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Chen IC, Chang CL, Huang IW, Chang MH, Ko LW. Electrophysiological functional connectivity and complexity reflecting cognitive processing speed heterogeneity in young children with ADHD. Psychiatry Res 2024; 340:116100. [PMID: 39121760 DOI: 10.1016/j.psychres.2024.116100] [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] [Received: 09/10/2022] [Revised: 05/19/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
Early intervention is imperative for young children with attention-deficit/hyperactivity disorder (ADHD) who manifest heterogeneous neurocognitive deficits. The study investigated the functional connectivity and complexity of brain activity among young children with ADHD exhibiting a fast cognitive processing speed (ADHD-F, n = 26), with ADHD exhibiting a slow cognitive processing speed (ADHD-S, n = 17), and typically developing children (n = 35) using wireless electroencephalography (EEG) during rest and task conditions. During rest, compared with the typically developing group, the ADHD-F group displayed lower long-range intra-hemispheric connectivity, while the ADHD-S group had lower frontal beta inter-hemispheric connectivity. During task performance, the ADHD-S group displayed lower frontal beta inter-hemispheric connectivity than the typically developing group. The ADHD-S group had lower frontal inter-hemispheric connectivity in broader frequency bands than the ADHD-F group, indicating ADHD heterogeneity in mental processing speed. Regarding complexity, the ADHD-S group tended to show lower frontal entropy estimators than the typically developing group during the task condition. These findings suggest that the EEG profile of brain connectivity and complexity can aid the early clinical diagnosis of ADHD, support subgrouping young children with ADHD based on cognitive processing speed heterogeneity, and may contain specific novel neural biomarkers for early intervention planning.
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Affiliation(s)
- I-Chun Chen
- Department of Physical Medicine and Rehabilitation, Ton-Yen General Hospital, Hsinchu, Taiwan, ROC; Department of Early Childhood Education and Care, Minghsin University of Science and Technology, Hsinchu, Taiwan, ROC; International Ph.D. Program in Interdisciplinary Neuroscience, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC.
| | | | - I-Wen Huang
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
| | - Meng-Han Chang
- Department of Psychiatry, Ton-Yen General Hospital, Hsinchu, Taiwan, ROC
| | - Li-Wei Ko
- Department of Electronics and Electrical Engineering, Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC; Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC; Department of Biomedical Science and Environment Biology, Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
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Feng A, O'Neill S, Rostain AL. Contributors to Underdiagnosis of ADHD among Asian Americans: A Narrative Review. J Atten Disord 2024; 28:1499-1519. [PMID: 39082427 DOI: 10.1177/10870547241264113] [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: 09/15/2024]
Abstract
OBJECTIVE Rates of ADHD are lowest among Asian American children (1-6.1%) compared to all other major ethnic and racial groups in the US, but there is limited literature on reasons for the disparity in estimated prevalence rates. METHOD We conducted a narrative review to integrate the literature on ADHD in children in Asian countries with that on ADHD among Asian American youth to highlight potential explanations for disparities in ADHD diagnosis and treatment among Asian American children relative to other racial and ethnic groups. RESULTS Factors possibly contributing to the low estimated prevalence rates of ADHD among Asian American children include: a higher proportion of Inattentive ADHD presentation among Chinese, Malaysian, and Indian children; racial bias and the influence of the Model Minority Myth; cultural differences in classroom identification; mental health stigma in Asian American communities; parent perception of ADHD as misbehavior rather than a neurodevelopmental disorder; and parent support for children's academic activities that may mask impairment. CONCLUSION We offer recommendations to inform individual and community-level psychoeducation, and new directions for research to address this health disparity.
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Affiliation(s)
- Ashley Feng
- Psychology Department, The City College of New York, City University of New York, New York, NY, USA
| | - Sarah O'Neill
- Psychology Department, The City College of New York, City University of New York, New York, NY, USA
- Psychology Department, The Graduate Center, City University of New York, New York, NY, USA
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, USA
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3
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Overgaard KR, Oerbeck B, Friis S, Pripp AH, Aase H, Biele G, Ingeborgrud CB, Polanczyk GV, Zeiner P. Attention-deficit/hyperactivity disorder from preschool to school age: change and stability of parent and teacher reports. Eur Child Adolesc Psychiatry 2023; 32:1947-1955. [PMID: 35737107 PMCID: PMC10533600 DOI: 10.1007/s00787-022-02019-1] [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: 11/26/2021] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Identifying attention-deficit/hyperactivity disorder (ADHD) in pre-schoolers may improve their development if treated, but it is unclear whether ADHD symptoms from this age are stable enough to merit treatment. We aimed to investigate the stability of parent- and teacher-reported ADHD symptoms and ADHD classified above the diagnostic symptom thresholds, including for hyperactivity-impulsivity (HI), inattention and combined presentations from age 3 to 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. At child age 3 years, parents were interviewed and teachers rated ADHD symptoms. At age 8 years, parents (n = 783) and teachers (n = 335) reported ADHD symptoms by the Child Symptom Inventory-4. We found a significant reduction in the mean number of parent-reported ADHD and HI symptoms from age 3 to 8 years, but otherwise similar mean numbers. Parent-reported ADHD symptoms were moderately correlated between ages, while correlations were low for teachers. A total of 77/108 (71%) of the children classified with parent-reported HI presentation at age 3 years were no longer classified within any ADHD presentation at age 8 years, the only clear trend across time for either informant. There was a low to moderate parent-teacher-agreement in the number of reported symptoms, and very low informant agreement for the classified ADHD presentations. Overall, clinicians should exercise caution in communicating concern about HI symptoms in preschool children. Age 3 years may be too early to apply the ADHD diagnostic symptom criteria, especially if parents and teachers are required to agree.
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Affiliation(s)
- Kristin Romvig Overgaard
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Guido Biele
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hunt E, Hogan A, Will EA, Roberts JE. ADHD and ASD symptoms in young males with fragile X syndrome: associations with early trajectories of inhibitory control. Child Neuropsychol 2023; 29:760-786. [PMID: 36082630 PMCID: PMC9995619 DOI: 10.1080/09297049.2022.2120605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Inhibitory control (IC), the ability to suppress inappropriate responses, emerges late in the first year of life and improves across typical development, concurrent with brain maturation. The development of IC is critical to various social-emotional and behavioral functions, with IC difficulties being linked to numerous neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Fragile X syndrome (FXS) is a single-gene disorder characterized by IC difficulties, and elevated rates of ADHD and ASD, making it a useful model for understanding the early development and consequences of IC. In this longitudinal study, we characterized IC trajectories across multiple time points between 16 and 71 months of age in young males with FXS (n = 79) relative to neurotypical (NT) controls (n=49). To explore the association between behavioral outcomes and IC, we identified a subsample of 50 children with longitudinal IC data and an outcome assessment for ADHD and ASD symptoms at age 5 (FXS: n = 26, NT: n = 24). Results indicated that, compared to their NT peers, young males with FXS exhibit differences in IC as early as 24 months, with group differences increasing through age 5. Additionally, we determined that lower IC levels at 24 months were associated with later ADHD symptoms and a decreasing slope in IC over time was associated with later ASD symptoms in male children with FXS. These findings help refine early developmental phenotypes of FXS and highlight IC as a potential target for early detection and intervention of ASD and ADHD symptoms in male children with FXS.
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Affiliation(s)
- Erin Hunt
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Abigail Hogan
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Elizabeth A Will
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Chen IC, Lee PW, Wang LJ, Chang CH, Lin CH, Ko LW. Incremental Validity of Multi-Method and Multi-Informant Evaluations in the Clinical Diagnosis of Preschool ADHD. J Atten Disord 2022; 26:1293-1303. [PMID: 34949123 DOI: 10.1177/10870547211045739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study investigated the discriminative validity of various single or combined measurements of electroencephalogram (EEG) data, Conners' Kiddie Continuous Performance Test (K-CPT), and Disruptive Behavior Disorder Rating Scale (DBDRS) to differentiate preschool children with ADHD from those with typical development (TD). METHOD We recruited 70 preschoolers, of whom 38 were diagnosed with ADHD and 32 exhibited TD; all participants underwent the K-CPT and wireless EEG recording in different conditions (rest, slow-rate, and fast-rate task). RESULTS Slow-rate task-related central parietal delta (1-4 Hz) and central alpha (8-13 Hz) and beta (13-30 Hz) powers between groups with ADHD and TD were significantly distinct (p < .05). A combination of DBDRS, K-CPT, and specific EEG data provided the best probability scores (area under curve = 0.926, p < .001) and discriminative validity to identify preschool children with ADHD (overall correct classification rate = 85.71%). CONCLUSIONS Multi-method and multi-informant evaluations should be emphasized in clinical diagnosis of preschool ADHD.
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Affiliation(s)
- I-Chun Chen
- National Yang Ming Chiao Tung University, Hsinchu.,Ton Yen General Hospital, Hsinchu
| | | | - Liang-Jen Wang
- Chang Gung Memorial Hospital, Kaohsiung.,Chang Gung University, Taoyuan
| | | | | | - Li-Wei Ko
- National Yang Ming Chiao Tung University, Hsinchu
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Chen IC, Chen CL, Chang CH, Fan ZC, Chang Y, Lin CH, Ko LW. Task-Rate-Related Neural Dynamics Using Wireless EEG to Assist Diagnosis and Intervention Planning for Preschoolers with ADHD Exhibiting Heterogeneous Cognitive Proficiency. J Pers Med 2022; 12:jpm12050731. [PMID: 35629153 PMCID: PMC9143733 DOI: 10.3390/jpm12050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
This study used a wireless EEG system to investigate neural dynamics in preschoolers with ADHD who exhibited varying cognitive proficiency pertaining to working memory and processing speed abilities. Preschoolers with ADHD exhibiting high cognitive proficiency (ADHD-H, n = 24), those with ADHD exhibiting low cognitive proficiency (ADHD-L, n = 18), and preschoolers with typical development (TD, n = 31) underwent the Conners’ Kiddie Continuous Performance Test and wireless EEG recording under different conditions (rest, slow-rate, and fast-rate task). In the slow-rate task condition, compared with the TD group, the ADHD-H group manifested higher delta and lower beta power in the central region, while the ADHD-L group manifested higher parietal delta power. In the fast-rate task condition, in the parietal region, ADHD-L manifested higher delta power than those in the other two groups (ADHD-H and TD); additionally, ADHD-L manifested higher theta as well as lower alpha and beta power than those with ADHD-H. Unlike those in the TD group, the delta power of both ADHD groups was enhanced in shifting from rest to task conditions. These findings suggest that task-rate-related neural dynamics contain specific neural biomarkers to assist clinical planning for ADHD in preschoolers with heterogeneous cognitive proficiency. The novel wireless EEG system used was convenient and highly suitable for clinical application.
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Affiliation(s)
- I-Chun Chen
- International Ph.D. Program in Interdisciplinary Neuroscience, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan;
- Department of Physical Medicine and Rehabilitation, Ton-Yen General Hospital, Hsinchu 30268, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (C.-L.C.); (L.-W.K.)
| | - Chih-Hao Chang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan; (C.-H.C.); (Z.-C.F.)
- Brain Research Center and the Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan;
| | - Zuo-Cian Fan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan; (C.-H.C.); (Z.-C.F.)
- Brain Research Center and the Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan;
| | - Yang Chang
- Brain Research Center and the Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan;
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | | | - Li-Wei Ko
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan; (C.-H.C.); (Z.-C.F.)
- Brain Research Center and the Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan;
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Department of Electronics and Electrical Engineering, Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Drug Development and Value Creation Research Center, Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (C.-L.C.); (L.-W.K.)
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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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Overgaard KR, Oerbeck B, Friis S, Pripp AH, Aase H, Zeiner P. Predictive validity of attention-deficit/hyperactivity disorder from ages 3 to 5 Years. Eur Child Adolesc Psychiatry 2022; 31:1-10. [PMID: 33677627 PMCID: PMC9343262 DOI: 10.1007/s00787-021-01750-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
We investigated to what extent parent-rated attention-deficit/hyperactivity disorder (ADHD) and impairment at age 3 years predicted elevated ADHD symptoms at age 5 years, and whether teacher-rated ADHD symptoms improved these predictions. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-old children (n = 1195) were interviewed about ADHD and impairment, and teachers rated child ADHD symptoms by the Strengths and Difficulties Questionnaire or the Early Childhood Inventory-4. At 5 years of age, the children (n = 957) were classified as ADHD-positive or -negative using Conners' Parent Rating Scale. Relying solely on parent-rated ADHD or impairment at age 3 years did moderately well in identifying children with persistent elevation of ADHD symptoms, but gave many false positives (positive predictive values (PPVs): .40-.57). A small group of children (n = 20, 13 boys) scored above cut-off on both parent-rated ADHD and impairment, and teacher-rated ADHD symptoms, although adding teacher-rated ADHD symptoms slightly weakened the predictive power for girls. For this small group, PPVs were .76 for boys and .64 for girls. Limiting follow-up to these few children will miss many children at risk for ADHD. Therefore, we recommend close monitoring also of children with parent-reported ADHD symptoms and/or impairment to avoid delay in providing interventions. Clinicians should also be aware that teachers may miss ADHD symptoms in preschool girls.
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Affiliation(s)
- Kristin Romvig Overgaard
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Suk JW, Soltis-Vaughan B, Mahato K, Hwang S. Practical and Ethical Issues in Pediatric Psychopharmacology: Introductory Considerations. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210913-01] [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: 11/20/2022]
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Ohmann S, Wurzer M, Popow C. Attention-deficit hyperactivity disorder and executive dysfunction in preschool children. A comparison of NEPSY and BRIEF-P assessments. Encephale 2021; 48:232-240. [PMID: 34092380 DOI: 10.1016/j.encep.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to explore prevalence, interrelations and accuracy of assessing psychopathology, intelligence, and executive functions (EF) in preschool children with ADHD (age 2.1-6.5 years). METHOD We prospectively investigated 115 preschool outpatient children (91 boys, 24 girls, aged 4.3±1.0 years) with the clinical diagnosis of ADHD. Assessment included clinical history, background, psychosocial problems (CBCL, C-TRF), ADHD (DISYPS external ratings), cognitive performance (WPPSI-III, K-ABC), and executive functions (BRIEF-P, NEPSY). RESULTS We found a high frequency of dysexecutive problems in up to 64 % in the parental BRIEF-P assessments, up to 62 % in the BRIEF-P teachers' assessments, and 62 % in the NEPSY functional assessments. Parental and teachers' BRIEF-P scores were only correlated in one subscale, inhibition, and NEPSY and BRIEF-P were not correlated at all. It was found that 42.5 % of the children with noticeable findings had agreeing results in all three, and another 45 % in two tests. CONCLUSIONS About 2/3 of the ADHD preschool children had detectable EF dysfunctions. In order to assess dysexecutive problems, multi-method testing is mandatory.
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Affiliation(s)
- S Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Wurzer
- Institute of Statistics and Mathematics, Vienna University of Economics and Business, Building D4, Welthandelsplatz 1, 1020 Vienna, Austria
| | - C Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Behavioural Measures of Infant Activity but Not Attention Associate with Later Preschool ADHD Traits. Brain Sci 2021; 11:brainsci11050524. [PMID: 33919004 PMCID: PMC8143002 DOI: 10.3390/brainsci11050524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Mapping infant neurocognitive differences that precede later ADHD-related behaviours is critical for designing early interventions. In this study, we investigated (1) group differences in a battery of measures assessing aspects of attention and activity level in infants with and without a family history of ADHD or related conditions (ASD), and (2) longitudinal associations between the infant measures and preschool ADHD traits at 3 years. Participants (N = 151) were infants with or without an elevated likelihood for ADHD (due to a family history of ADHD and/or ASD). A multi-method assessment protocol was used to assess infant attention and activity level at 10 months of age that included behavioural, cognitive, physiological and neural measures. Preschool ADHD traits were measured at 3 years of age using the Child Behaviour Checklist (CBCL) and the Child Behaviour Questionnaire (CBQ). Across a broad range of measures, we found no significant group differences in attention or activity level at 10 months between infants with and without a family history of ADHD or ASD. However, parent and observer ratings of infant activity level at 10 months were positively associated with later preschool ADHD traits at 3 years. Observable behavioural differences in activity level (but not attention) may be apparent from infancy in children who later develop elevated preschool ADHD traits.
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Karr JE, Kibby MY, Jagger-Rickels AC, Garcia-Barrera MA. Sensitivity and Specificity of an Executive Function Screener at Identifying Children With ADHD and Reading Disability. J Atten Disord 2021; 25:134-140. [PMID: 29562850 PMCID: PMC6146073 DOI: 10.1177/1087054718763878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study evaluated the sensitivity/specificity of a global sum score (GSS) from the Behavior Assessment System for Children, Second Edition, Executive Function screener (BASC-2-EF) at classifying children with/without ADHD and/or reading disability (RD). Method: The BASC-2 Teacher/Parent Rating Scales (TRS/PRS) were completed for children (8-12 years old; 43.1% female) with no diagnosis (n = 53), RD (n = 34), ADHD (n = 85), co-morbid RD/ADHD (n = 36), and other diagnoses (n = 15). Receiver operating characteristic (ROC) curve analyses evaluated the sensitivity/specificity of the BASC-2-EF GSS at discriminating between children with/without ADHD or RD. Results: Area under the curve (AUC) scores indicated the sensitivity/specificity of the BASC-2-EF GSS at discriminating between children with/without ADHD (TRS: AUC = .831, p < .001; PRS: AUC = .919, p < .001), with/without RD (TRS: AUC = .724, p = .001; PRS: AUC = .615, p = .101), and with ADHD or RD through post hoc analysis (TRS: AUC = .674, p = .006; PRS: AUC = .819, p < .001). Conclusion: The findings support utilizing the BASC-2-EF GSS when differentiating ADHD from RD and typical development.
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Merkt J, Siniatchkin M, Petermann F. Neuropsychological Measures in the Diagnosis of ADHD in Preschool: Can Developmental Research Inform Diagnostic Practice? J Atten Disord 2020; 24:1588-1604. [PMID: 27006414 DOI: 10.1177/1087054716629741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The diagnosis of ADHD in preschool is challenging. Behavioral ratings are less reliable, but the value of neuropsychological tests in the diagnosis of ADHD has been debated. Method: This article provides an overview of neuropsychological measures utilized in preschoolers with ADHD (3-5 years). In addition, the manuscript discusses the extent to which these measures have been tested for their diagnostic capacity. Results: The diagnostic utility of computerized continuous performance tests and working memory subtests from IQ-batteries has been demonstrated in a number of studies by assessing their psychometric properties, sensitivity, and specificity. However, findings from developmental and basic research attempting to describe risk factors that explain variance in ADHD show the most consistent associations of ADHD with measures of delay aversion. Conclusion: Results from developmental research could benefit studies that improve ADHD diagnosis at the individual level. It might be helpful to consider testing as a structured situation for behavioral observation by the clinician.
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Affiliation(s)
- Julia Merkt
- Helmut-Schmidt-University, Hamburg, Germany.,Center for Research on Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany
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14
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Karlsberg Bennett J, O'Neill S, Rajendran K, Halperin JM. Do Preschoolers' Neuropsychological Functioning and Hyperactivity/Inattention Predict Social Functioning Trajectories Through Childhood? J Pediatr Psychol 2020; 45:793-802. [PMID: 32679586 DOI: 10.1093/jpepsy/jsaa053] [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: 01/28/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This longitudinal study examined whether preschool attention deficit hyperactivity disorder (ADHD) symptoms and neuropsychological functioning predicted trajectories of children's social functioning from age 3 to 4 through 12 years. METHODS Three- and four-year-old children (N = 208; 72.6% boys) were evaluated annually through age 12. Parent and teacher Attention Deficit/Hyperactivity Disorder Rating Scale, Fourth Edition responses during the initial evaluation were used to categorize preschoolers as "High" or "Low" risk for ADHD. Children's neuropsychological functioning was assessed using the NEPSY. Teachers' reports of children's social functioning were obtained annually from preschool through age 12 years using the Adaptability, Functional Communication, and Social Skills subscales of the Behavioral Assessment System for Children, Second Edition. Hierarchical linear modeling was used to assess the trajectories of social functioning and determine whether preschoolers' neuropsychological functioning and ADHD risk status predicted social functioning at age 12 years, and/or change in social functioning throughout childhood. All models controlled for baseline socioeconomic status. RESULTS High Risk children had significantly lower teacher-rated Adaptability and Social Skills at age 12 years. High Risk children and those with lower Verbal neuropsychological functioning in preschool had lower teacher-rated Functional Communication at 12 years old. Lower preschool Verbal neuropsychological functioning predicted greater positive change in teacher-rated Functional Communication across childhood. CONCLUSIONS Early identification of and intervention for children exhibiting ADHD behaviors is critical given the enduring negative impact of these behaviors on social functioning. Screening preschoolers for verbal difficulties is encouraged given their long-term impact on children's ability to clearly express thoughts and feelings and obtain and provide information.
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Affiliation(s)
| | - Sarah O'Neill
- Doctoral Program in Psychology, The Graduate Center.,Department of Psychology, The City College of New York
| | - Khushmand Rajendran
- Social Sciences, Human Services and Criminal Justice, Borough of Manhattan Community College
| | - Jeffrey M Halperin
- Doctoral Program in Psychology, The Graduate Center.,Psychology Department, Queens College, City University of New York
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15
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Wigal S, Chappell P, Palumbo D, Lubaczewski S, Ramaker S, Abbas R. Diagnosis and Treatment Options for Preschoolers with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:104-118. [PMID: 31967914 PMCID: PMC7047251 DOI: 10.1089/cap.2019.0116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), classifies attention-deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder, with symptoms becoming apparent as early as the preschool years. Early recognition can lead to interventions such as parent/teacher-administered behavior therapy, the recommended first-line treatment for preschool patients. There are few data, however, to inform the use of second-line, pharmacotherapy options in this population. In this review, we identified recent literature on the diagnosis and treatment of ADHD in preschool children. Methods: A PubMed and clinicaltrials.gov search was conducted for trials assessing efficacy or safety of ADHD medications in children aged <6 years. Diagnostic methods and criteria focusing on recognition of ADHD in preschool children were also surveyed. Results: The DSM-5 describes different manifestations of ADHD in preschool versus school-aged children, but does not list separate criteria by age group. Importantly, behaviors indicative of ADHD in older children may be developmentally appropriate in preschool children. Several behavioral rating scales have been validated in children younger than 6 years of age for assessing ADHD. The Preschool ADHD Treatment Study (PATS) has provided the most extensive efficacy and safety data on methylphenidate (MPH) for ADHD in preschoolers to date, with significant improvement in ADHD symptoms observed with MPH compared with placebo, although adverse event-related discontinuation was higher in PATS compared with studies of MPH for ADHD in school-aged children. Since PATS was conducted, few studies designed to assess ADHD medication effectiveness in preschool children have been published. One article reported significant improvement in ADHD symptoms with MPH (immediate release) versus placebo, two studies showed no difference between MPH and risperidone or MPH plus risperidone in relief of ADHD symptoms, and one study demonstrated the efficacy of atomoxetine versus placebo for ADHD symptoms in preschoolers. Conclusions: Further research is needed on pharmacotherapy for preschool children with ADHD.
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Affiliation(s)
- Sharon Wigal
- AVIDA Inc., Newport Beach, California.,Address correspondence to: Sharon Wigal, PhD, AVIDA Inc., 1133 Camelback Street #9802, Newport Beach, CA 92658
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16
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Peskin M, Sommerfeld E, Basford Y, Rozen S, Zalsman G, Weizman A, Manor I. Continuous Performance Test Is Sensitive to a Single Methylphenidate Challenge in Preschool Children With ADHD. J Atten Disord 2020; 24:226-234. [PMID: 27887009 DOI: 10.1177/1087054716680075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: There is a lack of evidence-based diagnostic paradigms and personalized interventions for preschoolers with ADHD. This study aimed to evaluate the performance of preschoolers diagnosed with ADHD on a continuous performance test (CPT) before and after a single methylphenidate (MPH) challenge. Method: The Test of Variables of Attention (TOVA)-a CPT-was administered to 61 preschoolers (5.64 ± 0.69 years; 74% boys) with ADHD before and after a single MPH challenge (0.3 or 0.5 mg/kg). Baseline TOVA performance was correlated with Conners' Rating Scales (CRS) and compared with post-MPH TOVA performance. Results: A high rate of omission errors and several significant correlations between TOVA values and CRS scores were found at baseline. A single MPH administration improved TOVA performance significantly and was well tolerated. Conclusion: TOVA assessment may assist in the evaluation of the effect of MPH in preschoolers with ADHD and may help in planning interventions for them.
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Affiliation(s)
- Miriam Peskin
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Eliane Sommerfeld
- Geha Mental Health Center, Petah Tikva, Israel.,Ariel University, Israel
| | | | | | - Gil Zalsman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel.,Columbia University, New York, NY, USA
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel.,Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Iris Manor
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
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17
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Halperin JM, Marks DJ. Practitioner Review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 2019; 60:930-943. [PMID: 30690737 DOI: 10.1111/jcpp.13014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) often emerges during the preschool years and remains impairing throughout the life span. Early identification and intervention may yield lasting benefits that alter the often-adverse trajectory of the disorder. METHODS This Practitioner Review provides up-to-date information regarding the evaluation and treatment of ADHD in preschool children. The clinical presentation of ADHD in preschool children, its persistence into later childhood, the applicability of DSM-5 criteria for preschoolers with ADHD, and early predictors of long-term trajectories are addressed, as well as current findings from randomized controlled trials of both nonpharmacological and pharmacological interventions. RESULTS Symptoms of hyperactivity/impulsivity extend down to age 3, but several inattention symptoms, as defined by DSM-V, less accurately differentiate preschoolers with and without ADHD. Most preschool youth with ADHD symptoms continue to manifest symptoms and impairment into school-age and adolescence. However, few predictors of persistence beyond early severity have been identified. Behavioral interventions constitute a first-line treatment for preschool ADHD symptoms, with telepsychiatry increasing in prominence to help to mitigate financial, geographic, and/or logistical barriers to care. Pharmacological interventions, particularly psychostimulants, also confer demonstrable benefits, yet efficacy and safety profiles are less desirable relative to findings in school-age youth. CONCLUSIONS Acute treatments have demonstrable efficacy, but do not appear to fundamentally alter underlying mechanisms or long-term trajectories.
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Affiliation(s)
- Jeffrey M Halperin
- Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA
| | - David J Marks
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York, NY, USA
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18
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Aretouli E. How neuropsychology can inform our understanding of preschool ADHD: Clinical and research implications. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 8:174-181. [PMID: 29364695 DOI: 10.1080/21622965.2017.1421463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neuropsychological assessments in preschoolers have not received as much attention as in older children and adults. Attention-deficit/hyperactivity disorder (ADHD) is a common disorder that occurs in early childhood associated with poor academic and personal outcomes, such as learning and social difficulties. Preschoolers with ADHD may present cognitive deficits that are related with the ADHD symptoms of inattention, hyperactivity, and impulsivity, but may also interfere, beyond and above the ADHD symptoms, with everyday functioning. Most importantly, cognitive deficits in preschoolers seem to predict future ADHD symptoms. Yet, the practice of neuropsychological assessment in this age-group has been limited. The present selective review highlights the contribution of comprehensive neuropsychological assessments to the early identification of symptomatic preschoolers and to our understanding of the nature and developmental trajectory of ADHD.
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Affiliation(s)
- Eleni Aretouli
- a Lab of Cognitive Neuroscience, School of Psychology , Aristotle University of Thessaloniki , Thessaloniki , Greece
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19
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Canals J, Morales-Hidalgo P, Jané MC, Domènech E. ADHD Prevalence in Spanish Preschoolers: Comorbidity, Socio-Demographic Factors, and Functional Consequences. J Atten Disord 2018; 22:143-153. [PMID: 27009923 DOI: 10.1177/1087054716638511] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The object was to examine the prevalence of ADHD among preschoolers, analyzing comorbidity, and the association with socio-demographic factors. METHOD We conducted a two-phase epidemiological study of 1,104 preschoolers aged 3 to 6 years in Catalonia, Spain. The Early Childhood Inventory-4 (ECI-4) was administered to parents and teachers. Children at risk of ADHD were assessed using open-ended face-to-face interviews and were observed in a school setting. ADHD diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. RESULTS The prevalence of ADHD diagnosis was 5.4%. Male sex and first-born status were risk factors for ADHD. Parents reported more symptoms (12.9%) than teachers (8.7%). Behavioral problems (odds ratio [OR] = 12, p = .001), autism spectrum disorder problems (OR = 9.5, p = .001), and obsessive-compulsive problems and tics (OR = 5.9, p = .001) were specifically related to ADHD diagnosis. Mother's health status and school achievement were lower in ADHD children. CONCLUSION Even at early stages of development, ADHD has high rates of comorbidity and a significant impact on school performance and family health.
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20
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O'Neill S, Rajendran K, Mahbubani SM, Halperin JM. Preschool Predictors of ADHD Symptoms and Impairment During Childhood and Adolescence. Curr Psychiatry Rep 2017; 19:95. [PMID: 29082443 PMCID: PMC6349372 DOI: 10.1007/s11920-017-0853-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This paper summarizes key, recently published research examining longitudinal outcomes for preschoolers with high levels of inattention and/or hyperactivity/impulsivity. RECENT FINDINGS Symptom trajectories show that hyperactivity/impulsivity declines across childhood. At the group level, the course of inattention appears more variable. However, identification of subgroups of children showing stable, rising, and falling inattention over time is promising. Early ADHD-like symptoms portend risk for academic and social difficulties, as well as comorbid emotional and behavioral problems in childhood and adolescence. Several early risk factors appear to moderate these relations, including comorbid symptoms, parental psychopathology, socioeconomic disadvantage, and perhaps neuropsychological dysfunction. Furthermore, high levels of inattention and/or hyperactivity/impulsivity during the preschool period appear to compromise development of regulatory and neuropsychological functions, which in turn increases risk for negative outcomes later in childhood. Identified risk factors are targets for novel interventions, which ideally would be delivered early to at-risk children.
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Affiliation(s)
- Sarah O'Neill
- The City College and The Graduate Center, City University of New York, New York, NY, USA.
- Department of Psychology, The City College and The Graduate Center, The City College of New York, 160 Convent Avenue, New York, NY, 10031, USA.
| | - Khushmand Rajendran
- Department of Social Sciences, Human Services and Criminal Justice, Borough of Manhattan Community College, City University of New York, New York, NY, USA
| | | | - Jeffrey M Halperin
- Department of Psychology, Queens College and The Graduate Center, City University of New York, Flushing, NY, USA
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21
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Morales-Hidalgo P, Hernández-Martínez C, Vera M, Voltas N, Canals J. Psychometric properties of the Conners-3 and Conners Early Childhood Indexes in a Spanish school population. Int J Clin Health Psychol 2017; 17:85-96. [PMID: 30487884 PMCID: PMC6236327 DOI: 10.1016/j.ijchp.2016.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/20/2016] [Indexed: 12/01/2022] Open
Abstract
Ba#ckground/Obje#ctive: To examine the psychometric properties of the Conners 3 ADHD Index (Conners 3 AI) and the Conners Early Children Global Index (Conners ECGI) parents' form (PF) and teachers' form (TF) in Spanish schoolers. Method: Two-phase cross-sectional study. In the first phase, information was gathered from teachers (n = 1,796) and parents (n = 882) of 4-5 and 10-11 year-old children. In the second phase (n = 196), children at risk of ADHD and controls were individually assessed. Results: The results confirmed the two-factor structure of the Conners 3 ADHD Index, which contains hyperactive-impulsive and inattentive symptoms, and the two-factor structure of the Conners ECGI PF, consisting of emotional lability and restless-impulsive symptoms. In contrast with the original version, the Conners ECGI TF presented an additional inattentive factor. Moderate-to-high rates of evidence of convergent validity with Child Behavior Checklist and Kiddie-Schedule for Affective Disorders & Schizophrenia, and evidence of external validity (academic achievement) were found. Scores were significantly higher in boys than in girls, for both indexes. Raw scores corresponding to clinical T-scores were higher than the original version. Conclusions: The Conners indexes may be considered reliable and valid instruments for detecting ADHD symptoms in Spanish populations.
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Affiliation(s)
- Paula Morales-Hidalgo
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
| | - Carmen Hernández-Martínez
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
| | - Magally Vera
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
- Faculty of Humanities and Education, Universidad de los Andes, Venezuela
| | - Núria Voltas
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
| | - Josefa Canals
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
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22
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Validity of proposed DSM-5 ADHD impulsivity symptoms in children. Eur Child Adolesc Psychiatry 2016; 25:1121-32. [PMID: 26979524 DOI: 10.1007/s00787-016-0839-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/03/2016] [Indexed: 12/21/2022]
Abstract
The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.
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Gleason MM, Humphreys KL. CATEGORICAL DIAGNOSIS OF EXTREME HYPERACTIVITY, IMPULSIVITY, AND INATTENTION IN VERY YOUNG CHILDREN. Infant Ment Health J 2016; 37:476-85. [PMID: 27603932 DOI: 10.1002/imhj.21592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/18/2016] [Accepted: 06/25/2016] [Indexed: 11/08/2022]
Abstract
Severe hyperactivity and impulsivity are common reasons for referral to infant mental health services. Past versions of ZERO TO THREE's () diagnostic nosology, the Diagnostic Classification of Mental and Developmental Disorders in Infancy and Early Childhood (DC:0-3), did not address this clinical issue because it had been addressed in other nosologies. These general diagnostic nosologies describe attention deficit hyperactivity disorder (ADHD), but with little attention to developmentally specific aspects of the diagnosis in very young children. Categorical diagnosis related to hyperactivity and impulsivity in very young children warrants careful review of existing literature. Explicit attention must be paid to ensure that categorical diagnoses serve to describe syndromes that cause significant impairment to the family to allow children and families to access effective supports and ensure that behaviors typical of the developmental level are not described as pathologic. This article reviews proposed diagnostic criteria for ADHD and overactivity disorder of toddlerhood as well as the rationale for the criteria and evidence supporting validity and reliability of the diagnoses in very young children. Clinical implications also are presented.
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Demmer DH, Hooley M, Sheen J, McGillivray JA, Lum JAG. Sex Differences in the Prevalence of Oppositional Defiant Disorder During Middle Childhood: a Meta-Analysis. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:313-325. [DOI: 10.1007/s10802-016-0170-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Pimus I, Peleg M, Schertz M. Sequence Mining of Comorbid Neurodevelopmental Disorders Using the SPADE Algorithm. Methods Inf Med 2016; 55:223-33. [PMID: 26848079 DOI: 10.3414/me15-01-0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Understanding the progression of comorbid neurodevelopmental disorders (NDD) during different critical time periods may contribute to our comprehension of the underlying pathophysiology of NDDs. The objective of our study was to identify frequent temporal sequences of developmental diagnoses in noisy patient data. METHODS We used a data set of 2810 patients, documenting NDD diagnoses given to them by an NDD expert at a child developmental center during multiple visits at different ages. Extensive preprocessing steps were developed in order to allow the data set to be processed by an efficient sequence mining algorithm (SPADE). RESULTS The discovered sequences were validated by cross validation for 10 iterations; all correlation coefficients for support, confidence and lift measures were above 0.75 and their proportions were similar. No signifi- cant differences between the distributions of sequences were found using Kolmogorov-Smirnov test. CONCLUSIONS We have demonstrated the feasibility of using the SPADE algorithm for discovery of valid temporal sequences of comorbid disorders in children with NDDs. The identification of such sequences would be beneficial from clinical and research perspectives. Moreover, these sequences could serve as features for developing a full-fledged temporal predictive model.
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Affiliation(s)
| | - Mor Peleg
- Mor Peleg, Ph.D., Assoc. Prof., Department of Information Systems, Rabin Building, room 7047, Faculty of Social Sciences, University of Haifa, Haifa, Israel, 3498838, E-mail:
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Morgan PL, Li H, Cook M, Farkas G, Hillemeier MM, Lin YC. Which kindergarten children are at greatest risk for attention-deficit/hyperactivity and conduct disorder symptomatology as adolescents? SCHOOL PSYCHOLOGY QUARTERLY : THE OFFICIAL JOURNAL OF THE DIVISION OF SCHOOL PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION 2016; 31:58-75. [PMID: 26192391 PMCID: PMC4720575 DOI: 10.1037/spq0000123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We sought to identify which kindergarten children are simultaneously at risk of moderate or severe symptomatology in both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) as adolescents. These risk factor estimates have not been previously available. We conducted multinomial logistic regression analyses of multiinformant ratings by the end of middle school of a population-based, longitudinal sample of children followed from kindergarten to eighth grade (N = 7,456). Kindergarten children from low SES households, those raised by mothers with depressive symptoms or experiencing emotional problems or substance abuse, or those who were punished by spanking were significantly more likely to later display severe levels of ADHD-CD symptomatology in eighth grade. Kindergarten children frequently engaging in ADHD-CD-type behaviors were more likely to later experience both moderate (covariate adjusted OR = 2.37) and severe (covariate adjusted OR = 3.63) ADHD-CD symptomatology. Low academic achievement uniquely increased the risk of both moderate and severe symptomatology (adjusted OR range = 1.7 to 2.24). The results should guide early screening and school-based intervention efforts for ADHD-CD. Reducing children's risk for adolescent ADHD-CD symptomatology may require remediating low behavioral and academic functioning by the end of kindergarten. When these 2 modifiable factors occur together they increase kindergarten children's odds of experiencing severe ADHD-CD symptomatology in eighth grade by a multiplicative factor of 8.1.
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Affiliation(s)
- Paul L Morgan
- Department of Education Policy Studies, The Pennsylvania State University
| | - Hui Li
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University
| | - Michael Cook
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University
| | - George Farkas
- School of Education, University of California, Irvine
| | | | - Yu-Chu Lin
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University
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Ford-Jones PC. Misdiagnosis of attention deficit hyperactivity disorder: 'Normal behaviour' and relative maturity. Paediatr Child Health 2015; 20:200-2. [PMID: 26038639 DOI: 10.1093/pch/20.4.200] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders in children, yet it remains poorly understood. Substantial controversy exists regarding correct diagnosis of ADHD, and areas of subjectivity in diagnosis have been identified. Concerns for appropriate diagnosis are critical in terms of children's educational outcomes, as well as health concerns associated with the use and potential overuse of stimulant medications. There exists a relative-age effect in which children who are relatively younger than their peers and born closest to the school start age cut-off are more frequently diagnosed and treated for ADHD. Additionally, substantial variation exists in ADHD diagnosis between boys and girls, with boys often presenting with more stereotypical symptoms. Both the relative-age effect and variation in sex diagnosis, as well as the challenges of early preschool diagnosis, emphasize the importance of considering relative maturity in ADHD diagnosis of children. Implications and knowledge translation strategies for practitioners, parents and the education system are presented.
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Tseng WL, Guyer AE, Briggs-Gowan MJ, Axelson D, Birmaher B, Egger HL, Helm J, Stowe Z, Towbin KA, Wakschlag LS, Leibenluft E, Brotman MA. Behavior and emotion modulation deficits in preschoolers at risk for bipolar disorder. Depress Anxiety 2015; 32:325-34. [PMID: 25691090 PMCID: PMC4409452 DOI: 10.1002/da.22342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 10/07/2014] [Accepted: 11/23/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is highly familial, but studies have yet to examine preschoolers at risk for BD using standardized, developmentally appropriate clinical assessment tools. We used such methods to test whether preschoolers at familial risk for BD have more observed difficulty modulating emotions and behaviors than do low-risk preschoolers. Identification of emotional and behavioral difficulties in at-risk preschoolers is crucial for developing new approaches for early intervention and prevention of BD. METHODS Using the standardized disruptive behavior diagnostic observation schedule (DB-DOS) protocol for preschoolers, we compared 23 preschoolers (M(age): 4.53 ± 0.73 years; 18 males) with a first-degree relative with BD to 21 preschoolers (M(age): 4.65 ± 0.84 years; 11 males) without a family history of BD. We characterized psychopathology in this sample using the Preschool Aged Psychiatric Assessment and behavioral and emotional problems using the Child Behavior Checklist. RESULTS High-risk preschoolers demonstrated significantly more intense, pervasive, and clinically concerning problems in anger modulation and behavior dysregulation on the DB-DOS than the low-risk group. High-risk relative to low-risk preschoolers, were also more likely to have maternal-reported anxiety and oppositional defiant disorders and internalizing and externalizing problems. CONCLUSIONS Clinically concerning problems in anger modulation and behavior regulation, measured during standardized laboratory observation, differentiate preschoolers at high familial risk for BD from those at low risk. Investigation in a large longitudinal sample is critical for replication and for determining whether these observed behavioral differences can be reliably used as prodromal indicators of mood disorders.
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Affiliation(s)
- Wan-Ling Tseng
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
| | - Amanda E. Guyer
- Department of Human Ecology, Center for Mind and Brain, University of California, Davis
| | | | - David Axelson
- Nationwide Children’s Hospital and The Ohio State University School of Medicine
| | | | | | - Jonathan Helm
- Center for Mind and Brain, University of California, Davis
| | | | - Kenneth A. Towbin
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
| | - Lauren S. Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services
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29
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Mlodnicka AE, O'Neill S, Marks DJ, Rajendran K, Bedard ACV, Schneiderman RL, Basu B, Halperin JM. Impact of occupational, physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: A naturalistic 2-year follow-up study. CHILDRENS HEALTH CARE 2015; 45:67-83. [PMID: 27011416 DOI: 10.1080/02739615.2014.979918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Impact of speech and language therapy (ST) and occupational/physical therapy (OT/PT) on language and motor skills was examined in hyperactive/inattentive children. METHODS Preschoolers were divided into those receiving and not receiving ST or OT/PT. RESULTS Children receiving ST showed no gains in language functioning relative to those not receiving ST. OT/PT yielded similar results for motor functions. Hours of a service did not predict improvement. However, children who received ST showed improvement in social skills. DISCUSSION The apparent lack of benefit suggests the need for further investigation into efficacy of these treatments in hyperactive/inattentive preschool children.
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Affiliation(s)
- Agnieszka E Mlodnicka
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, NY
| | - Sarah O'Neill
- Department of Psychology, City College of New York, CUNY, New York, NY
| | - David J Marks
- Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY
| | | | | | | | - Bipasha Basu
- Queens College, City University of New York, New York, NY
| | - Jeffrey M Halperin
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Queens College, City University of New York, New York, NY
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Bendiksen B, Aase H, Svensson E, Friis S, Myhre AM, Reichborn-Kjennerud T, Zeiner P. Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2014-014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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