ADHD, bruxism and psychiatric disorders: does bruxism increase the chance of a comorbid psychiatric disorder in children with ADHD and their parents?

Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study

OBJECTIVES

Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters.

METHODS

A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group.

RESULTS

Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p < .00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p > .05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p < .001).

CONCLUSIONS

A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d.

Secondary bruxism: A valid diagnosis or just a coincidental finding of additional masticatory muscle activity? A narrative review of literature

INTRODUCTION

Bruxism is defined as a repetitive masticatory muscle activity that can manifest it upon awakening (awake bruxism-AB) or during sleep (sleep bruxism-SB). Some forms of both, AB and SB can be associated to many other coexistent factors, considered of risk for the initiation and maintenance of the bruxism. Although controversial, the term 'secondary bruxism' has frequently been used to label these cases. The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques, however, are important factors to be considered when judging the literature findings. The use (and abuse) of drugs, caffeine, nicotine, alcohol and psychoactive substances, the presence of respiratory disorders during sleep, gastroesophageal reflux disorders and movement, neurological and psychiatric disorders are among these factors. The scarcity of controlled studies and the complexity and interactions among all aforementioned factors, unfortunately, does not allow to establish any causality or temporal association with SB and AB. The supposition that variables are related depends on different parameters, not clearly demonstrated in the available studies.

OBJECTIVES

This narrative review aims at providing oral health care professionals with an update on the co-risk factors and disorders possibly associated with bruxism. In addition, the authors discuss the appropriateness of the term 'secondary bruxism' as a valid diagnostic category based on the available evidence.

CONCLUSION

The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques found in many studies preclude any solid and convincing conclusion on the existence of the 'secondary' bruxism.

Importance of oral health in mental health disorders: An updated review

Background

Mental disorders are indeed an expanding threat, which requires raised awareness, education, prevention, and treatment initiatives nationally and globally. This review presents an updated review on the relationships between oral health and mental health disorders and the importance of oral health in mental health disorders.

Method

A literature search was done regarding mental disorders and oral health approaches in Google Scholar and PubMed from the year 1995 until 2023. All the English-language papers were evaluated based on the inclusion criteria. Publications included original research papers, review articles and book chapters.

Results

Common mental disorders include depression, anxiety, bipolar disorder, Schizophrenia, dementia, and alcohol and drug use disorders. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others.

Conclusion

There is a complex relationship between mental disorders and oral diseases. Various oral health problems are associated with mental health problems. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others. Mental health nurses including physicians and dental professionals should be involved in the oral health care of mental health disorder patients. Therefore, multidisciplinary should be involved in the care of mental health disorders, and they should consider oral health care as an essential part of their care for patients with mental health disorders. Future investigations should strive to elucidate the exact biological relationships, to develop new directions for treatment.

Recurrent Osteomyelitis Requiring Surgical Management Secondary to Nail-Biting: A Case Report

CASE

Onychophagia, or nail-biting, is a common habit seen in both children and adults. Harmful effects include oral exposure to a variety of pathogens and concomitant damage to dentition and fingers. This report focuses on the most severe reported case of recurrent osteomyelitis of the bilateral hands with destructive changes secondary to onychophagia.

CONCLUSION

Successful treatment relies on a multidisciplinary approach which in this case included surgical management and counseling on cessation, with referrals to other providers to address underlying psychiatric and/or psychologic conditions that may predispose to this compulsion.

Prevalence, comorbidity, and predictors of obsessive-compulsive disorder in Iranian children and adolescents

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) is a disease that causes personal distress or social dysfunction, especially in childhood. The present study aimed to provide the prevalence, comorbidity, and predictors of OCD among children and adolescents.

METHODS

This was a cross-sectional national project conducted on 29,858 children and adolescents using the multi-stage cluster random sampling in Iran. There were both genders in each cluster and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research included a demographic questionnaire and K-SADS-PL. To analyze the data, logistic regression and cross-tab tests were used.

RESULTS

According to the results, the prevalence of OCD in children and adolescents was 3.1 in boys and 3.8 in girls. Also, gender, age, place of residence, and history of psychiatric hospitalization of parents could predict OCD. OCD had comorbidity with behavioral disorders (OR = 0.60, 95%CI: 0.39-0.92), elimination disorders (OR = 0.50, 95%CI: 0.30-0.83), mood disorders (OR = 2.92, 95%CI: 1.43-5.94), and smoking and alcohol disorders (OR = 4.33, 95%CI: 1.28-14.63).

CONCLUSION

In the development of the obsessive-compulsive disorder, other disorders and symptoms also environmental factors can play a role and are important. Based on our findings, given the prevalence rate of OCD was higher in the age groups of 10-14 and 15-18 years, are one of the most important stages of development for the prevention and treatment of mental disorders, especially OCD, clinical specialists can design appropriate clinical trials or modify existing interventions based on the results of such research.

Epidemiology of Psychotic Disorders Based on Demographic Variables in Iranian Children and Adolescents

Objective: Psychosis is still among the most debilitating and severe mental disorders. The main objective of the present study was to investigate the estimated prevalence of psychotic disorders and finding the main predictors of psychotic disorders among Iranian children and adolescents.

Method: Our total sample consisted of 30 553 individuals (49% males and 51%females) from 30 provinces of Iran, aged between 6 and 18 years, who were selected via cluster sampling method from rural and urban areas of all provinces. The data were analyzed using descriptive statistical analysis and multiple logistic regression method.

Results: The results of multiple regression analysis showed that prevalence estimate of psychotic disorders was 0.25%. It was 0.3% and 0.2% in males and females, respectively. The age of 10-14 (OR = 2.24; 95% CI, 1.11-4.55) and the age of 15-18 (OR = 3.42; 95% CI, 1.74-6.75) were significant positive predictors, whereas none of the demographic variables were predictors for psychotic symptoms.

Conclusion: This research highlights the main predictors of psychosis in children and adolescents. The study design also allowed a better understanding of predictors of psychotic disorders. The assessment of the prevalence of psychiatric disorders, particularly their comorbidities, may help to prevent mental illnesses in children and adolescents.

Is there an association between attention deficit hyperactivity disorder in children and adolescents and the occurrence of bruxism? A systematic review and meta-analysis

Aim of the present systematic review was to evaluate whether children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are at greater chance of developing bruxism compared to individuals without this disorder. Observational studies that evaluated the occurrence of bruxism in children and adolescents with ADHD were included. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Thirty-two studies involving a total of 2629 children/adolescents with ADHD and 1739 with bruxism (1629 with sleep bruxism and 110 with awake bruxism) were included. The prevalence of bruxism, irrespective of type, in the children/adolescents was 31% (95% CI: 0.22-0.41, I² = 93%). ADHD was associated with an increased chance of bruxism (OR: 2.94, 95% CI: 2.12-4.07, I² = 61%), independently of the type [sleep bruxism (OR: 2.77, 95% CI: 1.90-4.03, I² = 66%) or awake bruxism (OR: 10.64, 95% CI: 2.41-47.03, I² = 65%)]. The presence of signs of ADHD without a diagnostic confirmation was not associated with an increased chance of bruxism (OR: 3.26, 95% CI: 0.76-14.04, I² = 61%). Children and adolescents with a definitive diagnosis of ADHD are at greater chance of developing sleep and awake bruxism than those without this disorder.

Are maternal mental disorders associated with children's oral health? A systematic review

Maternal mental problems may lead to a negative effect on children's oral health (COH). The aim of this study was to systematically review the literature to answer the question: Are maternal mental disorders (MMD) associated with COH from zero to 12 years old? Electronic searches were performed in five databases with no language restriction. Cohort, case-control, and cross-sectional studies were included. A total of 1183 references were identified, and seven studies were included. In relation to MMD studies investigated: Common Mental Disorders (n = 2), Major Depressive Disorder (MDD) (n = 2), symptoms of depression (SD) (n = 3), Alcohol-related diagnosis (n = 1), and symptoms of anxiety (n = 2). As outcome, the studies investigated dental caries (n = 5), gingivitis and periodontal diseases (n = 1), sleep bruxism (SB) (n = 1), and malocclusion (n = 1). Positive association was found between MDD and OH (SB and dental caries). There was no MMD associated with malocclusion. Alcohol-related diagnosis showed a positive association with gingivitis and periodontal diseases and no association with dental caries; anxiety had a positive association with dental caries and no association with SB. The heterogeneity of the data precluded precise conclusions to be drawn, but MMD may have influence on COH.

A survey of Psychiatric Disorders and Their Comorbidities in Children and Adolescents

Background:

This community-based study aimed to investigate the psychiatric disorders and their comorbidities according to the kind of psychiatric disorders. Frequency of demographic factors and the prevalence of total psychiatric disorders in term of demographic charactheristics were obtained too.

Materials and Methods:

The present study focused on 1028 children and adolescent aged 6 to 18 years old across the Razavi Khorasan province by random sampling. The subjects included 496 boys and 532 girls from three age groups (6-9 years, 10-14 years and 15-18 years). Eight clinical psychologists trained to complete the Persian version of K-SADS-PL (Kiddie-SADS present and life time version). This scale measures five diagnostic appendixes of psychiatric disorders. Demographic data of participants were collected too. The data were recorded into the SPSS version 16. The relationship between psychiatric disorders and demographic factors deliberate by descriptive analysis and 95% confidence interval.

Results:

The total rate of psychiatric disorders among children and adolescent was estimated as 20.5%, elimination disorders with a rate of 12.9% was the most prevalent disorder in the subjects. The lowest prevalence belongs to psychotic disorder and bulimia nervosa (0.1%). Of participants with mood disorders about 71.4% have behavioral disorders too. Anxiety disorders also commonly occurred in person with mood disorders. The comparison of ORs and their 95% confidence interval revealed that there is a significant difference for total psychiatric disorder among boys and girls (OR=0.6 for girls; 95% CI: 0.44-0.82). The rate of total psychiatric disorders in rural and urban areas was 14.9% and 21.1% respectively.

Conclusion:

With attention to the high prevalence of psychiatric disorders among children and adolescents, it’s necessary that healthcare officials pay more attention to reinforcement of mental health care.

The effect of memantine in adult patients with attention deficit hyperactivity disorder

BACKGROUND

Hyperactivity disorder and attention deficit are common neurological disorders in children and adolescents. The symptoms of hyperactivity are decreased in adults, and attention deficit is more noticeable. This study was carried out to evaluate the effect of memantine on adult patients with attention deficit hyperactivity disorder (ADHD).

MATERIALS AND METHODS

In a double-blind clinical trial study, 40 patients aged 18 to 45 years with ADHD were selected on the basis on the Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, and randomly assigned memantine or placebo. Before starting the treatment, Conners' screening questionnaire was completed for each patient, and the subjects were entered the study after acquiring minimum acceptable score in the questionnaire.

RESULTS

The mean age of patients who were receiving memantine and placebo was about 34.7 ± 4.48 and 31.5 ± 7.4 years, respectively. The results have shown a significant difference in the behavior and attention deficit between the two groups treated with memantine and placebo during 6 weeks (p < 0.001). Also, there was a significant difference in the third and sixth weeks between treatment groups in hyperactivity and attention deficit index (p = 0.001).

CONCLUSION

The results of this study indicated that memantine was effective in reducing symptoms of Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability.

Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder

Aim

The aim of the study was to evaluate the oral health conditions of children and adolescents with attention deficit hyperactivity disorder (ADHD).

Materials and methods

Two groups were selected: a test group comprising 51 individuals with ADHD and a control group with 50 individuals without ADHD, with ages ranging from 7 to 14 years. Through an intraoral clinical examination, the numbers of decayed, missing, and filled teeth (DMFT index), the visible plaque index (VPI), the gingival bleeding index (GBI), bruxism, and dental traumatism were verified. A questionnaire confirmed oral hygiene supervision.

Results

In the test group, the average DMFT index was 3.41 while it was 2.52 in the control group (p = 0.405). The VPI in the test and control groups was 36.84% and 24.54%, respectively (p = 0.004). The GBI was 8.37% for the test group and 4.94% for the control group (p = 0.012). The DMFT index when supervised the oral hygiene by those responsible in comparison with the nonsupervision was 1.89 and 4.31, respectively, in the test group, and 1.71 and 2.94, respectively, in the control group.

Conclusion

These data suggest that children and adolescents with ADHD present with worse oral health conditions and need greater attention from dental professionals and those responsible for their diet and oral hygiene.

Clinical significance

Attention deficit hyperactivity disorder needs a special attention. This research brings this important issue focus on oral health.

How to cite this article

Begnini GJ, Brancher JA, Guimarães ATB, et al. Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder. Int J Clin Pediatr Dent 2019;12(6):543–547.

Epidemiology of psychiatric disorders in children and adolescents; in Tehran, 2017

OBJECTIVE

This survey was conducted to investigate the prevalence of various psychiatric disorders among children and adolescents aged 6-18 years in urban areas of Tehran.

METHODS

In the study, which was done with random sampling method, 2095 children and adolescents in the range seniors aged 6-18 years, have been studied and based on Persian version of K-SADS-PL, we reviewed the psychiatric disorders related to them.

RESULTS

The overall prevalence of psychiatric disorders in children and adolescents was 28.2%. The most commonly diagnosed disorders were anxiety disorders (21.9%), followed by behavioral disorders (9.6%).

CONCLUSION

According to the results, 28.2% of the children and adolescents in Tehran province had psychiatric disorders, that is with increasing rate, compared with similar studies. Therefore, as a public health policy, the necessary tools for identifying, preventing and treating psychiatric disorders in children and adolescents should be considered in Tehran.

Sleep-related movement disorders and disturbances of motor control

PURPOSE OF REVIEW

Review of the literature pertaining to clinical presentation, classification, epidemiology, pathophysiology, diagnosis, and treatment of sleep-related movement disorders and disturbances of motor control.

RECENT FINDINGS

Sleep-related movement disorders and disturbances of motor control are typically characterized by positive motor symptoms and are often associated with sleep disturbances and consequent daytime symptoms (e.g. fatigue, sleepiness). They often represent the first or main manifestation of underlying disorders of the central nervous system, which require specific work-up and treatment. Diverse and often combined cause factors have been identified. Although recent data provide some evidence regarding abnormal activation and/or disinhibition of motor circuits during sleep, for the majority of these disorders the pathogenetic mechanisms remain speculative. The differential diagnosis is sometimes difficult and misdiagnoses are not infrequent. The diagnosis is based on clinical and video-polysomnographic findings. Treatment of sleep-related motor disturbances with few exceptions (e.g. restless legs/limbs syndrome) are based mainly on anecdotal reports or small series.

SUMMARY

More state-of-the-art studies on the cause, pathophysiology, and treatment of sleep-related movement disorders and disturbances of motor control are needed.

Childhood intelligence and early tooth wear patterns

OBJECTIVE

The aim of this study is to explore the relationships between early dental wear patterns and preschool IQ (Intelligence Quotient, by Stanford-Binet) of the child to illuminate the historic relationship of mental queries and bruxism.

METHODS

The dental study participants were 864 Euro-American preschool and school children whose IQs were tested for school maturity purposes at the age of 4 years, followed by dental data in a cross-sectional manner at the mean age of 7.8 years. Worn dentitions were classified as "symmetric" or "right-" and "left-sided," based on the faceting of the teeth.

RESULTS

In general, the relationships of tooth wear and intelligence were scarce, reflecting social background factors. Statistically significant results between asymmetric wear and gender groups suggest that direction of jaw function has a role in the regulation of processes responsible for individual mental performance in childhood.

DISCUSSION

Increased left-side tooth wear and early advantage in the intelligence test in girls is intriguing due to the fact that they reach maturity earlier than boys in verbal articulation, controlled in most cases by the limited area on the left side of the brain.

Effect of adenotonsillectomy on ADHD symptoms of children with adenotonsillar hypertrophy and sleep disordered breathing

BACKGROUND

Adenotonsillar hypertrophy is the most common etiologic agent for the obstruction of the upper airways in children, which might be associated with attention-deficit hyperactivity disorder (ADHD), one of the most common psychiatric disorders of childhood. Despite the concurrence of these two conditions, i.e., obstruction of the airways and ADHD, no exact etiologic relationship has been established between adenotonsillectomy (AT) and ADHD symptoms. This study was undertaken to evaluate the effect of AT on the ADHD symptoms in children with adenotonsillar hypertrophy and sleep disordered breathing (SDB).

METHODS

The design of the present study consisted of pre-test and post-test, followed by post hoc tests. Fifty-three children aged 3-12 were included in this study, selected from those referring to the Pediatric Hospital of Tabriz University of Medical Sciences, with SDB, adenotonsillar hypertrophy and ADHD based on DSM-IV criteria, by availability of the subjects undergoing adenotonsillectomy after evaluation of the severity of ADHD symptoms. The scores of ADHD symptoms were evaluated before AT and at 3- and 6-month postoperative intervals based on Conner's Parent Rating Scale-Revised (CPRS-R) Questionnaire. Repeated-measures ANOVA and Fisher's exact test were used for data analysis.

RESULTS

AT resulted in a significant decrease in the severity of ADHD symptoms (oppositional behavior, cognitive disorders, inattention, hyperactivity and ADHD index) at 3- and 6-month postoperative intervals (P<0.001), with more significant decreases at 6-month postoperative interval compared to 3-month interval (P<0.001).

CONCLUSIONS

Based on the results of this pilot study, AT in children with SDB associated with ADHD resulted in a significant decrease in the severity of ADHD symptoms.

Effect of an occlusal splint on sleep bruxism in children in a pilot study with a short-term follow up

The aim of the present study was to evaluate the effect of the use of an occlusal splint in children with bruxism in a pilot study with a short-term follow up. Seventeen children were recruited, only nine of whom formed the sample following the application of the inclusion criteria: presence of sleep bruxism for at least six months (based on parents' reports); presence of at least the first permanent molars; and no previous history of treatment involving an occlusal splint. The sample was submitted to a clinical exam. Other sleep problems were screened with the use of a sleep questionnaire filled out by parents before and after 90 days of occlusal splint usage. The children received a flat acrylic resin splint with full coverage of the occlusal surfaces to be worn in the maxilla. In children with erupting teeth, a space was created in the splint to allow normal eruption. After the 90-day period, the absence of sleep bruxism and sleep movements was noted in most of children. Moreover, snoring was reduced in nearly 50%, which raises a new issue to be investigated with regard to the pathophysiology of sleep bruxism. The use of an occlusal splint was effective in reducing the symptoms of sleep bruxism and other sleep problems. Further investigations should be carried out on the relationship between snoring and sleep bruxism in children.

Double-blind controlled trial of venlafaxine for treatment of adults with attention deficit/hyperactivity disorder

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders beginning in childhood that may continue to adulthood. The purpose of this study was to evaluate the possible therapeutic effect of venlafaxine in adults with ADHD.

METHODS

In a double-blind setting, drug-naïve adults with a diagnosis of ADHD based on DSM-IV-TR criteria were randomly selected to receive either venlafaxine (up to 225 mg/day) or a placebo for 6 weeks. The Conners Adult ADHD Rating Scale self-report screening version was administered before and during the treatment at 2-week intervals to measure the therapeutic effects.

RESULTS

The mean age (SD) of patients was 30.5 (8.1) years. Eleven out of 20 patients receiving venlafaxine and 13 out of 21 patients receiving the placebo were male. The two groups were not significantly different in terms of age, educational level, weight, or blood pressure. Significant decrease was observed in both subscales (inattentive, hyperactive/impulsive), total ADHD symptoms score, and ADHD index in both the venlafaxine and the placebo groups. Seventy-five percent of treatment group versus 20% of placebo group met treatment response criteria when defined as a 25% drop in total ADHD score (p = 0.001). No serious adverse effects were reported during the trial.

CONCLUSIONS

In this double-blind trial, the symptoms of adult ADHD decreased after a 6-week trial of either venlafaxine or a placebo with no significant difference. However, a significant treatment response defined as a 25% drop in ADHD index (measured by a self-report scale) was achieved by venlafaxine. The interpretation of these results is limited by the short duration of follow-up in this study.

Functional gastrointestinal disorders among adolescents with poor sleep: a school-based study in Shanghai, China

PURPOSE

This study aimed to determine whether functional gastrointestinal disorders are more common among adolescents with self-reported poor sleep.

METHODS

Junior middle school and senior high school students (n = 1,362) were recruited from schools in Shanghai. Students completed two questionnaires: the questionnaire for irritable bowel syndrome (IBS) in adolescents and the Pittsburgh Sleep Quality Index.

RESULTS

The prevalence of poor sleep was 34.29% [95% confidence interval (CI) = 31.77-36.81] and there was no significant difference between genders (P = 0.991). The tendency towards poor sleep increased with age, with age group yielding a significant effect (P = 0.001). In junior middle school and senior high school students, the propensity towards poor sleep was 30.10% (95% CI = 27.08-33.12%) and 42.11% (95% CI = 37.67-46.55%), respectively. Among students with poor sleep, the prevalence of IBS was 19.70% (95% CI = 16.09-23.31). After adjusting for age, sex, night pain, and psychological factors, IBS was significantly more common in students with poor sleep (odds ratio = 1.92; 95% CI = 1.07-2.58).

CONCLUSION

We conclude that IBS is prevalent in students with poor sleep. Poor sleep was independently associated with IBS among adolescents in Shanghai China.

Fatores associados ao bruxismo em crianças de 4 a 6 anos

TEMA: o bruxismo tem trazido prejuízos para a qualidade de vida das pessoas. Suas implicações para a motricidade orofacial e fala em crianças ainda não estão bem estabelecidas. OBJETIVO: investigar a ocorrência do bruxismo e fatores associados relativos aos hábitos orais, motricidade orofacial e funções de mastigação, respiração e deglutição em crianças de 4 a 6 anos. MÉTODO: participaram 141 crianças da referida faixa etária que frequentam três centros de educação infantil paulistas. Os pais preencheram protocolo de investigação sobre bruxismo e as crianças passaram por avaliação da motricidade orofacial. O grupo pesquisa foi composto pelas crianças cujos pais indicaram qualquer frequência de ranger ou apertamento de dentes, durante o sono ou não. Para análise estatística utilizou-se Análise de Variância, Teste de Igualdade de Duas Proporções e cálculo da Odds Ratio, nível de significância de 5%. RESULTADOS: observou-se elevada ocorrência de bruxismo entre as crianças (55,3%). Foram fatores associados a esta ocorrência: sialorreia durante o sono, uso de chupeta, hábito de morder lábios e roer unhas, tônus de bochechas e tipo de mordida alterados, além da participação da musculatura perioral durante deglutição de líquidos. Houve alta ocorrência de crianças dos dois grupos com queixa de dor de cabeça frequente (76%) e que dormem menos do que o recomendado para a idade (35%). CONCLUSÃO: os achados comprovaram relação entre bruxismo, hábitos orais e aspectos alterados da motricidade orofacial das crianças da faixa etária estudada reforçando a necessidade de ações fonoaudiológicas junto às instituições e famílias.

The predictors of parent reported behaviors related to olfactory information processing in children with ADHD

OBJECTIVE

Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder with contradictory findings about smell detection function. It is not clear if the parent perceived behavior related to olfactory function is associated with age, gender, severity of ADHD, and cooccurring symptoms of anxiety and oppositional behavior in children with ADHD.

METHODS

Participants were a clinical sample of 104 children and adolescents with ADHD using DSM-IV diagnostic criteria by a semi-structured interview. Parent perceived behavior related to olfactory processing function was assessed trough a questionnaire. The parent reported Olfactory Functioning Checklist was used to evaluate "seeking behavior and over-responsiveness to smell (SSBO)" and "smell detection ability (SDA)".

RESULTS

ADHD and separation anxiety symptoms count (severity) predicted the SDA scale score. None of the variables of gender, age, ADHD subtypes, co-morbidity with oppositional defiant disorder (ODD), and symptom count of ODD predicted SSBO and SDA scales' scores.

CONCLUSION

Parent reported behavior related to olfactory detection impairment increased with higher ADHD and anxiety severity. It is independent of age and gender.

Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies

OBJECTIVE

To perform a meta-analysis of subjective (i.e., based on questionnaires) and objective (i.e., using polysomnography or actigraphy) studies comparing sleep in children with attention-deficit/hyperactivity disorder (ADHD) versus controls.

METHOD

We searched for subjective and objective sleep studies (1987-2008) in children with ADHD (diagnosed according to standardized criteria). Studies including subjects pharmacologically treated or with comorbid anxiety/depressive disorders were excluded.

RESULTS

Sixteen studies, providing 9 subjective and 15 objective parameters and including a total pooled sample of 722 children with ADHD versus 638 controls, were retained. With regard to subjective items, the meta-analysis indicated that children with ADHD had significantly higher bedtime resistance (z = 6.94, p <.001), more sleep onset difficulties (z = 9.38, p <.001), night awakenings (z = 2.15, p =.031), difficulties with morning awakenings (z = 5.19, p <.001), sleep disordered breathing (z = 2.05, p =.040), and daytime sleepiness (z = 1.96, p =.050) compared with the controls. As for objective parameters, sleep onset latency (on actigraphy), the number of stage shifts/hour sleep, and the apnea-hypopnea index were significantly higher in the children with ADHD compared with the controls (z = 3.44, p =.001; z = 2.43, p =.015; z = 3.47, p =.001, respectively). The children with ADHD also had significantly lower sleep efficiency on polysomnography (z = 2.26, p =.024), true sleep time on actigraphy (z = 2.85, p =.004), and average times to fall asleep for the Multiple Sleep Latency Test (z = 6.37, p <.001) than the controls.

CONCLUSIONS

The children with ADHD are significantly more impaired than the controls in most of the subjective and some of the objective sleep measures. These results lay the groundwork for future evidence-based guidelines on the management of sleep disturbances in children with ADHD.