Attention-deficit/hyperactivity disorder

Latent structure of working memory and emotion regulation in pediatric ADHD

Working memory is a key cognitive function that is often implicated in ADHD and may represent an underlying cognitive endophenotype of the disorder. Working memory is related to emotion regulation, which is a common area of impairment in children with ADHD. Given the high rate of comorbid diagnoses with ADHD, children with comorbid internalizing, externalizing, and developmental disorders may present with variable working memory profiles and subsequent emotion regulation deficits. This study aimed to adequately characterize the latent structure of working memory impairments and emotional regulation outcomes in a clinical sample of children ages 6-16 with ADHD. This study also examined the interplay between the identified working memory/emotion regulation patterns, demographic characteristics, and the role of comorbid diagnoses. Results highlighted two distinct, invariant, unrestricted classes of working memory/emotion regulation. Class 1 (Average; 62% of the sample) had significantly lower digit-span scores, and generally persevered emotion regulation functioning per parent/teacher report. Class 2 (Emotionally Dysregulated) had average working memory scores, and elevated emotion regulation problems. The working memory indicators had small correlations with parents (and not teacher) measures of emotion regulation. Finally, latent class membership did not differ by comorbid diagnosis, age, gender, or verbal IQ. Findings elucidate heterogeneity in common domains affected by ADHD and suggest that this heterogeneity may not be due to demographic/comorbidity factors. The role of varying information reports is discussed, and potential assessment and treatment implications are highlighted.

Shared cognitive resources between memory and attention during sound-sequence encoding

You are on the phone, walking down a street. This daily situation calls for selective attention, allowing you to ignore surrounding irrelevant sounds, while trying to encode in memory the relevant information from the phone. Attention and memory are indeed two cognitive functions that are interacting constantly. However, their interaction is not yet well characterized during sound-sequence encoding. We independently manipulated both selective attention and working memory in a delayed-matching-to-sample of two tone-series, played successively in one ear. During the first melody presentation (memory encoding), weakly or highly distracting melodies were played in the other ear. Detection of the difference between the two comparison melodies could be easy or difficult, requiring low- or high-precision encoding, i.e., low or high memory load. Sixteen non-musician and 16 musician participants performed this new task. As expected, both groups of participants were less accurate in the difficult memory task and in difficult-to-ignore distractor conditions. Importantly, an interaction between memory-task difficulty and distractor difficulty was found in both groups. Non-musicians presented less difference between easy and difficult-to-ignore distractors in the difficult than in the easy memory task. On the contrary, musicians, with better performance than non-musicians, showed a greater difference between easy and difficult-to-ignore distractors in the difficult than in the easy memory task. In a second experiment including trials without a distractor, we could show that these effects are in line with the cognitive load theory. Taken together, these results speak for shared cognitive resources between working memory and attention during sound-sequence encoding.

Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.

Enablers and hindrances for longer-term abstinence in opioid dependent individuals receiving treatment with extended-release naltrexone: A Norwegian longitudinal recovery trial (NaltRec study)

Opioid-dependence is a comprehensive, relapsing disorder with negative individual, - family, - and societal consequences. Recovery is difficult to achieve. Research has shown reduced substance use and improved health- and psychosocial factors with extended-release naltrexone (XR-NTX) treatment. Pharmacological treatment should include psychosocial interventions to improve longer-term recovery. This study explores how voluntary monthly treatment with extended-release naltrexone hydrochloride (Vivitrol®) will influence longer-term recovery, health and psychosocial relationships in opioid-dependent patients. Close relatives' experiences and societal costs will be assessed. This Norwegian naturalistic, multicenter, open-label study includes 150 opioiddependent patients. Patients are assessed every four weeks for 24 weeks, with 28 weeks optional follow-up treatment-period, and at three, six and 12 months posttreatment. Controls are opioid-dependent patients enrolled in Opioid Maintenance Treatment programs (n = 150). Data on recovery will be collected from participants, close relatives, and community health service providers. Genetic analyses of major signaling pathways and national registries on prescriptions and health care use will be analyzed. Recruitment period is September 2018 to September 2020. The assessment of medical, psychological, relational and societal factors may provide novel in-depth knowledge on the complexity of personal recovery-processes. The results are expected to have impact on priorities in treatment and follow-up for opioid dependent patients.

Differential associations of neurobehavioral traits and cognitive ability to academic achievement in higher education

BACKGROUND

People vary between each other on several neurobehavioral traits, which may have implications for understanding academic achievement.

METHODS

University-level Psychology or Engineering students were assessed for neurobehavioral traits, intelligence, and current psychological distress. Scores were compared with their grade point average (GPA) data.

RESULTS

Factors associated with higher GPA differed markedly between groups. For Engineers, intelligence, but not neurobehavioral traits or psychological distress, was a strong correlate of grades. For Psychologists, grades were not correlated with intelligence but they were with the neurobehavioral traits of executive dysfunction, disinhibition, apathy, and positive schizotypy. However, only the latter two were associated independently of psychological distress. Additionally, higher mixed-handedness was associated with higher GPA in the combined sample.

CONCLUSIONS

Neurological factors (i.e., neurobehavioral traits and intelligence), are differentially associated with university-level grades, depending on the major studied. However, mixed-handedness may prove to be a better general predictor of academic performance across disciplines.

Evaluation of Risk Factors for ADHD and Co-Morbid Psychiatric Disorders Among the Parents of Children With ADHD

OBJECTIVE

The aim of this study is to investigate the presence of ADHD and other psychiatric disorders among parents with at least one child with ADHD relative to parents with children who do not have ADHD.

METHOD

Eighty five parents of children with ADHD with 68 control parents who had healthy children without ADHD were interviewed for participation in present study. Each parent was evaluated for co-existing psychiatric disorders using the Structured Clinical Interview for the DSM IV Axis I Disorders (SCID I).

RESULTS

We found that ADHD and co-morbid psychiatric symptoms were increased in the parents of children with ADHD in comparison with the healthy control group.

CONCLUSION

Psychiatric co-morbidity was more common among the parents of patients with inattentive and combined presentations. Adult ADHD is associated with psychiatric co-morbidities including anxiety disorders, mood disorders, and somatoform disorders as well as substantial role impairment.

The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder: a literature review

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in childhood. This disorder, in addition to its main symptoms, creates significant difficulties in education, social performance, and personal relationships. Given the importance of rehabilitation for these patients to combat the above issues, the use of virtual reality (VR) technology is helpful. The aim of this study was to highlight the opportunities for VR in the rehabilitation of children with ADHD. This narrative review was conducted by searching for articles in scientific databases and e-Journals, using keywords including VR, children, and ADHD. Various studies have shown that VR capabilities in the rehabilitation of children with ADHD include providing flexibility in accordance with the patients' requirements; removing distractions and creating an effective and safe environment away from real-life dangers; saving time and money; increasing patients' incentives based on their interests; providing suitable tools to perform different behavioral tests and increase ecological validity; facilitating better understanding of individuals' cognitive deficits and improving them; helping therapists with accurate diagnosis, assessment, and rehabilitation; and improving working memory, executive function, and cognitive processes such as attention in these children. Rehabilitation of children with ADHD is based on behavior and physical patterns and is thus suitable for VR interventions. This technology, by simulating and providing a virtual environment for diagnosis, training, monitoring, assessment and treatment, is effective in providing optimal rehabilitation of children with ADHD.

Autism severity as a predictor of inattention and impulsivity in toddlers

OBJECTIVE

Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers.

METHOD

Parents/caregivers of 2300 atypically developing toddlers' ages 18-37 months were assessed about their children's behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2.

RESULTS

ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R(2) = 0.49, F (1, 2298) = 2234.72, p < 0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, β = 0.70, t (2298) = 47.27, p < 0.001.

CONCLUSIONS

ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.

Child maltreatment and ADHD symptoms in a sample of young adults

OBJECTIVE

The present study investigated the relationship between different types of childhood maltreatment (emotional, sexual, overall abuse, and no abuse) and the symptoms of attention deficit hyperactivity disorder (ADHD) in young adulthood.

METHOD

Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (24 years of age) were randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2,980 participants.

RESULTS

Chi-square analyses revealed significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS). Binary logistic regression analysis showed that the overall abuse class was more strongly associated with probable ADHD (OR=5.08), followed by emotional abuse (OR=3.09) and sexual abuse (OR=2.07).

CONCLUSIONS

The results showed that childhood maltreatment was associated with increased risk of ADHD symptoms in young adulthood. The findings of this study are discussed within the existing literature and suggestions for future research are outlined in order to replicate these findings in other adult populations.

Effects of methylphenidate on the catecholaminergic system in attention-deficit/hyperactivity disorder

Stimulants are part of the standard-of-care treatment for attention-deficit/hyperactivity disorder (ADHD). Methylphenidate, with a history of use spanning approximately 5 decades, is a first-line stimulant treatment for ADHD. Methylphenidate chiefly affects the prefrontal cortex and striatum, the mechanism of action being modulation of catecholaminergic tone. Methylphenidate treatment produces an increase in dopamine (DA) signaling through multiple actions, including blockade of the DA reuptake transporter and amplification of DA response duration, disinhibition of DA D2 autoreceptors and amplification of DA tone, and activation of D1 receptors on the postsynaptic neuron. The actions of methylphenidate may also be mediated by stimulation of the noradrenergic alpha2 receptor and DA D1 receptor in the cortex. The role of other neurotransmitters such as histamine, acetylcholine, serotonin, and alpha-agonists in modulating catecholamine pathophysiology in ADHD and ADHD treatment needs to be elucidated. Overall, the changes in catecholaminergic tone clinically manifest as improvements in attention deficit, distractibility, and motor hyperactivity in patients with ADHD.

Zur Wirksamkeit körperorientierter Therapieverfahren bei der Behandlung hyperaktiver Störungen: Ergebnisse einer kontrollierten Pilotstudie

Zusammenfassung: Fragestellung: Zur Effektivität körperorientierter Therapieverfahren bei hyperkinetischen Störungen liegen bisher kaum methodisch gut kontrollierte Studien vor. Ziel der Arbeit war die Prüfung der differentiellen Wirksamkeit eines an kindliche Bedürfnisse angepassten Yoga Trainings im Vergleich zu einem herkömmlichen Bewegungstraining. Methodik: Bei 19 Kindern mit klinischer Diagnose einer hyperkinetischen Störung (nach ICD-10) wurden nach randomisierter Gruppenzuordnung im 2×2 cross-over Design die Trainingseffekte (Yoga vs. Bewegungstraining) anhand von Varianzanalysen mit Messwiederholung geprüft. Ergebnisse: Es zeigte sich eine deutliche Überlegenheit des Yoga Trainings sowohl hinsichtlich der Verbesserungen der Testleitungen im Dortmunder Aufmerksamkeitstest (DAT) als auch bei der Reduktion der hyperkinetischen Symptomatik im standardisiert erhobenen Elternurteil mit Effektstärken (ES) im mittleren bis hohen Bereich (ES = 0.60-0.97). Bei Trainingsende lagen die Gruppenmittelwerte im unauffälligen Bereich und unterschieden sich nicht bedeutsam von den Werten einer repräsentativen Vergleichsstichprobe. Kinder mit Methylphenidat Behandlung profitierten mehr vom Training und zeigten aufgrund höherer Ausgangswerte zu Studienbeginn deutlichere Symptomverbesserungen als Kinder ohne pharmakologische Unterstützung. Schlussfolgerungen: Die Befunde der Pilotstudie legen nahe, dass Yoga als Intervention oder begleitende Therapie bei hyperkinetischen Störungen erfolgreich eingesetzt werden kann. Sie fordern dazu auf, die Wirksamkeit körperorientierter Therapieverfahren bei der Behandlung hyperaktiver Störungen in weiteren Studien systematisch zu prüfen.

Attention deficit and learning disabilities (ADHD/LD) among high school pupils in Holon (Israel)

Five hundred forty-three students participated in the study. The prevalence of ADHD according to criteria of DSM-4 among them was 15.2%, including three subgroups: ADHD (inattentive)- 9.7%, combined- 4.5%, and ADHD-hyperactivity-impulsivity (HI)- 1%. The prevalence of learning disability (LD) was 17.6%. The gender ratio in both groups (ADHD and LD) was equal. These pupils had lower academic achievements with lower marks. The prevalence of ADHD/LD found in the present study in Israel is in a higher range of those reported in the literature. We should remember that ADHD/LD is a neuro-behavioral disability and these children and adolescents need an early educational correcting program at home and at school.

Attention deficit hyperactivity disorder: an update

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder, affecting 3% to 5% of school-aged children. Of the 3 subtypes--predominantly inattentive, predominantly hyperactive/impulsive, and a combined subtype--the latter is the most commonly represented group, accounting for 50% to 70% of all ADHD individuals. Stimulant medication is the cornerstone of management; however, stimulants with a short duration of action have been problematic for some patients. Recent technologic advances in delivery systems offer many patients the option of a once-daily dosage.

Animal models of attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) involves clinically heterogeneous dysfunctions of sustained attention, with behavioral overactivity and impulsivity, of juvenile onset. Experimental models, in addition to mimicking syndromal features, should resemble the clinical condition in pathophysiology, and predict potential new treatments. One of the most extensively evaluated animal models of ADHD is the spontaneously hypertensive rat. Other models include additional genetic variants (dopamine transporter gene knock-out mouse, coloboma mouse, Naples hyperexcitable rat, acallosal mouse, hyposexual rat, and population-extreme rodents), neonatal lesioning of dopamine neurons with 6-hydroxydopamine, and exposure to other neurotoxins or hippocampal irradiation. None is fully comparable to clinical ADHD. The pathophysiology involved varies, including both deficient and excessive dopaminergic functioning, and probable involvement of other monoamine neurotransmitters. Improved models as well as further testing of their ability to predict treatment responses are required.

Lack of a relation between human neonatal thyroxine and pediatric neurobehavioral disorders

The growth and differentiation of the central nervous system are closely related to the presence of iodine and thyroid hormones. It has been hypothesized that neurobehavioral disabilities of childhood, such as attention deficit hyperactivity disorder (ADHD), learning disorders, and autism can be attributed to fetal thyroidal endocrine disruption in utero. To determine whether there is an association between neonatal thyroid status and a subsequent diagnosis of a neurobehavioral disability, neonatal thyroxine (T(4)) levels have been used as the indicator of the presence of intrauterine thyroidal dysfunction. Neonatal T(4) levels were obtained from the neonatal hypothyroidism screening program. All cases were diagnosed at medical school diagnostic clinics, the diagnostic categories being ADHD, autism spectrum disorder, behavioral disorder, cognitive disorder, developmental delay, emotional disorder, learning disability, and speech/language disorder. Conditional logistic regression analysis was performed for each clinical condition. Odds ratios for the conditions ranged from 0.92 to 1.13 with p values ranging between 0.19 and 0.84. No significant differences were detected between neonatal T(4) values of the cases and the controls for any of the neurobehavioral conditions. All neonatal T(4) values were within normal ranges. The data provide no evidence to suggest that intrauterine thyroid status as reflected by the neonatal T(4) values had an impact on the neurologic disorders diagnosed in childhood.

Treatment of attention-deficit disorder, cerebral palsy, and mental retardation in epilepsy

Epilepsy in childhood is often associated with other neurologic disorders, including attention-deficit/hyperactivity disorder, cerebral palsy, and mental retardation. A single pathologic process may explain both epilepsy and these associated disorders. However, in some cases, distinct etiologies may be present. Recognition of these problems is essential, as is individualized treatment. Proper classroom placement; behavior modification, speech, occupational, and physical therapies; pharmacological agents; and even surgical procedures have a role in the management of these comorbid disorders. Diagnostic criteria and therapeutic modalities used in these syndromes will be discussed.

Pemoline ingestion in children: a report of five cases and review of the literature

The authors describe five pediatric cases of excessive pemoline ingestion. Based on their experience compared with previously reported cases in the literature, they describe the clinical presentation and rational treatment recommendations for acute pemoline ingestion. Overall, patients experienced a relatively benign clinical course following pemoline ingestion. Symptoms of pemoline ingestion appear to be primarily an accentuation of the drug's pharmacological effects on the central nervous and cardiovascular systems with sinus tachycardia, hypertension, hyperactivity, choreoathetoid movements, and hallucinations being most commonly observed. These findings are consistent with previously reported cases. Possible rhabdomyolysis manifested by evaluation of serum CPK was also observed in 3 of 4 patients in whom this laboratory parameter was measured and appears to be a common finding in acute pemoline poisoning. After acute ingestion, symptoms occurred within 6 hours, lasting up to 48 hours in all patients. Gastric lavage and/or activated charcoal would be effective decontamination measures, whereas ipecac-induced emesis should be avoided after massive ingestion due to the possibility of seizures. Aggressive use of a benzodiazepine appears a reasonable first choice to treat associated involuntary movements, tremor, hyperactivity, irritability, and agitation. Phenothiazines or butyrophenones may also be used especially for serious life-threatening symptoms, including hypertensive crisis and severe hyperthermia, although these serious complications of stimulant overdose have not been reported after pemoline ingestion. If a patient should experience pemoline-induced hypertensive crisis, individual dose titration of labetalol or sodium nitroprusside would appear reasonable pharmacologic approaches for rapid stabilization of blood pressure.

Newborn thyroxine levels and childhood ADHD

OBJECTIVES

Normal brain development is highly dependent on adequate levels of iodine and thyroid hormone. It has been suggested that Attention Deficit Hyperactivity Disorder (ADHD) is the consequence of prenatal thyroidal endocrine disruption. The hypothesis was examined using neonatal thyroxine levels as a bio-marker of prenatal thyroid status and comparing it to subsequent development of ADHD.

DESIGN AND METHODS

In a matched case-control study, cases were defined as children diagnosed with ADHD, while children born in the same hospital and tested on the same day served as matched controls. Conditional logistic regression analysis with unequal numbers of controls was performed.

RESULTS

The neonatal thyroxine levels were within normal limits for each of the children who were subsequently diagnosed as having ADHD, and their distribution was no different from that of their controls.

CONCLUSIONS

Children diagnosed with ADHD do not demonstrate prenatal thyroidal dysfunction as reflected in the newborn thyroxine levels, therefore neonatal thyroxine levels are not a bio-marker for the subsequent development of ADHD.