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Koppelmaa K, Yde Ohki CM, Walter NM, Walitza S, Grünblatt E. Stress as a mediator of brain alterations in attention-deficit hyperactivity disorder: A systematic review. Compr Psychiatry 2024; 130:152454. [PMID: 38281339 DOI: 10.1016/j.comppsych.2024.152454] [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: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE Stress is a known risk factor for numerous psychopathologies, whereas evidence is lacking regarding the specific consequences of stress on the neural basis of attention-deficit hyperactivity disorder (ADHD). A systematic literature review was thus conducted to clarify the role of stress in the association between the resulting alterations of brain structure, connectivity, and function in ADHD. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identifier CRD42023379809. A systematic search of the PubMed and CINAHL databases was conducted for articles published prior to December 22nd, 2022. Retrieved literature was screened in Rayyan and data extraction was performed with respect to neuroimaging, stress exposure, and ADHD outcomes. The Quality in Prognosis Studies (QUIPS) tool was adapted based on the Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Etiology (COSMOS-E) guidance article to assess risk of bias and quality of studies. Strength of the evidence was assessed under the guidance of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS Screening 25,026 non-duplicate articles yielded 20 eligible studies for inclusion. Exposure to early life trauma, institutionalization, prenatal smoking or alcohol consumption, air pollution, low socioeconomic status, or low birth weight were associated with alterations in brain structure, function, and connectivity in ADHD. However, most studies did not provide strong evidence due to small sample sizes and lack of statistical approaches to determine a direct mediation of the association between stress and ADHD by neural outcomes. CONCLUSION This systematic review was the first to summarize evidence of structural and functional stress-associated alterations in the brain, which were found to be directly and indirectly associated with ADHD outcomes. Overall, stress requires consideration as a significant determinant of neurodevelopmental outcomes in ADHD. However, extensive further research is warranted due to little available evidence and the difficulty of obtaining clear results. In light of such a complex research question, in order to confirm findings, provide further evidence, and establish causality systematic longitudinal studies would be required. Investigating the topic may provide invaluable information when it comes to tailoring prevention and treatment strategies in ADHD, and should be pursued in order to integrate the factor of stress into a more comprehensive understanding of ADHD.
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Affiliation(s)
- Kristin Koppelmaa
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH, Zurich, Zurich, Switzerland
| | - Cristine Marie Yde Ohki
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Natalie Monet Walter
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and the ETH, Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and the ETH, Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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Gimbach S, Vogel D, Fried R, Faraone SV, Banaschewski T, Buitelaar J, Döpfner M, Ammer R. ADHD medicine consumption in Europe after COVID-19: catch-up or trend change? BMC Psychiatry 2024; 24:112. [PMID: 38336744 PMCID: PMC10854136 DOI: 10.1186/s12888-024-05505-9] [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: 10/27/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Although the COVID-19 pandemic and its implications have been associated with mental health services utilization and medication consumption, there is no longitudinal study on the long-term impact on ADHD medication use trends. METHODS This study examines the European ADHD medication consumption in 2020 to 2022 compared to the predicted consumption assuming the persistence of pre-pandemic trends. Predictions are calculated using Seasonal Autoregressive Integrated Moving Average (SARIMA) models. RESULTS While European ADHD medication sales recorded a drop in 2020, they returned to the predicted level in 2021, even slightly exceeding it. In 2022, we found a clear exceedance of the predicted level by 16.4% on average at country level. Furthermore, the increase in consumption growth in the post-pandemic period (2021-2022) compared to the pre-pandemic period (2014-2019) was significant in 26 of the 28 European countries under consideration. CONCLUSION There is strong evidence of a trend change in the ADHD medicine consumption growth throughout Europe after the COVID-19 pandemic.
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Affiliation(s)
- Sophie Gimbach
- Data Science Hub, MEDICE Arzneimittel Pütter GmbH & Co. KG, 58638, Iserlohn, Germany.
- Department of Statistics, TU Dortmund University, 44221, Dortmund, Germany.
| | - Daniel Vogel
- Data Science Hub, MEDICE Arzneimittel Pütter GmbH & Co. KG, 58638, Iserlohn, Germany
| | - Roland Fried
- Department of Statistics, TU Dortmund University, 44221, Dortmund, Germany
| | - Stephen V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Tobias Banaschewski
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 68159, Mannheim, Germany
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
- Karakter Child and Adolescent Psychiatry, University Centre, Nijmegen, The Netherlands
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, 50969, Cologne, Germany
| | - Richard Ammer
- Data Science Hub, MEDICE Arzneimittel Pütter GmbH & Co. KG, 58638, Iserlohn, Germany
- Poliklinik und Innere Medizin, University Hospital Münster, 48149, Münster, Germany
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Skandsen A, Nilsen SA, Hysing M, Teicher MH, Sand L, Bøe T. Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01671-9. [PMID: 38332363 DOI: 10.1007/s10578-024-01671-9] [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] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Adolescents who experience potentially traumatic experiences (PTEs) have an increased risk of psychopathology. PTEs often co-occur and may form interrelated patterns of exposure. This study investigated underlying classes of PTE exposure among Norwegian adolescent participants in the youth@hordaland study, and whether such classes were associated with contact with child and adolescent mental health services (CAMHS) and psychiatric diagnoses. The data stem from the population-based youth@hordaland study conducted in 2012 which was linked to the Norwegian Patient Registry (NPR, n = 8845). Exposure to PTEs was assessed by adolescent self-report whereas psychiatric disorders (Axis 1) were derived from the NPR. Latent Class Analysis was used to identify distinct classes of PTE exposure-patterns in the data. Logistic regression analyses were performed to investigate associations between classes of PTEs and contact with CAMHS and psychiatric diagnoses. Three classes of PTE exposure were identified based on model fit indices and theoretical considerations. Compared with participants in the low trauma class (88% of participants), those in the Situational-(6%) and Interpersonal trauma class (6%) had higher odds-ratios (ORs) for contact with CAMHS (OR = 2.27 (95% CI [1.78, 2.87])) and (OR = 3.26 (95% CI [2.61, 4.04])) respectively, and for being diagnosed with a psychiatric disorder in CAMHS (ORs ranged from 2.19 - 10.4) after adjusting for sex and parental education. There were more participants diagnosed with ADHD within the Interpersonal trauma class compared to the Situational trauma class when adjusting for sex and parental education (OR = 2.22 (95% CI [1.17, 4.40])). Three relatively homogeneous PTE classes, consisting of distinct patterns of trauma exposure were associated with a higher odds of contact with CAMHS and of being diagnosed with a psychiatric disorder in CAMHS. The study highlights the co-occurrence of PTEs and their impact across the diagnostic spectrum.
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Affiliation(s)
- Annika Skandsen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.
- Stavanger University Hospital, Stavanger, Norway.
| | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Liv Sand
- Stavanger University Hospital, Stavanger, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
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Buthmann JL, Miller JG, Uy JP, Coury SM, Jo B, Gotlib IH. Early life stress predicts trajectories of emotional problems and hippocampal volume in adolescence. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02331-4. [PMID: 38135803 DOI: 10.1007/s00787-023-02331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
Exposure to early life stress (ELS) has been consistently associated with adverse emotional and neural consequences in youth. The development of brain structures such as the hippocampus, which plays a significant role in stress and emotion regulation, may be particularly salient in the development of psychopathology. Prior work has documented smaller hippocampal volume (HCV) in relation to both ELS exposure and risk for psychopathology. We used longitudinal k-means clustering to identify simultaneous trajectories of HCV and emotional problems in 155 youth across three assessments conducted approximately two years apart (mean baseline age = 11.33 years, 57% female). We also examined depressive symptoms and resilience approximately two years after the third timepoint. We identified three clusters of participants: a cluster with high HCV and low emotional problems; a cluster with low HCV and high emotional problems; and a cluster with low HCV and low emotional problems. Importantly, severity of ELS was associated with greater likelihood of belonging to the low HCV/high symptom cluster than to the low HCV/low symptom cluster. Further, low HCV/high symptom participants had more depressive symptoms and lower resilience scores than did participants in the low HCV/low symptom, but not than in the high HCV/low symptom cluster. Our findings suggest that smaller HCV indexes biological sensitivity to stress. This adds to our understanding of the ways in which ELS can affect hippocampal and emotional development in young people and points to hippocampal volume as a marker of susceptibility to context.
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Affiliation(s)
- Jessica L Buthmann
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA.
| | - Jonas G Miller
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Jessica P Uy
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA
| | - Saché M Coury
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA
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Li F, Luo J, Qi Y, Huang H, Wu Y, Xu G, Liu Z, He F, Zheng Y. The prevalence of SCT in China, its comorbidity with ADHD and its association with life events and parental-rearing behaviors. Sci Rep 2023; 13:16946. [PMID: 37805610 PMCID: PMC10560280 DOI: 10.1038/s41598-023-43225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Although sluggish cognitive tempo (SCT) symptoms are often observed in children with attention deficit hyperactivity disorder (ADHD), an increasing number of studies have highlighted its uniqueness. Nevertheless, no national survey on SCT among children and adolescents has been conducted in China. Hence, this research aims to study SCT in China and to evaluate the differences between SCT and ADHD symptoms by comparing their risk factors in terms of life events (LE) and parental rearing behaviors (PRB). This cross-sectional study used data from a survey on 71,929 children and adolescents in 5 province-level regions in China to study the incidence and demographic information of SCT in the Chinese population. Subsequently, the study investigated the comorbidity of ADHD and SCT, and conducted three logistic regressions on the LE and PRB scores to predict whether participants develop symptoms of ADHD or SCT, or neither symptom. 6658 participants were allocated into the SCT group, and the weighted point prevalence of SCT was 9.78%. 36.34% of participants with ADHD (n = 676) were found to demonstrate SCT symptoms, whereas no statistically significant difference was observed in its comorbidity to the three ADHD subtypes (χ2 = 1.668, p > 0.05, Δ = 2). The regression results on the presence or absence of ADHD revealed paternal excessive-interference and rejection, and maternal favoring were associated with ADHD diagnosis, whereas paternal punishment and favoring and maternal emotional warmth was related to the absence of ADHD symptoms. Academic stress and maternal excessive-interference were associated with SCT symptoms, and maternal emotional warmth associated with SCT absence. Concerning the presence of ADHD-only or SCT-only symptoms, LE adaptation was found to relate to SCT-only symptoms, while PRB paternal rejection and maternal favoring were associated with ADHD-only symptoms. While evidencing the high prevalence of SCT in China, our findings supported that although ADHD and SCT were highly comorbid, they may be considered two independent disorders with different risk factors. Specifically, participants with SCT symptoms are more vulnerable to stress from LE and tend to face more maladjustment than ADHD and normally-developing participants, and maternal rearing behaviours are the key factors to SCT symptoms. SCT brings global challenges in its diagnosis and treatment, and the challenge is more severe in a mentally stressful environment. Therefore, stress management and SCT etiology studies are recommended.
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Affiliation(s)
- Fenghua Li
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jie Luo
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China
| | - Yanjie Qi
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China
| | - Huanhuan Huang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China
| | - Yuanzhen Wu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China
| | - Gaoyang Xu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China
| | - Zhengkui Liu
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Fan He
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China.
| | - Yi Zheng
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, De Sheng Men Wai An Kang Hu Tong 5 Hao, Xi Cheng Qu, Beijing, 100088, China.
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Kanina A, Larsson H, Sjölander A, Butwicka A, Taylor MJ, Martini MI, Lichtenstein P, Lundberg FE, Onofrio BMD, Rosenqvist MA. Association between cumulative psychosocial adversity in the family and ADHD and autism: a family-based cohort study. Transl Psychiatry 2023; 13:282. [PMID: 37580324 PMCID: PMC10425335 DOI: 10.1038/s41398-023-02571-7] [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: 01/20/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
Cumulative exposure to psychosocial adversity at an early age has been shown to be a risk factor for attention-deficit hyperactivity disorder (ADHD) and autism that often co-occur. However, it is not clear if this association reflects a causal effect or familial confounding. We aimed to assess whether cumulative psychosocial adversity in the family increases the risk for ADHD and autism in offspring while accounting for unmeasured familial confounding. We used a population-based cohort of 1,877,901 individuals born in Sweden between 1990 and 2009. Participants were followed from the age of 3 until 2013, with a median follow up time of 13.8 years. We created a cumulative index based on 7 psychosocial adversity factors. We used Cox regression to estimate the hazard ratios (HRs) relating neurodevelopmental conditions to cumulative psychosocial adversity. To address familial confounding, the analyses were repeated in groups of relatives of different kinship: siblings and half-siblings and cousins. A dose-response relationship was observed between cumulative exposure to psychosocial adversity and ADHD at a general population level (covariate adjusted HRs (aHRs) with 95% confidence intervals ranged from 1.55 [one adversity; 1.53-1.58] to 2.65 [ ≥ 4 adversities; 1.98-3.54]). No clear dose-response relation was seen for autism (aHRs ranged from 1.04 [.59-1.84] to 1.37 [1.30-1.45]). HRs of ADHD and autism decreased with increasing level of kinship in the analysis of relatives. Cumulative exposure to psychosocial adversity was associated with both ADHD and autism in the general population, these associations were partly explained by unmeasured familial confounding between relatives. This highlights the need for using family-based designs in studies of psychosocial adversity and ADHD and autism.
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Affiliation(s)
- Aleksandra Kanina
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Henrik Larsson
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of medical sciences, Örebro University, Örebro, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Mark J Taylor
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Miriam I Martini
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Frida E Lundberg
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D' Onofrio
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Mina A Rosenqvist
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Summerton A, Bellows ST, Westrupp EM, Stokes MA, Coghill D, Bellgrove MA, Hutchinson D, Becker SP, Melvin G, Quach J, Efron D, Stringaris A, Middeldorp CM, Banaschewski T, Sciberras E. Longitudinal Associations Between COVID-19 Stress and the Mental Health of Children With ADHD. J Atten Disord 2023:10870547231168334. [PMID: 37122232 PMCID: PMC10130929 DOI: 10.1177/10870547231168334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To investigate the longitudinal associations between COVID-19 induced stress (related to COVID-19 restrictions/changes), attention-deficit/hyperactivity disorder (ADHD) symptoms, oppositional symptoms, and mental health outcomes (negative affect, anxiety, depression, and irritability) in children with ADHD during the COVID-19 pandemic. METHOD Parents of 140 Australian children with ADHD (aged 5-17 years) completed an online survey in May 2020 during stay-at-home restrictions and 12-months later. RESULTS Baseline COVID-19 stress was associated with increased total ADHD symptom severity (β = .21, p = .007) and hyperactivity/impulsivity symptoms (β = .23, p = .002) at 12-months, after accounting for covariates (i.e., child age, gender, ADHD medication, socio-economic status, and baseline symptoms). Despite some indication of associations between baseline COVID-19 stress and 12-month oppositional symptoms and negative affect, these were attenuated when adjusting for baseline symptoms. CONCLUSIONS The study provides initial evidence of the medium-term impacts of pandemic-related stress for children with ADHD.
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Affiliation(s)
| | | | - Elizabeth M Westrupp
- Deakin University, Geelong, VIC, Australia
- La Trobe University, Bundoora, VIC, Australia
| | | | - David Coghill
- University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | | | - Delyse Hutchinson
- Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | | | - Jon Quach
- University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Daryl Efron
- University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | - Argyris Stringaris
- University College London, UK
- National and Kapodistrian University of Athens, Greece
| | - Christel M Middeldorp
- University of Queensland, Brisbane, QLD, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | | | - Emma Sciberras
- Deakin University, Geelong, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
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Makris G, Eleftheriades A, Pervanidou P. Early Life Stress, Hormones, and Neurodevelopmental Disorders. Horm Res Paediatr 2023; 96:17-24. [PMID: 35259742 DOI: 10.1159/000523942] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early life stress (ELS) describes a broad spectrum of adverse and stressful prenatal events, namely, prenatal maternal stress (PMS), or early postnatal events, which can have detrimental long-term influences on the physiology, cognition, and behavior of an individual. There is abundant evidence indicating that ELS exerts its lasting effects on the physical and mental health of the individual, likely acting through a number of mediating mechanisms, including the disruption of developmental programming of the fetus. Neurodevelopmental disorders (NDDs), for example, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are a group of conditions that typically manifest during infancy, childhood, or adolescence and are characterized by developmental deficits in various domains. SUMMARY The scope of the current mini-review is to provide an up-to-date summary of the findings regarding the association of ELS and NDDs and the possible hormonal mechanisms through which PMS exerts its impact on neurodevelopment. We focus on the available evidence regarding children and adolescents diagnosed with ADHD or ASD. ELS exposure during developmental vulnerability windows may increase the risk for either subclinical neuropsychological alterations or clinical conditions, such as NDDs. In fact, a large body of evidence underlies the association of ELS exposure and increased risk for NDDs in the offspring. KEY MESSAGES The majority of data suggest that ELS, including PMS, may be associated with ADHD and ASD in the offspring, although there is no consensus regarding the critical developmental periods. Carefully controlled prospective studies are needed to determine the possible causal processes and mechanisms underlying the association of ELS and NDDs.
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Affiliation(s)
- Gerasimos Makris
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Anna Eleftheriades
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece,
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ADHD Follow-Up in Adulthood among Subjects Treated for the Disorder in a Child and Adolescent Mental Health Service from 1995 to 2015. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020338. [PMID: 36837537 PMCID: PMC9966311 DOI: 10.3390/medicina59020338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0) and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions. Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments.
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Berens A, LeMoult J, Kircanski K, Gotlib IH. ADHD symptoms and diurnal cortisol in adolescents: The importance of comorbidities. Psychoneuroendocrinology 2023; 148:105990. [PMID: 36462296 PMCID: PMC10193285 DOI: 10.1016/j.psyneuen.2022.105990] [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: 04/03/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Altered regulation of diurnal cortisol has been associated with both dimensional symptoms and clinical diagnoses of attention deficit-hyperactivity disorder (ADHD). Indeed, a recent meta-analysis suggests that lower diurnal cortisol output may be a biomarker of attention deficit-hyperactivity disorder (ADHD); importantly, however, the influence of psychiatric comorbidities on this association has not been characterized. Approximately two-thirds of children with ADHD have at least one co-occurring neuropsychiatric condition, and altered HPA-axis function has been implicated in many of these conditions. Using dimensional measures of psychopathology, we examined whether comorbid symptoms influence the association of ADHD symptoms with daily cortisol output. METHODS 138 adolescents (ages 11-15 years) completed measures of symptoms of psychopathology and provided saliva samples over two days. We analyzed whether ADHD symptoms were related to morning, afternoon, and evening cortisol, the cortisol awakening response (CAR) and cumulative daily cortisol (area under the curve with respect to ground [AUCg]) while accounting for symptoms of three psychiatric disorders that are commonly comorbid with ADHD: conduct disorder (CD), anxiety, and depression. In sensitivity analyses, we included symptoms of oppositional defiant disorder (ODD) in place of CD symptoms. FINDINGS After controlling for symptoms of CD, anxiety, and depression, ADHD symptoms were associated significantly with higher cumulative diurnal cortisol (AUCg), morning cortisol, and afternoon cortisol. Symptoms of CD, anxiety and depression were not associated significantly with any cortisol metrics; however, in sensitivity analyses, ODD symptoms were associated with lower AUCg and morning cortisol. DISCUSSION Our findings highlight the distinct influence of ADHD and externalizing symptoms on cortisol output. Further work is needed to examine the specificity of altered HPA-axis activity as a biomarker of ADHD and to elucidate whether symptoms of ADHD differ in their association with diurnal cortisol as a function of their severity.
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Affiliation(s)
- Anne Berens
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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11
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Grossman A, Avital A. Emotional and sensory dysregulation as a possible missing link in attention deficit hyperactivity disorder: A review. Front Behav Neurosci 2023; 17:1118937. [PMID: 36935890 PMCID: PMC10017514 DOI: 10.3389/fnbeh.2023.1118937] [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] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a common developmental disorder affecting 5-7% of adults and children. We surveyed the literature to examine ADHD through three pillars: developmental characteristics, symptomatology, and treatment strategies. Firstly, in terms of developmental characterstics, early life stress may increase the risk of developing ADHD symptoms according to animal models' research. Secondly, the current core symptoms of ADHD are comprised of inattention, hyperactivity, and impulsivity. However, the up-to-date literature indicates individuals with ADHD experience emotional and sensory dysregulation as well, which early-life stress may also increase the risk of. Finally, we discuss the therapeutic benefits of methylphenidate on both the current core ADHD symptoms and the sensory and emotional dysregulation found in those with ADHD. In summation, we surveyed the recent literature to analyze (i) the potential role of early-life stress in ADHD development, (ii) the involvement of emotional and sensory dysregulation in ADHD symptomatology and finally, (iii) the therapeutic intervention with methylphenidate, aiming to reduce the potential effect of early life stress in ADHD, and mainly emotional and sensory dysregulation. The apparent but currently less recognized additional symptoms of emotional and sensory dysregulation in ADHD call for further investigation of these possible causes and thus increasing treatments efficacy in individuals with ADHD.
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12
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Prenatal and early postnatal exposure to a natural disaster and Attention-Deficit/Hyperactivity Disorder symptoms in Indian children. Sci Rep 2022; 12:16235. [PMID: 36171270 PMCID: PMC9519978 DOI: 10.1038/s41598-022-20609-6] [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: 01/04/2022] [Accepted: 09/15/2022] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to assess the relation between early exposure to stressful events and symptoms of the Attention-Deficit/Hyperactivity Disorder (ADHD) in children, based on the outcomes from a natural experiment. It was hypothesized that children pre- and postnatally exposed to cyclone Aila have increased ADHD symptoms compared to the control group, and the effect depends on the timing of the exposure. Indian children (8–11 years) prenatally (N = 336) and early postnatally (N = 216) exposed to cyclone Aila were compared to a non-exposed control peer group (N = 285). ADHD symptoms were assessed using the Conner’s Teacher Rating Scale Revised. The main effect of exposure to the cyclone on the total ADHD symptoms’ score, ADHD index, Hyperactivity and Oppositional symptoms was significant and independent to covariates: age and sex of children, gestational age and birth weight, maternal stress during the year before the study and the socioeconomic status of a family. The timing of exposure and sex of the children were found to be a significant moderator of the relation between early exposure to the natural disaster and ADHD symptoms. The prenatal, but also early postnatal exposure to stressful experiences such as a natural disaster, may disturb the development of cognitive functions and behavioural control, thus increasing the risk of ADHD in children.
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13
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Fuhrmann D, Madsen KS, Johansen LB, Baaré WFC, Kievit RA. The midpoint of cortical thinning between late childhood and early adulthood differs between individuals and brain regions: Evidence from longitudinal modelling in a 12-wave neuroimaging sample. Neuroimage 2022; 261:119507. [PMID: 35882270 DOI: 10.1016/j.neuroimage.2022.119507] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Charting human brain maturation between childhood and adulthood is a fundamental prerequisite for understanding the rapid biological and psychological changes during human development. Two barriers have precluded the quantification of maturational trajectories: demands on data and demands on estimation. Using high-temporal resolution neuroimaging data of up to 12-waves in the HUBU cohort (N = 90, aged 7-21 years) we investigate changes in apparent cortical thickness across childhood and adolescence. Fitting a four-parameter logistic nonlinear random effects mixed model, we quantified the characteristic, s-shaped, trajectory of cortical thinning in adolescence. This approach yields biologically meaningful parameters, including the midpoint of cortical thinning (MCT), which corresponds to the age at which the cortex shows most rapid thinning - in our sample occurring, on average, at 14 years of age. These results show that, given suitable data and models, cortical maturation can be quantified with precision for each individual and brain region.
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Affiliation(s)
- D Fuhrmann
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - K S Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark; Radiography, Department of Technology, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N., Denmark
| | - L B Johansen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark
| | - W F C Baaré
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark
| | - R A Kievit
- Cognitive Neuroscience Department, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Plowden KO, Legg T, Wiley D. Attention deficit/hyperactivity disorder in adults: A case study. Arch Psychiatr Nurs 2022; 38:29-35. [PMID: 35461644 DOI: 10.1016/j.apnu.2021.12.003] [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: 06/06/2021] [Revised: 09/06/2021] [Accepted: 12/04/2021] [Indexed: 11/02/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is often misdiagnosed or mistreated in adults because it is often thought of as a childhood problem. If a child is diagnosed and treated for the disorder, it often persists into adulthood. In adult ADHD, the symptoms may be comorbid or mimic other conditions making diagnosis and treatment difficult. Adults with ADHD require an in-depth assessment for proper diagnosis and treatment. The presentation and treatment of adults with ADHD can be complex and often requires interdisciplinary care. Mental health and non-mental health providers often overlook the disorder or feel uncomfortable treating adults with ADHD. The purpose of this manuscript is to discuss the diagnosis and management of adults with ADHD.
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Affiliation(s)
| | - Timothy Legg
- University of North Dakota, United States of America
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15
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Rauschenberg C, Schulte-Strathaus JCC, van Os J, Goedhart M, Schieveld JNM, Reininghaus U. Negative life events and stress sensitivity in youth's daily life: an ecological momentary assessment study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1641-1657. [PMID: 35467134 PMCID: PMC9288944 DOI: 10.1007/s00127-022-02276-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/31/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE Negative life events (LEs) are associated with mental health problems in youth. However, little is known about underlying mechanisms. The aim of the study was to investigate whether exposure to LEs modifies stress sensitivity in youth's daily life. METHODS Ecological Momentary Assessment (EMA) was used to assess stress sensitivity (i.e., association of momentary stress with (i) negative affect and (ii) psychotic experiences) in 99 adolescents and young adults (42 service users, 17 siblings, and 40 controls; Mage 15 years). Before EMA, exposure to LEs (e.g., intrusive threats, experience of loss, serious illness) was assessed. RESULTS Lifetime as well as previous-year exposure to LEs modified stress sensitivity in service users: they experienced more intense negative affect and psychotic experiences in response to stress when high vs. low exposure levels were compared. In contrast, controls showed no differences in stress sensitivity by exposure levels. Looking at specific types of LEs, controls showed less intense negative affect in response to stress when high vs. low exposure levels to threatening events during the last year, but not lifetime exposure, were compared. In siblings, no evidence was found that LEs modified stress sensitivity. CONCLUSION Stress sensitivity may constitute a putative risk mechanism linking LEs and mental health in help-seeking youth, while unfavourable effects of LEs on stress sensitivity may attenuate over time or do not occur in controls and siblings. Targeting individuals' sensitivity to stress in daily life using novel digital interventions may be a promising approach towards improving youth mental health.
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Affiliation(s)
- Christian Rauschenberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - Julia C C Schulte-Strathaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthieu Goedhart
- Tilburg School of Humanities, Tilburg University, Tilburg, The Netherlands
- Mutsaers Foundation and Educational Institute Wijnberg, Venlo, The Netherlands
| | - Jan N M Schieveld
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Miller JG, Chahal R, Gotlib IH. Early Life Stress and Neurodevelopment in Adolescence: Implications for Risk and Adaptation. Curr Top Behav Neurosci 2022; 54:313-339. [PMID: 35290658 DOI: 10.1007/7854_2022_302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An alarming high proportion of youth experience at least one kind of stressor in childhood and/or adolescence. Exposure to early life stress is associated with increased risk for psychopathology, accelerated biological aging, and poor physical health; however, it is important to recognize that not all youth who experience such stress go on to develop difficulties. In fact, resilience, or positive adaptation in the face of adversity, is relatively common. Individual differences in vulnerability or resilience to the effects of early stress may be represented in the brain as specific patterns, profiles, or signatures of neural activation, structure, and connectivity (i.e., neurophenotypes). Whereas neurophenotypes of risk that reflect the deleterious effects of early stress on the developing brain are likely to exacerbate negative outcomes in youth, neurophenotypes of resilience may reduce the risk of experiencing these negative outcomes and instead promote positive functioning. In this chapter we describe our perspective concerning the neurobiological mechanisms and moderators of risk and resilience in adolescence following early life stress and integrate our own work into this framework. We present findings suggesting that exposure to stress in childhood and adolescence is associated with functional and structural alterations in neurobiological systems that are important for social-affective processing and for cognitive control. While some of these neurobiological alterations increase risk for psychopathology, they may also help to limit adolescents' sensitivity to subsequent negative experiences. We also discuss person-centered strategies that we believe can advance our understanding of risk and resilience to early stress in adolescents. Finally, we describe ways in which the field can broaden its focus to include a consideration of other types of environmental factors, such as environmental pollutants, in affecting both risk and resilience to stress-related health difficulties in youth.
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Affiliation(s)
- Jonas G Miller
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rajpreet Chahal
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA.
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17
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Li T, Franke B, AriasVasquez A, Mota NR. Mapping relationships between ADHD genetic liability, stressful life events, and ADHD symptoms in healthy adults. Am J Med Genet B Neuropsychiatr Genet 2021; 186:242-250. [PMID: 33319511 PMCID: PMC8359274 DOI: 10.1002/ajmg.b.32828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) symptoms are continuously distributed in the general population, where both genetic and environmental factors play roles. Stressful life events (SLEs) have been associated with ADHD diagnosis, but the relationship between ADHD genetic liability, SLEs, and ADHD symptoms in healthy individuals is less clear. Using a sample of 1,531 healthy adults (average age 26.9 years; 55.8% female), we investigated relationships between ADHD polygenic risk scores (ADHD-PRSs), SLEs, and ADHD symptoms in a general population sample. Confirming earlier findings in an overlapping sample, all SLE-measures assessed (lifetime SLEs, recent SLEs, and childhood trauma (CT)) were significantly correlated with total ADHD, inattention (IA), and hyperactivity-impulsivity (HI) scores (r2 range = .08-.15; all p < .005). ADHD-PRSs was associated with HI (R2best-fit = .37%), lifetime SLEs (R2best-fit = .56%), and CT (R2best-fit = .40%). Mediation analyses showed that lifetime SLEs partially mediated the association between ADHD-PRSs and HI (indirect effect: β = 68.6, bias corrected accelerated 95% confident interval (BCa95%CI) [11.9, 131.0], p = .016, proportion mediated (PM ) =19.5%), with strongest effects contributed by CT (β = 34.4, BCa95%CI [0.4, 76.5], p = .040, PM = 9.8%). On the other hand, HI partially mediated the association between the ADHD-PRSs and lifetime SLEs (β = 42.9, BCa95%CI [7.3, 83.9], p = .014, PM = 18.8%). Our study observed a complex relationship of genetic and environmental risk factors contributing to ADHD symptoms in the healthy adult population.
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Affiliation(s)
- Ting Li
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Barbara Franke
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands,Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Alejandro AriasVasquez
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands,Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Nina Roth Mota
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
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18
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Consequences of Confinement Due to COVID-19 in Spain on Anxiety, Sleep and Executive Functioning of Children and Adolescents with ADHD. SUSTAINABILITY 2021. [DOI: 10.3390/su13052487] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The outbreak and the quick expansion of SARS-CoV-2, from December 2019 to today, has forced countries around the world to resolve virus containment measures in order to slow down the contagion curve. Between these measures, the situation of lockdown, and the isolation or limitation of social contact between the citizens, there has been an unknown psychological impact. Certain groups (the elderly, children and teenagers, and the clinical population, for instance) arouse serious fears among professionals due to their greater vulnerability and ignorance regarding the short- and long-term consequences. The main purposes of this work are first of all to evaluate the consequences of the lockdown in children and teenagers diagnosed with attention deficit hyperactivity disorder (ADHD), sleep-related problems, and problems with executive functions. Secondly, we aim to compare the effects produced with respect to the previously mentioned variables with normotypic subjects; that is to say, between a group that was subject to lockdown and another group that was not confined. The findings show that the clinic confined group had high levels of state anxiety and problems with sleep and executive functions; differences could also be seen between the two groups, with the confined ADHD group being more negatively affected in all measured variables.
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19
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Humphreys KL, Guyon-Harris KL, Tibu F, Wade M, Nelson CA, Fox NA, Zeanah CH. Psychiatric outcomes following severe deprivation in early childhood: Follow-up of a randomized controlled trial at age 16. J Consult Clin Psychol 2020; 88:1079-1090. [PMID: 33370132 DOI: 10.1037/ccp0000613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Early psychosocial deprivation is associated with increased risk for psychopathology, yet few studies have examined outcomes in adolescents. METHOD At baseline (M age 22 months), 136 children from Bucharest, Romania, living in large institutions, were randomized into foster care (FCG) or to care as usual (CAUG). Caregivers completed psychiatric interviews regarding their children (52 FCG; 51 CAUG) at age 16 years (M = 16.67 years; SD = 0.78) to assess past year diagnoses and symptom counts. In addition, never-institutionalized community comparison children (n = 47) were included. RESULTS Ever-institutionalized children had higher rates of meeting criteria for any psychiatric disorder and higher symptom counts of internalizing, externalizing, attention-deficit/hyperactivity, and substance use disorders compared to never-institutionalized children (ps < .05). Using intent-to-treat analyses, we found that children in the CAUG had more than twice the rate of psychiatric disorders than children in the FCG (OR = 2.48, 95% CI [1.12, 5.48]). Furthermore, children in foster care who remained in their original placement did not significantly differ in their rates of psychiatric disorders compared to never-institutionalized children. CONCLUSIONS There are many ways children can be separated from parents, including placement into institutional care. The current findings indicate that such placements are associated with significant risks for psychopathology. Moreover, we provide causal evidence for the long-lasting positive effect of foster care in reducing the risk of psychopathology in adolescence, especially among those in stable placements. These results provide strong evidence that early and stable placements into quality foster care may mitigate risk for psychopathology following severe early psychosocial deprivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Mark Wade
- Department of Applied Psychology and Human Development, University of Toronto
| | - Charles A Nelson
- Department of Pediatrics, Boston Children's Hospital/ Harvard Medical School
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park
| | - Charles H Zeanah
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine
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20
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Humphreys KL, Sisk LM, Manczak EM, Lin J, Gotlib IH. Depressive Symptoms Predict Change in Telomere Length and Mitochondrial DNA Copy Number Across Adolescence. J Am Acad Child Adolesc Psychiatry 2020; 59:1364-1370.e2. [PMID: 31628984 PMCID: PMC7160006 DOI: 10.1016/j.jaac.2019.09.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/10/2019] [Accepted: 10/11/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Several studies have found associations between a diagnosis or symptoms of major depressive disorder and markers of cellular aging and dysfunction. These investigations, however, are predominantly cross-sectional and focus on adults. In the present study, we used a prospective longitudinal design to test the cross-sectional association between depressive symptoms in adolescents and telomere length (TL) as well as mitochondrial DNA copy number (mtDNA-cn). METHOD A total of 121 adolescents (mean age = 11.38 years, SD = 1.03; 39% male adolescents and 61% female adolescents) were followed for approximately 2 years. At baseline and follow-up, participants provided saliva for DNA extraction, from which measures of TL and mtDNA-cn were obtained. Depressive symptoms were obtained via the Children's Depression Inventory. RESULTS There was no association between depressive symptoms and markers of cellular aging at baseline; however, depressive symptoms at baseline predicted higher rates of telomere erosion (β = -0.201, p = .016) and greater increases in mtDNA-cn (β = 0.190, p = .012) over the follow-up period. Markers of cellular aging at baseline did not predict subsequent changes in depressive symptoms. Furthermore, including the number of stressful life events did not alter these patterns of findings. CONCLUSION These results indicate that depressive symptoms precede changes in cellular aging and dysfunction, rather than the reverse.
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Affiliation(s)
| | | | | | - Jue Lin
- University of California, San Francisco
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21
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Correlates of Sluggish Cognitive Tempo Among Clinic-Referred Youth: Expanding Awareness of Somatic Symptoms and Stress in the Clinical Picture. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2020. [DOI: 10.1007/s40817-020-00083-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Abstract
Executive function (EF) skills are neurocognitive skills that support the reflective, top-down coordination and control of other brain functions, and there is neural and behavioral evidence for a continuum from more "cool" EF skills activated in emotionally neutral contexts to more "hot" EF skills needed for the reversal of motivationally significant tendencies. Difficulties in EF are transdiagnostic indicators of atypical development. A neurodevelopmental model traces the pathway from adverse childhood experiences and stress to disruption of the development of neural systems supporting reflection and EF skills to an increased risk for general features of psychopathology. Research indicates that EF skills can be cultivated through scaffolded training and are a promising target for therapeutic and preventive intervention. Intervention efficacy can be enhanced by mitigating disruptive bottom-up influences such as stress, training both hot and cool EF skills, and adding a reflective, metacognitive component to promote far transfer of trained skills.
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Affiliation(s)
- Philip David Zelazo
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota 55455-0345, USA;
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23
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Öster C, Ramklint M, Meyer J, Isaksson J. How do adolescents with ADHD perceive and experience stress? An interview study. Nord J Psychiatry 2020; 74:123-130. [PMID: 31613179 DOI: 10.1080/08039488.2019.1677771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is linked to high levels of perceived stress in adult populations. Thus, it is not surprising that stress managing techniques are being included in treatment protocols for adults with ADHD. There is, however, a paucity of studies on perceived stress in adolescents with ADHD.Aims: This study aims to explore how adolescents with ADHD perceive and experience stress (and stressors) using a qualitative approach.Methods: Explorative interviews were conducted with 20 adolescents (Mean age: 16.30) diagnosed with ADHD in conjunction with group treatment therapy. Data were analysed using qualitative content analysis.Results: Stress and ADHD, as well as stress, anxiety and ill-health, were described as closely intertwined. The result is presented in four categories: stress is often present, triggers of stress, stress affects daily life, and stress can be handled and prevented. A relation was found between stress and feelings of helplessness, ill-health and anxiety. Stress was viewed as being out of proportion with reality and was driven by such factors as ADHD symptoms, school demands, unpredictable situations and relational problems. Several negative consequences of stress were reported, including postponing schoolwork and the tendency to give up. Some participants also reported performing better when stressed. Accepting help from others, practising acceptance, settling down and controlling oneself, and planning in advance were seen as helpful stress managing techniques.Conclusions: Stress should be considered among other problems related to ADHD. Psychoeducation about stress, stress managing techniques and coaching should be included in the treatment of adolescents with ADHD.
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Affiliation(s)
- Caisa Öster
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jenny Meyer
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institute (KIND), Karolinska Institute, Stockholm, Sweden
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24
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Zhang Y, Zhang X, Zhang L, Guo C. Executive Function and Resilience as Mediators of Adolescents' Perceived Stressful Life Events and School Adjustment. Front Psychol 2019; 10:446. [PMID: 30873099 PMCID: PMC6403185 DOI: 10.3389/fpsyg.2019.00446] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Abstract
This study investigated psychological mechanisms underlying the relationship between stressful life events and school adjustment in Chinese adolescents. The Adolescent Self-rating Life Events Checklist, the Adolescent Executive Function Scale, the Chinese version of the Resilience Scale, and the School-adjustment Scale were administered to 1101 Chinese adolescents (465 males, 636 females), aged 11–19 years, from three secondary schools. Results from serial mediation analysis revealed that perceived stressful life events could affect school adjustment through the mediation of executive function and resilience. The mediation effect contained three paths, the separate mediation effect of executive function, the separate mediation effect of resilience, and the serial mediation effect of executive function and resilience. These findings provide valuable insights into the effect of perceived stressful life events on school adjustment of Chinese adolescents, and suggest that, the researchers and educators could enhance school adjustment in vulnerable groups by improving their executive function and resilience.
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Affiliation(s)
- Yuqing Zhang
- The Lab of Mental Health and Social Adaptation, Faulty of Psychology, Southwest University, Chongqing, China.,Research Center of Mental Health Education, Southwest University, Chongqing, China
| | - Xing Zhang
- Faulty of Psychology, Southwest University, Chongqing, China
| | - Liwei Zhang
- Physical Education Department, Luoyang Vocational & Technical College, Luoyang, China
| | - Cheng Guo
- The Lab of Mental Health and Social Adaptation, Faulty of Psychology, Southwest University, Chongqing, China.,Research Center of Mental Health Education, Southwest University, Chongqing, China
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25
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Effectiveness of Neurofeedback on Executive Functions and Tendency Toward High-Risk Behaviors in Adolescents with Attention Deficit Hyperactivity Disorder. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS AND ADDICTION 2018. [DOI: 10.5812/ijhrba.82012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jacob L, Haro JM, Koyanagi A. Attention deficit hyperactivity disorder symptoms and disordered eating in the English general population. Int J Eat Disord 2018; 51:942-952. [PMID: 30256445 DOI: 10.1002/eat.22934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) symptoms and eating problems often coexist, but many of the previous studies have not taken into account key variables which may be important in this association. Thus, the goal of this study was to assess the association between ADHD symptoms and disordered eating, while taking into account of a variety of factors. METHOD This study used cross-sectional, nationally representative data from 7,403 people aged ≥16 years from England who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener. Questions from the five-item SCOFF screening instrument were used to identify possible ED. Multivariable logistic regression analyses were conducted. RESULTS The prevalence of possible eating disorder (ED) was much higher among those with ADHD symptoms (ASRS score ≥14) compared to those without ADHD symptoms (19.2 vs. 5.7%). ADHD symptoms were associated with possible ED (odds ratio [OR] = 3.48; 95% confidence interval [CI] = 2.56-4.72) after adjustment for age, sex, and ethnicity. After further adjustment for alcohol dependence, drug use, intelligence quotient, stressful life events, perceived stress, impulsivity, depression, anxiety disorder, and borderline personality disorder (BPD) traits, the OR was attenuated to 1.32 (95% CI = 0.82-2.13). Anxiety and BPD were the factors that led to the largest degree of attenuation. DISCUSSION A high prevalence of disordered eating in individuals with ADHD was observed. Factors such as co-existing anxiety and BPD traits may be particularly important in this association. Future research should focus on the factors involved in the association between ADHD symptoms and disordered eating behavior.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
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