhythm is controlled by aminergic neurons in the brainstem's ascending reticular activating system, which is associated with synaptogenesis and the promotion of brain development. The sleep-wake rhythm develops rapidly within the first year after birth. At 3-4 months of age, the framework of the circadian rhythm is established. The objective of the present review is to assess a hypothesis concerning problems in the development of the sleep-wake rhythm and their effect on neurodevelopmental disorders. Autism spectrum disorder is characterised by a delay in the development of sleep rhythms at 3-4 months of age and also insomnia and night-time awakenings, as supported by several reports. Melatonin may shorten the sleep latency in ASD. Rett syndrome sufferers kept awake during the daytime were analysed by the Sleep-wake Rhythm Investigation Support System (SWRISS) (IAC, Inc., (Tokyo, Japan)), and the cause was found to be the dysfunction of aminergic neurons. Children and adolescents with attention deficit hyperactivity disorder show sleep problems such as resistance to bedtime, difficulty falling asleep, sleep apnoea, and restless legs syndrome. Sleep deprivation syndrome in schoolchildren is deeply influenced by Internet use, games, and smartphones, and this syndrome affects emotion, learning, concentration, and executive functioning. Sleep disorders in adults are strongly considered to affect not only the physiological/autonomic nervous system but also neurocognitive/psychiatric symptoms. Even adults cannot avoid serious problems, much less children, and the impact of sleep problems is considerably greater in adults. Paediatricians and nurses should be aware of the significance, from birth, of sleep development and sleep hygiene education for carers and parents. This research was reviewed and approved by the ethical committee of the Segawa Memorial Neurological Clinic for Children (No. SMNCC23-02).
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Affiliation(s)
- Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children, Tokyo 101-0062, Japan
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Fiani D, Engler S, Fields S, Calarge CA. Iron Deficiency in Attention-Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Internalizing and Externalizing Disorders, and Movement Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:451-467. [PMID: 37147046 DOI: 10.1016/j.chc.2022.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This article reviews the role of iron in brain development and function, with a focus on the association between iron deficiency (ID) and neuropsychiatric conditions. First, we describe how ID is defined and diagnosed. Second, the role of iron in brain development and function is summarized. Third, we review current findings implicating ID in a number of neuropsychiatric conditions in children and adolescents, including attention deficit hyperactivity disorder and other disruptive behavior disorders, depressive and anxiety disorders, autism spectrum disorder, movement disorders, and other situations relevant to mental health providers. Last, we discuss the impact of psychotropic medication on iron homeostasis.
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Affiliation(s)
- Dimitri Fiani
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 8080 N Stadium Dr. Ste 180.35, Houston, TX 77054, USA. https://twitter.com/dimitrifiani
| | - Solangia Engler
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Sherecce Fields
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Chadi Albert Calarge
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 8080 N Stadium Dr. Ste 180.35, Houston, TX 77054, USA; Department of Pediatrics, Baylor College of Medicine, 1102 Bates Avenue, Ste 790, Houston, TX 77030, USA.
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McWilliams S, Singh I, Leung W, Stockler S, Ipsiroglu OS. Iron deficiency and common neurodevelopmental disorders—A scoping review. PLoS One 2022; 17:e0273819. [PMID: 36173945 PMCID: PMC9522276 DOI: 10.1371/journal.pone.0273819] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background A wealth of human and experimental studies document a causal and aggravating role of iron deficiency in neurodevelopmental disorders. While pre-, peri-, and early postnatal iron deficiency sets the stage for the risk of developing neurodevelopmental disorders, iron deficiency acquired at later ages aggravates pre-existing neurodevelopmental disorders. Yet, the association of iron deficiency and neurodevelopmental disorders in childhood and adolescence has not yet been explored comprehensively. In this scoping review, we investigate 1) the association of iron deficiency in children and adolescents with the most frequent neurodevelopmental disorders, ADHD, ASD, and FASD, and 2) whether iron supplementation improves outcomes in these disorders. Method Scoping review of studies published between 1994 and 2021 using “iron deficiency / iron deficiency anemia” AND “ADHD” OR “autism” OR “FASD” in four biomedical databases. The main inclusion criterion was that articles needed to have quantitative determination of iron status at any postnatal age with primary iron markers such as serum ferritin being reported in association with ADHD, ASD, or FASD. Results For ADHD, 22/30 studies and 4/4 systematic reviews showed an association of ADHD occurrence or severity with iron deficiency; 6/6 treatment studies including 2 randomized controlled trials demonstrated positive effects of iron supplementation. For ASD, 3/6 studies showed an association with iron deficiency, while 3/6 and 1/1 systematic literature review did not; 4 studies showed a variety of prevalence rates of iron deficiency in ASD populations; 1 randomized controlled trial found no positive effect of iron supplementation on behavioural symptoms of ASD. For FASD, 2/2 studies showed an association of iron deficiency with growth retardation in infants and children with prenatal alcohol exposure. Conclusion Evidence in favor of screening for iron deficiency and using iron supplementation for pediatric neurodevelopmental disorders comes primarily from ADHD studies and needs to be further investigated for ASD and FASD. Further analysis of study methodologies employed and populations investigated is needed to compare studies against each other and further substantiate the evidence created.
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Affiliation(s)
- Scout McWilliams
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Ishmeet Singh
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Wayne Leung
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Division of Biochemical Diseases, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Osman S. Ipsiroglu
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Divisions of Child & Adolescent Psychiatry, Developmental Pediatrics and Respirology, Department of Pediatrics, Sleep/Wake-Behaviour Clinic at Sleep Program, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
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Tang CY, Wen F. Serum ferritin levels in children with attention deficit hyperactivity disorder and tic disorder. World J Clin Cases 2022; 10:7749-7759. [PMID: 36158507 PMCID: PMC9372851 DOI: 10.12998/wjcc.v10.i22.7749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/01/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain. Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.
AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.
METHODS A total of 1565 children with attention deficit hyperactivity disorder (ADHD), 1694 children with tic disorder (TD), 93 children with ASD and 1997 healthy control children were included between January 1, 2020, and December 31, 2021 at Beijing Children's Hospital. We describe the differences in age levels and ferritin levels between different disease groups and their sex differences. The differences between the sexes in each disease were analyzed using the t test. The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups. A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group. Analysis of variance was used for comparisons between subgroups, and regression analysis was used for confounding factor control.
RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study, and the average serum ferritin levels of male and female children were 36.82 ± 20.64 μg/L and 35.64 ± 18.56 μg/L, respectively. A total of 1694 TD patients aged 5-12 years were included in this study, and the average serum ferritin levels of male and female children were 35.72 ± 20.15 μg/L and 34.54 ± 22.12 μg/L, respectively. As age increased, the incidence of low serum ferritin in ADHD and TD first decreased and then increased, and 10 years old was the turning point of rising levels. The incidence of ADHD with low serum ferritin was 8.37%, the incidence of TD with low serum ferritin was 11.04%, and the incidence of the healthy control group with low serum ferritin was 8.61%, among which male children with TD accounted for 9.25% and female children with TD accounted for 11.62%. There was a significant difference among the three groups (P < 0.05). In addition, there were 93 children with ASD with an average serum ferritin level of 30.99 ± 18.11 μg/L and a serum ferritin incidence of 15.05%.
CONCLUSION In conclusion, low serum ferritin is not a risk factor for ADHD or TD. The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.
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Affiliation(s)
- Cai-Yun Tang
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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Topal Z, Tufan AE, Karadag M, Gokcen C, Akkaya C, Sarp AS, Bahsi I, Kilinc M. Evaluation of peripheral inflammatory markers, serum B12, folate, ferritin levels and clinical correlations in children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Nord J Psychiatry 2022; 76:150-157. [PMID: 34232109 DOI: 10.1080/08039488.2021.1946712] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM The aim of the current study is to compare serum B12, folate, and ferritin levels and peripheral inflammatory indicators between children with Autism Spectrum Disorders (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and healthy controls (HC) and to evaluate the correlation of those with symptoms. MATERIALS AND METHODS A total of 203 children were evaluated (ASD = 72; ADHD = 61; HC = 70). Diagnoses of ASD and ADHD were ascertained according to Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Control group was chosen among the healthy children who applied to general pediatrics outpatient clinic. Gilliam Autism Rating Scale-2 is used to assess autistic symptoms and Atilla Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale is used for ADHD symptoms. RESULTS Neutrophil levels (p = 0.014) and neutrophil/lymphocyte ratio (NLR) (p = 0.016) were higher in the ADHD and ASD groups compared to HC. Neutrophil values explained 70.1% of the variance across groups while NLR explained a further 29.9% of the variance. NLR significantly correlated with social interaction problems in ASD (r = 0.26, p = 0.04). There were no significant differences between groups in terms of vitamin B12, folate and ferritin levels. CONCLUSION Our results may support involvement of inflammation in the underlying pathophysiology of neurodevelopmental disorders. However, these parameters should be analyzed in a wider population to clarify the effect on the etiology and symptomatology of neurodevelopmental disorders.
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Affiliation(s)
- Zehra Topal
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Karadag
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Cem Gokcen
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Canan Akkaya
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ayse Sevde Sarp
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ilhan Bahsi
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Metin Kilinc
- Department of Pediatrics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials. Nutrients 2021; 13:nu13114059. [PMID: 34836314 PMCID: PMC8618748 DOI: 10.3390/nu13114059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder common from childhood to adulthood, affecting 5% to 12% among the general population in developed countries. Potential etiological factors have been identified, including genetic causes, environmental elements and epigenetic components. Nutrition is currently considered an influencing factor, and several studies have explored the contribution of restriction and dietary supplements in ADHD treatments. Iron is an essential cofactor required for a number of functions, such as transport of oxygen, immune function, cellular respiration, neurotransmitter metabolism (dopamine production), and DNA synthesis. Zinc is also an essential trace element, required for cellular functions related to the metabolism of neurotransmitters, melatonin, and prostaglandins. Epidemiological studies have found that iron and zinc deficiencies are common nutritional deficits worldwide, with important roles on neurologic functions (poor memory, inattentiveness, and impulsiveness), finicky appetite, and mood changes (sadness and irritability). Altered levels of iron and zinc have been related with the aggravation and progression of ADHD. Objective: This is a systematic review focused on the contribution of iron and zinc in the progression of ADHD among children and adolescents, and how therapies including these elements are tolerated along with its effectiveness (according to PRISMA guidelines). Method: The scientific literature was screened for randomized controlled trials published between January 2000 to July 2021. The databases consulted were Medline, PsycINFO, Web of Science, and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed quality and risk of bias (CONSORT, NICE, and Cochrane checklists used). Conclusion: Nine studies met the eligibility criteria and were selected. Evidence was obtained regarding the contribution of iron-zinc supplementation in the treatment of ADHD among young individuals. The discussion was focused on how the deficits of these elements contribute to affectation on multiple ADHD correlates, and potential mechanisms explaining the mediational pathways. Evidence also suggested that treating ADHD with diet interventions might be particularly useful for specific subgroups of children and adolescents, but further investigations of the effects of these diet interventions are needed.
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Clinical efficacy and safety of intravenous ferric carboxymaltose treatment of pediatric restless legs syndrome and periodic limb movement disorder. Sleep Med 2021; 87:114-118. [PMID: 34562823 DOI: 10.1016/j.sleep.2021.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Iron supplementation is the most commonly considered treatment option for children with restless legs syndrome (RLS) or periodic limb movement disorder (PLMD); however, there is a scarcity of evidence on the effectiveness of intravenous preparations. In this study, we evaluated the effectiveness and tolerability of intravenous ferric carboxymaltose (IV FCM) on clinical symptoms and iron indices in children with RLS or PLMD. METHODS This was a single-center retrospective data analysis. Children with a diagnosis of RLS or PLMD, who underwent a single infusion of IV FCM, were included. Clinical Global Impression (CGI) Scale scores, serum ferritin, and serum iron profile at baseline and after eight weeks post infusion were obtained. Adverse effects were assessed. RESULTS Thirty-nine children received IV FCM, 29 with RLS and 10 with PLMD. Pre-infusion CGI-Severity revealed moderate illness, with post-infusion CGI-Improvement between "very much improved" and "much improved". Ferritin increased from 14.6 μg/L±7.01 to 112.4 μg/L±65.86 (p < 0.00001), together with improvements in iron, total iron binding capacity, and transferrin levels from baseline to post-treatment. When compared to children with RLS, those with PLMD had a similar improvement in clinical symptoms and laboratory parameters. Seven subjects (14.3%) experienced one or two adverse events; all were mild. CONCLUSIONS Children with RLS and PLMD responded to IV iron supplementation with improvement in both clinical severity and laboratory parameters. Treatment was well tolerated. Although larger, randomized-controlled trials are needed, IV FCM appears to be a promising alternative to oral iron supplementation for the treatment of pediatric RLS or PLMD.
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DelRosso LM, Picchietti DL, Ferri R. Comparison between oral ferrous sulfate and intravenous ferric carboxymaltose in children with restless sleep disorder. Sleep 2021; 44:5897018. [PMID: 32840615 DOI: 10.1093/sleep/zsaa155] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES Recent work has identified clinical and polysomnographic features of a newly defined pediatric sleep disorder, restless sleep disorder (RSD). One of these features is low serum ferritin. In this retrospective, pilot study, we assess the response to iron supplementation. Children were given oral ferrous sulfate (FS) or intravenous ferric carboxymaltose (IV FCM). METHODS Children 5-18 years old with a diagnosis of RSD were evaluated clinically. Serum ferritin, iron profile, and video-polysomnography were obtained at baseline. Oral or IV iron supplementation was offered as part of routine care. Oral FS was one 325 mg tablet daily or 3 mg/kg/day liquid for 3 months. IV FCM was 15 mg/kg, up to 750 mg as a single infusion. Adverse effects were assessed. Ferritin and iron profile were checked after 2-3 months. Eight weeks after FCM, the phosphorus level was checked. Clinical Global Impression (CGI) scale was obtained pre- and posttreatment. RESULTS A total of 15 children received oral FS and 15 IV FCM. Baseline RSD severity, age, gender, or pretreatment lab values did not differ significantly between groups. CGI-improvement median score was "minimally improved" after oral FS and "much improved" after IV FCM (effect size 1.008, p < 0.023). All iron parameters were found to be significantly higher after intravenous iron treatment than oral iron, especially ferritin (effect size 3.743, p < 0.00003). Adverse effects: constipation, three with FS; noncompliance, one with FS; syncope, one with FCM infusion; and hypophosphatemia, zero post-FCM. CONCLUSIONS In this retrospective, clinical case series, RSD responded to iron supplementation with improvement in both clinical and laboratory parameters. The response was greater with IV FCM than oral FS.
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Affiliation(s)
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, and Carle Foundation Hospital, University of Illinois School of Medicine, Urbana, IL
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
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11
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Ryan CS, Edlund W, Mandrekar J, Wong-Kisiel LC, Gavrilova RH, Kotagal S. Iron Deficiency and Its Role in Sleep Disruption in Patients With Angelman Syndrome. J Child Neurol 2020; 35:963-969. [PMID: 32713229 DOI: 10.1177/0883073820941755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if Angelman syndrome patients with sleep complaints have an increased risk of iron deficiency, and if iron therapy improves their sleep difficulties. BACKGROUND About two-thirds of Angelman syndrome patients experience sleep difficulties, which are likely multifactorial. Because iron deficiency can contribute toward restlessness in sleep, we investigated whether it might be a contributing factor in this special population. METHODS This retrospective study involved medical record review of Angelman syndrome patients <18 years old who had attended our multidisciplinary Angelman syndrome clinic and had sleep complaints. Serum ferritin levels were compared to age- and sex-matched controls. Sleep history and nocturnal polysomnogram findings of the Angelman syndrome patients were also characterized. RESULTS Nineteen Angelman syndrome patients (9 female, mean age 6.2±4.4 years) were identified. All 19 reported sleep difficulties. The mean serum ferritin level was 19.9±8.5 μg/L, while that in controls was 27.8±17.8 μg/L (P value .13). The odds ratio of iron deficiency in Angelman syndrome compared to controls was 4.17 (95% confidence interval 1.23-14.10), using normal serum ferritin level of 24 μg/L based on literature. Fifteen Angelman syndrome patients underwent nocturnal polysomnogram with 9/15 showing an elevated periodic limb movement index (overall mean 9.8±10.4). Seventeen of 19 received iron therapy. Twelve had follow-up after iron therapy, with parents reporting improved sleep quality. Eight had serum ferritin levels rechecked after iron therapy, showing a mean increase of 24±5.1 μg/L. CONCLUSIONS Sleep difficulties in Angelman syndrome, though multifactorial, may in part be related to iron deficiency. Treatment with iron improved sleep to a modest degree in this population.
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Affiliation(s)
- Conor S Ryan
- Department of Neurology, 4352Mayo Clinic, Rochester, MN, USA
| | - Wendy Edlund
- Department of Neurology, 4352Mayo Clinic, Rochester, MN, USA
| | - Jay Mandrekar
- Department of Neurology, 4352Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, 4352Mayo Clinic, Rochester, MN, USA
| | | | - Ralitza H Gavrilova
- Department of Neurology, 4352Mayo Clinic, Rochester, MN, USA.,Department of Genetics, 4352Mayo Clinic, Rochester, MN, USA
| | - Suresh Kotagal
- Department of Neurology, 4352Mayo Clinic, Rochester, MN, USA
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12
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Gong A, Wan D, Liang H, Yan L, Yu Z, Zhang H, Wang Q, Dou M. Joint replenishment of zinc and folic acid enhances the anti-depressive effect of paroxetine via increasing serum calcium and copper and decreasing serum arsenic. Neurosci Lett 2020; 737:135270. [PMID: 32777348 DOI: 10.1016/j.neulet.2020.135270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/23/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Insufficient zinc and folic acid levels are associated with depression and poor response to antidepressants. This study aimed to investigate the influences of combined zinc and folic acid replenishment on the anti-depressive effect of paroxetine. Male rats were randomly divided into five groups: control (C), model (M), paroxetine (MP), zinc + folic acid (MZnF), and zinc + folic acid + paroxetine (MZnFP) groups. Rats were exposed to mild unpredictable stress for 3 weeks as a depression model. The combinations of drug and supplements were applied via daily gavage for 4 weeks. The open field test was conducted to observe behavioral changes. A chemiluminescence method was used to detect folacin, and inductively coupled plasma mass spectrometry was used to detect serum elements. Supplementation of zinc and folic acid significantly improved behavior responses to paroxetine, including movement speed, total distance, and central zone frequency. In addition, higher calcium and copper levels and a lower arsenic level were found in the serum of the MZnFP group. Thus, supplementation of zinc and folacin can enhance the anti-depressive effect of paroxetine, and the mechanism is potentially related to the improved levels of calcium and copper and a reduced level of arsenic.
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Affiliation(s)
- Anjing Gong
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Dehong Wan
- Department of Operating Room, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Hui Liang
- Department of Human Nutrition, College of Public Health, Qingdao University, Qingdao 266000, China
| | - Liping Yan
- Department of Laboratory Medicine, Qingdao Central Hospital, Qingdao 266042, China
| | - Zhou Yu
- Research Center, Qingdao Supervision and Testing Center of Product Quality, Qingdao, 266000, China
| | - Huizhen Zhang
- Department of Food Inspection, Qingdao Food and Drug Inspection Institute, Qingdao, 266071, China
| | - Qiuzhen Wang
- Department of Human Nutrition, College of Public Health, Qingdao University, Qingdao 266000, China
| | - Mei Dou
- Department of Human Nutrition, College of Public Health, Qingdao University, Qingdao 266000, China.
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13
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Robberecht H, Verlaet AAJ, Breynaert A, De Bruyne T, Hermans N. Magnesium, Iron, Zinc, Copper and Selenium Status in Attention-Deficit/Hyperactivity Disorder (ADHD). Molecules 2020; 25:molecules25194440. [PMID: 32992575 PMCID: PMC7583976 DOI: 10.3390/molecules25194440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/21/2022] Open
Abstract
In this study, we critically review the literature concerning the relation of Mg, Fe, Zn, Cu and Se and attention-deficit/hyperactivity disorder (ADHD). Elemental status is estimated using peripheral blood parameters, hair, urine, daily intake and response to supplementation. The observed associations between concentration levels of the elements Mg, Fe, Zn, Cu and Se and ADHD symptoms are contradictory. This is partly due to the heterogeneity and complexity of the disorder. As a trend, lower ferritin and zinc levels can be observed. However, this correlation is not causative, as illustrated by placebo-controlled trials reporting conflicting evidence on the efficacy of supplementation. Well-defined studies on changes in concentration levels of the elements in relation to ADHD symptoms before and after treatment with therapeutics it will be possible to shed more light on the significance of these elements in this behavioral disorder. The discussion on whether a change in concentration of an element is cause or consequence of ADHD is not within the scope of this article.
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14
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Leung W, Singh I, McWilliams S, Stockler S, Ipsiroglu OS. Iron deficiency and sleep – A scoping review. Sleep Med Rev 2020; 51:101274. [DOI: 10.1016/j.smrv.2020.101274] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022]
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15
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Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 2020; 179:527-545. [PMID: 32020331 DOI: 10.1007/s00431-020-03597-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.
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Affiliation(s)
- Veneranda Mattiello
- Department "Woman-Mother-Child and Adolescent", Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Schmugge
- Division of Pediatric Hematology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Heinz Hengartner
- Pediatric Hematology-Oncology Unit, Children's Hospital of Sankt Gallen, Sankt Gallen, Switzerland
| | - Nicolas von der Weid
- Pediatric Hematology-Oncology Department, University Children's Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Renella
- Department "Woman-Mother-Child", Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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16
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Bruni O, Angriman M, Melegari MG, Ferri R. Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders. Expert Opin Pharmacother 2019; 20:2257-2271. [DOI: 10.1080/14656566.2019.1674283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Marco Angriman
- Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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17
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McDonald A, Joseph D. Paediatric neurodisability and sleep disorders: clinical pathways and management strategies. BMJ Paediatr Open 2019; 3:e000290. [PMID: 30957021 PMCID: PMC6422245 DOI: 10.1136/bmjpo-2018-000290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 02/03/2023] Open
Abstract
Sleep disorders are common in children with neurodisability. Their presentation is often complex. This complexity of presentation can make sleep disorders in children with neurodisability daunting to diagnose and manage. Both parents and healthcare professionals have identified sleep disorders as a healthcare outcome that they prioritise in children with neurodisability. We aim to explore the challenges of diagnosing sleep problems, discuss common difficulties with sleep in children with neurodisability and will touch on how to set up a service to support and manage sleep, working through case examples.
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Affiliation(s)
- Aoife McDonald
- Paediatric Neurosciences, Evelina London Children's Healthcare, London, UK
| | - Desaline Joseph
- Paedatric Neurosciences, Evelina London Children's Healthcare, London, UK
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18
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Adil S, Khan AU, Badshah H, Asghar F, Usman M, Badshah A, Ali S. In silico and in vivo investigation of ferrocene-incorporated acyl ureas and homoleptic cadmium carboxylate derivatives for anticonvulsant, anxiolytic, and sedative potential. Drug Dev Res 2018; 79:184-197. [DOI: 10.1002/ddr.21435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/30/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sadia Adil
- Riphah Institute of Pharmaceutical Sciences, Riphah International University; Islamabad Pakistan
| | - Arif-ullah Khan
- Riphah Institute of Pharmaceutical Sciences, Riphah International University; Islamabad Pakistan
| | - Haroon Badshah
- Riphah Institute of Pharmaceutical Sciences, Riphah International University; Islamabad Pakistan
- Department of Pharmacy; Abdul Wali Khan University; Mardan Pakistan
| | - Faiza Asghar
- Department of Chemistry; University of Wah Wah; Pakistan
| | - Muhammad Usman
- Department of Chemistry; Quaid e Azam University; Islamabad Pakistan
| | - Amin Badshah
- Department of Chemistry; Quaid e Azam University; Islamabad Pakistan
| | - Saqib Ali
- Department of Chemistry; Quaid e Azam University; Islamabad Pakistan
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19
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Bruni O, Angriman M, Calisti F, Comandini A, Esposito G, Cortese S, Ferri R. Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry 2018; 59:489-508. [PMID: 28921528 DOI: 10.1111/jcpp.12812] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sleep disturbances, in particular insomnia, represent a common problem in children with neurodevelopmental disabilities (NDDs). Currently, there are no approved medications for insomnia in children by the US Food and Drug Administration or European Medicines Agency and therefore they are prescribed off-label. We critically reviewed pediatric literature on drugs as well as nonpharmacological (behavioral) interventions used for sleep disturbances in children with NDDs. METHODS PubMed, Ovid (including PsycINFO, Ovid MEDLINE® , and Embase), and Web of Knowledge databases were searched through February 12, 2017, with no language restrictions. Two authors independently and blindly performed the screening. RESULTS Good sleep practices and behavioral interventions, supported by moderate-to-low level evidence, are the first recommended treatments for pediatric insomnia but they are often challenging to implement. Antihistamine agents, such as hydroxyzine or diphenhydramine, are the most widely prescribed sedatives in the pediatric practice but evidence supporting their use is still limited. An increasing body of evidence supports melatonin as the safest choice for children with NDDs. Benzodiazepines are not recommended in children and should only be used for transient insomnia, especially if daytime anxiety is present. Only few studies have been carried out in children's and adolescents' zolpidem, zaleplon, and eszopiclone, with contrasting results. Limited evidence supports the use of alpha-agonists such as clonidine to improve sleep onset latency, especially in attention deficit/hyperactivity disorder subjects. Tricyclic antidepressants, used in adults with insomnia, are not recommended in children because of their safety profile. Trazodone and mirtazapine hold promise but require further studies. CONCLUSIONS Here, we provided a tentative guide for the use of drugs for insomnia in children with NDDs. Well-controlled studies employing both objective polysomnography and subjective sleep measures are needed to determine the efficacy, effectiveness, and safety of the currently prescribed pediatric sleep medicines in children with NDDs.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Marco Angriman
- Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Central Hospital of Bolzano, Bolzano, Italy
| | | | | | | | - Samuele Cortese
- Academic Unit of Psychology, Developmental Brain-Behavior Laboratory, University of Southampton, Southampton, UK.,New York University Child Study Center, New York, NY, USA.,Solent NHS Trust, Southampton, UK
| | - Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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20
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DEMİRCİ K, YILDIRIM BAŞ F, ARSLAN B, SALMAN Z, AKPINAR A, DEMİRDAŞ A. The Investigation of Symptoms and Diagnoses of Adult-Attention Deficit/ Hyperactivity Disorder in Women with Iron Deficiency Anemia. Noro Psikiyatr Ars 2017; 54:72-77. [PMID: 28566963 PMCID: PMC5439476 DOI: 10.5152/npa.2016.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/17/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate symptoms and diagnoses of Adult-Attention Deficit/Hyperactivity Disorder (ADHD) in women with iron deficiency anemia, to evaluate relationship between ADHD with clinical features and to compare with the women without iron deficiency anemia. METHODS Eighty-three newly diagnosed iron deficiency anemia patients and 70 healthy controls were included in this study. All participants were assessed using a sociodemographic form, Structured Clinical Interview I (SCID-I), Wender Utah Rating Scale (WURS); Moreover, participants having WURS scores 36 and above were also assessed using the Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria. RESULTS In the study, 22.9% of patients with iron deficiency anemia and 12.9% of healthy controls were found to have WURS scores 36 and above. Fifteen patients (18.1%) in iron deficiency anemia group and two patients (2.9%) in control group had adult ADHD, when they were evaluated with Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria (p=0.007). The patients with iron deficiency anemia had significantly higher WURS scores compared to controls (p=0.002). The levels of iron and ferritin had negative correlation (r=-0.166, p<0.05; r=-0.255, p<0.01, respectively) and the levels of serum iron binding capacity had positive correlation (r=0.255, p<0.01) with the scores of WURS. CONCLUSION The prevalence of adult ADHD is higher than those reported for general population in patients with iron deficiency anemia. Early diagnose and treatment of adult ADHD may positively contribute to the patients with iron deficiency anemia.
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Affiliation(s)
- Kadir DEMİRCİ
- Department of Psychiatry, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Funda YILDIRIM BAŞ
- Department of Family Medicine, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Bahriye ARSLAN
- Department of Family Medicine, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Zeliha SALMAN
- Department of Family Medicine, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Abdullah AKPINAR
- Department of Psychiatry, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Arif DEMİRDAŞ
- Department of Psychiatry, Süleyman Demirel University School of Medicine, Isparta, Turkey
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21
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Oner P, Oner O, Cop E, Munir KM. Effect of Ferritin on Short-Term Treatment Response in Attention Deficit Hyperactivity Disorder. KLINIK PSIKOFARMAKOLOJI BULTENI = BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY 2016; 22:325-331. [PMID: 28804252 PMCID: PMC5551506 DOI: 10.5455/bcp.20120403015900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Several studies have shown that iron deficiency and ferritin levels are associated with parent and teacher Attention Deficit Hyperactivity Disorder (ADHD) ratings. Although there are conflicting results, it has also been reported that iron supplementation may help to decrease ADHD symptoms. When all these previous studies are taken into account, it is clear that a large study investigating the effects of iron deficiency and ferritin levels on routine pharmacological treatment of ADHD with stimulants would be helpful to elucidate this treatment from a clinical point of view. METHODS A total of 345 subjects with combined or predominantly hyperactive-impulsive (PHI) subtypes of ADHD were included. All diagnoses were based on the DSM-IV criteria and ascertained by direct interviews conducted by the authors, who are experienced child psychiatrists certified in the use of the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) semi-structured interview. The two treatment response criteria were: 1) 25% or more decrease in pre-treatment Conners Parent Rating Scale (CPRS) and Conners Teacher Rating Scale (CTRS) Hyperactivity (HA) and Total Problems scores; 2) CPRS and CTRS HA scores lower than the cut-off point ("very improved"). RESULTS A total of 255 (73.9%) patients were on OROS-methylphenidate (OROS-MPH) and 90 (26.1%) were on immediate release methylphenidate (IR-MPH). The mean±sd of OROS-MPH and IR-MPH doses were 28.8±8.1 and 20.9±7.1 mg, respectively. More than half (52.5%) of the subjects were previously drug-naive at treatment inception. Two hundred and seventy eight (80.6%) subjects had combined subtype ADHD and the remainder had predominantly hyperactive-impulsive subtype. Only 60 (17.4%) of the subjects had no comorbid disorders, while 38.3% had one comorbid disorder, 32.8% had two comorbid disorders, and 11.6% had three or more comorbid disorders. The most frequent comorbidity was Oppositional Defiant Disorder/Conduct Disorder (ODD/CD, 51.6%), followed by Learning Disabilities (LD, 35.4%) and Anxiety Disorders (AD, 15.9%). Logistic regression analysis showed that subjects with comorbid ODD/CD and LD were less likely to respond to treatment. Ferritin levels and iron deficiency were not associated significantly with outcomes. CONCLUSIONS In a large sample of subjects with combined or predominantly hyperactive-impulsive subtypes of ADHD, after controlling for several factors, we found that neither iron deficiency (ferritin <12 ng/ml) nor ferritin levels were associated with less favorable short-term treatment outcomes with stimulants. Subjects with comorbid ODD/CD and LD were less likely to have a 25% or more decrease in CTRS Total score. The presence of ODD/CD was also a negative predictor of treatment response in terms of CPRS Total and HA scores. The lack of a negative treatment response in ADHD subjects with iron deficiency and lack of a negative association with ferritin levels suggest that the relationship between iron metabolism and ADHD, a highly heterogeneous disorder, may be more complicated than previously believed.
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Affiliation(s)
- Pinar Oner
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Childrens’ Hospital, Ankara - Turkey
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children’s Hospital, Boston, MA, USA
| | - Ozgur Oner
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Childrens’ Hospital, Ankara - Turkey
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children’s Hospital, Boston, MA, USA
| | - Esra Cop
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Childrens’ Hospital, Ankara - Turkey
| | - Kerim M. Munir
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children’s Hospital, Boston, MA, USA
- Children’s Hospital, Boston; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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22
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Blackmer AB, Feinstein JA. Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review. Pharmacotherapy 2016; 36:84-98. [PMID: 26799351 DOI: 10.1002/phar.1686] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Neurodevelopmental disorders (NDDs) are defined as a group of disorders caused by changes in early brain development, resulting in behavioral and cognitive alterations in sensory and motor systems, speech, and language. NDDs affect approximately 1-2% of the general population. Up to 80% of children with NDDs are reported to have disrupted sleep; subsequent deleterious effects on daytime behaviors, cognition, growth, and overall development of the child are commonly reported. Examples of NDDs discussed in this review include autism spectrum disorder, cerebral palsy, Rett syndrome, Angelman syndrome, Williams syndrome, and Smith-Magenis syndrome. The etiology of sleep disorders in children with NDDs is largely heterogeneous and disease specific. The diagnosis and management of sleep disorders in this population are complex, and little high-quality data exist to guide a consistent approach to therapy. Managing sleep disorders in children with NDDs is critical both for the child and for the family but is often frustrating due to the refractory nature of the problem. Sleep hygiene must be implemented as first-line therapy; if sleep hygiene alone fails, it should be combined with pharmacologic management. The available evidence for the use of common pharmacologic interventions, such as iron supplementation and melatonin, as well as less common interventions, such as melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics is reviewed. Further, parents and caregivers should be provided with appropriate education on the nature of the sleep disorders and the expectation for modest pharmacologic benefit, at best. Additional data from well-designed trials in children with NDDs are desperately needed to gain a better understanding of sleep pharmacotherapy including efficacy and safety implications. Until then, clinicians must rely on the limited available data, as well as clinical expertise, when managing sleep disorders in the population of children with NDDs.
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Affiliation(s)
- Allison Beck Blackmer
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.,Department of Pharmacy/Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado
| | - James A Feinstein
- Adult and Child Center for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, Colorado.,Division of General Pediatrics, University of Colorado, Aurora, Colorado
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23
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Ramos-Quiroga JA, Corominas-Roso M, Palomar G, Ferrer R, Valero S, Corrales M, Richarte V, Casas M. Cortisol awakening response in adults with attention deficit hyperactivity disorder: Subtype differences and association with the emotional lability. Eur Neuropsychopharmacol 2016; 26:1140-9. [PMID: 27084305 DOI: 10.1016/j.euroneuro.2016.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 02/12/2016] [Accepted: 03/24/2016] [Indexed: 01/08/2023]
Abstract
Cortisol awakening response (CAR) has been studied in children with ADHD, and some authors have reported morning cortisol differences among ADHD subtypes. Despite, only half of the children with ADHD continue to exhibit the disorder into adulthood, CAR has not been studied in adults so far. One hundred and nine adults with ADHD according to the DSM-IV criteria (46 inattentive and 63 combined) ranging in age from 18 to 55 years, and 27 healthy controls were included. Psychiatric and organic comorbidities were excluded. Salivary cortisol samples were obtained at 0, 30, 45 and 60 minutes after awakening. CAR was present in 84% of the healthy controls but in only 64% of the adults with ADHD (68% of the inattentive and 61% of the combined were CAR-positive). There were no significant differences in any of the morning cortisol measures between patients and controls or between the combined and inattentive subtypes of ADHD. Among the inattentive subtype but not in the combined patients, significant positive correlations were observed between the CAR and emotional lability (p=0.05), or self-concept (p=0.014) CAARS subscales, as well as with the cognitive impulsivity subscale of the Barratt impulsiveness scale (p=0.028). These results suggest that adults with ADHD exhibit normal cortisol responses upon awakening and thus cannot be defined in terms of hypo-arousal. Neurobiological differences between the combined and inattentive subtypes involving cortisol, are discussed.
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Affiliation(s)
- J A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - M Corominas-Roso
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain.
| | - G Palomar
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - R Ferrer
- Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - S Valero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M Corrales
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - V Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
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24
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Iron Deficiency Parameters in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev 2016; 47:259-69. [PMID: 26092605 DOI: 10.1007/s10578-015-0562-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study is to compare iron deficiency parameters in patients with stimulant-naive attention-deficit/hyperactivity disorder (ADHD) and healthy controls, to investigate whether there are differences among the ADHD presentations, and to evaluate the relationship between ADHD symptom severity and serum ferritin levels. In addition, ADHD-Predominantly Inattentive (ADHD-PI) patients with restrictive hyperactivity/impulsivity symptoms were evaluated as a separate group with "restrictive inattention presentation" (ADHD-Rest) and were compared with other groups. Patients with ADHD-Rest are typically defined as having six or more symptoms of inattention and fewer than three symptoms of hyperactivity/impulsivity. A total of 200 ADHD cases consisting of 100 ADHD-Combine (ADHD-C) and 100 ADHD-PI and a total of 100 healthy control cases were included in the study. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version was performed in a semi-structured interview during the diagnosis. The Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale, the Conners' Rating Scale-Revised: Long Form (Parent-Teacher) (CPRSR:L, CTRS-R:L) were used for clinical evaluation. Hemogram, serum iron, iron binding capacity and serum ferritin levels were assessed. There were no significant differences between the ADHD patients and the healthy control cases in terms of iron deficiency parameters. Further, there were no significant differences among the ADHD presentations in terms of the same parameters, nor were there any significant differences when the groups were examined after the identification of the ADHD-Rest. The CPRS-R:L Hyperactivity and the CTRS-R:L Hyperactivity scores were negatively correlated with serum ferritin level in the ADHD group. To our knowledge, our current study is the first to compare serum ferritin levels in ADHD-Rest with other presentations of ADHD, and included the largest number of patients that were classified by ADHD presentations. Elucidation of these findings is important for both the etiology and treatment of ADHD.
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Doom JR, Georgieff MK, Gunnar MR. Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5-5 years post-adoption. Dev Sci 2015; 18:484-94. [PMID: 25070881 PMCID: PMC4309749 DOI: 10.1111/desc.12223] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022]
Abstract
Increased ADHD symptomology and lower IQ have been reported in internationally adopted (IA) children compared to non-adopted peers (Hostinar, Stellern, Schaefer, Carlson & Gunnar, 2012; Kreppner, O'Connor & Rutter, 2001). However, it is unclear whether these outcomes are due to institutional deprivation specifically or to co-occurring micronutrient deficiencies that disrupt brain development (Fuglestad, Rao & Georgieff, 2008b). In this study, IA children were compared to children raised in their biological families to examine differences in ADHD symptomology and IQ 2.5-5 years post-adoption and to assess the contributions of iron deficiency (ID) and duration of deprivation to these cognitive outcomes. ADHD symptoms (parent- and experimenter-reported) and IQ were evaluated in 88 IA (M = 62.1 months, SD = 2.4) and 35 non-adopted children (M = 61.4 months, SD = 1.6). IA children were assessed 29-64 months post-adoption (M = 41.9 months, SD = 10.2). ID was assessed during the initial post-adoption medical visit in 69 children, and children were classified into four groups by iron status, ranging from normal to ID anemia (most severe). IA children had greater ADHD symptomology, p < .01, and lower IQ, p = .001, than non-adopted children. Within the IA group, children with more severe ID at adoption had greater ADHD symptomology, r(69) = 0.40, p = .001, and lower IQ, r(68) = -0.28, p < .05. Duration of institutional care was positively correlated with ADHD symptoms, r(86) = .28, p < .01, but not IQ, r(85) = -.08, p = .52. Longitudinal results indicate improvement in IQ from 12 months post-adoption to age 5 for children with greater ID severity at adoption and longer duration of institutional care but no improvement in ADHD symptoms. These results signify continuing effects of early deprivation and ID on ADHD symptoms and IQ years after adoption. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=vUFDAS3DD1c.
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Affiliation(s)
- Jenalee R Doom
- Institute of Child Development, University of Minnesota, USA; Center for Neurobehavioral Development, University of Minnesota, USA
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Pamuk GE, Uyanik MS, Top MS, Tapan U, Ak R, Uyanik V. Gastrointestinal symptoms are closely associated with depression in iron deficiency anemia: a comparative study. Ann Saudi Med 2015; 35:31-5. [PMID: 26142935 PMCID: PMC6152543 DOI: 10.5144/0256-4947.2015.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Until now, very few studies evaluated the association between gastrointestinal and psychiatric symptoms in iron deficiency anemia (IDA). The study investigated the frequency of functional dyspepsia (FD) in IDA patients and determined its association with depression and somatization. DESIGN AND SETTINGS The study was conducted at the Hematology Department of Trakya University Medical Faculty, which is a tertiary referral center in northwestern Turkey. It was a case-control study. MATERIALS AND METHODS A total of 125 consecutive IDA patients and 57 healthy control subjects were included. Patients and controls were questioned about the severity of their gastrointestinal system (GIS)-related symptoms and the presence of constipation and associated symptoms using a visual analog scale. In addition, IDA patients were administered a validated depression scale (Beck Depression Inventory, BDI) and somatization symptoms checklist. RESULTS IDA patients had more frequent self-reported constipation compared with controls (56% vs 22.8%, P < .001). The mean scores of bloating, dyspepsia, and constipation-related quality of life (QoL) disturbance were significantly higher in the IDA group than in the control group (all P values.
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Affiliation(s)
- Gulsum Emel Pamuk
- Department of Hematology, Trakya University Medical Faculty, Edirne-Turkey
| | | | - Mehmet Serif Top
- Department of Psychiatry, Trakya University Medical Faculty, Edirne-Turkey
| | - Umit Tapan
- Department of Internal Medicine, Steward Carney Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Recep Ak
- Department of Internal Medicine, Trakya University Medical Faculty, Edirne-Turkey
| | - Vesile Uyanik
- Department of Psychiatry, Trakya University Medical Faculty, Edirne-Turkey
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Cortese S, Angriman M. Attention-deficit/hyperactivity disorder, iron deficiency, and obesity: is there a link? Postgrad Med 2014; 126:155-70. [PMID: 25141253 DOI: 10.3810/pgm.2014.07.2793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The exact etiopathophysiology of attention-deficit/hyperactivity disorder (ADHD) remains elusive, likely because of its phenotypic heterogeneity. Given the involvement of iron in neurocognitive and behavioral functions, iron deficiency (ID) has been suggested as a possible etiopathophysiological factor in a subsample of individuals with ADHD. Most studies assessing ID in ADHD have focused on serum ferritin, a marker of peripheral iron status. Results from these studies are mixed, and the largest studies failed to find a significant association between ADHD and low serum ferritin levels. However, serum ferritin may be influenced by several conditions, including inflammatory status. Increasing evidence, especially from epidemiological studies, points to a significant association between ADHD and obesity. Interestingly, obesity is associated with a chronic inflammatory status, characterized by ID with normal-to-high serum ferritin levels. This article reviews the literature on iron status in ADHD and on the relationship between ADHD and obesity; discusses a possible link among ADHD, ID, and obesity; and proposes that comorbid obesity contributes to ID, via chronic inflammation, in a subsample of individuals with ADHD. Thus, the comorbidity between ADHD and obesity suggests moving beyond serum ferritin levels and assessing the molecular pathways of chronic inflammation that lead to ID in individuals with ADHD and obesity. In turns, this may pave the way for novel treatment strategies for cognitive and behavioral dysfunctions related to ID in ADHD.
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Affiliation(s)
- Samuele Cortese
- Child Neuropsychiatry Unit, G.B. Rossi Hospital, Department of Life Science and Reproduction, Verona University, Verona, Italy; Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone Medical Center, New York, NY.
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Pediatric Integrative Medicine Approaches to Attention Deficit Hyperactivity Disorder (ADHD). CHILDREN-BASEL 2014; 1:186-207. [PMID: 27417475 PMCID: PMC4928725 DOI: 10.3390/children1020186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/22/2014] [Accepted: 08/15/2014] [Indexed: 12/20/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in children and is increasing in prevalence. There has also been a related increase in prescribing stimulant medication despite some controversy whether ADHD medication makes a lasting difference in school performance or achievement. Families who are apprehensive about side effects and with concerns for efficacy of medication pursue integrative medicine as an alternative or adjunct to pharmacologic and cognitive behavioral treatment approaches. Integrative medicine incorporates evidence-based medicine, both conventional and complementary and alternative therapies, to deliver personalized care to the patient, emphasizing diet, nutrients, gut health, and environmental influences as a means to decrease symptoms associated with chronic disorders. Pediatric integrative medicine practitioners are increasing in number throughout the United States because of improvement in patient health outcomes. However, limited funding and poor research design interfere with generalizable treatment approaches utilizing integrative medicine. The use of research designs originally intended for drugs and procedures are not suitable for many integrative medicine approaches. This article serves to highlight integrative medicine approaches in use today for children with ADHD, including dietary therapies, nutritional supplements, environmental hygiene, and neurofeedback.
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Linguistic validation of the Sleep Disturbance Scale for Children (SDSC) in Iranian children with Persian language. Sleep Med 2014; 15:998-1001. [DOI: 10.1016/j.sleep.2014.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 11/18/2022]
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Rucklidge JJ, Johnstone J, Gorman B, Boggis A, Frampton CM. Moderators of treatment response in adults with ADHD treated with a vitamin-mineral supplement. Prog Neuropsychopharmacol Biol Psychiatry 2014; 50:163-71. [PMID: 24374068 DOI: 10.1016/j.pnpbp.2013.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND To date there has been no research investigating moderators of response to micronutrient treatment of mental illness, specifically baseline nutrient levels. METHOD We conducted analyses of data from a randomized placebo-controlled trial (RCT) of 80 adults (≥16years) with Attention-Deficit/Hyperactivity Disorder (ADHD), whereby participants were treated acutely (8weeks) with micronutrients or placebo followed by an open-label (OL) phase of 8weeks whereby all participants received micronutrients. To ensure that all participants had been exposed to the micronutrients for 8weeks, only those 64 who had adhered to the treatment protocol and completed 8weeks on nutrients were included in the data analysis: 34 from the group that had been randomized to the micronutrient arm, and 30 from the group that had been randomized to the placebo group and hence had only received nutrients in the OL phase. Six outcomes were examined: change in ADHD symptoms (self/clinician), ADHD responder, Clinical Global Impression-Improvement (CGI-I), change in mood, and change in Global Assessment of Functioning (GAF). Demographic, developmental and psychiatric history, current clinical characteristics, and baseline nutrient levels were all considered as putative predictors. RESULTS There were significant changes in all outcome variables after 8weeks exposure to the micronutrients. Among the nutrients recorded at baseline, substantial deficiencies (27%) were only observed for vitamin D. However, other than an association showing that higher iron at baseline was correlated with higher baseline depression scores, baseline nutrient levels were not correlated with baseline psychiatric variables/current clinical characteristics. Regression analyses revealed that higher baseline ferritin and lower baseline copper and vitamin D levels were associated with a better response to treatment for some but not all outcomes. None of the other nutrient levels was found to be associated with outcome, including zinc, vitamin B12, iron, and folate. There were no childhood risk factors, demographic variables or clinical correlates that contraindicated micronutrient treatment; more severe symptoms at baseline and greater number of developmental risk factors predicted greater treatment response. CONCLUSIONS Further research looking at nutrients more broadly is required to confirm these initial observations about ferritin, vitamin D and copper; however, the results suggest that serum nutrient levels have limited value for identifying who will respond to treatment.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand.
| | - Jeanette Johnstone
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Brigette Gorman
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Anna Boggis
- Canterbury District Health Board, Christchurch, New Zealand
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Sleep in Individuals with an Intellectual or Developmental Disability: Recent Research Reports. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014. [DOI: 10.1007/s40474-014-0010-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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32
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Sleep disorders in children with cerebral palsy: neurodevelopmental and behavioral correlates. Sleep Med 2014; 15:213-8. [DOI: 10.1016/j.sleep.2013.08.793] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 11/22/2022]
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Cortese S, Angriman M, Lecendreux M, Konofal E. Iron and attention deficit/hyperactivity disorder: what is the empirical evidence so far? A systematic review of the literature. Expert Rev Neurother 2014; 12:1227-40. [DOI: 10.1586/ern.12.116] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abou-Khadra MK, Amin OR, Shaker OG, Rabah TM. Parent-reported sleep problems, symptom ratings, and serum ferritin levels in children with attention-deficit/hyperactivity disorder: a case control study. BMC Pediatr 2013; 13:217. [PMID: 24377840 PMCID: PMC3878403 DOI: 10.1186/1471-2431-13-217] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 12/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background Sleep problems are common among children with attention-deficit/hyperactivity disorder (ADHD). Serum ferritin levels have been associated with the severity of symptoms and sleep disturbances among children with ADHD. This study was conducted to investigate parent-reported sleep problems in a sample of Egyptian children with ADHD and to examine the relationship between their sleep, symptom-ratings, and low serum ferritin levels. Methods Parents of 41 ADHD children, aged 6 to 12 years, filled out the Children’s Sleep Habits Questionnaire (CSHQ) and Conners’ Parent Rating Scale-Revised: Long Version (CPRS-R:L) in Arabic. Serum ferritin levels were determined with an enzyme-linked immunosorbent assay. The parents of the 62 controls filled out the CSHQ. Results The ADHD group showed significantly higher scores in CSHQ subscales and total score. Children with serum ferritin levels <30 ng/mL had more disturbed sleep. There were significant negative correlations between sleep duration subscale, total score of CSHQ, and serum ferritin levels. There were no significant differences in hyperactivity, cognitive problems/inattention, oppositional, or ADHD index subscale scores between children with serum ferritin levels <30 ng/mL and those with serum ferritin levels ≥30 ng/mL. Conclusions Sleep problems are common, and this study suggests an association between low serum ferritin levels and sleep disturbances.
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Affiliation(s)
- Maha K Abou-Khadra
- Department of Pediatrics, Faculty of Medicine, Cairo University, 2 Yousef Fahmy Street, El-Areech Street, Al-Ahram Street, Giza, Egypt.
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Soto-Insuga V, Calleja M, Prados M, Castaño C, Losada R, Ruiz-Falcó M. Utilidad del hierro en el tratamiento del trastorno por déficit de atención e hiperactividad. An Pediatr (Barc) 2013; 79:230-5. [DOI: 10.1016/j.anpedi.2013.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022] Open
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Youssef J, Singh K, Huntington N, Becker R, Kothare SV. Relationship of serum ferritin levels to sleep fragmentation and periodic limb movements of sleep on polysomnography in autism spectrum disorders. Pediatr Neurol 2013; 49:274-8. [PMID: 24053984 DOI: 10.1016/j.pediatrneurol.2013.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/17/2013] [Accepted: 06/27/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Although children with autism spectrum disorders experience a range of sleep disturbances, exact mechanisms are not well-characterized. We investigated the association of serum-ferritin to sleep fragmentation and periodic limb movements of sleep using polysomnography in children with autism spectrum disorders. METHODS We conducted a retrospective chart review of children with autism spectrum disorders followed from 1990 to 2010. Inclusion criteria were availability of polysomnography data and ferritin levels within 12 months of each other. The following variables on polysomnography characterized sleep fragmentation: increased arousal index, alpha intrusions, and reduced sleep efficiency. The data were compared with age- and gender-matched controls. RESULTS Of 9791 children with autism spectrum disorders identified, 511 had a ferritin level, 377 had polysomnography data, and 53 had both ferritin and polysomnography data. As compared with the controls (86 ng/mL), the median ferritin level was 27 ng/mL in the study autism spectrum disorders population (53 patients) (P < 0.01), 27 ng/mL in autism spectrum disorder subjects with periodic limb movements of sleep (25 patients) (P = 0.01), and 24 ng/mL in autism spectrum disorders subjects with sleep fragmentation (21 patients) (P = 0.02). Within the autism spectrum disorders population, median ferritin levels were significantly lower in patients with poor sleep efficiency (7 ng/mL) versus those with normal sleep efficiency (29 ng/mL) (P = 0.01). The prevalence of periodic limb movements of sleep was 47% in autism spectrum disorders compared with 8% in controls (P < 0.01). CONCLUSION Children with autism spectrum disorders had significantly lower ferritin levels compared with controls. In addition, they experience a higher prevalence of sleep fragmentation, obstructive sleep apnea, and periodic limb movements of sleep than children with ASD and no sleep complaints. Our preliminary observations, which have not been described before, need to be validated in multicenter prospective studies.
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Affiliation(s)
- Julie Youssef
- Division of Developmental Medicine, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Hare D, Ayton S, Bush A, Lei P. A delicate balance: Iron metabolism and diseases of the brain. Front Aging Neurosci 2013; 5:34. [PMID: 23874300 PMCID: PMC3715022 DOI: 10.3389/fnagi.2013.00034] [Citation(s) in RCA: 275] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/25/2013] [Indexed: 12/12/2022] Open
Abstract
Iron is the most abundant transition metal within the brain, and is vital for a number of cellular processes including neurotransmitter synthesis, myelination of neurons, and mitochondrial function. Redox cycling between ferrous and ferric iron is utilized in biology for various electron transfer reactions essential to life, yet this same chemistry mediates deleterious reactions with oxygen that induce oxidative stress. Consequently, there is a precise and tightly controlled mechanism to regulate iron in the brain. When iron is dysregulated, both conditions of iron overload and iron deficiencies are harmful to the brain. This review focuses on how iron metabolism is maintained in the brain, and how an alteration to iron and iron metabolism adversely affects neurological function.
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Affiliation(s)
- Dominic Hare
- The Florey Institute of Neuroscience and Mental Health, University of MelbourneVIC, Australia
- Elemental Bio-imaging Facility, University of TechnologySydney, NSW, Australia
| | - Scott Ayton
- The Florey Institute of Neuroscience and Mental Health, University of MelbourneVIC, Australia
| | - Ashley Bush
- The Florey Institute of Neuroscience and Mental Health, University of MelbourneVIC, Australia
| | - Peng Lei
- The Florey Institute of Neuroscience and Mental Health, University of MelbourneVIC, Australia
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Arnold LE, Hurt E, Lofthouse N. Attention-deficit/hyperactivity disorder: dietary and nutritional treatments. Child Adolesc Psychiatr Clin N Am 2013; 22:381-402, v. [PMID: 23806311 DOI: 10.1016/j.chc.2013.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dozens of complementary and alternative treatments have been advocated for attention-deficit/hyperactivity disorder. Some verge into standard treatment of specific cases. Most do not have conclusive evidence of effectiveness or safety for attention-deficit/hyperactivity disorder, but some have enough evidence and are safe, easy, cheap, and sensible enough that individual patient trials can be justified. There is a need to flesh out the evidence base, which could be done cost effectively for supplements or off-label agents that are amenable to placebo control.
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Affiliation(s)
- L Eugene Arnold
- Nisonger Center, Ohio State University, McCampbell 395E, 1581 Dodd Drive, Columbus, OH 43210, USA.
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Lucila Andrade A. Relacion entre problemas habituales del sueño con deficit atencional y trastornos conductuales en niños. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Donfrancesco R, Parisi P, Vanacore N, Martines F, Sargentini V, Cortese S. Iron and ADHD: time to move beyond serum ferritin levels. J Atten Disord 2013; 17:347-57. [PMID: 22290693 DOI: 10.1177/1087054711430712] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE (a) To compare serum ferritin levels in a sample of stimulant-naïve children with ADHD and matched controls and (b) to assess the association of serum ferritin to ADHD symptoms severity, ADHD subtypes, and IQ. METHOD The ADHD and the control groups included 101 and 93 children, respectively. Serum ferritin levels were determined with the enzyme-linked immunosorbent assay method. RESULTS Serum ferritin did not significantly differ between children with ADHD and controls, as well as among ADHD subtypes. Correlations between serum ferritin levels and measures related to IQ or ADHD severity were not significant. CONCLUSION This is the largest controlled study that assessed ferritin levels in stimulant-naïve ADHD children. The findings of this study do not support a significant relationship between serum ferritin levels and ADHD. However, the authors' results based on peripheral measures of iron do not rule out a possible implication of brain iron deficiency in ADHD, grounded on neurobiological hypotheses and preliminary empirical evidence.
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Romanos M, Tiesler CMT, Koletzko S, Berdel D, von Berg A, Hoffmann B, Schaaf B, Herbarth O, Lehmann I, Bauer CP, Stach B, Gerlach M, Schulte-Körne G, Heinrich J. No cross-sectional and longitudinal association of ferritin and symptoms of attention-deficit-/hyperactivity disorder in a large population-based sample of children: results from the GINIplus and LISAplus studies. ACTA ACUST UNITED AC 2013; 5:313-20. [DOI: 10.1007/s12402-013-0108-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
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Gottfried RJ, Gerring JP, Machell K, Yenokyan G, Riddle MA. The iron status of children and youth in a community mental health clinic is lower than that of a national sample. J Child Adolesc Psychopharmacol 2013; 23:91-100. [PMID: 23480325 PMCID: PMC3609602 DOI: 10.1089/cap.2012.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Iron plays a key role in brain function, and a deficiency of iron has been implicated in various cognitive, motor, and psychiatric disorders. Because of recent evidence that iron deficiency may be related to attention-deficit/hyperactivity disorder (ADHD) and other psychiatric disorders, the goal of this study was to compare the iron status of children and youth seen in a community mental health clinic with a national sample of same-aged subjects. METHODS In this study, a consecutive series of 108 patients (79 males) referred to a community mental health clinic was compared with a National Health and Nutrition Examination Survey (NHANES) sample on measures of iron status. Wilcoxon sign rank and median tests were used to compare distributions of ferritin. Quantile regression was performed to compare the ferritin level in the two samples while adjusting for demographic differences. Chi squared (χ2) was used to compare rates of low hemoglobin in the two samples. RESULTS The iron status of the clinic sample, as measured by ferritin levels (median=23 μg/L), was significantly lower than that of the national sample (median=43 μg/L). After adjustment for age, gender, and race, the clinic sample was found to have 19.2 μg/L lower ferritin than the national sample (95% CI from 7.6 to 30.9, p value=0.001). There were also significantly more subjects in the clinic sample with low hemoglobin than in the national sample. There were no differences in ferritin levels between those patients in the clinic sample with and without an ADHD or other specific psychiatric diagnosis. CONCLUSIONS The ferritin levels of children and youth in a mental health clinic sample were significantly lower than those of the same-aged subjects in a national sample. Therefore, compromised iron status may be an additional biological risk factor for cognitive, behavioral, and psychiatric problems in pediatric populations served by the community mental health clinic.
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Affiliation(s)
| | - Joan P. Gerring
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyla Machell
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gayane Yenokyan
- Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Mark A. Riddle
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Attention-deficit/hyperactivity disorder (ADHD) and adaptation night as determinants of sleep patterns in children. Eur Child Adolesc Psychiatry 2012; 21:681-90. [PMID: 22810917 DOI: 10.1007/s00787-012-0308-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
Sleep problems are a prominent feature in children with attention-deficit/hyperactivity disorder (ADHD) but their relationships to sleep structure are not consistent across studies. We aimed at further examining the sleep architecture in children with ADHD, while considering the role of the first-night effect (FNE) as a possible confounder. Twenty unmedicated children with ADHD combined type (8-15 years old; mean 11.24, SD 2.31) and 19 healthy controls, matched for age and gender, underwent polysomnography during an adaptation and a consecutive second night. ADHD and controls displayed a typical FNE without group differences. Independently of testing night, children with ADHD spent more time in sleep and had shortened rapid eye movement (REM) sleep latency and a greater amount of REM sleep relative to controls. However, the increased REM sleep amount in ADHD children was more expressed in the second night when it was also significantly related to scores of inattention and hyperactivity. Our results (1) document similar sleep adaptation processes in children with ADHD and typically developing children, (2) reveal that REM sleep changes in association with ADHD-specific psychopathology may characterize sleep in ADHD children, which is evident only when the FNE is accounted for, (3) indicate that ADHD psychopathology and adaptation night may exert opposite effects on REM sleep in children. These results may prompt the awareness of clinicians about the importance of actual sleep alterations and their precise evaluation in children with ADHD, which could significantly contribute to better diagnostic, treatment and early prevention strategies.
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Reynolds A, Krebs NF, Stewart PA, Austin H, Johnson SL, Withrow N, Molloy C, James SJ, Johnson C, Clemons T, Schmidt B, Hyman SL. Iron status in children with autism spectrum disorder. Pediatrics 2012; 130 Suppl 2:S154-9. [PMID: 23118246 PMCID: PMC4536584 DOI: 10.1542/peds.2012-0900m] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorders (ASDs) often have food selectivity and restricted diets, putting them at risk for nutritional deficiencies. Previous studies have demonstrated a high prevalence of iron deficiency (ID) in children with ASDs living in Wales, Canada, and Turkey. The objectives of this study were to determine the prevalence of ID and the adequacy of iron intake in children with ASD in the United States. METHODS Participants (age 2-11 years recruited from the Autism Treatment Network Diet and Nutrition Study) completed a 3-day diet record (n = 368) and had laboratory measures of serum ferritin (SF), complete blood count, iron, total iron binding capacity, and transferrin saturation (TS) (n = 222). RESULTS Of the 222 participants with laboratory data, 18 (8%) had SF <12 µg/L and 2 (1%) had ID defined by both low SF and TS (3 children with low SF had missing TS data). One subject had iron deficiency anemia. Fewer than 2% of subjects had iron intake below the estimated average requirement. CONCLUSIONS Although the determination of iron status is complex, these data do not support previous reports that children with ASD are at greater risk for ID than the general population; however, 8% percent of the sample did demonstrate low SF despite <2% of the sample demonstrating iron intake below the estimated average requirement. The prevalence of low SF may be an underestimate, because SF is an acute phase reactant and the study included no measure of inflammation.
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Affiliation(s)
- Ann Reynolds
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, B-140, Aurora, Colorado 80045, USA.
| | - Nancy F. Krebs
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | | | - Harriet Austin
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Susan L. Johnson
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Nikki Withrow
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Cynthia Molloy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S. Jill James
- Department of Pediatrics, University of Arkansas, Little Rock, Arkansas
| | - Cynthia Johnson
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | - Brianne Schmidt
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Susan L. Hyman
- Department of Pediatrics, University of Rochester, Rochester, New York
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Cortese S, Vincenzi B, Angriman M. Identifying and managing sleep disorders associated with ADHD. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parisi P, Villa MP, Donfrancesco R, Miano S, Paolino MC, Cortese S. Could treatment of iron deficiency both improve ADHD and reduce cardiovascular risk during treatment with ADHD drugs? Med Hypotheses 2012; 79:246-9. [DOI: 10.1016/j.mehy.2012.04.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/16/2012] [Indexed: 12/19/2022]
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Turner C, Xie D, Zimmerman B, Calarge CA. Iron status in toddlerhood predicts sensitivity to psychostimulants in children. J Atten Disord 2012; 16:295-303. [PMID: 20978274 PMCID: PMC3556512 DOI: 10.1177/1087054710385067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Iron deficiency is associated with impaired dopaminergic signaling and externalizing behavior. The authors examine, whether iron stores in toddlerhood influence later response to psychostimulants. METHOD Youth participating in a study monitoring the long-term safety of risperidone were included in this analysis if they had received psychostimulant monotherapy for at least 3 weeks and had a complete blood count obtained before psychostimulant treatment. Sensitivity to psychostimulants was defined based on the weight-adjusted dose during the 1st year of treatment. Regression analysis examined whether the hematological tests based on the characteristics of red blood cells were associated with sensitivity to psychostimulants. RESULTS A total of 29 participants (93% men; 76% Whites), primarily with ADHD (93%), comprised the current sample. The hematological tests were obtained, on average, 3 years before the initiation of psychostimulants monotherapy that occurred at 5.8 years of age and continued for a median of 0.85 years, at an average daily dose of 0.98 mg/kg (SD = 0.38) in methylphenidate equivalent. Compared with those who were poorly sensitive to psychostimulants, after adjusting for age, mean corpuscular volume was significantly higher in the highly and moderately psychostimulants sensitive groups. CONCLUSIONS If replicated, these findings suggest that more attention should be paid to optimizing body iron in early childhood.
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Affiliation(s)
- Catharyn Turner
- Medical Student, The University of Iowa Carver College of Medicine
| | - Diqiong Xie
- Graduate Student, The University of Iowa College of Public Health
| | - Bridget Zimmerman
- The University of Iowa College of Public Health, Director, Biostatistics Consultation Center
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Cortese S, Azoulay R, Castellanos FX, Chalard F, Lecendreux M, Chechin D, Delorme R, Sebag G, Sbarbati A, Mouren MC, Bernardina BD, Konofal E. Brain iron levels in attention-deficit/hyperactivity disorder: a pilot MRI study. World J Biol Psychiatry 2012; 13:223-31. [PMID: 21585274 DOI: 10.3109/15622975.2011.570376] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Brain iron deficiency has been supposed to be involved in the pathophysiology of ADHD. Available studies assessing iron in ADHD are based on serum ferritin, a peripheral marker of iron status. To what extent serum ferritin correlates with brain iron (BI) is unclear. The main aim of this study was to compare BI, estimated with magnetic resonance imaging (MRI) in the putamen, pallidum, caudate, and thalamus, between children with and without ADHD. The secondary aim was to assess the correlation between serum ferritin and BI levels. METHODS Thirty-six children (18 with and 18 without ADHD, the latter including nine healthy controls and nine psychiatric controls) completed MRI and blood sampling. Brain iron levels were estimated by imaging T2*. RESULTS Children with ADHD showed significantly lower estimated BI in right and left thalamus compared to healthy controls. Estimated BI did not differ significantly between children with ADHD and psychiatric controls. Children with ADHD had significantly lower levels of serum ferritin than healthy as well as psychiatric controls. Serum ferritin and T2* values did not correlate significantly in most regions. CONCLUSIONS Low iron in the thalamus may contribute to ADHD pathophysiology.
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Affiliation(s)
- Samuele Cortese
- Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France.
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49
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Ferritin and iron levels in children with autistic disorder. Eur J Pediatr 2012; 171:143-6. [PMID: 21643649 DOI: 10.1007/s00431-011-1506-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED Iron has an important role on cognitive, behavioral, and motor development. High prevalence of iron deficiency has been reported in autism. The aim of this study was to investigate iron status in a group of children with autistic disorder. The sample was composed of 116 children between 3 and 16 years with a diagnosis of autistic disorder according to DSM-IV criteria. Serum ferritin, iron, hemoglobin, hematocrit, mean corpuscular volume, and red cell distribution width values were measured. We found that 24.1% of subjects had iron deficiency, and 15.5% had anemia. There was a significant positive correlation between age and ferritin and hematological measures. Results of this study confirmed that iron deficiency and anemia are common in children with autistic disorder. CONCLUSION These findings suggest that ferritin levels should be measured in subjects with autism as a part of routine investigation.
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50
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Mahmoud MM, El-Mazary AAM, Maher RM, Saber MM. Zinc, ferritin, magnesium and copper in a group of Egyptian children with attention deficit hyperactivity disorder. Ital J Pediatr 2011; 37:60. [PMID: 22206662 PMCID: PMC3268715 DOI: 10.1186/1824-7288-37-60] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 12/29/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder is a behavioral syndrome of childhood characterized by inattention, hyperactivity and impulsivity. There were many etiological theories showed dysfunction of some brain areas that are implicated in inhibition of responses and functions of the brain. Minerals like zinc, ferritin, magnesium and copper may play a role in the pathogenesis and therefore the treatment of this disorder. OBJECTIVE This study aimed to measure levels of zinc, ferritin, magnesium and copper in children with attention deficit hyperactivity disorder and comparing them to normal. METHODS This study included 58 children aged 5-15 years with attention deficit hyperactivity disorder attending Minia University Hospital from June 2008 to January 2010. They were classified into three sub-groups: sub-group I included 32 children with in-attentive type, sub-group II included 10 children with hyperactive type and sub-group III included 16 children with combined type according to the DSM-IV criteria of American Psychiatric Association, 2000. The control group included 25 apparently normal healthy children. RESULTS Zinc, ferritin and magnesium levels were significantly lower in children with attention deficit hyperactivity disorder than controls (p value 0.04, 0.03 and 0.02 respectively), while copper levels were not significantly different (p value 0.9). Children with inattentive type had significant lower levels of zinc and ferritin than controls (p value 0.001 and 0.01 respectively) with no significant difference between them as regards magnesium and copper levels (p value 0.4 and 0.6 respectively). Children with hyperactive type had significant lower levels of zinc, ferritin and magnesium than controls (p value 0.01, 0.02 and 0.02 respectively) with no significant difference between them as regards copper levels (p value 0.9). Children with combined type had significant lower levels of zinc and magnesium than controls (p value 0.001 and 0.004 respectively) with no significant difference between them as regards ferritin and copper levels (p value 0.7 and 0.6 respectively). CONCLUSIONS Children with attention deficit hyperactivity disorder had lower levels of zinc, ferritin and magnesium than healthy children but had normal copper levels.
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Affiliation(s)
- Magdy M Mahmoud
- Pediatric department, Minia university, Minia city, Minia, postcode 61111, Egypt
| | | | - Reham M Maher
- Pediatric department, Minia university, Minia city, Minia, postcode 61111, Egypt
| | - Manal M Saber
- Clinical-pathology department, Minia university, Minia city, Minia, postcode 61111, Egypt
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