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Öğütlü H, Kütük ÖM, Tufan AE, Akay AP, Gündoğdu ÖY, Ercan ES. The detect consensus report on Attention Deficit/Hyperactivity Disorder and its management among Turkish children and adolescents (Detect: consensus report on ADHD among Turkish youth). Front Psychiatry 2024; 15:1372341. [PMID: 38577402 PMCID: PMC10993048 DOI: 10.3389/fpsyt.2024.1372341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common and heritable neurodevelopmental disorders which may last through the life-span. A consensus report on diagnosis and management of ADHD among Turkish youth was prepared previously. However, the participants as well as the management options were rather limited and developments in the past decade necessitated a revision and update of the consensus. Therefore, this review aims to summarize the consensus among Child and Adolescent Psychiatrists from Türkiye on the nature and management of pediatric ADHD. For those aims, the etiology of ADHD, diagnostic and evaluation process, epidemiology, developmental presentations, differential diagnoses and comorbidities, course/outcome and pharmacological as well as non-pharmacological management options were reviewed and suggestions for clinical practice are presented. Since ADHD is a chronic disorder with wide-ranging effects on functionality that is frequently accompanied by other mental disorders, a multidimensional therapeutic approach is recommended. However, since the disorder has neurobiological basis, pharmacotherapy represents the mainstay of treatment. Additional therapies may include psychosocial therapy, behavioral therapy, school-based therapeutic approaches, and family education. This review provides recommendations for ADHD at the national and global levels. It contains information about ADHD that will contribute to and facilitate clinicians' decision-making processes. It is advisable to consider this guideline in clinical practice.
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Affiliation(s)
- Hakan Öğütlü
- Child and Adolescent Psychiatry Department, Cognitive Behavioral Psychotherapies Association, Ankara, Türkiye
| | - Özlem Meryem Kütük
- Child and Adolescent Psychiatry Department, Medical Faculty, Baskent University, Adana, Türkiye
| | - Ali Evren Tufan
- Child and Adolescent Psychiatry Department, Medical Faculty, Bolu Abant Izzet Baysal University, Bolu, Türkiye
| | - Aynur Pekcanlar Akay
- Child and Adolescent Psychiatry Department, Medical Faculty, Dokuz Eylul University, Izmir, Türkiye
| | - Özlem Yildiz Gündoğdu
- Child and Adolescent Psychiatry Department, Medical Faculty, Kocaeli University, Kocaeli, Türkiye
| | - Eyüp Sabri Ercan
- Child and Adolescent Psychiatry Department, Medical Faculty, Ege University, Izmir, Türkiye
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Wu ZM, Wang P, Liu J, Liu L, Cao XL, Sun L, Yang L, Cao QJ, Wang YF, Yang BR. The clinical, neuropsychological, and brain functional characteristics of the ADHD restrictive inattentive presentation. Front Psychiatry 2023; 14:1099882. [PMID: 36937718 PMCID: PMC10014598 DOI: 10.3389/fpsyt.2023.1099882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/07/2023] [Indexed: 03/05/2023] Open
Abstract
Objectives There is an ongoing debate about the restrictive inattentive (RI) presentation of attention deficit hyperactivity disorder (ADHD). The current study aimed to systematically investigate the clinical, neuropsychological, and brain functional characteristics of children with ADHD restrictive inattentive presentation. Methods A clinical sample of 789 children with or without ADHD participated in the current study and finished clinical interviews, questionnaires, and neuropsychological tests. Those individuals with a diagnosis of ADHD were further divided into three subgroups according to the presentation of inattentive and/or hyperactive/impulsive symptoms, the ADHD-RI, the ADHD-I (inattentive), and the ADHD-C (combined) groups. Between-group comparisons were carried out on each clinical and neuropsychological measure using ANCOVA, with age and sex as covariates. Bonferroni corrections were applied to correct for multiple comparisons. Two hundred twenty-seven of the subjects also went through resting-state functional magnetic resonance imaging scans. Five ADHD-related brain functional networks, including the default mode network (DMN), the dorsal attention network (DAN), the ventral attention network, the executive control network, and the salience network, were built using predefined regions of interest (ROIs). Voxel-based group-wise comparisons were performed. Results Compared with healthy controls, all ADHD groups presented more clinical problems and weaker cognitive function. Among the ADHD groups, the ADHD-C group had the most clinical problems, especially delinquent and aggressive behaviors. Regarding cognitive function, the ADHD-RI group displayed the most impaired sustained attention, and the ADHD-C group had the worst response inhibition function. In terms of brain functional connectivity (FC), reduced FC in the DMN was identified in the ADHD-C and the ADHD-I groups but not the ADHD-RI group, compared to the healthy controls. Subjects with ADHD-I also presented decreased FC in the DAN in contrast to the control group. The ADHD-RI displayed marginally significantly lower FC in the salience network compared to the ADHD-I and the control groups. Conclusion The ADHD-RI group is distinguishable from the ADHD-I and the ADHD-C groups. It is characterized by fewer externalizing behaviors, worse sustained attention, and better response inhibition function. The absence of abnormally high hyperactive/impulsive symptoms in ADHD-RI might be related to less impaired brain function in DMN, but potentially more impairment in the salience network.
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Affiliation(s)
- Zhao-Min Wu
- Shenzhen Children's Hospital, Shenzhen, China
- *Correspondence: Zhao-Min Wu,
| | - Peng Wang
- Cardiac Rehabilitation Center, Fuwai Hospital, CAMS and PUMC, Beijing, China
| | - Juan Liu
- Shenzhen Children's Hospital, Shenzhen, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | | | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Li Yang
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Qing-Jiu Cao
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Yu-Feng Wang
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
- Yu-Feng Wang,
| | - Bin-Rang Yang
- Shenzhen Children's Hospital, Shenzhen, China
- Bin-Rang Yang,
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Genetic variations influence brain changes in patients with attention-deficit hyperactivity disorder. Transl Psychiatry 2021; 11:349. [PMID: 34091591 PMCID: PMC8179928 DOI: 10.1038/s41398-021-01473-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurological and neurodevelopmental childhood-onset disorder characterized by a persistent pattern of inattentiveness, impulsiveness, restlessness, and hyperactivity. These symptoms may continue in 55-66% of cases from childhood into adulthood. Even though the precise etiology of ADHD is not fully understood, it is considered as a multifactorial and heterogeneous disorder with several contributing factors such as heritability, auxiliary to neurodevelopmental issues, severe brain injuries, neuroinflammation, consanguineous marriages, premature birth, and exposure to environmental toxins. Neuroimaging and neurodevelopmental assessments may help to explore the possible role of genetic variations on ADHD neuropsychobiology. Multiple genetic studies have observed a strong genetic association with various aspects of neuropsychobiological functions, including neural abnormalities and delayed neurodevelopment in ADHD. The advancement in neuroimaging and molecular genomics offers the opportunity to analyze the impact of genetic variations alongside its dysregulated pathways on structural and functional derived brain imaging phenotypes in various neurological and psychiatric disorders, including ADHD. Recently, neuroimaging genomic studies observed a significant association of brain imaging phenotypes with genetic susceptibility in ADHD. Integrating the neuroimaging-derived phenotypes with genomics deciphers various neurobiological pathways that can be leveraged for the development of novel clinical biomarkers, new treatment modalities as well as therapeutic interventions for ADHD patients. In this review, we discuss the neurobiology of ADHD with particular emphasis on structural and functional changes in the ADHD brain and their interactions with complex genomic variations utilizing imaging genetics methodologies. We also highlight the genetic variants supposedly allied with the development of ADHD and how these, in turn, may affect the brain circuit function and related behaviors. In addition to reviewing imaging genetic studies, we also examine the need for complementary approaches at various levels of biological complexity and emphasize the importance of combining and integrating results to explore biological pathways involved in ADHD disorder. These approaches include animal models, computational biology, bioinformatics analyses, and multimodal imaging genetics studies.
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Baytunca MB, de Frederick B, Bolat GU, Kardas B, Inci SB, Ipci M, Calli C, Özyurt O, Öngür D, Süren S, Ercan ES. Increased cerebral blood flow in the right anterior cingulate cortex and fronto-orbital cortex during go/no-go task in children with ADHD. Nord J Psychiatry 2021; 75:224-233. [PMID: 33411645 DOI: 10.1080/08039488.2020.1864775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we aimed to compare the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls during a neurocognitive task by using event-related ASL scanning. METHODS The study comprised of 17 healthy controls and 20 children with ADHD. The study subjects were scanned on 3 Tesla MRI scanner to obtain ASL imaging data. Subjects performed go/no-go task during the ASL image acquisition. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. RESULTS The mean age was 10.88 ± 1.45 and 11 ± 1.91 for the control and ADHD group, respectively (p = .112). The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the frontopolar and orbitofrontal cortices (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p < .001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. CONCLUSION These results indicate that children with ADHD needed to over-activate frontopolar cortex, anterior cingulate as well as the dorsal and ventral attention networks to compensate for the attention demanded in a given cognitive task.
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Affiliation(s)
| | - Blaise de Frederick
- McLean Imaging Center, Department of Psychiatry, Harvard University, MA, USA
| | - Gul Unsel Bolat
- Department of Child and Adolescent Psychiatry, Balikesir University, School of Medicine, Balikesir, Turkey
| | - Burcu Kardas
- Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey
| | | | - Melis Ipci
- Clinical Psychology Department of Hasan Kalyoncu University, Gaziantep, Turkey
| | - Cem Calli
- Department of Radiology, Ege University, Izmir, Turkey
| | - Onur Özyurt
- Telemed, Bogazici University, Teknopark, Istanbul, Turkey
| | - Dost Öngür
- Division of Psychotic Disorders, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Serkan Süren
- Department of Child and Adolescent Psychiatry, Ege University, School of Medicine, Izmir, Turkey
| | - Eyüp Sabri Ercan
- Department of Child and Adolescent Psychiatry, Ege University, School of Medicine, Izmir, Turkey
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Bacanlı A, Unsel-Bolat G, Suren S, Yazıcı KU, Callı C, Aygunes Jafari D, Kosova B, Rohde LA, Ercan ES. Effects of the dopamine transporter gene on neuroimaging findings in different attention deficit hyperactivity disorder presentations. Brain Imaging Behav 2021; 15:1103-1114. [PMID: 33469789 DOI: 10.1007/s11682-020-00437-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 11/29/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a phenotipically and neurobiologically heterogeneous disorder. Deficiencies at different levels in response inhibition, differences in dopamine transporter genotype (DAT1) and various symptomatic presentations contribute to ADHD heterogeneity. Integrating these three aspects into a functional neuroimaging research could help unreval specific neurobiological components of more phenotipically homogeneous groups of patients with ADHD. During the Go-NoGo trial, we investigated the effect of the DAT1 gene using 3 T MRI in 72 ADHD cases and 24 (TD) controls that typically developed between the ages 8 and 15 years. In the total ADHD group, DAT1 predicted homozygosity for the 10R allele and hypoactivation in the anterior cingulate cortex and paracingulate cortex. There were no significant activation differences between DAT1 10R/10R homozygotes and 9R carriers in TD controls. Subjects with predominantly inattentive ADHD (ADHD-I) presentation with DAT1 10R/10R homozygous reduced neuronal activation during Go trial particularly in the frontal regions and insular cortex, and in the parietal regions during NoGo trial (brain regions reported as part of Default Mode Network- DMN). Additionally, DAT1 10R/10R homozygousness was associated with increased occipital zone activation during only the Go trial in the ADHD combined presentation (ADHD-C) group. Our results point the three main findings: 1) The DAT1 gene is 10R homozygous for differentiated brain activation in ADHD cases but not in the TD controls, supporting the DAT1 gene as a potential marker for ADHD, 2) The relationship between the DAT1 gene and the occipital regions in ADHD-C group which may reflect compensatory mechanisms, 3) The relationship between DAT1 gene and the reduced DMN suppression for 9R carriers probabaly stems from the ADHD-I group.
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Affiliation(s)
- Ali Bacanlı
- Department of Child and Adolescent Psychiatry, Zubeyde Hanim Training and Research Hospital, Başkent University, Izmir, Turkey
| | - Gul Unsel-Bolat
- Department of Child and Adolescent Psychiatry, Balıkesir University, Balıkesir, Turkey.
| | - Serkan Suren
- Department of Child and Adolescent Psychiatry, Medical Park Hospital, Samsun, Turkey
| | - Kemal Utku Yazıcı
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Cem Callı
- Department of Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Duygu Aygunes Jafari
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Buket Kosova
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Eyup Sabri Ercan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
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Saad JF, Griffiths KR, Korgaonkar MS. A Systematic Review of Imaging Studies in the Combined and Inattentive Subtypes of Attention Deficit Hyperactivity Disorder. Front Integr Neurosci 2020; 14:31. [PMID: 32670028 PMCID: PMC7327109 DOI: 10.3389/fnint.2020.00031] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Insights to underlying neural mechanisms in attention deficit hyperactivity disorder (ADHD) have emerged from neuroimaging research; however, the neural mechanisms that distinguish ADHD subtypes remain inconclusive. Method: We reviewed 19 studies integrating magnetic resonance imaging [MRI; structural (sMRI), diffusion, functional MRI (fMRI)] findings into a framework exploring pathophysiological mechanisms underlying the combined (ADHD-C) and predominantly inattentive (ADHD-I) ADHD subtypes. Results: Despite equivocal structural MRI results, findings from fMRI and DTI imaging modalities consistently implicate disrupted connectivity in regions and tracts involving frontal striatal thalamic in ADHD-C and frontoparietal neural networks in ADHD-I. Alterations of the default mode, cerebellum, and motor networks in ADHD-C and cingulo-frontoparietal attention and visual networks in ADHD-I highlight network organization differences between subtypes. Conclusion: Growing evidence from neuroimaging studies highlight neurobiological differences between ADHD clinical subtypes, particularly from a network perspective. Understanding brain network organization and connectivity may help us to better conceptualize the ADHD types and their symptom variability.
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Affiliation(s)
- Jacqueline Fifi Saad
- Brain Dynamics Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia.,The Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia.,The Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia.,The Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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Kostyrka-Allchorne K, Wass SV, Sonuga-Barke EJS. Research Review: Do parent ratings of infant negative emotionality and self-regulation predict psychopathology in childhood and adolescence? A systematic review and meta-analysis of prospective longitudinal studies. J Child Psychol Psychiatry 2020; 61:401-416. [PMID: 31696514 DOI: 10.1111/jcpp.13144] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Identifying low-cost and easy to implement measures of infant markers of later psychopathology may improve targeting of early intervention for prevention. Because of their early manifestation, relative stability and overlap with constructs central to affect-based dimensions of child and adolescent psychopathology, negative emotionality and self-regulation have been the focus of this research. We conducted a meta-analysis of longitudinal studies examining the prospective association between infant temperament measured with parent ratings and child/adolescent psychopathology. METHODS A systematic literature search for prospective longitudinal studies, which included measures of questionnaire-assessed infant temperament (negative emotionality, self-regulation, behavioural inhibition, surgency/extraversion, activity level) and symptoms of child or adolescent mental health (externalising, internalising) and neurodevelopmental problems (attention deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD]), was conducted. Standardised estimates of association were calculated and pooled in meta-analyses. RESULTS Twenty-five studies (n = 28,425) met inclusion criteria. Small associations were seen between psychopathology aggregated across all domains and infant negative emotionality (r = .15; p < .001) and self-regulation (r = -.19; p = .007). Effects were also significant but weaker for behavioural inhibition (r = .10; p = .027) and activity level (r = .08; p = .016). Surgency/extraversion was not significantly associated with psychopathology in general (r = -.04; p = .094); however, it was negatively associated with ASD (r = -.10, p = .015). Significant correlations were observed with some outcomes isomorphic with predictors, internalising problems and behavioural inhibition (r = .10; p = .013), ADHD symptoms and activity level (r = .19; p = .009). CONCLUSION Questionnaire-based assessments of infant negative emotionality may have transdiagnostic potential to contribute to a risk index of later childhood psychopathology. Behavioural inhibition, surgency/extraversion and activity ratings may provide more specific predictive power. More data from prospective studies are required before the potential of self-regulation and surgency/extraversion can be properly gauged.
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Affiliation(s)
- Katarzyna Kostyrka-Allchorne
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam V Wass
- School of Psychology, University of East London, London, UK
| | - Edmund J S Sonuga-Barke
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
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Kibby MY, Vadnais SA, Jagger-Rickels AC. Which components of processing speed are affected in ADHD subtypes? Child Neuropsychol 2019; 25:964-979. [PMID: 30558479 PMCID: PMC6581645 DOI: 10.1080/09297049.2018.1556625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/01/2018] [Indexed: 10/27/2022]
Abstract
The term "processing speed" (PS) encompasses many components including perceptual, cognitive and output speed. Despite evidence for reduced PS in Attention-Deficit/Hyperactivity Disorder (ADHD), little is known about which component(s) is most impacted in ADHD, or how it may vary by subtypes. Participants included 151 children, ages 8-12 years, with ADHD Predominantly Inattentive Type, ADHD Combined Type and typically developing controls using DSM-IV criteria. All children completed four measures of processing speed: Symbol Search, Coding, Decision Speed, and simple reaction time. We found children with ADHD-PI and ADHD-C had slower perceptual and psychomotor/incidental learning speed than controls and that ADHD-PI had slower decision speed than controls. The subtypes did not differ on any of these measures. Mean reaction time was intact in ADHD. Hence, at a very basic output level, children with ADHD do not have impaired speed overall, but as task demands increase their processing speed becomes less efficient than controls'. Further, perceptual and psychomotor speed were related to inattention, and psychomotor speed/incidental learning was related to hyperactivity/impulsivity. Thus, inattention may contribute to less efficient performance and worse attention to detail on tasks with a higher perceptual and/or psychomotor load; whereas hyperactivity/impulsivity may affect psychomotor speed/incidental learning, possibly via greater inaccuracy and/or reduced learning efficiency. Decision speed was not related to either dimension. Results suggest that PS deficits are primarily linked to the inattention dimension of ADHD but not exclusively. Findings also suggest PS is not a singular process but rather a multifaceted system that is differentially impacted in ADHD.
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Affiliation(s)
- Michelle Y Kibby
- a Department of Psychology , Southern Illinois University , Carbondale , IL , USA
| | - Sarah A Vadnais
- a Department of Psychology , Southern Illinois University , Carbondale , IL , USA
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Becker SP, Willcutt EG. Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. Eur Child Adolesc Psychiatry 2019; 28:603-613. [PMID: 29524018 PMCID: PMC6131087 DOI: 10.1007/s00787-018-1136-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/23/2018] [Indexed: 02/06/2023]
Abstract
Sluggish cognitive tempo (SCT) is separable from attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies, and growing evidence demonstrates SCT to be associated with impairment in both children and adults. However, it remains unclear how SCT should optimally be conceptualized. In this article, we argue that multiple models of psychopathology should be leveraged to make substantive advances to our understanding of SCT. Both categorical and dimensional approaches should be used, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) nosology, the Research Domain Criteria (RDoC) initiative, and hierarchical models of psychopathology. Studies are needed to determine whether individuals categorized with SCT can be reliably identified and differentiated from individuals without SCT in pathophysiological, neuropsychological, behavioral, and daily life functioning. Studies are also needed to evaluate the validity and utility of SCT as a transdiagnostic and dimensional construct. In considering SCT as a dimensional and potentially transdiagnostic construct, we describe ways in which SCT might be examined within the RDoC framework, including negative valence systems, cognitive systems, and arousal/regulatory systems, as well as within hierarchical models of psychopathology. Conceptualizing SCT within both categorical and dimensional models of psychopathology will help to better understand the causes, developmental pathways, and clinical implications of SCT, both as a construct in its own right and also in relation to other psychopathologies.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA.
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45229, USA.
| | - Erik G Willcutt
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA
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Ünsel-Bolat G, Ercan ES, Bolat H, Süren S, Bacanlı A, Yazıcı KU, Rohde LA. Comparisons between sluggish cognitive tempo and ADHD-restrictive inattentive presentation phenotypes in a clinical ADHD sample. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2019; 11:363-372. [PMID: 30911899 DOI: 10.1007/s12402-019-00301-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
There is a debate how different ADHD cases with a comorbid sluggish cognitive tempo (SCT) phenotype are from subjects with a pure inattentive ADHD presentation (ADHD-restrictive inattentive presentation). In this study, 214 patients aged 8-15 years from an ADHD outpatient clinic were assessed, and 100 typically developing controls (TD) were recruited as comparisons. No psychiatric comorbidities except for oppositional defiant disorder were allowed. We compared 29 cases with ADHD + SCT with 34 ADHD-RI cases and 92 TD subjects on sociodemographic profiles, CBCL subscales scores and neurocognitive findings. Regarding sociodemographic profiles (age, gender and parental education) and CBCL subscales, ADHD + SCT and ADHD-RI cases did not differ in any score (all p > 0.05). Comparing with SCT cases, ADHD-RI cases presented slower psychomotor speed and worse neurocognitive index (p < 0.001). We found that only SCT was independently associated with a lower performance in total memory score. ADHD-RI was independently associated with longer reaction time. Our findings suggest that although SCT might be expected to present longer reaction time, we found that slower psychomotor speed and longer reaction time scores were related to inattention. Overall, SCT and ADHD-RI groups were distinguished by differential associations with measures of memory and reaction time.
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Affiliation(s)
- Gül Ünsel-Bolat
- Department of Child and Adolescent Psychiatry, Elazig City Hospital, Elazig, Turkey.
| | - Eyüp Sabri Ercan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hilmi Bolat
- Department of Medical Genetics, Elazig City Hospital, Elazig, Turkey
| | - Serkan Süren
- Department of Child and Adolescent Psychiatry, Medical Park Hospital, Samsun, Turkey
| | - Ali Bacanlı
- Department of Child and Adolescent Psychiatry, Zübeyde Hanım Hospital, Başkent University, Izmir, Turkey
| | - Kemal Utku Yazıcı
- Department of Child and Adolescent Psychiatry, Fırat University, Elazig, Turkey
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
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Baytunca MB, Inci SB, Ipci M, Kardas B, Bolat GU, Ercan ES. The neurocognitive nature of children with ADHD comorbid sluggish cognitive tempo: Might SCT be a disorder of vigilance? Psychiatry Res 2018; 270:967-973. [PMID: 29602533 DOI: 10.1016/j.psychres.2018.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/23/2017] [Accepted: 03/16/2018] [Indexed: 11/16/2022]
Abstract
UNLABELLED Sluggish Cognitive Tempo (SCT) refers to a clinical construct including several symptoms such as sluggishness, absentmindedness, low energy. In the present study, we compared neurocognitive laboratory outcomes of ADHD children with or without SCT. METHOD The CNS Vital Signs Battery was utilized to measure neurocognitive measure of the participants. The SCT+ADHD group comprised of 42 subjects, ADHD group was 41 subjects and control group was 24 subjects. RESULTS The cognitive flexibility score was found to be more severely impaired in ADHD children with SCT in comparison to the ADHD-only. Additionally, greater deficits in the Shifting Attention Test (p = 0.014) and the Continuous Performance Test (reaction time score, p < 0.01) were found in the SCT+ADHD group relative to ADHD group. Processing speed, visual/auditory memory, psychomotor speed and reaction time were not found to more impaired in those comorbid with SCT. CONCLUSION Impairments in the cognitive flexibility and more specifically shifting attention and continuous performance may be indicative of vigilance and orientation problems rather than executive functions for the SCT construct.
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Affiliation(s)
- Muharrem Burak Baytunca
- Department of Child & Adolescent Psychiatry, School of Medicine, Ege University, Izmir, Turkey.
| | - Sevim Berrin Inci
- Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| | | | - Burcu Kardas
- Department of Child & Adolescent Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Gul Unsel Bolat
- Department of Child & Adolescent Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Eyup Sabri Ercan
- Department of Child & Adolescent Psychiatry, School of Medicine, Ege University, Izmir, Turkey
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12
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Vadnais SA, Kibby MY, Jagger-Rickels AC. Which neuropsychological functions predict various processing speed components in children with and without attention-deficit/hyperactivity disorder? Dev Neuropsychol 2018; 43:403-418. [PMID: 29718727 DOI: 10.1080/87565641.2018.1469135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We identified statistical predictors of four processing speed (PS) components in a sample of 151 children with and without attention-deficit/hyperactivity disorder (ADHD). Performance on perceptual speed was predicted by visual attention/short-term memory, whereas incidental learning/psychomotor speed was predicted by verbal working memory. Rapid naming was predictive of each PS component assessed, and inhibition predicted all but one task, suggesting a shared need to identify/retrieve stimuli rapidly and inhibit incorrect responding across PS components. Hence, we found both shared and unique predictors of perceptual, cognitive, and output speed, suggesting more specific terminology should be used in future research on PS in ADHD.
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Affiliation(s)
- Sarah A Vadnais
- a Department of Psychology , Southern Illinois University , Carbondale , IL , USA
| | - Michelle Y Kibby
- a Department of Psychology , Southern Illinois University , Carbondale , IL , USA
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13
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Al-Amin M, Zinchenko A, Geyer T. Hippocampal subfield volume changes in subtypes of attention deficit hyperactivity disorder. Brain Res 2018; 1685:1-8. [DOI: 10.1016/j.brainres.2018.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
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14
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Gürbüz Özgür B, Aksu H, Yılmaz M, Karakoç Demirkaya S. The probable role of adrenomedullin and nitric oxide in childhood attention deficit hyperactivity disorder. Nord J Psychiatry 2017; 71:521-524. [PMID: 28670953 DOI: 10.1080/08039488.2017.1343382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The role of adrenomedullin hormone, which has been shown to be associated with many psychiatric disorders, in the etiology of ADHD and its relation to disease is not yet known. AIM In this study, it was aimed to compare plasma adrenomedullin and nitric oxide (NO) levels of newly diagnosed, treatment-naive patients with ADHD with healthy children. METHODS A total of 45 children with ADHD and 45 healthy children were included. The Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS), a semi-structured interview, was applied to all cases by child and adolescent psychiatrist. Age and gender matched participants who admitted to the hospital for any other reasons without any psychiatric diagnosis according to K-SADS were selected as a control group. Sociodemographic data form and The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale-parental form were applied to the all groups. NO and adrenomedullin levels were analysed by ELISA method with specific commercial kits. RESULTS There was no statistically significant difference in NO and adrenomedullin levels, neither between the groups nor ADHD subtypes. A positive correlation between adrenomedullin and NO levels was found in both the case (r = 0.659) and the control groups (r = 0.494). CONCLUSIONS Besides being the first study to evaluate adrenomedullin levels to elucidate the etiology of childhood ADHD as well as NO, significant differences was not found between the case and the control groups in terms of NO and adrenomedullin levels.
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Affiliation(s)
- Börte Gürbüz Özgür
- a Department of Child and Adolescent Psychiatry, Medical Faculty , Adnan Menderes University , Aydın , Turkey
| | - Hatice Aksu
- a Department of Child and Adolescent Psychiatry, Medical Faculty , Adnan Menderes University , Aydın , Turkey
| | - Mustafa Yılmaz
- b Department of Biochemistry, Medical Faculty , Adnan Menderes University , Aydın , Turkey
| | - Sevcan Karakoç Demirkaya
- a Department of Child and Adolescent Psychiatry, Medical Faculty , Adnan Menderes University , Aydın , Turkey
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15
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Vilgis V, Sun L, Chen J, Silk TJ, Vance A. Global and local grey matter reductions in boys with ADHD combined type and ADHD inattentive type. Psychiatry Res Neuroimaging 2016; 254:119-126. [PMID: 27399309 DOI: 10.1016/j.pscychresns.2016.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 01/06/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has reliably been associated with global grey matter reductions but local alterations are largely inconsistent with perhaps the exception of the caudate nucleus. The aim of this study was to examine local and global brain volume differences between typically developing children (TD) and children with a diagnosis of ADHD. We also addressed whether these parameters would differ between children with the ADHD-combined type (ADHD-C) and those with the ADHD-inattentive type (ADHD-I). Using an ROI approach caudate volume differences were also examined. 79 boys between the ages of 8 and 17 participated in the study. Of those 33 met diagnostic criteria for the ADHD-C and 15 for the ADHD-I subtype. 31 boys were included in the TD group. Structural magnetic resonance imaging data were analysed using voxel-based morphometry. The ADHD group had significantly lower global and local grey matter volumes within clusters in the bilateral frontal, right parietal and right temporal regions compared to TD. A significant group by age interaction was found for right caudate nucleus volume. No differences between the ADHD-C and ADHD-I groups were found. Right caudate nucleus volume and age are more strongly related in ADHD than in TD consistent with previous research.
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Affiliation(s)
- Veronika Vilgis
- Academic Child Psychiatry Unit, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville Australia; Developmental Imaging, Murdoch Childrens Research Institute, Parkville, Australia
| | - Li Sun
- Institute of Mental Health, Peking University, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China
| | - Jian Chen
- Developmental Imaging, Murdoch Childrens Research Institute, Parkville, Australia
| | - Timothy J Silk
- Developmental Imaging, Murdoch Childrens Research Institute, Parkville, Australia
| | - Alasdair Vance
- Academic Child Psychiatry Unit, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville Australia; Developmental Imaging, Murdoch Childrens Research Institute, Parkville, Australia.
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