ADHD in a school sample of Brazilian adolescents: a study of prevalence, comorbid conditions, and impairments

White matter properties in fronto-parietal tracts predict maladaptive functional activation and deficient response inhibition in ADHD

Response inhibition is a key characteristic of adaptive human behaviour. However, in attention deficit hyperactivity disorder (ADHD) it is often impaired. Previous neuroimaging investigations implicate a myriad of brain networks in response inhibition, making it more difficult to understand and overcome response inhibition difficulties. Recently, it has been suggested that a specific fronto-parietal functional circuitry between the inferior frontal gyrus (IFG) and the intraparietal sulcus (IPS), dictates the recruitment of the IPS during response inhibition in ADHD. To ascertain the critical role of the IFG-IPS functional circuit and its relevance to response inhibition in ADHD, it is crucial to understand the underlying structural architecture of this circuit so that the functional relevance could be interpreted correctly. Here we investigated the white matter pathways connecting the IFG and IPS using seed-based probabilistic tractography on diffusion data in 33 ADHD and 19 neurotypicals, assessing their impact on both IPS recruitment during response inhibition and on response inhibition performance in a Go/No-go task. Our results showed that individual differences in the structural properties of the IPS-IFG circuit, including tract volume and diffusivity, were linked to IPS activation and even predicted response inhibition performance outside the scanner. These findings highlight the structural-functional coupling within the IFG-IPS circuit in response inhibition in ADHD and suggest a structural basis for maladaptive functional top-down control in deficient inhibition in ADHD.

Evaluation of Motor Skills With Functional Dexterity Test in Children With ADHD and Comparison With Healthy Controls

OBJECTIVE

The study aimed to investigate whether the fine motor skills measured by the Functional Dexterity Test (FDT) in ADHD children differ from healthy controls. The second aim was to assess the applicability of the FDT assessment method among ADHD children.

METHOD

The FDT results as an objective assessment of hand skills were compared between 7 and 17 years old ADHD cases (n = 146) and age and gender-matched healthy controls (n = 213).

RESULTS

We found lower dominant and non-dominant processing time (respectively for dominant hand and non-dominant hand p = .001, effect size Cliff's Delta = .22; p = .001, ES Cliff's Delta = .29), higher peg processing speed (p = .001, ES Cliff's Delta = .23; p = .001, ES Cliff's Delta = .29), higher total error (p = .001, ES Cliff's Delta = .40; p = .001, ES Cliff's Delta = .51), and total FDT time (p = .0017, ES Cliff's Delta = .14; p = .011, ES Cliff's Delta = .16) in ADHD patients compared to healthy controls.

CONCLUSION

Manual dexterity evaluation would be helpful to detect the fine motor skill deficits of ADHD children. Although ADHD children were advantageous regarding speed, they were disadvantageous regarding processing errors and total process time. Therefore, the error time data should be considered in evaluating ADHD children, unlike healthy children.

Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis

BACKGROUND

The estimates of attention-deficit hyperactivity disorder (ADHD) prevalence across various studies are significantly variable, contributing to uncertainty in ADHD prevalence estimation. Previous systematic reviews and meta-analyses have attributed this variability primarily to the methodological characteristics of the studies, including the diagnostic criteria, source of information, and impairment requirement for the diagnosis.

METHODS

Review identified studies reporting ADHD prevalence in representative samples of children and adults in Europe and worldwide. Studies that were conducted in the general population were included. We focused on studies that report ADHD prevalence based on clinical diagnosis (clinical diagnostic criteria based on the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases criteria, other diagnostic tools, such as various scales or interviews based on clinical diagnostic criteria). PubMed/Medline was searched to identify relevant articles published until 2024/2/01. The study was registered in PROSPERO (CRD42020200220) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic review and meta-analysis.

RESULTS

In total, 117 studies were subjected to full evaluation. In the meta-analysis, 103 studies representing 159 independent datapoints were included. The overall prevalence of ADHD in register studies was 1.6%, 95% CI [0.9; 3.0], in survey studies 5.0%, 95% CI [2.9; 8.6], in one-stage clinical studies 4.2%, 95% CI [2.9; 6.0], and in two-stage clinical studies 4.8%, 95% CI [4.0; 5.8].

CONCLUSIONS

Exact comparisons among studies with different diagnostic criteria and types of sampling can impact prevalence estimates. When comparing data from methodologically different studies, these factors need to be considered.

Can exposure to lisdexamfetamine dimesylate from juvenile period to peripubertal compromise male reproductive parameters in adult rats?

Lisdexamfetamine (LDX) is a d-amphetamine prodrug used to treat attention deficit and hyperactivity disorder, a common neurodevelopmental disorder in children and adolescents. Due to its action mediated by elevated levels of catecholamines, mainly dopamine and noradrenaline, which influence hormonal regulation and directly affect the gonads, this drug may potentially disrupt reproductive performance. This study evaluated the effects of exposure to LDX from the juvenile to peripubertal period (critical stages of development) on systemic and reproductive toxicity parameters in male rats. Male Wistar rats (23 days old) were treated with 0; 5.2; 8.6 or 12.1 mg/kg/day of LDX from post-natal day (PND) 23 to 53, by gavage. LDX treatment led to reduced daily food and water consumption, as well as a decrease in social behaviors. The day of preputial separation remained unaltered, although the treated animals exhibited reduced weight. At PND 54, the treated animals presented signs of systemic toxicity, evidenced by a reduction in body weight gain, increase in the relative weight of the liver, spleen, and seminal gland, reduction in erythrocyte and leukocyte counts, reduced total protein levels, and disruptions in oxidative parameters. In adulthood, there was an increase in immobile sperm, reduced sperm count, morphometric changes in the testis, and altered oxidative parameters, without compromising male sexual behavior and fertility. These findings showed that LDX-treatment during the juvenile and peripubertal periods induced immediate systemic toxicity and adversely influenced reproductive function in adult life, indicating that caution is necessary when prescribing this drug during the peripubertal phase.

Exploring Diagnostic Performance of a Screening Instrument for ADHD and DSM-5 Number of Symptoms Criterion in Primary School Students From Mozambique

OBJECTIVE

To explore the ADHD diagnostic performance of a screening instrument, and which DSM-5 ADHD number of symptoms (criterion A) was best associated with impairment in a sample of students from 106 primary schools in Nampula, Mozambique.

METHODS

A random sample of 748 students were assessed using SNAP-IV and 152 youths (76 positive and 76 negative screeners) were invited for psychiatric diagnostic confirmation.

RESULTS

The performance of the screening instrument for predicting ADHD diagnosis was poor (all AUCs < 0.53). No other cut-off worked best in predicting impairment than the six symptoms cutoff suggested by DSM-5 for both inattention (AUC = 0.78; 95% CI [0.69, 0.86]) and hyperactivity/impulsivity (AUC = 0.75; 95% CI [0.67, 0.84]).

CONCLUSION

Our findings highlight the adequacy of the DSM-5 ADHD criterion A in an African culture but indicate low diagnostic performance of a screening instruments only based in parent or teacher reports on symptoms to predict ADHD diagnosis.

The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Attention-Deficit / Hyperactivity Disorder is a developmental neurological disorder that has three basic characteristics: Attention Deficit, Hyperactivity, and impulsivity. This study aimed to investigate the prevalence of ADHD in children and adolescents.

METHODS

This investigation was carried out using the meta-analysis method under PRISMA guidelines. Until October 2020, the articles were gathered by scanning PubMed, Scopus, WOS, and Science Direct databases. The second version of Comprehensive Meta-Analysis software was used to run analyses after extracting data from chosen papers. At a significance level of 0.05, the I² test was used to analyze study heterogeneity, and the Egger test was used to assess publication bias.

RESULTS

This analysis includes 61 cross-sectional research, with 53 research used to determine the prevalence of ADHD in children, 7.6% of 96,907 children aged 3 to 12 years had ADHD (95% confidence interval: 6.1-9.4%), and 5.6% of teenagers aged 12 to 18 years have ADHD (95% confidence interval: 4.8-7%). The prevalence of ADHD in children and adolescents according to the DSM-V criterion is also higher than previous diagnostic criteria, according to studies.

CONCLUSION

The findings of this study based on meta-analysis show the high prevalence of attention deficit hyperactivity disorder (ADHD). The findings of this study demonstrate the importance of management and policy in the treatment and control of ADHD in children and adolescents.

Emerging findings of glutamate-glutamine imbalance in the medial prefrontal cortex in attention deficit/hyperactivity disorder: systematic review and meta-analysis of spectroscopy studies

One of the main challenges in investigating the neurobiology of ADHD is our limited capacity to study its neurochemistry in vivo. Magnetic resonance spectroscopy (MRS) estimates metabolite concentrations within the brain, but approaches and findings have been heterogeneous. To assess differences in brain metabolites between patients with ADHD and healthy controls, we searched 12 databases screening for MRS studies. Studies were divided into 'children and adolescents' and 'adults' and meta-analyses were performed for each brain region with more than five studies. The quality of studies was assessed by the Newcastle-Ottawa Scale. Thirty-three studies met our eligibility criteria, including 874 patients with ADHD. Primary analyses revealed that the right medial frontal area of children with ADHD presented higher concentrations of a composite of glutamate and glutamine (p = 0.02, SMD = 0.53). Glutamate might be implicated in pruning and neurodegenerative processes as an excitotoxin, while glutamine excess might signal a glutamate depletion that could hinder neurotrophic activity. Both neuro metabolites could be implicated in the differential cortical thinning observed in patients with ADHD across all ages. Notably, more homogeneous designs and reporting guidelines are the key factors to determine how suitable MRS is for research and, perhaps, for clinical psychiatry. Results of this meta-analysis provided an overall map of the brain regions evaluated so far, addressed the role of glutamatergic metabolites in the pathophysiology of ADHD, and pointed to new perspectives for consistent use of the tool in the field.

Neurodevelopmental disorders among Spanish school-age children: prevalence and sociodemographic correlates

BACKGROUND

Prevalence estimates of neurodevelopmental disorders (ND) are essential for treatment planning. However, epidemiological research has yielded highly variable rates across countries, including Spain. This study examined the prevalence and sociodemographic correlates of ND in a school sample of Spanish children and adolescents.

METHODS

The Child Behaviour Checklist/Teacher's Report Form/Youth Self-Report and the Conners' Rating Scales were administered for screening purposes. Additionally, teachers provided information on reading and writing difficulties. Subjects who screened positive were interviewed for diagnostic confirmation according to the Diagnostic and Statistical Manual of Mental Disorders criteria. The final population comprised 6834 students aged 5-17. Multivariate analyses were performed to determine the influence of gender, age, educational stage, school type, socioeconomic status (SES), and ethnicity on the prevalence estimates.

RESULTS

A total of 1249 (18.3%) subjects met criteria for at least one ND, although only 423 had already received a diagnosis. Specifically, the following prevalence rates were found: intellectual disabilities (ID), 0.63%; communication disorders, 1.05%; autism spectrum disorder (ASD), 0.70%; attention-deficit/hyperactivity disorder (ADHD), 9.92%; specific learning disorder (SLD), 10.0%; and motor disorders, 0.76%. Students of foreign origin and from low SES evidenced higher odds of having ID. Boys were more likely to display ASD or a motor disorder. Age, SES, and ethnicity were significant predictors for SLD, while communication disorders and ADHD were also associated with gender.

CONCLUSIONS

The prevalence of ND among Spanish students is consistent with international studies. However, a substantial proportion had never been previously diagnosed, which emphasise the need for early detection and intervention programmes.

Decline in attention-deficit hyperactivity disorder traits over the life course in the general population: trajectories across five population birth cohorts spanning ages 3 to 45 years

BACKGROUND

Trajectories of attention-deficit hyperactivity disorder (ADHD) traits spanning early childhood to mid-life have not been described in general populations across different geographical contexts. Population trajectories are crucial to better understanding typical developmental patterns.

METHODS

We combined repeated assessments of ADHD traits from five population-based cohorts, spanning ages 3 to 45 years. We used two measures: (i) the Strengths and Difficulties Questionnaire (SDQ) hyperactive-inattentive subscale (175 831 observations, 29 519 individuals); and (ii) scores from DSM-referenced scales (118 144 observations, 28 685 individuals). Multilevel linear spline models allowed for non-linear change over time and differences between cohorts and raters (parent/teacher/self).

RESULTS

Patterns of age-related change differed by measure, cohort and country: overall, SDQ scores decreased with age, most rapidly declining before age 8 years (-0.157, 95% CI: -0.170, -0.144 per year). The pattern was generally consistent using DSM scores, although with greater between-cohort variation. DSM scores decreased most rapidly between ages 14 and 17 years (-1.32%, 95% CI: -1.471, -1.170 per year). Average scores were consistently lower for females than males (SDQ: -0.818, 95% CI: -0.856, -0.780; DSM: -4.934%, 95% CI: -5.378, -4.489). This sex difference decreased over age for both measures, due to an overall steeper decrease for males.

CONCLUSIONS

ADHD trait scores declined from childhood to mid-life, with marked variation between cohorts. Our results highlight the importance of taking a developmental perspective when considering typical population traits. When interpreting changes in clinical cohorts, it is important to consider the pattern of expected change within the general population, which is influenced by cultural context and measurement.

Efficacy and Safety of a Long-Acting Multilayer-Release Methylphenidate Formulation (PRC-063) in the Treatment of Adolescent Attention-Deficit/Hyperactivity Disorder: A Randomized, Double-Blind Clinical Trial with a 6-Month Open-Label Extension

Objectives: To study the safety and efficacy of the long-acting methylphenidate formulation PRC-063 in adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: Adolescents 12 to ≤17 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for ADHD and had a baseline ADHD Rating Scale DSM-5 (ADHD-5-RS) score ≥24 participated in a randomized, double-blind, placebo-controlled, fixed-dose, parallel-group study. Participants were randomized 1:1:1:1:1 to receive placebo or one of four doses of PRC-063 once daily for 4 weeks. The primary endpoint was change from baseline in least-squares mean clinician-rated ADHD-5-RS total score for PRC-063 (all doses combined) versus placebo. Other efficacy assessments included Conners third Edition: Self-Report (C3SR) and Clinical Global Impression-Improvement (CGI-I). A subset of double-blind study participants entered a subsequent open-label, dose-optimized study. Safety outcomes in both studies included treatment-emergent adverse events (TEAEs). Results: Three hundred fifty-four participants were included in the primary analysis. The least-squares mean change from baseline in ADHD-5-RS total score was -15.17 for PRC-063 versus -10.98 for placebo (least-squares mean difference -4.2, p = 0.0067). For individual PRC-063 doses, improvements in ADHD-5-RS total score versus placebo were significant for 45 mg (p = 0.0155) and 70 mg (p = 0.0401), but not for 25 or 85 mg. A significant improvement for PRC-063 versus placebo was recorded for C3SR Inattention (p = 0.0168), but not for the other C3SR subscales. About 52.7% of participants randomized to PRC-063 were responders based on CGI-I versus 32.4% of those randomized to placebo (p = 0.0004). Further improvements in ADHD symptoms based on ADHD-5-RS were observed from 1 month through 6 months of open-label treatment (p < 0.0001). There were two serious adverse events (both during the open-label study), one of which (aggressive behavior) was assessed as related to study drug. The only TEAEs that occurred in >10% of participants during double-blind treatment were decreased appetite (20.1%) and headache (15.0%). Most TEAEs were of mild or moderate severity. Conclusion: PRC-063 significantly improved ADHD symptomatology in adolescents. It was generally well tolerated, with an AE profile consistent with other long-acting stimulants. NCT02139111 and NCT02168127.

Influences on Teachers’ Intention to Apply Classroom Management Strategies for Students with ADHD: A Model Analysis

Students with attention deficit/hyperactivity disorder (ADHD) show reduced on-task behavior at school and educational problems due to the symptoms associated with this diagnosis. Classroom management strategies (CMS) are important to reduce impairment due to ADHD symptoms but are not yet well implemented. In this study we analyzed whether the facilitators and barriers regarding the intention to apply CMS identified for pre-service teachers are replicable in a sample of teachers in service. Overall, 599 teachers in service completed an online survey on the intention to apply CMS, their attitude towards CMS and towards students with ADHD, direct experiences, individual differences, and social influences. We calculated path models that significantly clarified variance in the intention to apply CMS (R2intention to use effective CMS = 0.47, p < 0.01 and R2intention to use ineffective CMS = 0.39, p < 0.01). It turns out that similar variables are relevant to teachers in service as well as pre-service teachers. A models’ extension to include variables that do justice to the difference between the two groups, such as work experience, shows a better model fit. Especially, attitude towards CMS, attitude towards students with ADHD, strain, perceived behavioral control and teachers’ affiliation with primary or special needs schools are important variables regarding the intention to apply CMS. The implementation of effective and elimination of ineffective CMS should thus be addressed by targeting teacher’s attitudes towards children with ADHD. Furthermore, strain prevention and education might enhance the application of effective CMS.

Working with Children with ADHD—A Latent Profile Analysis of Teachers’ and Psychotherapists’ Attitudes

A positive attitude of teachers and psychotherapists towards children with ADHD can both support their mutual relationship and support reducing ADHD-related symptoms. According to Fishbein and Ajzen’s rational-choice approach, attitude formation is based on a person’s expectations and the appraisal of these, thus attitude, therefore, differs individually. The present study aimed to identify different attitude profiles based on our participants’ answer patterns on the ADHD-school-expectation questionnaire’s (ASE) subscales, and to examine which attitude profile would be desirable for professionals working with children with ADHD. We conducted a latent profile analysis and investigated differences between the latent profiles. Our analysis revealed three attitude profiles characterized by negative, moderate and extreme ratings of expectations. The attitude profiles differed in further variables such as the use and effectiveness of rating classroom management strategies, knowledge of ADHD, perceived control, stress and strain, as well as some personality traits. The extreme rating profile seems to be beneficial for children with ADHD, whereas the moderate rating profile might appeal to certain professionals.

Bibliometric Review: Classroom Management in ADHD—Is There a Communication Gap Concerning Knowledge Between the Scientific Fields Psychiatry/Psychology and Education?

Many students with ADHD experience educational attainment difficulties. Nevertheless, evidence-based classroom management strategies (CMS) are seldom used. This science–practitioner gap might be due to a lack of shared knowledge between the scientific fields of psychology/psychiatry and education. This review uses science mapping to explore the basis of the current stock of knowledge in each of the two scientific fields, compares current approaches, and examines whether implementation methods and related barriers are investigated topics. We conducted a systematic search of the literature to identify articles on CMS in ADHD. We then conducted co-citation analyses and bibliographic coupling analysis. The former revealed six clusters of psychology/psychiatry and five clusters of education. Bibliographic coupling analysis resulted in eight clusters, with literature from both fields. The majority of the research is conducted in the field of psychology/psychiatry; teachers’ perspectives are focused only in the field of education. The number of studies on implementation and potential barriers is small. There was thus relatively little communication between the sciences, but the scientific fields have seemed to converge recently. Connecting the scientific fields more and concentrating on implementation methods and barriers is strongly needed to close the science–practitioner gap.

Attention-deficit hyperactivity disorder in Brazilian patients with phenylketonuria

Recent studies have shown that patients with phenylketonuria (PKU), even with the early diagnosis and continuous treatment, may have symptoms of attention-deficit hyperactivity disorder (ADHD) and that the prevalence of ADHD in this population would be higher than in the general population. This study aims to determine the prevalence of ADHD in a sample of PKU patients from Southern Brazil. Patients were prospectively assessed by clinical interviews, neurological examination, and application of the MTA-SNAP-IV scales for patients aged 5-17 years and the Adult Self-Report Scale for patients over 17 years. Thirty-one patients (mean age = 17.4; early diagnosis = 27) were followed. Patients with ADHD and younger than 17 years had a median Phe in the last 6 months of life higher than those without the diagnosis of ADHD (ADHD patients = 617.1 µmol/L, no-ADHD patients 393.2 µmol/L, and p = 0.03). There was a predominantly hyperactive/impulsivity clinical presentation of ADHD (n = 4/5 patients), which differs from that reported elsewhere in the literature. Future studies are essential to better define the clinical presentation of ADHD in these patients and further elucidate its pathophysiology.

Exploring the association between attention-deficit/hyperactivity disorder and entrepreneurship

OBJECTIVE

To investigate the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and entrepreneurial profiles and the effects of entrepreneurial characteristics in individuals who screen positive for ADHD and self-identify as entrepreneurs.

METHODS

We sent 4,341 questionnaires by e-mail to applicants for a career development course for entrepreneurs. We used the propensity score covariate adjustment to balance differences between included and excluded individuals. ADHD symptoms were evaluated with the Adult ADHD Self-Report Scale. The Individual Entrepreneurial Orientation scale was used to assess the entrepreneurial profile of the participants. Impairment from ADHD symptoms was assessed with the Barkley Functional Impairment Scale.

RESULTS

Those who screened positive for ADHD had higher risk-taking scores (p-value = 0.016) and lower proactivity (p-value = 0.001) than those who screened negative. Higher inattention scores were related to lower proactivity (p-value < 0.001), while higher hyperactive symptom scores were related to a more generalized entrepreneurial profile (p-value = 0.033). Among ADHD-positive participants, entrepreneurial profile scores were not significantly associated with company profits or impairment.

CONCLUSIONS

Inattention symptoms were related to less proactivity, whereas hyperactive symptoms were positively associated with a general entrepreneurial orientation. ADHD-positive individuals had a higher risk-taking profile, and these characteristics did not negatively impact their lives.

Suggestive diagnosis of attention-deficit/hyperactivity disorder in indigenous children and adolescents from the Brazilian Amazon

The prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms has been scarcely studied in indigenous cultures that preserve ancestral cultural characteristics. The objective of the study is to estimate the prevalence of suggestive diagnosis of ADHD among indigenous children and adolescents from villages in the Amazon. This is an analytical cross-sectional study using instruments to track ADHD symptoms (the Child Behaviour Checklist for ages 6-18: CBCL/6-18 and the teacher report form for ages 6-18: TRF/6-18) and to investigate their negative impact on the patients (using the Strengths and Difficulties Questionnaire-SDQ). The prevalence of a suggestive ADHD diagnosis according to the CBCL/TRF DSM-IV ADHD subscale without and with negative impact as assessed by the SDQ was 4.3% and 1.1%, respectively. Comorbid oppositional-defiant, conduct problems and anxious symptoms were present in all cases screening positive for ADHD. We also presented a case report as an illustration of the observed clinical presentation. ADHD is a recognizable disorder even in a culture that preserves millennial characteristics. Furthermore, the presence of ADHD symptoms was associated with significant impairment.

Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil

Global Mental Health (GMH) is the field of study, research, and intervention, which aims at improving access to mental health worldwide. It is based on the global burden of disease research program and on the existence of a large "treatment gap" between the need and availability of mental health services, displaying individual and social costs of undiagnosed and untreated mental disorders, especially in low- and middle-income countries (LMIC). Few academic publications in Brazil dialogue directly with the field of GMH, although several issues drawn from its agenda have been the subject of mental health policies in the country. Brazil can be classified as a middle-income country with a well-structured national health system. This system is oriented toward primary health care, which integrates both community mental health services and the broader health care network. The debate between GMH advocates and critics has unearthed old controversies in psychiatry such as universality or cultural specificity of mental disorders, their expressions, and their relationship with social and economic factors. We intend to examine how these controversies reverberate in the Brazilian mental health scenario, taking as an illustration the debates around Attention Deficit Hyperactivity Disorder (ADHD) in the country. ADHD discussions oppose those who argue that the condition is underdiagnosed and undertreated, and those who claim that there is overdiagnosis and overtreatment and thus, medicalization of childhood. This article presents the current status of the Brazilian mental health literature on ADHD, with emphasis on tensions around diagnosis, prevalence and interventions. Our aim is to highlight how the differential in discourse shapes the debate on ADHD in Brazil and how this may contribute to the GMH agenda. This goal will be undertaken in three steps. First, we will briefly examine studies around GMH and ADHD. Secondly, we address Brazilian studies on this theme, considering the specificities regarding the constitution of the mental health field. Finally, we will examine the debate of treatment gap vs. medicalization in the country in order to underscore the potentials and limitations of each perspective.

School Dropout and Associated Factors Among Omani Children with Attention-Deficit Hyperactivity Disorder: A Cross-Sectional Study

OBJECTIVE

Despite the rising incidence of attention-deficit hyperactivity disorder (ADHD), there is a dearth of studies examining the rate of school dropout and its correlates in non-Western populations.

METHODS

Medical records were scrutinized to identify Omani children diagnosed with ADHD from 2006 to 2014 in a tertiary care hospital in Oman. The persistence of ADHD symptoms, school performance and dropout, as well as sociodemographic characteristics were examined.

RESULTS

Three hundred sixty-seven children fulfilled the diagnosis of ADHD based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria and 16.6% of them had dropped out of school. School dropout was associated with poor school performance, comorbid conduct disorder, and parental divorce.

CONCLUSION

This study from Oman concurs with existing literature that school dropout is common among children with ADHD. Concerted efforts are needed to mitigate this trend. Management strategies should incorporate the treatment of comorbid conduct disorder.

Associations Between ADHD Symptoms and Occupational, Interpersonal, and Daily Life Impairments Among Pregnant Women

OBJECTIVE

Past research links symptoms of depression and anxiety with functional impairments among pregnant women. However, no prior research has examined the impact of ADHD symptoms among this population. The current study examines associations between ADHD symptoms and impairment in several life domains.

METHOD

Self-report measures of ADHD symptoms, impairment, and demographic information were collected from 250 pregnant women at an urban women's health clinic in the Southeast. Data were assessed using multivariate path analysis.

RESULTS

Inattentive symptoms were significant predictors of professional life impairment, daily life impairment, and relationship impairment. Impulsivity uniquely predicted variability in professional life impairment and relationship impairment. Hyperactivity was not a significant predictor.

CONCLUSION

Future research should focus on the mechanisms by which inattention and impulsivity affect daily functioning in pregnant women, in addition to investigating potential interventions. Health care professionals should assess for impulsivity and inattention among pregnant women.

Cross-Cultural and Gender Differences in ADHD Among Young Adults

OBJECTIVE

This study explored the effect of cultural and gender differences in ADHD among Spanish, African American, Hispanic American, and European American young adults.

METHOD

Structural equivalence between the four groups was examined by Tucker's phi coefficient. A MANCOVA was carried out with cultural groups and gender as factors and age as covariate.

RESULTS

Structural equivalence was observed across all groups, and no differential item functioning was found. No significant effect was found for gender, although, with the exception of the Hispanic group, males scored higher than females. Furthermore, small, though significant, cultural differences were found. The lowest levels of ADHD were observed in the European American group and the highest in the Hispanic American group. ADHD symptoms, notably inattention, showed some decline with age.

CONCLUSION

Findings extend existing data and suggest a relationship between culture and the development of ADHD, which might be mediated by parenting style.

Predictive value of dysregulation profile trajectories in childhood for symptoms of ADHD, anxiety and depression in late adolescence

We examined whether there are certain dysregulation profile trajectories in childhood that may predict an elevated risk for mental disorders in later adolescence. Participants (N = 554) were drawn from a representative community sample of German children, 7-11 years old, who were followed over four measurement points (baseline, 1, 2 and 6 years later). Dysregulation profile, derived from the parent report of the Strengths and Difficulties Questionnaire, was measured at the first three measurement points, while symptoms of attention deficit hyperactivity disorder (ADHD), anxiety and depression were assessed at the fourth measurement point. We used latent class growth analysis to investigate developmental trajectories in the development of the dysregulation profile. The predictive value of dysregulation profile trajectories for later ADHD, anxiety and depression was examined by linear regression. For descriptive comparison, the predictive value of a single measurement (baseline) was calculated. Dysregulation profile was a stable trait during childhood. Boys and girls had similar levels of dysregulation profile over time. Two developmental subgroups were identified, namely the low dysregulation profile and the high dysregulation profile trajectory. The group membership in the high dysregulation profile trajectory (n = 102) was best predictive of later ADHD, regardless of an individual's gender and age. It explained 11% of the behavioural variance. For anxiety this was 8.7% and for depression 5.6%, including some gender effects. The single-point measurement was less predictive. An enduring high dysregulation profile in childhood showed some predictive value for psychological functioning 4 years later. Hence, it might be helpful in the preventive monitoring of children at risk.

Protective factors for social-emotional well-being of refugee children in the first three years of settlement in Australia

AIM

This longitudinal study investigated protective factors for social-emotional well-being in refugee children in Australia.

METHODS

Newly arrived refugee children aged 4-15 years were recruited between 2009 and 2013 and assessments were conducted at two points, at years 2 and 3 postarrival. Social-emotional well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). Protective factors were assessed by structured interview and the Social Readjustment Rating Scale (SRRS); scores <150 reflect fewer stressful life events in the previous year.

RESULTS

Forty-three eligible refugee children were recruited. The SDQ was completed by parents in 90% and protective factor data in 80% at years 2 and 3 of follow-up. Protective factors for normal SDQ scores were: originating from Africa (p=0.01), father present on arrival (p=0.019) and family SRRS scores <150 at year 2 (p=0.045). The median number of protective factors was 4 (range 1-8). Better SDQ scores were associated with ≥4 protective factors (p<0.006). Furthermore, more protective factors increased the child's likelihood of a stable or improved SDQ score over time (p<0.04). Modifiable protective factors likely to promote social-emotional well-being include stability in the child's school and residence, parental employment, financial and marital stability, proximity to one's own ethnic community and external community support.

CONCLUSIONS

Cumulative protective factors, some of which are potentially modifiable, can predict social-emotional well-being in newly arrived refugee children. Children with four or more protective factors are at low risk of poor social-emotional well-being.

The relationship between exclusion from school and mental health: a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007

BACKGROUND

Children with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded.

METHOD

Psychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multi-variable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress.

RESULTS

Exclusion from school was commoner among boys, secondary school pupils and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow-up.

CONCLUSIONS

We detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.

Social contextual risk factors for stimulant use among adolescent American Indians

OBJECTIVE

Stimulants are the most common and efficacious treatment for Attention-Deficit Hyperactivity Disorder (ADHD). We examined the relationship between stimulant misuse and social factors that could be malleable to prevention among American Indian (AI) adolescents.

METHOD

Participants were AI students (N=3498) sampled from 33 schools in 11 states. Participants completed the American Drug and Alcohol Survey. A multilevel analytic approach was used to evaluate the effects of participant-level (level 1) variables (i.e., gender, grade, peer, school, family, stimulant prescribed by doctor) on lifetime and current simulant use to 'get high.'

RESULTS

Nearly 7% of our sample had been prescribed stimulants and nearly 6% of the sample reported using stimulants to get high. Age [OR=1.22; 95% CI=1.09, 1.36, p<0.001], perception of peer substance use [OR=1.19; 95% CI=1.14, 1.23, p<0.001], parental monitoring [OR=0.96; 95% CI=0.92, 1.99, p=0.04], and stimulants prescribed by a doctor [OR=8.79, 95% CI=5.86, 13.18, p<0.001] were associated with ever using stimulants to get high. Perception of peer substance use, [b=0.09, SE=0.02, p<0.001, 95%CI [0.05, 0.13], and having stimulants prescribed by a doctor, [b=0.58, SE=0.21, p=0.006, 95%CI [0.17, 0.99], were associated with frequency of past month use to get high. There was also a significant quadratic effect for parental monitoring, suggesting that low and high levels were associated with increased stimulant use.

CONCLUSIONS

Our results suggest a need for prevention efforts to be directed to AI youth who are prescribed stimulants.

Prevalence and associated factors of attention deficit hyperactivity disorder (ADHD) among Ugandan children; a cross-sectional study

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among the children. The burden of ADHD or its associated factors in Uganda are not known. The objective of this study was to determine the prevalence and the associated factors of ADHD among children attending the neurology and psychiatry clinics at Mulago National Referral Hospital.

METHODS

Using the disruptive behavior scale (45 items), we investigated the presence of ADHD symptoms among children attending Mulago Hospital. Questionnaires were administered to the primary care-takers of the study participants to gather information on the factors associated with ADHD. All children were subject to a clinical examination. Children presumed to have ADHD, using the aforementioned rating scale were further assessed by a child psychiatrist to confirm the diagnosis and associated co-morbid conditions.

RESULTS

The estimated prevalence of DSM-IV ADHD symptoms was 11%. Children aged less than 10 years were four times likely to have ADHD (OR 4.1, 95% CI 1.7-9.6, p < 0.001). The demographic factors independently associated with ADHD were age less than 10 years, male gender, history of maternal abnormal vaginal discharge during pregnancy, and no formal education or the highest level of education being primary school.

CONCLUSION

The prevalence of ADHD among children attending the pediatric neurology and psychiatry clinics is high in our settings and is associated with delayed milestones. Early identification and addressing the co-morbid conditions associated with ADHD such as epilepsy, autism spectrum of disorder, conduct disorder, opposition defiant disorder and intellectual disability in our setting is needed.

Desempenho de escolares com transtorno do déficit de atenção com hiperatividade em habilidades metalinguísticas, leitura e compreensão leitora

RESUMO Objetivo: caracterizar e comparar o desempenho de escolares com Transtorno do Déficit de Atenção com Hiperatividade em habilidades metalinguísticas, leitura e compreensão leitora, com escolares de bom desempenho acadêmico. Métodos: participaram deste estudo 30 escolares do Ensino Fundamental I, de ambos os gêneros, na faixa etária de 8 anos a 12 anos e 11 meses de idade, divididos em dois grupos: Grupo I, composto por 15 escolares com diagnóstico de Transtorno do Déficit de Atenção com Hiperatividade; Grupo II, composto por 15 escolares com bom desempenho acadêmico. Os escolares foram pareados em relação à idade, à escolaridade e ao gênero e foram submetidos à aplicação das provas de habilidades metalinguísticas, de leitura e de compreensão de leitura. Resultados: foi possível verificar desempenho inferior do GI em habilidades de identificação de fonema inicial e final, subtração e adição de sílabas e de fonemas, bem como de segmentação de fonemas. O desempenho do GI também foi inferior ao do GII em provas de leitura e de repetição de não palavras. Não houve diferença estatisticamente significante entre o desempenho dos grupos em compreensão leitora. Conclusão: os escolares com Transtorno do Déficit de Atenção com Hiperatividade em comparação com grupo controle apresentaram desempenho inferior na decodificação leitora e nas tarefas metalinguísticas consideradas mais complexas, as quais exigem retenção, análise e recuperação de informação. Na compreensão de leitura ambos os grupos apresentaram classificação de desempenho inferior com resultados semelhantes.

School-based Screening to Identify Children At Risk for Attention-Deficit/Hyperactivity Disorder: Barriers and Implications

This report describes a school-based screening project to improve early identification of children at risk for attention-deficit/hyperactivity disorder (ADHD) and communicate these concerns to parents, recommending that they contact their child's primary care provider (PCP). Of 17,440 eligible children in first through fifth grades in five school districts, 47.0% of parents provided required written consent, and teachers completed 70.4% of the online screeners (using the Vanderbilt AD/HD Diagnostic Teacher Rating Scale). Of 5,772 screeners completed, 18.1% of children (n = 1,044) were identified as at risk. Parents of at-risk children were contacted to explain risk status and recommended to visit their child's PCP for further evaluation. It was not possible to contact 39.1% of parents of at-risk children. Of the 636 parents of at-risk children who could be contacted, 53.1% (n = 338) verbally accepted the recommendation to follow-up with their PCP, which was not related to ADHD symptom severity. Parents of children with IEPs or related services were more likely to accept the recommendation to visit the PCP. Our exploration of the potential for school-based screening for ADHD identified a number of barriers to successful execution, but the data also indicated that this is an important problem to address.

Confirmatory Factor Analysis of Parents' and Teachers' Ratings of DSM-IV Symptoms of Attention Deficit Hyperactivity Disorder in a Spanish Sample

Confirmatory factor analysis examined the factor structure of DSM-IV Attention Deficit Hyperactivity Disorder symptoms and analyzed the differences in informants' ratings of ADHD symptoms by children's age and sex. A sample of 1,018 Spanish school children, 574 girls and 444 boys, ages 4 to 12 years, was rated by teachers and parents. Confirmatory factor analysis showed a similar fit for the three-factor model of Inattention, Hyperactivity, and Impulsivity (teachers: CFI = .976, RMR = .041, % of total variance = 83.2; parents: CFI = .969, RMR = .037, % of total variance = 82.7) and for the two-factor model of Inattention and Hyperactivity-Impulsivity (teachers: CFI = .958, RMR = .044, % of total variance = 79.3; parents: CFI = .961, RMR = .038, % of total variance, 79.9). The two-factor model was selected as a parsimonious representation of the teachers' and parents' ratings of ADHD symptoms. Analyses of variance indicated significant differences in teachers' and parents' mean ratings across sex and school grades of children.

Integration of an EEG biomarker with a clinician's ADHD evaluation

BACKGROUND

This study is the first to evaluate an assessment aid for attention-deficit/hyperactivity disorder (ADHD) according to both Class-I evidence standards of American Academy of Neurology and De Novo requirements of US Food and Drug Administration. The assessment aid involves a method to integrate an electroencephalographic (EEG) biomarker, theta/beta ratio (TBR), with a clinician's ADHD evaluation. The integration method is intended as a step to help improve certainty with criterion E (i.e., whether symptoms are better explained by another condition).

METHODS

To evaluate the assessment aid, investigators conducted a prospective, triple-blinded, 13-site, clinical cohort study. Comprehensive clinical evaluation data were obtained from 275 children and adolescents presenting with attentional and behavioral concerns. A qualified clinician at each site performed differential diagnosis. EEG was collected by separate teams. The reference standard was consensus diagnosis by an independent, multidisciplinary team (psychiatrist, psychologist, and neurodevelopmental pediatrician), which is well-suited to evaluate criterion E in a complex clinical population.

RESULTS

Of 209 patients meeting ADHD criteria per a site clinician's judgment, 93 were separately found by the multidisciplinary team to be less likely to meet criterion E, implying possible overdiagnosis by clinicians in 34% of the total clinical sample (93/275). Of those 93, 91% were also identified by EEG, showing a relatively lower TBR (85/93). Further, the integration method was in 97% agreement with the multidisciplinary team in the resolution of a clinician's uncertain cases (35/36). TBR showed statistical power specific to supporting certainty of criterion E per the multidisciplinary team (Cohen's d, 1.53). Patients with relatively lower TBR were more likely to have other conditions that could affect criterion E certainty (10 significant results; P ≤ 0.05). Integration of this information with a clinician's ADHD evaluation could help improve diagnostic accuracy from 61% to 88%.

CONCLUSIONS

The EEG-based assessment aid may help improve accuracy of ADHD diagnosis by supporting greater criterion E certainty.

Delinquency and association with behavioral disorders and substance abuse

Objective: to determine the incidence and associations of attention deficit-hyperactivity disorder (ADHD), conduct disorder (CD), and substance abuse disorder (SAD) in adolescents in conflict with the law in a Brazilian cohort. Methods: the Brazilian version of the Schedule for Affective Disorders and Schizophrenia for School Aged-Children (K-SADS-PL) was administered to 69 adolescent boys who were incarcerated for 45 days in the city of Curitiba, Brazil. Results: mean age was 15.5 years (range, 12-16.9 years) and most adolescents originated from disadvantaged social classes (87%). They resided in neighborhoods on the outskirts of the city or towns in the greater metropolitan area. Truancy and low educational achievement were common, with 73.9% not currently attending school and 43.4% not having finished the 5th grade. The great majority lived in single-parent families and many had relatives who themselves had problems with the law. Psychiatric disorders were apparent in 81.1% of the subjects, with the most common disorders being CD (59.4%), SAD (53.6%), and ADHD (43.5%). Both ADHD (p <0.001) and CD (p <0.01) had significant associations with substance abuse. Conclusion: in male adolescents in conflict with the law, ADHD, CD, and SAD were all found to be associated with delinquency.

Clinical and neuropsychological assessment of attention and ADHD comorbidity in a sample of children and adolescents with idiopathic epilepsy

Children with epilepsy present significant problems concerning attention and comorbidity with attention deficit hyperactivity disorder (ADHD). Objective To determine the prevalence of attention complaints, ADHD diagnosis and attention profile in a sample of children and adolescents with idiopathic epilepsy. Method 36 children and adolescents with idiopathic epilepsy and 37 genre and age matched healthy controls underwent several procedures to diagnose their neuropsychological profile and comorbidity with ADHD. Results The prevalence of ADHD was higher in patients with epilepsy [χ2= 4.1, p = 0.043, 6 (16.7%) vs 1 (2.7%)], with worse results in attention related WISC items and factors in patients with epilepsy comparing to the controls, but not between patients with and without ADHD. Clinical characteristics did not influence those results. Conclusion This study found a greater prevalence of problems wih attention in pediatric patients with idiopathic epilepsy, but not a distinct profile between those with or without ADHD.

Increasing teachers' knowledge about ADHD and learning disorders: an investigation on the role of a psychoeducational intervention

OBJECTIVE

To investigate elementary school teachers' baseline knowledge about ADHD and learning disorders (LD) and the impact of a strategy to increase awareness of these disorders.

METHOD

A total of 37 teachers were selected from four elementary schools in the catchment area of the University Hospital, in Porto Alegre, Brazil. To evaluate teachers' knowledge, two self-report questionnaires about ADHD and LD were applied before and after an awareness program on these disorders.

RESULTS

The intervention significantly increased teachers' knowledge of both disorders, even after adjustment for confounding factors (p < .001). In the repeated measures ANCOVA, only teachers' previous knowledge of ADHD/LD (p < .001) was significant in predicting score change in knowledge before and after the intervention.

CONCLUSION

Results suggest the efficacy of a brief psychoeducational intervention program for increasing teacher awareness and knowledge about ADHD and LD. Future studies are warranted to confirm the efficacy and evaluate the long-term impact of this intervention.

Attention deficit hyperactivity disorder in adolescent school children

The prevalence of Attention deficit hyperactivity disorder was estimated in 500 adolescents using Conners' parents and teachers rating scales. Thirty six (7.2%) adolescents had positive scores on both the scales. The parents and teachers also completed a Diagnostic and Statistical Manual-IV based questionnaire which showed good agreement with Conners' rating scales.

The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review

This paper reviews the empirical literature on the association between attention-deficit/hyperactivity disorder (ADHD) and depression (i.e., unipolar depressive disorders and symptoms) among children and adolescents. Findings from cross-sectional and longitudinal studies published on the co-occurrence of ADHD and depression were summarized and subjected to a meta-analysis. Results (k=29, N=8755; rbar=0.22) indicated that ADHD and depression were positively related, but substantial variability existed across the studies. Subgroup analyses indicated medium positive effects for cross-sectional studies, studies that operationalized ADHD based on DSM-III or DSM-IV diagnostic criteria, and studies that did not include teacher report in the assessment of ADHD. Subgroup analyses showed a large positive effect for studies that operationalized ADHD based on DSM-III-R criteria and studies using clinic referred samples. In contrast, subgroup analyses indicated a small negative and/or unreliable association between ADHD and depression for longitudinal studies, studies using DSM-II diagnostic criteria for hyperkinetic reaction of childhood or used a dichotomous motor hyperactivity criterion, studies that used nonreferred samples, and studies including teacher report in the assessment of ADHD. When studies that used DSM-II diagnostic criteria were removed, a reliable medium effect was found for studies that included teacher report. Similarly when the study that used idiosyncratic methods of diagnosing ADHD was excluded, a reliable medium effect was found for studies that used nonreferred samples. Potential explanations for the findings are discussed, including explanations based on sampling and base rates, artifacts of diagnostic criteria, inaccurate diagnostic boundaries, and etiological relationships. Directions for future research and clinical implications are discussed.

Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder of childhood onset, which may persist into adulthood. ADHD has a significant impact on a child's daily life, affecting relationships and academic performance. Its core symptoms include developmentally inappropriate levels of inattention, hyperactivity, and impulsive behaviour. Tricyclic antidepressants (TCAs) are sometimes used as second line of treatment in the reduction of ADHD symptoms in children and adolescents with ADHD. However, their efficacy is not yet known.

OBJECTIVES

To assess the efficacy of TCAs in the reduction of ADHD symptoms within the broad categories of hyperactivity, impulsivity, and inattentiveness in young people aged 6 to 18 years with established diagnoses of ADHD.

SEARCH METHODS

On 26 September 2013, we searched CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, seven other databases, and two trials registers. We also searched the reference lists of relevant articles, and contacted manufacturers and known experts in the field to determine if there were any ongoing trials or unpublished studies available.

SELECTION CRITERIA

Randomised controlled trials (RCTs), including both parallel group and cross-over study designs, of any dose of TCA compared with placebo or active medication in children or adolescents with ADHD, including those with comorbid conditions. 

DATA COLLECTION AND ANALYSIS

Working in pairs, three review authors independently screened records, extracted data, and assessed trial quality. We calculated the standardised mean differences (SMD) for continuous data, the odds ratio (OR) for dichotomous data, and 95% confidence intervals (CIs) for both. We conducted the meta-analyses using a random-effects model throughout. We used the Cochrane 'Risk of bias' tool to assess the risk of bias of each included trial and the GRADE approach to assess the quality of the body evidence.

MAIN RESULTS

We included six RCTs with a total of 216 participants. Five of the six trials compared desipramine with placebo; the remaining trial compared nortriptyline with placebo. One trial compared desipramine with clonidine and placebo, and another compared two TCAs (desipramine and clomipramine) with methylphenidate and placebo. Of the six trials, one RCT primarily assessed the efficacy of TCA in children with ADHD and comorbid tic or Tourette disorder, and another one trial was in children with comorbid tic disorder. RCTs that met our inclusion criteria varied both in design and quality, and none were free of bias. The quality of the evidence was low to very low according to our GRADE assessments.TCA outperformed placebo regarding the proportions of patients achieving a predefined improvement of core ADHD symptom severity (OR 18.50, 95% CI 6.29 to 54.39, 3 trials, 125 participants, low quality evidence). In particular, there was evidence that desipramine improved the core symptoms of ADHD in children and adolescents as assessed by parents (SMD -1.42, 95% CI -1.99 to -0.85, 2 trials, 99 participants, low quality evidence), teachers (SMD -0.97, 95% CI -1.66 to -0.28, 2 trials, 89 participants, low quality evidence), and clinicians (OR 26.41, 95% CI 7.41 to 94.18, 2 trials, 103 participants, low quality evidence). Nortriptryline was also efficacious in improving the core symptoms of ADHD in children and adolescents as assessed by clinicians (OR 7.88, 95% CI 1.10 to 56.12). Desipramine and placebo were similar on "all-cause treatment discontinuation" (RD -0.10, 95% CI -0.25 to 0.04, 3 trials, 134 participants, very low quality evidence). Desipramine appeared more efficacious than clonidine in reducing ADHD symptoms as rated by parents (SMD -0.90, 95% CI -1.40 to -0.40, 1 trial, 68 participants, very low quality evidence) in participants with ADHD and comorbid tics or Tourette syndrome.Although this Cochrane Review did not identify serious adverse effects in patients taking TCAs, it did identify mild increases in diastolic blood pressure and pulse rates. Also, patients treated with desipramine had significantly higher rates of appetite suppression compared to placebo whilst nortriptyline resulted in weight gain. Other reported adverse effects included headache, confusion, sedation, tiredness, blurred vision, diaphoresis, dry mouth, abdominal discomfort, constipation, and urinary retention.

AUTHORS' CONCLUSIONS

Most evidence on TCAs relates to desipramine. Findings suggest that, in the short term, desipramine improves the core symptoms of ADHD, but its effect on the cardiovascular system remains an important clinical concern. Thus, evidence supporting the clinical use of desipramine for the treatment of children with ADHD is low.

Attention deficit hyperactivity disorder: a neglected issue in the developing world

Background. Attention deficit hyperactivity disorder (ADHD) is a neglected illness in a developing country. Objectives. The objectives of this study are to investigate the prevalence and pattern of ADHD among children in a Nigeria. Methods. A structured self-administered questionnaire was used to collect information from the parents of children (and older children) who attended children outpatients' clinic during the study period. The DSM-IV-TR diagnostic criteria for attention deficit hyperactivity disorder were used. Results. Two hundred and seventy-three (273) out of 282 questionnaires were filled completely, giving a response rate of 96.8%. Nine (9) children fulfilled the stated criteria for ADHD giving a prevalence rate of 3.2%. There is no association between gender and ADHD (P = 0.784). Conclusions. The prevalence of ADHD in our setting is 3.2%, which is similar to that obtained elsewhere in the world.

Processamento fonológico em indivíduos com transtorno de Déficit de Atenção e Hiperatividade

Objetivo analisar e descrever o desempenho das habilidades dos componentes do processamento fonológico nos sujeitos com Transtorno do Déficit de Atenção e Hiperatividade (TDA/H). Métodos trata-se de estudo descritivo analítico dos dados de avaliação das habilidades do processamento fonológico de 45 sujeitos, com idade entre 7 e 16 anos, com diagnóstico multiprofissional de TDA/H. Os dados foram obtidos pela análise dos prontuários dos sujeitos avaliados pelo Laboratório de Estudo dos Transtornos de Aprendizagem (LETRA) do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), nos anos de 2008 a 2011. Os resultados analisados incluem a prova de Consciência Fonológica proposta pela bateria de testes BELEC, prova de Nomeação Seriada Rápida (RAN) e Memória Auditiva. Duas variáveis foram consideradas nesta análise: idade e presença ou não de comorbidades associadas. O teste aplicado para caracterização da amostra foi o não paramétrico de Mann Whitney. Resultados os grupos tendem a se diferenciarem ao se analisar a variável idade, nas provas de consciência fonológica e RAN. Quando a variável comorbidade foi analisada, a consciência fonológica é a mais influenciada pela presença de comorbidades. Na habilidade de memória fonológica, sob a mesma ótica, não houve diferenças entre os grupos. Conclusão o maior déficit do processamento fonológico foi observado na habilidade de consciência fonológica, segundo as variáveis idade e comorbidade, seguido pela habilidade de acesso ao léxico, na variável idade. Já para a memória de trabalho não houve significância.

Association between ADHD drug use and injuries among children and adolescents

To study the association between attention deficit hyperactivity disorder (ADHD) drug use and the incidence of hospitalization due to injuries. A random sample of 150,000 persons (0-18 years) was obtained from the Dutch PHARMO record linkage system. An ADHD medication cohort as well as an up to six age/sex/index date sampled control cohort with no history of ADHD drug use was formed. Differences in incidence of hospitalization due to injuries were stratified for age and sex and compared prior, during and after exposure on ADHD drugs. The overall incidence of hospital admissions for injuries was two times higher in the ADHD medication cohort [incidence rate ratios (IRR) 2.2 (95 % CI 1.6-2.9)]. The incidence rate for injuries during exposure to ADHD drugs was lower in the exposed period compared to the period prior to ADHD drug use, although the difference was not statistically significant [IRR 0.68 (95 % CI 0.29-1.60)]. The relative risk for injuries was almost five times higher in the ADHD medication cohort among those who concomitantly used other psychotropics [IRR 4.8 (95 % CI 1.4-16.9)]. Risk for injuries was highest in 12-18 years olds. Children and adolescents using ADHD medication showed a twofold risk for hospital admissions for injuries. ADHD drug use might diminish the increased injury risk, but still overall risk is higher than in age/sex sampled children and adolescents without treatment with ADHD drugs. Use of ADHD and concomitant psychotropics increases the risk for injuries compared to only ADHD drug use.

Prevalence of ADHD in a sample of Italian students: a population-based study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common diagnosis for children and adolescents, although the reported estimates for prevalence are extremely variable worldwide. In the present work we investigate the prevalence of ADHD in a sample of Italian students in a study divided in two phases. In Phase I, a total of 6183 schoolchildren (3178 males and 3005 females, aged range 5-15 years) were screened using the SDAI rating scale for teachers. In Phase II, the parents of children and adolescents who met high screen criteria according to SDAI (cut-off>14; n=471, 7.3%) were invited to complete a specific clinical-diagnostic assessment for ADHD with the help of an experienced clinician. Within the entire sample, 107 children dropped out and 12 had mental retardation, whereas 332 subjects (278 males and 54 females, age range 5-14 years) completed the Phase II of the study. One hundred ninety subjects (163 males and 27 females, male: female ratio 6:1, mean age 8 years) were diagnosed with ADHD, indicating a prevalence of 3%. ADHD subtypes included the following: combined (n=108; 56.8%), inattentive (n=48; 25.2%) and hyperactive/impulsive (n=33; 17.3%). Our findings are in line with other reports of ADHD prevalence in the European Countries, and may contribute to underline the impact of this phenomenon in the population, and the need of achieving an improvement in the quality of the public health mental service for the prevention and treatment of ADHD.

Association between family environment and attention deficit hyperactivity disorder in children--mothers' and teachers' views

BACKGROUND

To ascertain whether factors of the family environment and gestational period are associated with the appearance of ADHD in children, as reported by various different informants (mothers and teachers).

METHODS

This paper presents results from the dataset of a longitudinal study to evaluate behavioral problems among schoolchildren in São Gonçalo, Rio de Janeiro State, in 2005 and 2006. The cross-section considered for this paper comprises records of exposure factors and ADHD. In all, 370 schoolchildren of the public school system were assessed by 3-stage cluster sampling. The Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) were used to measure outcomes. The exposure factors examined were: profile of child and mother, variables relating to the family environment, and perinatal considerations. The questions were answered by mothers and teachers. A hierarchical logistic regression model was used.

RESULTS

Precariously functioning families, lack of social support for mothers, adverse life events and discord during pregnancy were the factors associated with mother-reported ADHD. When ADHD was reported by teachers, the variables selected were: Intelligence quotient (IQ) and sex, with children with low IQ scores and boys more likely to display the disorder.

CONCLUSIONS

Assessment of ADHD by teachers or mothers reveals specific characteristics that reflect how each of these informants understands the children. This highlights the importance of using informants from different environments in diagnosing the disorder.

Prevalence and diagnostic stability of ADHD and ODD in Turkish children: a 4-year longitudinal study

BACKGROUND

This study was designed to assess the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) in a representative sample of second grade students from a country in a region where no previous rates are available (Turkey). The second aim is to evaluate the differences in ADHD and ODD prevalence rates among four different waves with one-year gap in reassessments.

METHOD

Sixteen schools were randomly selected and stratified according to socioeconomic classes. The DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) was delivered to parents and teachers for screening in around 1500 children. Screen positive cases and matched controls were extensively assessed using the K-SADS-PL and a scale to assess impairment criterion. The sample was reassessed in the second, third and fourth waves with the same methodology.

RESULTS

The prevalence rates of ADHD in the four waves were respectively 13.38%, 12.53%, 12.22% and 12.91%. The ODD prevalence was found to be 3.77% in the first wave, 0.96% in the second, 5.41% in the third and 5.35% in the fourth wave. Mean ODD prevalence was found to be 3.87%.

CONCLUSIONS

The prevalence rates of ADHD in the four waves were remarkably higher than the worldwide pooled childhood prevalence. ADHD diagnosis was quite stable in reassessments after one, two and three years. A mean ODD prevalence consistent with the worldwide-pooled prevalence was found; but diagnostic stability was much lower compared to ADHD.

Attention deficit-hyperactivity disorder, comorbidities, and risk situations

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is highly prevalent, and its symptoms often represent a significant public health problem; thus, the aim of this study was to verify emergency situations caused by certain comorbidities, or by exposing the patient to a higher risk of accidents.

DATA SOURCE

A literature search was carried out in the PubMed database between the years 1992 and 2012, using the key words "adhd", "urgency", "comorbidity", "substance disorder", "alcohol", "eating disorder", "suicide", "trauma", "abuse", "crime", "internet", "videogame", "bullying", and their combinations. The selection considered the most relevant articles according to the scope of the proposed topic, performed in a non-systematic way.

DATA SYNTHESIS

Several situations were observed in which ADHD is the most relevant psychiatric diagnosis in relation to its urgency, such as the risk of accidents, suicide risk and addition, exposure to violence, or risk of internet abuse or sexual abuse; or when ADHD is the most prevalent comorbidity and is also correlated with emergency situations, such as in bipolar and eating disorders.

CONCLUSIONS

The results show several comorbidities and risk situations involving the diagnosis of ADHD, thus reinforcing the importance of their identification for the adequate treatment of this disorder.