Attention deficit hyperactivity disorder: part I

Child Maltreatment and Associated Parental Factors Among Children With ADHD: A Comparative Study

OBJECTIVE

This study investigated the role of child and parental factors in maltreatment of children with ADHD compared with a healthy control group.

METHOD

We examined the rates and correlations of child maltreatment by parents in a sample of children with ADHD ( n = 100) and a matched comparison sample of children without ADHD ( n = 100), all aged 6 to 11 years. Parent and child ratings evaluated demographic characteristics, severity of ADHD symptoms, and childhood trauma exposure.

RESULTS

According to regression analysis, maternal hyperactivity/impulsivity and male gender of the child increase the emotional abuse; whereas maternal history of emotional abuse and physical neglect and paternal attention deficit increase sexual abuse, and higher maternal hyperactivity/impulsivity increases emotional neglect of ADHD children.

CONCLUSION

The study's findings provide strong evidence that the maltreatment of children with ADHD is more associated with parental factors than with the symptoms of ADHD in children.

Diagnostic and Demographic Differences Between Incarcerated and Nonincarcerated Youth (Ages 6-15) With ADHD in South Carolina

OBJECTIVE

Analyze diagnostic and demographic factors to identify predictors of delinquency resulting in incarceration within a group of children/adolescents diagnosed with ADHD.

METHOD

The study followed a cohort of 15,472 Medicaid covered children/adolescents with ADHD, ages 6 to 15 inclusive, between January 1, 2003, and December 31, 2006. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. [ DSM-IV-TR]), 2000 Codes were used for qualifying diagnosis codes. Available demographic characteristics included race, sex, and residence. The outcome was incarceration at the South Carolina Department of Juvenile Justice during 2005-2006.

RESULTS

Among youth with ADHD, incarceration was more likely among black, male, and urban youth. Children/adolescents with comorbid ODD and/or CD were at greater risk compared with those with ADHD alone.

CONCLUSION

Within ADHD-diagnosed youth, comorbid conditions and demographic characteristics increase the risk of incarceration. Intervention and treatment strategies that address behavior among youth with these characteristics are needed to reduce incarceration.

Attention-deficit/hyperactivity disorder casts a long shadow: findings from a population-based study of adult women with self-reported ADHD

BACKGROUND

To develop a sociodemographic and health profile of women with self-reported attention deficit/hyperactivity disorder (ADHD) in comparison to women without.

METHODS

Chi-square tests and logistic regression analyses were conducted on data from the nationally representative Canadian Community Health Survey-Mental Health (2012) comparing 107 women aged 20 to 39 years (inclusive) with ADHD to 3801 without ADHD. Depression, generalized anxiety disorder and substance abuse were measured using the WHO-CIDI.

RESULTS

Women with ADHD had triple the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse and generalized anxiety disorder and double the prevalence of substance abuse, current smoking, depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD (all P < 0.001). Even after adjustments for age, race, education and income, women with ADHD had substantially higher odds of a wide range of problems.

CONCLUSION

Our results suggest that women with ADHD are particularly vulnerable to early adversities, health and mental health problems.

The relationship between early adversities and attention-deficit/hyperactivity disorder

This study examined whether retrospectively reported childhood physical abuse, childhood sexual abuse and/or exposure to parental domestic violence were associated with self-report of a health-professional diagnosis of attention-deficit/hyperactivity disorder (ADHD) among adults. We analyzed nationally representative data from the 2012 Canadian Community Health Survey-Mental Health using gender-specific bivariate and logistic regression analyses (n=10,496 men; n=12,877 women). For both men and women, childhood physical abuse was associated with significantly higher odds of reporting ADHD (men odds ratio [OR]=1.66, p<.001; women OR=1.95, p<.001). For both genders, childhood sexual abuse was also significantly related to higher odds of ADHD (men OR=2.57, p<.001; women OR=2.55, p<.001); however, exposure to parental domestic violence was only associated with elevated odds of ADHD among women (men OR=0.89, p=.60; women OR=1.54, p=.03). The results demonstrate a link between childhood physical and sexual abuse and ADHD for both men and women. Future prospective studies are required to further understand this interesting relationship.

A review of OROS methylphenidate (Concerta(®)) in the treatment of attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioural disorder with onset during childhood. It affects a child's development, both at home and at school, and impacts on social, emotional and cognitive functioning, in both the home and the school environment. Untreated ADHD is very often associated with poor academic achievement, low occupational status, increased risk of substance abuse and delinquency. Current practice guidelines recommend a multimodal approach in the treatment of ADHD, which includes educational, behavioural and mental health interventions, and pharmacological management. Stimulant medications, including methylphenidate (MPH) and amphetamine products, are recommended as first-line pharmacotherapy in the treatment of ADHD. The choice of stimulant is influenced by several factors; the most influential factor is the duration of action. Long-acting medication provides benefits long after school and work. It also increases the likelihood of once-daily dosing, thereby eliminating the need for mid-day dosing, making the treatment more private, avoiding stigma and improving adherence to medication. MPH is the most widely used psychotropic medication in child psychiatry. It was first developed for use in children as an oral, immediate-release formulation and more recently as various extended-release formulations. These latter formulations include the 12 h preparation Concerta(®) (osmotic-release oral system [OROS] MPH), which utilizes an osmotic pump system, designed to overcome the difficulties of multiple daily dosing. Since it received approval from the US Food and Drug Administration in August 2000, OROS MPH has been quickly and widely accepted as one of the preferred treatments for ADHD because of its once-daily dosing. This paper reviews the data in support of long-acting OROS MPH in children, adolescents and adults, both in ADHD and in association with its comorbidities.

Clinical and acoustic vocal profile in children with attention deficit hyperactivity disorder

PURPOSE

The objective of this study was to evaluate the presence of etiologic factors, symptoms, and vocal acoustic alterations related to vocal hyperfunction in children with attention deficit hyperactivity disorder (ADHD).

METHOD

In 23 children with ADHD and 28 control children, vocal acoustic exploration was performed to analyze the F₀, jitter %, and voice turbulence index for the sustained vowels /a/ and /i/ and the average tone and intensity and tonal modulation in tests of continuous speech. The children's parents completed a specific questionnaire aimed at detecting etiologic factors and vocal symptoms.

RESULTS

Children with ADHD displayed more vocal symptoms (hoarseness, neck strain, and shortness of breath while talking) and more etiologic factors (they shouted more, spoke louder and faster, and became angry more easily) than did children in the Control group. Likewise, children in the ADHD group exhibited a greater % jitter and a lower average intensity in the continuous speech tests.

CONCLUSIONS

These results indicate that children with ADHD display greater vocal hyperfunction as compared with children in the Control group and suggest a higher risk of developing dysphonia. The results of this study could be useful for designing vocal programs focusing on vocal education and hygiene to prevent and decrease vocal risks and on promoting vocal health in children with ADHD.

Omega-3 fatty acids are inversely related to callous and unemotional traits in adolescent boys with attention deficit hyperactivity disorder

A number of research studies have reported abnormal plasma fatty acid profiles in children with ADHD along with some benefit of n-3 to symptoms of ADHD. However, it is currently unclear whether (lower) long chain-polyunsaturated fatty acids (LC-PUFAs) are related to ADHD pathology or to associated behaviours. The aim of this study was to test whether (1) ADHD children have abnormal plasma LC-PUFA levels and (2) ADHD symptoms and associated behaviours are correlated with LC-PUFA levels. Seventy-two, male children with (n=29) and without a clinical diagnosis of ADHD (n=43) were compared in their plasma levels of LC-PUFA. Plasma DHA was higher in the control group prior to statistical correction. Callous-unemotional (CU) traits were found to be significantly negatively related to both eicosapentaenoic acid (EPA), and total omega-3 in the ADHD group. The findings unveil for the first time that CU and anti-social traits in ADHD are associated with lower omega-3 levels.

Guanfacine extended release as adjunctive therapy to psychostimulants in children and adolescents with attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder associated with a wide range of impairments. Psychostimulants are generally first-line pharmacotherapy, but symptom improvement is suboptimal in some patients. In these patients, clinicians frequently use a combination of psychostimulants and nonscheduled medications to manage ADHD, although published evidence supporting this practice was relatively scarce until recently.Guanfacine extended release (GXR), a selective alpha2A-adrenoceptor agonist, is approved as a monotherapy and adjunctive therapy to psychostimulant medications for ADHD in patients 6-17 years of age. Drug-drug interaction studies have demonstrated that the adjunctive administration of GXR with a long-acting methylphenidate preparation or lisdexamfetamine dimesylate did not change exposure to the active components of either medication in a clinically meaningful way compared with either treatment alone.Data supporting the potential efficacy of GXR adjunctive to psychostimulants were preliminarily observed in a 9-week, open-label, dose-escalation study and subsequent extension study (≤ 24 months) in subjects aged 6-17 years with suboptimal control of ADHD symptoms on psychostimulant monotherapy. In a subsequent 9-week, randomized, double-blind, placebocontrolled study of subjects aged 6-17 years with suboptimal response to a long-acting, extendedrelease, oral psychostimulant, adjunctive GXR (administered in the morning or evening) was associated with significantly greater symptom reduction than placebo and psychostimulant (ADHD Rating Scale IV [ADHD-RS-IV] total score, placebo-adjusted least squares mean reductions: GXR AM, -4.5, P = 0.002; GXR PM, -5.3, P < 0.001, based on Dunnett's test). Across multiple studies, the safety and tolerability profile of GXR administered adjunctively to psychostimulants has been consistent with the known profiles of each medication. Additional studies should further explore the role of adjunctive GXR in clinical practice to help identify those patients most likely to benefit from such therapy.