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Barnard-Brak L. Parental Report of Remission in ADHD: Results From a Community-Based, Nationally Representative Sample. J Atten Disord 2024; 28:1340-1344. [PMID: 38166450 DOI: 10.1177/10870547231219005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
OBJECTIVE Various studies have examined rates of remission in ADHD with mixed results. METHOD Survival curve analyses were performed on a community-based sample. RESULTS The results of the current study appear to support the contemporary literature that rates of remission in ADHD are lower than have been found in many earlier studies. The current study also reports a mean age of remission in ADHD of around 14 years old, which has not been previously reported via survival curve analyses. Additionally, the results of the current study found several variables to be significantly associated with remission in ADHD which included: the presence of comorbid disorder; lower symptoms of ADHD; sex of the child (being female); and the receipt of behavioral treatment. CONCLUSION Implications and limitations are discussed as related to these findings.
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Chan HK, Rowe R, Carroll D. Factors associated with parent-teacher hyperactivity/inattention screening discrepancy: Findings from a UK national sample. PLoS One 2024; 19:e0299980. [PMID: 38758772 PMCID: PMC11101030 DOI: 10.1371/journal.pone.0299980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND To fulfil the diagnostic criteria of Attention Deficit Hyperactivity Disorder in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms should be observed in two or more settings. This implies that diagnostic procedures require observations reported from informants in different settings, such as teachers in school and caregivers at home. This study examined parent-teacher agreement in reporting hyperactivity/inattention and its relationship with child's, parent's, and family's characteristics. METHOD We used data from the 2004 United Kingdom Mental Health of Children and Young People survey, including 7977 children aged 4-17, to investigate cross-informant agreement between parents and teachers on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire. The characteristics of different patterns of informant agreement were assessed using multinomial logistic regression. RESULTS Cross-informant agreement of parent and teacher was low (weighted kappa = .34, 95% C.I.: .31, .37). Some characteristics, such as male child and parental emotional distress, were associated with higher likelihood of parent-teacher discrepancy. CONCLUSION We found low informant agreement in the hyperactive/inattention subscale, as hypothesised and consistent with previous studies. The current study has found several factors that predict discrepancy, which were partly consistent with previous research. Possible explanation, implications, and further research on parent-teacher informant discrepancy in reporting hyperactivity/inattention were discussed.
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Affiliation(s)
- Hei Ka Chan
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Richard Rowe
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Daniel Carroll
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Maletic V, Mattingly GW, Earnest J. Viloxazine extended-release capsules as an emerging treatment for attention-deficit/hyperactivity disorder in children and adolescents. Expert Rev Neurother 2024; 24:443-455. [PMID: 38502148 DOI: 10.1080/14737175.2024.2327533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and/or hyperactivity and impulsivity. Viloxazine extended-release (ER) capsules (Qelbree®) is a US Food and Drug Administration-approved nonstimulant treatment option for children, adolescents, and adults with ADHD. AREAS COVERED This review manuscript summarizes the neurobiology of ADHD and currently available treatment options before discussing viloxazine pharmacology, efficacy, safety, and tolerability data from phase II and III trials in children and adolescents (6-17 years old). Viloxazine clinical efficacy has also been further demonstrated by post hoc analyses of pediatric clinical trial results. EXPERT OPINION Current stimulant and nonstimulant treatments for ADHD may be suboptimal given low response rates and that tolerability issues are frequently experienced. Preclinical and clinical evidence has implicated both the role of catecholamine and serotonin signaling in the pathophysiology of ADHD and the pharmacologic effect of viloxazine on these critical neurotransmitter systems. With a relatively rapid onset of action, sustained symptom improvement, and clinical benefit in ADHD-associated impairments (functional and social), viloxazine ER represents a novel and emerging ADHD treatment option.
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Affiliation(s)
- Vladimir Maletic
- Department of Psychiatry and Behavioral Science, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Gregory W Mattingly
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Jami Earnest
- Medical Affairs, Supernus Pharmaceuticals, Inc, Rockville, MD, USA
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4
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Martin J. Why are females less likely to be diagnosed with ADHD in childhood than males? Lancet Psychiatry 2024; 11:303-310. [PMID: 38340761 DOI: 10.1016/s2215-0366(24)00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
ADHD is less likely to be diagnosed in females than males, especially in childhood. Females also typically receive the diagnosis later than males and are less likely to be prescribed ADHD medication. Understanding why these sex differences in clinical care and treatment for ADHD occur is key to improving timely diagnosis in people affected by ADHD. This Personal View is a conceptual review synthesising literature on this topic. This publication considers potential biological explanations (eg, genetic factors), influence of diagnostic practices (eg, criteria suitability, diagnostic overshadowing, and sex-specific diagnostic thresholds), and sociocultural explanations (eg, sex differences in presentation and compensatory behaviours), for the observed sex differences in ADHD clinical practice. This Personal View also outlines future research directions for improving understanding of sex differences in recognition and diagnosis of ADHD.
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Affiliation(s)
- Joanna Martin
- Centre for Neuropsychiatric Genetics and Genomics and Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK.
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5
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Grevet EH, Bandeira CE, Vitola ES, de Araujo Tavares ME, Breda V, Zeni G, Teche SP, Picon FA, Salgado CAI, Karam RG, da Silva BS, Sibley MH, Rohde LA, Cupertino RB, Rovaris DL, Bau CHD. The course of attention-deficit/hyperactivity disorder through midlife. Eur Arch Psychiatry Clin Neurosci 2024; 274:59-70. [PMID: 36484846 DOI: 10.1007/s00406-022-01531-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
The course of ADHD from childhood up to young adulthood has been characterized in several studies. However, little is known about the course of symptoms into middle age and beyond. This study aims to evaluate predictors of ADHD trajectories in midlife based on three assessments. The follow-up sample comprised 323 adults with ADHD, evaluated at baseline and seven and thirteen years later, from the average ages of 34 up to 47 years old. ADHD status at reassessments was used to characterize trajectories. Demographics, ADHD features, comorbidities, and polygenic scores for ADHD and genetically correlated psychiatric disorders were evaluated to predict ADHD trajectories. Study retention rate was 67% at T2 (n = 216) and 62% at T3 (n = 199). Data from patients evaluated three times showed that 68.8% coursed stable, 25.5% unstable, and 5.7% remission trajectory of ADHD. Women, individuals with more severe syndromes, higher frequency of comorbidities at reassessments, and genetic liability to depression present a higher probability of a stable trajectory. Our findings shed light on midlife ADHD trajectories and their gender, genomic and clinical correlates.
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Affiliation(s)
- Eugenio Horacio Grevet
- Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratory of Developmental Psychiatry, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cibele Edom Bandeira
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Schneider Vitola
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Eduarda de Araujo Tavares
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vitor Breda
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gregory Zeni
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Stefania Pigatto Teche
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Almeida Picon
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos Alberto Iglesias Salgado
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Gomes Karam
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna Santos da Silva
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, USA
| | - Luis Augusto Rohde
- Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratory of Developmental Psychiatry, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Basso Cupertino
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Diego Luiz Rovaris
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Physiology and Biophysics, Instituto de Ciencias Biomedicas Universidade de Sao Paulo, São Paulo, Brazil
| | - Claiton Henrique Dotto Bau
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Laboratory of Developmental Psychiatry, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
- ADHD Outpatient Program, Clinical Research Center, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Department of Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Houmann TB, Kaalund-Brok K, Clemmensen L, Petersen MA, Plessen KJ, Bilenberg N, Verhulst F, Jeppesen P. Early treatment response as predictor of long-term outcome in a clinical cohort of children with ADHD. Eur Child Adolesc Psychiatry 2024; 33:357-367. [PMID: 36795232 PMCID: PMC10869385 DOI: 10.1007/s00787-023-02158-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
This study investigates early onset of treatment response as predictor of symptomatic and functional outcome 3 years after initiation of methylphenidate (MPH) administration in a naturalistic, clinical cohort of children and adolescents with ADHD. Children were followed across an initial 12-week MPH treatment trial and after 3 years, with ratings of symptoms and impairment. Associations between a clinically significant MPH treatment response in week 3 (defined as ≥ 20% reduction in clinician-rated symptoms) and in week 12 (defined as ≥ 40% reduction), and 3-year outcome were tested in multivariate linear regression models, adjusting for sex, age, comorbidity, IQ, maternal education, parental psychiatric disorder, and baseline symptoms and function. We did not have information on treatment adherence or the nature of treatments beyond 12 weeks. 148 children, mean age 12.4 years (range 10-16 years), 77% males, participated in the follow-up. We found a significant decrease in symptom score from baseline [M = 41.9 (SD = 13.2)] to 3-year follow-up [M = 27.5 (SD = 12.7), p < 0.001, and in impairment score from baseline (M = 41.6 (SD = 19.4)] to 3-year follow-up [M = 35.6 (SD = 20.2), p = 0.005]. Treatment responses in week 3 and week 12 were significant predictors of the long-term outcome of symptoms, but not of impairment at 3-year follow-up, when adjusting for other well-known predictors. Early treatment response predicts long-term outcome over and above other well-known predictors. Clinicians should follow-up patients carefully, during the first months of treatment, and detect non-responders, since there might be a window of opportunity to alter the outcome, by changing the treatment strategy.Clinical trial registration: ClinicalTrials.gov, registration number NCT04366609, April 28, 2020 retrospectively registered.
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Affiliation(s)
- Tine Bodil Houmann
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark.
| | - Kristine Kaalund-Brok
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Clemmensen
- Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, 2900, Hellerup, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Service Universitaire de Psychiatrie de L'Enfant Et de L'Adolescent, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Research Unit (University Function), Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Smedegade 16, 4000, Roskilde, Denmark
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7
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Baykal S, Çobanoğlu Osmanlı C, Bozkurt A, Önal BS, Şahin B, Karaçizmeli M, Öz Gazi A, Karabekiroğlu K. Continuation of Treatment in Children With ADHD: A Multicenter Turkish Sample Study. J Atten Disord 2024:10870547231222021. [PMID: 38294169 DOI: 10.1177/10870547231222021] [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: 02/01/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the variables that may affect treatment continuation in children aged 6 to 12 years who were newly diagnosed with ADHD. METHODS A total of 132 children diagnosed with ADHD and their parents participated in the study. Sociodemographic and clinical risk factors affecting continuation of treatment were examined using logistic regression analysis. RESULTS Multiple model examination revealed that greater age increased the risk of treatment discontinuation 1.824 times (p = .003) while a lower total length of paternal education increased the risk of discontinuation (1/0.835) 1.198 times (p = .022). Other variables emerging as significant in the univariate model lost that significance in the multiple model. CONCLUSIONS Understanding the variables associated with medication discontinuation in ADHD in different populations and taking these variables into account in the development of health policies, will be useful in improving the long-term devastating effects of the disorder.
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Privitera CM, Noah S, Carney T, Klein SA, Lenartowicz A, Hinshaw SP, McCracken JT, Nigg JT, Karalunas SL, Reid RC, Oliva MT, Betts SS, Simpson GV. Pupillary dilations in a Target/Distractor visual task paradigm and attention deficit hyperactivity disorder (ADHD). Neurosci Lett 2024; 818:137556. [PMID: 37951300 DOI: 10.1016/j.neulet.2023.137556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/30/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Abstract
ADHD is a neurocognitive disorder characterized by attention difficulties, hyperactivity, and impulsivity, often persisting into adulthood with substantial personal and societal consequences. Despite the importance of neurophysiological assessment and treatment monitoring tests, their availability outside of research settings remains limited. Cognitive neuroscience investigations have identified distinct components associated with ADHD, including deficits in sustained attention, inefficient enhancement of attended Targets, and altered suppression of ignored Distractors. In this study, we examined pupil activity in control and ADHD subjects during a sustained visual attention task specifically designed to evaluate the mechanisms underlying Target enhancement and Distractor suppression. Our findings revealed some distinguishing factors between the two groups which we discuss in light of their neurobiological implications.
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Affiliation(s)
- Claudio M Privitera
- School of Optometry and Vision Science, University of California, Berkeley, United States.
| | - Sean Noah
- School of Optometry and Vision Science, University of California, Berkeley, United States; Helen Wills Neuroscience Institute, University of California, Berkeley, United States
| | - Thom Carney
- School of Optometry and Vision Science, University of California, Berkeley, United States
| | - Stanley A Klein
- School of Optometry and Vision Science, University of California, Berkeley, United States
| | - Agatha Lenartowicz
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, United States
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute and David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Joel T Nigg
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health & Science University, Portland, United States
| | - Sarah L Karalunas
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, United States
| | - Rory C Reid
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Mercedes T Oliva
- Division of Social Sciences, University of California, Santa Cruz, United States
| | - Samantha S Betts
- Graduate Program in Neurosciences, University of Southern California, Los Angeles, United States
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Ayoubipour S, Sho'ouri N. A Comparative Investigation of Wavelet Families for Classification of EOG Signals Related to Healthy and ADHD Children. Clin EEG Neurosci 2024; 55:11-21. [PMID: 37605610 DOI: 10.1177/15500594231192817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Based on previous research, there are differences between eye movements of people with attention-deficit hyperactivity disorder (ADHD) and of healthy people, as a result, the existence of differences regarding the electrooculogram (EOG) signals of the 2 groups exists. Thus, this study aimed to examine the recorded EOG signals of 30 ADHD children and 30 healthy children while performing an attention-related task. For this purpose, the EOG signals of these 2 groups were decomposed utilizing various wavelet functions. Afterward, features, including mean, energy, and standard deviation (SD) of approximation and detail wavelet coefficients were calculated. The Davies-Bouldin (DB) index was used for the evaluation of the feature space quality. Finally, the 2 groups were classified using one-dimensional feature vector and support vector machine (SVM). The SD of detail coefficients (db4) was selected as the most effective feature for separating the 2 groups. Statistical analysis revealed that the values of energy and SD of EOG signals' detail coefficients were significantly lower in the ADHD group in comparison with the healthy group (P<.001). These results showed that the speed of the ADHD group's eye movements was slower due to the fact that the high-frequency band activity of EOG signals in the healthy group was higher. In addition, the EOG signals were classified with a detection accuracy of 83.42 ± 3.8%. The results of this study can be applied in designing an EOG biofeedback protocol to treat or mitigate the symptoms of ADHD patients.
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Affiliation(s)
- Shahrzad Ayoubipour
- Department of Technology and Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Nasrin Sho'ouri
- Department of Technology and Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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10
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Sanguineti C, Nisticò V, Folatti I, Santangelo G, Faggioli R, Bertani A, Gambini O, Demartini B. Toward an Increased Attention on ADHD Symptoms and Traits in Young Adults: Prevalence Data From Screening Tools in a Psychiatric Outpatient Clinic. J Atten Disord 2024; 28:151-160. [PMID: 37919945 DOI: 10.1177/10870547231201954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE to analyze the prevalence of ADHD symptoms and traits in a heterogeneous clinical psychiatric sample of young adults (aged 18-24 years old), who referred to a specialized outpatient clinic for various psychiatric and psychological disturbances. METHOD 259 participants completed three validated self-report screening questionnaires for ADHD: the Wender Utah Rating Scale (WURS), the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5), and the Conners' adult ADHD rating scale (CAARS). RESULTS 12.4% of our sample scored above the cut-off at both the WURS and the ASRS-5 and was considered at risk of ADHD. CONCLUSION the prevalence rate in our sample is higher than the one found in the adult general population (6.76%), and in the lower range of the one found in the adult clinical population (6.9%-38.8%). The potential role of sociodemographic (age, sex, gender identity, and employment) and comorbidity factors is discussed.
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Affiliation(s)
- Claudio Sanguineti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
| | - Irene Folatti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Giulia Santangelo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Raffaella Faggioli
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Angelo Bertani
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
- Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy
- Unità di Psichiatria 51 e 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
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11
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Pagán AF, Huizar YP, Short TR, Gotcher Z, Schmidt AT. Adult Attention-Deficit/Hyperactivity Disorder: a Narrative Review of Biological Mechanisms, Treatments, and Outcomes. Curr Neurol Neurosci Rep 2023:10.1007/s11910-023-01280-4. [PMID: 37335460 DOI: 10.1007/s11910-023-01280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous and complex neurodevelopmental disorder related to disruptions in various neuronal structures and pathways, dopamine (DA) transporter, and receptor genes, resulting in cognitive and regulation deficits. This article reviews recent research on the biological mechanisms and markers, clinical manifestations, treatments, and outcomes of adult ADHD as well as current controversies within the field. RECENT FINDINGS New research identifies white matter disruptions in multiple cortical pathways in adults with ADHD. New treatments for ADHD in adults such as viloxazine ER have shown preliminary effectiveness in addition to research showing transcranial direct current stimulation can be an effective treatment for adults with ADHD. Although questions exist about the effectiveness of current assessments of and treatments for adult ADHD, recent findings represent a step towards improving the quality of life and outcomes for individuals experiencing this life-long, chronic health condition.
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Affiliation(s)
- Antonio F Pagán
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA.
| | - Yazmine P Huizar
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Tucker R Short
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Zoe Gotcher
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
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12
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Speranza AM, Liotti M, Spoletini I, Fortunato A. Heterotypic and homotypic continuity in psychopathology: a narrative review. Front Psychol 2023; 14:1194249. [PMID: 37397301 PMCID: PMC10307982 DOI: 10.3389/fpsyg.2023.1194249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Psychopathology is a process: it unfolds over time and involves several different factors. To extend our knowledge of such process, it is vital to understand the trajectories that lead to developing and maintaining a specific disorder. The construct of continuity appears very useful to this aim. It refers to the consistency, similarity, and predictability of behaviors or internal states across different developmental phases. This paper aims to present a narrative review of the literature on homotypic and heterotypic continuity of psychopathology across the lifespan. A detailed search of the published literature was conducted using the PsycINFO Record and Medline (PubMed) databases. Articles were included in the review based on the following criteria: (1) publication dates ranging from January 1970 to October 2022; and (2) articles being written in the English language. To ensure a thorough investigation, multiple combinations of keywords such as "continuity," "psychopathology," "infancy," "childhood," "adolescence," "adulthood," "homotypic," and "heterotypic" were used. Articles were excluded if exclusively focused on epidemiologic data and if not specifically addressing the topic of psychopathology continuity. The literature yielded a total of 36 longitudinal studies and an additional 190 articles, spanning the research published between 1970 and 2022. Studies on continuity focus on the etiology of different forms of mental disorders and may represent a fundamental resource from both a theoretical and clinical perspective. Enhancing our understanding of the different trajectories beneath psychopathology may allow clinicians to implement more effective strategies, focusing both on prevention and intervention. Since literature highlights the importance of early detection of clinical signs of psychopathology, future research should focus more on infancy and pre-scholar age.
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Affiliation(s)
- Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Marianna Liotti
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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13
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Sonuga-Barke EJS, Becker SP, Bölte S, Castellanos FX, Franke B, Newcorn JH, Nigg JT, Rohde LA, Simonoff E. Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause. J Child Psychol Psychiatry 2023; 64:506-532. [PMID: 36220605 PMCID: PMC10023337 DOI: 10.1111/jcpp.13696] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Sven Bölte
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Division of Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Sweden
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Emily Simonoff
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
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14
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Girela-Serrano B, Miguélez C, Porras-Segovia AA, Díaz C, Moreno M, Peñuelas-Calvo I, Roselló R, Baca-García E, Carballo JJ. Predictors of mental health service utilization as adolescents with attention deficit hyperactivity disorder transition into adulthood. Early Interv Psychiatry 2023; 17:252-262. [PMID: 35706409 DOI: 10.1111/eip.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/01/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) symptoms may persist into adulthood and are likely to cause great problems in young adults. To date, few studies have explored the characteristics of patients diagnosed with ADHD that might influence the utilization of adult mental health services (AMHS). We aimed to examine and identify predictive symptoms of AMHS. METHODS We analysed data from 114 participants diagnosed with ADHD from a cohort of adolescents recruited at the age of 12-17 years, who, at the time of data analysis, were over 18 years old. RESULTS Among AMHS users, hyperactivity/impulsivity measures were significantly more severe (t = 2.668, df = 112, p < .001), ADHD combined subtype diagnosis (χ2 = 4.66, df = 1, p = .031) was more frequent and dysregulation profile in the SDQ-P was also significantly higher (t = -2.497, df = 109, p = .014). However, the dysregulation profile did not remain statistically significant after controlling for type of AMHS contact. CONCLUSIONS Our findings suggest that adolescents with ADHD are more likely continue their care under AMHS if they present more severe symptoms of hyperactivity/impulsivity and emotional dysregulation. The better characterization of the patient profile will help clinicians to early identify groups at-risk and to tailor interventions and prevention strategies.
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Affiliation(s)
- Braulio Girela-Serrano
- Westminster Child & Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College, London, UK
| | - Carolina Miguélez
- Department of Child and Adolescent Psychiatry, Hospital Niño Jesús, Madrid, Spain
| | - Alejandro Albán Porras-Segovia
- Division of Psychiatry, Imperial College, London, UK
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Manon Moreno
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rocio Roselló
- Division of Psychiatry, Imperial College, London, UK
- Department of Psychiatry, University Hospital Doctor Peset of Valencia & University of Valencia, Valencia, Spain
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Université de Nîmes, Nîmes, France
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15
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Leffa DT, Ferrari-Souza JP, Bellaver B, Tissot C, Ferreira PCL, Brum WS, Caye A, Lord J, Proitsi P, Martins-Silva T, Tovo-Rodrigues L, Tudorascu DL, Villemagne VL, Cohen AD, Lopez OL, Klunk WE, Karikari TK, Rosa-Neto P, Zimmer ER, Molina BSG, Rohde LA, Pascoal TA. Genetic risk for attention-deficit/hyperactivity disorder predicts cognitive decline and development of Alzheimer's disease pathophysiology in cognitively unimpaired older adults. Mol Psychiatry 2023; 28:1248-1255. [PMID: 36476732 DOI: 10.1038/s41380-022-01867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/07/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) persists in older age and is postulated as a risk factor for cognitive impairment and Alzheimer's Disease (AD). However, these findings rely primarily on electronic health records and can present biased estimates of disease prevalence. An obstacle to investigating age-related cognitive decline in ADHD is the absence of large-scale studies following patients with ADHD into older age. Alternatively, this study aimed to determine whether genetic liability for ADHD, as measured by a well-validated ADHD polygenic risk score (ADHD-PRS), is associated with cognitive decline and the development of AD pathophysiology in cognitively unimpaired (CU) older adults. We calculated a weighted ADHD-PRS in 212 CU individuals without a clinical diagnosis of ADHD (55-90 years). These individuals had baseline amyloid-β (Aβ) positron emission tomography, longitudinal cerebrospinal fluid (CSF) phosphorylated tau at threonine 181 (p-tau181), magnetic resonance imaging, and cognitive assessments for up to 6 years. Linear mixed-effects models were used to test the association of ADHD-PRS with cognition and AD biomarkers. Higher ADHD-PRS was associated with greater cognitive decline over 6 years. The combined effect between high ADHD-PRS and brain Aβ deposition on cognitive deterioration was more significant than each individually. Additionally, higher ADHD-PRS was associated with increased CSF p-tau181 levels and frontoparietal atrophy in CU Aβ-positive individuals. Our results suggest that genetic liability for ADHD is associated with cognitive deterioration and the development of AD pathophysiology. Findings were mostly observed in Aβ-positive individuals, suggesting that the genetic liability for ADHD increases susceptibility to the harmful effects of Aβ pathology.
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Affiliation(s)
- Douglas T Leffa
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - João Pedro Ferrari-Souza
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Bellaver
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cécile Tissot
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Translational Neuroimaging Laboratory, McGill University, Montreal, Quebec, Canada
| | | | - Wagner S Brum
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arthur Caye
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Center for Innovation in Mental Health (CISM)/National Institute for Developmental Psychiatry (INPD), São Paulo, Brazil
| | - Jodie Lord
- Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Petroula Proitsi
- Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
| | - Thais Martins-Silva
- Human Development and Violence Research Centre (DOVE), Post-Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Dana L Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas K Karikari
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, McGill University, Montreal, Quebec, Canada
| | - Eduardo R Zimmer
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Pharmacology, Graduate Program in Biological Sciences: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
- Center for Innovation in Mental Health (CISM)/National Institute for Developmental Psychiatry (INPD), São Paulo, Brazil.
- UniEduk, Indaiatuba, São Paulo, Brazil.
| | - Tharick A Pascoal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
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Øie MG, Storaas TAV, Egeland J. Neuropsychological and Symptom Predictors of Diagnostic Persistence in ADHD: A 25-Year Follow-up Study. J Atten Disord 2023; 27:612-622. [PMID: 36802957 DOI: 10.1177/10870547231154903] [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: 02/22/2023]
Abstract
BACKGROUND This study extends long-term predictive research on ADHD by including both neuropsychological and symptom measures at baseline in adolescence as predictors of diagnostic persistence 25 years later. METHODS Nineteen males with ADHD and 26 healthy controls (HC; M/F = 13/13), were assessed in adolescence and 25 years later. Measurements at baseline included a comprehensive test battery measuring eight neuropsychological domains, an IQ estimate, the Child Behavior Checklist (CBCL), and the Global Assessment Scale of Symptoms. Differences between ADHD Retainers, Remitters, and HC were calculated with ANOVAs, and potential predictions of differences in the ADHD group by linear regression analyses. RESULTS Eleven (58%) participants retained their ADHD diagnoses at follow-up. Motor Coordination and Visual perception at baseline predicted diagnosis at follow-up. CBCL Attention problems at baseline in the ADHD group predicted variance in diagnostic status. CONCLUSION Lower-order neuropsychological functions related to motor function and perception are important long-time predictors of persistence of ADHD.
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Affiliation(s)
- Merete Glenne Øie
- University of Oslo, Norway.,Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Jens Egeland
- University of Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
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Brancati GE, De Dominicis F, Petrucci A, Pallucchini A, Carli M, Medda P, Schiavi E, De Rossi P, Vicari S, Perugi G. Long-term treatment of adult ADHD in a naturalistic setting: clinical predictors of attrition, medication choice, improvement, and response. World J Biol Psychiatry 2023:1-16. [PMID: 36637001 DOI: 10.1080/15622975.2023.2168750] [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: 01/14/2023]
Abstract
Objectives: The aim of this study was to identify clinical predictors of treatment attrition, medication choice, improvement and response to pharmacotherapy in adult attention-deficit/hyperactivity disorder (ADHD). Methods: 150 ADHD patients were enrolled and naturalistically followed-up for at least 4 months. Conners' Adult ADHD Rating Scales-Observer: Screening Version (CAARS-O:SV) were used to measure ADHD severity. Results: 58 subjects (38.7%) were lost at follow-up, while 75 (50%) completed follow-up assessment, on average after 26.05 ± 11.99 weeks; 35 were treated with atomoxetine (ATX) and 40 with methylphenidate (MPH). Treatments were moderately effective (d = 0.72) and 37 patients (49.3%) were responders (≥30% CAARS-O:SV decrease). Patients lost at follow-up had lower inattentive symptoms, less generalized anxiety and family history of bipolar disorder, more amphetamine use disorder than follow-up completers. Compared to ATX-treated subjects, MPH-treated patients had greater severity of hyperactivity/impulsivity and were more frequently diagnosed with alcohol use disorder. While MPH and ATX showed similar efficacy, more pronounced improvements were observed in patients with combined ADHD, anxiety and substance use disorders. ADHD severity and comorbid substance use positively predicted response. Conclusions: Consensus-based hierarchical treatment of ADHD comorbidity is not consistently supported. Comorbid anxiety, mood and substance use disorders should not discourage the treatment of adult ADHD.
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Affiliation(s)
- Giulio Emilio Brancati
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | - Alessandra Petrucci
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pierpaolo Medda
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Elisa Schiavi
- Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Pietro De Rossi
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I.R.C.C.S. Bambino Gesù Children's Hospital, Rome (Italy)
| | - Stefano Vicari
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I.R.C.C.S. Bambino Gesù Children's Hospital, Rome (Italy)
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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18
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Sun J, Jiang X, Wei S. Combinations of physical activity, screen time and sleep, and their association with subjective wellbeing in children. Complement Ther Clin Pract 2023; 51:101720. [PMID: 36812734 DOI: 10.1016/j.ctcp.2023.101720] [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: 12/08/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Subjective wellbeing is an important indicator of health outcomes in children. 24-hour movement behaviours (i.e., physical activity, sedentary behaviour, sleep and their combination), a set of modifiable lifestyle behaviours, have been demonstrated to be associated with subjective wellbeing. Thus, the aim of this study was to investigate the relationship between the compliance of the 24-h movement guidelines and subjective wellbeing in a sample of Chinese children. METHODS Cross-sectional data from primary and secondary school students in Anhui Province, China were used for the analysis. A total of 1098 study participants (mean age: 11.6 years, body mass index: 19.7 ± 2.9) were included, of which 51.5% were boys. Physical activity, screen time, sleep, and subjective wellbeing were measured using validated self-reported questionnaires. Multivariable logistic regression analysis was used to assess the relationships between the compliance of different combinations of 24-h movement guidelines and subjective wellbeing in participants. RESULTS The compliance of (i.e., physical activity recommendations, screen time recommendations and sleep recommendations) 24-h movement guidelines was associated with better subjective wellbeing (OR: 2.09; 95CI%: 1.01-5.90) compared to the compliance of none of the guidelines. Furthermore, there was a dose-response relationship between the number of guidelines met (3 > 2 > 1 > 0) and improved subjective wellbeing (p < 0.05). Despite some exceptions, there was a significant relationship between the compliance of different combinations of the guidelines and better subjective wellbeing. CONCLUSION This study found that the compliance of 24-h movement guidelines was associated with greater subjective wellbeing in Chinese children.
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Affiliation(s)
| | | | - Shanshan Wei
- Shandong First Medical University, Tai'an, China.
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19
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Rhodes JD. An Examination of the Role of Sluggish Cognitive Tempo as a Moderator of the Relationship Between ADHD and Nicotine Use. J Atten Disord 2023; 27:220-227. [PMID: 36264077 DOI: 10.1177/10870547221130454] [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: 11/17/2022]
Abstract
OBJECTIVE ADHD is a neurodevelopmental disorder characterized by executive dysfunction and functional impairments including nicotine consumption. Sluggish cognitive tempo (SCT) has been associated with ADHD and posited as an independent construct. The present study hypothesized that SCT would moderate the relationships between ADHD and nicotine-related behaviors. METHOD Participants (n = 309) were recruited using Mechanical Turk and completed measures of ADHD symptoms, SCT, and smoking history. RESULTS ADHD was associated with age of initiation of smoking and more severe withdrawal symptoms for both combustible and electronic cigarettes. SCT significantly moderated the relationship between ADHD and withdrawal symptom severity (both electronic and combustible cigarettes). CONCLUSION The results of the present study suggest that SCT plays an important role in the complex relationship between ADHD and smoking withdrawal. Future research should further explore the construct of SCT to better understand its role in psychopathology and intervention strategies.
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Kato M, Tsuda H, Chen Y, Tsuji T, Nishigaki N. The Burden of Attention-Deficit/Hyperactivity Disorder Traits in Adult Patients with Major Depressive Disorder in Japan. Neuropsychiatr Dis Treat 2023; 19:1055-1067. [PMID: 37153353 PMCID: PMC10162103 DOI: 10.2147/ndt.s399915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose Symptoms of attention-deficit/hyperactivity disorder (ADHD) often overlap with and are hidden by those of mood disorders, including major depressive disorder (MDD), resulting in adult ADHD patients being misdiagnosed as MDD. This study aims to examine if diagnosed MDD patients are more likely to exhibit ADHD traits and if the presence of ADHD traits increases the humanistic burden, including the impairment of health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), and health-care resource utilization (HRU), on MDD patients in Japan. Methods This study utilized existing National Health and Wellness Survey (NHWS) data. The 2016 Japan NHWS is an internet-based survey comprising a total of 39,000 respondents, including those with MDD and/or ADHD. A randomly selected subset of the respondents responded to the Japanese-version Adult ADHD self-report scale (ASRS-v1.1; ASRS-J) symptom checklist. Respondents were considered ASRS-J-positive if the total score was ≥36. The HRQoL, WPAI, and HRU were assessed. Results Among MDD patients (n = 267), 19.9% were screened ASRS-J-positive, while 4.0% of non-MDD respondents (n = 8885) were ASRS-J-positive. There was a significant association between MDD status and ASRS-J status (crude odds-ratio [OR]: 5.9) as well as between MDD status and ADHD-diagnosis status (crude OR: 22.6). MDD patients who were ASRS-J positive experienced significantly lower HRQoL and higher WPAI than those who were ASRS-J negative. Limitations of this study include potential recall bias owing to the self-report nature of the survey and lack of objective confirmation of MDD diagnosis through review of medical records. Conclusion This study demonstrated a significant association between MDD status and exhibiting ADHD traits. Adult MDD patients screened ASRS-J-positive experienced significantly higher humanistic burden than patients screened ASRS-J-negative. Our results emphasize the importance of ensuring appropriate screening of ADHD and looking out for potentially hidden ADHD symptoms when diagnosing and treating MDD in adulthood.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Hiroshi Tsuda
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Neurology, Toho University Faculty of Medicine, Tokyo, Japan
- Clinical Research, Innovation and Education Center, Tohoku University, Sendai, Japan
| | | | - Toshinaga Tsuji
- Medical Affairs Department, Shionogi & Co. Ltd, Osaka, Japan
| | - Nobuhiro Nishigaki
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Correspondence: Nobuhiro Nishigaki, Japan Medical Office, Takeda Pharmaceutical Company Limited, 1-1, Nihonbashi-Honcho 2-Chome, Chuo-Ku, Tokyo, 103-8668, Japan, Tel +81-80-9305-2077, Fax +81-3-3278-2925, Email
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Kaiser A, Broeder C, Cohen JR, Douw L, Reneman L, Schrantee A. Effects of a single-dose methylphenidate challenge on resting-state functional connectivity in stimulant-treatment naive children and adults with ADHD. Hum Brain Mapp 2022; 43:4664-4675. [PMID: 35781371 PMCID: PMC9491277 DOI: 10.1002/hbm.25981] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
Prior studies suggest that methylphenidate, the primary pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), alters functional brain connectivity. As the neurotransmitter systems targeted by methylphenidate undergo significant alterations throughout development, the effects of methylphenidate on functional connectivity may also be modulated by age. Therefore, we assessed the effects of a single methylphenidate challenge on brain network connectivity in stimulant-treatment naïve children and adults with ADHD. We obtained resting-state functional MRI from 50 boys (10-12 years of age) and 49 men (23-40 years of age) with ADHD (DSM IV, all subtypes), before and after an oral challenge with 0.5 mg/kg methylphenidate; and from 11 boys and 12 men as typically developing controls. Connectivity strength (CS), eigenvector centrality (EC), and betweenness centrality (BC) were calculated for the striatum, thalamus, dorsal anterior cingulate cortex (dACC), and prefrontal cortex (PFC). In line with our hypotheses, we found that methylphenidate decreased measures of connectivity and centrality in the striatum and thalamus in children with ADHD, but increased the same metrics in adults with ADHD. Surprisingly, we found no major effects of methylphenidate in the dACC and PFC in either children or adults. Interestingly, pre-methylphenidate, participants with ADHD showed aberrant connectivity and centrality compared to controls predominantly in frontal regions. Our findings demonstrate that methylphenidate's effects on connectivity of subcortical regions are age-dependent in stimulant-treatment naïve participants with ADHD, likely due to ongoing maturation of dopamine and noradrenaline systems. These findings highlight the importance for future studies to take a developmental perspective when studying the effects of methylphenidate treatment.
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Affiliation(s)
- Antonia Kaiser
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Caroline Broeder
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jessica R. Cohen
- Department of Psychology and NeuroscienceUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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22
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Adamis D, Flynn C, Wrigley M, Gavin B, McNicholas F. ADHD in Adults: A Systematic Review and Meta-Analysis of Prevalence Studies in Outpatient Psychiatric Clinics. J Atten Disord 2022; 26:1523-1534. [PMID: 35373645 DOI: 10.1177/10870547221085503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Systematic review and meta-analysis to estimate the pooled prevalence of ADHD in adult attendees of outpatient mental health clinics and to investigate factors influencing prevalence rates. METHODS The following were extracted: demographics, design of the study (screening only or two-phase), scales/criteria for diagnosis of ADHD, number of ADHD, and non-ADHD participants. RESULTS The pooled prevalence of ADHD from screening studies (n = 9) was 26.7%, (95% CI [17.2-37.4]), ADHD = 1727, No ADHD = 3,578. From studies employing a two-stage design (n = 5), prevalence was 14.61%, CI [10.39-19.41], ADHD = 561, No ADHD = 3,578. Age and gender did not have any significant effect on the estimated prevalence. By contrast exclusion of psychotic disorders lowers prevalence. The screening scale used also influence prevalence rates. CONCLUSION Meta-analysis shows high rates of adult ADHD among psychiatric outpatient clinics. Applying DSM-5 criteria increased prevalence rates. More methodologically robust studies, using two-stage design, need to be conducted to help assist in service planning.
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Affiliation(s)
- Dimitrios Adamis
- Sligo Mental Health Services, Ireland.,University College Dublin, Ireland.,Research and Academic Institute of Athens, Greece
| | | | - Margo Wrigley
- National Clinical Programme for Adult ADHD, Dublin, Ireland
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23
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Taghizade S, Mahmoodi Z, Zandifar A, Qorbani M, Mohamadi F, Mehrafzoun N. The relationship model among parent-child relationship, coping responses and behavioral problems in children with attention deficit hyperactivity disorder. BMC Psychiatry 2022; 22:596. [PMID: 36076206 PMCID: PMC9453719 DOI: 10.1186/s12888-022-04224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) constitutes a prevalent behavioral problem. The present study examined the parent-child relationship model and investigated strategies to cope with behavioral problems in children with ADHD. METHODS This descriptive study selected 300 children with ADHD using convenience sampling. The data collected using the child behavior checklist, the parent-child relationship scale (PCRS), the Billings and Moos Coping Checklist, the socioeconomic status questionnaire, the general health questionnaire-28 (GHQ-28) and a demographic checklist were analyzed in SPSS-25 and LISREL 8.8. RESULTS According to the results of the path analysis on the relationship model among parent-child relationship domains, coping responses and children's behavioral problems, parent-child dependency domain (B = 0.22) in the direct path, disease duration (B = 0.085) in the indirect path, and conflicts in the domain of parent-child relationship (B = 0.366) in both direct and indirect paths had the most positive causal effect on behavioral problems. Furthermore, intimacy in the said domain (B = -0.42) had the most negative causal effect in both direct and indirect paths. The extent to which parents used coping responses via the direct path had a positive causal effect on behavioral problems (B = 0.12). Based on the path analysis test findings in the relationship model among positive parent-child relationship, coping responses and children's behavioral problems, the positive parent-child relationship score had the most negative causal effect via the direct path (B = -0.56). Conversely, the child's age had the highest positive causal effect via the indirect path (B = 0.1) on behavioral problems in children. CONCLUSION Based on findings, there is a causal and significant relationship between the parent-child relationship and the extent to which coping responses are used. It is recommended that training programs be developed to strengthen communication skills, coping responses and problem-solving techniques in parents.
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Affiliation(s)
- Soulmaz Taghizade
- grid.411705.60000 0001 0166 0922Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Atefeh Zandifar
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farima Mohamadi
- grid.411600.2Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Mehrafzoun
- grid.412112.50000 0001 2012 5829Kermanshah University of Medical Sciences, Kermanshah, Iran
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24
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Peripheral blood inflammatory markers in patients with attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2022; 118:110581. [PMID: 35660454 DOI: 10.1016/j.pnpbp.2022.110581] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 02/06/2023]
Abstract
It has been observed that subclinical inflammation might be involved in the pathophysiology of attention deficit/hyperactivity disorder (ADHD). However, studies investigating peripheral blood levels of immune-inflammatory markers have provided mixed findings. We performed a systematic review and meta-analysis of studies comparing unstimulated serum or plasma levels of C-reactive protein (CRP) and cytokines in subjects with ADHD and healthy controls (the PROSPERO registration number: CRD 42021276869). Online searches covered the publication period until 30th Sep 2021 and random-effects meta-analyses were carried out. Out of 1844 publication records identified, 10 studies were included. The levels of interleukin (IL)-6 were significantly higher in studies of participants up to the age of 18 years (k = 10, g = 0.70, 95%CI: 0.10-1.30, p = 0.023) and after including those above the age of 18 years (k = 10, g = 0.71, 95%CI: 0.12-1.31, p = 0.019). In turn, the levels of tumor necrosis factor-α (TNF-α) were significantly lower in subjects with ADHD compared to healthy controls (k = 7, g = -0.16, 95%CI: -0.30 - -0.03, p = 0.020). Individual studies had a high contribution to the overall effect, since the overall effect was no longer significant after removing single studies. No significant differences were found with respect to the levels of CRP, IL-1β, IL-10 and interferon-γ. The present findings indicate that individuals with ADHD tend to show elevated levels of IL-6 and reduced levels of TNF-α. Larger and longitudinal studies recording potential confounding factors and comorbid psychopathology are needed to confirm our findings.
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25
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Lauder K, McDowall A, Tenenbaum HR. A systematic review of interventions to support adults with ADHD at work—Implications from the paucity of context-specific research for theory and practice. Front Psychol 2022; 13:893469. [PMID: 36072032 PMCID: PMC9443814 DOI: 10.3389/fpsyg.2022.893469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is estimated to affect 3.5% of the global workforce. Despite the high prevalence rate, little is known about how best to support adults with ADHD (ADHDers) at work. Relevant research is dispersed across different disciplines such as medicine, health studies and psychology. Therefore, it is important to synthesize interventions aimed at ADHDers to examine what learning can be gleaned for effective workplace support. We conducted a systematic review of relevant interventions framed by realist evaluation and the Context-Intervention-Mechanism-Outcome classification to identify key mechanisms of effectiveness for workplace interventions. We searched 10 databases including a range of journals from medical science to business management applying predetermined inclusion criteria and quality appraisal through a risk of bias assessment for quantitative and qualitative methods. We synthesized 143 studies with realist evaluation. Most studies evaluated the effectiveness of pharmacological interventions highlighting the dominance of the medical approach to supporting ADHDers. Key mechanisms of effectiveness were identified from psychosocial interventions including group therapy, involvement of people in the ADHDers network, and the importance of the client-patient relationship. Overall, there is limited research that examines the effectiveness of workplace interventions for ADHDers. Furthermore, much of the existing research evaluates pharmacological interventions which is difficult to transfer to the workplace context. It is recommended that future research and practice consider the key mechanisms identified in this review when designing interventions as well as barriers to accessing support such as disclosure and self-awareness.
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Affiliation(s)
- Kirsty Lauder
- Centre for Neurodiversity Research at Work, Birkbeck College, London, United Kingdom
- *Correspondence: Kirsty Lauder
| | - Almuth McDowall
- Centre for Neurodiversity Research at Work, Birkbeck College, London, United Kingdom
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26
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Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci 2022; 16:900981. [PMID: 35874653 PMCID: PMC9299434 DOI: 10.3389/fnbeh.2022.900981] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.
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Affiliation(s)
- Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Arthur Caye
- 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
| | - Nina Christmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent National Health System Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, NY, United States
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Markus Gleitz
- Medice Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sandra Kooij
- Amsterdam University Medical Center, Location VUMc, Amsterdam, Netherlands.,PsyQ, Expertise Center Adult ADHD, The Hague, Netherlands
| | - Douglas Teixeira Leffa
- 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
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mark Stein
- Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Department of Public Health, Johns Hopkins University, Baltimore, MA, United States
| | - Yanki Yazgan
- GuzelGunler Clinic, Istanbul, Turkey.,Yale Child Study Center, New Haven, CT, United States
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Neurocenter, Saarland, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.,School for Child and Adolescent Cognitive Behavioural Therapy, University Hospital of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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27
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Quintero J, Rodríguez-Quiroga A, Álvarez-Mon MÁ, Mora F, Rostain AL. Addressing the Treatment and Service Needs of Young Adults with Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:531-551. [PMID: 35697400 DOI: 10.1016/j.chc.2022.03.007] [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: 11/25/2022]
Abstract
The transition from adolescence to adulthood is a complex period in which multiple changes take place (education, work, independent living, and social relations). This stage is especially difficult for adolescents suffering from attention deficit hyperactivity disorder (ADHD), who have to move on from child and adolescent mental health services to adult mental health services. This review analyzes developmental and environmental risk and protective factors as well as critical variables such as executive functioning and self-monitoring that influence the course of ADHD in transitional age youth and guide the priorities for an optimal transition of care. The influence of the COVID-19 pandemic is also discussed. We reflect on the unmet needs for an optimal transition of care and propose practice and policy recommendations to achieve this goal.
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Affiliation(s)
- Javier Quintero
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain.
| | - Alberto Rodríguez-Quiroga
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Miguel Ángel Álvarez-Mon
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28801 Alcala de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Fernando Mora
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA
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28
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Liu N, Jia G, Li H, Zhang S, Wang Y, Niu H, Liu L, Qian Q. The potential shared brain functional alterations between adults with ADHD and children with ADHD co-occurred with disruptive behaviors. Child Adolesc Psychiatry Ment Health 2022; 16:54. [PMID: 35761295 PMCID: PMC9238266 DOI: 10.1186/s13034-022-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Many previous studies have shown that the comorbid status of disruptive behaviour disorders (DBD) was a predictor for ADHD persistence into adulthood. However, the brain mechanisms underlying such a relationship remain unclear. Thus, we aim to investigate whether the brain functional alteration in adults with ADHD could also be detected in children with ADHD co-occurring with disruptive behaviours from both quantitative and categorical dimensions. METHODS A total of 172 children with ADHD (cADHD), 98 adults with ADHD (aADHD), 77 healthy control children (cHC) and 40 healthy control adults (aHC) were recruited. The whole-brain spontaneous fluctuations in brain activity of each participant were recorded using functional near-infrared spectroscopy (fNIRS), and the functional connectivities (FCs) were calculated. We first compared the FC differences between aADHD and aHC. Then, for the regions with significantly abnormal FCs in aADHD, we further compared these features between cADHD and cHC. In addition, the correlation between these FCs and the conduct disorder (CD)/oppositional defiant disorder (ODD) symptoms were analysed in cADHD. Moreover, to render the results readily interpretable, we compared the FC differences among ADHDCD-, subthreshold ADHDCD+ and cHC groups, and among ADHDODD-, ADHDODD+ and cHC groups. Finally, we repeated the above analysis after controlling for other comorbidities and core symptoms to diminish the potential confounding effects. RESULTS We found that compared with aHC, aADHD showed significantly increased FCs in the VN, DMN, SMN, and DAN. The aforementioned abnormal FCs were also detected in cADHD, however, in an opposite orientation. Notably, these abnormal FCs were positively correlated with CD symptoms. Finally, the subthreshold ADHDCD+ group even exhibited a tendency of adult-like increased FCs compared with the cHC. The results held after controlling for other comorbidities and core symptoms. CONCLUSION This study provides functional neuroimaging evidence that CD might be a risk factor for ADHD persistence into adulthood. Our work highlights the importance of differentiating ADHDCD+ from ADHD and inspiring further understanding of brain development in ADHD.
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Affiliation(s)
- Ningning Liu
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191 China ,grid.459847.30000 0004 1798 0615NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Gaoding Jia
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
| | - Haimei Li
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191 China ,grid.459847.30000 0004 1798 0615NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Shiyu Zhang
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191 China ,grid.459847.30000 0004 1798 0615NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Yufeng Wang
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191 China ,grid.459847.30000 0004 1798 0615NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Haijing Niu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China.
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China. .,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China. .,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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29
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Wootton RE, Riglin L, Blakey R, Agnew-Blais J, Caye A, Cadman T, Havdahl A, Gonçalves H, Menezes AMB, Wehrmeister FC, Rimfeld K, Davey Smith G, Eley TC, Rohde LA, Arseneault L, Moffitt TE, Stergiakouli E, Thapar A, Tilling K. Decline in attention-deficit hyperactivity disorder traits over the life course in the general population: trajectories across five population birth cohorts spanning ages 3 to 45 years. Int J Epidemiol 2022; 51:919-930. [PMID: 35403686 PMCID: PMC9189965 DOI: 10.1093/ije/dyac049] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Trajectories of attention-deficit hyperactivity disorder (ADHD) traits spanning early childhood to mid-life have not been described in general populations across different geographical contexts. Population trajectories are crucial to better understanding typical developmental patterns. METHODS We combined repeated assessments of ADHD traits from five population-based cohorts, spanning ages 3 to 45 years. We used two measures: (i) the Strengths and Difficulties Questionnaire (SDQ) hyperactive-inattentive subscale (175 831 observations, 29 519 individuals); and (ii) scores from DSM-referenced scales (118 144 observations, 28 685 individuals). Multilevel linear spline models allowed for non-linear change over time and differences between cohorts and raters (parent/teacher/self). RESULTS Patterns of age-related change differed by measure, cohort and country: overall, SDQ scores decreased with age, most rapidly declining before age 8 years (-0.157, 95% CI: -0.170, -0.144 per year). The pattern was generally consistent using DSM scores, although with greater between-cohort variation. DSM scores decreased most rapidly between ages 14 and 17 years (-1.32%, 95% CI: -1.471, -1.170 per year). Average scores were consistently lower for females than males (SDQ: -0.818, 95% CI: -0.856, -0.780; DSM: -4.934%, 95% CI: -5.378, -4.489). This sex difference decreased over age for both measures, due to an overall steeper decrease for males. CONCLUSIONS ADHD trait scores declined from childhood to mid-life, with marked variation between cohorts. Our results highlight the importance of taking a developmental perspective when considering typical population traits. When interpreting changes in clinical cohorts, it is important to consider the pattern of expected change within the general population, which is influenced by cultural context and measurement.
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Affiliation(s)
- Robyn E Wootton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Rachel Blakey
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Agnew-Blais
- Department of Psychology, School of Biological and Chemical Science, Queen Mary University of London, London, UK
| | - Arthur Caye
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Brazil
- ADHD and Developmental Psychiatry Programs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tim Cadman
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Kaili Rimfeld
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- Department of Psychology, Royal Holloway University of London, London, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thalia C Eley
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, Brazil
- ADHD and Developmental Psychiatry Programs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Terrie E Moffitt
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Rajkumar RP. Is There a Relationship Between ADHD and COVID-19 Prevalence and Mortality Indices? An Analysis of Data From 156 Countries. J Atten Disord 2022; 26:1069-1077. [PMID: 34784830 DOI: 10.1177/10870547211056894] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the relationship between nation-level prevalence of ADHD and COVID-19 prevalence and mortality indices. METHOD Associations between nation-wise estimated prevalence, crude mortality rates and case-fatality ratios for COVID-19 and estimated prevalence rates for ADHD were examined, controlling for medical conditions known to be associated with COVID-19 outcome, as well as demographic, climate-related, and economic variables. RESULTS Prevalence of ADHD was positively correlated with COVID-19 prevalence and crude mortality rates on bivariate analyses, though the strength of this association was low. On multivariate regression, prevalence of ADHD was negatively associated with COVID-19 prevalence and crude mortality rates, though only the former finding was statistically significant. CONCLUSION The association between ADHD and COVID-19 prevalence and mortality at a national level is inconsistent, modest, and may be largely due to confounding factors such as age, lifestyle factors, and medical comorbidities.
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Affiliation(s)
- Ravi Philip Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Ceyhun HA, Gürbüzer N. New Hematological Parameters as Inflammatory Biomarkers: Systemic Immune Inflammation Index, Platerethritis, and Platelet Distribution Width in Patients with Adult Attention Deficit Hyperactivity Disorder. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:211-223. [PMID: 35573104 PMCID: PMC9091147 DOI: 10.1007/s41252-022-00258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The potential role of neuroinflammation in adult attention deficit hyperactivity disorder (ADHD) patients has been investigated with peripheral hemogram-related inflammatory markers. Systemic immune inflammation index (SII) is defined as a new index that has been developed for the balance of inflammatory and immune status. METHODS Our study was based on a prospective routine complete blood count(CBC) analysis of 74 Adult ADHD patients and 70 healthy participants. The DSM-5-Clinician version and Barratt impulsivity scale-11 were used to evaluate the participants. RESULTS There was no statistical difference in the comparison of the SII ratios, platelet distribution width (PDW), and plateretritis (PCT) (p>0.05 for each) in a group of a young adults with ADHD and in a comparison control group. These inflammatory indicators were found to be similar between patients newly diagnosed with ADHD (n=40) and patients using methylphenidate (n=34) (p>0.05 for each). The relationship between ADHD clinical symptoms and severity and inflammation was evaluated. A significant negative correlation was observed between attention deficit scores and PCT (r=-0.301, p=0.009). A positive significant correlation was found between hyperactivity scores and SII (r=0.247, p=0.034). A significant positive correlation was found between Barrat motor scores and PDW(r=241, p=0.038). In the regression analysis, the PCT variable changed the attention deficit variable (β=.33, t(70)= -2.703, p=.009, pr 2= .094) predicted negatively and significantly. CONCLUSIONS We demonstrated the association of SII, which is independently associated with adverse outcomes in many diseases, and the severity of hyperactivity symptoms in adult ADHD. The fact that PCT predicts attention deficit negatively and decisively shows the importance of inflammatory assessments specific to clinical presentations. The critical importance of platelets in inflammatory processes in ADHD has been demonstrated once again with inflammatory markers such as SII, PLT, and PDW, which can be accessed by an easily applicable complete blood count method.
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Affiliation(s)
- Hacer Akgül Ceyhun
- Department of Psychiatry, Ataturk University School of Medicine, Atatürk University, 25 240 Erzurum, Turkey
| | - Nilifer Gürbüzer
- Department of Psychiatry, Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
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Singh S, Saini R, Sagar R. Quality of web-based information on attention deficit hyperactivity disorder. Asian J Psychiatr 2022; 71:103071. [PMID: 35303590 DOI: 10.1016/j.ajp.2022.103071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The limited literature available on quality of online health information about attention deficit hyperactivity disorder (ADHD), reported mixed findings and was more than five years old. This study aimed to assess the content quality, readability, aesthetics, and interactivity of current web-based information on ADHD. METHODS We screened first 50 links obtained on searching for ADHD using two popular search engines (Google and Bing), out of which 44 websites were selected for quality assessment. They were analysed using pre-decided study Performa, which included previously validated DISCERN instrument for content quality. Flesch-Kincaid grade level score and Flesch-Kincaid readability index were calculated for assessing readability. RESULTS About 61.4% of websites had DISCERN score ≥40, suggestive of good content quality. However, only 38.6% and 13.6% of websites were written at recommended reading level of eighth and sixth grade respectively. The DISCERN score had significant positive correlation with aesthetics and interactivity scores. Websites with the Health On Net (HON) label had better content quality. No significant difference in the readability, aesthetics, and interactivity of websites with and without the HON label. CONCLUSION This study underscores the need for improving readability of web-based information on ADHD, and highlight important areas for improving the overall quality of websites. The use of HONCode label might guide general public in gauging the content quality of online health information, but not its readability or presentation.
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Affiliation(s)
- Swarndeep Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Romil Saini
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India.
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Cochrane WG, Dinu LM, Kika NB, Dommett EJ. Attitudes and preferences toward exercise interventions in adults with attention deficit hyperactivity disorder: A survey study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2060027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- William G. Cochrane
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Larisa M. Dinu
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Natalia B. Kika
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eleanor J. Dommett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Balogh L, Pulay AJ, Réthelyi JM. Genetics in the ADHD Clinic: How Can Genetic Testing Support the Current Clinical Practice? Front Psychol 2022; 13:751041. [PMID: 35350735 PMCID: PMC8957927 DOI: 10.3389/fpsyg.2022.751041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a childhood prevalence of 5%. In about two-thirds of the cases, ADHD symptoms persist into adulthood and often cause significant functional impairment. Based on the results of family and twin studies, the estimated heritability of ADHD approximates 80%, suggests a significant genetic component in the etiological background of the disorder; however, the potential genetic effects on disease risk, symptom severity, and persistence are unclear. This article provides a brief review of the genome-wide and candidate gene association studies with a focus on the clinical aspects, summarizing findings of ADHD disease risk, ADHD core symptoms as dimensional traits, and other traits frequently associated with ADHD, which may contribute to the susceptibility to other comorbid psychiatric disorders. Furthermore, neuropsychological impairment and measures from neuroimaging and electrophysiological paradigms, emerging as potential biomarkers, also provide a prominent target for molecular genetic studies, since they lie in the pathway from genes to behavior; therefore, they can contribute to the understanding of the underlying neurobiological mechanisms and the interindividual heterogeneity of clinical symptoms. Beyond the aforementioned aspects, throughout the review, we also give a brief summary of the genetic results, including polygenic risk scores that can potentially predict individual response to different treatment options and may offer a possibility for personalized treatment for the therapy of ADHD in the future.
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Affiliation(s)
- Lívia Balogh
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Attila J Pulay
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - János M Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
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Cutler AJ, Suzuki K, Starling B, Balakrishnan K, Komaroff M, Castelli M, Meeves S, Childress AC. Efficacy and Safety of Dextroamphetamine Transdermal System for the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Results from a Pivotal Phase 2 Study. J Child Adolesc Psychopharmacol 2022; 32:89-97. [PMID: 35020462 PMCID: PMC8972004 DOI: 10.1089/cap.2021.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: To assess efficacy and safety of the new Dextroamphetamine Transdermal System (d-ATS) to treat children and adolescents (aged 6-17 years) with attention-deficit/hyperactivity disorder (ADHD). Methods: In this phase 2, randomized, placebo-controlled study, 4 d-ATS patches of differing doses (5, 10, 15, and 20 mg) were evaluated. Patients began a 5-week, open-label, stepwise dose-optimization period in which they received a 5-mg d-ATS patch (applied to hip) for 9 hours. During weekly visits, patients were evaluated for possible adjustments to the next dose level based on efficacy and safety. Once at the optimal dose, that dose was maintained during a 2-week, crossover double-blind treatment period. Primary endpoint was to assess efficacy of d-ATS versus placebo as measured by Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale (SKAMP) total score; key secondary endpoints included assessing onset and duration of efficacy by SKAMP total score, and additional secondary endpoints included Permanent Product Measure of Performance (PERMP) scores. Safety was assessed throughout. Results: d-ATS treatment resulted in significant improvements versus placebo in ADHD symptoms as measured by SKAMP total score, with overall least-squares mean difference (95% confidence interval) versus placebo of -5.87 (6.76, -4.97; p < 0.001) over the 12-hour assessment period. Onset of efficacy was observed at 2 hours postdose (p < 0.001), and duration of effect continued through 12 hours (patch removed at 9 hours), with significant differences between d-ATS and placebo at all time points from 2 hours onward (all p ≤ 0.003). Significant improvements versus placebo in PERMP-A and PERMP-C scores were also observed from 2 to 12 hours postdose with d-ATS treatment. d-ATS was safe and well-tolerated, with a systemic safety profile similar to that observed with oral amphetamines. Conclusions: This study demonstrates that d-ATS is an effective and well-tolerated treatment for children and adolescents with ADHD. These data indicate that d-ATS can deliver sustained levels of efficacy along with the advantages of transdermal drug delivery, making it a beneficial new treatment option. Clinical Trial Registration no.: NCT01711021.
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Affiliation(s)
- Andrew J. Cutler
- Department of Psychiatry, SUNY Upstate Medical University, Lakewood Ranch, Florida, USA.,Address correspondence to: Andrew J. Cutler, MD, SUNY Upstate Medical University, Department of Psychiatry, Lakewood Ranch, FL 34201, USA
| | - Katsumi Suzuki
- Product Development, Noven Pharmaceuticals, Inc., Jersey City, New Jersey, USA
| | - Brittney Starling
- Product Development, Noven Pharmaceuticals, Inc., Jersey City, New Jersey, USA
| | - Kanan Balakrishnan
- Product Development, Noven Pharmaceuticals, Inc., Jersey City, New Jersey, USA
| | - Marina Komaroff
- Product Development, Noven Pharmaceuticals, Inc., Jersey City, New Jersey, USA
| | | | - Suzanne Meeves
- Product Development, Noven Pharmaceuticals, Inc., Jersey City, New Jersey, USA
| | - Ann C. Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada, USA
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Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. Recent investigations have shed light on different aspects regarding the trajectory of ADHD, including reports on risk factors in childhood, that are associated with remission or persistence in adulthood. Despite significant advances in our understanding of the pathophysiology of the disorder, the diagnosis of ADHD remains strictly clinical and is based on behavioral symptoms of inattention, impulsivity, and hyperactivity. In this chapter we review the diagnostic process of ADHD, discuss the clinical presentation of the disorder across the lifespan, and examine patterns of comorbidity and longitudinal predictor of outcomes.
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Affiliation(s)
- Douglas Teixeira Leffa
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Arthur Caye
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
- National Institute of Developmental Psychiatry, São Paulo, Brazil.
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Vos M, Rommelse NNJ, Franke B, Oosterlaan J, Heslenfeld DJ, Hoekstra PJ, Klein M, Faraone SV, Buitelaar JK, Hartman CA. Characterizing the heterogeneous course of inattention and hyperactivity-impulsivity from childhood to young adulthood. Eur Child Adolesc Psychiatry 2022; 31:1-11. [PMID: 33813662 PMCID: PMC9343304 DOI: 10.1007/s00787-021-01764-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
To advance understanding of the heterogeneity in the course of ADHD, joint symptom trajectories of inattention and hyperactivity-impulsivity from childhood to young adulthood were modelled and associated with genetic, demographic, and clinical characteristics. Data were obtained from the NeuroIMAGE cohort which includes 485 individuals with ADHD, their 665 siblings, and 399 typically developing children. Trajectories were based on scores of the Conners Parent Rating Scale Revised and estimated over seven homogeneous age bins (from 5 to 28 years) using parallel process latent class growth analysis on data collected across 2-4 time points. Multilevel multinomial logistic regression was used to identify characteristics that differentiated between the derived classes. A seven-class solution revealed "severe combined stable" (4.8%), "severe combined decreasing" (13%), "severe inattentive stable" (4.8%), "moderate combined increasing" (7.5%), "moderate combined decreasing" (12.7%), "stable mild" (12.9%), and "stable low" (44.3%) classes. Polygenic risk for depression, ADHD diagnosis, ADHD medication use, IQ, comorbid symptom levels (foremost oppositional behaviour), and functional impairment levels differentiated classes with similar ADHD symptom levels in childhood but a diverging course thereafter. The course of ADHD is highly heterogeneous, with stable, decreasing, and increasing trajectories. Overall, severe symptom levels in childhood are associated with elevated-to-severe symptom levels in adolescence and young adulthood, despite substantial symptom reductions. Beyond symptom severity in childhood, genetic, demographic, and clinical characteristics distinguish the heterogeneous course.
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Affiliation(s)
- Melissa Vos
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Nanda N. J. Rommelse
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Barbara Franke
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jaap Oosterlaan
- grid.12380.380000 0004 1754 9227Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Pediatrics, Emma Children’s Hospital, Amsterdam Medical Center and Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Dirk J. Heslenfeld
- grid.12380.380000 0004 1754 9227Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter J. Hoekstra
- grid.4494.d0000 0000 9558 4598Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Klein
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.7692.a0000000090126352Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephen V. Faraone
- grid.411023.50000 0000 9159 4457Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, NY USA ,grid.411023.50000 0000 9159 4457Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, NY USA ,grid.7914.b0000 0004 1936 7443Department of Biomedicine, K.G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Jan K. Buitelaar
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina A. Hartman
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Riedel O, Klau S, Langner I, Bachmann C, Scholle O. Prevalence of multimodal treatment in children and adolescents with ADHD in Germany: a nationwide study based on health insurance data. Child Adolesc Psychiatry Ment Health 2021; 15:76. [PMID: 34922587 PMCID: PMC8684641 DOI: 10.1186/s13034-021-00431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) ranks top among neurodevelopmental disorders in children and adolescents. Due to a large number of unfavorable outcomes including psychiatric comorbidities, school problems, and lower socioeconomic status, early and effective treatment of ADHD is essential. Multimodal treatment has become the gold standard in ADHD management, comprising pharmacotherapy and psychosocial interventions, e.g., psychotherapy. Yet, little is known about the prevalence of multimodal treatment in routine care. METHODS Based on German health claims data for the years 2009-2017, we identified children and adolescents aged 3-17 years diagnosed with ADHD and characterized them cross-sectionally (per calendar year) in terms of treatment status and psychiatric comorbidities. The detection of pharmacotherapy was based on dispensations of drugs to treat ADHD (e.g., methylphenidate); psychotherapeutic treatment was based on corresponding billing codes. Multimodal treatment was assumed if ADHD medication and psychotherapeutic treatment were coded within the same calendar year. Psychiatric comorbidities were based on outpatient and inpatient diagnoses. Prevalences of ADHD and proportions of different treatment options were calculated and standardized by age and sex. RESULTS In 2017, 91,118 children met the study criteria for ADHD (prevalence: 42.8/1000). Of these, 25.2% had no psychiatric comorbidity, 28.8% had one, 21.6% had two, and 24.5% had three or more. Regarding overall treatment status, 36.2% were treated only pharmacologically, 6.5% received multimodal treatment, and 6.8% were treated with psychotherapy only (neither treatment: 50.2%). With increasing numbers of psychiatric comorbidities, the proportions of patients with multimodal treatment increased from 2.2% (no psychiatric comorbidities) to 11.1% (three or more psychiatric comorbidities) while the proportions of untreated (from 56.8% to 42.7%) or only pharmacologically treated patients (38.4% to 35.0%) decreased. From 2009 to 2017, prevalences were stable and the proportion of patients with only pharmacotherapy decreased from 48% to 36.5%. Concurrently, the proportion of patients with neither pharmacotherapy nor psychotherapy increased from 40.5% to 50.2%. The fraction of patients with multimodal treatment ranged between 6.5% (2017) and 7.4% (2013). CONCLUSIONS Multimodal treatment, although recommended as the standard of treatment, is rather the exception than the rule. It is, however, increasingly common in ADHD patients with psychiatric comorbidities.
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Affiliation(s)
- Oliver Riedel
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Simon Klau
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Ingo Langner
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Christian Bachmann
- Department of Child & Adolescent Psychiatry, University Hospital Ulm, Ulm University, Steinhövelstrasse 5, 89075, Ulm, Germany.
| | - Oliver Scholle
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, 28359 Bremen, Germany
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Murray AL, Ushakova A, Speyer L, Brown R, Auyeung B, Zhu X. Sex/gender differences in individual and joint trajectories of common mental health symptoms in early to middle adolescence. JCPP ADVANCES 2021. [DOI: 10.1002/jcv2.12057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Anastasia Ushakova
- Center for Health Informatics, Computing and Statistics Medical School Lancaster University Lancaster UK
| | - Lydia Speyer
- Department of Psychology University of Edinburgh Edinburgh UK
- Department of Psychology University of Cambridge Cambridge UK
| | - Ruth Brown
- Department of Psychology University of Edinburgh Edinburgh UK
| | - Bonnie Auyeung
- Department of Psychology University of Edinburgh Edinburgh UK
| | - Xinxin Zhu
- Department of Psychology University of Edinburgh Edinburgh UK
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Novi M, Paraskevopoulou M, Van Rooij D, Schene AH, Buitelaar JK, Schellekens AFA. Effects of substance misuse and current family history of substance use disorder on brain structure in adolescents and young adults with attention-deficit/hyperactivity disorder. Drug Alcohol Depend 2021; 228:109032. [PMID: 34555690 DOI: 10.1016/j.drugalcdep.2021.109032] [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] [Received: 03/27/2021] [Revised: 07/03/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alterations in brain structure in attention-deficit/hyperactivity disorder (ADHD) show considerable overlap with those observed in substance use disorder (SUD). These overlapping structural alterations in ADHD and SUD might be explained by family history (FH-trait) effects of SUD, and/or substance misuse (state) effects. Our aim was to investigate effects of 1) current parental SUD (SUD-FH) and 2) recent substance misuse (SM) on brain structure in a cohort of ADHD patients and controls. DESIGN Cortical thickness and subcortical volumes were measured using structural MRI. We compared ADHD subjects and controls with or without SUD-FH (aim 1) and additionally explored differences between SUD-FH- and SUD-FH + subjects with one versus two parents with SUD. We also compared ADHD groups with and without SM (ADHD + SM and ADHD-only, respectively) and controls (aim 2). FINDINGS There was no association between SUD-FH and brain structure. Exploratory analysis on SUD-FH showed decreased IFG thickness (p = 0.032) and nucleus accumbens (NAcc) volume (p = 0.017) in subjects with two versus one SUD parent, regardless of ADHD. ADHD + SM showed decreased inferior frontal gyrus (IFG) thickness compared to controls (pars opercularis p = 0.025, pars orbitalis p = 0.010, pars triangularis p = 0.049), while no difference was found between ADHD-only and either ADHD + SM or controls. CONCLUSIONS Despite negative findings in the primary trait-analysis, exploratory trait-analysis on SUD-FH loading suggested potential SUD trait-effects on IFG thickness and NAcc volume. Substance misuse state effects in ADHD were linked to lower IFG thickness. Future studies should confirm these findings and investigate their clinical relevance, including the functional consequences of decreased IFG thickness.
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Affiliation(s)
- Martina Novi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, 56100, Italy; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Maria Paraskevopoulou
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Daan Van Rooij
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Aart H Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
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Kaalund-Brok K, Houmann TB, Hebsgaard MB, Lauritsen MBG, Lundstrøm LH, Grønning H, Darling L, Reinert-Petersen S, Petersen MA, Jepsen JRM, Pagsberg AK, Plessen KJ, Rasmussen HB, Jeppesen P. Outcomes of a 12-week ecologically valid observational study of first treatment with methylphenidate in a representative clinical sample of drug naïve children with ADHD. PLoS One 2021; 16:e0253727. [PMID: 34673771 PMCID: PMC8530346 DOI: 10.1371/journal.pone.0253727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Randomized placebo-controlled trials have reported efficacy of methylphenidate (MPH) for Attention-deficit/hyperactivity disorder (ADHD); however, selection biases due to strict entry criteria may limit the generalizability of the findings. Few ecologically valid studies have investigated effectiveness of MPH in representative clinical populations of children. This independently funded study aims to describe treatment responses and their predictors during the first 12 weeks of MPH treatment using repeated measurements of symptoms and adverse reactions (ARs) to treatment in 207 children recently diagnosed with ADHD. The children were consecutively included from the Child and Adolescent Mental Health Centre, Mental Health Services, The Capital Region of Denmark. The children (mean age, 9.6 years [range 7–12], 75.4% males) were titrated with MPH, based on weekly assessments of symptoms (18-item ADHD-rating scale scores, ADHD-RS-C) and ARs. At study-end 187 (90.8%) children reached a mean end-dose of 1.0 mg/kg/day. A normalisation/borderline normalisation on ADHD-RS-C was achieved for 168 (81.2%) children on the Inattention and/or the Hyperactivity-Impulsivity subscale in week 12, and 31 (15.0%) children were nonresponders, which was defined as absence of normalisation/borderline normalisation (n = 19) or discontinuation due to ARs (n = 12), and eight (3.8%) children dropped out from follow-up. Nonresponders were characterised by more severe symptoms of Hyperactivity-Impulsivity and global impairment before the treatment. ARs were few; the most prominent were appetite reduction and weight loss. A decrease in AR-like symptoms during the treatment period questions the validity of currently available standard instruments designed to measure ARs of MPH. This ecologically valid observational study supports prior randomized placebo-controlled trials; 81.2% of the children responded favourably in multiple domains with few harmful effects to carefully titrated MPH. Clinical trial registration: ClinicalTrials.gov with registration number NCT04366609.
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Affiliation(s)
- Kristine Kaalund-Brok
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
- * E-mail:
| | - Tine Bodil Houmann
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Marie Bang Hebsgaard
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Maj-Britt Glenn Lauritsen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Louise Hyldborg Lundstrøm
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Helene Grønning
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Lise Darling
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Susanna Reinert-Petersen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Services Glostrup, The Capital Region of Denmark, Glostrup, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, The Capital Region of Denmark, Roskilde, Denmark
- Department of Science & Environment, Roskilde University, Roskilde, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
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Agnew-Blais JC, Belsky DW, Caspi A, Danese A, Moffitt TE, Polanczyk GV, Sugden K, Wertz J, Williams BS, Lewis CM, Arseneault L. Polygenic Risk and the Course of Attention-Deficit/Hyperactivity Disorder From Childhood to Young Adulthood: Findings From a Nationally Representative Cohort. J Am Acad Child Adolesc Psychiatry 2021; 60:1147-1156. [PMID: 33440202 PMCID: PMC8417462 DOI: 10.1016/j.jaac.2020.12.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/01/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand whether genetic risk for attention-deficit/hyperactivity disorder (ADHD) is associated with the course of the disorder across childhood and into young adulthood. METHOD Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-based birth cohort of 2,232 twins. ADHD was assessed at ages 5, 7, 10, and 12 with mother- and teacher-reports and at age 18 with self-report. Polygenic risk scores (PRSs) were created using a genome-wide association study of ADHD case status. Associations with PRS were examined at multiple points in childhood and longitudinally from early childhood to adolescence. We investigated ADHD PRS and course to young adulthood, as reflected by ADHD remission, persistence, and late onset. RESULTS Participants with higher ADHD PRSs had increased risk for meeting ADHD diagnostic criteria (odds ratios ranging from 1.17 at age 10 to 1.54 at age 12) and for elevated symptoms at ages 5, 7, 10, and 12. Higher PRS was longitudinally associated with more hyperactivity/impulsivity (incidence rate ratio = 1.18) and inattention (incidence rate ratio = 1.14) from age 5 to age 12. In young adulthood, participants with persistent ADHD exhibited the highest PRS (mean PRS = 0.37), followed by participants with remission (mean PRS = 0.21); both groups had higher PRS than controls (mean PRS = -0.03), but did not significantly differ from one another. Participants with late-onset ADHD did not show elevated PRS for ADHD, depression, alcohol dependence, or marijuana use disorder. CONCLUSION Genetic risk scores derived from case-control genome-wide association studies may have relevance not only for incidence of mental health disorders, but also for understanding the longitudinal course of mental health disorders.
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Affiliation(s)
| | | | - Avshalom Caspi
- King’s College London, United Kingdom,Duke University, Durham, North Carolina
| | - Andrea Danese
- King’s College London, United Kingdom,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Terrie E. Moffitt
- King’s College London, United Kingdom,Duke University, Durham, North Carolina
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A randomized-controlled neurofeedback trial in adult attention-deficit/hyperactivity disorder. Sci Rep 2021; 11:16873. [PMID: 34413344 PMCID: PMC8376871 DOI: 10.1038/s41598-021-95928-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood onset disorder persisting into adulthood for a large proportion of cases. Neurofeedback (NF) has shown promising results in children with ADHD, but randomized controlled trials in adults with ADHD are scarce. We aimed to compare slow cortical potential (SCP)- and functional near-infrared spectroscopy (fNIRS) NF to a semi-active electromyography biofeedback (EMG-BF) control condition regarding changes in symptoms and the impact of learning success, as well as changes in neurophysiological parameters in an adult ADHD population. Patients were randomly assigned to SCP-NF (n = 26), fNIRS-NF (n = 21) or EMG-BF (n = 20). Outcome parameters were assessed over 30 training sessions (pre, intermediate, post) and at 6-months follow-up (FU) including 3 booster sessions. EEG was recorded during two auditory Go/NoGo paradigms assessing the P300 and contingent negative variation (CNV). fNIRS measurements were conducted during an n-back- as well as a Go/NoGo task. All three groups showed equally significant symptom improvements suggesting placebo- or non-specific effects on the primary outcome measure. Only when differentiating between learners and non-learners, fNIRS learners displayed stronger reduction of ADHD global scores compared to SCP non-learners at FU, and fNIRS learners showed specifically low impulsivity ratings. 30.8% in the SCP-NF and 61.9% of participants in the fNIRS-NF learned to regulate the respective NF target parameter. We conclude that some adults with ADHD learn to regulate SCP amplitudes and especially prefrontal hemodynamic activity during NF. We did not find any significant differences in outcome between groups when looking at the whole sample. When evaluating learners only, they demonstrate superior effects as compared to non-learners, which suggests specific effects in addition to non-specific effects of NF when learning occurs.
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Caye A, Leffa DT, Rohde LA. The influence of comorbidities on the trajectories of ADHD throughout development. Neurosci Biobehav Rev 2021; 130:31-32. [PMID: 34375674 DOI: 10.1016/j.neubiorev.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Arthur Caye
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 4o Andar - Serviço de Psiquiatria, Porto Alegre, RS, CEP 90035-003, Brazil; National Institute of Developmental Psychiatry (INPD, CNPq), Rua Dr. Ovídio Pires de Campos, 785 1º Andar, Sala 6, Ala sul, Bairro Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
| | - Douglas Teixeira Leffa
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 4o Andar - Serviço de Psiquiatria, Porto Alegre, RS, CEP 90035-003, Brazil; National Institute of Developmental Psychiatry (INPD, CNPq), Rua Dr. Ovídio Pires de Campos, 785 1º Andar, Sala 6, Ala sul, Bairro Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 4o Andar - Serviço de Psiquiatria, Porto Alegre, RS, CEP 90035-003, Brazil; National Institute of Developmental Psychiatry (INPD, CNPq), Rua Dr. Ovídio Pires de Campos, 785 1º Andar, Sala 6, Ala sul, Bairro Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
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Fuller-Thomson E, Lewis DA, Agbeyaka S. Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey. Alcohol Alcohol 2021; 57:385-395. [PMID: 34343246 DOI: 10.1093/alcalc/agab048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 12/31/2022] Open
Abstract
AIM (a) To document the prevalence and odds of (i) alcohol use disorders, (ii) cannabis use disorders, (iii) other drug use disorders and (iv) any substance use disorder (SUD), among young adults with and without ADHD, and (b) to investigate the degree to which the association between ADHD and SUDs is attenuated by socio-demographics, early adversities and mental health. METHOD Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH). The sample included 6872 respondents aged 20-39, of whom 270 had ADHD. The survey response rate was 68.9%. MEASUREMENTS Substance Use Disorder: World Health Organization's Composite International Diagnostic Interview criteria, SUDs, were derived from lifetime algorithms for alcohol, cannabis and other substance abuse or dependence. ADHD was based on self-report of a health professional's diagnosis. FINDINGS One in three young adults with ADHD had a lifetime alcohol use disorder (36%) compared to 19% of those without ADHD (P < 0.001). After adjusting for all control variables, those with ADHD had higher odds of developing alcohol use disorders (OR = 1.38, 95% CI: 1.05, 1.81), cannabis use disorders (OR = 1.46, 95% CI: 1.06, 2.00), other drug use disorders (OR = 2.07, 95% CI: 1.46, 2.95) and any SUD (OR = 1.69, 95% CI: 1.28, 2.23). History of depression and anxiety led to the largest attenuation of the ADHD-SUD relationship, followed by childhood adversities and socioeconomic status. CONCLUSIONS Young adults with ADHD have a high prevalence of alcohol and other SUDs. Targeted outreach and interventions for this extremely vulnerable population are warranted.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, Canada.,Department of Family and Community Medicine, 500 University Avenue, 5th Floor University of Toronto, Toronto, Canada.,Institute for Life Course & Aging, University of Toronto, 246 Bloor St. W., Toronto, Canada
| | - Danielle A Lewis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, Canada
| | - Senyo Agbeyaka
- Toronto General Hospital, 200 Elizabeth St, University Health Network, Toronto, ON, Canada
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Predicting the course of ADHD symptoms through the integration of childhood genomic, neural, and cognitive features. Mol Psychiatry 2021; 26:4046-4054. [PMID: 33173195 PMCID: PMC8345321 DOI: 10.1038/s41380-020-00941-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
Childhood attention deficit hyperactivity disorder (ADHD) shows a highly variable course with age: some individuals show improving, others stable or worsening symptoms. The ability to predict symptom course could help individualize treatment and guide interventions. By studying a cohort of 362 youth, we ask if polygenic risk for ADHD, combined with baseline neural and cognitive features could aid in the prediction of the course of symptoms over an average period of 4.8 years. Compared to a never-affected comparison group, we find that participants with worsening symptoms carried the highest polygenic risk for ADHD, followed by those with stable symptoms, then those whose symptoms improved. Participants with worsening symptoms also showed atypical baseline cognition. Atypical microstructure of the cingulum bundle and anterior thalamic radiation was associated with improving symptoms while reduction of thalamic volume was found in those with stable symptoms. Machine-learning algorithms, trained and tested on independent groups, performed well in classifying those never affected against groups with worsening, stable, and improving symptoms (area under the curve >0.79). We conclude that some measures of polygenic risk, cognition, and neuroimaging show significant associations with the future course of ADHD symptoms and may have modest predictive power. These features warrant further exploration as prognostic tools.
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Adult attention-deficit hyperactivity disorder symptoms and psychological distress, hazardous drinking, and problem gambling: A population-based study. Psychiatry Res 2021; 301:113985. [PMID: 34023674 DOI: 10.1016/j.psychres.2021.113985] [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: 02/20/2020] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
Recognition of ADHD in the adult population is relatively recent. Epidemiological research examining the mental health impact of ADHD in adulthood is thus limited. The objective of this study was to examine whether adult ADHD symptoms are associated with psychological distress, hazardous drinking, and problem gambling, after controlling for traumatic brain injury and sociodemographic characteristics. We analyzed data from a population-based survey administered in 2015 and 2016 to adults aged 18 years and over in Ontario, Canada (N = 3,817). Logistic regression was used to construct unadjusted and multivariable models for each of the three focal relationships. In the unadjusted models, ADHD symptoms were significantly related to psychological distress (OR = 9.3; 95% CI:6.1, 14.0) and hazardous drinking (OR = 2.1; 95% CI: 1.3, 3.4), but not to problem gambling (OR = 1.5; 0.5, 4.3). After adjustment, ADHD symptoms were significantly related to psychological distress (OR = 7.1; 95% CI: 4.6, 11.1), but not hazardous drinking (OR = 1.4; 95% CI: 0.8, 2.5) or problem gambling (OR = 0.6; 95% CI: 0.2, 2.5). This study further highlights the importance of clinicians assessing for concomitant ADHD and psychological distress in adults.
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Methylphenidate and atomoxetine treatment negatively affect physical growth indexes of school-age children and adolescents with attention-deficit/hyperactivity disorder. Pharmacol Biochem Behav 2021; 208:173225. [PMID: 34217783 DOI: 10.1016/j.pbb.2021.173225] [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] [Received: 12/19/2020] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
AIM To determine the effects of drug therapy on the physical growth of school-age children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHOD The medical records of 86 participants (average age: 8.9 ± 2.2 years) with ADHD prescribed methylphenidate (MPH) or atomoxetine (ATX) for ≥24 weeks from the Children's Hospital of Chongqing Medical University were analysed. RESULTS The Z-scores of height, weight and body mass index (BMI) of children with ADHD decreased significantly over the first six months of MPH treatment (P < 0.001). The slopes of the fitting lines after the first six months of MPH (-0.18, -0.58 and -0.69, respectively) returned over the entire treatment (the slopes changed to -0.027, -0.26 and -0.20, respectively). For ATX, the Z-scores of height of children decreased significantly over the first six months (P < 0.001), but the Z-scores of weight and BMI did not (P > 0.05). The slopes of the fitting lines after the first six months of ATX (-0.058, -0.032 and 0.0094, respectively) changed over the entire treatment (slopes were 0.16, 0.52 and 0.26, respectively). Children taking MPH were more likely to report decreased appetite (P < 0.05). The weight and BMI of the children receiving MPH were significantly correlated with decreased appetite (P < 0.01). CONCLUSION The physical growth indexes (PGIs) of school-age children and adolescents with ADHD were negatively affected while taking MPH, and these effects were gradually mitigated with continued treatment. ATX hardly had negative effects on weight and BMI. Neither MPH nor ATX had a significant negative effect on the height of children in long-term ADHD treatment. It is necessary for clinicians to consider children's diet during treatment.
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Weis R, Hombosky ML, Schafer KK, Shulman D, Tull JK. Accommodation decision-making for postsecondary students with ADHD: Implications for neuropsychologists. J Clin Exp Neuropsychol 2021; 43:370-383. [PMID: 33899673 DOI: 10.1080/13803395.2021.1918645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuropsychologists are often asked to evaluate students for attention-deficit/hyperactivity disorder (ADHD) and to provide documentation to support their requests for academic accommodations in college. Research points to the importance of multi-method, multi-informant data when evaluating ADHD and determining the need for accommodations. However, the Association on Higher Education and Disability (AHEAD) directs disability service providers to give primacy to students' self-reports and their own impressions of students' narratives over objective, third-party data when rendering accommodation decisions. The organization asserts that in many cases information from parents, teachers, and psychologists is not needed to confirm the existence of a disability or students' need for accommodations. In this article, we describe the way disability service providers are directed to evaluate accommodation requests, the limitations of these procedures, and the dangers of well-intentioned, but indiscriminate accommodation-granting. We then provide recommendations for neuropsychologists who conduct ADHD evaluations for college students in light of these professional guidelines.
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Affiliation(s)
- Robert Weis
- Department of Psychology, Denison University, Granville, OH, USA
| | | | - Kendra K Schafer
- Department of Psychology, Denison University, Granville, OH, USA
| | - Darcy Shulman
- Department of Psychology, Denison University, Granville, OH, USA
| | - Jessica K Tull
- Department of Psychology, Denison University, Granville, OH, USA
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Correll CU, Starling BR, Huss M. Systematic review of transdermal treatment options in attention-deficit/hyperactivity disorder: implications for use in adult patients. CNS Spectr 2021:1-13. [PMID: 33843531 DOI: 10.1017/s1092852921000341] [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: 11/07/2022]
Abstract
BACKGROUND Adults with attention-deficit/hyperactivity disorder (ADHD) often face delays in diagnosis and remain untreated, despite significant negative impacts. To evaluate the safety and efficacy of transdermal treatment options in children, adolescents, and adults, a systematic literature review was conducted, with a focus on the implications of transdermal therapies for ADHD in adults. METHODS A MEDLINE/Embase/BIOSIS/SCOPUS database search was conducted December 4, 2019, for English-language articles of interventional clinical trials using transdermal formulations for the treatment of ADHD without publication date limit. Assessed outcomes included efficacy, safety, adherence, abuse potential, cost efficacy, and health-related quality of life. RESULTS Of 23 eligible publications, 18 were in children or adolescents (n = 1699; range 23-305), and 5 in adults (n = 274; range 14-90); all included methylphenidate transdermal system (MTS). All seven pediatric publications reporting change in ADHD symptomology from baseline reported a significant improvement with MTS treatment. Similarly, in three adult publications, ADHD symptoms improved significantly with MTS treatment. Safety findings in pediatric and adult studies were comparable; the most frequently reported treatment-emergent adverse events (TEAEs), namely, headache, decreased appetite, and insomnia, were reported in 13/16 (81%) of publications reporting specific TEAEs. MTS-related dermal reactions were mostly mild and transient. Discontinuation due to dermal reactions was reported in 10 studies (range 0%-7.1% [1 of 14 patients]). MTS compliance was high when assessed (97%-99%). CONCLUSIONS Transdermal therapies provide a useful treatment formulation for ADHD. Studies of MTS and other transdermal formulations, such as amphetamine, in adult patients are needed in this underserved population.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Brittney R Starling
- Research and Development, Noven Pharmaceuticals, Inc., Jersey City, New Jersey, USA
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, Johannes Gutenberg University of Medicine, Mainz, Germany
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