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Davis NO, Lerebours R, Aiello RE, Carpenter KLH, Compton S, Franz L, Kollins SH, Sabatos-DeVito M, Spanos M, Dawson G. Behavioral characteristics of toddlers later identified with an autism diagnosis, ADHD symptoms, or combined autism and ADHD symptoms. J Child Psychol Psychiatry 2024. [PMID: 39227035 DOI: 10.1111/jcpp.14050] [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] [Accepted: 05/30/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Autism commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD), but less is known regarding how ADHD symptoms impact the early presentation of autism. This study examined early behavioral characteristics of a community sample of toddlers later identified with autism diagnosis, ADHD symptoms, combined autism and ADHD symptoms, or neither condition. METHODS Participants were 506 toddlers who were part of a longitudinal study of children's behavioral development. Parents completed questionnaires about their children's behavior at two time points. Four groups were identified based on study measures or medical record: autism diagnosis (n = 45), elevated ADHD symptoms (n = 70), autism and ADHD symptoms (n = 30), or neurotypical development (n = 361). Relationships between early parent report of autism- and ADHD-related behaviors, social-emotional and behavioral functioning, and caregiver experience and subsequent group designation were evaluated with adjusted linear regression models controlling for sex. RESULTS Significant group differences were found in measures of autism-related behaviors, ADHD-related behaviors, externalizing and internalizing behaviors, and parent support needs (p < .0001). Pairwise comparisons indicated toddlers later identified with combined autism diagnosis and ADHD symptoms had higher levels of autism-related behaviors, externalizing and internalizing behaviors, and autism-related parent support needs compared to the other groups. Toddlers with subsequent elevated ADHD symptoms or combined autism diagnosis and ADHD symptoms exhibited similar levels of ADHD-related behaviors, while both groups displayed more ADHD-related behaviors than toddlers subsequently identified with autism or those with neither condition. CONCLUSIONS In this community sample, toddlers for whom combined autism diagnosis and ADHD symptoms were subsequently identified showed a distinct presentation characterized by higher early autism-related behaviors, broader behavioral concerns, and higher parent support needs. Presence of ADHD symptoms (alone or in combination with autism) was associated with higher parent-reported ADHD-related behaviors during toddlerhood. Results indicate that ADHD-related behaviors are manifest by toddlerhood, supporting screening for both autism and ADHD during early childhood.
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Affiliation(s)
- Naomi O Davis
- Duke ADHD Program, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Reginald Lerebours
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Rachel E Aiello
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly L H Carpenter
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Scott Compton
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lauren Franz
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Scott H Kollins
- Duke ADHD Program, Duke University School of Medicine, Durham, NC, USA
- Akili Interactive, Boston, MA, USA
| | - Maura Sabatos-DeVito
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Marina Spanos
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Gleason MM. Editorial: It's Not Just a Phase, and We Know What to Do: Children With Early-Onset Mental Health Concerns Deserve Care Now. J Am Acad Child Adolesc Psychiatry 2024; 63:865-867. [PMID: 38070866 DOI: 10.1016/j.jaac.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023]
Abstract
Suicide is the second leading cause of death in 10-14 year old, and the prevalence of suicidal thoughts and behaviors (STBs) young children is as high as 7.5%.1 Importantly, children 5 to 11 years old account for 43% of STB-focused emergency department visits in the United States.2 Despite the public health implications of STBs, limited research has focused on the longitudinal development of STBs. In this issue of the Journal, Hennefield et al.3 provide valuable insight into the persistence of preschool-onset major depressive disorder (PO-MDD) and STBs in preadolescents, highlighting opportunities for clinical systems of care.
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Affiliation(s)
- Mary Margaret Gleason
- Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Virginia.
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3
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Overgaard KR, Oerbeck B, Friis S, Pripp AH, Aase H, Biele G, Ingeborgrud CB, Polanczyk GV, Zeiner P. Early and repeated screening detects children with persistent attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2024; 33:1807-1815. [PMID: 37624573 PMCID: PMC11211128 DOI: 10.1007/s00787-023-02284-8] [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] [Received: 04/18/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Preschool screening of attention-deficit/hyperactivity disorder (ADHD) has been found too inaccurate to be clinically useful. This may be due to the known instability of ADHD symptoms from preschool onwards, and the use of a single screening only. We hypothesized that by identifying a group of children with persistent ADHD from preschool to school age and repeating the screening, the clinical usefulness of screening would increase. This study is part of the prospective longitudinal, population-based Norwegian Mother, Father and Child Cohort Study, with a diagnostic parent interview at 3.5 years and follow-up with parent questionnaires at ages 5 and 8 years (n = 707). We identified a group classified with ADHD at all three time points (persistent ADHD). We then used the Child Behavior Checklist ADHD DSM-oriented scale at ages 3.5 and 5 years to investigate the accuracies of single- and two-stage screening at different thresholds to identify children with persistent ADHD. About 30% of the children were classified with ADHD at least once across time (at ages 3.5, 5, and/or 8 years), but only 4% (n = 30) had persistent ADHD. At all thresholds, the two-stage screening identified children with persistent ADHD more accurately than single screening, mainly due to a substantial reduction in false positives. Only a small group of children were classified with persistent ADHD from preschool to school age, underlining that future screening studies should distinguish this group from those with fluctuating symptoms when estimating screening accuracies. We recommend a two-stage screening process to reduce false positives.
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Affiliation(s)
- Kristin Romvig Overgaard
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, PO box 4959, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, PO box 4959, 0424, Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, PO box 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Guido Biele
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Guilherme V Polanczyk
- Faculdade de Medicina FMUSP, Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, PO box 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Lavigne JV, Hopkins J, Ballard RJ, Gouze KR, Ariza AJ, Martin CP. A Precision Mental Health Model for Predicting Stability of 4-year-olds' Attention Deficit/Hyperactivity Disorder Symptoms to Age 6 Diagnostic Status. Acad Pediatr 2024; 24:433-441. [PMID: 37865171 PMCID: PMC10997456 DOI: 10.1016/j.acap.2023.09.003] [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: 02/07/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Estimates of the stability of a preschooler's diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) into early elementary school vary greatly. Identified factors associated with diagnostic instability provide little guidance about the likelihood a particular child will have ADHD in elementary school. This study examined an approach to predicting age 6 ADHD-any subtype (ADHD-any) from preschoolers' demographics and ADHD symptoms. METHOD Participants were 796 preschool children (Mage = 4.44; 51% boys; 54% White, non-Hispanic) recruited from primary pediatric care and school settings. Parents completed ADHD Rating Scales at child ages 4 and 5 years, and a structured diagnostic interview (DISC-YC) at ages 4 and 6. Classification tree analyses (CTAs) examined the predictive utility of demographic and symptom variables at ages 4 and 5 years for age 6 ADHD. RESULTS Over half (52.05%) of preschoolers meeting diagnostic criteria for ADHD-any at age 4 did not meet those criteria at age 6; more than half (52.05%) meeting criteria for ADHD-any at age 6 had not met those criteria at age 4. A CTA conducted at age 4 predicted age 6 ADHD-any diagnosis 65.82% better than chance; an age 5 CTA predicted age 6 ADHD-any 70.60% better than chance. At age 4, likelihood of age 6 ADHD-any diagnosis varied from <5% to >40% across CTA tree branches and from <5% to >78% at age 5. CONCLUSIONS Parent-reported patterns of preschool-age symptoms may differentially predict ADHD-any at age 6. Psychoeducation regarding these patterns may aid in decision about pursuing multidisciplinary evaluations or initiating treatment.
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Affiliation(s)
- John V Lavigne
- Pritzker Department of Psychiatry and Behavioral Health (JV Lavigne, RJ Ballard, KR Gouze, and CP Martin), Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill.
| | - Joyce Hopkins
- Department of Psychology (J Hopkins and CP Martin), Illinois Institute of Technology, Chicago, Ill
| | - Rachel J Ballard
- Pritzker Department of Psychiatry and Behavioral Health (JV Lavigne, RJ Ballard, KR Gouze, and CP Martin), Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Karen R Gouze
- Pritzker Department of Psychiatry and Behavioral Health (JV Lavigne, RJ Ballard, KR Gouze, and CP Martin), Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Adolfo J Ariza
- Department of Pediatrics (AJ Ariza and CP Martin), Ann and Robert H. Lurie Children's Hospital of Chicago, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Caroline P Martin
- Pritzker Department of Psychiatry and Behavioral Health (JV Lavigne, RJ Ballard, KR Gouze, and CP Martin), Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill; Institute for Child Success (CP Martin), Greenville, SC
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Vitiello B, Davico C, Döpfner M. Is prevention of ADHD and comorbid conditions in adolescents possible? J Atten Disord 2024; 28:225-235. [PMID: 37961885 DOI: 10.1177/10870547231211596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To examine how the concept of prevention is applicable to adolescent ADHD, which preventive interventions may be feasible, and which methods can be used to evaluate effectiveness. METHOD Following a literature search for prevention clinical trials relevant to adolescent ADHD, selected studies are critically reviewed to identify suitable targets and promising interventions. RESULTS There is some evidence from controlled studies that interventions delivered to prepubertal children at high risk for ADHD or diagnosed with ADHD may decrease the incidence or persistence of ADHD in adolescence. Uncontrolled follow-up of clinical samples and population studies suggest that treatment of adolescents with ADHD can decrease the risk for several negative functional outcomes in youth. A controlled trial found a specific cognitive training intervention to decrease risky driving. CONCLUSIONS Prevention of ADHD and associated negative outcomes is possible and of high clinical relevance. Assessing prevention effects is methodologically challenging, but feasible.
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Affiliation(s)
- Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- Department of Mental Health, School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Germany
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Carlson GA. Does the apple fall far from the tree? Commentary on Hafeman et al., early indicators of bipolar risk in preschool offspring of parents with bipolar disorder. J Child Psychol Psychiatry 2023; 64:1501-1504. [PMID: 37424107 DOI: 10.1111/jcpp.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
Comorbid externalizing and internalizing disorders are common in offspring of a parent with bipolar I or II disorder. In some cases, the symptoms are harbingers of future bipolar spectrum disorder. Even when they are not, they are likely to be impairing to the child. Clinicians need to be better informed about how the history leading up to mania/hypomania unfolds, and what comorbid disorders are impairing in and of themselves. More information is needed about the parents' psychopathology, course of illness and response to treatment. Until we have data on how to prevent bipolar disorder, the best course of action is to treat the child's current impairing symptoms and render the parent as asymptomatic as possible.
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Affiliation(s)
- Gabrielle A Carlson
- Division of Child and Adolescent Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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7
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Overgaard KR, Oerbeck B, Friis S, Pripp AH, Aase H, Biele G, Ingeborgrud CB, Polanczyk GV, Zeiner P. Attention-deficit/hyperactivity disorder from preschool to school age: change and stability of parent and teacher reports. Eur Child Adolesc Psychiatry 2023; 32:1947-1955. [PMID: 35737107 PMCID: PMC10533600 DOI: 10.1007/s00787-022-02019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Identifying attention-deficit/hyperactivity disorder (ADHD) in pre-schoolers may improve their development if treated, but it is unclear whether ADHD symptoms from this age are stable enough to merit treatment. We aimed to investigate the stability of parent- and teacher-reported ADHD symptoms and ADHD classified above the diagnostic symptom thresholds, including for hyperactivity-impulsivity (HI), inattention and combined presentations from age 3 to 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. At child age 3 years, parents were interviewed and teachers rated ADHD symptoms. At age 8 years, parents (n = 783) and teachers (n = 335) reported ADHD symptoms by the Child Symptom Inventory-4. We found a significant reduction in the mean number of parent-reported ADHD and HI symptoms from age 3 to 8 years, but otherwise similar mean numbers. Parent-reported ADHD symptoms were moderately correlated between ages, while correlations were low for teachers. A total of 77/108 (71%) of the children classified with parent-reported HI presentation at age 3 years were no longer classified within any ADHD presentation at age 8 years, the only clear trend across time for either informant. There was a low to moderate parent-teacher-agreement in the number of reported symptoms, and very low informant agreement for the classified ADHD presentations. Overall, clinicians should exercise caution in communicating concern about HI symptoms in preschool children. Age 3 years may be too early to apply the ADHD diagnostic symptom criteria, especially if parents and teachers are required to agree.
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Affiliation(s)
- Kristin Romvig Overgaard
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Guido Biele
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.B. 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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8
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Sugaya LS, Farhat LC, Califano P, Polanczyk GV. Efficacy of stimulants for preschool attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12146. [PMID: 37720577 PMCID: PMC10501696 DOI: 10.1002/jcv2.12146] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
Background Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD. Methods We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age ≤ 7 years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by the inverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597). Results Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference = -0.59; 95% CI -0.77, -0.41; p < 0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR = 0.59; 95% CI 0.15, 2.37; p = 0.45) but the confidence of estimate was very low. Conclusions Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.
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Affiliation(s)
- Luisa S. Sugaya
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
| | - Luis C. Farhat
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
| | - Pietro Califano
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
| | - Guilherme V. Polanczyk
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
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9
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Hunt E, Hogan A, Will EA, Roberts JE. ADHD and ASD symptoms in young males with fragile X syndrome: associations with early trajectories of inhibitory control. Child Neuropsychol 2023; 29:760-786. [PMID: 36082630 PMCID: PMC9995619 DOI: 10.1080/09297049.2022.2120605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Inhibitory control (IC), the ability to suppress inappropriate responses, emerges late in the first year of life and improves across typical development, concurrent with brain maturation. The development of IC is critical to various social-emotional and behavioral functions, with IC difficulties being linked to numerous neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Fragile X syndrome (FXS) is a single-gene disorder characterized by IC difficulties, and elevated rates of ADHD and ASD, making it a useful model for understanding the early development and consequences of IC. In this longitudinal study, we characterized IC trajectories across multiple time points between 16 and 71 months of age in young males with FXS (n = 79) relative to neurotypical (NT) controls (n=49). To explore the association between behavioral outcomes and IC, we identified a subsample of 50 children with longitudinal IC data and an outcome assessment for ADHD and ASD symptoms at age 5 (FXS: n = 26, NT: n = 24). Results indicated that, compared to their NT peers, young males with FXS exhibit differences in IC as early as 24 months, with group differences increasing through age 5. Additionally, we determined that lower IC levels at 24 months were associated with later ADHD symptoms and a decreasing slope in IC over time was associated with later ASD symptoms in male children with FXS. These findings help refine early developmental phenotypes of FXS and highlight IC as a potential target for early detection and intervention of ASD and ADHD symptoms in male children with FXS.
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Affiliation(s)
- Erin Hunt
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Abigail Hogan
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Elizabeth A Will
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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10
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Miller M, Arnett AB, Shephard E, Charman T, Gustafsson HC, Joseph HM, Karalunas S, Nigg JT, Polanczyk GV, Sullivan EL, Jones EJH. Delineating early developmental pathways to ADHD: Setting an international research agenda. JCPP ADVANCES 2023; 3:e12144. [PMID: 37753147 PMCID: PMC10519745 DOI: 10.1002/jcv2.12144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/13/2023] [Indexed: 09/28/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, impairing, and highly heritable condition typically diagnosed in middle childhood. However, it is now recognized that symptoms emerge much earlier in development. Research focused on understanding-using multiple units of analysis-the cascade of early-life (i.e., prenatal-infant-toddler) developmental changes that will later emerge as ADHD has the potential to transform early identification, prevention, and intervention. To this end, we introduce the recently established Early ADHD Consortium, an international network of investigators engaged in prospective, longitudinal studies of risk for ADHD beginning early in life, conducted within a developmental framework, and which incorporate multimethod approaches. This network seeks to harmonize measures and methodological approaches to increase the potential for data sharing and subsequent impact. Methods This perspective paper highlights the importance of investigating pre-diagnostic markers of ADHD, and potential models and mechanisms of ADHD risk and development, with the long-term objective of facilitating development of preemptive interventions that will minimize the impact of ADHD symptoms on everyday functioning and maximize health and developmental outcomes. Results We selectively describe key challenges and questions for this field related to theoretical models and developmental mechanisms in ADHD and recommend next steps for the science, including methodological, measurement, and study design considerations. We then describe potential implications for preemptive intervention development. We conclude by considering other issues including ethical concerns and the critical value of incorporating stakeholder input. Conclusions It is hoped that this perspective puts forth a research agenda that will enhance collaborative efforts and accelerate progress in understanding developmental mechanisms and the early ADHD phenotype, with implications for early intervention enhancement of healthy development for infants, young children, and their families.
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Affiliation(s)
- Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND InstituteUniversity of CaliforniaDavisCaliforniaUSA
| | - Anne B. Arnett
- Division of Developmental MedicineBoston Children's HospitalBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Elizabeth Shephard
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSao PauloBrasil
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN)King's College LondonLondonUK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN)King's College LondonLondonUK
| | | | - Heather M. Joseph
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sarah Karalunas
- Department of Psychological SciencesPurdue UniversityWest LafayetteIndianaUSA
| | - Joel T. Nigg
- Department of PsychiatryOregon Health & Science UniversityPortlandOregonUSA
| | - Guilherme V. Polanczyk
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSao PauloBrasil
| | - Elinor L. Sullivan
- Department of PsychiatryOregon Health & Science UniversityPortlandOregonUSA
| | - Emily J. H. Jones
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonLondonUK
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11
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Sonuga-Barke EJS, Becker SP, Bölte S, Castellanos FX, Franke B, Newcorn JH, Nigg JT, Rohde LA, Simonoff E. Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause. J Child Psychol Psychiatry 2023; 64:506-532. [PMID: 36220605 PMCID: PMC10023337 DOI: 10.1111/jcpp.13696] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Sven Bölte
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Division of Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Sweden
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Emily Simonoff
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
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12
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Storebø OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling Rasmussen P, Huus CML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2023; 3:CD009885. [PMID: 36971690 PMCID: PMC10042435 DOI: 10.1002/14651858.cd009885.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
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Affiliation(s)
- Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Maria Skoog
- Clinical Study Support, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Camilla Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Morris Zwi
- Islington Child and Adolescent Mental Health Service, Whittington Health, London, UK
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Erik Simonsen
- Research Unit, Mental Health services, Region Zealand Psychiatry, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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13
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Hall AM, Ramos AM, Drover SS, Choi G, Keil AP, Richardson DB, Martin CL, Olshan AF, Villanger GD, Reichborn-Kjennerud T, Zeiner P, Øvergaard KR, Sakhi AK, Thomsen C, Aase H, Engel SM. Gestational organophosphate ester exposure and preschool attention-deficit/hyperactivity disorder in the Norwegian Mother, Father, and Child cohort study. Int J Hyg Environ Health 2023; 248:114078. [PMID: 36455478 PMCID: PMC9898152 DOI: 10.1016/j.ijheh.2022.114078] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity-disorder (ADHD) is a leading neurodevelopmental disorder in children worldwide; however, few modifiable risk factors have been identified. Organophosphate esters (OPEs) are ubiquitous chemical compounds that are increasingly prevalent as a replacement for other regulated chemicals. Current research has linked OPEs to neurodevelopmental deficits. The purpose of this study was to assess gestational OPE exposure on clinically-assessed ADHD in children at age 3 years. METHODS In this nested case-control study within the Norwegian Mother, Father, and Child Cohort study, we evaluated the impact of OPE exposure at 17 weeks' gestation on preschool-age ADHD. Between 2007 and 2011, 260 ADHD cases were identified using the Preschool Age Psychiatric Assessment and compared to a birth-year-stratified control group of 549 children. We categorized bis(2-butoxyethyl) phosphate (BBOEP) and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) as values < limit of detection (LOD) (BBOEP N = 386, BDCIPP N = 632), ≥LOD but < limit of quantification (LOQ) (BBOEP N = 413; BDCIPP N = 75), or above LOQ (BBOEP N = 70; BDCIPP N = 102). Diphenyl phosphate (DPhP) and di-n-butyl phosphate (DnBP) were categorized as quartiles and also modeled with a log10 linear term. We estimated multivariable adjusted odds ratios (ORs) using logistic regression and examined modification by sex using an augmented product term approach. RESULTS Mothers in the 3rd DnBP quartile had 1.71 times the odds of having a child with ADHD compared to the 1st quartile (95%CI: 1.13, 2.58); a similar trend was observed for log10 DnBP and ADHD. Mothers with BDCIPP ≥ LOD but < LOQ had 1.39 times the odds of having a child with ADHD compared to those with BDCIPP < LOD (95%CI: 0.83, 2.31). Girls had lower odds of ADHD with increasing BBOEP exposure (log10 OR: 0.55 (95%CI: 0.37, 0.93), however boys had a weakly increased odds (log10 OR: 1.25 (95%CI: 0.74, 2.11) p-interaction = 0.01]. CONCLUSIONS We found modest increased odds of preschool ADHD with higher DnBP and BDCIPP exposure.
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Affiliation(s)
- Amber M Hall
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Amanda M Ramos
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Samantha Sm Drover
- Department of Public Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Giehae Choi
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Chantel L Martin
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gro D Villanger
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Mental Disorders, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin R Øvergaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Amrit K Sakhi
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Thomsen
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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14
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Rezey ML. A macro-level understanding of levels and trends in the abuse and homicide of children, 1997-2020. CHILD ABUSE & NEGLECT 2023; 137:106005. [PMID: 36682190 DOI: 10.1016/j.chiabu.2022.106005] [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: 07/17/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data suggest that U.S. rates of violence declined beginning in the 1990s. However, crime trend studies have not entirely agreed on reasons for the decline, and few have empirically assessed the decline in violence against children more specifically. OBJECTIVE This study investigates several competing hypotheses for explaining declines in reported child physical abuse, sexual abuse, and homicide. Attention is given to the importance of these explanatory factors for explaining both rates (levels) and year-over-year differences (trends) in these child outcomes. PARTICIPANTS AND SETTING Population-level state-panel data for the years 1997-2020 are used, totaling 1176 state-years. METHODS Linear panel-data models are used to examine the relationship between explanatory factors and levels and trends in rates of reported child abuse and child homicide. RESULTS As operationalized in this study, few of the hypotheses proposed for explaining declines in child victimization were associated with levels or trends in reported child abuse. The only explanatory factor significantly associated with lower rates of reported child physical abuse was the rate of alternative response. Year-over-year increases in lagged female incarceration rates were associated with year-over-year declines in rates of reported physical abuse. Several explanatory measures were associated with levels or trends in child homicide, while only methylphenidate distribution was associated with levels of reported child sexual abuse. CONCLUSIONS Policymakers should be aware of the importance of alternative response rates on rates of reported child physical abuse and recognize that macro-level declines in reported child victimization may only be possible if macro-level conditions are also addressed.
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Affiliation(s)
- Maribeth L Rezey
- Department of Criminal Justice and Criminology, Loyola University Chicago, Chicago, IL, United States of America.
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15
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Hatch B, Kadlaskar G, Miller M. Diagnosis and treatment of children and adolescents with autism and ADHD. PSYCHOLOGY IN THE SCHOOLS 2023; 60:295-311. [PMID: 37065905 PMCID: PMC10092654 DOI: 10.1002/pits.22808] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 11/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and autism are neurodevelopmental disorders that emerge in childhood. There is increasing recognition that ADHD and autism frequently co-occur. Yet, questions remain among clinicians regarding the best ways to evaluate and treat co-occurring autism and ADHD. This review outlines issues relevant to providing evidence-based practice to individuals and families who may be experiencing difficulties associated with co-occurring autism and ADHD. After describing the complexities of the co-occurrence of autism and ADHD, we present practical considerations for best practice assessment and treatment of co-occurring autism and ADHD. Regarding assessment, this includes considerations for interviewing parents/caregivers and youth, using validated parent and teacher rating scales, conducting cognitive assessments, and conducting behavior observations. Regarding treatment, consideration is given to behavioral management, school-based interventions, social skills development, and the use of medications. Throughout, we note the quality of evidence that supports a particular component of assessment or treatment, highlighting when evidence is most relevant to those with co-occurring autism and ADHD across stages of development. In light of the current evidence for assessment and treatment of co-occurring autism and ADHD, we conclude by outlining practical implications for clinical and educational practice.
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Affiliation(s)
- Burt Hatch
- School of PsychologyVictoria University of WellingtonWellingtonNew Zealand
| | - Girija Kadlaskar
- Department of Psychiatry & Behavioral Sciences and MIND InstituteUniversity of CaliforniaDavisCaliforniaUSA
| | - Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND InstituteUniversity of CaliforniaDavisCaliforniaUSA
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16
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Ben Shoham A, Shefer G, Tsafrir S. Patterns of longitudinal medical treatment of pediatric patients ever-diagnosed with attention deficit hyperactive disorder: A community-based, retrospective, naturalistic study. Clin Child Psychol Psychiatry 2022; 27:1033-1047. [PMID: 35729797 DOI: 10.1177/13591045221110732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pharmacological treatment for ADHD exhibits much variation. Longitudinal prescription-filling trajectories are interesting objects to explore. The goal of this study is to identify distinct patterns of longitudinal prescription filling among pediatric patients who were ever diagnosed with ADHD. METHODS Longitudinal data of ADHD-specific prescription filling during 2010-2019 of children diagnosed with ADHD during 2000-2019 who were 4-17-years-old at the time of diagnosis was obtained. Clustering of prescription-filling vectors was performed using K-means. RESULTS Analysis of 57,110 prescription vectors yields five distinct patterns: high intensity treatment, from early childhood to late teens (5.7%); moderate intensity, from early childhood to late teens (13.3%); high intensity, from late childhood to late teens (6.1%); moderate intensity, from late childhood to late teens (14.2%); and low intensity, sporadic treatment (60.7%). These patterns correspond with observed clinical presentations. CONCLUSIONS Identifying longitudinal prescription-filling patterns substantiates and qualifies the variation in long-term efficacy of pharmacological treatment for ADHD in a treatment-as-usual community setting. Prescription-filling implies that symptoms are present, and that treatment is efficacious, as perceived by parents' and carers. Prolonged pharmacological treatment was perceived to have had a positive net value for 40% of the children, which under appropriate reservations, provides weak evidence of efficacy.
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Affiliation(s)
- Assaf Ben Shoham
- Department of Family medicine, 36631Clalit health services, Jerusalem, Israel
| | - Galit Shefer
- Research Authority, Kaplan Medical Center, Rehovot, Israel
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Effectiveness of Clinic-Based Brief Behavioral Intervention (BBI) in Long-term Reduction of ADHD Symptoms Among Preschoolers. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09907-3. [PMID: 35976580 DOI: 10.1007/s10880-022-09907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Preschoolers commonly experience symptoms of ADHD and disruptive behavior problems. Behavioral parent management training (PMT) is an evidence-based intervention for addressing both ADHD and disruptive behaviors in this population; however, many PMT programs are burdensome in length and have limited data regarding long-term effectiveness for ADHD specific outcomes. This study examined outcomes up to 1 year following completion of a brief behavioral intervention (M = 6.51 sessions) for preschoolers. Participants were children aged 2-6 years with clinically significant disruptive behaviors and their parents. Results demonstrated significant improvements in parent-reported child hyperactivity and inattention from pre-to-post intervention, with sustained improvement at 6 months and 1 year post intervention. Teacher-reported hyperactivity and inattention also showed significant improvements from pre-to-post intervention, which were maintained across time points. These results were also found among a subset of participants with clinically significant ADHD symptoms at baseline. This study highlights the long-term effectiveness of a brief PMT program to address symptoms of ADHD and disruptive behaviors in preschoolers. Findings support the recommendation to offer PMT as a first-line intervention for preschoolers with ADHD symptoms to reduce the need for early intervention with stimulant medication and address comorbid disruptive behaviors.
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Law E, Sideridis G, Alkhadim G, Snyder J, Sheridan M. Classifying Young Children with Attention-Deficit/Hyperactivity Disorder Based on Child, Parent, and Family Characteristics: A Cross-Validation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159195. [PMID: 35954547 PMCID: PMC9368489 DOI: 10.3390/ijerph19159195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
We aimed to identify subgroups of young children with differential risks for ADHD, and cross-validate these subgroups with an independent sample of children. All children in Study 1 (N = 120) underwent psychological assessments and were diagnosed with ADHD before age 7. Latent class analysis (LCA) classified children into risk subgroups. Study 2 (N = 168) included an independent sample of children under age 7. A predictive model from Study 1 was applied to Study 2. The latent class analyses in Study 1 indicated preference of a 3-class solution (BIC = 3807.70, p < 0.001). Maternal education, income-to-needs ratio, and family history of psychopathology, defined class membership more strongly than child factors. An almost identical LCA structure from Study 1 was replicated in Study 2 (BIC = 5108.01, p < 0.001). Indices of sensitivity (0.913, 95% C.I. 0.814−0.964) and specificity (0.788, 95% C.I. 0.692−0.861) were high across studies. It is concluded that the classifications represent valid combinations of child, parent, and family characteristics that are predictive of ADHD in young children.
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Affiliation(s)
- Evelyn Law
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
- Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
- Singapore Institute of Clinical Sciences, Agency of Science, Technology and Research, Singapore 117609, Singapore
| | - Georgios Sideridis
- ICCTR, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Primary Education, National and Kapodistrian University of Athens, 157 72 Athens, Greece
- Correspondence:
| | - Ghadah Alkhadim
- Department of Psychology, College of Arts, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia;
| | - Jenna Snyder
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA; (J.S.); (M.S.)
| | - Margaret Sheridan
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA; (J.S.); (M.S.)
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder in childhood. The major components of this disorder are developmentally inappropriate levels of inattention and hyperactivity/impulsivity, which result in functional impairment in 1 or more areas of academic, social, and emotional function. In addition to the propensity for children to have some compromise of academic and emotional function, children with ADHD also have a higher frequency of co-occurring learning, cognitive, language, motor, and mental health disorders. Similarly, children with developmental disorders have a higher risk of co-occurring ADHD. The diagnosis of ADHD can be ascertained by a review of the risks for the condition, consideration of masquerading conditions, a careful history and physical examination, and the recognition of co-occurring disorders. The signs and symptoms of co-occurring disorders and the management of ADHD differ across early childhood, middle childhood, and adolescence. Management is largely limited to behavioral and pharmacologic interventions, and it favors behavioral strategies in early childhood, pharmacologic and behavioral strategies in middle childhood, and pharmacologic interventions in adolescence. This article offers an approach to the evaluation, presentation, and management of ADHD with a focus on guiding primary care pediatricians.
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Affiliation(s)
- Meghna Rajaprakash
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary L Leppert
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Spencer AE, Oblath R, Sheldrick RC, Ng LC, Silverstein M, Garg A. Social Determinants of Health and ADHD Symptoms in Preschool-Age Children. J Atten Disord 2022; 26:447-455. [PMID: 33641514 PMCID: PMC8408273 DOI: 10.1177/1087054721996458] [Citation(s) in RCA: 2] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Attention-Deficit/Hyperactivity Disorder (ADHD) disproportionately affects socioeconomically disadvantaged children, but for unclear reasons. We examined the association between social determinants of health (SDH) and ADHD symptoms in a national sample of preschool-age children. METHODS We conducted exploratory factor analysis (EFA) and exploratory structural equation modeling (ESEM) with a sample of 7,565 preschool-age children from the 2016 National Survey of Children's Health, to examine the association between ADHD symptoms and SDH. RESULTS EFA indicated a one-factor structure for ADHD symptoms, and three factors for SDH (socioeconomic status, access to basic needs, and caregiver well-being). Independently, all three SDH were significantly associated with higher ADHD symptoms. However, in the ESEM model, only worse caregiver well-being (β = .39, p < .01) was significantly associated with ADHD symptoms, and fully mediated the relationship between SDH and ADHD symptoms. CONCLUSION Addressing caregiver well-being in preschoolers with ADHD symptoms could be an early intervention strategy.
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Affiliation(s)
- Andrea E. Spencer
- Boston University School of Medicine, Boston Medical Center, MA, USA
| | - Rachel Oblath
- Boston University School of Medicine, Boston Medical Center, MA, USA
| | | | | | | | - Arvin Garg
- Boston University School of Medicine, Boston Medical Center, MA, USA
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21
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Martin CP, Shoulberg EK, Hoza B. The Developmental Course of Teacher-Rated ADHD Symptom Levels in an Early Childhood Community Sample. J Atten Disord 2022; 26:456-466. [PMID: 33660546 DOI: 10.1177/1087054721997561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined trajectories of inattention and hyperactivity/impulsivity symptom levels across one preschool year and explored variation in trajectories by age, sex, and end-of-year impairment. METHOD Participants were 261 preschoolers (87% Head Start; 59% Caucasian; 53% boys; Mage = 3.97 years). Teachers rated ADHD symptom levels four times throughout one academic year. RESULTS Results showed a course of increasing inattention that decelerated over time and steadily increasing hyperactivity/impulsivity. Group-based finite mixture modeling revealed three trajectories of inattention: stable low (57%), change (32%), and stable high (11%), as well as three trajectories of hyperactivity/impulsivity: stable low (63%), increasing (26%), and stable high (11%). Compared to children with increasing or changing symptoms levels, children with stable high levels were more impaired and children with stable low symptom levels were less impaired. CONCLUSION Findings suggest a "wait and see" approach to treatment may miss an important opportunity for early intervention.
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Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. Recent investigations have shed light on different aspects regarding the trajectory of ADHD, including reports on risk factors in childhood, that are associated with remission or persistence in adulthood. Despite significant advances in our understanding of the pathophysiology of the disorder, the diagnosis of ADHD remains strictly clinical and is based on behavioral symptoms of inattention, impulsivity, and hyperactivity. In this chapter we review the diagnostic process of ADHD, discuss the clinical presentation of the disorder across the lifespan, and examine patterns of comorbidity and longitudinal predictor of outcomes.
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Affiliation(s)
- Douglas Teixeira Leffa
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Arthur Caye
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
- National Institute of Developmental Psychiatry, São Paulo, Brazil.
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Overgaard KR, Oerbeck B, Friis S, Pripp AH, Aase H, Zeiner P. Predictive validity of attention-deficit/hyperactivity disorder from ages 3 to 5 Years. Eur Child Adolesc Psychiatry 2022; 31:1-10. [PMID: 33677627 PMCID: PMC9343262 DOI: 10.1007/s00787-021-01750-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
We investigated to what extent parent-rated attention-deficit/hyperactivity disorder (ADHD) and impairment at age 3 years predicted elevated ADHD symptoms at age 5 years, and whether teacher-rated ADHD symptoms improved these predictions. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-old children (n = 1195) were interviewed about ADHD and impairment, and teachers rated child ADHD symptoms by the Strengths and Difficulties Questionnaire or the Early Childhood Inventory-4. At 5 years of age, the children (n = 957) were classified as ADHD-positive or -negative using Conners' Parent Rating Scale. Relying solely on parent-rated ADHD or impairment at age 3 years did moderately well in identifying children with persistent elevation of ADHD symptoms, but gave many false positives (positive predictive values (PPVs): .40-.57). A small group of children (n = 20, 13 boys) scored above cut-off on both parent-rated ADHD and impairment, and teacher-rated ADHD symptoms, although adding teacher-rated ADHD symptoms slightly weakened the predictive power for girls. For this small group, PPVs were .76 for boys and .64 for girls. Limiting follow-up to these few children will miss many children at risk for ADHD. Therefore, we recommend close monitoring also of children with parent-reported ADHD symptoms and/or impairment to avoid delay in providing interventions. Clinicians should also be aware that teachers may miss ADHD symptoms in preschool girls.
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Affiliation(s)
- Kristin Romvig Overgaard
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Shuai L, Wang Y, Li W, Wilson A, Wang S, Chen R, Zhang J. Executive Function Training for Preschool Children With ADHD: A Randomized Controlled Trial. J Atten Disord 2021; 25:2037-2047. [PMID: 32964771 DOI: 10.1177/1087054720956723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This randomized controlled study explored the efficacy, feasibility, and acceptability of executive function training (EFT) for preschool children with ADHD. METHOD The current study design was an 8 week randomized parallel groups, single-blinded trial, using EFT-P. A total of 96 children with an ADHD diagnosis at age 4 to 5 years old were randomized into the intervention group and waitlist group. In the intervention group, 46 out of 50 participants completed the 8-week program, compared with 39 out of 46 in the waiting group. The level of ADHD symptoms and the executive function (EF) were evaluated by both neuropsychological tests from NEPSY Second Edition (NEPSY-II) and Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P). RESULTS The EFT is feasible to administer and is acceptable for preschool children, with a 93% retention rate. Results showed that following the intervention, the visual-motor precision (p = .024), ADHD diagnostic state (p = .01), and oppositional defiant symptoms (p = .023) improved significantly in preschool children. However, the symptoms of ADHD and other EF evaluations were found to be insignificant. CONCLUSION The EFT is feasible, acceptable, and potentially effective to reduce symptoms and improve EF for preschool children with ADHD. The next step is to extend the program time and provide more frequent practice of activities between the children and the therapist and/or parent, to improve the effectiveness.
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Affiliation(s)
- Lan Shuai
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, China
| | | | - Wei Li
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | | | - Shanshan Wang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Runsen Chen
- Central South University, Chinese National Clinical Research Centre on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, China
| | - Jinsong Zhang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, China
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25
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Hare MM, Graziano PA. Treatment Response among Preschoolers with Disruptive Behavior Disorders: The Role of Temperament and Parenting. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:950-965. [PMID: 33275456 PMCID: PMC8175459 DOI: 10.1080/15374416.2020.1846540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: This study examined associations between temperament (negative affect, effortful control, and surgency) and symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) within a diverse preschool sample. Interactions between temperament and parenting in the prediction of ADHD/ODD symptoms before and after an 8-week early intervention program (i.e., Summer Treatment Program for Pre-kindergartners; STP-PreK) were also examined.Method: The sample included 215 children (Mage = 5.0, 80.9% male, 84.7% Latinx) with a diagnosis of ADHD and/or ODD who completed the STP-PreK. Temperament was measured via parent report while ADHD/ODD symptoms were assessed via combination of parent and teacher report. Positive and negative parenting were assessed via rating scales and a standardized parent-child interaction observation.Results: Higher surgency was associated with greater symptom severity of ADHD/ODD pre- and post-treatment. Higher negative affect was associated with greater symptom severity of ODD pre- and post-treatment, while higher effortful control was only associated with lower symptom severity of inattention pre-treatment. Positive parenting predicted lower symptom severity of ADHD/ODD post-treatment. Moderation analyses indicated that the benefits of low levels of negative parenting only occurred when paired with low temperament risk for symptoms of hyperactivity and ODD. Additionally, only the combination of high surgency and high observed negative parenting resulted in greater symptom severity of ODD. Finally, decreases in inconsistent discipline predicted decreases across all symptom domains post-treatment.Conclusions: Our findings add to the temperament-based model of ADHD/ODD by highlighting temperament's unique prediction of treatment response as well as important interactions with the caregiving environment.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University
| | - Paulo A Graziano
- Center for Children and Families, Department of Psychology, Florida International University
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26
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Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2021; 41 Suppl 2S:S35-S57. [PMID: 31996577 DOI: 10.1097/dbp.0000000000000770] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder and is associated with an array of coexisting conditions that complicate diagnostic assessment and treatment. ADHD and its coexisting conditions may impact function across multiple settings (home, school, peers, community), placing the affected child or adolescent at risk for adverse health and psychosocial outcomes in adulthood. Current practice guidelines focus on the treatment of ADHD in the primary care setting. The Society for Developmental and Behavioral Pediatrics has developed this practice guideline to facilitate integrated, interprofessional assessment and treatment of children and adolescents with "complex ADHD" defined by age (<4 years or presentation at age >12 years), presence of coexisting conditions, moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.
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Loyer Carbonneau M, Demers M, Bigras M, Guay MC. Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits. J Atten Disord 2021; 25:1640-1656. [PMID: 32495675 DOI: 10.1177/1087054720923736] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: A meta-analysis was carried out to determine whether there are sex differences among children and adolescents with ADHD on the primary symptoms of ADHD and on executive and attentional functioning. Method: Studies published from 1997 to 2017 comparing boys and girls with a valid ADHD diagnosis were retained. Results: The meta-analysis found boys with ADHD to be more hyperactive than girls with ADHD and boys to have more difficulties in terms of motor response inhibition and cognitive flexibility. Results also confirm that youths with ADHD have more executive deficits than non-ADHD peers have, but there is no sex difference in this regard. Conclusion: Results show that there are sex differences in the behavioral expression of the difficulties related to ADHD. This highlights the importance of pursuing research to refine the profile of girls with ADHD and to develop diagnostic criteria adapted to each sex.
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Sharma E, Jacob P, Dharmendra A, Reddy YCJ, Seshadri SP, Girimaji SC, Vijaysagar KJ. Preschool-onset OCD: A review of literature and clinical experience. Bull Menninger Clin 2021; 85:298-315. [PMID: 34468213 DOI: 10.1521/bumc.2021.85.3.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2-3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those treated adequately.
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Affiliation(s)
- Eesha Sharma
- Assistant professor, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Preeti Jacob
- Associate professor, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Apoorva Dharmendra
- PhD Scholar in Clinical Neurosciences in the Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Y C Janardhan Reddy
- Professor in the Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Shekhar P Seshadri
- Senior professors, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sathish C Girimaji
- Senior professors, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - K John Vijaysagar
- Professor and head in the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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29
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Miller M, Iosif AM, Bell LJ, Farquhar-Leicester A, Hatch B, Hill A, Hill MM, Solis E, Young GS, Ozonoff S. Can Familial Risk for ADHD Be Detected in the First Two Years of Life? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:619-631. [PMID: 31951755 PMCID: PMC7365744 DOI: 10.1080/15374416.2019.1709196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: We evaluated trajectories of attention-deficit/hyperactivity (ADHD)-relevant behaviors in a sample of infants at high and low familial risk for ADHD who were prospectively evaluated at 12, 18, and 24 months of age.Method: Participants included 43 infants at risk for ADHD based on family history (i.e., diagnosed first-degree relative) and 40 low-risk infants (i.e., no family history of ADHD). Instances of inattention, out-of-seat, and grabbing behavior were coded from video; analogous constructs were rated by examiners unaware of familial risk status after completing structured standardized assessments with the infants/toddlers. At the end of each study visit, examiners solicited parents' concerns about their child's behavior. Differences in ADHD-related behaviors and parent concerns were examined between 12 and 24 months of age.Results: Infants with an older sibling or parent diagnosed with ADHD were distinguishable from infants with no family history of ADHD as early as 12 months of age based on directly observed and examiner reports of behavior, particularly with respect to hyperactive-impulsive behavior. Parents of infants at familial risk for ADHD also reported significantly more behavior/temperament concerns as early as 12 months of age compared to parents of infants at low risk for ADHD.Conclusions: These findings highlight the ability to detect genetic liability for ADHD by the end of the first year of life, suggesting that well-designed family risk studies of ADHD are feasible and may be clinically valuable. They also suggest the potential for earlier detection of risk for ADHD than has previously been possible.
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Affiliation(s)
- Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis
| | - Laura J Bell
- Department of Psychology, University of California, Berkeley
| | | | - Burt Hatch
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Alesha Hill
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Monique Moore Hill
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Erika Solis
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Gregory S Young
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Sally Ozonoff
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
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The preattentive change detection in preschool children with attention deficit hyperactivity disorder: a mismatch negativity study. Neuroreport 2021; 31:776-779. [PMID: 32453022 DOI: 10.1097/wnr.0000000000001472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the preattentive change detection in preschool children with attention deficit hyperactivity disorder (ADHD), we compared the mismatch negativity (MMN) and P3a of event-related potentials (ERPs) between preschool ADHD and normal children using three-stimulus oddball paradigm. Analyzing MMN and P3a components, we found that MMN elicited by deviants and P3a elicited by novelty were significantly reduced in patients than in controls. In addition, the P3a amplitude was positive correlated to IQ and negatively correlated to hyperactivity, antagonistic defiance and conduct problems in Swanson, Nolan, and Pelham IV Rating Scale, parent version. These data provided new neurophysiological evidence for the dysfunction of preattentive change detection and attentional shift in ADHD children.
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31
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Caye A, Leffa DT, Rohde LA. The influence of comorbidities on the trajectories of ADHD throughout development. Neurosci Biobehav Rev 2021; 130:31-32. [PMID: 34375674 DOI: 10.1016/j.neubiorev.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Arthur Caye
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 4o Andar - Serviço de Psiquiatria, Porto Alegre, RS, CEP 90035-003, Brazil; National Institute of Developmental Psychiatry (INPD, CNPq), Rua Dr. Ovídio Pires de Campos, 785 1º Andar, Sala 6, Ala sul, Bairro Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
| | - Douglas Teixeira Leffa
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 4o Andar - Serviço de Psiquiatria, Porto Alegre, RS, CEP 90035-003, Brazil; National Institute of Developmental Psychiatry (INPD, CNPq), Rua Dr. Ovídio Pires de Campos, 785 1º Andar, Sala 6, Ala sul, Bairro Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 4o Andar - Serviço de Psiquiatria, Porto Alegre, RS, CEP 90035-003, Brazil; National Institute of Developmental Psychiatry (INPD, CNPq), Rua Dr. Ovídio Pires de Campos, 785 1º Andar, Sala 6, Ala sul, Bairro Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
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Halperin JM, Marks DJ, Chacko A, Bedard AC, O'Neill S, Curchack-Lichtin J, Bourchtein E, Berwid OG. Training Executive, Attention, and Motor Skills (TEAMS): a Preliminary Randomized Clinical Trial of Preschool Youth with ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2021; 48:375-389. [PMID: 31834588 DOI: 10.1007/s10802-019-00610-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This preliminary randomized controlled trial compared Training Executive, Attention and Motor Skills (TEAMS), a played-based intervention for preschool children with attention-deficit/hyperactivity disorder (ADHD), to an active comparison intervention consisting of parent education and support (ClinicalTrials.gov Identifier: NCT01462032). The primary aims were to gauge preliminary efficacy and assist in further development of TEAMS. Four- and 5-year-old children with ADHD were randomly assigned to receive TEAMS (N = 26) or the comparison intervention (N = 26) with blinded assessments by parents, teachers and clinicians ascertained pretreatment, post-treatment, and 1- and 3-months post-treatment. Changes in ADHD severity, impairment, parenting factors, and neuropsychological functioning over time as a function of treatment condition were assessed using the PROC MIXED procedure in SAS. Across most measures, significant main effects for Time emerged; both treatments were associated with reduced ADHD symptoms that persisted for three months post-treatment. There were no significant Treatment effects or Time x Treatment interactions on symptom and impairment measures, suggesting that the magnitude of improvement did not differ between the two interventions. However, significant correlations emerged between the magnitude of behavioral change, as assessed by parents and clinicians, and the amount of time families engaged in TEAMS-related activities during treatment. Across a wide array of parenting and neuropsychological measures, there were few significant group differences over time. TEAMS and other psychosocial interventions appear to provide similar levels of benefit. Play-based interventions like TEAMS represent a potentially viable alternative/addition to current ADHD treatments, particularly for young children, but more research and further development of techniques are necessary.
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Affiliation(s)
- Jeffrey M Halperin
- Psychology Department, Queens College and the Graduate Center, City University of New York, 65-30 Kissena Boulevard, Flushing, New York, 11367, USA.
| | | | - Anil Chacko
- New York University - Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Anne-Claude Bedard
- Ontario Institute for Studies in Education, the University of Toronto, Toronto, Canada
| | - Sarah O'Neill
- The City College and the Graduate Center, City University of New York, New York, NY, USA
| | | | | | - Olga G Berwid
- York College, City University of New York, New York, NY, USA
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Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions. CNS Drugs 2021; 35:403-424. [PMID: 33770390 DOI: 10.1007/s40263-021-00806-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 01/27/2023]
Abstract
In this review, we consider issues relating to the pharmacological treatment of young children with attention deficit hyperactivity disorder (ADHD). ADHD in preschool-age children has a profound impact on psychosocial function and developmental trajectory. Clinical studies on pharmacotherapies for ADHD in young children have expanded rapidly in the past 2 decades, providing some evidence of efficacy for both psychostimulant and non-psychostimulant medications. However, preschool children may be more susceptible to adverse effects of medications, including growth reduction and cardiovascular side effects. Many questions remain regarding the long-term safety and effectiveness of these interventions; thus more research is needed to help clinicians evaluate the risk-benefit ratio for preschoolers with ADHD. As this body of knowledge grows, providers should consider the level of impairment caused by current symptoms in the risk-benefit analysis. Families should be educated not just about potential effects of medication but known complications of untreated ADHD; parents will likely not fully appreciate the long-term psychological effects of chronic behavioral problems and underachievement on a young child. A blanket "wait and see" approach should be avoided, in order to prevent a permanent loss of self-esteem and motivation that may affect some children throughout their lifespan.
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Sluiter MN, de Vries YA, Koning LG, Hak E, Bos JHJ, Schuiling-Veninga CCM, Batstra L, Doornenbal JM, de Jonge P. A Prescription Trend Analysis of Methylphenidate: Relation to Study Reports on Efficacy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:291-299. [PMID: 31620909 DOI: 10.1007/s10488-019-00983-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Use of methylphenidate in children has increased substantially, despite conflicting evidence regarding efficacy. In this study, prescription data were analyzed in relation to the publication of new evidence regarding efficacy. Incidence rates and prescribed doses of methylphenidate increased, with a decline during the last few years. Duration of use is still increasing. In half of the cases, starting dosages are higher than recommended in guidelines. There was little evidence that publication of new evidence directly influenced the use of methylphenidate. Recent and critical study findings should receive more attention to contribute to the development and use of treatment guidelines for ADHD and evidence-based methylphenidate use.
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Affiliation(s)
- Maruschka N Sluiter
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands.
- Youth, Education and Society, Hanze University of Applied Sciences, Groningen, Groningen, The Netherlands.
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
| | - Lotte G Koning
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
| | - Eelko Hak
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Laura Batstra
- Department of Special Needs Education and Child Care, University of Groningen, Groningen, The Netherlands
| | - Jeannette M Doornenbal
- Youth, Education and Society, Hanze University of Applied Sciences, Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
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Soled D, Keim SA, Rapoport E, Rosen L, Adesman A. Breastfeeding Is Associated with a Reduced Risk of Attention-Deficit/Hyperactivity Disorder Among Preschool Children. J Dev Behav Pediatr 2021; 42:9-15. [PMID: 33347037 DOI: 10.1097/dbp.0000000000000854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breastfeeding has been associated with a lower risk of attention-deficit/hyperactivity disorder (ADHD). However, most studies examining this association have focused on small samples outside the United States or were likely subject to substantial residual confounding. Our objectives were to investigate, in a nationally representative sample of preschool children in the United States, the associations between ADHD and both age of breastfeeding cessation and age of formula introduction, as well as associations between ADHD and exclusive breastfeeding duration. METHODS Analysis of data from children aged 3 to 5 years in the 2011/12 National Survey of Children's Health (n = 12,793). Logistic regressions were used to model current medical diagnosis of preschool ADHD as a function of breastfeeding duration, breastfeeding exclusivity, and the timing of formula introduction with adjustment for 12 potential confounders using propensity scores, including sex, age, race, household income, prematurity, insurance, and medical home. RESULTS After adjustment for potential confounders, exclusive breastfeeding for at least 6 months was associated with substantially reduced odds of ADHD (adjusted prevalence odds ratio [aPOR] = 0.38; 95% confidence interval [CI], 0.15-0.99). Breastfeeding duration was also associated with ADHD, with 8% reduced odds of ADHD for each additional month of breastfeeding (aPOR = 0.92; 95% CI, 0.86-0.99). The results for exclusive breastfeeding duration were similar, but the confidence interval included the null (aPOR = 0.92; 95% CI, 0.85-1.00). The age of formula introduction was not associated with ADHD (aPOR = 0.92; 95% CI, 0.81-1.05). CONCLUSION In a nationally representative sample of preschool children, breastfeeding was associated with a lower prevalence of ADHD. These findings provide evidence in support of the neurodevelopmental benefits of breastfeeding.
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Affiliation(s)
- Derek Soled
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY
| | - Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH
| | - Eli Rapoport
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY
| | | | - Andrew Adesman
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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Fedewa A, Mayo MR, Ahn S, Erwin H. A School-Based Physical Activity Intervention for Young Children: Are There Effects on Attention and Behavior? JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2020. [DOI: 10.1080/15377903.2020.1858380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Soyeon Ahn
- University of Miami, Coral Gables, Florida, USA
| | - Heather Erwin
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
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Davis DW, Feygin Y, Creel L, Kong M, Jawad K, Sun J, Blum NJ, Lohr WD, Williams PG, Le J, Jones VF, Pasquenza N. Epidemiology of Treatment for Preschoolers on Kentucky Medicaid Diagnosed with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:448-455. [PMID: 32614247 DOI: 10.1089/cap.2020.0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives: The National Survey of Children's Health reported a concerning increase in children 2-5 years being diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 2016. Concerns include both the increase in diagnosing and potential deviations from published guidelines for the treatment of ADHD in preschoolers. The present study aims to describe the epidemiology and factors associated with receiving the diagnosis and treatment types for low-income preschoolers. Methods: Using Kentucky Medicaid claims from 2012 to 2017, a retrospective cohort study of children 2-5 years of age (n = 337,631) with a diagnosis of ADHD (n = 11,712) was completed. Trends in demographics, comorbidities, and treatment and provider types are presented. Multinomial logistic regression was used to determine predictors of receipt of the diagnosis and treatment type (a stimulant only, an alpha-2 agonist [A2A] only, both, or neither) based on nonmissing 2017 data (n = 2394). Results: The number of children in the cohort diagnosed with ADHD and receiving a stimulant decreased from 2012 to 2017, but the use of A2As increased. Primary care physicians were the most frequent prescribers of both medications. The adjusted odds ratios (AORs) of receipt of an A2A alone, stimulant alone, or both medications over receiving no ADHD medication were associated with specific demographics and comorbid conditions for each medication regimen. Race/ethnicity is associated with receiving the diagnosis of ADHD and treatment with A2A. Comorbid mental health conditions and provider type are associated with treatment type. Conclusion: Use of stimulants for preschoolers in Kentucky has decreased and A2A use has increased since 2012. Continued vigilance and long-term follow-up of preschoolers with ADHD are warranted. The appropriateness of the diagnosis and treatment type could not be determined.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yana Feygin
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Liza Creel
- Department of Health Management and System Sciences and University of Louisville School of Public Health and Information Science, Louisville, Kentucky, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Science, Louisville, Kentucky, USA
| | - Kahir Jawad
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - JingChao Sun
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Science, Louisville, Kentucky, USA
| | - Nathan J Blum
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - P Gail Williams
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jennifer Le
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - V Faye Jones
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Natalie Pasquenza
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Pearson DA, Santos CW, Aman MG, Arnold LE, Lane DM, Loveland KA, Mansour R, Ward AR, Casat CD, Jerger S, Schachar RJ, Bukstein OG, Cleveland LA. Effects of Extended-Release Methylphenidate Treatment on Cognitive Task Performance in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:414-426. [PMID: 32644833 PMCID: PMC7475091 DOI: 10.1089/cap.2020.0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: To examine the effectiveness of four doses of psychostimulant medication, combining extended-release methylphenidate (ER-MPH) in the morning with immediate-release MPH (IR-MPH) in the afternoon, on cognitive task performance. Method: The sample comprised 24 children (19 boys and 5 girls) who met the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text Revision (DSM-IV-TR) criteria for an autism spectrum disorder (ASD) on the Autism Diagnostic Interview-R and the Autism Diagnostic Observation Schedule, and had significant symptoms of attention-deficit/hyperactivity disorder (ADHD). This sample consisted of elementary school-age, community-based children (mean chronological age = 8.8 years, SD = 1.7; mean intelligence quotient = 85; SD = 16.8). Effects of placebo and three dose levels of ER-MPH (containing 0.21, 0.35, and 0.48 mg/kg equivalent of IR-MPH) on cognitive task performance were compared using a within-subject, crossover, placebo-controlled design. Each of the four MPH dosing regimens (placebo, low-dose MPH, medium-dose MPH, and high-dose MPH) was administered for 1 week; the dosing order was counterbalanced across children. Results: MPH treatment was associated with significant performance gains on cognitive tasks tapping sustained attention, selective attention, and impulsivity/inhibition. Dose/response was generally linear in the dose range studied, with no evidence of deterioration in performance at higher MPH doses in the dose range studied. Conclusion: The results of this study suggest that MPH formulations are associated with significant improvements on cognitive task performance in children with ASD and ADHD.
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Affiliation(s)
- Deborah A. Pearson
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cynthia W. Santos
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | | | - David M. Lane
- Department of Psychological Sciences and Department of Statistics, Rice University, Houston, Texas, USA
| | - Katherine A. Loveland
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rosleen Mansour
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Anthony R. Ward
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles D. Casat
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Susan Jerger
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas, USA
| | | | | | - Lynne A. Cleveland
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Wigal S, Chappell P, Palumbo D, Lubaczewski S, Ramaker S, Abbas R. Diagnosis and Treatment Options for Preschoolers with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:104-118. [PMID: 31967914 PMCID: PMC7047251 DOI: 10.1089/cap.2019.0116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), classifies attention-deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder, with symptoms becoming apparent as early as the preschool years. Early recognition can lead to interventions such as parent/teacher-administered behavior therapy, the recommended first-line treatment for preschool patients. There are few data, however, to inform the use of second-line, pharmacotherapy options in this population. In this review, we identified recent literature on the diagnosis and treatment of ADHD in preschool children. Methods: A PubMed and clinicaltrials.gov search was conducted for trials assessing efficacy or safety of ADHD medications in children aged <6 years. Diagnostic methods and criteria focusing on recognition of ADHD in preschool children were also surveyed. Results: The DSM-5 describes different manifestations of ADHD in preschool versus school-aged children, but does not list separate criteria by age group. Importantly, behaviors indicative of ADHD in older children may be developmentally appropriate in preschool children. Several behavioral rating scales have been validated in children younger than 6 years of age for assessing ADHD. The Preschool ADHD Treatment Study (PATS) has provided the most extensive efficacy and safety data on methylphenidate (MPH) for ADHD in preschoolers to date, with significant improvement in ADHD symptoms observed with MPH compared with placebo, although adverse event-related discontinuation was higher in PATS compared with studies of MPH for ADHD in school-aged children. Since PATS was conducted, few studies designed to assess ADHD medication effectiveness in preschool children have been published. One article reported significant improvement in ADHD symptoms with MPH (immediate release) versus placebo, two studies showed no difference between MPH and risperidone or MPH plus risperidone in relief of ADHD symptoms, and one study demonstrated the efficacy of atomoxetine versus placebo for ADHD symptoms in preschoolers. Conclusions: Further research is needed on pharmacotherapy for preschool children with ADHD.
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Affiliation(s)
- Sharon Wigal
- AVIDA Inc., Newport Beach, California.,Address correspondence to: Sharon Wigal, PhD, AVIDA Inc., 1133 Camelback Street #9802, Newport Beach, CA 92658
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A review of measures used to examine medication adherence in people with ADHD at initiation, implementation and discontinuation of pharmacotherapy. Res Social Adm Pharm 2020; 16:277-289. [DOI: 10.1016/j.sapharm.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/29/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
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Vaidyanathan S, Rajan TM, Chandrasekaran V, Kandasamy P. Pre-school attention deficit hyperactivity disorder: 12 weeks prospective study. Asian J Psychiatr 2020; 48:101903. [PMID: 31865197 DOI: 10.1016/j.ajp.2019.101903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Extant literature lack studies on behavioural training or pharmacotherapy in Indian preschool children. With adverse long term outcomes, effective, safe and affordable early interventions for ADHD are a priority. Aim of this prospective study is to report on short term outcome of preschool ADHD with specific focus on safety and tolerability of medications. METHODS Children with ADHD aged 2.5-6 years were assessed for severity and adverse events at baseline and follow-up using Conner's abbreviated rating scale and Clinical Global Impression-Severity scale. Children with Autism spectrum disorder and those with social quotient less than 50 were excluded. Statistical Analysis included descriptive statistics and Repeated measures ANOVA. RESULTS Of 56 children recruited, 33.93 %(N = 19) were on behavioural interventions alone, 66.07 %(N = 37) were on a combination of medication and behavioural intervention. All children received treatment according to standard care. The most prescribed drug was clonidine (44.64%), then risperidone (28.7%), methylphenidate (10.7%) and atomoxetine (10.7%). Medication choice was determined by affordability, availability and comorbidity profile. Sedation occurred in 24 % of children on clonidine. Atomoxetine was not well tolerated in 2 children. Methylphenidate was well tolerated. Irrespective of medication choice, all children showed significant improvement at 12 weeks (p < 0.001). CONCLUSIONS Choice of interventions is largely determined by availability and affordability. There is a need for structured parent behavioural training program deliverable in low resource setting. Anti-ADHD medications should be made available under the NMHP, RBSK program and all government settings in India, to address over-prescription of antipsychotics in preschool ADHD.
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Affiliation(s)
- Sivapriya Vaidyanathan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Tess Maria Rajan
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.
| | - Venkatesh Chandrasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Preeti Kandasamy
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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42
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McCabe KM, Yeh M, Zerr AA. Personalizing Behavioral Parent Training Interventions to Improve Treatment Engagement and Outcomes for Culturally Diverse Families. Psychol Res Behav Manag 2020; 13:41-53. [PMID: 32021508 PMCID: PMC6966146 DOI: 10.2147/prbm.s230005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral Parent Training (BPT) interventions are efficacious for young children with externalizing behavior problems. However, not all families benefit, and ethnic minority families in particular are less likely to enroll, engage, and improve in BPT. Versions of BPT interventions tailored for specific ethnic groups have been successful at improving engagement and outcomes for ethnic minorities; however, the specificity of these models presents challenges for broad dissemination. This article presents a personalization approach (PersIn) that utilizes cultural assessment results to tailor treatment protocols to the characteristics of individual families. We believe this approach has the potential to maximize cultural sensitivity while preserving generalizability to both minority and non-minority ethnic groups. We further propose that personalization on Parent Explanatory Model (PEM) parameters that have been found to vary across ethnic groups and to impact treatment engagement and/or outcomes is a promising approach to decreasing disparities in BPTs. We describe examples of evidence-supported PEMs that present good targets for personalization and provide examples from MY PCIT to illustrate how PersIn can be applied to Parent-Child Interaction Therapy (PCIT).
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Affiliation(s)
- Kristen M McCabe
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Argero A Zerr
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Department of Psychology, California State University Channel Islands, Camarillo, CA, USA
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Stobernack T, de Vries SPW, Rodrigues Pereira R, Pelsser LM, Ter Braak CJF, Aarts E, van Baarlen P, Kleerebezem M, Frankena K, Hontelez S. Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) - study protocol of an open-label trial to investigate the mechanisms underlying the effects of a few-foods diet on ADHD symptoms in children. BMJ Open 2019; 9:e029422. [PMID: 31694844 PMCID: PMC6858247 DOI: 10.1136/bmjopen-2019-029422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is the most common childhood behavioural disorder, causing significant impediment to a child's development. It is a complex disorder with numerous contributing (epi)genetic and environmental factors. Currently, treatment consists of behavioural and pharmacological therapy. However, ADHD medication is associated with several side effects, and concerns about long-term effects and efficacy exist. Therefore, there is considerable interest in the development of alternative treatment options. Double-blind research investigating the effects of a few-foods diet (FFD) has demonstrated a significant decrease in ADHD symptoms following an FFD. However, an FFD requires a considerable effort of both child and parents, limiting its applicability as a general ADHD treatment. To make FFD intervention less challenging or potentially obsolete, we need to understand how, and in which children, an FFD affects ADHD behaviour and, consequently, the child's well-being. We hypothesise that an FFD affects brain function, and that the nutritional impact on ADHD is effectuated by a complex interplay between the microbiota, gut and brain, that is, the microbiota-gut-brain axis. METHODS AND ANALYSIS The Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) study is an open-label trial with researchers blinded to changes in ADHD symptoms during sample processing and initial data analyses. ETHICS AND DISSEMINATION The Medical Research and Ethics Committee of Wageningen University has approved this study (NL63851.081.17, application 17/24). Results will be disseminated through peer-reviewed journal publications, conference presentations, (social) media and the BRAIN study website. A summary of the findings will be provided to the participants. TRIAL REGISTRATION NUMBER NCT03440346. STUDY DATES Collection of primary outcome data started in March 2018 and will be ongoing until 100 children have participated in the study. Sample data analysis will start after all samples have been collected.
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Affiliation(s)
- Tim Stobernack
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Stefan P W de Vries
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | | | | | - Cajo J F Ter Braak
- Biometris, Wageningen University and Research, Wageningen, The Netherlands
| | - Esther Aarts
- Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Peter van Baarlen
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Michiel Kleerebezem
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Klaas Frankena
- Adaptation Physiology, Wageningen University and Research, Wageningen, The Netherlands
| | - Saartje Hontelez
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
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Halperin JM, Marks DJ. Practitioner Review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 2019; 60:930-943. [PMID: 30690737 DOI: 10.1111/jcpp.13014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) often emerges during the preschool years and remains impairing throughout the life span. Early identification and intervention may yield lasting benefits that alter the often-adverse trajectory of the disorder. METHODS This Practitioner Review provides up-to-date information regarding the evaluation and treatment of ADHD in preschool children. The clinical presentation of ADHD in preschool children, its persistence into later childhood, the applicability of DSM-5 criteria for preschoolers with ADHD, and early predictors of long-term trajectories are addressed, as well as current findings from randomized controlled trials of both nonpharmacological and pharmacological interventions. RESULTS Symptoms of hyperactivity/impulsivity extend down to age 3, but several inattention symptoms, as defined by DSM-V, less accurately differentiate preschoolers with and without ADHD. Most preschool youth with ADHD symptoms continue to manifest symptoms and impairment into school-age and adolescence. However, few predictors of persistence beyond early severity have been identified. Behavioral interventions constitute a first-line treatment for preschool ADHD symptoms, with telepsychiatry increasing in prominence to help to mitigate financial, geographic, and/or logistical barriers to care. Pharmacological interventions, particularly psychostimulants, also confer demonstrable benefits, yet efficacy and safety profiles are less desirable relative to findings in school-age youth. CONCLUSIONS Acute treatments have demonstrable efficacy, but do not appear to fundamentally alter underlying mechanisms or long-term trajectories.
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Affiliation(s)
- Jeffrey M Halperin
- Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA
| | - David J Marks
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York, NY, USA
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45
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Peskin M, Rotem A, Golubchik P, Weizman A, Manor I. Demographic and Clinical Predictors of Hospitalization in Preschoolers With ADHD. J Atten Disord 2019; 23:1284-1290. [PMID: 29749278 DOI: 10.1177/1087054718772145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This chart review study characterized demographic and clinical indicators of the need for hospitalization in preschoolers with ADHD. Method: Medical records of preschoolers with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) ADHD during 2009-2012 were systematically reviewed. The cohort included 111 children (aged 5.13 ± 0.55 years, 77.47% boys). The demographic and clinical variables of hospitalized at a day-care unit (n = 30) and nonhospitalized (n = 81) preschoolers were compared. Results: Hospitalized preschoolers were younger (p < .0001), had higher rates of unmarried mothers (p < .001), and a higher number of comorbidities. The number of inattentive/hyperactivity-impulsivity symptoms was similar in both groups. Neurodevelopmental comorbidity (p < .0001), but not externalized (p = .82) or internalized (p = .20) psychopathology, was significantly higher in the hospitalized group. Conclusion: ADHD severity in preschoolers tends to be associated with younger age, specific parenthood constellations, and a high rate of neurodevelopmental, but not other, comorbidities. These findings emphasize the importance of the neurodevelopmental context in planning ADHD interventions at preschool age.
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Affiliation(s)
- Miriam Peskin
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
| | - Ann Rotem
- 1 Geha Mental Health Center, Petah Tikva, Israel
| | - Pavel Golubchik
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
| | - Abraham Weizman
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
| | - Iris Manor
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
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Sluiter MN, Wienen AW, Thoutenhoofd ED, Doornenbal JM, Batstra L. Teachers’ role and attitudes concerning ADHD medication: A qualitative analysis. PSYCHOLOGY IN THE SCHOOLS 2019. [DOI: 10.1002/pits.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maruschka N. Sluiter
- Department of Developmental PsychologyUniversity of GroningenGroningen The Netherlands
- Professorship Youth, Education and SocietyHanze University of Applied Sciences GroningenGroningen The Netherlands
| | - Albert W. Wienen
- Department of Developmental PsychologyUniversity of GroningenGroningen The Netherlands
| | | | - Jeannette M. Doornenbal
- Professorship Youth, Education and SocietyHanze University of Applied Sciences GroningenGroningen The Netherlands
| | - Laura Batstra
- Department of Special Needs Education and Child CareUniversity of GroningenGroningen The Netherlands
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47
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Inattentive Behavior in Boys with ADHD during Classroom Instruction: the Mediating Role of Working Memory Processes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:713-727. [PMID: 28825170 DOI: 10.1007/s10802-017-0338-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children with ADHD exhibit clinically impairing inattentive behavior during classroom instruction and in other cognitively demanding contexts. However, there have been surprisingly few attempts to validate anecdotal parent/teacher reports of intact sustained attention during 'preferred' activities such as watching movies. The current investigation addresses this omission, and provides an initial test of how ADHD-related working memory deficits contribute to inattentive behavior during classroom instruction. Boys ages 8-12 (M = 9.62, SD = 1.22) with ADHD (n = 32) and typically developing boys (TD; n = 30) completed a counterbalanced series of working memory tests and watched two videos on separate assessment days: an analogue math instructional video, and a non-instructional video selected to match the content and cognitive demands of parent/teacher-described 'preferred' activities. Objective, reliable observations of attentive behavior revealed no between-group differences during the non-instructional video (d = -0.02), and attentive behavior during the non-instructional video was unrelated to all working memory variables (r = -0.11 to 0.19, ns). In contrast, the ADHD group showed disproportionate attentive behavior decrements during analogue classroom instruction (d = -0.71). Bias-corrected, bootstrapped, serial mediation revealed that 59% of this between-group difference was attributable to ADHD-related impairments in central executive working memory, both directly (ER = 41%) and indirectly via its role in coordinating phonological short-term memory (ER = 15%). Between-group attentive behavior differences were no longer detectable after accounting for ADHD-related working memory impairments (d = -0.29, ns). Results confirm anecdotal reports of intact sustained attention during activities that place minimal demands on working memory, and indicate that ADHD children's inattention during analogue classroom instruction is related, in large part, to their underdeveloped working memory abilities.
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48
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Mian A, Jansen PW, Nguyen AN, Bowling A, Renders CM, Voortman T. Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort. J Nutr 2019; 149:642-648. [PMID: 30915449 DOI: 10.1093/jn/nxy273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/07/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is. OBJECTIVES We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association-that is, whether dietary patterns predict ADHD symptoms or vice versa. METHODS We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling. RESULTS Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = -0.08; 95% CI: -0.11, -0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls. CONCLUSION Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk.
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Affiliation(s)
- Annemiek Mian
- Departments of Epidemiology, Rotterdam, Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pauline W Jansen
- Departments of Child and Adolescent Psychiatry/Psychology, Rotterdam, Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, Netherlands
| | - Anh N Nguyen
- Departments of Epidemiology, Rotterdam, Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands
| | - April Bowling
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA.,Department of Health Sciences, Merrimack College, North Andover, MA
| | - Carry M Renders
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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49
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Davis DW, Feygin Y, Creel L, Williams PG, Lohr WD, Jones VF, Le J, Pasquenza N, Ghosal S, Jawad K, Yan X, Liu G, McKinley S. Longitudinal Trends in the Diagnosis of Attention-Deficit/Hyperactivity Disorder and Stimulant Use in Preschool Children on Medicaid. J Pediatr 2019; 207:185-191.e1. [PMID: 30545564 DOI: 10.1016/j.jpeds.2018.10.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/31/2018] [Accepted: 10/26/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To describe trends in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and prescribing of stimulants in preschool-age children receiving Medicaid and to identify factors associated with the receipt of psychosocial care. STUDY DESIGN Data were extracted from 2012-2016 Kentucky Medicaid claims for children aged <6 years. ADHD was identified using International Classification of Diseases, Tenth Revision codes F90.0, F90.1, F90.2, F90.8, and F90.9. Psychosocial therapy was defined as having at least 1 relevant Current Procedural Terminology code in a claim within the year. A generalized linear model with a logit link and binomial distribution was used to assess factors associated with receipt of psychosocial treatment in 2016. RESULTS More than 2500 (1.24%) preschool-aged children receiving Medicaid had a diagnosis of ADHD in 2016, with 988 (38.2%) of those receiving a stimulant medication. Children in foster care were diagnosed with and/or treated for ADHD 4 times more often than other Medicaid recipients. Of the 1091 preschoolers receiving stimulants, 99 (9%) did not have a diagnosis of ADHD. There were no significant differences in diagnoses by race/ethnicity, but children reported to be black, Hispanic, or other race/ethnicity received stimulants at a lower rate than white children. Positive predictors for receiving psychosocial therapy in 2016 included having the diagnosis but not receiving a stimulant, having at least 1 prescription written by a psychiatrist, having comorbidities, and age. The use of stimulants in children aged <6 years declined from 0.9% in 2012 to 0.5% in 2016. CONCLUSIONS Promising trends demonstrate a decreasing use of stimulants in preschoolers; however, continued vigilance is needed to promote the optimal use of psychosocial interventions.
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Affiliation(s)
- Deborah Winders Davis
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA.
| | - Yana Feygin
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA
| | - Liza Creel
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA; University of Louisville School of Public Health and Information Sciences, Health Management & Systems Science, Louisville, KY, USA
| | - P Gail Williams
- University of Louisville School of Medicine, Department of Pediatrics, Weisskopf Child Evaluation Center, Louisville, KY, USA
| | - W David Lohr
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA; University of Louisville School of Medicine, Department of Pediatrics, Division of Child & Adolescent Psychiatry & Psychology, Louisville, KY, USA
| | - V Faye Jones
- University of Louisville School of Medicine, Department of Pediatrics, Division of General Pediatrics, Louisville, KY, USA
| | - Jennifer Le
- University of Louisville School of Medicine, Department of Pediatrics, Division of Child & Adolescent Psychiatry & Psychology, Louisville, KY, USA
| | - Natalie Pasquenza
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA
| | - Soutik Ghosal
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA; University of Louisville School of Public Health and Information Sciences, Bioinformatics and Biostatistics, Louisville, KY, USA
| | - Kahir Jawad
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA
| | - Xiaofang Yan
- University of Louisville School of Medicine; Department of Pediatrics, Child & Adolescent Research Design & Support Unit, Louisville, KY, USA; University of Louisville School of Public Health and Information Sciences, Bioinformatics and Biostatistics, Louisville, KY, USA
| | - Gil Liu
- University of Louisville School of Medicine, Department of Pediatrics, Division of General Pediatrics, Louisville, KY, USA; Kentucky Department of Medicaid Services, Frankfort, KY, USA
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Jacobson LA, Schneider H, Mahone EM. Preschool Inhibitory Control Predicts ADHD Group Status and Inhibitory Weakness in School. Arch Clin Neuropsychol 2019; 33:1006-1014. [PMID: 29293868 DOI: 10.1093/arclin/acx124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/27/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Discriminative utility of performance measures of inhibitory control was examined in preschool children with and without ADHD to determine whether performance measures added to diagnostic prediction and to prediction of informant-rated day-to-day executive function. Method Children ages 4-5 years (N = 105, 61% boys; 54 ADHD, medication-naïve) were assessed using performance measures (Auditory Continuous Performance Test for Preschoolers-Commission errors, Conflicting Motor Response Test, NEPSY Statue) and caregiver (parent, teacher) ratings of inhibition (Behavior Rating Inventory of Executive Function-Preschool version). Results Performance measures and parent and teacher reports of inhibitory control significantly and uniquely predicted ADHD group status; however, performance measures did not add to prediction of group status beyond parent reports. Performance measures did significantly predict classroom inhibitory control (teacher ratings), over and above parent reports of inhibitory control. Conclusions Performance measures of inhibitory control may be adequate predictors of ADHD status and good predictors of young children's classroom inhibitory control, demonstrating utility as components of clinical assessments.
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Affiliation(s)
- Lisa A Jacobson
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - E Mark Mahone
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
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