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Ward J, McBride A, Gudka R, Becker K, Newlove-Delgado T, Price A. Wider health needs in attention deficit hyperactivity disorder from lived and professional experience: a qualitative framework analysis. BMJ Open 2024; 14:e083539. [PMID: 39153774 PMCID: PMC11331868 DOI: 10.1136/bmjopen-2023-083539] [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: 12/21/2023] [Accepted: 07/26/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVES This study aimed to explore the perspectives of people with attention deficit hyperactivity disorder (ADHD), their supporters and primary care professionals (PCPs), on the wider physical and mental health needs of people with ADHD and the support currently available. DESIGN Qualitative semi-structured interviews, analysed using reflexive thematic analysis. SETTING Five general practice surgeries across England. PARTICIPANTS Participants with lived experience (people with ADHD and their supporters (n=11)) and PCPs (n=9) (eg, general practitioners and practice managers), recruited via clinical academic networks and previous work packages of this study. RESULTS We generated three major themes in relation to ADHD, using reflexive thematic analysis: understanding health, barriers to health and addressing health. Within these, participants reflected on mental and physical health challenges, as well as wider social difficulties and variability in support offered/accessed. CONCLUSIONS This study highlights that health problems in ADHD are complex and rooted both in individual factors (eg, mental health) and social factors (eg, support). This study also highlights the differences in expectations and fulfilment of healthcare.
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Affiliation(s)
- John Ward
- University of Exeter Medical School, Exeter, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | | | - Anna Price
- University of Exeter Medical School, Exeter, UK
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Toole KP, Frank C. A Young adolescent with undiagnosed ADHD-inattentive presentation and co-morbid anxiety and depression: A case report. J Pediatr Nurs 2024:S0882-5963(24)00275-6. [PMID: 39127589 DOI: 10.1016/j.pedn.2024.07.013] [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: 05/13/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024]
Abstract
This case report discusses a young adolescent with attention deficit hyperactivity disorder (ADHD) - inattentive presentation, and comorbid anxiety and depression that was not diagnosed until age 13. However, most ADHD is diagnosed before age 12. Anxiety and depression are common comorbidities of ADHD that present in primary care and can mimic the symptoms of ADHD. Due to the shortage of trained pediatric behavioral and mental health specialists, primary care pediatric nurse practitioners often diagnose and manage children and adolescents with ADHD and various comorbid conditions. It is essential to look for red flags in young children, especially in ADHD inattentive presentation, because symptoms are often masked and go unrecognized, undiagnosed, and untreated for years, resulting in academic and social problems causing the child and family stress, frustration, and reduced quality of life.
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Affiliation(s)
- Kimberly P Toole
- Xavier University College of Nursing, Pediatric Nurse Practitioner, City of Cincinnati Primary Care, 8330 Ridge Road, Cincinnati, OH 45236, United States of America.
| | - Catherine Frank
- Xavier University College of Nursing, Acute Care Nurse Practitioner, Mercy Health Emergency Departments, United States of America.
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Jiang X, Han X, Kong T, Wu Y, Shan L, Yang Z, Liu Y, Wang F. Association of impulsive behavior and cerebrospinal fluid/plasma oxidation and antioxidation ratio in Chinese men. Brain Res 2024; 1835:148935. [PMID: 38609031 DOI: 10.1016/j.brainres.2024.148935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Impulsive behavior is the precursor of many psychiatric and neurological conditions. High levels of impulsive behavior will increase health risk behavior and related injuries. Impulsive behavior is produced and regulated by central and peripheral biological factors, and oxidative stress (OS) can aggravate it. However, previous studies only showed that impulsive behavior was related to the level of the peripheral OS. Therefore, this study aims to clarify the relationship between OS and impulsive behavior in the brain and peripheral blood. METHODS We recruited 64 Chinese men. We measured superoxide dismutase (SOD) (including copper, zinc and manganese) and nitric oxide synthase (NOS) (including total, inducible and constitutive) in cerebrospinal fluid (CSF) and plasma. The Barratt Impulsiveness Scale version 11 (BIS-11) was used to evaluate impulsive behavior. The relationship between OS and impulsive behavior was evaluated by partial correlation analysis and stepwise multiple regression analysis. RESULTS Partial correlation analysis showed that the ratio of total NOS-to-MnSOD and iNOS-to-MnSOD in CSF were negatively correlated with the BIS-11 motor scores (r = -0.431, p = -0.001; r = -0.434, p = -0.001). Stepwise multiple regression analysis showed that the ratio of CSF iNOS-to-MnSOD was the most influential variable on the BIS-11 motor scores(β = -0.434, t = -3.433, 95 %CI(-0.374, -0.098), p = 0.001). CONCLUSIONS AND RELEVANCE The imbalance of central oxidation and antioxidation is related to impulsive behavior, which broadens our understanding of the correlation between impulsive behavior and OS.
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Affiliation(s)
- Xiaoning Jiang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China; Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot 010110, China
| | - Xiaoli Han
- Clinical Nutrition Department, Friendship Hospital of Urumqi, Urumqi 830049, China
| | - Tiantian Kong
- Xinjiang Key Laboratory of Neurological Disorder Research, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, China
| | - Yan Wu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Ligang Shan
- Department of Anesthesiology, the Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, China
| | - Zhuqing Yang
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot 010110, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou 325035, China.
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China.
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Jakobsson Støre S, Van Zalk N, Granander Schwartz W, Nilsson V, Tillfors M. The Relationship Between Social Anxiety Disorder and ADHD in Adolescents and Adults: A Systematic Review. J Atten Disord 2024; 28:1299-1319. [PMID: 38651640 PMCID: PMC11168018 DOI: 10.1177/10870547241247448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This review aimed to systematically gather empirical data on the link between social anxiety disorder and ADHD in both clinical and non-clinical populations among adolescents and adults. METHOD Literature searches were conducted in PsycInfo, PubMed, Scopus, and Web of Science, resulting in 1,739 articles. After screening, 41 articles were included. Results were summarized using a narrative approach. RESULTS The prevalence of ADHD in adolescents and adults with SAD ranged from 1.1% to 72.3%, while the prevalence of SAD in those with ADHD ranged from 0.04% to 49.5%. Studies indicate that individuals with both SAD and ADHD exhibit greater impairments. All studies were judged to be of weak quality, except for two studies which were rated moderate quality. DISCUSSION Individuals with SAD should be screened for ADHD and vice versa, to identify this common comorbidity earlier. Further research is needed to better understand the prevalence of comorbid ADHD and SAD in adolescents.
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Affiliation(s)
- Siri Jakobsson Støre
- Karlstad University, Sweden
- Child and Adolescent Psychiatry, Region Värmland, Karlstad, Sweden
| | | | | | - Victoria Nilsson
- Pediatric and Adolescent Medicine, Region Värmland, Karlstad, Sweden
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Ward JH, Becker K, Smith J, Price A, Newlove-Delgado T. Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study. BMC Health Serv Res 2024; 24:751. [PMID: 38898441 PMCID: PMC11188530 DOI: 10.1186/s12913-024-11188-5] [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: 08/07/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders. METHODS This study forms part of the 'Managing young people with ADHD in Primary care (MAP) study'. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September-October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one. RESULTS 782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively). CONCLUSIONS Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD.
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Affiliation(s)
- John H Ward
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Royal Devon University Hospital NHS Foundation Trust, Devon, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Kieran Becker
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Jane Smith
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Anna Price
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Tamsin Newlove-Delgado
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
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Bentivegna F, Papachristou E, Flouri E. The relationship between mental health and risky decision-making in children and adolescents: a scoping review. BMC Psychiatry 2024; 24:424. [PMID: 38840072 PMCID: PMC11154980 DOI: 10.1186/s12888-024-05850-9] [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: 07/10/2023] [Accepted: 05/15/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Evidence from studies on adult participants and clinical samples of children suggest an association between risky decision-making and mental health problems. However, the extent and nature of this association in the general youth population remains unknown. Therefore, this scoping review explores the current evidence on the relationship between mental health (internalising and externalising symptoms) and risky decision-making in the general youth population. METHODS A three-step search strategy was followed and applied to four databases. Selection criteria included participants < 18 years representative of the general population, and information on both risky decision-making (assessed using gambling tasks) and internalising /externalising symptoms. Data were extracted and synthesised for study and participant characteristics, aspects and measures for the main variables, and key findings. RESULTS Following screening, twenty-one studies were retrieved. Non-significant associations were more frequent than significant associations for both internalising and externalising symptoms, particularly for social difficulties and broad externalising symptoms. Among the significant associations, hyperactivity/inattention and conduct problems appeared to be positively associated with risk-taking and negatively associated with quality of decision-making. However, patterns were less clear for links between risky decision-making and internalising symptoms, especially between risk-taking and anxiety symptoms. CONCLUSIONS The present review suggests predominantly a lack of relationship between risky decision-making and mental health problems, and outlines several possible reasons for it. However, when specificity is considered carefully there seems to be a link between risk-taking and specific externalising problems. Future research should employ study designs aimed at disentangling the direction of this relationship and identifying specific aspects of mental health and risky decision-making that could be eventually addressed by tailored interventions.
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Affiliation(s)
- Francesca Bentivegna
- Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA, UK.
| | - Efstathios Papachristou
- Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA, UK
| | - Eirini Flouri
- Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA, UK
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Smith JN, Jusko ML, Fosco WD, Musser ED, Raiker JS. A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions. Dev Psychopathol 2024; 36:601-615. [PMID: 36734223 DOI: 10.1017/s0954579422001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.
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Affiliation(s)
| | | | | | - Erica D Musser
- Florida International University (FIU), USA
- FIU Center for Children and Families, USA
- FIU Embrace, USA
| | - Joseph S Raiker
- Florida International University (FIU), USA
- FIU Center for Children and Families, USA
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Fabio RA, Orsino C, Lecciso F, Levante A, Suriano R. Atypical sensory processing in adolescents with Attention Deficit Hyperactivity Disorder: A comparative study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 146:104674. [PMID: 38306842 DOI: 10.1016/j.ridd.2024.104674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
Atypical sensory processing is common in Attention Deficit Hyperactivity Disorder (ADHD). Despite growing evidence that ADHD symptoms persist into adolescence, the sensory processing of individuals with ADHD in this age group is limited. The aim of this study was to assess differences in self-reported sensory experiences between adolescents with and without ADHD. One hundred thirty-eight Italian adolescents aged between 14 and 18 years (M=16.20; SD= ± 1.90) participated in the study. Sixty-nine participants with ADHD were matched by gender, age, and IQ to 69 typically developing individuals. The sensory processing of all participants was assessed using the Adolescent Sensory Profile (ASP) on the components: low registration, sensation seeking, sensory sensitivity, and sensation avoiding. Moreover, the modalities of ASP were measured: movement, vision, touch, activity level, hearing, and taste/smell. Results show that the ADHD group consistently displayed higher scores across all four components of the sensory profile compared to the control group. The subjects with ADHD also reported higher scores than the control group in all the modalities of ASP. These results confirming the presence of atypical sensory processing in adolescents with ADHD were discussed considering the Cumulative and Emergent Automatic Deficit model (CEAD).
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Affiliation(s)
- Rosa Angela Fabio
- Department of Economics, University of Messina, 98100 Messina, Italy
| | - Caterina Orsino
- Department of Cognitive, Psychological and Pedagogical Sciences and Cultural Studies, University of Messina, 98100 Messina, Italy
| | - Flavia Lecciso
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | - Annalisa Levante
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | - Rossella Suriano
- Department of Cognitive, Psychological and Pedagogical Sciences and Cultural Studies, University of Messina, 98100 Messina, Italy.
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9
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DeRosa J, Rosch KS, Mostofsky SH, Nikolaidis A. Developmental deviation in delay discounting as a transdiagnostic indicator of risk for child psychopathology. J Child Psychol Psychiatry 2024; 65:148-164. [PMID: 37524685 PMCID: PMC10828118 DOI: 10.1111/jcpp.13870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The tendency to prefer smaller, immediate rewards over larger, delayed rewards is known as delay discounting (DD). Developmental deviations in DD may be key in characterizing psychiatric and neurodevelopmental disorders. Recent work empirically supported DD as a transdiagnostic process in various psychiatric disorders. Yet, there is a lack of research relating developmental changes in DD from mid-childhood to adolescence to psychiatric and neurodevelopmental disorders. Additionally, examining the interplay between socioeconomic status/total household income (THI) and psychiatric symptoms is vital for a more comprehensive understanding of pediatric pathology and its complex relationship with DD. METHODS The current study addresses this gap in a robust psychiatric sample of 1843 children and adolescents aged 5-18 (M = 10.6, SD = 3.17; 1,219 males, 624 females). General additive models (GAMs) characterized the shape of age-related changes in monetary and food reward discounting for nine psychiatric disorders compared with neurotypical youth (NT; n = 123). Over 40% of our sample possessed a minimum of at least three psychiatric or neurodevelopmental disorders. We used bootstrap-enhanced Louvain community detection to map DD-related comorbidity patterns. We derived five subtypes based on diagnostic categories present in our sample. DD patterns were then compared across each of the subtypes. Further, we evaluated the effect of cognitive ability, emotional and behavioral problems, and THI in relation to DD across development. RESULTS Higher discounting was found in six of the nine disorders we examined relative to NT. DD was consistently elevated across development for most disorders, except for depressive disorders, with age-specific DD differences compared with NTs. Community detection analyses revealed that one comorbidity subtype consisting primarily of Attention-Deficit/Hyperactivity Disorder (ADHD) Combined Presentation and anxiety disorders displayed the highest overall emotional/behavioral problems and greater DD for the food reward. An additional subtype composed mainly of ADHD, predominantly Inattentive Presentation, learning, and developmental disorders, showed the greatest DD for food and monetary rewards compared with the other subtypes. This subtype had deficits in reasoning ability, evidenced by low cognitive and academic achievement performance. For this ADHD-I and developmental disorders subtype, THI was related to DD across the age span such that participants with high THI showed no differences in DD compared with NTs. In contrast, participants with low THI showed significantly worse DD trajectories than all others. Our results also support prior work showing that DD follows nonlinear developmental patterns. CONCLUSIONS We demonstrate preliminary evidence for DD as a transdiagnostic marker of psychiatric and neurodevelopmental disorders in children and adolescents. Comorbidity subtypes illuminate DD heterogeneity, facilitating the identification of high-risk individuals. Importantly, our findings revealed a marked link between DD and intellectual reasoning, with children from lower-income households exhibiting lower reasoning skills and heightened DD. These observations underscore the potential consequences of compromised self-regulation in economically disadvantaged individuals with these disorders, emphasizing the need for tailored interventions and further research to support improved outcomes.
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Affiliation(s)
- Jacob DeRosa
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Keri S Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aki Nikolaidis
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
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10
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Schachar RJ. Fifty years of executive control research in attention-deficit/hyperactivity disorder:What we have learned and still need to know. Neurosci Biobehav Rev 2023; 155:105461. [PMID: 37949153 DOI: 10.1016/j.neubiorev.2023.105461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
For 50 years, attention-deficit/hyperactivity disorder (ADHD) has been considered a disorder of executive control (EC), the higher-order, cognitive skills that support self-regulation, goal attainment and what we generally call "attention." This review surveys our current understanding of the nature of EC as it pertains to ADHD and considers the evidence in support of eight hypotheses that can be derived from the EC theory of ADHD. This paper provides a resource for practitioners to aid in clinical decision-making. To support theory building, I draw a parallel between the EC theory of ADHD and the common gene-common variant model of complex traits such as ADHD. The conclusion offers strategies for advancing collaborative research.
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Affiliation(s)
- Russell J Schachar
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
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Dekkers TJ, Flisar A, Karami Motaghi A, Karl A, Frick MA, Boyer BE. Does Mind-Wandering Explain ADHD-Related Impairment in Adolescents? Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01557-2. [PMID: 37382726 DOI: 10.1007/s10578-023-01557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
Currently, diagnostic criteria for ADHD mainly reflect behavioral symptoms, neglecting internal phenomena like mind-wandering. Recent studies found that mind-wandering explains impairment beyond ADHD symptoms in adults. To better capture ADHD-related impairment in adolescents, we aimed to elucidate whether mind-wandering is associated with impairments that are prevalent in adolescents (i.e., risk-taking behavior, homework problems, emotional dysregulation, and general impairment) beyond ADHD symptoms. Furthermore, we sought to validate the Dutch translation of the Mind Excessively Wandering Scale (MEWS). We assessed a community sample of 626 adolescents on ADHD symptoms, mind-wandering, and the impairment domains. The Dutch MEWS had good psychometric properties. Mind-wandering was linked to general impairment and emotional dysregulation beyond ADHD symptoms, but was not linked to risk-taking behavior and homework problems beyond ADHD symptoms. Internal psychological phenomena such as mind-wandering may add to the behavioral symptoms of ADHD in explaining part of the impairment that adolescents with ADHD characteristics experience.
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Affiliation(s)
- Tycho J Dekkers
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Accare Child Study Center, Groningen, the Netherlands.
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands.
| | - Ajda Flisar
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Alexandra Karl
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Matilda A Frick
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bianca E Boyer
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Psychologenpraktijk Kuin, Haarlem, the Netherlands
- Department of Developmental and Educational Psychology, Leiden University, Leiden, the Netherlands
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Botelho C, Fernandes C, Campos C, Seixas C, Pasion R, Garcez H, Ferreira-Santos F, Barbosa F, Maques-Teixeira J, Paiva TO. Uncertainty deconstructed: conceptual analysis and state-of-the-art review of the ERP correlates of risk and ambiguity in decision-making. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023:10.3758/s13415-023-01101-8. [PMID: 37173606 DOI: 10.3758/s13415-023-01101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Risk and uncertainty are central concepts of decision neuroscience. However, a comprehensive review of the literature shows that most studies define risk and uncertainty in an unclear fashion or use both terms interchangeably, which hinders the integration of the existing findings. We suggest uncertainty as an umbrella term that comprises scenarios characterized by outcome variance where relevant information about the type and likelihood of outcomes may be somewhat unavailable (ambiguity) and scenarios where the likelihood of outcomes is known (risk).These conceptual issues are problematic for studies on the temporal neurodynamics of decision-making under risk and ambiguity, because they lead to heterogeneity in task design and the interpretation of the results. To assess this problem, we conducted a state-of-the-art review of ERP studies on risk and ambiguity in decision-making. By employing the above definitions to 16 reviewed studies, our results suggest that: (a) research has focused more on risk than ambiguity processing; (b) studies assessing decision-making under risk often implemented descriptive-based paradigms, whereas studies assessing ambiguity processing equally implemented descriptive- and experience-based tasks; (c) descriptive-based studies link risk processing to increased frontal negativities (e.g., N2, N400) and both risk and ambiguity to reduced parietal positivities (e.g., P2, P3); (d) experience-based studies link risk to increased P3 amplitudes and ambiguity to increased frontal negativities and the LPC component; (e) both risk and ambiguity processing seem to be related with cognitive control, conflict monitoring, and increased cognitive demand; (f) further research and improved tasks are needed to dissociate risk and ambiguity processing.
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Affiliation(s)
- Catarina Botelho
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - Carina Fernandes
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
- Faculdade de Ciências Humanas e Sociais, Universidade Fernando Pessoa, Porto, Portugal
- Molecular Oncology and Viral Pathology Group, Research Center of IPO (CI-IPOP) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072, Porto, Portugal
| | - Carlos Campos
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
- Neurocognition Group | LabRP, Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, Porto, Portugal
- Digital Human-Environment Interaction Lab (HEI-LAB), Lusófona University, Lisboa, Portugal
| | - Carlos Seixas
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
- Research on Economics, Management and Information Technologies (REMIT), Portucalense University, Porto, Portugal
| | - Rita Pasion
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
- Digital Human-Environment Interaction Lab (HEI-LAB), Lusófona University, Lisboa, Portugal
| | - Helena Garcez
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Fernando Ferreira-Santos
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - João Maques-Teixeira
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Tiago O Paiva
- Faculty of Psychology and Education Sciences, Laboratory of Neuropsychophysiology, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal.
- Digital Human-Environment Interaction Lab (HEI-LAB), Lusófona University, Lisboa, Portugal.
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Keuppens L, Marten F, Baeyens D, Boyer B, Danckaerts M, van der Oord S. Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial. BMJ Open 2023; 13:e065355. [PMID: 37055205 PMCID: PMC10106018 DOI: 10.1136/bmjopen-2022-065355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Adolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment-Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)-that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD. METHODS AND ANALYSIS A randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13-17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach. ETHICS AND DISSEMINATION The study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards. TRIAL REGISTRATION NUMBER NCT04723719.
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Affiliation(s)
| | | | - Dieter Baeyens
- Parenting and Special Education, KU Leuven, Leuven, Belgium
| | - Bianca Boyer
- Developmental and Educational Psychology, University of Leiden, Leiden, The Netherlands
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14
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Truckenbrod LM, Cooper EM, Orsini CA. Cognitive mechanisms underlying decision making involving risk of explicit punishment in male and female rats. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:248-275. [PMID: 36539558 PMCID: PMC10065932 DOI: 10.3758/s13415-022-01052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Individuals engage in the process of risk-based decision making on a daily basis to navigate various aspects of life. There are, however, individual differences in this form of decision making, with some individuals exhibiting preference for riskier choices (risk taking) and others exhibiting preference for safer choices (risk aversion). Recent work has shown that extremes in risk taking (e.g., excessive risk taking or risk aversion) are not only cognitive features of neuropsychiatric diseases, but may in fact predispose individuals to the development of such diseases. To better understand individual differences in risk taking, and thus the mechanisms by which they confer disease vulnerability, the current study investigated the cognitive contributions to risk taking in both males and females. Rats were first behaviorally characterized in a decision-making task involving risk of footshock punishment and then tested on a battery of cognitive behavioral assays. Individual variability in risk taking was compared with performance on these tasks. Consistent with prior work, females were more risk averse than males. With the exception of the Set-shifting Task, there were no sex differences in performance on other cognitive assays. There were, however, sex-dependent associations between risk taking and specific cognitive measures. Greater risk taking was associated with better cognitive flexibility in males whereas greater risk aversion was associated with better working memory in females. Collectively, these findings reveal that distinct cognitive mechanisms are associated with risk taking in males and females, which may account for sex differences in this form of decision making.
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Affiliation(s)
- Leah M Truckenbrod
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Emily M Cooper
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Caitlin A Orsini
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
- Department of Neurology, The University of Texas at Austin, Austin, TX, USA.
- Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, 1601B Trinity Street, Austin, TX, 78712, USA.
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15
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Winter GN, Aran A, Pollak Y. Risk-Taking Behaviors in Children with ADHD Compared to Children with Primary Headaches. Neuropediatrics 2023. [PMID: 36442789 DOI: 10.1055/a-1988-2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study examined the engagement in risk-taking behaviors and their onset in children with attention-deficit/hyperactivity disorder (ADHD) compared with children with primary headaches. Whether ADHD is associated with higher engagement in risk-taking behavior compared with other neurodevelopmental disorders (and not only typical development) has yet to be demonstrated. A sample of 189 children, 10 to 18 years old, undergoing neurological surveillance for ADHD (N = 144) or primary headaches (N = 45) participated in the study. The children and their parents reported the children's engagement in various risk-taking behaviors. The ADHD group reported a higher level of general risk-taking behavior relative to the headache group. The differences remained significant even after controlling for demographic and clinical variables. No differences in the age of onset of risk-taking behaviors were found. It is concluded that risk-taking behavior is more common in children with ADHD under active neurological surveillance than in children followed for primary headaches.
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Affiliation(s)
- Gidon Nathan Winter
- Department of Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Aran
- Department of Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yehuda Pollak
- Department of Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
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16
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Dekkers TJ, van Hoorn J. Understanding Problematic Social Media Use in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): A Narrative Review and Clinical Recommendations. Brain Sci 2022; 12:brainsci12121625. [PMID: 36552085 PMCID: PMC9776226 DOI: 10.3390/brainsci12121625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is consistently associated with a host of social problems, such as victimization and difficulties in maintaining close friendships. These problems are not limited to offline relations but also manifest in the online social world, as previous research shows that ADHD is associated with problematic use of social media. Given the ubiquitous nature of social media, the goal of the current review is to understand why adolescents with ADHD demonstrate more problematic social media use than their typically developing peers. To this end, we provide a narrative review on the evidence for the link between ADHD and social media use, and consequently present an integrative framework, which encompasses neurobiological mechanisms (i.e., imbalance theory of brain development and dual pathway model of ADHD) and social mechanisms, including influences from peers and parents. We conclude that empirical work shows most consistent evidence for the link between problematic social media use and ADHD (symptoms), while intensity of social media use is also associated with several other behaviors and outcomes. Finally, we hypothesize how existing interventions for ADHD may work on the identified mechanisms and provide at-hand clinical recommendations for therapists working with adolescents with ADHD who exhibit problematic social media use.
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Affiliation(s)
- Tycho J. Dekkers
- University Medical Center Groningen, Department of Child and Adolescent Psychiatry, University of Groningen, 9723 HE Groningen, The Netherlands
- Accare Child Study Center, 9713 GZ Groningen, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, 1105 AZ Amsterdam, The Netherlands
- Amsterdam University Medical Center (AUMC), Department of Child and Adolescent Psychiatry, 1100 DD Amsterdam, The Netherlands
- Correspondence:
| | - Jorien van Hoorn
- Levvel, Academic Center for Child and Adolescent Psychiatry, 1105 AZ Amsterdam, The Netherlands
- Department of Developmental and Educational Psychology, Leiden University, 2311 EZ Leiden, The Netherlands
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17
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Matsuda E, Takenaga T, Iwabuchi M, Nakamura K. Time Series Analyses of the Responses to Sensory Stimuli of Children with Severe and Multiple Disabilities. JOURNAL OF ROBOTICS AND MECHATRONICS 2022. [DOI: 10.20965/jrm.2022.p0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Severe and multiple disabilities (SMD) refers to the simultaneous occurrence of intellectual and physical problems. SMD in children is difficult to assess, as they often do not have the proper language or bodily responses to represent their feelings. In this study, we propose a methodology for evaluating reactions of children with SMD to sensory stimuli that does not rely on observations by humans, but rather is based on automatic detection of video-recorded data and quantification by time-series analyses. We present two case studies with typical participants: one with large body movements (P1) and another with subtle body movements (P2). For P1, it was observed that he showed larger bodily movements just before the onset of tactile stimuli, while he became silent for approximately 10 s after the onset, with the stimuli causing him to reduce self-stimulatory behavior and pay attention to his external environment. For P2, two quantitative methodologies – correlation coefficient and Granger causality – were adopted, to compare behavioral difference during the presentation of either sour or sweet taste stimuli. For the sweet conditions, the movement of the mouth was considered to be generated by some internal causes. Through these experiments, we confirmed the authenticity of assessments made by the participants’ caregivers, and also revealed otherwise unseen behavioral patterns and structures.
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18
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Prepubertal methylphenidate leads to sex-dependent differences in probabilistic discounting. Pharmacol Biochem Behav 2022; 218:173424. [PMID: 35780911 DOI: 10.1016/j.pbb.2022.173424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/08/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
Prescription psychostimulants, such as methylphenidate (MPH), have served as a first line treatment for ADHD and associated developmental disorders since 1961. Psychostimulants has been shown to improve attention, response inhibition, and reduce hyperactivity in patients with ADHD, as well as in non-clinical human populations and animals. While there is a considerable amount of preclinical research investigating the effects of stimulant medications on reward sensitivity and basic learning in male rats, less is understood about their effects in females. Further, there are competing theories on the long-term cognitive impact of MPH, specifically in children who do not have ADHD. To this end, Long-Evans female and male rats were exposed to methylphenidate (0, 2.5, 5 mg/kg, BID, IP) for 20 days during early development (PD10-29). After discontinuation of MPH into adulthood, rats (beginning PD 60) were trained and tested for risk-preference using a 2-choice probabilistic discounting task. For this task, rats were given an option between a 'large-risky' choice (3 sugar pellets delivered on a probabilistic VR schedule) and 'small-certain' choice (1 sugar pellet delivered on a FR schedule). Rats were subsequently tested on an open field conflict test. The results demonstrate that prepubertal exposure to MPH can have lasting effects on decision-making. Specifically, female rats treated with 2.5 mg/kg MPH displayed a decrease in preference for the risky option, whereas male rats treated with the same dose showed an overall increase in preference compared to sex-matched controls. Irrespective of sex, rats treated with 2.5 mg/kg MPH also demonstrated a decrease in anxiety/inhibitory behavior on the modified open field test compared to controls. These results were not due to differences in locomotor behavior. Overall, the study contributes to the growing body of evidence to suggest that MPH exposure early in development can have a sex-dependent impact on decision-making in adulthood.
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Hoorn J, Water E, Dekkers TJ, Pollak Y, Popma A, Jansen BRJ, Huizenga HM, Duijvenvoorde ACK. Peer feedback decreases impulsive choice in adolescents with and without attention‐deficit/hyperactivity disorder. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Jorien Hoorn
- Institute of Psychology, Department of Developmental and Educational Psychology Leiden University Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
- Levvel Academic Center for Child‐ and Adolescent Psychiatry Amsterdam The Netherlands
| | | | - Tycho J. Dekkers
- Levvel Academic Center for Child‐ and Adolescent Psychiatry Amsterdam The Netherlands
- Department of Psychology University of Amsterdam Amsterdam The Netherlands
- Department of Child‐ and Adolescent Psychiatry University Medical Center Groningen Groningen The Netherlands
- Department of Child‐ and Adolescent Psychiatry Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Yehuda Pollak
- Seymour Fox School of Education Hebrew University of Jerusalem Jerusalem Israel
| | - Arne Popma
- Levvel Academic Center for Child‐ and Adolescent Psychiatry Amsterdam The Netherlands
- Department of Child‐ and Adolescent Psychiatry Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Brenda R. J. Jansen
- Department of Psychology University of Amsterdam Amsterdam The Netherlands
- Amsterdam Brain and Cognition Center Amsterdam The Netherlands
- Research Priority Area Yield Amsterdam The Netherlands
| | - Hilde M. Huizenga
- Department of Psychology University of Amsterdam Amsterdam The Netherlands
- Amsterdam Brain and Cognition Center Amsterdam The Netherlands
- Research Priority Area Yield Amsterdam The Netherlands
| | - Anna C. K. Duijvenvoorde
- Institute of Psychology, Department of Developmental and Educational Psychology Leiden University Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
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20
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Sun CF, Mansuri Z, Trivedi C, Vadukapuram R, Reddy A. Homicidal ideation and psychiatric comorbidities in the inpatient adolescents aged 12-17. Front Psychiatry 2022; 13:933524. [PMID: 36465293 PMCID: PMC9709343 DOI: 10.3389/fpsyt.2022.933524] [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: 05/01/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Adolescents with a homicidal tendency is a growing concern in the United States. Studies in the past have showcased the relationship between homicidal ideation (HI) and psychiatric illnesses, but very limited information is available on the adolescent and inpatient population. We aim to evaluate the prevalence of demographic characteristics and psychiatric disorders in adolescents with and without HI. MATERIALS AND METHODS Adolescent (age 12-17) population admitted to the hospital with the diagnosis of homicidal ideation was identified from the 2016-2018 National Inpatient Sample Dataset (NISD). Patients without HI were defined as the control group. The prevalence of psychiatric comorbidities between the groups was compared by applying the Rao-Scott adjusted chi-square test. We used multivariable logistic regression to generate odds ratio (OR) of homicidal ideation as an outcome; we adjusted age, sex, race, socioeconomic status, substance use disorders, alcohol use disorders, and psychiatric comorbidities. RESULTS A total of 18,935 patients (mean age: 14.5) with HI diagnosis were identified in this study. Majority of the patients were male subjects in the HI group compared to the control group (58.7 vs. 41.2%, p < 0.001). Racially, HI was more prevalent in white race (56.0 vs. 52.6%, p < 0.001) and black race (22.3 vs. 17.8%, p < 0.001), compared to Hispanic race (14.9 vs. 21.3%, p < 0.001). Major depression (Odds ratio [OR]: 2.66, p < 0.001), bipolar disorder (OR: 3.52, p < 0.001), anxiety disorder (OR: 1.85, p < 0.001), ADHD, and other conduct disorders (OR: 4.01, p < 0.001), schizophrenia (OR: 4.35, p < 0.001) are strong predictors of HI. Suicidality was prevalent in 66.9% of patients with HI. CONCLUSION We found a higher prevalence of psychiatric illnesses such as depression, anxiety, and bipolar disorder in adolescents with homicidal ideation in the inpatient setting. White and black races were more prevalent in patients with homicidal ideation. Further large-scale longitudinal research studies are warranted to establish the correlation between psychiatric disorders and homicidal ideation among adolescents.
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Affiliation(s)
- Ching-Fang Sun
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Permian Basin, Odessa, TX, United States
| | - Ramu Vadukapuram
- Department of Psychiatry, The University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Abhishek Reddy
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
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