Attention deficit/hyperactivity disorder: a review and update

Functional somatic symptoms in preschool attention-deficit/hyperactivity disorder: a secondary analysis of data from a randomized controlled trial of parent training

Children with attention-deficit/hyperactivity disorder (ADHD) can be more stress-vulnerable, and thereby, it has been suggested, prone to develop functional somatic symptoms (FSS) compared to their peers. In this paper, using data from 160 children aged 3-7 years with ADHD from the D'SNAPP study, a randomized controlled trial testing a parent training intervention, we addressed a number of questions about the role of FSS in ADHD. First, are FSS levels higher in an ADHD sample than in the children of the general population. Second, do FSS levels predict psychopathology and health-related quality of life (HRQoL) in ADHD samples. Third, does FSS levels moderate the effect of parent training on ADHD symptoms. We found that preschoolers with ADHD experienced more severe FSS than a general population-based sample (18.80% vs. 2.11%). Severe FSS were associated with increased psychopathology and impaired daily function and lower HRQoL. Level of baseline FSS did not moderate the effect of parent training on ADHD. FSS in preschool children with ADHD is associated with impaired daily functioning, but further research is warranted to determine the clinical impact of FSS in children with ADHD.

Arab and Jewish mothers’ decisions regarding treatment of their children with attention-deficit/hyperactivity disorder: A qualitative study

The use of medication for attention deficit hyperactivity disorder (ADHD) differs globally. Stimulant prescriptions for ADHD among Israeli Jewish children are four times higher than among Arab children. This qualitative study aimed to identify mothers and teachers’ attitudes regarding ADHD and what affects mothers’ decisions on whether to medicate their child diagnosed with ADHD. In-depth interviews were conducted with 23 Arab and Jewish mothers of children diagnosed with ADHD and 12 elementary school teachers. Data were analyzed using thematic analysis. Four themes were revealed, describing different perceptions of ADHD in the two ethnic groups: (1) medicalization of ADHD; (2) between guilt and sympathy: Mothers’ feelings toward ADHD; (3) social pressure and social norms; (4) stigmatization: Jewish mothers and teachers tended to perceive ADHD as a medical problem, whereas Arab mothers and teachers perceived it more as a childhood social behavior. Arab mothers reported guilt feelings relating to ADHD, whereas Jewish mothers felt sympathy toward their child. The social environment influenced Arab mothers more than Jewish mothers. Stigmatization was reported only by Arab mothers. Ethnic differences in ADHD perception may explain the differences in diagnosis and treatment. Educators and school psychologists should consider cultural factors when advising parents and planning educational programs for children with ADHD.

The association between nonpharmacological interventions and quality of life in children with attention deficit hyperactivity disorder: A systematic review

BACKGROUND

Attention deficit hyperactivity disorder is a common psychiatric disorder with a worldwide prevalence of about five percent among children and adolescents. This disorder affects most aspects of their lives e.g., academic performance and social relations, and their overall quality of life is reduced compared to healthy peers. The majority of children with ADHD are treated with medication that potentially has an insufficient effect and/or frequently occurring side effects.

OBJECTIVES

To enable nurses and other health care professionals to guide children with ADHD and their families in their choices of treatment, based on the best available literature on the association between nonpharmacological interventions and quality of life.

DATA SOURCES

A literature search was performed in the databases CENTRAL, Embase, PubMed, CINAHL, and PsycINFO. Seven randomized controlled trials were included in this systematic review. They examined the use of polyunsaturated fatty acids, physical activity, psychoeducation, cognitive therapy, cognitive training, hippotherapy, and behavioral therapy.

CONCLUSIONS

The study of behavioral therapy in the form of a sleep intervention detected an improvement in quality of life which was statistically significant compared to the control group.

IMPLICATIONS FOR PRACTICE

Children with ADHD and a sleep disorder may gain improvement in their quality of life from a sleep intervention.

The role of harsh parenting practices in early- to middle-childhood socioemotional development: An examination in the Millennium Cohort Study

Patterson's coercion model describes a gradual escalation in maladaptive parent-child transactions whereby externalizing behaviors lead to increases in maladaptive parenting and vice versa. The current study investigates the role of (predominantly mother-reported) harsh parenting practices in the within-person development of conduct problems, hyperactive/inattentive behaviors, and emotional problems. A random-intercept cross-lagged panel model was fit across ages 3, 5, and 7 (N = 14,037, 49% female, 84% White) using the UK population-representative Millennium Cohort Study. Findings support Patterson's coercion model, providing evidence for reciprocal within-family relations between parenting practices and child behaviors. They suggest the importance of addressing parenting difficulties in families where children present with socioemotional difficulties in order to help prevent the accumulation of additional issues.

Detection of ADHD From EEG Signals Using Different Entropy Measures and ANN

Attention deficit hyperactivity disorder (ADHD) is a prevalent behavioral, cognitive, neurodevelopmental pediatric disorder. Clinical evaluations, symptom surveys, and neuropsychological assessments are some of the ADHD assessment methods, which are time-consuming processes and have a certain degree of uncertainty. This research investigates an efficient computer-aided technological solution for detecting ADHD from the acquired electroencephalography (EEG) signals based on different nonlinear entropy estimators and an artificial neural network classifier. Features extracted through fuzzy entropy, log energy entropy, permutation entropy, SURE entropy, and Shannon entropy are analyzed for effective discrimination of ADHD subjects from the control group. The experimented results confirm that the proposed techniques can effectively detect and classify ADHD subjects. The permutation entropy gives the highest classification accuracy of 99.82%, sensitivity of 98.21%, and specificity of 98.82%. Also, the potency of different entropy estimators derived from the t-test reflects that the Shannon entropy has a higher P-value (>.001); therefore, it has a limited scope than other entropy estimators for ADHD diagnosis. Furthermore, the considerable variance found from potential features obtained in the frontal polar (FP) and frontal (F) lobes using different entropy estimators under the eyes-closed condition shows that the signals received in these lobes will have more significance in distinguishing ADHD from normal subjects.

Chronic Physical Activity for Attention Deficit Hyperactivity Disorder and/or Autism Spectrum Disorder in Children: A Meta-Analysis of Randomized Controlled Trials

Purpose: To explore the effects of physical activity (PA) intervention on executive function (EF) and motor skills (MS) among children with attention deficit hyperactivity disorder and/or autism spectrum disorder (ASD).

Methods: Relevant studies were sourced from PubMed, Web of Science, EMBASE, Cochrane Library, CNKI and Wanfang Data. Only randomized controlled trials (RCT) were included based upon the following criteria: (1) participants were children and clinically diagnosed with ADHD/ASD, (2) intervention strategies were identified as chronic physical activity, and (3) EF (e.g., cognitive flexibility) and/or MS (e.g., gross motor skills) were measured at baseline and post-intervention and compared with an eligible control group.

Results: Eleven studies involving 346 participants were finally identified. PA elicited significant improvements in EF and MS in children with ADHD/ASD. Regarding changes in the EF of participants, PA showed a great improvement in overall EF [standardized mean difference (SMD): 0.90, 95% confidence interval (CI) 0.49–1.30, p < 0.00001], inhibitory control (SMD: 1.30, 95% CI 0.58–2.02, p = 0.0004) and cognitive flexibility (SMD: 0.85, 95% CI 0.42–1.29, p = 0.0001), but no significant improvement in working memory (SMD: 0.28, 95% CI −0.15–0.71, p = 0.20). Significant improvements were also found with respect to gross motor skills (SMD: 0.80, 95% CI 0.30–1.30, p = 0.002), but no significant changes were found in fine motor skills (SMD: 0.30, 95% CI −0.91–1.52, p = 0.62).

Conclusion: Chronic PA interventions may promote EF and MS in children with ADHD/ASD, especially in inhibitory control, cognitive flexibility, and gross motor skills. However, PA interventions seemed to have insignificant effects on working memory and fine motor skills to children with ADHD/ASD.

PROSPERO registration number: CRD42019118622

Delay Maturation in Occipital Lobe in Girls With Inattention Subtype of Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder. Differences in the presentations of ADHD between boys and girls have been well established. Three subtypes of ADHD exist. In addition to sex difference, different mechanisms may underlie different subtypes. The present study enrolled 30 girls with the inattentive subtype of ADHD and 30 age-matched controls. Low-resolution electromagnetic tomography (LORETA) and instantaneous frequency were used to analyze electroencephalography (EEG) for investigating the brain area and EEG bands involved in girls with inattentive ADHD. We found that the instantaneous frequencies in all EEG channels in girls with ADHD were lower than those in controls. Alpha 2 was the only EEG band that showed significant difference in current density between the ADHD and control groups (P = .0014). In the entire brain area, the posterior cingulate cortex, cingulate gyrus, and precuneus demonstrated the most significant difference between the ADHD and control groups. Our results suggest that brain maturation delay in the posterior areas might result in the inattention subtype of ADHD. In addition, posterior cingulate cortex, cingulate gyrus, and precuneus may play a critical role in the pathogenesis of ADHD. Our study provides a new approach method and possible mechanism of girls with inattentive subtype ADHD.

Increased Temporal Lobe Beta Activity in Boys With Attention-Deficit Hyperactivity Disorder by LORETA Analysis

Aim: Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder that affects 6.1 million US children. The mechanism of ADHD is currently unclear. Differences in ADHD presentations between boys and girls are well-established. In the present study, we used quantitative electroencephalography (EEG) to investigate the brain area and EEG bands of boys with ADHD.

Methods: This study enrolled 40 boys with ADHD and 40 age-matched controls without ADHD. Low-resolution electromagnetic tomography (LORETA) and instantaneous frequency were used to analyze EEG data to reveal the mechanisms underlying ADHD in boys.

Results: We found that the instantaneous frequencies in the T3 and T4 EEG channels in boys with ADHD were significantly higher than those in the controls. The beta band showed significant difference in current density between the ADHD and control groups. In the entire brain area, the bilateral inferior and middle temporal gyrus exhibited the most significant difference between the ADHD and control groups in the EEG beta band. Connectivity analysis revealed an increase in connectivity between the left middle frontal gyrus and fusiform gyrus of the temporal lobe in boys with ADHD.

Conclusions: LORETA is a promising tool for analyzing EEG signals and can be used to investigate the mechanism of ADHD. Our results reveal that the inferior temporal gyrus, middle temporal gyrus, and fusiform gyrus of the temporal lobe are potentially involved in the pathogenesis of ADHD in boys. In comparison with other imaging methods, such as magnetic resonance imaging, EEG is easy to perform, fast, and low cost. Our study presents a new approach for investigating the pathogenesis of ADHD in boys.

Behavioural difficulties in early childhood and risk of adolescent injury

OBJECTIVE

To evaluate long-term associations between early childhood hyperactivity and conduct problems (CP), measured using Strengths and Difficulties Questionnaire (SDQ) and risk of injury in early adolescence.

DESIGN

Data linkage between a longitudinal birth cohort and routinely collected electronic health records.

SETTING

Consenting Millennium Cohort Study (MCS) participants residing in Wales and Scotland.

PATIENTS

3119 children who participated in the age 5 MCS interview.

MAIN OUTCOME MEASURES

Children with parent-reported SDQ scores were linked with hospital admission and Accident & Emergency (A&E) department records for injuries between ages 9 and 14 years. Negative binomial regression models adjusting for number of people in the household, lone parent, residential area, household poverty, maternal age and academic qualification, child sex, physical activity level and country of interview were fitted in the models.

RESULTS

46% of children attended A&E or were admitted to hospital for injury, and 11% had high/abnormal scores for hyperactivity and CP. High/abnormal or borderline hyperactivity were not significantly associated with risk of injury, incidence rate ratio (IRR) with 95% CI of the high/abnormal and borderline were 0.92 (95% CI 0.74 to 1.14) and 1.16 (95% CI 0.88 to 1.52), respectively. Children with borderline CP had higher injury rates compared with those without CP (IRR 1.31, 95% CI 1.09 to 1.57).

CONCLUSIONS

Children with high/abnormal hyperactivity or CP scores were not at increased risk of injury; however, those with borderline CP had higher injury rates. Further research is needed to understand if those with difficulties receive treatment and support, which may reduce the likelihood of injuries.

Prevalence and correlates of Attention Deficit Hyperactive Disorder (ADHD) risk factors among school children in a rural area of North India

BACKGROUND

Attention-deficit hyperactive disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and has the potential for continuity into adolescence and adulthood. Its presence increases difficulties in academic performance and social interactions besides leading to low self-esteem. The present study aimed to determine the prevalence of ADHD among children of age 6-12 years in Government schools of a rural area in Jammu district of J and K.

METHODS

The present study was conducted in R.S. Pura block of Jammu district. Miran Sahib zone of R.S Pura block was chosen randomly and all the government primary schools in this zone were included in the survey. The presence of ADHD was assessed using Vanderbilt ADHD diagnostic teacher rating scale. The children positive for ADHD were visited at their residential places and a personal information questionnaire (PIQ) was administered to their parents-preferably the mother. The data thus collected was presented as proportions.

RESULTS

ADHD prevalence was found to be 6.34% (13/205). Majority (69.3%) of the ADHD-positive children were living in a joint family and belonged to lower/lower middle class. Family history of ADHD was absent in all the ADHD-positive children.

CONCLUSION

The current study conducted in a rural area among 6- to 12-year-old children of Government schools has shown a reasonably high ADHD prevalence of 6.34%.

A New Method of Diagnosing Attention-Deficit Hyperactivity Disorder in Male Patients by Quantitative EEG Analysis

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders of childhood. Diagnosis of ADHD is based on core symptoms and checklists. However, these are both subjective, which can lead to the problems of overdiagnosis and underdiagnosis. Elevated theta/beta ratio (TBR) of EEG band has been approved by the US Food and Drug Administration as a tool to assist in the diagnosis of ADHD. However, several recent studies have demonstrated that there are no significant differences in TBR between people with and without ADHD. In this study, we attempted to develop a new method for differentiating between male with and without ADHD by analyzing EEG features. Thirty boys with ADHD combined type (aged 8 years 5 months ± 1 year 11 months) and 30 age-matched controls (aged 8 years 5 months ± 1 year 8 months) were enrolled in this study. A classification analysis-based approach comprising training and classification phases was developed for classifying each subject's EEG features as ADHD or non-ADHD. Eight crucial feature descriptors were selected and ranked based on the t test. Compared with TBR in our study, the developed method had a higher area under the curve (87.78%), sensitivity (80.0%), and specificity (80.0%). Our method is more precise than using TBR in the diagnosis of ADHD. This newly developed method is a useful tool in identifying patients with ADHD and might reduce the possibility of overdiagnosis and underdiagnosis.

Risk of Atopic Diseases among Siblings of Patients with Attention-Deficit Hyperactivity Disorder: A Nationwide Population-Based Cohort Study

BACKGROUND

Increasing evidence suggests a positive association between attention-deficit hyperactivity disorder (ADHD) and atopic diseases. However, the risk of atopic diseases in unaffected siblings of patients with ADHD has not been investigated.

OBJECTIVE

To investigate the risk of developing atopic diseases among unaffected siblings of ADHD probands.

METHODS

Using data from the Taiwan National Health Insurance Research Database, 20,170 unaffected siblings of patients with ADHD born between 1980 and 2000 and 80,680 age-, birth time-, and residence-matchedcontrols were included in this study. Diagnoses of atopic diseases, including asthma, atopic dermatitis, allergic rhinitis, and allergic conjunctivitis, were ascertained from 1996 or the birth time until the end of 2011.

RESULTS

Breslow-Cox proportional hazard regression analyses with adjustment for demographic data showed that compared with the controls, unaffected siblings of patients with ADHD had a higher risk of developing asthma (relative risk [RR], 1.19; 95% confidence interval [CI], 1.15-1.24), atopic dermatitis (RR, 1.10; 95% CI, 1.04-1.16), allergic rhinitis (RR, 1.17; 95% CI, 1.14-1.21), allergic conjunctivitis (RR, 1.13; 95% CI, 1.09-1.17), and any of these atopic diseases (RR, 1.13; 95% CI, 1.10-1.15).

CONCLUSION

The unaffected siblings of ADHD probands were more likely to develop atopic diseases compared with the controls, suggesting shared risk factors for both diseases.

Entropy-Based Quantitative Electroencephalogram Analysis for Diagnosing Attention-Deficit Hyperactivity Disorder in Girls

Diagnosis of attention-deficit hyperactivity disorder (ADHD) is currently based on core symptoms or checklists; however, the inevitability of practitioner subjectivity leads to over- and underdiagnosis. Although the Federal Drug Administration has approved an elevated theta/beta ratio (TBR) of the electroencephalogram (EEG) band as a tool for assisting ADHD diagnosis, several studies have reported no significant differences of the TBR between ADHD and control subjects. This study detailed the development of a method based on approximate entropy (ApEn) analysis of EEG to compare ADHD and control groups. Differences between ADHD presentation in boys and girls indicate the necessity of separate investigations. This study enrolled 30 girls with ADHD and 30 age-matched controls. The results revealed significantly higher ApEn values in most brain areas in the control group than in the ADHD group. Compared with TBR-related feature descriptors, ApEn-related feature descriptors can produce the higher average true positive rate (0.846), average true negative rate (0.814), average accuracy (0.817), and average area under the receiver operating characteristic curve value (0.862). Therefore, compared with TBR, ApEn possessed the better potential for differentiating between girls with ADHD and controls.

The effects of physical activity on executive function in children with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis protocol

BACKGROUND

The effects of physical activity on executive function are well documented, but whether physical activity contributes to the executive function of attention deficit hyperactivity disorder (ADHD) children are still inconclusive.

METHODS

The study is guided by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will search the following databases PubMed, EMBASES, the Cochrane Library, CNKI, and Wanfang-Data to identify the Randomized Controlled Trials evaluating the effects of physical activity on executive function among ADHD children. The language of literature restricted in Chinese and English, which published from inception to January 2019. Two reviewers will screen the studies independently, while risk of bias assessment, data extraction, and inconsistent results will be discussed by the third reviewer. Revman 5.3 and Stata 12 software will be used to complete data analysis and synthesis.

CONCLUSION

This study will be based on findings of previous studies, thus the ethics approval is not required. The final results will be presented at an international conference and submitted to a peer-reviewed journal of relative field for consideration of publication.

PROSPERO REGISTRATION NUMBER

CRD42019118622.

Novel method using Hjorth mobility analysis for diagnosing attention-deficit hyperactivity disorder in girls

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder. Diagnosis of ADHD is based on core symptoms or checklists; however, practitioner subjectivity inevitably results in instances of over- or under-diagnosis. Although an elevated theta/beta ratio (TBR) of the electroencephalography (EEG) band has been approved by the Food and Drug Administration as a factor that may be used in diagnosis of ADHD, several studies have reported no significant differences between the TBR of patients with ADHD and controls.

PURPOSE

In this study, a method was developed based on Hjorth Mobility (M) analysis of EEG to compare patients with ADHD and controls.

METHODS

Differences in the presentations of ADHD between boys and girls are well established; therefore, separate investigations are required. The present study enrolled 30 girls with ADHD and 30 age-matched controls.

RESULTS

The results revealed that the control group had significantly higher Hjorth M values in most brain areas in EEG readings compared with the values for the ADHD group. Compared with TBR, our method revealed a greater number of more significant differences between the girls in the ADHD group and the controls. Moreover, our method can produce the higher average sensitivity (0.796), average specificity (0.796), average accuracy (0.792), and average area under the curve of receiver operating characteristic curve (AUC) value (0.885). Therefore, compared with TBR, Hjorth M possessed the better potential for differentiating between girls with ADHD and controls.

CONCLUSION

The proposed method was more accurate than the TBR in diagnosing ADHD. Therefore, Hjorth M may be a promising tool for differentiating between children with ADHD and controls.

Predictive factors of success in neurofeedback training for children with ADHD

INTRODUCTION

Neurofeedback (NF) training aims the enhancement of self-regulation over brain activities. While it is largely recognized as an effective treatment for attention deficit hyperactivity disorder (ADHD), the existence of non-learners has also been reported. The present study explored pre-training assessment indices that could predict learners prior to NF training.

METHODS

Twenty-two children with ADHD participated in slow cortical potential (SCP) NF training and completed pre- and post-training assessments. Participants were classified into learners or non-learners based on their progress in the SCP regulation, and pre-training indices that differentiate the two groups were examined by decision tree analysis.

RESULTS AND DISCUSSION

The learner rate in NF training was 45.5%. Learners were predicted by pre-training cognitive and neurophysiological measures regarding Stroop tasks, which suggested relatively intact executive function as their characteristics. Given that NF training is not universally effective for children with ADHD, further studies are necessary to establish application criteria.

Maternal Personality and Child Temperamental Reactivity: Differential Susceptibility for Child Externalizing Behavioral Problems in China

It is important to identify the developmental antecedents of externalizing behavioral problems in early childhood. The current study examined the main effects of maternal personality and its interactive effects with child temperamental reactivity in predicting child externalizing behavioral problems, indicated by impulsivity and aggression. This study was composed of 70 children (M _age = 17.6 months, SD = 3.73) and their mothers. The results showed that maternal agreeableness was negatively associated with child impulsivity. Child temperamental reactivity moderated the effect of maternal conscientiousness on child impulsivity in support of the differential susceptibility model. Specifically, for highly reactive children, maternal conscientiousness was negatively associated with child impulsivity whereas this association was non-significant for low reactive children. Child reactivity also moderated the contribution of maternal neuroticism to child impulsivity. That is, maternal neuroticism was negatively associated with impulsivity, only for highly reactive children.

ESCAlate - Adaptive treatment approach for adolescents and adults with ADHD: study protocol for a randomized controlled trial

BACKGROUND

Over the last decade, a wide range of attention-deficit/hyperactivity disorder (ADHD) treatment approaches for adults, including both pharmacological interventions and psychosocial treatments, have been proposed and observed to be efficient. In practice, individual treatment concepts are based on results of clinical studies as well as international guidelines (NICE Guidelines) that recommend a step-by-step treatment approach. Since the evidence supporting this approach is limited, the aim of the present study is to determine an optimal intervention regarding severity levels of ADHD symptomatology conducting a randomized controlled trial.

METHOD

We aim to include 279 ADHD subjects aged between 16 and 45 years. First, participants are randomized to either a face-to-face psychoeducation, telephone assisted self-help (TASH), or a waiting control group (Step 1). All participants assigned to the control group are treated using TASH after a 3-month waiting period. Participants are then allocated to one of three groups, based on their remaining severity level of ADHD symptoms, as (1) full responder, (2) partial responder, or (3) non-responder (Step 2). Full responders receive counseling, partial responders receive either counseling only or counseling and neurofeedback (NF), and non-responders receive either pharmacological treatment only or pharmacological treatment and NF, followed by a 3 month period without intervention.

DISCUSSION

The naturalistic sample is one of the study's advantages, avoiding highly selective inclusion or exclusion criteria. The efficacy of an evidence-based stepped care intervention is explored by primary (reduction of severity of ADHD symptoms) and secondary outcomes (functional outcomes, e.g., quality of life, anger management, enhancement of psychosocial well-being). Predictors of therapeutic response and non-response are being investigated at each step of intervention. Further, sex differences are also being explored.

TRIAL REGISTRATION

This study is registered by the German Trial Register (reference number: DRKS00008975 ), 23 October 2015.

Comparison of the effect of pharmacotherapy and neuro-feedback therapy on oral health of children with attention deficit hyperactivity disorder

Background

Attention deficit hyperactivity disorder (ADHD) is a chronic and progressive mental disorder related to the childhood period. This study aims to compare the oral health of two groups of ADHD children: those under pharmacotherapy and those under neuro-feedback therapy.

Material and Methods

72 ADHD children (aged 6-12) were divided into two 36 member groups: The pharmacotherapy group and the neuro-feedback therapy group. Unstimulated salivary flow (USF), DMFT, and plaque index were assessed in these children. Statistical analysis was carried out on the data with the independent t-test, which was performed using SPSS 16. The significance level of the study was p<0.05.

Results

In this study, the USF of ADHD children who used Ritalin was found to be significantly less than that of the neuro-feedback group (1.25 ± 1.21 vs. 1.91 ± 1.16 ml/min; p=0.002). Also, the plaque index (5.9 ± 3.1 vs. 3.94 ± 1.9; p=0.018) and DMFT scores (39% ± 9% vs. 31% ± 9%; p=0.018) were significantly higher for the pharmacotherapy group.

Conclusions

Neuro-feedback therapy is preferable to Ritalin treatment for ADHD children in terms of their oral health status. Key words:Attention deficit hyperactivity disorder, drug therapy, neurofeedback, oral health.

Parenting experiences of living with a child with attention deficit hyperactivity disorder: a systematic review of qualitative evidence

BACKGROUND

Attention deficit hyperactivity disorder is the most prevalent mental disorder among children and adolescents worldwide. Parenting a child with attention deficit hyperactivity disorder is challenging and parents find it difficult to raise the child and struggle to get professional support. Research has shown how living with a child with Attention Deficit Hyperactivity Disorder influences the families' daily life. This includes how the parents manage to maintain a bearable family life, supportive or not supportive factors as well as parents' experiences of collaboration with professionals in diverse settings.

OBJECTIVE

The objective of this systematic review was to identify and synthesize the best available evidence on parenting experiences of living with a child with attention deficit hyperactivity disorder, including their experiences of health care and other services.

INCLUSION CRITERIA

This review considered research articles with qualitative data examining the experiences of parents of children with attention deficit hyperactivity disorder. The phenomena of interest were parenting experiences of living with a child with attention deficit hyperactivity disorder, including their experiences of health care and other services, and collaboration with professionals.

SEARCH STRATEGY

Retrospective and prospective searches were conducted in MedNar, ProQuest Dissertations and Theses, PubMed, Embase, PsycINFO and CINAHL. The reference lists of the included research articles were searched for additional studies, and a search for cited citations in Web of Science was conducted.

METHODOLOGICAL QUALITY

Two independent reviewers assessed articles selected for retrieval for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute, the Qualitative Assessment and Review Instrument.

DATA EXTRACTION

Data were extracted from research articles included in the review using the standardized data extraction tool from the Qualitative Assessment and Review Instrument.

DATA SYNTHESIS

Qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved aggregation and synthesis of findings.

RESULTS

A total of 21 research articles were included in the review. The review process resulted in 129 study findings that were aggregated into 15 categories. The categories generated six synthesized findings: 1) An emotional roller coaster between hope and hopelessness, 2) Mothers as advocates in a battlefield within the system and family, 3) Parental experiences in a crossfire of blame, self-blame and stigmatization, 4) Shuttling between supportive and non-supportive services and professionals, 5) Routines, structures and strategies within everyday life, and 6) Despite multiple challenges, it is not all bad.

CONCLUSIONS

The findings illustrate the complexity of parental experiences that are influenced by guilt, hope, blame, stigmatization, exhaustion, reconciliation and professional collaboration. The findings address the impact attention deficit hyperactivity disorder has on the everyday family, and how parents seem to adapt to their life situation in the process of accepting their child's disorder.

IMPLICATIONS FOR PRACTICE

Health care systems and other professionals need to provide support and understanding to families of children with ADHD.

IMPLICATIONS FOR RESEARCH

Further research is needed to examine how professionals in health care settings can address the individual needs of the families and how future interventions may support the families and improve competences of health professionals.

ADHD and Everyday Life: Healthcare as a Significant Lifeline

AIM

The aim of this qualitative study was to explore parental experiences of how healthcare practices and healthcare professionals in hospital clinics in Denmark influence everyday life of parents with a child with ADHD.

DESIGN AND METHODS

The methodology was focused ethnography. Participant observation and interviews were used as the primary data collection methods. Fifteen families of children with ADHD were included from somatic and psychiatric hospital clinics.

RESULTS

Three main themes emerged from the experiences of the families: When the house of cards collapses in everyday life, Treading water before and after receiving the ADHD diagnosis, and Healthcare as a significant lifeline.

CONCLUSIONS

Accessibility to healthcare, trusting relationships and healthcare professionals recognizing how ADHD pervades all aspects of everyday life appear to be important factors in providing a lifeline for parents to help them regain confidence and control in disruptive phases. The parents depend on help from healthcare professionals and family-centred care to manage the complex challenges in everyday life.

Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population.

Objective

The objective of this study was to describe where, what, and when people search online for topics related to ADHD.

Methods

Data were collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods.

Results

Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis.

Conclusions

The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD.

Agomelatine as a Treatment for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Double-Blind, Randomized Clinical Trial

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Due to lack of response to the medication and significant side effects of the treatment with stimulants, alternative medications should be considered. The aim of this study is to evaluate efficacy of agomelatine in treatment of ADHD.

METHODS

Fifty-four outpatients, children 6-15 years old, with diagnosis of ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria participated in a 6-week, parallel, double-blind, randomized clinical trial. Fifty patients completed 6 weeks of treatment with either ritalin (methylphenidate hydrochloride [MPH]) (20 mg/day in participants below 30 kg and 30 mg/day in patients with weight ≥30 kg) or agomelatine (15 mg/day in patients with weight ≥30 kg and 25 mg/day in patients with weight ≥45 kg). Participants were assessed using Parent and Teacher ADHD Rating Scale-IV at baseline and at weeks 3 and 6.

RESULTS

General linear model repeated measures showed no significant differences between the two groups on Parent and Teacher Rating Scale scores (F = 1.13, df = 1.26, p = 0.305, and F = 0.95, df = 1.25, p = 0.353, respectively). Changes in Teacher and Parent ADHD Rating Scale scores from baseline to the study end were not significantly different between the agomelatine group (9.28 ± 8.72 and 24.12 ± 7.04, respectively) and the MPH group (6.64 ± 11.04 and 25.76 ± 7.82, respectively) (p = 0.46 and p = 0.44, respectively). There was a trend for less insomnia in the agomelatine group versus MPH-treated group (4% vs. 24%, p = 0.09).

CONCLUSIONS

A treatment course of 6 weeks with agomelatine demonstrated a favorable safety and efficacy profile in children and adolescents with ADHD. Nonetheless, larger controlled studies with longer treatment periods are necessary.

The emerging roles of human trace amines and human trace amine-associated receptors (hTAARs) in central nervous system

Human trace amines (TAs) are endogenous compounds, previously almost ignored in human pathology for many reasons (difficulty of their measurement in biological fluids, unknown receptors for elusive amines), are now considered to play a significant role in synaptic transmission within the central nervous system (CNS) acting as neuromodulators. The recent discovery of a novel family of G-protein-coupled receptors (GPCRs) that includes individual members that are highly specific for TAs indicates a potential role for TAs as vertebrate neurotransmitters or neuromodulators, although the majority of these GPCRs so far have not been demonstrated to be activated by TAs. Human trace amine receptors (including TAAR1 TAAR2 TAAR5 TAAR6 TAAR8 TAAR9) are expressed in the brain and play significant physiological and neuropathological roles by activation of trace amines. We herein discuss the recent findings that provide insights into the functional roles of human trace amines (including P-Octopamine, β phenylethylamine, Tryptamine, Tyramine, Synephrine, 3-Iodothyronamine, 3-Methoxytyramine, N-Methyltyramine, N-Methylphenethylamine) in brain. Furthermore, we discuss the known functions of human trace amine receptors in brain.

GPs' experiences with enhanced collaboration between psychiatry and general practice for children with ADHD

BACKGROUND

Most general practitioners (GPs) do not feel comfortable with diagnosing and treating children with attention deficit hyperactivity disorder (ADHD). This is problematic since ADHD is a prevalent disorder and an active role of GPs is desired. In the Netherlands a collaborative ADHD programme was established, comprising of shortened diagnostic assessment in specialized mental healthcare followed by psycho-education in mental healthcare and pharmacological treatment by pre-trained GPs.

OBJECTIVES

To explore the experiences of GPs regarding the diagnosis and treatment of children with uncomplicated ADHD within this programme.

METHODS

Semi-structured interviews with 15 GPs were conducted. The GPs participated in an evaluation of the collaborative ADHD programme. Data was analysed using the principles of constant comparative analysis.

RESULTS

Most participating GPs expressed reluctance to diagnose ADHD themselves. The reluctance was due to a lack of time, knowledge and experience. The GPs welcomed the collaborative programme because it met their need for both quick and adequate diagnosis by a specialist. Furthermore, an online ADHD course, offered by the programme, gave them the confidence to start and monitor ADHD medication. Finally, they appreciated the possibility of consulting a specialist when necessary.

CONCLUSION

GPs preferred that ADHD was diagnosed by a specialist. In the context of the ADHD collaborative programme, they felt competent and comfortable to start and monitor medication in children with uncomplicated ADHD. Key Messages Within a collaborative ADHD programme for children, participating GPs were positive about a quick and specialist diagnostic process within secondary care. After an online course, GPs felt confident to start and monitor ADHD medication in children with uncomplicated ADHD. GPs were content about the collaboration between primary and secondary care.

How 'core' are motor timing difficulties in ADHD? A latent class comparison of pure and comorbid ADHD classes

Children with attention-deficit/hyperactivity disorder (ADHD) have motor timing difficulties. This study examined whether affected motor timing accuracy and variability are specific for ADHD, or that comorbidity with autism spectrum disorders (ASD) contributes to these motor timing difficulties. An 80-trial motor timing task measuring accuracy (μ), variability (σ) and infrequent long response times (τ) in estimating a 1-s interval was administered to 283 children and adolescents (8-17 years) from both a clinic and population based sample. They were divided into four latent classes based on the SCQ and

CPRS-R

L data. These classes were: without behavioral problems 'Normal-class' (n = 154), with only ADHD symptoms 'ADHD-class' (n = 49), and two classes with both ASD and ADHD symptoms; ADHD(+ASD)-class (n = 39) and ASD(+ADHD)-class (n = 41). The pure ADHD-class did not deviate from the Normal class on any of the motor timing measures (mean RTs 916 and 925 ms, respectively). The comorbid ADHD(+ASD) and ASD(+ADHD) classes were significantly less accurate (more time underestimations) compared to the Normal class (mean RTs 847 and 870 ms, respectively). Variability in motor timing was reduced in the younger children in the ADHD(+ASD) class, which may reflect a tendency to rush the tedious task. Only patients with more severe behavioral symptoms show motor timing deficiencies. This cannot merely be explained by high ADHD severity with ASD playing no role, as ADHD symptom severity in the pure ADHD-class and the ASD(+ADHD) class was highly similar, with the former class showing no motor timing deficits.

Physical Fitness and Resting EEG in Children With Attention Deficit Hyperactivity Disorder

Children with attention deficit hyperactivity disorder (ADHD) are characterized by a deviant pattern of brain oscillations during resting state, particularly elevated theta power and increased theta/alpha and theta/beta ratios that are related to cognitive functioning. Physical fitness has been found beneficial to cognitive performance in a wide age population. The purpose of the present study was to investigate the relationship between physical fitness and resting-state electroencephalographic (EEG) oscillations in children with ADHD. EEG was recorded during eyes-open resting for 28 children (23 boys and 5 girls, 8.66 ± 1.10 years) with ADHD, and a battery of physical fitness assessments including flexibility, muscular endurance, power, and agility tests were administered. The results indicated that ADHD children with higher power fitness exhibited a smaller theta/alpha ratio than those with lower power fitness. These findings suggest that power fitness may be associated with improved attentional self-control in children with ADHD.

Subcortical encoding of speech cues in children with attention deficit hyperactivity disorder

OBJECTIVE

There is little information about processing of nonspeech and speech stimuli at the subcortical level in individuals with attention deficit hyperactivity disorder (ADHD). The auditory brainstem response (ABR) provides information about the function of the auditory brainstem pathways. We aim to investigate the subcortical function in neural encoding of click and speech stimuli in children with ADHD.

METHODS

The subjects include 50 children with ADHD and 34 typically developing (TD) children between the ages of 8 and 12 years. Click ABR (cABR) and speech ABR (sABR) with 40 ms synthetic /da/ syllable stimulus were recorded.

RESULTS

Latencies of cABR in waves of III and V and duration of V-Vn (P⩽0.027), and latencies of sABR in waves A, D, E, F and O and duration of V-A (P⩽0.034) were significantly longer in children with ADHD than in TD children. There were no apparent differences in components the sustained frequency following response (FFR).

CONCLUSIONS

We conclude that children with ADHD have deficits in temporal neural encoding of both nonspeech and speech stimuli.

SIGNIFICANCE

There is a common dysfunction in the processing of click and speech stimuli at the brainstem level in children with suspected ADHD.

Efficacy of a psychosocial intervention for parents of children with attention deficit hyperactivity disorder, Alexandria, Egypt

BACKGROUND

Childhood attention deficit hyperactivity disorder (ADHD) is a chronic disorder that carries an immense amount of suffering for its victims, their families, and communities. The efficacy of behavioral parent training in the treatment of ADHD has been supported in several studies.

OBJECTIVE

To evaluate the efficacy of a predesigned culturally sensitive psychosocial intervention program for parents of ADHD children in Alexandria, Egypt.

PARTICIPANTS AND METHODS

A pretest-post-test intervention study was carried out at the Child Mental Health Clinic for School Students affiliated to the Health Insurance Organization, Alexandria. The intervention aimed at improving parents' knowledge of ADHD, building their skills in effective parenting, stress management and problem-solving, as well as providing social support. All the participants (50 parents) were assigned to groups, each of five to eight parents. They received a total of eight sessions on a weekly basis. The program was evaluated immediately after completion and 2 months later using the Arabic Version of Conners' Rating Scale to identify ADHD and to assess its severity, Home Situations Questionnaire, Parenting Scale, the Arabic Version of Depression Anxiety Stress Scales (DASS), and parental ADHD-related knowledge questionnaire were used.

RESULTS

There was a statistically significant decrease in the mean total scores recorded by parents on Conners' Rating Scale (P<0.001), Home Situations Questionnaire (P<0.05), Parenting Scale (P<0.001), and DASS (P<0.001) immediately after program completion and 2 months later compared with that reported before program initiation. The total scores of participants on the ADHD-related knowledge questionnaire increased significantly after attending the program (P<0.001).

CONCLUSION AND RECOMMENDATIONS

Provision of a psychosocial intervention program for parents of ADHD children proved to be effective in reducing perceived severity of the symptoms and problem situations, as well as improving parents' knowledge, discipline practices, and psychological well-being.

A functional NPSR1 gene variant and environment shape personality and impulsive action: a longitudinal study

Neuropeptide S and its receptor NPSR1 are involved in the regulation of arousal, attention and anxiety. We examined whether the NPSR1 gene functional polymorphism Asn¹⁰⁷Ile (rs324981, A>T) influences personality, impulsivity, and attention-deficit/hyperactivity disorder (ADHD)-related symptoms in a population-representative sample, and whether any eventual associations depend on age, sex, family relations and stressful life events (SLE). We used self-reports or teachers' ratings for both the younger (n=593) and older (n=583) cohort of the longitudinal Estonian Children Personality, Behaviour and Health Study. Males with the TT genotype displayed more ADHD-related symptoms. Adaptive impulsivity and Extraversion increased the most from age 18 to 25. While highest increases were observed in AA men, TT women exhibited the largest decreases. For participants with the AA genotype, Warmth in family was inversely associated with Neuroticism, and positively associated with Extraversion and Adaptive impulsivity. High exposure to SLE increased impulsivity and ADHD scores in TT genotype subjects. We conclude that the NPSR1 A/T polymorphism is associated with impulsivity, ADHD symptoms and personality, mirroring the activity- and anxiety-mediating role of NPSR1. Heterozygous individuals were the least sensitive to environmental factors, whereas subjects with the AA genotype and TT genotype reacted to different types of environmental adversities.

Evaluation of neurofeedback in ADHD: the long and winding road

Among the clinical applications of neurofeedback, most research has been conducted in ADHD. As an introduction a short overview of the general history of neurofeedback will be given, while the main part of the paper deals with a review of the current state of neurofeedback in ADHD. A meta-analysis on neurofeedback from 2009 found large effect sizes for inattention and impulsivity and medium effects sizes for hyperactivity. Since 2009 several new studies, including 4 placebo-controlled studies, have been published. These latest studies are reviewed and discussed in more detail. The review focuses on studies employing (1) semi-active, (2) active, and (3) placebo-control groups. The assessment of specificity of neurofeedback treatment in ADHD is discussed and it is concluded that standard protocols such as theta/beta, SMR and slow cortical potentials neurofeedback are well investigated and have demonstrated specificity. The paper ends with an outlook on future questions and tasks. It is concluded that future controlled clinical trials should, in a next step, focus on such known protocols, and be designed along the lines of learning theory.

Impulsivity and substance-related attentional bias: a meta-analytic review

BACKGROUND

Previous research demonstrates the role of attentional bias in addictive behaviors. Impulsivity is thought to affect the strength of attentional biases, and thus, attentional biases might be one mechanism by which impulsivity affects addictive behaviors. However, whether or not impulsivity is related to attentional biases across different conceptualizations of impulsivity and attentional biases has yet to be examined as an initial test of such causal models.

METHODS

The authors completed a meta-analysis of 13 published research studies examining the relationship between substance-related attentional bias and different conceptualizations of impulsivity.

RESULTS

There was a small and significant effect size between impulsivity and substance-related attentional bias (r=0.20), which was moderated by impulsivity measurement type (Qb=5.91, df=1, p<0.05): there was a stronger relationship between behavioral impulsivity and substance-related attentional bias (r=0.22) than trait impulsivity and substance-related attentional bias (r=0.10). Different components of behavioral impulsivity and trait impulsivity did not affect the relationship.

CONCLUSIONS

This study is the first systematic and empirical demonstration of the relationship between substance-related attentional bias and impulsivity and suggests viability of future examinations of casual models relating these constructs. Since trait and behavioral conceptualizations differentially relate to substance-related attentional bias, the current review further supports research suggesting how disaggregation of multidimensional constructs can lead to more robust relationships.

A decade of EEG Theta/Beta Ratio Research in ADHD: a meta-analysis

OBJECTIVE

Many EEG studies have reported that ADHD is characterized by elevated Theta/Beta ratio (TBR). In this study we conducted a meta-analysis on the TBR in ADHD.

METHOD

TBR data during Eyes Open from location Cz were analyzed from children/adolescents 6-18 years of age with and without ADHD.

RESULTS

Nine studies were identified with a total of 1253 children/adolescents with and 517 without ADHD. The grand-mean effect size (ES) for the 6-13 year-olds was 0.75 and for the 6-18 year-olds was 0.62. However the test for heterogeneity remained significant; therefore these ESs are misleading and considered an overestimation. Post-hoc analysis found a decreasing difference in TBR across years, explained by an increasing TBR for the non-ADHD groups.

CONCLUSION

Excessive TBR cannot be considered a reliable diagnostic measure of ADHD, however a substantial sub-group of ADHD patients do deviate on this measure and TBR has prognostic value in this sub-group, warranting its use as a prognostic measure rather than a diagnostic measure.

Salivary bacteria and oral health status in medicated and non-medicated children and adolescents with attention deficit hyperactivity disorder (ADHD)

OBJECTIVES

Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder. Studies have shown that children with ADHD are more prone to caries than those without. The study investigated children diagnosed with ADHD, both with and without pharmacological intervention, and the following: DMFT\dmft, plaque index (PI), mutans streptococci (MS) levels, lactobacilli (LB) levels, salivary flow, salivary buffer capacity, oral hygiene, and diet.

STUDY DESIGN

DMFT/dmft index, PI, MS and LB levels, salivary flow, and salivary buffer capacity were examined in three groups of children: ADHD1-diagnosed with ADHD with no pharmacological intervention (N = 31), ADHD2-treated with medications for ADHD (N = 30), and a healthy control group (N = 30). Diet and oral health habits were assessed through questionnaires completed by parents.

RESULTS

There were no differences in the DMFT/dmft index, MS and LB counts, salivary buffer capacity, and parent reported diet and oral health behavior between the three groups. Children with ADHD demonstrated a higher plaque index.

CONCLUSIONS

Although children with ADHD did not report different diet and oral health behavior from children without ADHD, this group had significantly higher levels of plaque than the control group, which combined with hyposalivation may be a risk factor for caries at an older age.

CLINICAL RELEVANCE

Medicated and non-medicated ADHD children were similar to control children in their caries rate, MS and LB counts, salivary buffer capacity, and diet and oral health behavior. They differed in the amount of plaque found on their teeth. As a group, ADHD children demonstrated hyposalivation compared with the control.

Characteristics and comorbidity of ADHD sib pairs in the Central Valley of Costa Rica

BACKGROUND

While genetic epidemiological studies demonstrate a substantial degree of genetic predisposition for attention-deficit/hyperactivity disorder (ADHD), they also suggest that the genetics are complex and may differ between populations or ethnic groups.

OBJECTIVE

This study describes the phenomenology of siblings with ADHD from the genetically isolated population of the Central Valley of Costa Rica.

METHODS

Rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined ADHD subtypes and comorbid conditions were calculated in a sample of 157 ADHD-affected children (probands and siblings) recruited for genetic studies using standardized approaches. Sib-sib comparisons and logistic regressions were conducted to identify significant patterns of concordance.

RESULTS

Combined-type ADHD (69.5%) was the most common subtype among probands, followed by the inattentive (27.4%), and hyperactive-impulsive (3.2%) subtypes. Anxiety disorders were prevalent (55.9%), as were disruptive behavior disorders (30.9%) and Tourette disorder (17.0%). Probands and siblings showed high sib-sib concordance for anxiety disorders.

CONCLUSIONS

ADHD in Costa Rica is similar in clinical and demographic characteristics to ADHD seen in other parts of the world, although the rates of co-occurring psychiatric disorders differ somewhat from those previously reported in Latin American samples. Comorbid anxiety is prevalent, with high rates of sib-sib concordance, and may represent a distinct, homogeneous subgroup suitable for genetic studies.

Training children with ADHD to minimize impulsivity in auditory contralateral masking

OBJECTIVE

Impulsivity and distractibility are among the important symptoms of attention deficit hyperactivity disorder (ADHD). In this study, impulsivity is operationally measured using false-alarm rates in an auditory, contralateral-masking task. Intensive auditory training was attempted to decrease false alarm rates.

METHODS

In contralateral masking there is a distracting noise in one ear on every trial and a threshold-level tone in the other ear on half of those trials. Participants indicated whether the tone was present or not and received immediate feedback. The intensity of the masked tone was adaptively varied to track threshold. False alarms are the error of commission, saying that a stimulus is present when it is not. Seven school-aged children with ADHD (ages 10-16) and four adults without ADHD were trained on this task for 900 trials per day over four consecutive days.

RESULTS

False alarms from the children with ADHD decreased over the four days of training, beginning at the high level and ending at the low level expected from previous studies. There was no generalization to a different masking task. Results from the four adults were unexpected: soon after the training began they behaved no differently than the children with ADHD.

CONCLUSION

Children with ADHD can be trained to become less impulsive in an auditory detection task.

Altered serotonergic function may partially account for behavioral endophenotypes in steroid sulfatase-deficient mice

The X-linked gene STS encodes the steroid hormone-modulating enzyme steroid sulfatase. Loss-of-function of STS, and variation within the gene, have been associated with vulnerability to developing attention deficit hyperactivity disorder (ADHD), a neurodevelopmental condition characterized by inattention, severe impulsivity, hyperactivity, and motivational deficits. ADHD is commonly comorbid with a variety of disorders, including obsessive-compulsive disorder. The neurobiological role of steroid sulfatase, and therefore its potential role in ADHD and associated comorbidities, is currently poorly understood. The 39,X(Y)*O mouse, which lacks the Sts gene, exhibits several behavioral abnormalities relevant to ADHD including inattention and hyperactivity. Here, we show that, unexpectedly, 39,X(Y)*O mice achieve higher ratios than wild-type mice on a progressive ratio (PR) task thought to index motivation, but that there is no difference between the two groups on a behavioral task thought to index compulsivity (marble burying). High performance liquid chromatography analysis of monoamine levels in wild type and 39,X(Y)*O brain tissue regions (the frontal cortex, striatum, thalamus, hippocampus, and cerebellum) revealed significantly higher levels of 5-hydroxytryptamine (5-HT) in the striatum and hippocampus of 39,X(Y)*O mice. Significant correlations between hippocampal 5-HT levels and PR performance, and between striatal 5-HT levels and locomotor activity strongly implicate regionally-specific perturbations of the 5-HT system as a neurobiological candidate for behavioral differences between 40,XY and 39,X(Y)*O mice. These data suggest that inactivating mutations and functional variants within STS might exert their influence on ADHD vulnerability, and disorder endophenotypes through modulation of the serotonergic system.

Loss of striatal cannabinoid CB1 receptor function in attention-deficit / hyperactivity disorder mice with point-mutation of the dopamine transporter

Abnormal dopamine (DA) transmission in the striatum plays a pivotal role in attention-deficit/hyperactivity disorder (ADHD). As striatal DA signalling modulates the endocannabinoid system (ECS), the present study was aimed at investigating cannabinoid CB1 receptor (CB1R) function in a model of ADHD obtained by triple point-mutation in the dopamine transporter (DAT) gene in mice, making them insensitive to cocaine [DAT cocaine-insensitive (DAT-CI) mice]. DAT-CI mice had a marked hyperactive phenotype, and neurophysiological recordings revealed that the sensitivity of CB1Rs controlling GABA-mediated synaptic currents [CB1Rs((GABA)) ] in the striatum was completely lost. In contrast, CB1Rs modulating glutamate transmission [CB1Rs((Glu)) ], and GABA(B) receptors were not affected in this model of ADHD. In DAT-CI mice, the blockade of CB1R((GABA)) function was complete even after cocaine or environmental manipulations activating the endogenous DA-dependent reward system, which are known to sensitize these receptors in control animals. Conversely, the hedonic property of sucrose was intact in DAT-CI mice, indicating normal sweet perception in these animals. Our results point to CB1Rs as novel molecular players in ADHD, and suggest that therapeutic strategies aimed at interfering with the ECS might prove effective in this disorder.

Steroid sulfatase-deficient mice exhibit endophenotypes relevant to attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition characterised by inattention, impulsivity and hyperactivity; it is frequently co-morbid with anxiety and conduct disorders, sleep perturbation and abnormal consummatory behaviours. Recent studies have implicated the neurosteroid-modulating enzyme steroid sulfatase (STS) as a modulator of ADHD-related endophenotypes. The effects of steroid sulfatase deficiency on homecage activity, feeding/drinking behaviours, anxiety-related behaviours (assayed in light-dark box and open field paradigms), social dominance and serum steroid hormone levels were determined by comparing 40,XY and 39,X(Y*)O mice. Subsequently, mice administered the steroid sulfatase inhibitor COUMATE acutely were compared to vehicle-treated mice on behavioural tasks sensitive to enzyme deficiency to dissociate between its developmental and ongoing effects. 39,X(Y*)O mice exhibited heightened reactivity to a novel environment, hyperactivity in the active phase, and increased water (but not food) consumption relative to 40,XY mice during a 24h period; the former group also demonstrated evidence for heightened emotional reactivity. There was no difference in social dominance between the 40,XY and 39,X(Y*)O mice. COUMATE administration had no effect on homecage activity, water consumption or anxiety measures in the open field. 39,X(Y*)O mice exhibited significantly lower dehydroepiandrosterone (DHEA) serum levels than 40,XY mice, but equivalent corticosterone levels. Together with previous data, the present results suggest that steroid sulfatase may influence core and associated ADHD behavioural endophenotypes via both developmental and ongoing mechanisms, and that the 39,X(Y*)O model may represent a useful tool for elucidating the neurobiological basis of these endophenotypes.

Prevalence, determinants and spectrum of attention-deficit hyperactivity disorder (ADHD) medication of children and adolescents in Germany: results of the German Health Interview and Examination Survey (KiGGS)

OBJECTIVE

To investigate the prevalence, determinants and spectrum of attention-deficit hyperactivity disorder (ADHD) medication and its associations with socioeconomic status (SES), health-related behaviour and living conditions.

DESIGN

Observational cross-sectional study.

SETTING

Germany.

PARTICIPANTS

Representative population-based sample of non-institutionalised youth aged between 0 and 17 years (n=17 450) and examined between 2003 and 2006.

MAIN OUTCOME MEASURE

Prevalence and spectrum of ADHD medication (Anatomical Therapeutic Chemical (ATC) code N04BA) measured by standardised computer-assisted personal interview (CAPI) on drug use.

RESULTS

The overall prevalence of ADHD medication (stimulants including atomoxetine) was 0.9% (95% CI 0.7% to 1.1%). Boys used these drugs (1.5%, 1.2% to 1.8%) five times more than girls 0.3% (0.2% to 0.5%). The highest prevalence rates were for boys aged 6-10 years (2.3%, 1.7% to 3.1%S) and 11-13 (2.7%, 2.0% to 3.7%). Boys from families with no immigration background used ADHD medication almost 6 times as frequently as boys with an immigration background (1.7% vs 0.3%). Multivariate analysis (binary logistic regression) showed boys (OR 5.16, 95% CI 3.15 to 8.47), 11-year-olds to 13-year-olds (2.24, 1.28 to 3.49), children in large cities (2.18, 1.13 to 4.22), children with no immigration background (3.06, 1.34 to 6.99), and children with only a good (vs excellent) parent-rated health status (1.91, 1.18 to 3.08) being more likely to be using ADHD medication. A visit to the doctor in the last month or last quarter was associated with a higher probability for ADHD medication (3.18, 1.29 to 7.95 and 3.59, 1.45 to 8.90, respectively).

CONCLUSIONS

Results show prevalence rates of ADHD medication use for the German child and adolescent population that are considerably lower than published prevalence rates from the USA, but comparable with those of western European and Scandinavian countries. Lower use rates in rural versus urban regions may point to differential healthcare access. The inverse association of ADHD medication use with immigration status suggests potentially restricted access to healthcare services for immigrants or may reflect culture-specific differences in attitudes towards symptoms of ADHD.

Oral health status, salivary flow rate and salivary quality in children, adolescents and young adults with ADHD

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder that presents in 3-7% of school-age children. Studies have shown that children, adolescents and young adults with ADHD are more prone to caries than those without.

AIM

The study investigated a possible relationship between the oral health status of children, adolescents and young adults diagnosed with ADHD, both with and without pharmacological intervention, and the following: salivary flow rate, oral mucosal pH, plaque index (PI), oral hygiene and dietary behaviour.

STUDY DESIGN

DMFT/dmft index (D;d-Decay, M;m-Missing; F;f-Filled,T;t-teeth), plaque index, oral mucosal pH and unstimulated whole salivary flow (USF) were examined in three groups of children, adolescents and young adults: those diagnosed with ADHD with no pharmacological intervention (N=31), those treated with medications for ADHD (N=30), and a healthy control group (N=30). Diet and oral health habits were assessed by means of questionnaires completed by parents.

RESULTS

Mean USF values were 0.72, 0.85 and 1.13 ml/min for participants with ADHD and without medication, with ADHD and with medication, and without ADHD, respectively (p=0.016). There were no differences in the DMFT/dmft index and in parent reported diet and oral health behaviour between the three groups. Children with ADHD demonstrated a statistically significant higher plaque index (p<0.05).

CONCLUSIONS

The ADHD group, with or without pharmacological intervention, showed higher plaque index and lower USF, but no difference in DMFT/dmft. The ADHD group did not differ from the non-ADHD group in their diet or oral health behaviour as assessed by parent reports.

Altered tryptophan and alanine transport in fibroblasts from boys with attention-deficit/hyperactivity disorder (ADHD): an in vitro study

Background

The catecholaminergic and serotonergic neurotransmitter systems are implicated in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). The amino acid tyrosine is the precursor for synthesis of the catecholamines dopamine and norepinephrine, while tryptophan is the precursor of serotonin. A disturbed transport of tyrosine, as well as other amino acids, has been found in a number of other psychiatric disorders, such as schizophrenia, bipolar disorder and autism, when using the fibroblast cell model. Hence, the aim of this study was to explore whether children with ADHD may have disturbed amino acid transport.

Methods

Fibroblast cells were cultured from skin biopsies obtained from 14 boys diagnosed with ADHD and from 13 matching boys without a diagnosis of a developmental disorder. Transport of the amino acids tyrosine, tryptophan and alanine across the cell membrane was measured by the cluster tray method. The kinetic parameters, maximal transport capacity (V_max) and affinity constant (K_m) were determined. Any difference between the two groups was analyzed by Student's unpaired t-test or the Mann Whitney U test.

Results

The ADHD group had significantly decreased V_max (p = 0.039) and K_m (increased affinity) (p = 0.010) of tryptophan transport in comparison to controls. They also had a significantly higher V_maxof alanine transport (p = 0.031), but the Km of alanine transport did not differ significantly. There were no significant differences in any of the kinetic parameters regarding tyrosine transport in fibroblasts for the ADHD group.

Conclusions

Tryptophan uses the same transport systems in both fibroblasts and at the blood brain barrier (BBB). Hence, a decreased transport capacity of tryptophan implies that less tryptophan is being transported across the BBB in the ADHD group. This could lead to deficient serotonin access in the brain that might cause disturbances in both the serotonergic and the catecholaminergic neurotransmitter systems, since these systems are highly interconnected. The physiological importance of an elevated transport capacity of alanine to the brain is not known to date.

Ciclo vigília/sono e o transtorno de déficit de atenção/hiperatividade

OBJETIVO: Analisar as relações entre ciclo vigília/sono e transtorno de déficit de atenção/hiperatividade. FONTES DE DADOS: Os artigos foram selecionados nas bases de dados SciELO e PubMed, utilizando-se "sono", "transtorno de déficit de atenção/hiperatividade", "atividade motora" e "crianças" como palavras-chave para a busca. SÍNTESE DOS DADOS: Embora os resultados de diferentes estudos sejam inconclusivos e, por vezes, contraditórios, não sendo possível estabelecer relações claras entre sono e transtorno do déficit de atenção/hiperatividade, observa-se que o sono das crianças diagnosticadas difere do sono de crianças que não possuem o transtorno, sugerindo que alterações de sono possam se relacionar ao transtorno do déficit de atenção/hiperatividade. CONCLUSÕES: A falta de marcadores biológicos e de conhecimento a respeito da sua etiologia gera dificuldades na determinação da real prevalência do transtorno do déficit de atenção/hiperatividade, além de limitar sua compreensão e a busca por novas formas de tratamento e prevenção. Embora dificuldades de sono sejam frequentemente relatadas na prática clínica e já tenham sido utilizadas como um dos critérios diagnósticos para o transtorno, pouco se sabe sobre a possível participação da privação de sono na etiologia do transtorno do déficit de atenção/hiperatividade.

A comparative analysis of health-related quality of life and family impact between children with ADHD treated in a general pediatric clinic and a psychiatric clinic utilizing the PedsQL

OBJECTIVE

To evaluate health-related quality of life (HRQOL) from the perspective of children with ADHD and their parents being seen in a Pediatric Clinic in comparison to healthy children and children with ADHD being seen in a Psychiatric Clinic.

METHOD

Participants were children with a physician diagnosis of ADHD ages 5-18 years and their parents (n=17, General Pediatric Clinic; n=181, Psychiatric Clinic). Children and parents completed the PedsQL™ 4.0 Generic Core Scales. Parents completed the PedsQL Family Impact Module and Vanderbilt ADHD Diagnostic Rating Scales.

RESULTS

Pediatric patients with ADHD being seen in the Pediatric Clinic demonstrated substantially lower HRQOL in comparison to the matched healthy sample, and significantly higher HRQOL and family functioning than pediatric patients with ADHD being seen in the Psychiatric Clinic.

CONCLUSION

These data demonstrate the substantial negative impact of ADHD on HRQOL from the perspective of both children and parents.).