Hyperkinetic disorders in seven-year-old children with perceptual, motor and attentional deficits

The importance of recognizing worthlessness for suicide prevention in adolescents with Attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric diagnoses among children and adolescents. Depression and general anxiety disorder (GAD) are often co-occurring with ADHD among children and adolescents. Previous studies have found that ADHD, depression and GAD are all strongly correlated with suicidal thoughts and planning.

AIM

The current study aimed to further explore the association between ADHD, GAD and depressive symptoms as well as their association with suicidal thoughts and planning among adolescents.

METHOD

Adolescents with ADHD diagnosis were involved from child psychiatry outpatient clinics and adolescents without a psychiatric treatment or diagnosis were enrolled from high schools in Hungary. The Mini International Neuropsychiatric Interview for Children and Adolescents was used to evaluate psychiatric symptoms and disorders as well as suicidal thoughts and planning. Regularized psychological networks were used to investigate the associations.

RESULTS

Altogether 185 adolescents (58 females and 127 males; mean age 14.79 years, SD = 1.48), 89 with ADHD and 96 without ADHD were enrolled. Depression symptom worthlessness was directly related to suicidal thoughts and planning, CI95 of the logit B between worthlessness and suicidal thought (0.72, 1.66). Both ADHD and anxiety were indirectly related to suicidal thoughts and planning through depression: CI95 of the logit B between being disorganized and feeling worthless is (0.38, 3.02), and CI95 of the logit B between being distressed and feeling worthless is (0.57, 2.52).

CONCLUSIONS

This study draws the attention of clinicians to the importance of recognizing "worthlessness" for suicide prevention in adolescents with ADHD. Furthermore, the results support previous studies, whereby symptoms of depression and anxiety mediate the relationship between ADHD and suicidal thoughts and planning. These results highlight the importance of ADHD comorbidities with depression and GAD and their effect on suicidal thoughts and planning.

Multi-disciplinary assessment of attention-deficit hyperactivity disorder: a tertiary assessment package

Aims and method

A tertiary assessment package was set up for the more equivocal cases of attention-deficit hyperactivity disorder (ADHD) who present with problems of inattention, impulsivity and overactivity. The structure of the three-day package was discussed, with an analysis of our experience in assessing 12 children using the pilot project. The package and Its use in clinical practice are presented.

Results

The pilot project described can be modified into a two-day package.

Clinical implications

Assessment of ADHD conducted in multiple settings inherently has many advantages over single clinic assessment. We suggest that such an assessment protocol can be conducted cost effectively.

Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

Evolution of neurologic features in Williams syndrome

As a part of a large multidisciplinary clinical and research follow-up study, 47 Williams syndrome patients underwent detailed neurologic testing. Because previous studies have documented the absence of major neurologic signs in Williams syndrome, the neurologic testing focused on soft signs. Previous findings of impairment of both gross and fine motor coordination were confirmed, and the presence of mild cerebellar and extrapyramidal signs was documented. In a 4-year follow-up study, an age-related pattern was revealed: soft extrapyramidal signs became more evident from 8 years of age and increased in the 14+ age group. The results are discussed according to a hypothesis related to the dopaminergic system involvement in Williams syndrome: anomalous organization or accelerated ageing process.

Transtorno do déficit de atenção e hiperatividade (TDAH): aspectos relacionados à comorbidade com distúrbios da atividade motora

A presente revisão aborda aspectos fisiopatológicos e clínicos referentes ao Transtorno do Déficit de Atenção com Hiperatividade (TDAH), em especial aqueles que concernem à associação desse transtorno com o Distúrbio do Desenvolvimento da Coordenação (DDC). Utilizou-se a base de dados Medline para levantamento de artigos indexados a partir de 1965 até 2004. Aos artigos selecionados dessa forma, outros foram obtidos pela relevância atribuída a eles nas fontes iniciais. A pré-disposição hereditária desse transtorno é indiscutível, bem como a presença da disfunção nora-drenégica e dopaminérgica no córtex pré-frontal e suas conexões. Apesar desse conhecimento, o diagnóstico da condição se baseia em dados clínicos. As associações mórbidas ocorrem em cerca de metade dos indivíduos, sendo as principais comorbidades de natureza psiquiátrica. A presença de uma comorbidade pode modificar a terapêutica e o prognóstico. O Distúrbio do Desenvolvimento da Coordenação, condição também de diagnostico clínico, confere pior prognóstico às crianças que partilham ambos os quadros. Recomenda-se que uma busca ativa de condições associadas seja realizada em cada criança diagnosticada como portadora de TDAH.

Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women

This paper provides a summary of the current conceptualization of what AD/HD is, and its etiology, and then reviews some of the recent literature on the correlates and lifecourse outcomes for individuals diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD). The intention is to synthesize that which is known, and to identify important gaps in the literature and knowledge base, which secondary analysis of prospective large-scale longitudinal cohorts, tracking individuals from birth to adulthood, could help to fill. This review highlights the fact that such datasets are rare and that their analysis offers important opportunities for advancing knowledge, particularly of the adult outcomes of childhood AD/HD.

Growth status, behavior and neuropsychological performance: a study of Brazilian school age children

AIM

To assess the association between child growth and teacher-reported behavior and academic standing, and neuropsychological performance.

METHOD

The heights of 344 public-school children were measured using standard procedures. Teachers were requested to complete two behavioral and one academic performance rating scales. Neuropsychological assessment consisted of the Edinburgh Handedness Inventory, the Steadiness Test and the Purdue Pegboard. Height-for-age z (HAZ) scores were calculated based on an international reference. Standard (z) scores for each factor of the first two behavioral rating scales and for each neuropsychological variable were computed for each child based on locally-derived norms.

RESULTS

HAZ scores were negatively correlated with factors related to hyperactivity, conduct problem, impulsivity and inattention of the behavioral rating scales. In addition, the lower the HAZ score the worse the academic performance.

CONCLUSION

These results add to the existing evidence indicating a strong association between growth status and child behavior and academic performance.

Psychopathology and substance abuse in parents of young children with attention-deficit/hyperactivity disorder

OBJECTIVE

To compare the prevalence of psychological disorders in parents of young children with and without attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behavior disorders (DBD).

METHOD

Subjects included 98 three- to seven-year-old children with DSM-IV ADHD (68 with ADHD and comorbid oppositional defiant or conduct disorder [ADHD+ODD/CD]) and 116 non-ADHD comparison children recruited in 1995-96 during the first wave of a longitudinal study. Biological mothers were administered interviews to assess ADHD and DBD in their children and mood, anxiety, and substance use disorders in themselves. In addition, they were queried about symptoms of childhood ADHD and DBD, and antisocial personality disorder in themselves and their children's biological fathers.

RESULTS

Child ADHD was associated with increased rates of maternal and paternal childhood ADHD relative to comparison children. Child ADHD+ODD/CD was associated with maternal mood disorders, anxiety disorders, and stimulant/cocaine dependence, and paternal childhood DBD. Mothers of children with ADHD+ODD/CD also reported increased drinking problems in their children's fathers.

CONCLUSIONS

These findings indicate that many young children with ADHD, particularly those with comorbid ODD/CD, require comprehensive services to address both their ADHD and the mental health needs of their parents.

An evaluation of a short questionnaire for parents about their school-aged children's global maturity level

The aim was to evaluate a questionnaire for parents concerning their school-aged children's global maturity level. Immature children (n = 29) as reported by their parents were compared to a control group (n = 68). Immaturity was linked to a reduced general knowledge, a childish body appearance, problems with the fine motor function and problems with peers. The index group also had on average a lower test result in total score of the Wechsler Intelligence Scale for Children and more commission errors in the Continuous Performance Test, both test results indicating a lower mental age.

Functional polymorphism within the promotor of the serotonin transporter gene is associated with severe hyperkinetic disorders

In children and adolescents, hyperkinetic disorder (HD) with conduct disorder (CD) and without CD and attention-deficit/hyperactivity disorder (ADHD) is known to be comorbid with psychiatric disorders (anxiety, depression, aggression), some of which are related to disturbed serotonergic neurotransmission. The efficiency of serotonergic signalling relates to the concentration of the neurotransmitter in the synaptic cleft and is controlled by the serotonin transporter (5-HTT), which selectively removes serotonin out of the synaptic cleft.(1)The activity of serotonin transport itself has been shown to be also controlled by a 5-HTT-linked polymorphism in its promotor region with a L/L genotype yielding higher levels of 5-HTT function than do L/S or S/S genotypes.(2) Considering an association between 5-HTT polymorphism, serotonergic neurotransmission and HD +/- CD, we genotyped for 5-HTT polymorphism and compared patients with controls. In contrast to the distribution of L/L: L/S: S/S in controls (0.245: 0.509: 0.245), we found an enhanced expression of the L/L genotype in HD patients with CD (0.393: 0.304: 0.304; chi(2) = 7.603; P = 0.0211) and a significant overexpression of L/L in HD without CD (0.542: 0.333: 0.125; chi(2) = 9.127; P = 0.0092). To our knowledge, this is the first finding providing evidence for an association between the 5-HTT polymorphism and hyperkinetic disorder, implying that serotonergic neurotransmission might be affected in this desease. As a consequence, for a successful treatment of these patients one should now also consider drugs which specifically modulate serotonergic signalling such as selective serotonin reuptake inhibitors.

The identification of pervasive hyperactivity: is clinic observation necessary?

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

The diagnosis and prevalence of hyperactivity in Chinese schoolboys

BACKGROUND

This study was undertaken to examine the validity of different diagnostic definitions of hyperactivity in a Chinese population. Estimates of the prevalence of hyperactivity were made according to these different diagnostic definitions.

METHOD

In a two-stage epidemiological study of hyperactivity in Hong Kong, 3069 Chinese schoolboys were screened by questionnaires; and a stratified sample of 611 of them entered a second stage for more detailed diagnostic assessment.

RESULTS

Children with hyperkinetic disorder (ICD-10) or ADDH (DSM-III) both displayed significant hyperactive symptoms, but with somewhat different external correlates; hyperkinetic disorder tended to show more neurodevelopmental impairments, ADDH more cognitive and educational difficulties. These findings raise the possibility of heterogeneity in the disorders present with hyperactivity. The DSM-III-R category of ADHD was more common, and those extra cases, that did not overlap with ADDH or hyperkinetic disorder, included children with no obvious behavioural, cognitive or neurodevelopmental impairments. Hence ADHD may be an over-inclusive category. Prevalence rates for hyperkinetic disorder, ADDH and ADHD were respectively 0.78%, 6.1% and 8.9%.

CONCLUSIONS

A disorder of hyperactivity does exist in the Chinese culture, displaying the same kinds of symptomatology and external correlates as in the West. The prevalence rates of hyperkinetic disorder and ADDH in Chinese schoolboys are on the low side when compared to those reported in Western studies.

Hyperactivity: prevalence and relationship with conduct disorder

This paper reports the prevalence of situational and pervasive hyperactivity using different definitions of 'caseness', and explores the relationship between situational and pervasive hyperactivity and conduct disorder, using a large data base from the North of England. The prevalence of hyperactivity, and its relationship with conduct disorder, varied according to whether hyperactivity was pervasive or situational, according to the age of the child and to the definition of hyperactivity 'caseness'. Among younger children only, school based situational and pervasive hyperactivity had comparable comorbidity with other available evidence of psychiatric disorder and hyperactivity was virtually a prerequisite for conduct disorder. Among older children, pervasive hyperactivity had greater comorbidity with other psychiatric disorder than situational hyperactivity and, furthermore, displayed the strongest links with conduct disorder.

Attention-deficit hyperactivity disorder--etiology, diagnosis, and management

Attention deficit hyperactivity disorder is a developmentally disabling disorder of inattention, impulsivity, and hyperactivity that affects 3%-20% of school-aged children. It affects the child at home, at school, and with peers, and persists into adolescence and young adulthood. The author reviews the diagnostic criteria, etiological considerations, evaluation process, and management of this handicapping disorder. Included is a discussion of the most frequently used medications and suggestions for home and classroom management strategies that assist the child to behave and achieve success in school. It is pertinent to all nurses, since children with ADHD are in all settings and nurses are often asked questions about this controversial health care issue in both professional and personal arenas.

Parenting stress among families of children with attention deficit hyperactivity disorder

Prior research has shown that parenting stress levels can be quite high among families of children with attention deficit hyperactivity disorder (ADHD). This study investigated the degree to which such stress was related not only to the child's ADHD, but also to various other child, parent, and family-environment circumstances. Multimethod assessments were conducted on 104 clinic-referred children with ADHD. Data collected from these subjects were entered into hierarchical multiple-regression analyses, utilizing the Parenting Stress Index as the criterion. The results showed that the child and parent characteristics accounted for a substantial portion of the variance in overall parenting stress. The child's oppositional-defiant behavior and maternal psychopathology were especially potent predictors. The severity of the child's ADHD, the child's health status, and maternal health status also emerged as significant predictors. These findings are discussed in terms of their impact upon the clinical management of children with ADHD.

Clinic observations in the assessment of pervasiveness of childhood hyperactivity

Sixty-one boys, 6-12 years old, met both the diagnostic criteria of ADHD of DSM-III-R and hyperkinetic syndrome of ICD-9. They could be subdivided into two groups: 43 showed hyperactive symptoms in the clinic situation and 18 did not. The former group were younger and showed significantly poorer performance in measures of general intelligence, attention, cognitive styles, motor clumsiness and minor neurological deficits. Controlling for age and intelligence attenuated the differences, but significant differences remained in activity level, attention, and minor neurological deficits. This result suggests that direct observation is important in the assessment of pervasiveness of childhood hyperactivity.

Measures of attention deficit. Part II: Clinical perspectives and test interpretation

After a detailed behavioral and developmental history has been supplemented by the use of formal questionnaires, the diagnosis of an attentional disorder can be further clarified by the judicious selection of psychoeducational and pediatric physical and neurodevelopmental examinations. The most common difficulty in the interpretation of psychoeducational test subscores and profiles is the significant overlap between the patterns generated by attentional deficits and those associated with memory-based learning disabilities. Certain other medical and behavioral conditions need to receive careful consideration prior to finalizing the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). A thorough but focused general examination coupled with the pediatric neurodevelopmental examination can contribute to this differentiation.

Childhood hyperactivity

Severe degrees of inattentive and restless behaviour in childhood are a risk factor for later psychological disorders. They have many causes, but a pattern of severe and pervasive hyperactivity with poor concentration in the absence of affective or psychotic disorders should be recognised as a hyperkinetic syndrome. The syndrome is often associated with developmental delays in abilities such as language and motor control. Powerful short-term treatments are available, but long-term ways of promoting normal personality development need more research.

Hyperactive disorder of childhood. Some clinical implications of recent research

In many European countries hyperkinesis is a relatively rare clinical diagnosis compared with the United States. Though systematic international studies comparing the diagnostic process with regard to this disorder are still lacking, it is likely that the reasons for the vast differences in the rates of the disorder do not lie in the differences of the children's behaviour but in diagnostic practice. Individual components of hyperactivity, namely overactivity, restlessness and poor concentration are common among children attending clinics as well as in randomly selected samples in the general population. Treatment for hyperactivity is largely the same as for the majority of child psychiatric disorders which predominantly involve disturbances of conduct. As the 'causes', as well as the factors maintaining the symptoms, are often complex, one form of treatment is seldom adequate. In most cases a combination of psychological and educational treatments is necessary. Stimulant drugs, though in a few instances capable of producing instant and dramatic therapeutic effects, should not be used as a treatment of first choice.

Hyperactive and normal girls and boys: mother-child interaction, parent psychiatric status and child psychopathology

This study compared hyperactive and normal girls and boys on their mother-child interactions, family psychiatric status and ratings on the Personality Inventory for Children (PIC). Hyperactive children were less compliant and more negative, and their mothers responded more negatively to their compliance than mothers of normal children. Mothers of hyperactive children reported more depression, marital discord and psychiatric problems in their relatives, and rated their children more deviant on 15 of 16 PIC scales than normal children. Hyperactive boys received more direction and praise, and had greater maternal concern about their adjustment than hyperactive girls or normal children.

Three-year follow-up at age 10 of children with minor neurodevelopmental disorders. I: Behavioural problems

Sixty-one children selected from a total population study of six-year-old children in Gothenburg and diagnosed as suffering from minimal brain dysfunction (MBD), motor perception dysfunction (MPD) or attention deficit disorder (ADD), and 51 normal control children were followed up at age 10 for behavioural problems. According to teachers', parents' and self-rating questionnaires, the index children, especially those with MBD, showed extremely high rates of severe behavioural/experiential problems at follow-up. None had been treated with stimulants or other drugs directed at alleviating the symptoms of the neurodevelopmental disorder. It is argued that the high rates of disturbances according to the questionnaire ratings are a true reflection of the psychiatric ill-health in these children.

Perceptual, motor and attentional deficits in Swedish primary school children. Some child psychiatric aspects

One hundred and forty-one seven-year-old children took part in an extensive neuropsychiatric study. Eight-two of these children had been selected and sampled from a group of 3448 children for whom questionnaires concerning motor control, perception and attention/behaviour had been completed by pre-school teachers. They all showed pre-school signs of both attention deficit and motor/perception dysfunction. The fifty-nine remaining children had been randomly sampled from the group of 3448 children to serve as controls. The study was carried out in a blind fashion. The present paper reports on results of the neuropsychiatric study with special regard to psychiatric disorders in so-called MBD syndromes, defined in accordance with operational criteria. Prevalence figures for marked psychiatric abnormality in MBD were shown to be higher than for psychiatric abnormality in children with 'neuroepileptic' disorders in the Isle of Wight study. Psychotic behaviour was found to be specifically associated with MBD. Hereditary and neuropathogenic factors singly or together possibly caused the 'MBD handicap'. Non-optimal psychosocial factors appear to interact with the MBD syndrome in the moulding of psychiatric disorders.