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González-Villén R, Fernández-López ML, Checa-Ros A, Tortosa-Pinto P, Aguado-Rivas R, Garre-Morata L, Acuña-Castroviejo D, Molina-Carballo A. Differences in the Interleukin Profiles in Inattentive ADHD Prepubertal Children Are Probably Related to Conduct Disorder Comorbidity. Biomedicines 2024; 12:1818. [PMID: 39200282 PMCID: PMC11351999 DOI: 10.3390/biomedicines12081818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Inflammatory cytokines are involved in attention deficit hyperactivity disorder (ADHD), a highly prevalent neurodevelopmental disorder. To quantify the baseline levels of pro- and anti-inflammatory cytokines and their changes after methylphenidate (MPH), a total of 31 prepubertal children with ADHD were recruited and subclassified into only two ADHD presentations-ADHD attention deficit (n = 13) or ADHD combined (n = 18). The children were also screened for oppositional defiant conduct disorder (ODCD) and anxiety disorder. Blood samples were drawn at 09:00 and after 4.63 ± 1.87 months of treatment. Four pro-inflammatory cytokines (interleukin-1beta (IL-1β), IL-5, IL-6, tumor necrosis factor-alpha (TNF-α)) and three anti-inflammatory cytokines (IL-4, IL-10, IL-13) were measured using a Luminex® assay. For statistics, a factorial analysis was performed in Stata 15.1. Overall, there were no statistically significant differences in the interleukin (IL) values induced by treatment. When grouped by presentation, the differences were present almost exclusively in ADHD-AD, usually with a profile opposite to that observed in ADHD-C, and with interactions between comorbid factors, with IL-1β (p = 0.01) and IL-13 (p = 0.006) being the ones reaching the greatest statistical significance. These differences are probably related to the ODCD factor, and they disappear after treatment. In conclusion, the changes observed in cytokine levels in prepubertal children only in the ADHD-AD presentation are probably related to comorbidities (specifically ODCD) and are mitigated after treatment.
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Affiliation(s)
- Raquel González-Villén
- Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, Andalusian Health Service, 18016 Granada, Spain; (R.G.-V.); (P.T.-P.); (R.A.-R.)
| | - María Luisa Fernández-López
- Department of Pediatrics, School of Medicine, University of Granada, 18071 Granada, Spain
- Biohealth Research Institute Granada (ibs. GRANADA), University Hospital of Granada, 18016 Granada, Spain; (L.G.-M.); (D.A.-C.)
| | - Ana Checa-Ros
- Research Group on Cardiorenal and Metabolic Diseases, Department of Medicine and Surgery, Faculty of Health Sciences, Cardenal Herrera-CEU University, CEU Universities, 46115 Valencia, Spain;
| | - Pilar Tortosa-Pinto
- Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, Andalusian Health Service, 18016 Granada, Spain; (R.G.-V.); (P.T.-P.); (R.A.-R.)
| | - Raquel Aguado-Rivas
- Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, Andalusian Health Service, 18016 Granada, Spain; (R.G.-V.); (P.T.-P.); (R.A.-R.)
| | - Laura Garre-Morata
- Biohealth Research Institute Granada (ibs. GRANADA), University Hospital of Granada, 18016 Granada, Spain; (L.G.-M.); (D.A.-C.)
| | - Darío Acuña-Castroviejo
- Biohealth Research Institute Granada (ibs. GRANADA), University Hospital of Granada, 18016 Granada, Spain; (L.G.-M.); (D.A.-C.)
| | - Antonio Molina-Carballo
- Unit of Pediatric Neurology and Neurodevelopment, Clínico San Cecilio University Hospital, Andalusian Health Service, 18016 Granada, Spain; (R.G.-V.); (P.T.-P.); (R.A.-R.)
- Department of Pediatrics, School of Medicine, University of Granada, 18071 Granada, Spain
- Biohealth Research Institute Granada (ibs. GRANADA), University Hospital of Granada, 18016 Granada, Spain; (L.G.-M.); (D.A.-C.)
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Ojuri B, DeRonda A, Plotkin M, Mostofsky SH, Rosch KS. The Impact of Sex on Cognitive Control in ADHD: Girls Slow to Inhibit, Boys Inhibit Less, and Both Show Higher Response Variability. J Atten Disord 2024; 28:1275-1288. [PMID: 38491856 PMCID: PMC11166527 DOI: 10.1177/10870547241237242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine whether girls and boys with ADHD show distinct impairments in components of cognitive control across multiple tasks (go/no-go, stop signal, and flanker) and performance metrics (response speed, variability, and errors). METHOD A total of 300 children, ages 8 to 12 years with ADHD (n = 210, 58 girls) or typically developing (TD; n = 99, 37 girls), completed all tasks. Traditional response measures (e.g., mean and standard deviation of reaction time, inhibition errors, and stop signal reaction time) and ex-Gaussian modeling of reaction times (mu, sigma, and tau) were analyzed. RESULTS Girls showed intact response inhibition in the context of slower response speed, while boys made more inhibition errors and did not slow their response speed. Both girls and boys with ADHD showed higher response variability and poorer interference control than TD children. CONCLUSION Girls and boys with ADHD show distinct impairments in cognitive control that may be important for understanding the pathophysiology of ADHD.
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Affiliation(s)
| | | | | | - Stewart H. Mostofsky
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School Medicine, Baltimore, MD, USA
| | - Keri S. Rosch
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School Medicine, Baltimore, MD, USA
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Chan HK, Rowe R, Carroll D. Factors associated with parent-teacher hyperactivity/inattention screening discrepancy: Findings from a UK national sample. PLoS One 2024; 19:e0299980. [PMID: 38758772 PMCID: PMC11101030 DOI: 10.1371/journal.pone.0299980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND To fulfil the diagnostic criteria of Attention Deficit Hyperactivity Disorder in the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms should be observed in two or more settings. This implies that diagnostic procedures require observations reported from informants in different settings, such as teachers in school and caregivers at home. This study examined parent-teacher agreement in reporting hyperactivity/inattention and its relationship with child's, parent's, and family's characteristics. METHOD We used data from the 2004 United Kingdom Mental Health of Children and Young People survey, including 7977 children aged 4-17, to investigate cross-informant agreement between parents and teachers on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire. The characteristics of different patterns of informant agreement were assessed using multinomial logistic regression. RESULTS Cross-informant agreement of parent and teacher was low (weighted kappa = .34, 95% C.I.: .31, .37). Some characteristics, such as male child and parental emotional distress, were associated with higher likelihood of parent-teacher discrepancy. CONCLUSION We found low informant agreement in the hyperactive/inattention subscale, as hypothesised and consistent with previous studies. The current study has found several factors that predict discrepancy, which were partly consistent with previous research. Possible explanation, implications, and further research on parent-teacher informant discrepancy in reporting hyperactivity/inattention were discussed.
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Affiliation(s)
- Hei Ka Chan
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Richard Rowe
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Daniel Carroll
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Lopez JD, Daniels W, Joshi SV. Oppositional Defiant Disorder: Clinical Considerations and When to Worry. Pediatr Rev 2024; 45:132-142. [PMID: 38425161 DOI: 10.1542/pir.2022-005922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Juan David Lopez
- San Francisco Department of Public Health, Children, Youth and Families, San Francisco, CA
| | - Whitney Daniels
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Shashank V Joshi
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Garcia-Rosales A, Cortese S, Vitoratou S. Measurement invariance of Attention Deficit/Hyperactivity Disorder symptom criteria as rated by parents and teachers in children and adolescents: A systematic review. PLoS One 2024; 19:e0293677. [PMID: 38394179 PMCID: PMC10889893 DOI: 10.1371/journal.pone.0293677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/17/2023] [Indexed: 02/25/2024] Open
Abstract
This systematic review aimed to establish the extent to which each Attention Deficit/Hyperactivity Disorder (ADHD) symptom criterion is being assessed without being influenced (biased) by factors such as informant, sex/gender, and age. Measurement invariance (MI) testing using confirmatory factor analysis (CFA) is the prime statistical method to ascertain how these factors may affect the measurement and colour the perception or interpretation of symptom criteria. Such effects (non-invariance) can be operationalised in the form of altered association of a symptom criterion with the measured trait (expressed via variations in CFA loadings which represent the weight of each symptom criterion) due to the factor(s) and/or artificially alter the probability of endorsement of a particular symptom criterion (expressed via variations in the CFA threshold(s) representing how mild or severe a given symptom is). Based on a pre-registered protocol (CRD42022276105), we searched PubMed, Global Health, Embase and PsycInfo up to 21-02-23 for studies that included MI assessments on specific ADHD symptom criteria in individuals aged 0-18 years old, using parental and/or teacher report. Self-reports were excluded, given the poor reliability of self-report in ADHD. All included studies met specific COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. Results were synthesised in tabular form, grouping results by factors (e.g. informant) from 44 studies retained. Most comparisons indicated both metric (same loadings) and scalar invariance (same thresholds) with regard to informant, gender, age, temporal (repeated assessments) and co-morbidity. Therefore, the available evidence supports the current diagnostic criteria. However, findings could have been improved by systematic reporting of the direction of bias and its effect size. There appears to be a bias towards reporting MI instead of non-invariance. More studies in the literature are needed where the amalgamation of information provided by different informs and the association of specific symptoms with comorbidity are analysed.
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Affiliation(s)
- Alexandra Garcia-Rosales
- MRC Social Genetic Developmental and Psychiatry Centre, King’s College London, Institute of Psychiatry, Psychology, and Neurosciences, London, United Kingdom
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King’s College, London, United Kingdom
- Universidad Autónoma de Madrid, Madrid, Spain
- Kensington & Chelsea Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Samuele Cortese
- School of Psychology, Centre for Innovation in Mental Health (CIMH), Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York, New York, United States of America
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Horizon Centre, CAMHS West, Solent NHS Trust, Southampton, United Kingdom
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King’s College, London, United Kingdom
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Anning KL, Langley K, Hobson C, De Sonneville L, Van Goozen SHM. Inattention symptom severity and cognitive processes in children at risk of ADHD: the moderating role of separation anxiety. Child Neuropsychol 2024; 30:264-288. [PMID: 36960813 DOI: 10.1080/09297049.2023.2190964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/24/2023] [Indexed: 03/25/2023]
Abstract
Impairments in cognitive processes and their associations with dimensional measures of inattention, hyperactivity-impulsivity and anxiety were examined in children at risk of Attention-Deficit Hyperactivity Disorder. Children referred by teachers for exhibiting ADHD-type problems (n = 116; 43 meeting full diagnostic criteria for ADHD; 4-8 years) completed computerized tasks measuring episodic memory, response inhibition, visuomotor control and sustained attention, while parents were interviewed (DAWBA) to assess ADHD and anxiety symptoms. Of the 116 children assessed, 72% exhibited impaired cognitive processes; 47% had impaired visuomotor control, 37% impaired response inhibition, and 35% had impaired episodic memory. Correlational and hierarchical regression analyses using our final analytic sample (i.e., children who completed all cognitive tasks and a vocabulary assessment, n = 114) showed that poorer task performance and greater within-subject variability were significantly associated with more severe inattention symptoms but not with hyperactivity-impulsivity severity. Symptoms of separation anxiety, which were reported in over half of the sample, moderated associations between inattention and episodic memory, and between inattention and inhibition. Only children without separation anxiety showed significant correlations between ADHD symptoms and poor performance. However, separation anxiety had no moderating effect on associations between inattention and visuomotor control or sustaining attention. Children exhibiting signs of ADHD show impairments across a range of cognitive tasks. Further research to improve our understanding of these processes may be useful in the development of early interventions. Our results suggest that separation anxiety should be taken into account when considering interventions to address emerging neuropsychological deficits associated with this disorder.
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Affiliation(s)
- Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | | | - Leo De Sonneville
- Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, The Netherlands
| | - Stephanie H M Van Goozen
- School of Psychology, Cardiff University, Cardiff, UK
- Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, The Netherlands
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7
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Warsi NM, Wong SM, Germann J, Boutet A, Arski ON, Anderson R, Erdman L, Yan H, Suresh H, Gouveia FV, Loh A, Elias GJB, Kerr E, Smith ML, Ochi A, Otsubo H, Sharma R, Jain P, Donner E, Lozano AM, Snead OC, Ibrahim GM. Dissociable default-mode subnetworks subserve childhood attention and cognitive flexibility: Evidence from deep learning and stereotactic electroencephalography. Neural Netw 2023; 167:827-837. [PMID: 37741065 DOI: 10.1016/j.neunet.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/13/2023] [Accepted: 07/12/2023] [Indexed: 09/25/2023]
Abstract
Cognitive flexibility encompasses the ability to efficiently shift focus and forms a critical component of goal-directed attention. The neural substrates of this process are incompletely understood in part due to difficulties in sampling the involved circuitry. We leverage stereotactic intracranial recordings to directly resolve local-field potentials from otherwise inaccessible structures to study moment-to-moment attentional activity in children with epilepsy performing a flexible attentional task. On an individual subject level, we employed deep learning to decode neural features predictive of task performance indexed by single-trial reaction time. These models were subsequently aggregated across participants to identify predictive brain regions based on AAL atlas and FIND functional network parcellations. Through this approach, we show that fluctuations in beta (12-30 Hz) and gamma (30-80 Hz) power reflective of increased top-down attentional control and local neuronal processing within relevant large-scale networks can accurately predict single-trial task performance. We next performed connectomic profiling of these highly predictive nodes to examine task-related engagement of distributed functional networks, revealing exclusive recruitment of the dorsal default mode network during shifts in attention. The identification of distinct substreams within the default mode system supports a key role for this network in cognitive flexibility and attention in children. Furthermore, convergence of our results onto consistent functional networks despite significant inter-subject variability in electrode implantations supports a broader role for deep learning applied to intracranial electrodes in the study of human attention.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lauren Erdman
- Vector Institute for Artificial Intelligence, University Health Network, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Hrishikesh Suresh
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kerr
- Department of Psychology, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, Ontario, Canada, M5G 1X8
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, Ontario, Canada, M5G 1X8
| | - Ayako Ochi
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Roy Sharma
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
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Jackson A, Melvin GA, Mulraney M, Becker SP, Bellgrove MA, Quach J, Hutchinson D, Westrupp EM, Montgomery A, Sciberras E. Associations Between Anxiety and Home Learning Difficulties in Children and Adolescents with ADHD During the COVID-19 Pandemic. Child Psychiatry Hum Dev 2023; 54:1347-1359. [PMID: 35290556 PMCID: PMC8922068 DOI: 10.1007/s10578-022-01338-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
The COVID-19 pandemic has markedly impacted functioning for children and adolescents including those with attention-deficit/hyperactivity disorder (ADHD). We explored home learning difficulties (HLD) during COVID-19 restrictions in Australian children (aged 5-17) with ADHD, aiming to: (1) describe home learning experiences, and (2) examine associations between child anxiety (i.e., concurrent anxiety symptoms and pre-existing anxiety disorder status) and HLD. Baseline data from the longitudinal ADHD COVID-19 Survey were used (n = 122). Parents reported on school factors and HLD; pre-existing anxiety and co-occurring difficulties; anxiety, ADHD, and oppositional symptoms; demographics; and medications. Parents retrospectively reported more children often looked forward to school pre-pandemic, than during the pandemic. Anxiety symptoms, but not pre-existing anxiety disorder status, were associated with HLD after accounting for covariates. ADHD inattention symptoms were also associated with HLD. Results support recommendations to continue pre-pandemic supports to assist with ADHD symptoms during home learning, and strategies/supports for families are discussed.
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Affiliation(s)
- Anna Jackson
- Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
| | - Melissa Mulraney
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Institute for Social Neuroscience, ISN Innovations, Ivanhoe, VIC, Australia
| | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jon Quach
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- University of New South Wales, Kensington, NSW, Australia
| | - Elizabeth M Westrupp
- Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
- Judith Lumley Centre, La Trobe University, Victoria, Australia
| | - Alicia Montgomery
- University of New South Wales, Kensington, NSW, Australia
- Department of Community Paediatrics, Sydney Local Health District, Sydney, NSW, Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Hollingdale J, Woodhouse E, Young S, Gudjonsson G, Charman T, Mandy W. Sex differences in conduct and emotional outcomes for young people with hyperactive/inattentive traits and social communication difficulties between 9 and 16 years of age: a growth curve analysis. Psychol Med 2023; 53:4539-4549. [PMID: 35904163 PMCID: PMC10388317 DOI: 10.1017/s0033291722001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/15/2022] [Accepted: 04/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this paper is to identify the trajectory of conduct and emotional problems for young people within the general population at four time points (between 9 years 7 months and 16 years 6 months), investigate their relationship with hyperactive/inattentive traits and explore the moderating effect of autistic social traits (ASTs). METHODS Data from 9305 individuals involved in The Avon Longitudinal Study of Parents and Children (ALSPAC) study were included. Conduct and emotional problems and hyperactive/inattentive traits were measured by the Strengths and Difficulties Questionnaire. ASTs were assessed using the Social Communication Disorder Checklist. Individual trajectories for conduct and emotional problems were identified via growth curve modelling. Hyperactive/inattentive traits were included within the growth curve model as a time-varying covariate to determine their effect on these outcomes. Finally, participants were split into two groups (below and above clinical threshold ASTs Groups) and multi-group invariance testing was conducted on the data to identify the moderating effect of ASTs on the relationship between hyperactive/inattentive traits and outcomes (i.e. conduct and emotional problems). RESULTS Hyperactive/inattentive traits were associated with higher rates of conduct and emotional problems for both boys and girls. The presence of ASTs moderated these relationships for boys, but not for girls, by increasing the risk of boys with hyperactive/inattentive traits developing greater conduct and emotional problems. CONCLUSIONS These findings underscore the importance of identifying hyperactive/inattentive traits and ASTs in young people and addressing the increased risk of conduct and emotional problems. Research and clinical implications are explored.
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10
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León-Barriera R, Ortegon RS, Chaplin MM, Modesto-Lowe V. Treating ADHD and Comorbid Anxiety in Children: A Guide for Clinical Practice. Clin Pediatr (Phila) 2023; 62:39-46. [PMID: 35854648 DOI: 10.1177/00099228221111246] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is frequently comorbid with anxiety disorders with rates as high as 25% to 50% in children and adolescents. Despite various treatment options for ADHD symptoms, limited research addresses treatment in the context of comorbidity. This article seeks to provide a review of the evidence regarding treatment of this comorbid population. Distinct emotional, cognitive, and behavioral symptoms have been observed in this population, suggesting a need for tailored treatment. Despite common concerns about anxiety exacerbation, stimulant medications demonstrate good tolerability and good response in addressing symptoms. Atomoxetine has also demonstrated some benefit and good tolerability for treating this comorbid population. Selective serotonin reuptake inhibitors can be used as adjunctive treatment for anxiety but require careful monitoring of side effects. Cognitive behavioral therapy (CBT) is an important treatment to improve anxiety symptoms in the absence of significant ADHD symptoms. Psychosocial interventions are also essential to improve outcomes.
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Affiliation(s)
| | - Richard S Ortegon
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA
| | - Margaret M Chaplin
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA.,Department of Psychiatry, Farrel Treatment Center, New Britain, CT, USA
| | - Vania Modesto-Lowe
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA.,Connecticut Valley Hospital, Middletown, CT, USA
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11
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Öztürk FÖ. Internalizing and Externalizing Symptoms and MOXO-d-CPT Parameters in Attention Deficit/Hyperactivity Disorder. Psychiatr Ann 2023. [DOI: 10.3928/00485713-20221206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Fernández-Quirós J, Lacasa-Cazcarra M, Alegre-Martín J, Sanmartín-Sentañes R, Almirall M, Launois-Obregón P, Castro-Marrero J, Rodríguez-Urrutia A, Navarro-Sanchis JA, Ramos-Quiroga JA. The Conners Continuous Performance Test CPT3 ™: Is it a reliable marker to predict neurocognitive dysfunction in Myalgic encephalomyelitis/chronic fatigue syndrome? Front Psychol 2023; 14:1127193. [PMID: 36923151 PMCID: PMC10008938 DOI: 10.3389/fpsyg.2023.1127193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction The main objective is to delimit the cognitive dysfunction associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in adult patients by applying the Continuous Performance Test (CPT3™). Additionally, provide empirical evidence on the usefulness of this computerized neuropsychological test to assess ME/CFS. Method The final sample (n = 225; 158 Patients/67 Healthy controls) were recruited in a Central Sensitization Syndromes (CSS) specialized unit in a tertiary hospital. All participants were administered this neuropsychological test. Results There were significant differences between ME/CFS and healthy controls in all the main measures of CPT3™. Mainly, patients had a worse indicator of inattentiveness, sustained attention, vigilance, impulsivity, slow reaction time, and more atypical T-scores, which is associated with a likelihood of having a disorder characterized by attention deficits, such as Attention Deficit Hyperactivity Disorder (ADHD). In addition, relevant correlations were obtained between the CPT3™ variables in the patient's group. The most discriminative indicators of ME/CFS patients were Variability and Hit Reaction Time, both measures of response speed. Conclusion The CPT3™ is a helpful tool to discriminate neurocognitive impairments from attention and response speed in ME/CFS patients, and it could be used as a marker of ME/CFS severity for diagnosing or monitoring this disease.
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Affiliation(s)
- Judith Fernández-Quirós
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jose Alegre-Martín
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Sanmartín-Sentañes
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miriam Almirall
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Launois-Obregón
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Castro-Marrero
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amanda Rodríguez-Urrutia
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose A Navarro-Sanchis
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J Antoni Ramos-Quiroga
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Nejati V. Reading mind from the eyes in individuals with attention deficit-hyperactivity disorder (ADHD): A meta-analysis. Expert Rev Neurother 2022; 22:889-896. [PMID: 36420829 DOI: 10.1080/14737175.2022.2151899] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Individuals with ADHD struggle with social impairments. The present study aimed to find out the inconsistent results of theory of mind skill in individuals with ADHD. METHODS The current meta-analysis reviewed 17 empirical studies that compared theory of mind in individuals with and without ADHD based on reading mind from the eyes test (RMET). RESULTS Finding from 1620 participants with ADHD and 1249 healthy controls showed a significant impairment in theory of mind in individuals with ADHD (Hedges' g = 0.66). Moderator analyses indicated that the impaired theory of mind was not affected by age and gender. CONCLUSION These findings describe impaired theory of mind in individuals with ADHD and provide an insight to pay attention to theory of mind in respective clinical assessments and treatments.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, 1983969411 Tehran, Iran
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14
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Haugan ALJ, Sund AM, Thomsen PH, Lydersen S, Nøvik TS. Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population. Front Psychiatry 2022; 13:834356. [PMID: 36172514 PMCID: PMC9510657 DOI: 10.3389/fpsyt.2022.834356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Attention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of anxiety disorders in children and adolescents. The reasons for this association are poorly understood. Preliminary findings with young adults have suggested that executive functions and functional impairment may mediate the relationship between symptoms of ADHD and mixed anxiety and depressive symptoms. The objective of this study was to explore whether ADHD symptoms, executive functions and functional impairment predict anxiety in a clinical adolescent population. In addition, we investigated the possible mediating role of executive functions and functional impairment in this relationship. Method One hundred adolescents with ADHD and their parents completed the ADHD Rating Scale IV (ADHD RS-IV), the Behavior Rating Inventory of Executive Function (BRIEF), and the Weiss Functional Impairment Rating Scale (WFIRS) in relation to an RCT study. The adolescents also completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Analyses were conducted using regression and a serial multiple mediator model. Results In the regression analyses, parent-rated ADHD symptoms were unable to predict anxiety, but ADHD inattention symptoms predicted anxiety in the self-ratings. Executive dysfunction and functional impairment predicted anxiety in both the parent- and self-reports. In the mediation analyses ADHD symptoms alone did not predict anxiety, but executive dysfunction mediated this relationship as expected. Functional impairment mediated this relationship indirectly through executive functions. The results were similar in the parent- and self- reports. Conclusion The results pinpoint executive dysfunction as an important treatment target for alleviating anxiety in adolescents with impairing ADHD symptoms.
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Affiliation(s)
- Anne-Lise Juul Haugan
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Mari Sund
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Per Hove Thomsen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torunn Stene Nøvik
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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15
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Gomez R, Stavropoulos V, Watson S, Brown T, Chen W. Inter-relationships between ADHD, ODD and impulsivity dimensions in emerging adults revealed by network analysis: extending the ‘trait impulsivity hypothesis’. Heliyon 2022; 8:e10712. [PMID: 36247147 PMCID: PMC9561741 DOI: 10.1016/j.heliyon.2022.e10712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/23/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background The trait-impulsivity hypothesis posits impulsivity as the underlying substrate of Attention-deficit/hyperactivity disorder (ADHD) and Oppositional defiant disorder (ODD) symptom expressions. The current study applied network analysis to evaluate the inter-relationships of dimensions within ADHD (inattention and hyperactivity/impulsivity) and ODD (anger/irritable, vindictiveness, and argumentative/defiant behavior) with components of impulsivity as captured by the UPPS-P model (negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency). Method A total of 324 emerging adults (women = 246) from the general community completed questionnaires covering these dimensions. Results Our findings showed that the ADHD and ODD dimensions were associated differentially with different types of impulsivity, in their unique patterns of network connectivities, a possibility that has had little attention in the trait-impulsivity hypothesis literature. Conclusions This study is the first to tease out the unique associations of the ADHD and ODD dimensions with different types of impulsivity, and in that way provide new contributions to our understanding of the existing trait impulsivity theory. Our findings would be especially relevant to those interested in understanding how different dimensions of trait impulsivity underly the ADHD and ODD dimensions.
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Affiliation(s)
| | - Vasileios Stavropoulos
- Victoria University, Australia
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Taylor Brown
- Victoria University, Australia
- Corresponding author.
| | - Wai Chen
- Curtin Medical School, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
- Mental Health Services, Fiona Stanley Hospital, Perth, Australia
- Graduate School of Education, University of Western Australia, Perth, Australia
- School of Medicine (Fremantle), University of Notre Dame Australia, Perth, Australia
- Department of Psychology, Murdoch University, Perth, Australia
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16
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Chan ESM, Macias M, Kofler MJ. Does Child Anxiety Exacerbate or Protect Against Parent–Child Relationship Difficulties in Children with Elevated ADHD Symptoms? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022; 44:924-936. [PMID: 35967514 PMCID: PMC9360658 DOI: 10.1007/s10862-021-09922-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/01/2022]
Abstract
Pediatric ADHD is associated with parent–child relationship difficulties. However, the extent to which these relations are attributable to specific ADHD symptom clusters (i.e., inattentive vs. hyperactive/impulsive), and the extent to which child anxiety symptoms may exacerbate or protect against these difficulties, remains unclear. To address these gaps in the literature, the current study combined multi-informant measures (parent, teacher, child) with a clinically-evaluated and carefully-phenotyped sample of 188 children with and without ADHD and anxiety (ages 8–13; 63 girls). Results indicated that child-reported anxiety (β = .46) and teacher-reported inattentive (β = .71) symptoms, and their interaction (β = -1.06), along with child age and IQ (β = -.14 to -.15), predict the extent to which parents perceive themselves as confident and competent parents (all p < .05). In contrast, only comorbid oppositional-defiant disorder conferred risk for increased parent-reported relational frustration, and we were unable to detect any reliable child-level demographic, diagnostic, or behavioral predictors of parent-reported discipline practices. These findings were robust to control for child demographic characteristics, clinical diagnoses, and intellectual functioning, with sensitivity analyses highlighting the importance of assessing ADHD inattentive vs. hyperactive/impulsive symptoms separately for understanding parenting outcomes. Taken together, the current findings suggest that child ADHD and anxiety symptoms may influence specific rather than broad-based aspects of the parent–child relationship, and produce differently valenced outcomes in the presence vs. absence of the other condition. Interestingly, it appears that the combination of greater child inattention and anxiety, rather than elevations in either symptom domain independently, predict adverse parenting outcomes in terms of reduced parental confidence.
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17
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Warsi NM, Wong SM, Suresh H, Arski ON, Yan H, Ebden M, Kerr E, Smith ML, Ochi A, Otsubo H, Sharma R, Jain P, Donner EJ, Snead OC, Ibrahim GM. Interictal discharges delay target-directed eye movements and impair attentional set-shifting in children with epilepsy. Epilepsia 2022; 63:2571-2582. [PMID: 35833751 DOI: 10.1111/epi.17365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The theory of transient cognitive impairment in epilepsy posits that lapses in attention result from ephemeral disruption of attentional circuitry by interictal events. Eye movements are intimately associated with human attention and can be monitored in real -time using eye-tracking technologies. Here, we sought to characterize the associations between interictal discharges (IEDs), gaze, and attentional behaviour in children with epilepsy. METHODS Eleven consecutive children undergoing invasive monitoring with stereotactic electrodes for localization-related epilepsy performed an attentional set-shifting task while tandem intracranial electroencephalographic signals and eye-tracking data were recorded. Using an established algorithm, IEDs were detected across all intracranial electrodes on a trial-by-trial basis. Hierarchical mixed-effects modelling was performed to delineate associations between trial reaction time (RT), eye movements, and IEDs. RESULTS Hierarchical mixed-effects modelling revealed that both the presence of an IED (β±SE=72.74±24.21ms, p=0.003) and the frequency of epileptiform events (β±SE=67.54±17.30ms, p<0.001) were associated with prolonged RT on the attentional set-shifting task. IED occurrence at the time of stimulus presentation was associated with delays in gaze initiation toward the visual targets (p=0.017). SIGNIFICANCE The occurrence of epileptiform activity in close temporal association with stimulus presentation is associated with delays in target-directed gaze and prolonged response time, hallmarks of momentary lapses in attention. These findings provide novel insights into the mechanisms of transient impairments in children and support the use of visual tracking as a correlate of higher-order attentional behaviour.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON
| | - Simeon M Wong
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON.,Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Hrishikesh Suresh
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON
| | - Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Han Yan
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON
| | - Mark Ebden
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Elizabeth Kerr
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Mary Lou Smith
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - Roy Sharma
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | | | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON.,Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
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18
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Pavel DG, Henderson TA, DeBruin S. The Legacy of the TTASAAN Report-Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I. Front Neurol 2022; 12:749579. [PMID: 35450131 PMCID: PMC9017602 DOI: 10.3389/fneur.2021.749579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease-comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
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Affiliation(s)
- Dan G Pavel
- Pathfinder Brain SPECT Imaging, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Columbia, SC, United States
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19
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Carucci S, Narducci C, Bazzoni M, Balia C, Donno F, Gagliano A, Zuddas A. Clinical characteristics, neuroimaging findings, and neuropsychological functioning in attention-deficit hyperactivity disorder: Sex differences. J Neurosci Res 2022; 101:704-717. [PMID: 35293009 DOI: 10.1002/jnr.25038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/17/2022]
Abstract
Recent clinical studies, in both children/adolescents and adults, have shown the extreme neuropsychological heterogeneity of attention-deficit hyperactivity disorder (ADHD): specific neuropsychological deficits have been found only in a minority of individuals, with no direct correlation between discrete cognitive performances and the trajectory of clinical symptoms. Deficits in specific neuropsychological functions may be common in ADHD, but nevertheless no cognitive or neuropsychological profile may fully explain the disorder. Sex differences in the ADHD presentation, both at a neuropsychological and clinical level, also contribute to this clinical and neuropsychological heterogeneity. At a neuropsychological level, females with ADHD may show greater working memory problems, poorer vocabulary skills and worse visual spatial reasoning. Structural and functional imaging study also show discrete differences across sex; however, the great majority of clinical studies mainly or exclusively include male participants with insufficient data to draw firm conclusions on sex differences within the disorder. Here, we report the recent literature data, discussing still open research questions about the clinical presentation, neuroimaging findings, and neuropsychological functioning in ADHD with a focus on the impact of sex differences-a deeper insight in these unresolved issues may have relevant clinical and therapeutic implications for tailored, effective, and long-lasting interventions.
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Affiliation(s)
- Sara Carucci
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Child & Adolescent Neuropsychiatry Unit, "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Chiara Narducci
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Marzia Bazzoni
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Carla Balia
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Child & Adolescent Neuropsychiatry Unit, "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Federica Donno
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Child & Adolescent Neuropsychiatry Unit, "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Antonella Gagliano
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Child & Adolescent Neuropsychiatry Unit, "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,Child & Adolescent Neuropsychiatry Unit, "A.Cao" Paediatric Hospital, Cagliari, Italy
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20
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Garrison-Desany HM, Hong X, Maher BS, Beaty TH, Wang G, Pearson C, Liang L, Wang X, Ladd-Acosta C. Individual and Combined Association Between Prenatal Polysubstance Exposure and Childhood Risk of Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2022; 5:e221957. [PMID: 35275164 PMCID: PMC8917426 DOI: 10.1001/jamanetworkopen.2022.1957] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Polysubstance use among pregnant women has increased because of the opioid epidemic and the increasing legalization of cannabis along with persistent tobacco and alcohol consumption. Previous research on prenatal substance use and the child's risk of attention-deficit/hyperactivity disorder (ADHD) has mostly focused on single-substance exposures; simultaneous examination of multiple substance use and assessment of their synergistic health consequences is needed. OBJECTIVES To assess the consequences of the use of specific substances during pregnancy, investigate whether the interaction of multiple prenatal substance exposures is associated with increases in the risk of childhood ADHD, and estimate the aggregate burden of polysubstance exposure during gestation. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the Boston Birth Cohort from 1998 to 2019. The sample of the present study comprised a multiethnic urban cohort of mother-child pairs who were predominantly low income. A total of 3138 children who were enrolled shortly after birth at Boston Medical Center were included and followed up from age 6 months to 21 years. EXPOSURES Substance use during pregnancy was identified based on self-reported tobacco smoking, alcohol consumption, and use of cannabis, cocaine, or opioids in any trimester of pregnancy. Diagnostic codes for neonatal opioid withdrawal syndrome or neonatal abstinence syndrome from the International Classification of Diseases, Ninth Revision, and the International Classification of Diseases, Tenth Revision, were also used to identify opioid exposure during gestation. MAIN OUTCOMES AND MEASURES ADHD diagnosis in the child's electronic medical record. RESULTS Among 3138 children (1583 boys [50.4%]; median age, 12 years [IQR, 9-14 years]; median follow-up, 10 years [IQR, 7-12 years]) in the final analytic sample, 486 (15.5%) had an ADHD diagnosis and 2652 (84.5%) were neurotypical. The median postnatal follow-up duration was 12 years (IQR, 9-14 years). Among mothers, 46 women (1.5%) self-identified as Asian (non-Pacific Islander), 701 (22.3%) as Hispanic, 1838 (58.6%) as non-Hispanic Black, 227 (7.2%) as non-Hispanic White, and 326 (10.4%) as other races and/or ethnicities (including American Indian or Indigenous, Cape Verdean, Pacific Islander, multiracial, other, or unknown). A total of 759 women (24.2%) reported the use of at least 1 substance during pregnancy, with tobacco being the most frequently reported (580 women [18.5%]). Cox proportional hazards models revealed that opioid exposure (60 children) had the highest adjusted hazard ratio (HR) for ADHD (2.19; 95% CI, 1.10-4.37). After including main statistical effects of all individual substances in an elastic net regression model, the HR of opioids was reduced to 1.60, and evidence of a statistical interaction between opioids and both cannabis and alcohol was found, producing 1.42 and 1.15 times higher risk of ADHD, respectively. The interaction between opioids and smoking was also associated with a higher risk of ADHD (HR, 1.17). CONCLUSIONS AND RELEVANCE The findings of this study suggest that it is important to consider prenatal concurrent exposure to multiple substances and their possible interactions when counseling women regarding substance use during pregnancy, the future risk of ADHD for their children, and strategies for cessation and treatment programs.
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Affiliation(s)
- Henri M. Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiumei Hong
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Brion S. Maher
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Terri H. Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Guoying Wang
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Colleen Pearson
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xiaobin Wang
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore MD
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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21
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Does Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD? CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Anxiety disorders are common comorbidities in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are also at a high risk of bullying behavior. However, little is known about the roles of anxiety symptomatology in the relationship between ADHD and bullying behavior.
Objective
This cross-sectional, clinic-based study aims to investigate the associations between anxiety symptomatology and bullying involvement in youth with ADHD.
Method
One hundred and eighty children and adolescents with ADHD aged 10–18 years participated in the study. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was self-rated, and the participants were interviewed with the Revised Olweus Bully/Victim Questionnaire to categorize bullying involvement. Data were analyzed through percentage, nonparametric statistics, chi-squared statistics, and logistic regression analysis.
Results
Sixty-nine percent of youth with ADHD reported involvement in bullying, of which 33.3%, 8.9%, and 27.2% were classified as victims, bullies, and bully-victims, respectively. The means and 95% confidence intervals of the total SCARED scores showed a significant difference among bullying behavior groups. The highest SCARED scores could be noticed in the victim and bully-victim groups, with the lowest scores observed in the bully group. Youth with ADHD who had comorbid anxiety were 3.51 times more likely to be bullied than those who did not have anxiety.
Conclusions
A differential effect of anxiety symptomatology on bullying behavior in youth with ADHD was evident. These results highlight the utility of including anxiety in the conceptualization of bullying problems in youth with ADHD to plan successful anti-bullying interventions.
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Male sex bias in early and late onset neurodevelopmental disorders: shared aspects and differences in autism spectrum disorder, attention deficit/hyperactivity disorder, and schizophrenia. Neurosci Biobehav Rev 2022; 135:104577. [DOI: 10.1016/j.neubiorev.2022.104577] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022]
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23
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Temperament Profiles Associated with Internalizing Symptoms and Externalizing Behavior in Adolescents with ADHD. Child Psychiatry Hum Dev 2022; 53:109-123. [PMID: 33398690 DOI: 10.1007/s10578-020-01116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
The current study investigated temperament profiles associated with internalizing symptoms and externalizing behavior in adolescents with ADHD. Participants were 121 adolescents (90 males) with ADHD, ranging in age from 13 to 18 years (M = 15.40, SD = 1.59). Emotional and behavioral ratings were obtained using the Strengths and Difficulties Questionnaire (SDQ) and temperament profiles were assessed by administering the Temperament and Character Inventory (TCI). Multivariate profile analyses and post hoc tests revealed that youth high in internalizing symptoms were significantly higher in harm avoidance and lower in self-directedness. Youth high in externalizing behavior were significantly lower in cooperativeness. No cognitive differences were observed across groups, but youth high in externalizing behavior had more ADHD symptoms and greater impairment in daily life. Findings reveal unique temperament factors associated with comorbid concerns, which may have implications for adapting and personalizing intervention efforts based on these different profiles within adolescents with ADHD.
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Amen DG, Henderson TA, Newberg A. SPECT Functional Neuroimaging Distinguishes Adult Attention Deficit Hyperactivity Disorder From Healthy Controls in Big Data Imaging Cohorts. Front Psychiatry 2021; 12:725788. [PMID: 34899414 PMCID: PMC8653781 DOI: 10.3389/fpsyt.2021.725788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background: The diagnosis of attention deficit hyperactivity disorder (ADHD) relies on history and observation, as no reliable biomarkers have been identified. In this study, we compared a large single diagnosis group of patients with ADHD (combined, inattentive, and hyperactive) to healthy controls using brain perfusion single-photon emission computed tomography (SPECT) imaging to determine specific brain regions which could serve as potential biomarkers to reliably distinguish ADHD. Methods: In a retrospective analysis, subjects (n = 1,135) were obtained from a large multisite psychiatric database, where resting state (baseline) and on-task SPECT scans were obtained. Only baseline scans were analyzed in the present study. Subjects were separated into two groups - Group 1 (n = 1,006) was composed of patients who only met criteria for ADHD with no comorbid diagnoses, while a control group (n = 129) composed of individuals who did not meet criteria for any psychiatric diagnosis, brain injury, or substance use served as a non-matched control. SPECT regions of interests (ROIs) and visual readings were analyzed using binary logistic regression. Predicted probabilities from this analysis were inputted into a Receiver Operating Characteristic analysis to identify sensitivity, specificity, and accuracy. Results: The baseline ROIs and visual readings show significant separations from healthy controls. Sensitivity of the visual reads was 100% while specificity was >97%. The sensitivity and specificity of the post-hoc ROI analysis were both 100%. Decreased perfusion was primarily seen in the orbitofrontal cortices, anterior cingulate gyri, areas of the prefrontal cortices, basal ganglia, and temporal lobes. In addition, ROI analysis revealed some unexpected areas with predictive value in distinguishing ADHD, such as cerebellar subregions and portions of the temporal lobes. Conclusions: Brain perfusion SPECT distinguishes adult ADHD patients without comorbidities from healthy controls. Areas which were highly significantly different from control and thus may serve as biomarkers in baseline SPECT scans included: medial anterior prefrontal cortex, left anterior temporal lobe, and right insular cortex. Future studies of these potential biomarkers in ADHD patients with comorbidities are warranted.
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Affiliation(s)
| | - Theodore A. Henderson
- The Synaptic Space, Denver, CO, United States
- The International Society of Applied Neuroimaging, Denver, CO, United States
- Neuro-Luminance, Inc., Denver, CO, United States
- Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Andrew Newberg
- Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
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Loyer Carbonneau M, Demers M, Bigras M, Guay MC. Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits. J Atten Disord 2021; 25:1640-1656. [PMID: 32495675 DOI: 10.1177/1087054720923736] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: A meta-analysis was carried out to determine whether there are sex differences among children and adolescents with ADHD on the primary symptoms of ADHD and on executive and attentional functioning. Method: Studies published from 1997 to 2017 comparing boys and girls with a valid ADHD diagnosis were retained. Results: The meta-analysis found boys with ADHD to be more hyperactive than girls with ADHD and boys to have more difficulties in terms of motor response inhibition and cognitive flexibility. Results also confirm that youths with ADHD have more executive deficits than non-ADHD peers have, but there is no sex difference in this regard. Conclusion: Results show that there are sex differences in the behavioral expression of the difficulties related to ADHD. This highlights the importance of pursuing research to refine the profile of girls with ADHD and to develop diagnostic criteria adapted to each sex.
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Sulkama S, Puurunen J, Salonen M, Mikkola S, Hakanen E, Araujo C, Lohi H. Canine hyperactivity, impulsivity, and inattention share similar demographic risk factors and behavioural comorbidities with human ADHD. Transl Psychiatry 2021; 11:501. [PMID: 34599148 PMCID: PMC8486809 DOI: 10.1038/s41398-021-01626-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/15/2021] [Indexed: 02/08/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder impairing the quality of life of the affected individuals. The domestic dog can spontaneously manifest high hyperactivity/impulsivity and inattention which are components of human ADHD. Therefore, a better understanding of demographic, environmental and behavioural factors influencing canine hyperactivity/impulsivity and inattention could benefit both humans and dogs. We collected comprehensive behavioural survey data from over 11,000 Finnish pet dogs and quantified their level of hyperactivity/impulsivity and inattention. We performed generalised linear model analyses to identify factors associated with these behavioural traits. Our results indicated that high levels of hyperactivity/impulsivity and inattention were more common in dogs that are young, male and spend more time alone at home. Additionally, we showed several breed differences suggesting a substantial genetic basis for these traits. Furthermore, hyperactivity/impulsivity and inattention had strong comorbidities with compulsive behaviour, aggressiveness and fearfulness. Multiple of these associations have also been identified in humans, strengthening the role of the dog as an animal model for ADHD.
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Affiliation(s)
- Sini Sulkama
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Jenni Puurunen
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Milla Salonen
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Salla Mikkola
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Emma Hakanen
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - César Araujo
- grid.7737.40000 0004 0410 2071Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Hannes Lohi
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland. .,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
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Popow C, Ohmann S, Plener P. Practitioner's review: medication for children and adolescents with autism spectrum disorder (ASD) and comorbid conditions. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2021; 35:113-134. [PMID: 34160787 PMCID: PMC8429404 DOI: 10.1007/s40211-021-00395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
Alleviating the multiple problems of children with autism spectrum disorder (ASD) and its comorbid conditions presents major challenges for the affected children, parents, and therapists. Because of a complex psychopathology, structured therapy and parent training are not always sufficient, especially for those patients with intellectual disability (ID) and multiple comorbidities. Moreover, structured therapy is not available for a large number of patients, and pharmacological support is often needed, especially in those children with additional attention deficit/hyperactivity and oppositional defiant, conduct, and sleep disorders.
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Affiliation(s)
- Christian Popow
- Dept. Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Susanne Ohmann
- Dept. Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Paul Plener
- Dept. Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
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Robe A, Păsărelu CR, Dobrean A. Exploring autonomic regulation in children with ADHD with and without comorbid anxiety disorder through three systematic levels of cardiac vagal control analysis: Rest, reactivity, and recovery. Psychophysiology 2021; 58:e13850. [PMID: 34046904 DOI: 10.1111/psyp.13850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022]
Abstract
Autonomic nervous system (ANS) dysregulation, characterized by reduced vagally mediated Heart Rate Variability (HRV), has been associated with Attention-Deficit/ Hyperactivity Disorder (ADHD). This study investigated the dynamic vagal modulation of cardiac output in response to shifts in environmental demands in children and adolescents with ADHD, with and without a comorbid anxiety disorder. High-frequency HRV (HF-HRV) measures were obtained from 46 children and adolescents ranging from 6 to 17 (M = 9.38; SD = 2.31) years old, during three successive experimental conditions: a baseline recording followed by a sustained attention task, and a post-task recovery period. Findings support the reliability of the d2 Test, a cancelation test of attention and concentration, to induce parasympathetic withdrawal and extend prior work on "vagal flexibility". Further, these findings suggest a pattern of group differences in ANS functioning in children with ADHD, with and without a comorbid anxiety disorder. Only the ADHD without comorbid anxiety group showed a normative autonomic response to the cognitive challenge (reduced HF-HRV). The participants did not display an adaptive process of restoration following the cognitive challenge; the HRV suppression was prolonged during post-task recovery period, suggesting that ANS responded as if the cognitive stressor was still present. The current paper covers and discusses theoretical implications for the abnormalities in neurophysiological functioning and the different physiological responses in the two ADHD subtypes.
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Affiliation(s)
- Andreea Robe
- Doctoral School "Evidence-based Assessment and Psychological Interventions, Babeʂ-Bolyai University, Cluj-Napoca, Romania.,The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeʂ-Bolyai University, Cluj-Napoca, Romania
| | - Costina-Ruxandra Păsărelu
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeʂ-Bolyai University, Cluj-Napoca, Romania.,Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania
| | - Anca Dobrean
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeʂ-Bolyai University, Cluj-Napoca, Romania.,Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania
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Distinct Patterns of Impaired Cognitive Control Among Boys and Girls with ADHD Across Development. Res Child Adolesc Psychopathol 2021; 49:835-848. [PMID: 33646480 DOI: 10.1007/s10802-021-00792-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
This study examined whether girls and boys with ADHD show similar impairments in cognitive control from childhood into adolescence and the developmental relationship between cognitive control and ADHD symptoms. Participants include 8-17-year-old children with ADHD (n = 353, 104 girls) and typically developing (TD) controls (n = 241, 86 girls) with longitudinal data obtained from n = 137. Participants completed two go/no-go (GNG) tasks that varied in working memory demand. Linear mixed-effects models were applied to compare age-related changes in cognitive control for each GNG task among girls and boys with ADHD and TD controls and in relation to ADHD symptoms. Boys with ADHD showed impaired response inhibition and increased response variability across tasks. In contrast, girls with ADHD showed impaired response inhibition only with greater working memory demands whereas they displayed increased response variability regardless of working memory demands. Analysis of age-related change revealed that deficits in cognitive control under minimal working memory demands increase with age among girls with ADHD and decrease with age among boys with ADHD. In contrast, deficits in cognitive control with greater working memory demands decrease with age among both boys and girls with ADHD compared to TD peers. Among children with ADHD poor response inhibition during childhood predicted inattentive symptoms in adolescence and was associated with less age-related improvement in inattentive symptoms. These findings suggest that girls and boys with ADHD show differential impairment in cognitive control across development and response inhibition in childhood may be an important predictor of ADHD symptoms in adolescence.
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Carolan D. ADHD stimulant medication misuse and considerations for current prescribing practice: a literature review. Ir J Med Sci 2021; 191:313-320. [PMID: 33559870 DOI: 10.1007/s11845-020-02502-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stimulant medications have been prescribed to effectively treat childhood Attention Deficit Hyperactivity Disorder (ADHD) since the 1960's, with improved outcomes observed in the three core symptom domains. Over the course of these decades researchers and clinicians have debated the issue of negative outcomes with regard to later development of substance use disorders (SUD) for these children. AIMS To chronicle the development of medical and scientific opinion on the subject of SUD outcomes in ADHD and to appraise most recently published research in this sphere. METHODS A systematic search of the literature was conducted over 4 databases. Removal of duplicates, application of exclusion criteria and inclusion of publications identified through manual and citation-based search yielded 9 papers. RESULTS Prescriptions for stimulant medications are increasing worldwide and in tandem the prevalence of stimulant misuse. Much research focuses on non-medical stimulant misuse as a study aid; however, they are also used as recreational drugs with action on dopaminergic neurotransmitter pathways implicated in addiction disorders. Considering the risks and benefits of stimulant prescribing on later SUD development research in recent decades has produced inconsistent results. Current research supports the hypothesis of improved SUD outcomes for young people treated early and intensely, with poorer outcomes for those with less robust treatment histories. CONCLUSIONS Consideration of the impact that variable treatment trajectories may have on the risk of later SUD development is recommended, with further research potentially leading to the development of different management pathways based on an individual's multivariate treatment profile.
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Affiliation(s)
- Deirdre Carolan
- Department of Psychiatry, Health Service Executive South, Cork, Ireland.
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32
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Doidge JL, Flora DB, Toplak ME. A Meta-Analytic Review of Sex Differences on Delay of Gratification and Temporal Discounting Tasks in ADHD and Typically Developing Samples. J Atten Disord 2021; 25:540-561. [PMID: 30596297 DOI: 10.1177/1087054718815588] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To examine whether males and females with ADHD differ in their preferences for delayed rewards, since there is some evidence that suggests a sex difference with typically developing (TD) samples. Method: We used meta-analyses to examine sex differences on delay of gratification and temporal discounting tasks in both TD and ADHD samples. We identified 28 papers with 52 effect sizes for children and adults, and calculated the average effect size for sex comparisons within TD and ADHD samples. Results: The estimated mean difference between TD males and TD females was negligible, but males with ADHD were more likely to choose the larger delayed rewards than females with ADHD. Meta-regressions indicated that task type, age, and reward type did not significantly predict sex differences. Conclusion: These findings suggest that females referred for ADHD may make less adaptive choices by preferring smaller immediate rewards over larger delayed rewards more often than males with ADHD. Implications of our findings are discussed.
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Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2299-2310. [PMID: 34482427 PMCID: PMC8418687 DOI: 10.1007/s00127-021-02171-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. METHODS A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. RESULTS The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. CONCLUSION Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.
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Choo AL, Smith SA, Li H. Associations between stuttering, comorbid conditions and executive function in children: a population-based study. BMC Psychol 2020; 8:113. [PMID: 33129350 PMCID: PMC7603732 DOI: 10.1186/s40359-020-00481-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to investigate the relationship between executive function (EF), stuttering, and comorbidity by examining children who stutter (CWS) and children who do not stutter (CWNS) with and without comorbid conditions. Data from the National Health Interview Survey were used to examine behavioral manifestations of EF, such as inattention and self-regulation, in CWS and CWNS. Methods The sample included 2258 CWS (girls = 638, boys = 1620), and 117,725 CWNS (girls = 57,512; boys = 60,213). EF, and the presence of stuttering and comorbid conditions were based on parent report. Descriptive statistics were used to describe the distribution of stuttering and comorbidity across group and sex. Regression analyses were to determine the effects of stuttering and comorbidity on EF, and the relationship between EF and socioemotional competence. Results Results point to weaker EF in CWS compared to CWNS. Also, having comorbid conditions was also associated with weaker EF. CWS with comorbidity showed the weakest EF compared to CWNS with and without comorbidity, and CWS without comorbidity. Children with stronger EF showed higher socioemotional competence. A majority (60.32%) of CWS had at least one other comorbid condition in addition to stuttering. Boys who stutter were more likely to have comorbid conditions compared to girls who stutter. Conclusion Present findings suggest that comorbidity is a common feature in CWS. Stuttering and comorbid conditions negatively impact EF.
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Affiliation(s)
- Ai Leen Choo
- Department of Communication Sciences and Disorders, Georgia State University, 30 Pryor St SW, Atlanta, GA, 30303, USA.
| | - Sara Ashley Smith
- Department of Teaching and Learning, University of South Florida, Tampa, FL, 33620, USA
| | - Hongli Li
- Department of Educational Policy Studies, Georgia State University, 30 Pryor St SW, Atlanta, GA, 30303, USA
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35
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Corona JC. Role of Oxidative Stress and Neuroinflammation in Attention-Deficit/Hyperactivity Disorder. Antioxidants (Basel) 2020; 9:antiox9111039. [PMID: 33114154 PMCID: PMC7690797 DOI: 10.3390/antiox9111039] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder of childhood. Although abnormalities in several brain regions and disturbances of the catecholaminergic pathway have been demonstrated, the pathophysiology of ADHD is not completely understood, but as a multifactorial disorder, has been associated with an increase in oxidative stress and neuroinflammation. This review presents an overview of factors that increase oxidative stress and neuroinflammation. The imbalance between oxidants and antioxidants and also the treatment with medications are two factors that can increase oxidative damage, whereas the comorbidity between ADHD and inflammatory disorders, altered immune response, genetic and environmental associations, and polymorphisms in inflammatory-related genes can increase neuroinflammation. Evidence of an association with these factors has become valuable for research on ADHD. Such evidence opens up new intervention routes for the use of natural products as antioxidants that could have potential as a treatment against oxidative stress and neuroinflammation in ADHD.
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Affiliation(s)
- Juan Carlos Corona
- Laboratory of Neurosciences, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico
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36
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Klymkiw DF, Milligan K, Lackner C, Phillips M, Schmidt LA, Segalowitz SJ. Does Anxiety Enhance or Hinder Attentional and Impulse Control in Youth With ADHD? An ERP Analysis. J Atten Disord 2020; 24:1746-1756. [PMID: 28494637 DOI: 10.1177/1087054717707297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Youth with ADHD and comorbid anxiety (ADHD+ANX) experience increased social and academic impairment compared with youth with ADHD without anxiety (ADHD). Group differences in attentional and impulse control may underlie this increased impairment. Examination of group differences using behavioral measures of attentional and impulse control has yielded inconsistent findings. This study explored group differences using event-related potentials (ERPs), which provide neural information concerning early information processing. Method: ERPs (early frontal positivity [EFP], N2) were collected while youth aged 11 to 17 with ADHD (n = 31) and ADHD+ANX (n = 35) completed a visual and an auditory computer task. Results: Compared with the ADHD group, the ADHD+ANX group exhibited larger N2 amplitudes to no-go stimuli and larger EFP amplitudes to target auditory stimuli, with variable attention allocation to nontarget stimuli. Conclusion: The addition of anxiety to ADHD appears to alter early attentional processing, which may be an important aspect of this comorbidity.
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Janiczak D, Perez-Reisler M, Ballard R. Diagnosis and Management of Comorbid Anxiety and ADHD in Pediatric Primary Care. Pediatr Ann 2020; 49:e436-e439. [PMID: 33034659 DOI: 10.3928/19382359-20200922-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, which are the most common pediatric mental health problems, frequently co-occur. The overlap of symptoms and the varied presentations of both disorders can make diagnosis and treatment planning challenging. Picking an initial treatment target with reassessment of the diagnoses based on response may help clinicians successfully treat children with comorbid ADHD/anxiety. Treating ADHD with stimulants can lead to improvement in ADHD-related anxiety symptoms. Treating anxiety can reduce anxiety-related attentional problems and executive functioning. Atomoxetine and alpha agonists treat ADHD and may have some benefit for anxiety symptoms. Behavioral treatment should be part of the plan for ADHD co-occurring with anxiety disorders. [Pediatr Ann. 2020;49(10):e436-e439.].
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Mphahlele RM, Pillay B, Meyer A. Internalising comorbidities in primary school children with attention-deficit hyperactivity disorder (ADHD): sex and age differences. J Child Adolesc Ment Health 2020; 32:119-129. [DOI: 10.2989/17280583.2020.1848851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Basil Pillay
- Department of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Anneke Meyer
- Psychology Department, University of Limpopo, Polokwane, South Africa
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39
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Young S, Adamo N, Ásgeirsdóttir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry 2020; 20:404. [PMID: 32787804 PMCID: PMC7422602 DOI: 10.1186/s12888-020-02707-9] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. METHODS The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. RESULTS A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. CONCLUSIONS This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, PO 1735, Croydon, London, CR9 7AE, UK.
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.
| | - Nicoletta Adamo
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- Service for Complex Autism and Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | | | | | | | | | | | - Quinton Deeley
- National Autism Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Emad Farrag
- South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE
| | - Gisli Gudjonsson
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter Hill
- Independent Consultant in Child and Adolescent Psychiatry, Private Practice, London, UK
| | - Jack Hollingdale
- Michael Rutter Centre, South London and Maudsley Hospital, London, UK
| | | | | | - Peter Mason
- ADHD and Psychiatry Services Limited, Liverpool, UK
| | | | | | - Jane Sedgwick
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Kevin Tierney
- Neuropsychiatry Team, National Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kobus van Rensburg
- Adult ADHD and AS Team & CYP ADHD and ASD Service in Northamptonshire, Northampton, UK
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
- Compass, London, UK
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Sánchez-Pérez N, Putnam SP, Gartstein MA, González-Salinas C. ADHD and ODD Symptoms in Toddlers: Common and Specific Associations with Temperament Dimensions. Child Psychiatry Hum Dev 2020; 51:310-320. [PMID: 31624999 DOI: 10.1007/s10578-019-00931-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this work was to study the relationship between temperament and signs of psychopathology in typically developing toddlers. More specifically, Attentional Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) symptoms were analyzed in connection with fine-grained temperament dimensions. The sample was composed of 65 toddlers aged between 18 and 35 months. Bivariate correlations showed that higher levels of negative emotionality and approach tendencies, and lower levels of inhibitory control, were related to more ADHD and ODD manifestations. Bivariate correlations also indicated unique associations: lower levels of soothability were associated with higher ODD symptoms, whereas lower attentional focusing and low-intensity pleasure were related with higher ADHD symptoms. Additionally, regression and path analysis models indicated that ADHD was predominantly associated with attentional focusing and motor activation whereas ODD was most closely related to frustration. Our findings highlight the relevance of studying early correlates of psychopathological manifestations to identify children who could benefit from prevention and early intervention programs.
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Affiliation(s)
- Noelia Sánchez-Pérez
- Department of Psychology and Sociology, Faculty of Human and Social Sciences, University of Zaragoza, Teruel, Spain
| | | | - Maria A Gartstein
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Carmen González-Salinas
- Department of Developmental Psychology and Education, Faculty of Psychology, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain.
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Sex Differences in Externalizing and Internalizing Symptoms in ADHD, Autism, and General Population Samples. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09798-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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Antioxidants as a Potential Target against Inflammation and Oxidative Stress in Attention-Deficit/Hyperactivity Disorder. Antioxidants (Basel) 2020; 9:antiox9020176. [PMID: 32098021 PMCID: PMC7070894 DOI: 10.3390/antiox9020176] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
Psychostimulants and non-psychostimulants are the medications prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD). However, several adverse results have been linked with an increased risk of substance use and side effects. The pathophysiology of ADHD is not completely known, although it has been associated with an increase in inflammation and oxidative stress. This review presents an overview of findings following antioxidant treatment for ADHD and describes the potential amelioration of inflammation and oxidative stress using antioxidants that might have a future as multi-target adjuvant therapy in ADHD. The use of antioxidants against inflammation and oxidative conditions is an emerging field in the management of several neurodegenerative and neuropsychiatric disorders. Thus, antioxidants could be promising as an adjuvant ADHD therapy.
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Wang R, Martin CD, Lei AL, Hausknecht KA, Ishiwari K, Richards JB, Haj-Dahmane S, Shen RY. Prenatal Ethanol Exposure Leads to Attention Deficits in Both Male and Female Rats. Front Neurosci 2020; 14:12. [PMID: 32038156 PMCID: PMC6992663 DOI: 10.3389/fnins.2020.00012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/08/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prenatal ethanol exposure (PE) causes multiple behavioral and cognitive deficits, collectively referred to as fetal alcohol spectrum disorders (FASD). Studies show that 49-94% of FASD children exhibit attention deficits, even when they have normal IQs or lack severe facial deformities, suggesting that attention deficits could be caused by even moderate prenatal exposure to alcohol, of which the underlying neural mechanisms are still unclear. A valid rodent model could help elucidate this phenomenon. MATERIALS AND METHODS A second-trimester equivalent binge drinking PE model was utilized. Pregnant Sprague Dawley rats were administered with 15% (w/v) ethanol (6 g/kg/day, via gastric gavage) during gestational days 8-20, and their offspring were the subjects in the present study. A modified 2-choice reaction time (2-CRT) task was used to illustrate possible attention deficits, including increased action impulsivity and lapses of attention. Enhanced impulsivity was reflected by more premature responses while increased lapses of attention were manifested as more incorrect responses and/or greater variability of reaction time, demonstrated by more skewed distributions of reaction time. Ten-week-old male and female rats were tested for three sessions following 16-19 days of training. RESULTS Our PE paradigm caused no major teratogenic effects. PE led to increased impulsivity exhibited as greater premature responses and augmented lapses of attention shown by greater skewnesses of reaction time distributions, relative to controls. The deficits were observed in both PE male and female rats. Interestingly, in males, the attention deficits were detected only when the 2-CRT task was relatively difficult whereas in females they were detected even when the task was at a less demanding level. CONCLUSION We show that the binge drinking pattern of PE led to attention deficits in both sexes of rats even though no major teratogenic effects were observed. Therefore, this rodent model can be used to study neural mechanisms underlying attention deficits caused by PE and to explore effective intervention approaches for FASD.
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Affiliation(s)
- Ruixiang Wang
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Connor D. Martin
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Anna L. Lei
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Kathryn A. Hausknecht
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Keita Ishiwari
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Jerry B. Richards
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Samir Haj-Dahmane
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Roh-Yu Shen
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States
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Henderson TA, van Lierop MJ, McLean M, Uszler JM, Thornton JF, Siow YH, Pavel DG, Cardaci J, Cohen P. Functional Neuroimaging in Psychiatry-Aiding in Diagnosis and Guiding Treatment. What the American Psychiatric Association Does Not Know. Front Psychiatry 2020; 11:276. [PMID: 32351416 PMCID: PMC7176045 DOI: 10.3389/fpsyt.2020.00276] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
While early efforts in psychiatry were focused on uncovering the neurobiological basis of psychiatric symptoms, they made little progress due to limited ability to observe the living brain. Today, we know a great deal about the workings of the brain; yet, none of this neurobiological awareness has translated into the practice of psychiatry. The categorical system which dominates psychiatric diagnosis and thinking fails to match up to the real world of genetics, sophisticated psychological testing, and neuroimaging. Nevertheless, the American Psychiatric Association (APA) recently published a position paper stating that neuroimaging provided no benefit to the diagnosis and treatment of psychiatric disorders. Using the diagnosis of depression as a model, we illustrate how setting aside the unrealistic expectation of a pathognomonic "fingerprint" for categorical diagnoses, we can avoid missing the biological and, therefore, treatable contributors to psychopathology which can and are visualized using functional neuroimaging. Infection, toxicity, inflammation, gut-brain dysregulation, and traumatic brain injury can all induce psychiatric manifestations which masquerade as depression and other psychiatric disorders. We review these and provide illustrative clinical examples. We further describe situations for which single photon emission computed tomography (SPECT) and positron emission tomography (PET) functional neuroimaging already meet or exceed the criteria set forth by the APA to define a neuroimaging biomarker, including the differential diagnosis of Alzheimer's disease and other dementias, the differential diagnosis of ADHD, and the evaluation of traumatic brain injury. The limitations, both real and perceived, of SPECT and PET functional neuroimaging in the field of psychiatry are also elaborated. An important overarching concept for diagnostic imaging in all its forms, including functional neuroimaging, is that imaging allows a clinician to eliminate possibilities, narrow the differential diagnosis, and tailor the treatment plan. This progression is central to any medical diagnostic process.
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Affiliation(s)
- Theodore A Henderson
- The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,International Society of Applied Neuroimaging, Denver, CO, United States
| | - Muriel J van Lierop
- International Society of Applied Neuroimaging, Denver, CO, United States.,Private Practice, Toronto, ON, Canada
| | - Mary McLean
- International Society of Applied Neuroimaging, Denver, CO, United States.,Private Practice, Toronto, ON, Canada
| | - John Michael Uszler
- International Society of Applied Neuroimaging, Denver, CO, United States.,Nuclear Medicine, Providence St. John's Health Center, Santa Monica, CA, United States.,Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - John F Thornton
- International Society of Applied Neuroimaging, Denver, CO, United States.,Rossiter-Thornton Associates, Toronto, ON, Canada
| | - Yin-Hui Siow
- International Society of Applied Neuroimaging, Denver, CO, United States.,Nuclear Medicine, Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Dan G Pavel
- International Society of Applied Neuroimaging, Denver, CO, United States.,PathFinder Brain SPECT, Deerfield, IL, United States
| | - Joe Cardaci
- International Society of Applied Neuroimaging, Denver, CO, United States.,Fremantle-School of Medicine, University of Notre Dame, Fremantle, WA, Australia.,Diagnostic Nuclear Medicine, Hollywood Private Hospital, Nedlands, WA, Australia.,Consultant Physician, Perth, WA, Australia
| | - Phil Cohen
- International Society of Applied Neuroimaging, Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada
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Vallejo-Valdivielso M, de Castro-Manglano P, Díez-Suárez A, Marín-Méndez JJ, Soutullo CA. Clinical and Neuropsychological Predictors of Methylphenidate Response in Children and Adolescents with ADHD: A Naturalistic Follow-up Study in a Spanish Sample. Clin Pract Epidemiol Ment Health 2019; 15:160-171. [PMID: 32174998 PMCID: PMC7040471 DOI: 10.2174/1745017901915010160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Methylphenidate (MPH) is the most commonly used medication for Attention-Deficit/Hyperactivity Disorder (ADHD), but to date, there are neither consistent nor sufficient findings on conditions differentiating responsiveness to MPH response in ADHD. OBJECTIVE To develop a predictive model of MPH response, using a longitudinal and naturalistic follow-up study, in a Spanish sample of children and adolescents with ADHD. METHODS We included all children and adolescents with ADHD treated with MPH in our outpatient Clinic (2005 to 2015), evaluated with the K-SADS interview. We collected ADHD-RS-IV.es and CGI-S scores at baseline and at follow up, and neuropsychological testing (WISC-IV, Continuous Performance Test (CPT-II) & Stroop). Clinical response was defined as >30% reduction from baseline of total ADHD-RS-IV.es score and CGI-S final score of 1 or 2 maintained for the previous 3 months. RESULTS We included 518 children and adolescents with ADHD, mean (SD) age of patients was 11.4 (3.3) years old; 79% male; 51.7% had no comorbidities; and 75.31% had clinical response to a mean MPH dose of 1.2 mg/kg/day. Lower ADHD-RS-IV.es scores, absence of comorbidities (oppositional-defiant symptoms, depressive symptoms and alcohol/cannabis use), fewer altered neuropsychological tests, higher total IQ and low commission errors in CPT-II, were significantly associated with a complete clinical response to methylphenidate treatment. CONCLUSION Oppositional-defiant symptoms, depressive symptoms, and a higher number of impaired neuropsychological tests are associated with worse clinical response to methylphenidate. Other stimulants or non-stimulants treatment may be considered when these clinical and neuropsychological variables converged in the first clinical interview.
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Affiliation(s)
- María Vallejo-Valdivielso
- Child & Adolescent Psychiatry Unit, Department of Psychiatry & Medical Psychology, University of Navarra Clinic, Pamplona, Navarra, Spain
- IDISNA (Health Research Institute of Navarra - Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
| | - Pilar de Castro-Manglano
- Child & Adolescent Psychiatry Unit, Department of Psychiatry & Medical Psychology, University of Navarra Clinic, Madrid, Spain
- IDISNA (Health Research Institute of Navarra - Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
| | - Azucena Díez-Suárez
- Child & Adolescent Psychiatry Unit, Department of Psychiatry & Medical Psychology, University of Navarra Clinic, Pamplona, Navarra, Spain
- IDISNA (Health Research Institute of Navarra - Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
| | | | - Cesar A. Soutullo
- Child & Adolescent Psychiatry Unit, Department of Psychiatry & Medical Psychology, University of Navarra Clinic, Pamplona, Navarra, Spain
- Child & Adolescent Psychiatry Unit, Department of Psychiatry & Medical Psychology, University of Navarra Clinic, Madrid, Spain
- IDISNA (Health Research Institute of Navarra - Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
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Vitoratou S, Garcia-Rosales A, Banaschewski T, Sonuga-Barke E, Buitelaar J, Oades RD, Rothenberger A, Steinhausen HC, Taylor E, Faraone SV, Chen W. Is the endorsement of the Attention Deficit Hyperactivity Disorder symptom criteria ratings influenced by informant assessment, gender, age, and co-occurring disorders? A measurement invariance study. Int J Methods Psychiatr Res 2019; 28:e1794. [PMID: 31310449 PMCID: PMC7649942 DOI: 10.1002/mpr.1794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aims to ascertain whether the differences of prevalence and severity of attention deficit hyperactivity disorder (ADHD) are true or whether children are perceived and rated differently by parent and teacher informant assessments (INFAs) according to gender, age, and co-occurring disorders, even at equal levels of latent ADHD traits. METHODS Use of latent trait models (for binary responses) to evaluate measurement invariance in children with ADHD and their siblings from the International Multicenter ADHD Gene data. RESULTS Substantial measurement noninvariance between parent and teacher INFAs was detected for seven out of nine inattention (IA) and six out of nine hyperactivity/impulsivity (HI) items; the correlations between parent and teacher INFAs for six IA and four HI items were not significantly different from zero, which suggests that parent and teacher INFAs are essentially rating different kinds of behaviours expressed in different settings, instead of measurement bias. However, age and gender did not affect substantially the endorsement probability of either IA or HI symptom criteria, regardless of INFA. For co-occurring disorders, teacher INFA ratings were largely unaffected by co-morbidity; conversely, parental endorsement of HI symptoms is substantially influenced by co-occurring oppositional defiant disorder. CONCLUSIONS Our findings suggest general robustness of Diagnostic and Statistical Manual of Mental Disorders ADHD diagnostic items in relation to age and gender. Further research on classroom presentations is needed.
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Affiliation(s)
- Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Alexandra Garcia-Rosales
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.,Psychiatry Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Edmund Sonuga-Barke
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert D Oades
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Child and Adolescent Mental Health Center, Capital Region Psychiatry, Copenhagen, Denmark.,Department of Child and Adolescent Psychiatry, Southern Denmark University, Odense, Denmark
| | - Eric Taylor
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Wai Chen
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.,Complex Attention and Hyperactivity Disorders Service (CAHDS), Specialised Child and Adolescent Mental Health Services (CAMHS), WA Department of Health, Perth, Western Australia, Australia.,Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health and Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Western Australia, Australia
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Gomez R, Stavropoulos V. Oppositional Defiant Disorder Dimensions: Associations with Traits of the Multidimensional Personality Model among Adults. Psychiatr Q 2019; 90:777-792. [PMID: 31407123 DOI: 10.1007/s11126-019-09663-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The occurrence of Oppositional Defiant Disorder (ODD) behaviours among adults has been supported by a proportion of scholars. The current work examines potential ODD dimensions and their associations with the primary personality traits of Tellegen's [57] multi-dimensional conceptualization during adulthood. Two independent, general community, adult groups [Group 1: N = 214; mean age (SD) = 35.74 (16.60); Group 2: N = 205; mean age (SD) = 29.00 (12.42)] completed the Current Symptom Scale involving the eight ODD criteria. Group 2 additionally addressed the Multidimensional Personality Questionnaire -Brief Form (MPQ-BF). A series of Confirmatory Factor Analyses (CFA) were implemented. The three-dimensional ODD conceptualization of Burke and colleagues [14] referring to "Negative Affect", "Oppositional Behavior", and "Antagonistic Behavior" was confirmed. Considering personality traits, valuable associations were revealed between Oppositional Behavior and Aggression, Antagonistic Behavior and Social Potency as well as Harm Avoidance, and finally, Negative Affect and Stress Reaction, as well as Aggression. The dimensionality of ODD behaviours in adulthood and its correspondence with particular personality traits is approached in the context of psychological practice.
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Affiliation(s)
- Rapson Gomez
- Federation University, Mount Helen Campus, Ballarat, Victoria, Australia
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48
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Khoury JE, Milligan K. Comparing Executive Functioning in Children and Adolescents With Fetal Alcohol Spectrum Disorders and ADHD: A Meta-Analysis. J Atten Disord 2019; 23:1801-1815. [PMID: 26729621 DOI: 10.1177/1087054715622016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: Fetal alcohol spectrum disorders (FASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are associated with a range of neurocognitive impairments. Executive functioning deficits are a hallmark feature of both disorders. Method: The present meta-analysis was undertaken to disentangle the behavioral phenotype of FASD and ADHD by quantitatively differentiating executive functioning differences between these two groups. The current meta-analysis reviews 15 studies comparing children and adolescents with FASD and ADHD to typically developing (TD) samples, on a variety of executive function measures. Results: Results indicate that when compared with TD samples, FASD and ADHD samples demonstrate significant executive function deficits (d = 0.82 and d = 0.55, respectively). In addition, FASD samples experience significantly greater deficits when compared with ADHD samples (d = 0.25). Results were moderated by IQ and socioeconomic status. Conclusion: These findings further our understanding of the cognitive differences between FASD and ADHD samples and have the potential to influence future basic research, assessment, and intervention.
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49
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Sciberras E, Efron D, Patel P, Mulraney M, Lee KJ, Mihalopoulos C, Engel L, Rapee RM, Anderson V, Nicholson JM, Schembri R, Hiscock H. Does the treatment of anxiety in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using cognitive behavioral therapy improve child and family outcomes? Protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:359. [PMID: 31722690 PMCID: PMC6854614 DOI: 10.1186/s12888-019-2276-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Up to 60% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) meet diagnostic criteria for at least one anxiety disorder, including Social, Generalized and/or Separation Disorder. Anxiety in children with ADHD has been shown to be associated with poorer child and family functioning. Small pilot studies suggest that treating anxiety in children with ADHD using cognitive-behavioral therapy (CBT) has promising benefits. In a fully powered randomized controlled trial (RCT), we aim to investigate the efficacy of an existing CBT intervention adapted for children with ADHD and comorbid anxiety compared with usual care. METHODS This RCT is recruiting children aged 8-12 years (N = 228) from pediatrician practices in Victoria, Australia. Eligibility criteria include meeting full diagnostic criteria for ADHD and at least one anxiety disorder (Generalized, Separation or Social). Eligible children are randomized to receive a 10 session CBT intervention (Cool Kids) versus usual clinical care from their pediatrician. The intervention focuses on building child and parent skills and strategies to manage anxiety and associated impairments including cognitive restructuring and graded exposure. Minor adaptations have been made to the delivery of the intervention to meet the needs of children with ADHD including increased use of visual materials and breaks between activities. The primary outcome is change in the proportion of children meeting diagnostic criteria for an anxiety disorder at 5 months randomization. This will be assessed via diagnostic interview with the child's parent (Anxiety Disorders Interview Schedule for Children V) conducted by a researcher blinded to intervention condition. Secondary outcomes include a range of child (e.g., anxiety symptoms, ADHD severity, behavior, quality of life, sleep, cognitive functioning, school attendance) and parent (e.g., mental health, parenting behaviors, work attendance) domains of functioning assessed at 5 and 12 months post-randomization. Outcomes will be analyzed using logistic and mixed effects regression. DISCUSSION The results from this study will provide evidence on whether treating comorbid anxiety in children with ADHD using a CBT approach leads to improvements in anxiety and/or broader functional outcomes. TRIAL REGISTRATION This trial was prospectively registered: Current Controlled Trials ISRCTN59518816 (https://doi.org/10.1186/ISRCTN59518816). The trial was first registered 29/9/15 and last updated 15/1/19.
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Affiliation(s)
- Emma Sciberras
- School of Psychology, Deakin University, Geelong, Vic, Australia. .,Murdoch Children's Research Institute, Parkville, Vic, Australia. .,University of Melbourne, Parkville, Vic, Australia.
| | - Daryl Efron
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia ,0000 0004 0614 0346grid.416107.5The Royal Children’s Hospital, Parkville, Vic Australia
| | - Pooja Patel
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia
| | - Melissa Mulraney
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia
| | - Katherine J. Lee
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia
| | - Cathy Mihalopoulos
- 0000 0001 0526 7079grid.1021.2School of Psychology, Deakin University, Geelong, Vic Australia
| | - Lidia Engel
- 0000 0001 0526 7079grid.1021.2School of Psychology, Deakin University, Geelong, Vic Australia
| | - Ronald M. Rapee
- 0000 0001 2158 5405grid.1004.5Centre for Emotional Health, Macquarie University, Sydney, NSW Australia
| | - Vicki Anderson
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia ,0000 0004 0614 0346grid.416107.5The Royal Children’s Hospital, Parkville, Vic Australia
| | - Jan M. Nicholson
- 0000 0001 2342 0938grid.1018.8Judith Lumley Centre, La Trobe University, Bundoora, Vic Australia
| | - Rachel Schembri
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia
| | - Harriet Hiscock
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia ,0000 0004 0614 0346grid.416107.5The Royal Children’s Hospital, Parkville, Vic Australia
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50
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D'Agati E, Curatolo P, Mazzone L. Comorbidity between ADHD and anxiety disorders across the lifespan. Int J Psychiatry Clin Pract 2019; 23:238-244. [PMID: 31232613 DOI: 10.1080/13651501.2019.1628277] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Attention deficit/hyperactivity disorder (ADHD) and anxiety disorders are among the most common psychiatric disorders with a 25% comorbidity rate with each other. In this study, we overview the comorbidity between ADHD and anxiety disorders in a longitudinal perspective across the lifespan and we discuss possible therapeutic strategies.Methods: A literature search was performed using PubMed to identify clinical studies assessing comorbidity between ADHD and anxiety disorders from childhood to adulthood.Results: Anxiety disorders may substantially change the presentation, the prognosis, and the treatment of ADHD itself. In childhood, the presence of generalised anxiety disorder, could prevent the typical inhibitory dysfunction present in ADHD, in adolescence may increase the deficit of working memory, and in adulthood may enhance the presence of sleep problems. Individuals with comorbid ADHD and anxiety disorders would benefit from adjunctive psychosocial or adjunctive pharmacotherapy interventions to cognitive behavioural treatment.Conclusions: The management of individuals with comorbid ADHD and anxiety disorders could be challenging for clinicians, and assessing the developmental course is crucial in order to shed light on individualised treatment.KeypointsThe comorbidity between ADHD and anxiety disorders changes the clinical presentation, the prognosis and treatment of patients with ADHD across lifespan.ADHD and anxiety disorders shared common neurobiological dysfunctions but have also different neurobiological abnormalities suggesting that they are different diagnoses.These patients are less likely to benefit from cognitive behavioural treatment strategies alone and often need adjunctive pharmacological treatments.Studies that evaluated the response to MPH reported conflicting results. These patients could respond less well and get more unpleasant arousal side-effects, but these findings need to be confirmed.For his unique mechanism of action, low dose aripiprazole treatment in adolescents and adults with this comorbid condition could be an intriguing avenue of exploration.
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Affiliation(s)
- Elisa D'Agati
- Department of Systems Medicine, Unit of Child Neurology and Psychiatry, 'Tor Vergata' University of Rome, Rome, Italy
| | - Paolo Curatolo
- Department of Systems Medicine, Unit of Child Neurology and Psychiatry, 'Tor Vergata' University of Rome, Rome, Italy
| | - Luigi Mazzone
- Department of Systems Medicine, Unit of Child Neurology and Psychiatry, 'Tor Vergata' University of Rome, Rome, Italy
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