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Stamatis CA, Farlow DN, Mercaldi C, Suh M, Maple A, Savarese A, Childress A, Melmed RD, Kollins SH. Two single arm trials of AKL-T01, a digital therapeutic for adolescents and adults with ADHD. NPJ MENTAL HEALTH RESEARCH 2024; 3:30. [PMID: 38898133 PMCID: PMC11187123 DOI: 10.1038/s44184-024-00075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/25/2024] [Indexed: 06/21/2024]
Abstract
Inattention symptoms represent a key driver of functional impairment in ADHD and often persist into adolescence and adulthood, underscoring a need for novel treatments targeting attentional control. We evaluated AKL-T01-a digital therapeutic that is FDA-cleared for children 8-12 y with ADHD-in adolescents and adults with ADHD in two independent single-arm trials: STARS-ADHD-Adolescent, a 4-week trial in adolescents 13-17 y (n = 162 enrolled), and STARS-ADHD-Adult, a 6-week trial in adults 18 and older (n = 221 enrolled). AKL-T01 was linked with improvements on the Test of Variables of Attention (TOVA®) Attention Comparison Score (ACS) of 2.6 (95% CI: 2.02, 3.26; p < 0.0001) in adolescents and 6.5 in adults (95% CI: 5.35, 7.57; p < 0.0001), along with improvements in secondary endpoints. 15 participants reported adverse device effects, all mild or moderate. Though limited by a single-arm design, results provide preliminary support for the safety and efficacy of AKL-T01 for adolescents and adults with ADHD.
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Affiliation(s)
- Caitlin A Stamatis
- Akili Interactive Labs, Boston, MA, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | | | - Minny Suh
- Akili Interactive Labs, Boston, MA, USA
| | | | | | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
| | | | - Scott H Kollins
- Akili Interactive Labs, Boston, MA, USA
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
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Kaminski A, Xie H, Hawkins B, Vaidya CJ. Change in Striatal Functional Connectivity Networks Across Two Years Due to Stimulant Exposure in Childhood ADHD: Results from the ABCD Sample. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.18.24304470. [PMID: 38562872 PMCID: PMC10984058 DOI: 10.1101/2024.03.18.24304470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Widely prescribed for Attention-Deficit/Hyperactivity Disorder (ADHD), stimulants (e.g., methylphenidate) have been studied for their chronic effects on the brain in prospective designs controlling dosage and adherence. While controlled approaches are essential, they do not approximate real-world stimulant exposure contexts where medication interruptions, dosage non-compliance, and polypharmacy are common. Brain changes in real-world conditions are largely unexplored. To fill this gap, we capitalized on the observational design of the Adolescent Brain Cognitive Development (ABCD) study to examine effects of stimulants on large-scale bilateral cortical networks' resting-state functional connectivity (rs-FC) with 6 striatal regions (left and right caudate, putamen, and nucleus accumbens) across two years in children with ADHD. Bayesian hierarchical regressions revealed associations between stimulant exposure and change in rs-FC of multiple striatal-cortical networks, affiliated with executive and visuo-motor control, which were not driven by general psychotropic medication. Of these connections, three were selective to stimulants versus stimulant naive: reduced rs-FC between caudate and frontoparietal network, and between putamen and frontoparietal and visual networks. Comparison with typically developing children in the ABCD sample revealed stronger rs-FC reduction in stimulant-exposed children for putamen and frontoparietal and visual networks, suggesting a normalizing effect of stimulants. 14% of stimulant-exposed children demonstrated reliable reduction in ADHD symptoms, and were distinguished by stronger rs-FC reduction between right putamen and visual network. Thus, stimulant exposure for a two-year period under real-world conditions modulated striatal-cortical functional networks broadly, had a normalizing effect on a subset of networks, and was associated with potential therapeutic effects involving visual attentional control.
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Affiliation(s)
- Adam Kaminski
- Department of Psychology, Georgetown University, Washington, DC
| | - Hua Xie
- Children’s Research Institute, Children’s National Medical Center, Washington, DC
| | - Brylee Hawkins
- Department of Psychology, Georgetown University, Washington, DC
| | - Chandan J. Vaidya
- Department of Psychology, Georgetown University, Washington, DC
- Children’s Research Institute, Children’s National Medical Center, Washington, DC
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Caterfino A, Krishna S, Chen V. Novel and complementary treatment approaches in attention-deficit/hyperactivity disorder. Curr Opin Pediatr 2024:00008480-990000000-00196. [PMID: 38957089 DOI: 10.1097/mop.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder. RECENT FINDINGS The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks. SUMMARY There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.
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Affiliation(s)
- Andrew Caterfino
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Shruthi Krishna
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
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Chacko A, Merrill BM, Kofler MJ, Fabiano GA. Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Transl Psychiatry 2024; 14:244. [PMID: 38851829 PMCID: PMC11162428 DOI: 10.1038/s41398-024-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 06/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.
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Yang G, Liu Q, Wang W, Liu W, Li J. Effect of aerobic exercise on the improvement of executive function in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis. Front Psychol 2024; 15:1376354. [PMID: 38952825 PMCID: PMC11216162 DOI: 10.3389/fpsyg.2024.1376354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024] Open
Abstract
Objective Aerobic exercise (AE) interventions are beginning to be used as an emerging adjunctive treatment modality in the treatment of children with Attention Deficit Hyperactivity Disorder (ADHD). However, to date, there is no substantial evidence to support the improved effects of aerobic exercise intervention in children with ADHD aged 6-12 years. This study aims to investigate the effect of aerobic exercise therapy on executive function in children with attention deficit hyperactivity disorder aged 6-12 years. Method We conducted a systematic review and meta-analysis using PubMed and Web of Science. The cut-off date was June 1, 2023. The aim was to assess the impact of aerobic exercise interventions on children with ADHD and all randomized controlled trials eligible for aerobic exercise interventions for children with ADHD were included. Nine randomized controlled trials were screened for eligibility for systematic evaluation, and the nine studies were assessed for risk of bias using the PEDro score and the GRADE Quality of Evidence Evaluation System for quality grading of outcome indicators. After testing for heterogeneity, a random-effects model was selected for analysis. Finally, meta-analyses and regression analyses were performed on the core functions (inhibitory control, cognitive flexibility, and working memory) and subgroups of the nine studies on executive function using Revman 5.4 and Stata 16.0. Results The risk of bias evaluation showed a mean PEDro score of 7.78, and of the nine studies, two were rated as having excellent methodological quality, while the remaining seven had a good level of evidence, and the GRADE evidence evaluation showed that the outcome indicators were all of moderate quality. Inhibitory control [SMD = 0.83,95% CI (0.37-1.29), Z = 3.51, p = 0.0005], cognitive flexibility [SMD = 0.65,95% CI (0.37-0.93), Z = 4.58, p < 0.00001], and working memory [SMD = 0.48,95% CI (0.02-0.95), Z = 2.03, p = 0.04] were statistically significant, with effect sizes of moderate or higher; furthermore, in subgroup analyses type of intervention, duration, intensity, and medication use had different effects on inhibitory control and cognitive flexibility, and the combined IC, CF statistic found that a single category of aerobic exercise ( β = 0.867, p < 0.001), moderate intensity ( β = 0.928, p < 0.001), 6-12 weeks (β = 0.804, p < 0.001), 60-90 min ( β = 0.894, p < 0.001), and the use of medication ( β = 1.202, p = 0.002) were better for overall improvement in EF. Conclusion Aerobic exercise therapy significantly improved executive functioning in children with ADHD, showing above moderate effect sizes especially in inhibitory control, cognitive flexibility, and working memory. Aerobic exercise therapy can be used as a reference in improving executive function in children with ADHD, but given the limitations of this study, it should be used with caution when applied in clinical settings.
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Affiliation(s)
- Gao Yang
- College of Sports and Health, Medicine & Technology College of Zunyi Medical University, Zunyi, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Qiang Liu
- Department of Physical Education, Central South University, Changsha, China
| | - Wei Wang
- School of Physical Education and Health, Zunyi Medical University, Zunyi, China
| | - Wei Liu
- Institute of Physical Education, Xuzhou Kinder Garten Teachers College, Xuzhou, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
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Johnson M, Johnels JÅ, Östlund S, Jakobsson K, Högstedt J, Larsson PJ, Gillberg C, Billstedt E. Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes. Eur Arch Psychiatry Clin Neurosci 2024; 274:879-890. [PMID: 38280948 PMCID: PMC11127865 DOI: 10.1007/s00406-023-01744-1] [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: 04/12/2023] [Accepted: 12/11/2023] [Indexed: 01/29/2024]
Abstract
More knowledge is needed about long-term ADHD medication and symptom, daily functioning, comorbidity, and tolerability outcomes. This "Long-term Medication for ADHD (LMA) trial" was a prospective observational 2-year trial in children and adolescents aged 6-18 years (extension of 1-year trial). Participants met criteria for DSM-5 ADHD (inattentive or combined), with complex comorbidities; autism spectrum disorder (31%), autistic traits (24%), oppositional symptoms (59%), anxiety (32%), dyslexia/language disorder (16%), borderline intellectual functioning (17%). Medication was individually tailored and followed-up at clinical visits (1, 2, 3, 6, 12, 18, 24 months). Primary outcome: Clinical Global Impression-Severity and Improvement scales (CGI-S, CGI-I). Secondary outcomes: Investigator-rated ADHD-Rating Scale, Weiss Functional Impairment Rating Scale-Parent report (WFIRS-P; Family, School Learning and Behavior, Life Skills, Self-Concept, Social Activities, and Risky Activities domains), comorbidity symptoms and adverse events (AEs). One hundred twenty-eight participants were enrolled (1-year trial only n = 27, LMA trial n = 101). Of these 29 (23%) discontinued, mainly due to AEs (n = 7), moving (n = 7), or no longer needing medication (n = 6). Main AEs were poor appetite, low mood, anxiety, irritability, fatigue. Improvements from baseline to 2 years were large in CGI-S (effect size (ES) 2.28), ADHD-RS (ES 2.06), and moderate to large in WFIRS-P (ES total 0.73, learning 0.4, family 0.67). Overall, the trial showed robust and sustained improvements in ADHD symptom severity and daily functioning over a period of 2 years of ADHD medication in children and adolescents with ADHD and complex comorbidities. Most AEs were mild. Comorbidity symptoms were improved after 1 year, particularly oppositional symptoms, depression, and anxiety.
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Affiliation(s)
- M Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - J Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Östlund
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Jakobsson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Högstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Javid Larsson
- Habilitation and Health, Region Västra Götaland, Gothenburg, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Billstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fabiano GA, Lupas K, Merrill BM, Schatz NK, Piscitello J, Robertson EL, Pelham WE. Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings. J Sch Psychol 2024; 104:101309. [PMID: 38871418 DOI: 10.1016/j.jsp.2024.101309] [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: 03/22/2023] [Revised: 09/19/2023] [Accepted: 03/16/2024] [Indexed: 06/15/2024]
Abstract
The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.
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Widding-Havneraas T, Zachrisson HD, Markussen S, Elwert F, Lyhmann I, Chaulagain A, Bjelland I, Halmøy A, Rypdal K, Mykletun A. Effect of Pharmacological Treatment of Attention-Deficit/Hyperactivity Disorder on Criminality. J Am Acad Child Adolesc Psychiatry 2024; 63:433-442. [PMID: 37385582 DOI: 10.1016/j.jaac.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Criminality rates are higher among persons with attention-deficit/hyperactivity disorder (ADHD), and evidence that medication reduces crime is limited. Medication rates between clinics vary widely even within universal health care systems, partly because of providers' treatment preferences. We used this variation to estimate causal effects of pharmacological treatment of ADHD on 4-year criminal outcomes. METHOD We used Norwegian population-level registry data to identify all unique patients aged 10 to 18 years diagnosed with ADHD between 2009 and 2011 (n = 5,624), their use of ADHD medication, and subsequent criminal charges. An instrumental variable design, exploiting variation in provider preference for ADHD medication between clinics, was used to identify causal effects of ADHD medication on crime among patients on the margin of treatment, that is, patients who receive treatment because of their provider's preference. RESULTS Criminality was higher in patients with ADHD relative to the general population. Medication preference varied between clinics and strongly affected patients' treatment. Instrumental variable analyses supported a protective effect of pharmacological treatment on violence-related and public-order-related charges with numbers needed to treat of 14 and 8, respectively. There was no evidence for effects on drug-, traffic-, sexual-, or property-related charges. CONCLUSION This is the first study to demonstrate causal effects of pharmacological treatment of ADHD on some types of crimes in a population-based natural experiment. Pharmacological treatment of ADHD reduced crime related to impulsive-reactive behavior in patients with ADHD on the margin of treatment. No effects were found on crimes requiring criminal intent, conspiracy, and planning. STUDY PREREGISTRATION INFORMATION The ADHD controversy project: Long-term effects of ADHD medication; https://www.isrctn.com/; 11891971.
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Affiliation(s)
| | | | | | - Felix Elwert
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Ingvild Lyhmann
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Ashmita Chaulagain
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Ingvar Bjelland
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Knut Rypdal
- Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; Norwegian Institute of Public Health, Oslo, Norway; University of Tromsø, Tromsø, Norway; and Nordland Hospital, Bodø, Norway
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Hill DM, Sibley MH, Stein MA, Leviyah X. Longitudinal Patterns of Community-Based Treatment Utilization Among Ethnically and Racially Diverse Adolescents with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2024; 34:119-126. [PMID: 38306154 DOI: 10.1089/cap.2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) treatment utilization among adolescents is highly variable. This article describes pharmacological and nonpharmacological treatment utilization in a community sample of primarily Latinx and/or Black adolescents with ADHD (N = 218), followed longitudinally for 4 years, from early adolescence until approximately age 17 (M = 16.80, standard deviation = 1.65). Methods: Electronic surveys administered between 2012 and 2019 queried parent and youth reports of medication initiation, persistence, diversion, and misuse, as well as reasons for desistence. Nonpharmacological treatment utilization (including complementary and alternative treatments) was also measured. Results: Results indicated that: (1) the majority of the sample sought treatment for ADHD in their community, (2) rates of psychosocial treatment utilization were higher than medication utilization, (3) approximately half of the medicated sample discontinued community-administered ADHD medication during the follow-up period, most frequently citing tolerability issues and concerns that they were "tired of taking" medication, and (4) medication misuse consisted of youth diversion and parent utilization of teen medication, but both were reported at low rates. Race/ethnicity did not predict treatment utilization patterns, but lower family adversity and psychiatric comorbidity predicted persistence of medication use over time. Conclusions: ADHD treatment engagement efforts for Latinx and/or Black adolescents might link treatment to goals valued by the youth, address concerns related to medication tolerability, and promote secure monitoring of medication. Nonpharmacological treatments for ADHD may be more palatable to Latinx and Black youth with ADHD, and efforts to engage youth with ADHD in treatment should consider offering medication and psychosocial treatment options.
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Affiliation(s)
- Devin M Hill
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mark A Stein
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Xenia Leviyah
- Center for Children and Families, Florida International University, Miami, Florida, USA
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Cunniff PJ, Ahsan A, McCrary C, Dien T, Kuhn TH, Vazifedan T, Harrington JW. ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting. BMC Psychiatry 2024; 24:188. [PMID: 38454358 PMCID: PMC10921583 DOI: 10.1186/s12888-024-05623-4] [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: 07/18/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence. METHODS A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children's Hospital of The King's Daughters (CHKD) were included in the study. Patients were between the ages of 8-18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined "pre-pandemic months" as January 2019 through March 2020 and "pandemic months" as April 2020 through June 2022. RESULTS The total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31-44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33-50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments. CONCLUSIONS Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed.
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Affiliation(s)
| | - Amil Ahsan
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Tracy Dien
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Turaj Vazifedan
- Department of Pediatrics, General Academic Pediatrics, Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - John W Harrington
- Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Pediatrics, General Academic Pediatrics, Children's Hospital of The King's Daughters, Norfolk, VA, USA
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Kazda L, Bell K, Thomas R, Hardiman L, Heath I, Barratt A. Attention deficit/hyperactivity disorder (ADHD) in children: more focus on care and support, less on diagnosis. BMJ 2024; 384:e073448. [PMID: 38325889 DOI: 10.1136/bmj-2022-073448] [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: 02/09/2024]
Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Wiser Healthcare, Australia
- NHMRC Healthy Environments and Lives (HEAL) National Research Network, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Wiser Healthcare, Australia
| | - Rae Thomas
- Wiser Healthcare, Australia
- Institute for Evidence Based Healthcare, Bond University, QLD, Australia
- Tropical Australian Academic Health Centre, Townsville, QLD, Australia
| | | | | | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Wiser Healthcare, Australia
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Ponnou S, Timimi S, Briffault X, Batstra L, Gøtzsche PC, Gonon F. WHO Essential Medicines List and methylphenidate for ADHD in children and adolescents. Lancet Psychiatry 2024; 11:92-93. [PMID: 38245022 DOI: 10.1016/s2215-0366(23)00392-9] [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] [Received: 10/29/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Sébastien Ponnou
- Educational Sciences, University of Paris 8 (CIRCEFT-CLEF, EA 4384), 93200 Saint-Denis, France.
| | | | - Xavier Briffault
- Centre for Research in Medicine, Sciences, Health, Mental Health, and Society (CERMES3), National Centre for Scientific Research,Université Paris Cité, Paris, France
| | - Laura Batstra
- Faculty of the Behavioural and Social Sciences, Department of Child and Family Welfare, University of Groningen, Netherlands
| | | | - François Gonon
- Institute of Neurodegenerative Diseases, National Centre for Scientific Research, University of Bordeaux, Bordeaux, France
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Houmann TB, Kaalund-Brok K, Clemmensen L, Petersen MA, Plessen KJ, Bilenberg N, Verhulst F, Jeppesen P. Early treatment response as predictor of long-term outcome in a clinical cohort of children with ADHD. Eur Child Adolesc Psychiatry 2024; 33:357-367. [PMID: 36795232 PMCID: PMC10869385 DOI: 10.1007/s00787-023-02158-z] [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: 06/03/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
This study investigates early onset of treatment response as predictor of symptomatic and functional outcome 3 years after initiation of methylphenidate (MPH) administration in a naturalistic, clinical cohort of children and adolescents with ADHD. Children were followed across an initial 12-week MPH treatment trial and after 3 years, with ratings of symptoms and impairment. Associations between a clinically significant MPH treatment response in week 3 (defined as ≥ 20% reduction in clinician-rated symptoms) and in week 12 (defined as ≥ 40% reduction), and 3-year outcome were tested in multivariate linear regression models, adjusting for sex, age, comorbidity, IQ, maternal education, parental psychiatric disorder, and baseline symptoms and function. We did not have information on treatment adherence or the nature of treatments beyond 12 weeks. 148 children, mean age 12.4 years (range 10-16 years), 77% males, participated in the follow-up. We found a significant decrease in symptom score from baseline [M = 41.9 (SD = 13.2)] to 3-year follow-up [M = 27.5 (SD = 12.7), p < 0.001, and in impairment score from baseline (M = 41.6 (SD = 19.4)] to 3-year follow-up [M = 35.6 (SD = 20.2), p = 0.005]. Treatment responses in week 3 and week 12 were significant predictors of the long-term outcome of symptoms, but not of impairment at 3-year follow-up, when adjusting for other well-known predictors. Early treatment response predicts long-term outcome over and above other well-known predictors. Clinicians should follow-up patients carefully, during the first months of treatment, and detect non-responders, since there might be a window of opportunity to alter the outcome, by changing the treatment strategy.Clinical trial registration: ClinicalTrials.gov, registration number NCT04366609, April 28, 2020 retrospectively registered.
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Affiliation(s)
- Tine Bodil Houmann
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark.
| | - Kristine Kaalund-Brok
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Clemmensen
- Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, 2900, Hellerup, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Service Universitaire de Psychiatrie de L'Enfant Et de L'Adolescent, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Research Unit (University Function), Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Smedegade 16, 4000, Roskilde, Denmark
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Schweitzer JB, Zion Golumbic E. Editorial: The Use of Continuous Performance Tasks in Attention-Deficit/Hyperactivity Disorder Diagnosis: A Cautionary Note. J Am Acad Child Adolesc Psychiatry 2024; 63:114-116. [PMID: 37402465 DOI: 10.1016/j.jaac.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
Computer-based cognitive tasks aimed at assessing attention and executive function are used regularly-for both clinical and research purposes-with the belief that they provide an objective assessment of symptoms associated with attention-deficit/hyperactivity disorder (ADHD). As rates of the diagnosis of ADHD appear to be exploding, particularly since the onset of COVID-19,1 there is no doubt as to the need for reliable and valid diagnostic tools for ADHD. One of the most common types of such cognitive tests is continuous performance tasks (CPTs), which putatively not only help in diagnosing ADHD but can differentiate between ADHD subtypes. We urge diagnosticians to take a more cautious approach toward this practice and reconsider how CPTs are used given new evidence.
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Affiliation(s)
- Julie B Schweitzer
- University of California, Davis, Sacramento, California, and the MIND Institute, University of California, Davis, Sacramento, California.
| | - Elana Zion Golumbic
- The Gonda Center for Multidisciplinary Brain Research, Bar Ilan University, Ramat Gan, Israel
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Thongseiratch T, Chalermphol K, Traipidok P, Charleowsak P. Promoting Medication Adherence in Children with Attention Deficit Hyperactivity Disorder: A Mixed-Methods Systematic Review with Meta-analysis and Qualitative Comparative Analysis. J Atten Disord 2024; 28:139-150. [PMID: 38006238 DOI: 10.1177/10870547231211021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy of ADHD medication adherence interventions and explore the pathways to effectiveness. METHODS A systematic review was conducted using multiple databases to identify relevant randomized controlled trials (RCTs). Pooled effect sizes were calculated for medication adherence and ADHD symptom outcomes. Qualitative Comparative Analysis (QCA) was used to identify pathways to effectiveness. RESULTS Six RCTs were included. The interventions significantly improved medication adherence (OR = 2.39, 95% CI [1.19, 4.79]) and ADHD symptoms (Hedges' g = -0.96, 95% CI [-1.38, -0.54]). Multi-regression analysis showed a positive relationship between medication adherence and ADHD symptom reduction. QCA revealed two paths for effectiveness: (1) Presence of ADHD drug education and absence of reminder and (2) Presence of tracking and absence of reminder. CONCLUSION ADHD medication adherence interventions have a positive impact on both medication adherence and ADHD symptoms. Interventions should consider including ADHD drug education or tracking to maximize effectiveness.
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Affiliation(s)
- Therdpong Thongseiratch
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Kanokphorn Chalermphol
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pathrada Traipidok
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pattra Charleowsak
- Child Development Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Vitiello B, Davico C, Döpfner M. Is prevention of ADHD and comorbid conditions in adolescents possible? J Atten Disord 2024; 28:225-235. [PMID: 37961885 DOI: 10.1177/10870547231211596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To examine how the concept of prevention is applicable to adolescent ADHD, which preventive interventions may be feasible, and which methods can be used to evaluate effectiveness. METHOD Following a literature search for prevention clinical trials relevant to adolescent ADHD, selected studies are critically reviewed to identify suitable targets and promising interventions. RESULTS There is some evidence from controlled studies that interventions delivered to prepubertal children at high risk for ADHD or diagnosed with ADHD may decrease the incidence or persistence of ADHD in adolescence. Uncontrolled follow-up of clinical samples and population studies suggest that treatment of adolescents with ADHD can decrease the risk for several negative functional outcomes in youth. A controlled trial found a specific cognitive training intervention to decrease risky driving. CONCLUSIONS Prevention of ADHD and associated negative outcomes is possible and of high clinical relevance. Assessing prevention effects is methodologically challenging, but feasible.
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Affiliation(s)
- Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- Department of Mental Health, School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Germany
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Sibley MH, Link K, Antunez GT, Greenwood L. Engagement Barriers to Behavior Therapy for Adolescent ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:834-849. [PMID: 35084265 PMCID: PMC9325914 DOI: 10.1080/15374416.2022.2025597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify barriers to behavior therapy for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND) and understand the relationship between barriers and treatment engagement. METHOD A mixed-method design with qualitative coding of 822 audio-recorded therapy sessions attended by 121 adolescents with ADHD (ages 11-16; 72.7% male, 77.7% Latinx, 7.4% African-American, 11.6% White, non-Latinx) and parents. Grounded theory methodology identified barriers articulated by parents and adolescents in session. Barriers were sorted by subtype (cognitive/attitudinal, behavioral, logistical) and subject (parent, teen, dyad). Frequency and variety of barriers were calculated by treatment phase (engagement, skills, planning). Generalized linear models and generalized estimating equations examined between-phase differences in frequency of each barrier and relationships between barriers frequency, subtype, subject, and phase on engagement (attendance and homework completion). RESULTS Coding revealed twenty-five engagement barriers (ten cognitive/attitudinal, eleven behavioral, four logistical). Common barriers were: low adolescent desire (72.5%), parent failure to monitor skill application (69.4%), adolescent forgetfulness (60.3%), and adolescent belief that no change is needed (56.2%). Barriers were most commonly cognitive/attitudinal, teen-related, and occurring in STAND's planning phase. Poorer engagement was associated with cognitive/attitudinal, engagement phase, and dyadic barriers. Higher engagement in treatment was predicted by more frequent behavioral, logistical, parent, and skills/planning phase barriers. CONCLUSIONS Baseline assessment of barriers may promote individualized engagement strategies for adolescent ADHD treatment. Cognitive/attitudinal barriers should be targeted at treatment outset using evidence-based engagement strategies (e.g., Motivational Interviewing). Behavioral and logistical barriers should be addressed when planning and reviewing application of skills.
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Affiliation(s)
- Margaret H. Sibley
- University of Washington School of Medicine, Seattle Children’s Research Institute, Seattle, WA
| | - Kara Link
- University of Washington Department of Psychology, Seattle Children’s Research Institute, Seattle, WA
| | - Gissell Torres Antunez
- University of Washington Department of Psychology, Seattle Children’s Research Institute, Seattle, WA
| | - Lydia Greenwood
- University of Washington Department of Psychology, Seattle Children’s Research Institute, Seattle, WA
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Redmond SM, Ash AC, Zhang Y. A preliminary study of the effects of stimulant medications on estimates of psycholinguistic abilities for children with attention-deficit/hyperactivity disorder. CLINICAL LINGUISTICS & PHONETICS 2023:1-21. [PMID: 37906703 PMCID: PMC11058111 DOI: 10.1080/02699206.2023.2273750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
Underlying deficits in inattention, hyperactivity, and/or impulsivity might contribute to suboptimal test-taking behaviours during language assessments that can lead to diagnostic errors. Considerations of potential medication effects on estimates of children's nonword repetition, sentence recall, tense-marking, and narrative abilities are warranted given long-standing enthusiasm for these indices to serve as clinical markers for developmental language disorder (DLD). A battery consisting of 1 nonverbal, 1 reading, and 6 verbal measures was administered twice to 26 children (6-9 years) with independently diagnosed combined-type attention-deficit/hyperactivity disorder (ADHD). All participants had been prescribed stimulant medications for the management of their ADHD symptoms and were assessed off- and on-medication, with order counter-balanced across participants. Half of the participants had concomitant DLD. Examiners were unaware of children's clinical status during assessments or when they were testing children who had received medication. Effect sizes were calculated for each measure. Significant score differences indicating a beneficial impact of stimulant medications on children's performances were observed on the recalling sentences subtest of the Clinical Evaluation of Language Fundamentals and the Picture Peabody Vocabulary Test. Adjustments may be needed when speech language pathologists use sentence recall or receptive vocabulary measures to make diagnostic decisions with children who have ADHD.
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Affiliation(s)
- Sean M Redmond
- Communication Sciences and Disorders,University of Utah Health, Salt Lake City, Utah, USA
| | - Andrea C Ash
- Communication Sciences and Disorders,University of Utah Health, Salt Lake City, Utah, USA
| | - Yue Zhang
- Communication Sciences and Disorders,University of Utah Health, Salt Lake City, Utah, USA
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19
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Tallberg P, Rastam M, Hallin AL, Perrin S, Gustafsson P. A longitudinal investigation of parental ratings and performance metrics for executive functioning and symptom severity in clinically referred youth with ADHD. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:259-271. [PMID: 36126650 DOI: 10.1080/21622965.2022.2093113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There remains a knowledge gap concerning the persistence of attention deficit hyperactivity disorder (ADHD) over the longer term. The current study aimed to investigate the change in parent-rated, and performance-based metrics of executive functioning (EF) and the relationship between these EF metrics and ADHD symptoms in individuals with ADHD from childhood/adolescence to young adulthood. This was done by examining possible improvements in parent-rated EF and performance-based measures of inattention and inhibition over a three-year interval and their relationship to ADHD outcomes in 137 clinically referred youth with ADHD (mean age = 12.4 years, SD = 3.1). Participants' parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Swanson-Nolan-Pelham Scale at baseline and follow-up. Participants completed the Conners' Continuous Performance Test, Version II (CPT II) at baseline and follow-up. Statistical analyses were performed with Linear Mixed Models. The sex- and age-standardized measures Commission and Hit reaction time (RT) subscales of the CPT II and parent-rated metacognitive, and behavior regulation composites of the BRIEF were largely stable between measuring points. CPT Omissions, Hit RT standard error (reaction time variability), and parent-rated ADHD symptom scores improved slightly. BRIEF composites and reaction time variability were related to ADHD symptoms using longitudinal data. Overall, behavioral aspects of EF, as observed by parents in the home context, appear to play a significant role in the trajectory of childhood ADHD.
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Affiliation(s)
- Pia Tallberg
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Skane, Lund, Sweden
| | - Maria Rastam
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Psychiatry and Neurochemistry, Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Anne-Li Hallin
- Child and Adolescent Psychiatry, Region Skane, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Skane, Lund, Sweden
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20
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Shepard E, Sweeney C, Thompson L, Jacobs S, Grimm J, Weyandt LL. Effectiveness of executive functioning training among heterogeneous adolescent samples: A systematic review. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:327-343. [PMID: 35914534 DOI: 10.1080/21622965.2022.2106436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. A systematic review of the literature was conducted to retrieve and consolidate findings from articles evaluating executive functioning training techniques among adolescents. A total of 26 articles were located that examined the role of executive functioning training techniques among adolescents (age 10-19 years). Articles retrieved enabled comparison across psychiatric and medical diagnoses including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as adolescents with physical health concerns. Results revealed that among typically developing adolescents, executive functioning training was non-significant or yielded small effect size improvements in executive functioning as measured by behavioral and neuroimaging tasks among 62.5% of studies reviewed. In contrast, in those with medical conditions, ASD, ADHD, and conduct disorder, all but two studies reviewed yielded a medium to large effect size, supporting the effectiveness of EF training. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.
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Affiliation(s)
- Emily Shepard
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caroline Sweeney
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren Thompson
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Sophie Jacobs
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jessica Grimm
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lisa L Weyandt
- Department of Psychology, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
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21
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Waxmonsky JG, Waschbusch DA, Groff D, Jairath B, Sekhar DL, Sibley MH, Logan JM, Fogel B. Effects of a Primary Care-Based Engagement Intervention for Improving Use of ADHD Treatments. J Pediatr Health Care 2023; 37:537-547. [PMID: 37227324 DOI: 10.1016/j.pedhc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Uptake of attention deficit hyperactivity disorder (ADHD) treatments is low in primary care. A quasi-experimental study assessed the impact of a primary care-based engagement intervention to improve ADHD treatment use. METHOD Families of children with ADHD from four pediatric clinics were invited to participate in a two-stage intervention. The first step was an assessment battery to assess functioning and identify goals, followed by an in-office engagement session run by primary care staff. RESULTS Of the 636 invited families, 184 (28.9%) completed ratings, with 95 (51%) families completing the engagement session. ADHD office visits varied based on the number of steps completed (0-2). ADHD prescriptions decreased over time in families completing neither step but increased for children previously unmedicated whose parents completed either step. Families completing both steps had the highest rates of nonmedication ADHD treatments. DISCUSSION A brief two-step engagement intervention was associated with increased uptake of ADHD treatments.
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Sibley MH, Graziano PA, Coxe SJ, Bickman L, Martin P, Flores S. A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity. Behav Ther 2023; 54:839-851. [PMID: 37597961 PMCID: PMC10440417 DOI: 10.1016/j.beth.2023.03.001] [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: 06/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19-.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.
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Affiliation(s)
- Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute.
| | | | | | - Leonard Bickman
- Center for Children & Families, Florida International University
| | | | - Sabrina Flores
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
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23
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Geiss L, Stemmler M, Beck B, Hillemacher T, Widder M, Hösl KM. Dysregulation of the autonomic nervous system in adult attention deficit hyperactivity disorder. A systematic review. Cogn Neuropsychiatry 2023; 28:285-306. [PMID: 37702351 DOI: 10.1080/13546805.2023.2255336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/07/2023] [Indexed: 09/14/2023]
Abstract
Background: Adult Attention Deficit Hyperactivity Disorder (aADHD) is characterised by inattention, hyperactivity, impulsivity, and emotional instability, all of which were linked to altered modulation of the autonomic nervous system. This and the clinical effectiveness of sympathomimetic medication raised the question if autonomic modulation is altered in aADHD patients.Methods: We systematically searched PubMed, Cochrane Library, and Web Of Science for publications investigating autonomic modulation in aADHD and controls during resting-state and/or under task conditions.Results: We reviewed 15 studies involving 846 participants (424 aADHD and 422 controls), including 4 studies on sympathetic tone at rest, 13 studies on sympathetic modulation during tasks, 3 studies on resting state parasympathetic modulation and 3 papers on task-related parasympathetic modulation. Studies comprised measurements of electrodermal activity, heart rate variability, blood pressure variability, blood volume pulse, pre-ejection period, and baroreflex sensitivity. 2 studies reported reduced sympathetic tone in aADHD; 7 papers described lower sympathetic reactivity to task demands in this cohort. One study linked aADHD to impaired vagal tone, while no indications of altered tasks-related parasympathetic reactivity in aADHD patients were reported.Conclusion: The reviewed data revealed impaired cardiovascular autonomic modulation in aADHD patients, predominantly in sympathetic modulation and during stress exposure.
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Affiliation(s)
- Lennard Geiss
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Mark Stemmler
- Department of Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Beate Beck
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael Widder
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
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Checa-Ros A, Muñoz-Hoyos A, Molina-Carballo A, Viejo-Boyano I, Chacín M, Bermúdez V, D'Marco L. Low Doses of Melatonin to Improve Sleep in Children with ADHD: An Open-Label Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1121. [PMID: 37508618 PMCID: PMC10378280 DOI: 10.3390/children10071121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Only a few studies assessing the sleep effects of low doses of melatonin (aMT) have been performed in the past, most of them in adults, and only one in subjects with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to provide evidence of the changes induced by aMT doses as low as 1 mg in the sleep pattern of pediatric patients with ADHD under treatment with methylphenidate (MPH). METHODS Children and adolescents (7-15 years) with ADHD who were receiving extended-release MPH were recruited. A seven-week sleep diary was collected prior to starting a four-week treatment with 1 mg of aMT (30 min before bedtime). Seven-day actigraphic assessments of sleep were performed before and after treatment. RESULTS Twenty-seven patients (17 males, 62.96%) participated in the study, who had been receiving MPH for 1.57 (1.11) months. A significant increase in sleep duration (TST) was observed after one month of treatment (463 (49) min to 485 (41) min; p < 0.040), with nonsignificant improvements in sleep-onset latency (SOL), nocturnal awakenings, or sleep efficiency. Only minor adverse effects were reported. CONCLUSION Low doses of melatonin (1 mg) are able to increase TST in children and adolescents with ADHD receiving treatment with psychostimulants, with an adequate tolerability profile. Further placebo-controlled trials adjusting the time of aMT administration to the individual circadian profile should explore the effects of low doses of this hormone to shorten SOL in this population of patients.
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Affiliation(s)
- Ana Checa-Ros
- Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
- Aston Institute of Health & Neurodevelopment, School of Life & Health Sciences, Aston University, The Aston Triangle, Birmingham B4 7ET, UK
| | - Antonio Muñoz-Hoyos
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Avda. De La Investigación 11, 18016 Granada, Spain
| | - Antonio Molina-Carballo
- Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Avda. De La Investigación 11, 18016 Granada, Spain
| | - Iris Viejo-Boyano
- Departamento de Nefrología, Hospital Universitari I Politècnic La Fe, Avda. Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Maricarmen Chacín
- Facultad de Ciencias de la Salud. Barranquilla, Universidad Simón Bolívar, Barranquilla 080002, Colombia
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud. Barranquilla, Universidad Simón Bolívar, Barranquilla 080002, Colombia
| | - Luis D'Marco
- Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
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Frisch C, Tirosh E, Rosenblum S. Children with ADHD Symptomatology: Does POET Improve Their Daily Routine Management? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1083. [PMID: 37371314 DOI: 10.3390/children10061083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) struggle with executive delays while managing their daily tasks. This is a secondary analysis of existing data from open-label research examining the efficacy of Parental Occupational Executive Training (POET). It further examines POET's efficacy in increasing young children's (3.83 to 7.08 years) executive control over daily routines, and in decreasing their ADHD symptoms. Additionally, the second analysis investigates which of the children's increased capabilities is better associated with the change in their daily routine management following the intervention. Parents of children with ADHD symptomatology (N = 72, 55 boys) received eight POET sessions. They completed standardised ADHD symptomatology, executive management of daily routines, and executive functions (EF) questionnaires at pretest, post-test, and 3-month follow-up. Children's ADHD symptoms and their management of daily routines significantly improved following the POET intervention. The children's score changes in EF accounted for 37% of the variance in their improved routine management. These findings suggest that interventions aiming to increase children's executive control over their daily routines should improve their broader array of EF besides decreasing core ADHD symptoms.
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Affiliation(s)
- Carmit Frisch
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Emanuel Tirosh
- The Hannah Khoushy Child Development Center, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 69094, Israel
| | - Sara Rosenblum
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
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Kerson C, Lubar J, deBeus R, Pan X, Rice R, Allen T, Yazbeck M, Sah S, Dhawan Y, Zong W, Roley-Roberts ME, Arnold LE. EEG Connectivity in ADHD Compared to a Normative Database: A Cohort Analysis of 120 Subjects from the ICAN Study. Appl Psychophysiol Biofeedback 2023; 48:191-206. [PMID: 36469170 DOI: 10.1007/s10484-022-09569-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
This study explores how EEG connectivity measures in children with ADHD ages 7-10 (n = 140) differ from an age-matched nonclinical database. We differentiated connectivity in networks, Brodmann area pairs, and frequencies. Subjects were in the International Collaborative ADHD Neurofeedback study, which explored neurofeedback for ADHD. Inclusion criteria were mainly rigorously diagnosed ADHD and a theta/beta power ratio (TBR) ≤ 4.5. Using statistical and machine learning algorithms, connectivity values were extracted in coherence, phase, and lag coherence at all Brodmann, subcortical, and cerebellar areas within the main networks in all EEG frequencies and then compared with a normative database. There is a higher rate of dysregulation (more than ± 1.97SD), in some cases as much as 75%, of the Brodmann pairs observed in coherence and phase between BAs 7, 10, and 11 with secondary connections from these areas to BAs 21, 30, 35, 37, 39, and 40 in the ADHD children as compared to the normative database. Left and right Brodmann areas 10 and 11 are highly disconnected to each other. The most dysregulated Brodmann Areas in ADHD are 7, 10, and 11, relevant to ADHD executive-function deficits and provide important considerations when developing interventions for ADHD children.
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Affiliation(s)
- Cynthia Kerson
- Department of Applied Psychophysiology, Saybrook University, Pasadena, USA.
- APEd (Applied Psychophysiology Education), Napa, USA.
| | - Joel Lubar
- Southeastern Neurofeedback Institute, Pompano Beach, Florida, USA
| | - Roger deBeus
- University of North Carolina at Asheville, Asheville, NC, USA
| | - Xueliang Pan
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, Columbus, USA
| | - Robert Rice
- Department of Psychiatry and Behavioral Health, Ohio State University, Nisonger Center, Columbus, USA
| | - Theodore Allen
- Integrated Systems Engineering, The Ohio State University, Columbus, USA
| | - Maha Yazbeck
- Integrated Systems Engineering, The Ohio State University, Columbus, USA
| | - Shlok Sah
- Department of Computer Science and Engineering, Ohio State University, Columbus, USA
| | - Yajat Dhawan
- Department of Computer Science and Engineering, Ohio State University, Columbus, USA
| | - Wei Zong
- Department of Computer Science and Engineering, Ohio State University, Columbus, USA
| | | | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Nisonger Center, Columbus, USA
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Türk S, Korfmacher AK, Gerger H, van der Oord S, Christiansen H. Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis. Clin Psychol Rev 2023; 102:102271. [PMID: 37030086 DOI: 10.1016/j.cpr.2023.102271] [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: 07/08/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
There are several meta-analyses of treatment effects for children and adolescents with attention deficit hyperactivity disorder (ADHD). The conclusions of these meta-analyses vary considerably. Our aim was to synthesize the latest evidence of the effectiveness of psychological, pharmacological treatment options and their combination in a systematic overview and meta-meta-analyses. A systematic literature search until July 2022 to identify meta-analyses investigating effects of treatments for children and adolescents with ADHD and ADHD symptom severity as primary outcome (parent and teacher rated) yielded 16 meta-analyses for quantitative analyses. Meta-meta-analyses of pre-post data showed significant effects for pharmacological treatment options for parent (SMD = 0.67, 95% CI 0.60 to 0.74) and teacher ADHD symptom ratings (SMD = 0.68, 95% CI 0.54 to 0.82) as well as for psychological interventions for parent (SMD = 0.42, 95% CI 0.33 to 0.51) and teacher rated symptoms (SMD = 0.25, 95% CI 0.12 to 0.38). We were unable to calculate effect sizes for combined treatments due to the lack of meta-analyses. Our analyses revealed that there is a lack of research on combined treatments and for therapy options for adolescents. Finally, future research efforts should adhere to scientific standards as this allows comparison of effects across meta-analyses.
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Affiliation(s)
- Selina Türk
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Ann-Kathrin Korfmacher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Heike Gerger
- Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, Netherlands
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Sibley MH, Bruton AM, Zhao X, Johnstone JM, Mitchell J, Hatsu I, Arnold LE, Basu HH, Levy L, Vyas P, Macphee F, Gonzalez ES, Kelley M, Jusko ML, Bolden CR, Zulauf-McCurdy C, Manzano M, Torres G. Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:415-428. [PMID: 36907194 PMCID: PMC10370370 DOI: 10.1016/s2352-4642(22)00381-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 03/11/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Alisha M Bruton
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA
| | - Xin Zhao
- Department of Medicine, University of California-Irvine, Irvine, CA, USA
| | | | - John Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Irene Hatsu
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Hana H Basu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Laura Levy
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Pooja Vyas
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Fiona Macphee
- Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Erin Schoenfelder Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Megan Kelley
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Morgan L Jusko
- Department of Psychology, Florida International University, Miami, FL, USA
| | - China R Bolden
- Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Courtney Zulauf-McCurdy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Maychelle Manzano
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Gabriela Torres
- Department of Psychology, Florida International University, Miami, FL, USA
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Joseph HM, Lorenzo NE, Fisher N, Novick DR, Gibson C, Rothenberger SD, Foust JE, Chronis-Tuscano A. Research Review: A systematic review and meta-analysis of infant and toddler temperament as predictors of childhood attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 2023; 64:715-735. [PMID: 36599815 PMCID: PMC10404471 DOI: 10.1111/jcpp.13753] [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] [Accepted: 11/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset as early as preschool and impairment across the lifespan. Temperament factors, specifically those that theoretically map onto ADHD symptoms, may be early markers of risk for developing later childhood ADHD that could be identifiable in infancy or toddlerhood. This meta-analysis examined the associations between these early temperamental factors and later symptoms and diagnosis of ADHD and mapped early temperament constructs onto the three ADHD symptom dimensions. METHODS A systemic review of the literature was conducted to identify prospective longitudinal studies that included theoretically relevant temperament constructs (sustained attention, activity level, inhibition, and negative emotionality) examined from birth to 36 months old and ADHD (symptoms or diagnosis) in preschool or childhood. The association between each temperament construct and ADHD outcomes was examined using pooled standardized estimates in meta-analyses. RESULTS Forty-eight articles (n = 112,716 infants/toddlers) prospectively examined temperament and the relation to childhood ADHD symptoms or diagnosis. Activity level (k = 18) in infancy and toddlerhood was moderately associated with childhood ADHD (r = .39, CI = 0.27, 0.51, p < .001). Moderate effect sizes were also observed for sustained attention (k = 9; r = -.28, CI = -0.42, -0.12, p < .001) and negative emotionality (k = 33; r = .25, CI = 0.16, 0.34, p < .001) with ADHD. The specificity of each temperament construct for later ADHD symptom dimensions was such that activity level and negative emotionality were predictive of all three symptom dimensions (i.e., inattention, hyperactivity/impulsivity, and combined), whereas sustained attention was only associated with combined symptoms. CONCLUSIONS Infant and toddler temperament is an early risk factor for the development of childhood ADHD that could be utilized for early intervention identification. Yet, this systematic review found that relatively few prospective longitudinal studies have examined sustained attention (k = 9) and inhibition (k = 15) in infancy and toddlerhood in relation to later ADHD highlighting the need for further research.
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Affiliation(s)
| | - Nicole E. Lorenzo
- Department of Psychology, University of Maryland, MD
- Department of Psychology, American University, Washington, DC
| | - Nadiyah Fisher
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA
| | | | - Cassandra Gibson
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Jill E Foust
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA
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30
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Storebø OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling Rasmussen P, Huus CML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2023; 3:CD009885. [PMID: 36971690 PMCID: PMC10042435 DOI: 10.1002/14651858.cd009885.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
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Affiliation(s)
- Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Maria Skoog
- Clinical Study Support, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Camilla Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Morris Zwi
- Islington Child and Adolescent Mental Health Service, Whittington Health, London, UK
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Erik Simonsen
- Research Unit, Mental Health services, Region Zealand Psychiatry, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Kopp S, Asztély KS, Landberg S, Waern M, Bergman S, Gillberg C. Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation. J Atten Disord 2023; 27:830-846. [PMID: 36915033 DOI: 10.1177/10870547231158751] [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] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood. METHODS Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed. RESULTS At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women. CONCLUSION Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.
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Affiliation(s)
- Svenny Kopp
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | | | - Sara Landberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Margda Waern
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Stefan Bergman
- University of Gothenburg Institute of Medicine, Göteborg, VG Region, Sweden
| | - Christopher Gillberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
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ADHD Follow-Up in Adulthood among Subjects Treated for the Disorder in a Child and Adolescent Mental Health Service from 1995 to 2015. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020338. [PMID: 36837537 PMCID: PMC9966311 DOI: 10.3390/medicina59020338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0) and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions. Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments.
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33
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Vergunst F, Commisso M, Geoffroy MC, Temcheff C, Poirier M, Park J, Vitaro F, Tremblay R, Côté S, Orri M. Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes. JAMA Netw Open 2023; 6:e2249568. [PMID: 36622675 PMCID: PMC9856729 DOI: 10.1001/jamanetworkopen.2022.49568] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Little is known about the long-term economic and social outcomes for children with longitudinally assessed comorbid externalizing and internalizing symptoms, especially compared with children with externalizing symptoms or internalizing symptoms only. OBJECTIVE To examine the association between childhood trajectories of externalizing, internalizing, and comorbid symptoms and long-term economic and social outcomes. DESIGN, SETTING, AND PARTICIPANTS A 32-year prospective cohort study linked with administrative data was conducted in school-aged participants aged 6 to 12 years in the Québec Longitudinal Study of Kindergarten Children (N = 3017) followed up from 1985 to 2017. Data analysis was conducted between August 1, 2021, and March 31, 2022. EXPOSURES Teacher-rated behavioral symptoms were used to categorize children from age 6 to 12 years into developmental profiles using group-based trajectory modeling. MAIN OUTCOMES AND MEASURES Multivariable regression models were used to test the association between childhood symptom profile group and adult employment earnings, welfare receipt, intimate partnership status, and having children living in the household. Participant sex, IQ, and socioeconomic background were adjusted for. RESULTS Of 3017 participants in this sample, 1594 (52.8%) were male and 1423 (47.2%) were female. Per confidentiality rules established by Statistics Canada, income variables were rounded to base 100 and count variables were rounded to base 10; the mean (SD) age was 37 (0.29) years at follow-up. Four symptom profiles were identified: no/low (n = 1369 [45.4%]), high externalizing (882 [29.2%]), high internalizing (354 [11.7%]), and comorbid (412 [13.7%]) symptoms. Compared with the no/low symptom profile, participants in the high externalizing-only profile earned $5904 (95% CI, -$7988 to -$3821) less per year and had 2.0 (95% CI, 1.58-2.53) times higher incidence of welfare receipt, while participants in the high internalizing group earned $8473 (95% CI, -$11 228 to -$5717) less per year, had a 2.07 (95% CI, 1.51-2.83) higher incidence of welfare receipt, and had a lower incidence of intimate partnership (incident rate ratio [IRR], 0.89; 95% CI, 0.80-0.99). Participants in the comorbid profile fared especially poorly: they earned $15 031 (95% CI, -$18 030 to -$12 031) less per year, had a 3.79 (95% CI, 2.75-5.23) times higher incidence of annual welfare receipt, and were less likely to have an intimate partner (IRR, 0.71; 95% CI, 0.63-0.79) and children living in the household (IRR, 0.86; 95% CI, 0.80-0.92). Estimated lost earnings over a 40-year working career were $140 515 for the high externalizing, $201 657 for the high internalizing, and $357 737 for the comorbid profiles. CONCLUSIONS AND RELEVANCE In this cohort study, children exhibiting sustained childhood high externalizing, high internalizing, or comorbid symptoms were at increased risk of poor economic and social outcomes into middle age. These findings suggest that children exhibiting comorbid problems were especially vulnerable and that early detection and support are indicated.
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Affiliation(s)
- Francis Vergunst
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
| | - Melissa Commisso
- Department of Psychology, Concordia University, Montreal, Québec, Canada
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
| | - Caroline Temcheff
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
| | - Martine Poirier
- Department of Education, University of Rimouski, Rimouski, Québec, Canada
| | | | - Frank Vitaro
- Department of Psychoeducation, University of Montreal, Montreal, Québec, Canada
| | - Richard Tremblay
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | - Sylvana Côté
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Massimilliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, Montreal, Québec, Canada
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Voetterl H, van Wingen G, Michelini G, Griffiths KR, Gordon E, DeBeus R, Korgaonkar MS, Loo SK, Palmer D, Breteler R, Denys D, Arnold LE, du Jour P, van Ruth R, Jansen J, van Dijk H, Arns M. Brainmarker-I Differentially Predicts Remission to Various Attention-Deficit/Hyperactivity Disorder Treatments: A Discovery, Transfer, and Blinded Validation Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:52-60. [PMID: 35240343 DOI: 10.1016/j.bpsc.2022.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder is characterized by neurobiological heterogeneity, possibly explaining why not all patients benefit from a given treatment. As a means to select the right treatment (stratification), biomarkers may aid in personalizing treatment prescription, thereby increasing remission rates. METHODS The biomarker in this study was developed in a heterogeneous clinical sample (N = 4249) and first applied to two large transfer datasets, a priori stratifying young males (<18 years) with a higher individual alpha peak frequency (iAPF) to methylphenidate (N = 336) and those with a lower iAPF to multimodal neurofeedback complemented with sleep coaching (N = 136). Blinded, out-of-sample validations were conducted in two independent samples. In addition, the association between iAPF and response to guanfacine and atomoxetine was explored. RESULTS Retrospective stratification in the transfer datasets resulted in a predicted gain in normalized remission of 17% to 30%. Blinded out-of-sample validations for methylphenidate (n = 41) and multimodal neurofeedback (n = 71) corroborated these findings, yielding a predicted gain in stratified normalized remission of 36% and 29%, respectively. CONCLUSIONS This study introduces a clinically interpretable and actionable biomarker based on the iAPF assessed during resting-state electroencephalography. Our findings suggest that acknowledging neurobiological heterogeneity can inform stratification of patients to their individual best treatment and enhance remission rates.
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Affiliation(s)
- Helena Voetterl
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Giorgia Michelini
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, California; Department of Biological & Experimental Psychology, Queen Mary University of London, London, United Kingdom
| | - Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Roger DeBeus
- Department of Psychology, University of North Carolina at Asheville, Asheville, North Carolina
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra K Loo
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, California
| | | | - Rien Breteler
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L Eugene Arnold
- Department of Psychiatry & Behavioral Health, Nisonger Center, Ohio State University, Columbus, Ohio
| | | | | | - Jeanine Jansen
- Open Mind Neuroscience, Eindhoven, the Netherlands; Eindhovens Psychologisch Instituut, Eindhoven, the Netherlands
| | - Hanneke van Dijk
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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Teicher MH, Bolger E, Hafezi P, Garcia LCH, McGreenery CE, Weiser L, Ohashi K, Khan A. Open assessment of the therapeutic and rate-dependent effects of brain balance center® and interactive metronome® exercises on children with attention deficit hyperactivity disorder. Psychiatry Res 2023; 319:114973. [PMID: 36446221 DOI: 10.1016/j.psychres.2022.114973] [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] [Received: 12/31/2021] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022]
Abstract
The aim of this open study was to delineate domains of benefit and effect size measures to design an appropriately powered randomized control trial to assess the efficacy of Brain Balance@ exercises and Interactive Metronome@ training (BB/IM) on ADHD symptoms in children. Participants underwent an extensive 15-week, 5 time per week, at-home training program. Results were assessed in 16 youths with ADHD (14M/2F, 10.8±1.7 years) who completed the program and compared to 8 typically developing controls (4M/F4, 11.0±1.8 years). BB/IM was associated with a significant reduction of 8.3 and 8.2 points on the Conner's Parent Rating Scale - Revised and the ADHD Rating Scale - IV. BB/IM was not associated with improvement on the Quotient ADHD System but with rate-dependent effects on hyperactivity and attention that were similar to previously reported effects of low dose methylphenidate. Both therapeutic and rate-dependent effects were observed on the Tower of London. The study provides information that could be used to design a randomized control trial, which is required for proof of efficacy. A key limitation is that 59% of the 39 enrolled participants with ADHD dropped out of the study and a new study should include multiple ratings during the course of treatment.
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Affiliation(s)
- Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States.
| | - Elizabeth Bolger
- Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Poopak Hafezi
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Laura C Hernandez Garcia
- Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Cynthia E McGreenery
- Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Leslie Weiser
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Kyoko Ohashi
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Alaptagin Khan
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Developmental Biopsychiatry Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
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36
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Lam SL, Criaud M, Lukito S, Westwood SJ, Agbedjro D, Kowalczyk OS, Curran S, Barret N, Abbott C, Liang H, Simonoff E, Barker GJ, Giampietro V, Rubia K. Double-Blind, Sham-Controlled Randomized Trial Testing the Efficacy of fMRI Neurofeedback on Clinical and Cognitive Measures in Children With ADHD. Am J Psychiatry 2022; 179:947-958. [PMID: 36349428 PMCID: PMC7614456 DOI: 10.1176/appi.ajp.21100999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Functional MRI neurofeedback (fMRI-NF) could potentially be a novel, safe nonpharmacological treatment for attention deficit hyperactivity disorder (ADHD). A proof-of-concept randomized controlled trial of fMRI-NF of the right inferior frontal cortex (rIFC), compared to an active control condition, showed promising improvement of ADHD symptoms (albeit in both groups) and in brain function. However, comparison with a placebo condition in a larger trial is required to test efficacy. METHODS This double-blind, sham-controlled randomized controlled trial tested the effectiveness and efficacy of fMRI-NF of the rIFC on symptoms and executive functions in 88 boys with ADHD (44 each in the active and sham arms). To investigate treatment-related changes, groups were compared at the posttreatment and 6-month follow-up assessments, controlling for baseline scores, age, and medication status. The primary outcome measure was posttreatment score on the ADHD Rating Scale (ADHD-RS). RESULTS No significant group differences were found on the ADHD-RS. Both groups showed similar decreases in other clinical and cognitive measures, except for a significantly greater decrease in irritability and improvement in motor inhibition in sham relative to active fMRI-NF at the posttreatment assessment, covarying for baseline. There were no significant side effects or adverse events. The active relative to the sham fMRI-NF group showed enhanced activation in rIFC and other frontal and temporo-occipital-cerebellar self-regulation areas. However, there was no progressive rIFC upregulation, correlation with ADHD-RS scores, or transfer of learning. CONCLUSIONS Contrary to the hypothesis, the study findings do not suggest that fMRI-NF of the rIFC is effective in improving clinical symptoms or cognition in boys with ADHD.
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Affiliation(s)
- Sheut-Ling Lam
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Marion Criaud
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Samuel J Westwood
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Deborah Agbedjro
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Olivia S Kowalczyk
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Sarah Curran
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Nadia Barret
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Chris Abbott
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Holan Liang
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Gareth J Barker
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Vincent Giampietro
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry (Lam, Criaud, Lukito, Westwood, Simonoff, Rubia), Department of Neuroimaging (Kowalczyk, Barker, Giampietro), and Department of Biostatistics (Agbedjro), King's College London; Institute for Globally Distributed Open Research and Education (Criaud); Institute of Human Sciences, University of Wolverhampton, Wolverhampton, U.K. (Westwood); Department of Psychology, School of Social Science, University of Westminster, London (Westwood); Southwest London and St George's Mental Health NHS Trust, London (Curran); South London and Maudsley NHS Foundation Trust, London (Barret, Abbott); Great Ormond Street Hospital for Children NHS Foundation Trust, London (Liang); Department of Child and Adolescent Psychiatry, Technical University Dresden, Germany (Rubia)
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Rihal V, Khan H, Kaur A, Singh TG, Abdel-Daim MM. Therapeutic and mechanistic intervention of vitamin D in neuropsychiatric disorders. Psychiatry Res 2022; 317:114782. [PMID: 36049434 DOI: 10.1016/j.psychres.2022.114782] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022]
Abstract
Vitamin D deficiency is believed to affect between 35 and 55% of the world's population, making it a hidden pandemic. In addition to its role in bone and calcium homeostasis, vitamin D has also been linked in preclinical and clinical research to brain function. These outcomes have also been used for a variety of neuropsychiatric and neurodevelopmental problems. Nevertheless, these individuals are more prone to develop signs of cognitive decline. This review will emphasize the association between vitamin D and neuropsychiatric illnesses such as autism, schizophrenia, depression, and Attention Deficit Hyperactivity Disorder (ADHD). While numerous research show vitamin D's essential role in cognitive function in neuropsychiatric illnesses, it is too early to propose its effect on cognitive symptoms with certainty. It is necessary to conduct additional research into the associations between vitamin D deficiency and cognitive abnormalities, particularly those found in autism, schizophrenia, depression, and ADHD, to develop initiatives that address the pressing need for novel and effective preventative therapeutic strategies.
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Affiliation(s)
- Vivek Rihal
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Heena Khan
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Amarjot Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | | | - Mohamed M Abdel-Daim
- Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box 6231 Jeddah 21442, Saudi Arabia; Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
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38
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Kerr-German A, White SF, Santosa H, Buss AT, Doucet GE. Assessing the relationship between maternal risk for attention deficit hyperactivity disorder and functional connectivity in their biological toddlers. Eur Psychiatry 2022; 65:e66. [PMID: 36226356 PMCID: PMC9641653 DOI: 10.1192/j.eurpsy.2022.2325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with increased risk for poor educational attainment and compromised social integration. Currently, clinical diagnosis rarely occurs before school-age, despite behavioral signs of ADHD in very early childhood. There is no known brain biomarker for ADHD risk in children ages 2-3 years-old. METHODS The current study aimed to investigate the functional connectivity (FC) associated with ADHD risk in 70 children aged 2.5 and 3.5 years via functional near-infrared spectroscopy (fNIRS) in bilateral frontal and parietal cortices; regions involved in attentional and goal-directed cognition. Children were instructed to passively watch videos for approximately 5 min. Risk for ADHD in each child was assessed via maternal symptoms of ADHD, and brain data was evaluated for FC. RESULTS Higher risk for maternal ADHD was associated with lower FC in a left-sided parieto-frontal network. Further, the interaction between sex and risk for ADHD was significant, where FC reduction in a widespread bilateral parieto-frontal network was associated with higher risk in male, but not female, participants. CONCLUSIONS These findings suggest functional organization differences in the parietal-frontal network in toddlers at risk for ADHD; potentially advancing the understanding of the neural mechanisms underlying the development of ADHD.
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Affiliation(s)
- Anastasia Kerr-German
- Boys Town National Research Hospital, Center for Childhood Deafness, Language and Learning, Omaha, Nebraska68131, USA,Author for correspondence: Anastasia Kerr-German, E-mail:
| | - Stuart F. White
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska68010, USA,Department of Pharmacology and Neuroscience, Creighton School of Medicine, Omaha, Nebraska68124, USA
| | - Hendrik Santosa
- Department of Radiology, University of Pittsburg, Pittsburg, Pennsylvania15260, USA
| | - Aaron T. Buss
- Department of Psychology, University of Tennessee, Knoxville, Tennessee37996, USA
| | - Gaelle E. Doucet
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska68010, USA,Department of Pharmacology and Neuroscience, Creighton School of Medicine, Omaha, Nebraska68124, USA
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39
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Dixon JF, Akins R, Miller E, Breslau J, Gill S, Bisi E, Schweitzer JB. Changing Parental Knowledge and Treatment Acceptance for ADHD: A Pilot Study. Clin Pediatr (Phila) 2022; 62:301-308. [PMID: 36171719 PMCID: PMC10108330 DOI: 10.1177/00099228221124676] [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] [Indexed: 11/16/2022]
Abstract
This pilot study assessed the feasibility and potential effectiveness of a single-session workshop in modifying parental beliefs/knowledge about attention-deficit/hyperactivity disorder (ADHD) in children and impact on treatment acceptance/utilization. Concerns raised by school professionals about lack of treatment follow-through after ADHD diagnosis and parental misinformation about medication usage catalyzed this project. A single-group pre-post quasi-experimental design was used. Sixty-eight parents completed ADHD knowledge/belief scales and stress inventories, and pre-ADHD and post-ADHD information workshop. Follow-up calls were made after the workshop to assess treatment utilization. Parents/caregivers experienced significant knowledge and belief changes regarding medication efficacy, willingness to accept physician treatment recommendations, and rejection of non-empirically based treatments. Follow-up data showed that 41% of contacted participants met with physicians to discuss medication utilization and behavioral treatments. Brief, one-session psycho-educational workshops were feasible and impacted parental beliefs and behaviors regarding scientifically supported interventions for ADHD.
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Affiliation(s)
- J F Dixon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - R Akins
- UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA.,Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - E Miller
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Breslau
- Rand Corporation, Pittsburgh, PA, USA
| | - S Gill
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,Palo Alto University, Palo Alto, CA, USA
| | - E Bisi
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - J B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA.,UC Davis MIND Institute, School of Medicine, University of California, Davis, Sacramento, CA, USA
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40
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Arnett AB, McGrath LM, Flaherty BP, Pennington BF, Willcutt E. Heritability and Clinical Characteristics of Neuropsychological Profiles in Youth With and Without Elevated ADHD Symptoms. J Atten Disord 2022; 26:1422-1436. [PMID: 35102766 PMCID: PMC9283222 DOI: 10.1177/10870547221075842] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In the last decade, there has been an increase in research that aims to parse heterogeneity in attention deficit hyperactivity disorder (ADHD). The current study tests heritability of latent class neuropsychological subtypes. METHOD Latent class analysis was used to derive subtypes in a sample of school-age twins (N = 2,564) enriched for elevated ADHD symptoms. RESULTS Five neuropsychological profiles replicated across twin 1 and twin 2 datasets. Latent class membership was heritable overall, but heritability varied by profile and was lower than heritability of ADHD status. Variability in neuropsychological performance across domains was the strongest predictor of elevated ADHD symptoms. Neuropsychological profiles showed distinct associations with age, psychiatric symptoms and reading ability. CONCLUSION Neuropsychological profiles are associated with unique neurocognitive presentations, but are not strong candidate endophenotypes for ADHD diagnosis.
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Affiliation(s)
- Anne B. Arnett
- Division of Developmental Medicine, Boston Children’s Hospital, Brookline, MA
| | | | | | | | - Erik Willcutt
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO
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41
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Schein J, Childress A, Adams J, Gagnon-Sanschagrin P, Maitland J, Qu W, Cloutier M, Guérin A. Treatment patterns among children and adolescents with attention-deficit/hyperactivity disorder in the United States - a retrospective claims analysis. BMC Psychiatry 2022; 22:555. [PMID: 35982469 PMCID: PMC9387015 DOI: 10.1186/s12888-022-04188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder affecting approximately 10.0% of children and 6.5% of adolescents in the United States (US). A comprehensive assessment of the current treatment landscape is warranted to highlight potential unmet needs of children and adolescents with ADHD. Therefore, this study described treatment patterns and healthcare costs among commercially insured children and adolescents with ADHD in the US. METHODS Children and adolescents with ADHD initiating pharmacological treatment indicated for ADHD were identified from IBM MarketScan Commercial Database (2014-2018). A treatment sequence algorithm was used to examine treatment patterns, including discontinuation (≥ 180 days following the last day of supply of any ADHD treatment), switch, add-on, and drop (discontinuation of an agent in combination therapy), during the 12-month study period following the index date (i.e., first observed ADHD treatment). Total adjusted annual healthcare costs were compared between patients with and without treatment changes. RESULTS Among 49,756 children and 29,093 adolescents included, mean age was 9 and 15 years, respectively, and 31% and 38% were female. As the first treatment regimen observed, 92% of both children and adolescents initiated a stimulant and 11% initiated combination therapy. Over half of the population had a treatment change over 12 months-59% of children and 68% of adolescents. Treatment discontinuation over 12 months was common in both populations-21% of children and 36% of adolescents discontinued treatment. Healthcare costs increased with the number of treatment changes observed; children and adolescents with treatment changes (i.e., 1, 2, or ≥ 3) incurred an incremental annual cost of up to $1,443 and $2,705, respectively, compared to those without a treatment change (p < 0.001). Costs were largely driven by outpatient visits. CONCLUSIONS Over a 12-month period, treatment changes were commonly observed and were associated with excess costs, highlighting the unmet treatment needs of children and adolescents with ADHD in the US.
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Affiliation(s)
- Jeff Schein
- grid.419943.20000 0004 0459 5953Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ 08540 USA
| | - Ann Childress
- grid.490030.eCenter for Psychiatry and Behavioral Medicine, Inc., 7351 Prairie Falcon Rd STE 160, Las Vegas, NV 89128 USA
| | - Julie Adams
- grid.419943.20000 0004 0459 5953Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ 08540 USA
| | - Patrick Gagnon-Sanschagrin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 4W5, Canada.
| | - Jessica Maitland
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 4W5 Canada
| | - Wendi Qu
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 4W5 Canada
| | - Martin Cloutier
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 4W5 Canada
| | - Annie Guérin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 4W5 Canada
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Real-World Crash Circumstances Among Newly Licensed Adolescent Drivers With and Without Attention-Deficit/Hyperactivity Disorder. J Adolesc Health 2022; 71:172-179. [PMID: 35430145 PMCID: PMC9742980 DOI: 10.1016/j.jadohealth.2022.02.008] [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] [Received: 08/16/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Adolescents with attention-deficit/hyperactivity disorder (ADHD) have 30%-40% higher crash rates. However, we still do not understand which factors underlie heightened crash risk and if crash circumstances differ for drivers with ADHD. We compared prevalences of crash responsibility, driver actions, and crash types among adolescent and young adult drivers with and without ADHD who crashed within 48 months of licensure. METHODS In this exploratory retrospective cohort study, we identified patients of Children's Hospital of Philadelphia's (CHOP) New Jersey (NJ) primary care locations who were born between 1987 and 2000, NJ residents, had their last CHOP visit ≥ age 12 years, and acquired a driver's license. We linked CHOP electronic health records to NJ's licensing and crash databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision, Clinical Modification codes. Prevalence ratios were estimated using generalized estimating equation log-binomial regression. RESULTS We identified 934 drivers with ADHD in 1,308 crashes and 5,158 drivers without ADHD in 6,676 crashes. Within 48 months postlicensure, drivers with ADHD were more likely to be at fault for their crash (prevalence ratio: 1.09 [1.05-1.14]) and noted as inattentive (1.15 [1.07-1.23]). With the exception that drivers with ADHD were less likely to crash while making a left/U-turn, we did not find substantial differences in crash types by diagnosis. Analyses also suggest females with ADHD may have a higher risk of colliding with a nonmotor vehicle and crashing due to unsafe speed than females without ADHD. DISCUSSION The results suggest crash circumstances do not widely differ for drivers with and without ADHD but highlight several factors that may be particularly challenging for young drivers with ADHD.
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Mindfulness as an Adjunct to Behavior Modification for Elementary-aged Children with ADHD. Res Child Adolesc Psychopathol 2022; 50:1573-1588. [DOI: 10.1007/s10802-022-00947-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
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44
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Nermend M, Flaga-Gieruszyńska K, Kroplewski Z, Nermend K. Neurological Mechanisms of Diagnosis and Therapy in School Children with ADHD in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137615. [PMID: 35805275 PMCID: PMC9265331 DOI: 10.3390/ijerph19137615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
The paper aims to present a holistic view of attention deficit hyperactivity disorder (ADHD) in pedagogical, psychological, legal, and social dimensions in Polish schools. The authors present the benefits of neurofeedback therapy for elementary school pupils. In order to verify the validity, the paper compares the concordance of a medical diagnosis confirming ADHD syndrome with the occurrence of abnormal electrical brain function recording and abnormalities therein as well as the effectiveness of the neurofeedback therapy. The study confirms that the reported problems faced by pupils and affecting their emotional functioning are reflected in their EEG records. Conclusions from the study lead to the proposal that the neurofeedback assessment should be performed at schools, which should result in the implementation of effective therapy. Moreover, the neurofeedback method should be promoted in Polish schools as an alternative to pharmacological therapy, which, as the research proves, is not always effective. Neurofeedback therapy, similarly to behavioral therapy, is very much needed and useful because it provides optimal conditions for the child’s development and shapes their relations with the environment effectively and harmlessly.
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Affiliation(s)
- Małgorzata Nermend
- Department of Early Education, University of Szczecin, 71-004 Szczecin, Poland;
| | - Kinga Flaga-Gieruszyńska
- Research Team on Civil Procedural Law and Informatization of the Justice, Faculty of Law and Administration, University of Szczecin, 71-101 Szczecin, Poland;
| | - Zdzisław Kroplewski
- Institute of Psychology, University of Szczecin, Krakowska 69, 71-017 Szczecin, Poland;
| | - Kesra Nermend
- Department of Decision Support Methods and Cognitive Neuroscience, Institute of Management, University of Szczecin, 71-004 Szczecin, Poland
- Correspondence:
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45
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Joseph HM, Lorenzo NE, Wang FL, Wilson MA, Molina BSG. The interaction between infant negative emotionality and cognition predicts ADHD-related behaviors in toddlerhood. Infant Behav Dev 2022; 68:101742. [PMID: 35749823 PMCID: PMC9447408 DOI: 10.1016/j.infbeh.2022.101742] [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: 02/01/2022] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 11/05/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder commonly identified in childhood. Affective and cognitive characteristics that are identifiable as early as infancy could be signals of risk for developing ADHD. Specifically, the interplay between emotionality and cognition may be important in predicting early symptoms of ADHD. This study examined the independent and interactive effects of infant negative emotionality and cognition on the development of inattention and hyperactivity/impulsivity in toddlerhood among infants at high and low familial likelihood for ADHD. Participants were 64 infants (M = 8.7, SD = 1.8) at high (n = 32) and low (n = 32) familial likelihood for ADHD, defined as at least one parent with ADHD or two parents without ADHD, respectively. Negative emotionality and cognition in infancy were assessed using the Infant Behavior Questionnaire and the Bayley's Scales of Infant and Toddler Development, and ADHD symptoms were assessed at toddler follow-up (M= 20.0, SD= 3.2) using the Child Behavior Checklist. Accounting for the quality of parent-child interaction, infants' negative emotionality (β = .033, p = .938) and cognition (β = .006, p = .884) did not independently predict toddlers' ADHD-related behaviors, but their interaction did (β = .110, p = .019). For infants with higher levels of cognition (>95th percentile), higher negative emotionality predicted more ADHD-related behaviorss. For infants with lower levels of cognition (<11th percentile), higher negative emotionality predicted fewer ADHD-related behaviors. There may be two affective-cognitive pathways to inattention and hyperactivity/impulsivity in toddlerhood. The combination of higher levels of negative emotionality and cognition may result in greater frustration when goals are blocked, resulting in the expression of dysregulated behaviors (i.e., ADHD symptoms). Alternatively, low levels of negative emotionality and cognition combined may lead to dysregulation that is primarily cognitive in nature (such as the inattention symptoms of ADHD). Investigating affective and cognitive processes simultaneously may be important for increasing understanding of the early signals of ADHD risk.
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Affiliation(s)
- Heather M Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Nicole E Lorenzo
- Department of Psychology, University of Maryland, MD, USA; Department of Psychology, American University, USA
| | - Frances L Wang
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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46
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Haugan ALJ, Sund AM, Young S, Thomsen PH, Lydersen S, Nøvik TS. Cognitive behavioural group therapy as addition to psychoeducation and pharmacological treatment for adolescents with ADHD symptoms and related impairments: a randomised controlled trial. BMC Psychiatry 2022; 22:375. [PMID: 35655149 PMCID: PMC9164353 DOI: 10.1186/s12888-022-04019-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/25/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is recommended for attention-deficit/hyperactivity-disorder (ADHD) in adolescents. However, all CBTs are not created equal, and the guidelines do not specify which CBT interventions are the most effective for this patient group. This study examines the efficacy of a group CBT without parent involvement as follow-up treatment compared to no additional CBT in adolescents with persistent and impairing ADHD symptoms after a short psychoeducational intervention and medical treatment. METHODS The authors conducted a two-arm parallel randomized controlled trial in two child and adolescent mental health outpatient clinics in Norway. One hundred patients aged 14-18 years with a diagnosis of ADHD (66%) or subthreshold ADHD (34%) were randomized to either a 12-week group CBT program (N = 50) or a non-CBT control condition (N = 50). Assessments were made at admission to the clinic, two weeks before and two weeks after treatment. The primary outcomes were parent-, teacher- and self-ratings of ADHD symptoms (ADHD Rating Scale-IV), and the secondary outcomes were ratings of ADHD symptom severity, executive function, functional impairment, and emotional problems. Evaluators blinded to group allocation rated ADHD symptom severity with the Clinical Global Impression Scale for Severity (CGI-S) at baseline and post-treatment. RESULTS Analyses using mixed-effects models showed no difference between the treatment arms from baseline to post treatment in primary and secondary outcomes. CONCLUSIONS Contrary to our hypothesis, we found no incremental treatment effect on the part of a group CBT as follow-up to psychoeducation and pharmacological treatment on ADHD symptoms and accompanying impairments. Limitations with the CBT was the large number and low dosage of treatment components, causing restricted time for practice. Unlike evidence-based, individualized targeted CBTs with parent involvement, a group CBT directed solely at the adolescents with no parent involvement does not appear effective for treating ADHD. TRIAL REGISTRATION NCT02937142 , 18/10/2016.
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Affiliation(s)
- Anne-Lise Juul Haugan
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anne Mari Sund
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Susan Young
- Psychology Services Limited, London, UK ,grid.9580.40000 0004 0643 5232Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Per Hove Thomsen
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway ,grid.154185.c0000 0004 0512 597XDepartment of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Stene Nøvik
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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47
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Di Lonardo Burr SM, LeFevre JA, Arnold LE, Epstein JN, Hinshaw SP, Molina BSG, Hechtman L, Hoza B, Jensen PS, Vitiello B, Pelham WE, Howard AL. Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories. Child Dev 2022; 93:e563-e580. [PMID: 35635061 DOI: 10.1111/cdev.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.
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Affiliation(s)
- Sabrina M Di Lonardo Burr
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada
| | - Jo-Anne LeFevre
- Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada.,Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA
| | - Jeffrey N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, California, USA
| | - Brooke S G Molina
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Peter S Jensen
- The REACH Institute, New York, New York, USA.,Department of Psychiatry, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - William E Pelham
- College of Arts, Sciences, and Education, Florida International University, Miami, Florida, USA
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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48
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Barriers and Facilitators to Teachers’ Use of Behavioral Classroom Interventions. SCHOOL MENTAL HEALTH 2022; 14:844-862. [PMID: 35669254 PMCID: PMC9135387 DOI: 10.1007/s12310-022-09524-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
Multi-tiered behavioral classroom interventions are particularly important for students with or at risk for ADHD or other externalizing behaviors. Teachers often use these interventions infrequently or not as designed, and little is known about the barriers and facilitators to their use, especially from the teachers’ perspective. Using an exploratory sequential approach, we first used semi-structured qualitative interviews to identify teacher-reported barriers and facilitators to using three Tier 1 and one Tier 2 behavioral classroom interventions with students with ADHD symptoms (Study 1). Then, we identified which barriers and facilitators were most frequently endorsed on a survey (Study 2). The types of barriers and facilitators that emerged from semi-structured interviews included teachers’ beliefs about behavioral classroom interventions (i.e., about their effectiveness or the consequences of using them) that motivated teachers or reduced their motivation to use them, as well as factors that interfered or assisted with execution in the moment. The most frequently endorsed barriers were being distracted or forgetting due to competing demands, and feeling “stressed, frustrated, or burned out;” frequently endorsed facilitators included having a strong student–teacher relationship and having built the habit of using the intervention. Together, these results identify specific, malleable factors that can be targeted when supporting teachers in using Tier 1 and Tier 2 behavioral classroom interventions for students with ADHD symptoms.
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49
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Singh LJ, Gaye F, Cole AM, Chan ES, Kofler MJ. Central executive training for ADHD: Effects on academic achievement, productivity, and success in the classroom. Neuropsychology 2022; 36:330-345. [PMID: 35343732 PMCID: PMC9035079 DOI: 10.1037/neu0000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Central executive training (CET) is a "Level 2" evidence-based treatment for improving ADHD-related executive dysfunction and behavioral symptoms, but the extent to which these gains extend to the disorder's well-documented academic difficulties is unknown. METHOD Across two clinical trials, 108 children with attention-deficit/hyperactivity disorder (ADHD) 8-13 years old (M = 10.29, SD = 1.50; 32 girls; 75% White/Non-Hispanic) were treated with CET (n = 52), inhibitory control training (ICT; n = 29), or gold-standard behavioral parent training (BPT; n = 27). RESULTS CET was superior to BPT and ICT (d = 0.62-0.88) for improving masked teacher perceptions of academic success, impulse control, and academic productivity at 1-2 months posttreatment. At 2-4-month follow-up, CET (d = 0.76) and ICT (d = 0.54) were superior to BPT for improving objectively-tested academic achievement overall (reading comprehension, math problem-solving, language comprehension), and CET was superior to ICT (d = 0.56) for improving math problem-solving. The significant benefits of CET on academic success, academic productivity, reading comprehension, and math problem-solving replicated across both trials and were clinically significant as evidenced by low number needed to treat estimates (Needed to Treat; NNT = 3-7) and significantly higher proportions of individual cases demonstrating reliable improvements in academic success/productivity (33%-36% vs. 0%-18%) and achievement (38%-72% vs. 18%-54%) across outcomes (all p ≤ .01). CONCLUSIONS Results across the two trials provide strong support for the efficacy of CET for ADHD, and are consistent with model-driven hypotheses that academic difficulties in ADHD are due, in part, to these children's underdeveloped executive functioning abilities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Fatou Gaye
- Florida State University, Department of
Psychology
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50
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Meyer J, Alaie I, Ramklint M, Isaksson J. Associated predictors of functional impairment among adolescents with ADHD-a cross-sectional study. Child Adolesc Psychiatry Ment Health 2022; 16:29. [PMID: 35382854 PMCID: PMC8985377 DOI: 10.1186/s13034-022-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of this study was to investigate the associations between ADHD and functional impairment, if they varied by sex, and the potential impact of comorbid psychiatric symptoms on the associations. METHODS This was a cross-sectional study including adolescents with ADHD (n = 164) and a reference group of adolescents without ADHD (n = 106). Self-ratings and parental ratings of functional impairment in different life domains were used as outcomes in all analyses. Differences between groups were investigated with comparative analyses. General linear models (GLMs) were used to explore associations between ADHD symptoms and functional impairment in adolescents with ADHD, while adjusting for of comorbid symptoms, sex, and medication. RESULTS Adolescents with ADHD displayed higher levels of functional impairment than peers without ADHD, and girls with ADHD rated higher impairment than their male counterparts. The combined ADHD presentation was associated with the highest levels of self-reported impairment, while parental ratings indicated comparable levels of overall impairment across presentations. In the adjusted GLMs, symptoms of inattention were strongly associated with self- and parent-rated impairment in school, but symptoms of hyperactivity/impulsivity were not, whereas symptoms of both inattention and hyperactivity/impulsivity were modestly associated with self-rated impairment with friends. Further, both emotional and conduct problems were associated with impairment in daily life. CONCLUSIONS Our results suggest that attention difficulties, in particular, seem to impair academic functioning in adolescents with ADHD, and interventions targeting such difficulties are warranted. In addition, comorbid symptoms need to be assessed and treated, and self-reports of functioning should be included in research and clinical practice involving adolescents.
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Affiliation(s)
- Jenny Meyer
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Uppsala, Sweden.
| | - Iman Alaie
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden
| | - Johan Isaksson
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institute Centre of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
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