Generalized hyperkinesis: follow-up study from age 7 to 13 years

A systematic review of global publication trends regarding long-term outcomes of ADHD

There is increased global recognition of attention deficit hyperactivity disorder (ADHD) as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs) in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least 2 years in duration were examined. A total of 351 studies were identified in the final analysis. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of 42 publications in 2008. This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder. This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time.

Stability and change in children with Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) are a heterogeneous group who have a marked impairment in the performance of functional motor skills. Provision for these children is usually made via a paediatrician through occupational or physiotherapy; though with a prevalence rate of 5%, regular provision is rarely possible because of limited professional resources.

METHODS

This study covers a period of nearly 4 years and initially examined a group of 31 children first identified as having DCD at 7-9 years of age. The children were observed and assessed before, during and after a total of 16 weeks of intervention carried out by parents and teachers. This was followed by a period of monitoring of performance for 26 of the children in the motor domain plus other abilities such as educational progress and self-concept. Individual children were tracked using a variety of qualitative and quantitative approaches, building up longitudinal whole child profiles.

RESULTS

Following intervention, 14 of the 26 children have shown improvement and stability in all areas and no longer display DCD symptoms. Eight children have profiles which have shown variability, with the children moving in and out of the DCD classification, while the remaining four children have consistently scored poorly in their movement skills and in addition received ongoing support in school for academic subjects.

CONCLUSIONS

The study has confirmed that children with DCD show varying profiles over a period of time and that the profiles have distinct characteristics related to events in the child's life. This approach to examining stability and change in the progressions of children's difficulties is in keeping with an ecological approach to explaining development with its multilayered influences creating changes.

Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study

OBJECTIVE

There is a need for controlled longitudinal studies in the field of attention disorders in the general population.

METHOD

In a community-based follow-up study, 55 of 61 subjects aged 22 years, who had attention-deficit/hyperactivity disorder (ADHD) with and without comorbid developmental coordination disorder (DCD) at initial workup at age 7 years, were compared, on a multitude of outcome variables, with 46 of 51 age-matched subjects without such diagnoses. None of the subjects had received stimulant treatment. Psychiatrists performing the follow-up study were blind to original diagnostic group status.

RESULTS

In the ADHD/DCD group 58% had a poor outcome compared with 13% in the comparison group (p < .001). Remaining symptoms of ADHD, antisocial personality disorder, alcohol abuse, criminal offending, reading disorders, and low educational level were overrepresented in the ADHD/DCD groups. The combination of ADHD and DCD appeared to carry a particularly gloomy outlook.

CONCLUSIONS

Childhood ADHD and DCD appears to be a most important predictor of poor psychosocial functioning in early adulthood. It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.

The identification of pervasive hyperactivity: is clinic observation necessary?

Three groups of hyperactive children (clinic observed, reported and situational) and a normal control group were compared on measures of behavioural, developmental and cognitive functioning. The clinic observed and reported groups did not differ significantly on any of the dependent variables. Situationally hyperactive children were less active, and had fewer behavioural and social difficulties than children with pervasive hyperactivity. Normal control subjects were distinguished by their better academic and social performance, and the absence of behaviour problems, language delay and hearing concerns. The data support the distinction between pervasive and situational hyperactivity, but not the separation of pervasive hyperactivity into clinic observable and reported hyperactivity.

Children with deficits in attention, motor control and perception (DAMP) almost grown up: psychiatric and personality disorders at age 16 years

Fifty-six cases with childhood onset deficits in attention, motor control and perception (DAMP) were followed-up at age 16 years and compared with 45 children without DAMP. Both groups had originally been recruited from the general population at the age of 6 years. Psychiatric disorders (affective disorders in particular) were more common in the DAMP group. Personality disorders were common in both groups, but the DAMP group much more often had a combination of several different personality disorders. The reasons for the discrepancies between teenagers with and without a prior history of DAMP are discussed.

Children with deficits in attention, motor control and perception (DAMP) almost grown up: general health at 16 years

One hundred and one children (56 with and 45 without deficits in attention, motor control and perception (DAMP)), originally diagnosed at six or seven years of age and belonging to a representative cohort of children from the general population were followed up at 16 and 17 years of age. There was a significant excess of substance abuse, fractures and other accidents in the DAMP group than among controls, in addition to more motor co-ordination problems, clumsiness, and height and weight problems. Mean complex visual reaction time was significantly longer in the DAMP group, accounted for by the number of boys in the group. It appears that 10-year outcome for children who had attention problems and clumsiness during the preschool period is considerably poorer than for those who did not have such problems.

The Emanuel Miller Memorial Lecture 1991. Autism and autistic-like conditions: subclasses among disorders of empathy

Recent autism and autism-related research from Gothenburg is surveyed. In indigenous families, typical autism seems no more common now than 10 years ago. Genetic factors play a part in causing autism and Asperger syndrome. Certain medical syndromes carry a relatively high risk of concomitant autistic symptoms. Evidence for non-specific brain dysfunction is often found in autism and autistic-like conditions. The search for the underlying clue to the riddle of autism may be futile. Autism might be best conceptualized as a behavioural syndrome reflecting underlying brain dysfunction which shades into other clinical syndromes. A new class of disorders of empathy is proposed.

European perspectives on hyperkinetic disorder

Differences between, on the one hand, North American and European perspectives on Hyperkinetic Disorder, and, on the other hand, within Europe are noted and discussed in this paper. A dominant European tradition has stressed, since the beginning of this century, the organic involvement in hyperkinetic disorder, whereas the North American tradition has stressed both behavioural and social functioning in hyperactivity (Attention Deficit Hyperactivity Disorder) and its associated disorder, Conduct Disorder. Five reasons for the difference in prevalence between the two perspectives are discussed: association disorder, decision rules, expression of behaviour, weighting of symptoms, and diagnostic instruments. The review suggests that the differences within Europe in the diagnosis, management, and treatment should be utilized in well-designed collaborative studies to investigate the validity of the different diagnostic and therapeutic procedures. The coordination of such studies is seen as the main task of the newly founded European Network on Hyperkinetic Disorder (EUNETHYDIS).

Mental retardation in urban children: a population study of reduced optimality in the pre-, peri- and neonatal periods

One hundred and thirty representative cases of mentally retarded children in Sweden were surveyed in order to detect reductions in optimality in the prenatal, perinatal and postnatal periods. There was a small but statistically significant reduction in optimality, particularly pertaining to the prenatal and neonatal periods. It is of interest, however, that these mentally retarded children had smaller reductions of optimality than did children with cerebral palsy or infantile autism.