Research Review: Language problems in children with Attention-Deficit Hyperactivity Disorder - a systematic meta-analytic review

Links Among Attention-Deficit/Hyperactivity Disorder Symptoms and Psycholinguistic Abilities Are Different for Children With and Without Developmental Language Disorder

PURPOSE

Both developmental language disorder (DLD) and attention-deficit/hyperactivity disorder (ADHD) represent relatively common and chronic neurodevelopmental conditions associated with increased risk for poor academic and interpersonal outcomes. Reports of common co-occurrence suggest these neurodevelopmental disruptions might also be linked. Most of the data available on the issue have been based on case-control studies vulnerable to ascertainment and other biases.

METHOD

Seventy-eight children, representing four neurodevelopmental profiles (DLD, ADHD, co-occurring ADHD + DLD, and neurotypical development), were administered a battery of psycholinguistic tests. Parents provided standardized ratings of the severity of their children's inattention, hyperactivity/impulsivity, and executive function symptoms. Examiners were blinded to children's clinical status. Group differences, correlations, and best subset regression analyses were used to examine potential impacts of children's ADHD symptoms on their psycholinguistic abilities.

RESULTS

For children with DLD, significant links between their ADHD symptoms and psycholinguistic abilities were limited to the contributions of elevated hyperactivity/impulsivity symptoms to lower pragmatic abilities. For children without DLD, inattention symptoms contributed to lower levels of performance in pragmatic, sentence recall, receptive vocabulary, and narrative abilities.

DISCUSSION

Links among children's ADHD symptoms and their psycholinguistic abilities were different for children with and without DLD. Implications for the provision of clinical services are discussed.

Time after time: failure to identify and support females with ADHD - a Swedish population register study

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is associated with risk taking and negative health-related outcomes across the lifespan. Due to delay in referral and diagnostics, young females with ADHD may not be identified, nor appropriately supported by adequate interventions.

METHODS

A total of 85,330 individuals with ADHD, all of whom were residents in Stockholm County between January 01, 2011, and December 31, 2021, were included as participants in this population-based, cross-sectional cohort study. Population controls (n = 426,626) were matched by age, sex, and socioeconomic status (SES). Data was obtained from Regional Healthcare Data Warehouse of Region Stockholm (VAL) in Stockholm County. Exposure was ADHD-index, defined as the first record of either ICD-10 F90 diagnosis and/or ATC-code for stimulant or non-stimulant ADHD-medication during the study period. Primary outcome was age at ADHD-index. Secondary outcome measures were psychiatric comorbidity, pharmacological treatment, and health care utilization, prior to and after ADHD-index.

RESULTS

Females were older at ADHD-index (23.5 years, SD 13.8) compared to males (19.6 years, SD 13.9, 95% CI of difference 3.74-4.11). Overall, females with ADHD showed higher rates of psychiatric comorbidity, pharmacological treatment, and health care utilization, compared to males with ADHD and female controls.

CONCLUSIONS

Females with ADHD receive diagnosis and treatment for ADHD approximately 4 years later than males. They have a higher burden of comorbid psychiatric conditions and health care utilization, compared to males with ADHD and female controls, both prior to and after ADHD-index. To prevent long-term adverse consequences for females with ADHD, methods, and tools for early diagnosis and treatments that mitigate personal suffering and societal burden are warranted.

From Consensus Statement to Pills to Pixels: New Innovations in Attention-Deficit/Hyperactivity Disorder Care

Objectives: This review aims to present recent innovations and advancements in attention-deficit/hyperactivity disorder (ADHD) care, encompassing international consensus statement, new medication formulations, digital therapeutics, and neurostimulation devices. Methods: A comprehensive literature search of relevant articles published in the past five years was conducted, emphasizing the evidence base, efficacy, safety, and practical implications of these advancements. Results: The World Federation of ADHD Consensus Statement offers an updated diagnostic and treatment framework rooted in global scientific evidence. There are several newer ADHD medication formulations, including a nonstimulant (Viloxazine extended release) and the first transdermal amphetamine patch approved to treat ADHD. These options offer some unique benefits to personalize treatment based on symptom profile, lifestyle, preferences, and response. Digital tools offer additional means to restructure environments for individuals with ADHD, reducing impairment and reliance on others. In addition, digital therapeutics enhance access, affordability, personalization, and feasibility of ADHD care, complementing or augmenting existing interventions. Trigeminal nerve stimulation emerges as a well-tolerated nonpharmacological, device-based treatment for pediatric ADHD, with initial trials indicating effect sizes comparable to nonstimulant medications. Conclusions: These innovations in ADHD care represent clinically significant new treatment options and opportunities for personalized care. Health care professionals should integrate these developments into clinical practice, mindful of individual patient and family needs and preferences. Future research should assess long-term outcomes, cost-effectiveness, and acceptability of these innovations.

Language Skills in Children with Attention Deficit Hyperactivity Disorder and Developmental Language Disorder: A Systematic Review

(1) Background: Attention Deficit Hyperactivity Disorder (ADHD) and Developmental Language Disorder (DLD) are neurodevelopmental disorders that affect various areas of children's development, such as language. It exists an emerging idea that ADHD is characterised by the presence of language difficulties, which can be explained by the high comorbidity between ADHD and DLD. The aim of this review is to analyse the empirical evidence of language competence in children aged 6-17 years old, diagnosed with ADHD and/or DLD. (2) Method: Fifteen studies with experimental designs were identified from Scopus, PsycINFO, and WoS databases, reporting on language skills in children diagnosed with ADHD and/or DLD. Studies relating executive functioning to language skills in this target population were also included. (3) Results: The literature is heterogeneous and different components of language are also examined. Even though the results are contradictory, they convincingly demonstrate there are overlapping symptoms between ADHD and DLD, such as language skills and executive functions. (4) Conclusions: The differences in the samples limit the generalisability of the results. Therefore, this review highlights the importance of considering language skills when designing individualised interventions for the population with ADHD and DLD, both in comorbidity and in isolation.

Language abilities in children and adolescents with DLD and ADHD: A scoping review

PURPOSE

There is an emerging view that attention-deficit/hyperactivity disorder (ADHD) is marked by problems with language difficulties, an idea reinforced by the fact that ADHD is highly comorbid with developmental language disorder (DLD). This scoping review provides an overview of literature on language abilities in children with DLD and ADHD while highlighting similarities and differences.

METHOD

A comprehensive search was performed to examine the literature on language abilities in the two disorders, yielding a total of 18 articles that met the inclusion criteria for the present review. Qualitative summaries are provided based on the language domain assessed.

RESULTS

The current literature suggests children and adolescents with ADHD have better morphosyntax/grammar, general/core language abilities, receptive, and expressive abilities than those with DLD. Further, that performance is comparable on assessments of semantic and figurative language but varies by sample on assessments of phonological processing, syntax, narrative language, and vocabulary.

CONCLUSION

Evidence presented points to children and adolescents with DLD as having greater language difficulties compared to those with ADHD, but with some important caveats. Despite limitations related to the paucity of studies and inconsistencies in how the two types of disorders are identified, our review provides a necessary and vital step in better understanding the language profiles of these two highly prevalent childhood disorders. These findings are useful in optimizing language outcomes and treatment efficacy for children and adolescents with ADHD and DLD.

A preliminary study of the effects of stimulant medications on estimates of psycholinguistic abilities for children with attention-deficit/hyperactivity disorder

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.

Association between interruption of intervention and language performance in young children with language delay-a cohort study during COVID-19 pandemic

Introduction

To assess the association between a three-month interruption of language intervention programs and the language performance of children with language delay during the COVID-19 pandemic, and to identify which children are more vulnerable to such interruptions.

Materials and methods

This is a retrospective study involving 33 children with language delay who experienced a three-month suspension of language interventions due to the COVID-19 pandemic. We collected their demographic data and language performance scores from the Comprehensive Developmental Inventory for Infants and Toddlers-Diagnostic test (CDIIT-DT) at four different time points. The scores were analyzed using a Wilcoxon Signed Ranks test.

Results

The median scores of language comprehension and overall language ability showed a decreasing trend during the interruption period. However, resuming interventions post-interruption showed a statistically significant increase in all language domains. Children in the borderline delay group (CDIIT-DT DQ scores between 71 and 85) were more likely to experience a decline in their language abilities during the interruption.

Discussion

This is the first study to reveal a decreasing trend in language performance during interruption periods, and highlighting the significance of post-interruption language interventions in facilitating improvements. Furthermore, our study brings attention to the heightened vulnerability of children exhibiting borderline language delay in overall language ability tests when faced with interruptions in language interventions.

[Application of Preschool Auditory Processing Assessment Scale in children with attention deficit hyperactivity disorder]

OBJECTIVES

To investigate the characteristics of auditory processing (AP) in preschool children with attention deficit hyperactivity disorder (ADHD) using Preschool Auditory Processing Assessment Scale (hereafter referred to as "auditory processing scale").

METHODS

A total of 41 children with ADHD and 41 typically developing (TD) children were assessed using the auditory processing scale, SNAP-IV rating scale, and Conners' Kiddie Continuous Performance Test (K-CPT). The auditory processing scale score was compared between the TD and ADHD groups. The correlations of the score with SNAP-IV and K-CPT scores were assessed.

RESULTS

Compared with the TD group, the ADHD group had significantly higher total score of the auditory processing scale and scores of all dimensions except visual attention (P<0.05). In the children with ADHD, the attention deficit dimension score of the SNAP-IV rating scale was positively correlated with the total score of the auditory processing scale (rs30=0.531, P<0.05; rs27=0.627, P<0.05) as well as the scores of its subdimensions, including auditory decoding (rs=0.628, P<0.05), auditory attention (rs=0.492, P<0.05), and communication (rs=0.399, P<0.05). The hyperactivity-impulsivity dimension score of the SNAP-IV rating scale was positively correlated with the hyperactivity-impulsivity dimension score of the auditory processing scale (rs=0.429, P<0.05). In the children with ADHD, the attention deficit dimension score of the K-CPT was positively correlated with the total score (rs30=0.574, P<0.05; rs27=0.485, P<0.05) and the hyperactivity-impulsivity dimension score (rs=0.602, P<0.05) of the auditory processing scale.

CONCLUSIONS

Preschool children with ADHD have the risk of AP abnormalities, and the auditory processing scale should be used early for the screening and evaluation of AP abnormalities in children.

Do Language-Related Cognitive Capacities Help Predict Adjustment in Children with Attention-Deficit/Hyperactivity Disorder?

The goal of this paper was to examine the role that language-related cognitive capacities (LRCC) might play in explaining adjustment of 7 to 12 year-old children (M_age = 9.24; SD_age = 0.91) with and without ADHD. The sample was comprised of 178 children with ADHD and 86 typically-developing children (77.3% male; 81.4% White; 9.5% Black; 1.9% Hispanic; 0.8% Asian; 5.7% multiracial; 0.8% did not report race/ethnicity). Using simultaneous regression, we examined whether LRCC accounted for unique variance in achievement, attention problems, oppositional problems, conduct problems, and internalizing, over and above what standard covariates and ADHD diagnostic status could explain. Finally, we examined LRCC as a mediator of the relation between ADHD diagnostic status and these adjustment measures. Results indicated that LRCC significantly predicted 6 of 7 and partially mediated 5 of 7 measures, suggesting that language-related constructs warrant greater attention in diagnosis and treatment of ADHD.

Early-life gut microbiota and attention deficit hyperactivity disorder in preadolescents

BACKGROUND

Gut microbiota maturation coincides with nervous system development. Cross-sectional data suggest gut microbiota of individuals with and without attention deficit hyperactivity disorder (ADHD) differs. We hypothesized that infant gut microbiota composition is associated with later ADHD development in our on-going birth cohort study, WHEALS.

METHODS

Gut microbiota was profiled using 16S ribosomal RNA and the internal transcribed spacer region 2 (ITS2) sequencing in stool samples from 1 month and 6 months of age. ADHD was defined by parent-reported or medical record doctor diagnosis at age 10.

RESULTS

A total of 314 children had gut microbiota and ADHD data; 59 (18.8%) had ADHD. After covariate adjustment, bacterial phylogenetic diversity (p = 0.017) and bacterial composition (unweighted UniFrac p = 0.006, R2 = 0.9%) at age 6 months were associated with development of ADHD. At 1 month of age, 18 bacterial and 3 fungal OTUs were associated with ADHD development. At 6 months of age, 51 bacterial OTUs were associated with ADHD; 14 of the order Lactobacillales. Three fungal OTUs at 6 months of age were associated with ADHD development.

CONCLUSIONS

Infant gut microbiota is associated with ADHD development in pre-adolescents. Further studies replicating these findings and evaluating potential mechanisms of the association are needed.

IMPACT

Cross-sectional studies suggest that the gut microbiota of individuals with and without ADHD differs. We found evidence that the bacterial gut microbiota of infants at 1 month and 6 months of age is associated with ADHD at age 10 years. We also found novel evidence that the fungal gut microbiota in infancy (ages 1 month and 6 months) is associated with ADHD at age 10 years. This study addresses a gap in the literature in providing longitudinal evidence for an association of the infant gut microbiota with later ADHD development.

The association of prenatal phthalates, organophosphorous pesticides, and organophosphate esters with early child language ability in Norway

BACKGROUND

Prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides have been associated with neurodevelopmental deficits including language ability, however, few studies consider the effect of exposure mixtures and the potential longitudinal detriments over time.

OBJECTIVE

This study examines the influence of prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides, on children's language ability from toddlerhood to the preschool period.

METHODS

This study includes 299 mother-child dyads from Norway in the Norwegian Mother, Father and Child Cohort Study (MoBa). Prenatal exposure to chemicals were assessed at 17 weeks' gestation, and child language skills were assessed at 18 months using the Ages and Stages Questionnaire communication subscale and at preschool age using the Child Development Inventory. We ran two structural equation models to examine the simultaneous influences of chemical exposures on parent-reported and teacher-reported child language ability.

RESULTS

Prenatal organophosphorous pesticides were negatively associated with preschool language ability through language ability at 18 months. Additionally, there was a negative association between low molecular weight phthalates and teacher-reported preschool language ability. There was no effect of prenatal organophosphate esters on child language ability at either 18 months or preschool age.

CONCLUSIONS

This study adds to the literature on prenatal exposure to chemicals and neurodevelopment and highlights the importance of developmental pathways in early childhood.

Sex differences in resting state functional connectivity across the first two years of life

Sex differences in behavior have been reported from infancy through adulthood, but little is known about sex effects on functional circuitry in early infancy. Moreover, the relationship between early sex effects on the functional architecture of the brain and later behavioral performance remains to be elucidated. In this study, we used resting-state fMRI and a novel heatmap analysis to examine sex differences in functional connectivity with cross-sectional and longitudinal mixed models in a large cohort of infants (n = 319 neonates, 1-, and 2-year-olds). An adult dataset (n = 92) was also included for comparison. We investigated the relationship between sex differences in functional circuitry and later measures of language (collected in 1- and 2-year-olds) as well as indices of anxiety, executive function, and intelligence (collected in 4-year-olds). Brain areas showing the most significant sex differences were age-specific across infancy, with two temporal regions demonstrating consistent differences. Measures of functional connectivity showing sex differences in infancy were significantly associated with subsequent behavioral scores of language, executive function, and intelligence. Our findings provide insights into the effects of sex on dynamic neurodevelopmental trajectories during infancy and lay an important foundation for understanding the mechanisms underlying sex differences in health and disease.

Language Problems and ADHD Behaviors: Unique and Interactive Associations with School Readiness in a Socioeconomically Disadvantaged Preschool Sample

This study examined the unique and interactive effects of receptive language ability and ADHD behaviors on six school readiness outcomes, over and above the effects of socioeconomic status, in 49 preschoolers (M_age = 3.98, SD_age = .58; 53.06% female) recruited from Head Start-affiliated classrooms. Hierarchical regression analyses revealed unique positive associations between receptive language ability and cognitive and mathematics readiness, and unique negative associations between ADHD behaviors and social-emotional, physical, cognitive, and literacy readiness. Moderation analyses indicated that at higher, but not lower, levels of ADHD behaviors, lower receptive language ability was associated with lower social-emotional readiness. Results highlight that, when considered together, children's receptive language ability and ADHD behaviors vary in how they predict school readiness. Further, results provide preliminary evidence for ADHD behaviors as a risk factor in the association between receptive language deficits and social-emotional school readiness. Educational and clinical practice implications are discussed.

Review of neurodevelopmental disorders in patients with HNF1B gene variations

This review investigates the association between neurodevelopmental disorders (NDD) and variations of the gene HNF1B. Heterozygous intragenetic mutations or heterozygous gene deletions (17q12 microdeletion syndrome) of HNF1B are the cause of a multi-system developmental disorder, termed renal cysts and diabetes syndrome (RCAD). Several studies suggest that in general, patients with genetic variation of HNF1B have an elevated risk for additional neurodevelopmental disorders, especially autism spectrum disorder (ASD) but a comprehensive assessment is yet missing. This review provides an overview including all available studies of patients with HNF1B mutation or deletion with comorbid NDD with respect to the prevalence of NDDs and in how they differ between patients with an intragenic mutation or 17q12 microdeletion. A total of 31 studies was identified, comprising 695 patients with variations in HNF1B, (17q12 microdeletion N = 416, mutation N = 279). Main results include that NDDs are present in both groups (17q12 microdeletion 25.2% vs. mutation 6.8%, respectively) but that patients with 17q12 microdeletions presented more frequently with any NDDs and especially with learning difficulties compared to patients with a mutation of HNF1B. The observed prevalence of NDDs in patients with HNF1B variations seems to be higher than in the general population, but the validity of the estimated prevalence must be deemed insufficient. This review shows that systematical research of NDDs in patients with HNF1B mutations or deletions is lacking. Further studies regarding neuropsychological characteristics of both groups are needed. NDDs might be a concomitant of HFN1B-related disease and should be considered in clinical routine and scientific reports.

Transdiagnostic profiles of behaviour and communication relate to academic and socioemotional functioning and neural white matter organisation

BACKGROUND

Behavioural and language difficulties co-occur in multiple neurodevelopmental conditions. Our understanding of these problems has arguably been slowed by an overreliance on study designs that compare diagnostic groups and fail to capture the overlap across different neurodevelopmental disorders and the heterogeneity within them.

METHODS

We recruited a large transdiagnostic cohort of children with complex needs (N = 805) to identify distinct subgroups of children with common profiles of behavioural and language strengths and difficulties. We then investigated whether and how these data-driven groupings could be distinguished from a comparison sample (N = 158) on measures of academic and socioemotional functioning and patterns of global and local white matter connectome organisation. Academic skills were assessed via standardised measures of reading and maths. Socioemotional functioning was captured by the parent-rated version of the Strengths and Difficulties Questionnaire.

RESULTS

We identified three distinct subgroups of children, each with different levels of difficulties in structural language, pragmatic communication, and hot and cool executive functions. All three subgroups struggled with academic and socioemotional skills relative to the comparison sample, potentially representing three alternative but related developmental pathways to difficulties in these areas. The children with the weakest language skills had the most widespread difficulties with learning, whereas those with more pronounced difficulties with hot executive skills experienced the most severe difficulties in the socioemotional domain. Each data-driven subgroup could be distinguished from the comparison sample based on both shared and subgroup-unique patterns of neural white matter organisation. Children with the most pronounced deficits in language, cool executive, or hot executive function were differentiated from the comparison sample by altered connectivity in predominantly thalamocortical, temporal-parietal-occipital, and frontostriatal circuits, respectively.

CONCLUSIONS

These findings advance our understanding of commonly co-morbid behavioural and language problems and their relationship to behavioural outcomes and neurobiological substrates.

Are Reading Interventions Effective for At-Risk Readers with ADHD? A Meta-Analysis

OBJECTIVE

Utilizing a multi-level meta-analytic approach, this review is the first to systematically quantify the efficacy of reading interventions for school-aged children with ADHD and identify potential factors that may increase the success of reading-related interventions for these children.

METHOD

18 studies (15 peer-reviewed articles, 3 dissertations) published from 1986 to 2020 (N = 564) were meta-analyzed.

RESULTS

Findings revealed reading interventions are highly effective for improving reading skills based on both study-developed/curriculum-based measures (g = 1.91) and standardized/norm-referenced achievement tests (g = 1.11) in high-quality studies of children with rigorously-diagnosed ADHD. Reading interventions that include at least 30 hours of intervention targeting decoding/phonemic awareness meet all benchmarks to be considered a Level 1 (Well-Established) Evidence-Based Practice with Strong Research Support for children with ADHD based on clinical and special education criteria.

CONCLUSIONS

Our findings collectively indicate that reading interventions should be the first-line treatment for reading difficulties among at-risk readers with ADHD.

Is there a place for dietetic interventions in adult ADHD?

Current treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults are limited by lack of response and side effects in about one third of the individuals. Changes towards a healthier lifestyle could have a positive impact beyond the relief of specific symptoms. However, it is not clear if nutritional interventions influence mental health and cognition. The objective of this study was to summarize the available literature addressing the impact of different diets in ADHD. The most promising dietetic approaches in ADHD are diets considered to be healthy (Mediterranean-type; DASH) and the Few-Foods Diet for children. Studies should take into account the presence of multiple confounders, biases associated with difficulties in blinding participants and researchers, and search for possible mechanisms of action, so we can have better evidence to guide clinical mental care of adults with ADHD.

Findings of a Multidisciplinary Assessment of Children Referred for Possible Neurodevelopmental Disorders: Insights from a Retrospective Chart Review Study

Children with ASD have a wide spectrum of functional deficits in multiple neurodevelopmental domains. A multidisciplinary team assessment (MDT) is required to assess those deficits to help construct a multimodal intervention plan. This is a retrospective chart review of the assessment for children who were referred for an assessment of potential neurodevelopmental disorders. We reviewed 221 participants' charts from January 2019 to January 2020. The mean age of the children was 7.95 ± 3.69, while the mean age of the fathers and mothers was 37.31 ± 8.57 and 31.95 ± 6.93, respectively. Consanguinity was as high as 37.9% for the referred children with developmental delay who were first-degree related, and 13.2% of the parents were second-degree relatives. Approximately 26.6% of children had a family history of mental illness in first-degree relatives. ASD was the most commonly reported diagnosis post-assessment, and ADHD was the most common reported comorbidity at 64.3% and 88.5%, respectively. The MDT findings showed that 58% of children required moderate or higher assistance with toileting, 79.2% were unable to answer yes/no questions, and 86.8% were unable to understand "wh" questions. Only 26% of the nonverbal children had average IQ testing results, and 31% of verbal children did. In conclusion, the mean age of the children when assessed was above that recommended for early screening and intervention. An increased paternal and maternal age was noticeable. Consanguinity and a family history of mental disorders in first-degree relatives were high, attesting to a possible genetic risk.

Early manifestations of genetic risk for neurodevelopmental disorders

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (autism) and schizophrenia are highly heritable neurodevelopmental disorders, affecting the lives of many individuals. It is important to increase our understanding of how the polygenic risk for neurodevelopmental disorders manifests during childhood in boys and girls.

METHODS

Polygenic risk scores (PRS) for ADHD, autism and schizophrenia were calculated in a subsample of 15 205 children from the Norwegian Mother, Father and Child Cohort Study (MoBa). Mother-reported traits of repetitive behavior, social communication, language and motor difficulties, hyperactivity and inattention were measured in children at 6 and 18 months, 3, 5 and 8 years. Linear regression models in a multigroup framework were used to investigate associations between the three PRS and dimensional trait measures in MoBa, using sex as a grouping variable.

RESULTS

Before the age of 2, the ADHD PRS was robustly associated with hyperactivity and inattention, with increasing strength up to 8 years, and with language difficulties at age 5 and 8. The autism PRS was robustly associated with language difficulties at 18 months, motor difficulties at 36 months, and hyperactivity and inattention at 8 years. We did not identify robust associations for the schizophrenia PRS. In general, the PRS associations were similar in boys and girls. The association between ADHD PRS and hyperactivity at 18 months was, however, stronger in boys.

CONCLUSIONS

Polygenic risk for autism and ADHD in the general population manifests early in childhood and broadly across behavioral measures of neurodevelopmental traits.

A rapid systematic review of attention-deficit/hyperactivity disorder (ADHD) and high order writing: Current findings and implications for intervention

BACKGROUND

Theoretical writing models and empirical studies have suggested a possible strong association between attention-deficit/hyperactivity disorder (ADHD) and high order writing (e.g., planning, text production, and revising).

AIM

A rapid systematic review was conducted to examine this relationship with the aim of informing writing interventions specific to the ADHD population.

METHOD

A systematic search for empirical studies on ADHD and high order writing performance from the last two decades identified 18 eligible studies.

RESULTS

Most studies showed that, compared to their peers, students with ADHD have more significant difficulties in high order writing performance. Writing quality and writing process (e.g., planning and editing) were identified as a challenge for ADHD students and may be more challenging than writing productivity and meta-cognitive knowledge of writing. Individuals' inattention, short-term memory, working memory, executive functions, reading, oral language skills, and externalising behavioural problems were identified as significant predictors of high order writing performance.

CONCLUSIONS AND IMPLICATIONS

The findings support theoretical writing models that propose writing as a complex process influenced by multiple cognitive factors, which are commonly impaired in individuals with ADHD. Interventions specific to the identified problems are discussed.

Neural Effects of Physical Activity and Movement Interventions in Individuals With Developmental Disabilities-A Systematic Review

Individuals with developmental disabilities present with perceptuo-motor, social communication, and cognitive impairments that often relate to underlying atypical brain structure and functioning. Physical activity/movement interventions improve behavioral performance of individuals with and without developmental disabilities. Majority of the evidence on potential neural mechanisms explaining the impact of physical activity/movement interventions is based on studies in individuals with typical development; there is a dearth of systematic reviews synthesizing the neural effects of physical activity/movement interventions in individuals with developmental disabilities. In this systematic review, we have gathered evidence on the neural effects of physical activity/movement interventions from 32 papers reporting substantial neural effects and behavioral improvements in individuals with developmental disabilities. Chronic intervention effects (multiple sessions) were greater than acute intervention effects (single session). Specifically, using electroencephalogram, functional magnetic resonance imaging, diffusion tensor imaging, and functional near-infrared spectroscopy, studies found physical activity/movement intervention-related changes in neural activity, indicating normalization of cortical arousal in individuals with attention-deficit /hyperactivity disorder (ADHD), increased social brain connectivity in individuals with autism spectrum disorder (ASD), and more efficient executive functioning processes in individuals with a wide range of other developmental disabilities. Despite promising results, more research is clearly needed in this area with larger sample sizes, using standardized neuroimaging tools/variables, and across multiple diagnoses to further explore the neural mechanisms underlying physical activity/movement interventions and to replicate findings from the present review.

Social Skills Group Training for Students with Neurodevelopmental Disabilities in Senior High School-A Qualitative Multi-Perspective Study of Social Validity

Including students with neurodevelopmental disabilities (NDDs) in regular classrooms has become a law-enforced common practice in many high- and middle-income countries. Still, without appropriate actions supporting the implementation of inclusive pedagogical practice, students with NDDs remain at increased risk for absenteeism, bullying and underachievement. There is limited knowledge on the feasibility of social skills group training (SSGT) in naturalistic settings. Using a qualitative approach, the objective of this study was to explore the lived experiences of (i) students diagnosed with autism or attention-deficit hyperactivity disorder and those showing subclinical social difficulties receiving either SSGT or active social control activities in a regular senior high school setting, (ii) teachers providing SSGT or the active control activity and (iii) school leaders facilitating the implementation of these actions. Due to the impact of the COVID-19 pandemic, comparison between real life versus digital administration of SSGT was also examined. Within a randomized controlled pilot trial of the school-tailored SSGT SKOLKONTAKT^®, the primary perspectives of 20 students, teachers and school leaders on SSGT or the social control activities were explored. All groups perceived SSGT to enhance school attendance and academic achievement of students, as well as teacher inclusion skills and the social school climate. Findings indicate that SSGT is largely feasible and socially valid, and broader implementation of SSGT in school settings appears meaningful.

Association of Epigenetic Differences Screened in a Few Cases of Monozygotic Twins Discordant for Attention-Deficit Hyperactivity Disorder With Brain Structures

The present study examined the relationship between DNA methylation differences and variations in brain structures involved in the development of attention-deficit hyperactivity disorder (ADHD). First, we used monozygotic (MZ) twins discordant (2 pairs of 4 individuals, 2 boys, mean age 12.5 years) for ADHD to identify candidate DNA methylation sites involved in the development of ADHD. Next, we tried to replicate these candidates in a case-control study (ADHD: N = 18, 15 boys, mean age 10.0 years; Controls: N = 62, 40 boys, mean age 13.9 years). Finally, we examined how methylation rates at those sites relate to the degree of local structural alterations where significant differences were observed between cases and controls. As a result, we identified 61 candidate DNA methylation sites involved in ADHD development in two pairs of discordant MZ twins, among which elevated methylation at a site in the sortilin-related Vps10p domain containing receptor 2 (SorCS2) gene was replicated in the case-control study. We also observed that the ADHD group had significantly reduced gray matter volume (GMV) in the precentral and posterior orbital gyri compared to the control group and that this volume reduction was positively associated with SorCS2 methylation. Furthermore, the reduced GMV regions in children with ADHD are involved in language processing and emotional control, while SorCS2 methylation is also negatively associated with emotional behavioral problems in children. These results indicate that SorCS2 methylation might mediate a reduced GMV in the precentral and posterior orbital gyri and therefore influence the pathology of children with ADHD.

Interpersonal Negotiation Skills in ADHD

Social interaction difficulties are amongst the most prevalent and pervasive adverse outcomes for children and adolescents with ADHD. Problem-solving strategies are impaired in affected individuals, according to the literature. This study aimed to investigate the social problem-solving skills of children and adolescents with and without ADHD, using objective quantitative measures provided by the Interpersonal Negotiation Strategies Interview (INSI). Because verbal communication skills and working memory may be impaired in ADHD, we investigated their contribution to the performance. Forty-three children and adolescents with ADHD and 27 clinical controls with clinical diagnoses other than ADHD completed the INSI along with measures of verbal communication skills (Verbal Comprehension Index [VCI]): Similarities, Vocabulary and Comprehension subtests from the Wechsler Battery, visual (Corsi Blocks) and verbal (Digit Span) working memory tasks. Groups performed similarly on measures of intellectual functioning, working memory, and verbal communication. For the entire sample, VCI scores were positively correlated with INSI performance scores. The ADHD group performed worse on the INSI than the clinical control group. Linear regression analysis showed that inattention and hyperactivity/impulsivity levels and Similarities predicted INSI's performance. Our findings indicate that interpersonal negotiation difficulties in ADHD are related to DSM-5 defining symptoms of the disorder.

The Efficacy of Visual Activity Schedule Intervention in Reducing Problem Behaviors in Children With Attention-Deficit/Hyperactivity Disorder Between the Age of 5 and 12 Years: A Systematic Review

Objectives

Children with attention-deficit/hyperactivity disorder (ADHD) tend to be noisy and violate rules with their disruptive behaviors, resulting in greater difficulties with off-task behaviors and being at risk for social refusal. The visual activity schedule (VAS) intervention program is a frequently used method to teach multiple skills involving on-task, use of schedules, transition behaviors, social initiation, independent play skills, classroom skills, and academic skills. The current systematic review aimed to examine the efficacy of using VAS intervention in reducing problem behaviors in children with ADHD between 5 and 12 years of age.

Methods

Systematic searches were conducted using two electronic databases (PubMed and Scopus) to identify relevant studies published in English between 2010 and 2020. Four studies met the inclusion criteria: two studies examined the effect of schedule-based tasks and the use of an iPad on classroom skills, while the other two examined randomized clinical trials (RCTs) of psychosocial treatment for ADHD inattentive type and a cross-sectional study examined the impact of the group size on task behavior and work productivity in children with ADHD.

Results

The findings indicate that the interventions used in all four studies could lead to increased satisfaction among participants and parents, as well as a reduction in problem behavior. In terms of the research indicators, the RCT had low quality, while the others were of high quality.

Conclusion

A larger number of studies and the ADHD clinical population would help to increase the generalizability of future reviews of treatments in this context.

A Systematic Review and Meta-analysis of Narrative Language Abilities in Children with Attention-Deficit/Hyperactivity Disorder

While children with ADHD are reported to have language problems, it is less clear if their ability to use language to tell a story (i.e., form a narrative) is impaired. Therefore, a systematic review and meta-analysis of studies examining the oral production of fictional stories in children with ADHD was conducted. Databases were systematically searched in January 2019 and December 2020 (follow-up). Studies comparing children (≤ 18 years) with ADHD to a control group of typically developing children were included. The meta-analysis adhered to PRISMA guidelines and was preregistered with PROSPERO [CRD42019122040]. Sixteen studies were retained. Results indicated that compared to typically developing children, children with ADHD produced less coherent narratives (Hedges' g = 0.58 p < .001), gave more ambiguous references (Hedges' g = 0.52, p < .001), made more disruptive errors (Hedges' g = 0.41, p < .001), and produced language that was less syntactically complex (Hedges' g = 0.39, p < .05). Children with ADHD also produced less language overall (Hedges' g = 0.27, p < .05), although this result appeared to be an artefact of publication bias. Two studies investigated internal state language and both found children with ADHD to produce narratives with less internal state language. Children with ADHD did not produce less fluent narratives (Hedges' g = 0.23, p = .47), although a scarcity of studies [K = 4] preclude firm conclusions. In conclusion, children with ADHD were impaired in several areas of oral narrative production and screening for narrative language problems should be considered when assessing language and communicative abilities in children with ADHD.

Attention-deficit/hyperactivity disorder has a state-dependent association with asthma: The role of systemic inflammation in a population-based birth cohort followed from childhood to adulthood

There is a high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and asthma, and inflammation has been proposed as a potential pathophysiological mechanism behind this association. Most studies conducted so far have used a cross-sectional design, and none has evaluated the prevalence of asthma symptoms in patients with ADHD followed from childhood to adulthood. We relied on data from the 1993 Pelotas birth cohort to evaluate the association between ADHD and asthma in patients with distinct patterns of incidence, persistence and remission, and to explore the potential role of inflammatory markers in the comorbidity. We analyzed data from 3281 individuals from the 1993 Pelotas birth cohort collected at birth (1993), 11 years (2004), 18 years (2011), and 22 years (2015). Subjects were first classified according to their ADHD and asthma status as early-onset (EO) persistent (positive screening for ADHD at 11 years and diagnosis of ADHD according to DSM-5, except criterion E, at either 18 or 22 years), EO-remittent (positive screening for ADHD at 11 years only), late-onset (diagnosis of ADHD according to DSM-5, except criterion E, at 18 or 22 years only), or healthy subjects (negative for both conditions in all evaluation). After controlling for confounders, significant associations were observed between EO-remittent ADHD and EO-remittent asthma (OR 1.68, 95% CI 1.11-2.55), EO-persistent ADHD and EO-persistent asthma (OR 4.33, 95% CI 1.65-11.34), and between late-onset ADHD and late-onset asthma (OR 1.86, 95% CI 1.28-2.70), suggesting a state-dependent association. Serum interleukin-6 (IL-6) and C-reactive protein (CRP) were measured at the 18- and 22-year evaluations and compared between subjects positive for ADHD, asthma, and subjects with both or none conditions, regardless of the previously defined trajectories. Subjects with comorbid ADHD and asthma presented higher levels of IL-6 at the 18- and 22-year evaluations when compared to subjects negative for both conditions. Our results demonstrate a state-dependent association between ADHD and asthma despite underlying trajectories. Higher levels of serum IL-6 in patients with both conditions suggest that a pro-inflammatory environment might have a role in the pathophysiological mechanisms underlying the comorbidity.

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

BACKGROUND

Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base.

METHODS

We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder.

RESULTS

We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents.

CONCLUSIONS

Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Identification of genetic overlap and novel risk loci for attention-deficit/hyperactivity disorder and bipolar disorder

Differential diagnosis between childhood onset attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) remains a challenge, mainly due to overlapping symptoms and high rates of comorbidity. Despite this, genetic correlation reported for these disorders is low and non-significant. Here we aimed to better characterize the genetic architecture of these disorders utilizing recent large genome-wide association studies (GWAS). We analyzed independent GWAS summary statistics for ADHD (19,099 cases and 34,194 controls) and BD (20,352 cases and 31,358 controls) applying the conditional/conjunctional false discovery rate (condFDR/conjFDR) statistical framework that increases the power to detect novel phenotype-specific and shared loci by leveraging the combined power of two GWAS. We observed cross-trait polygenic enrichment for ADHD conditioned on associations with BD, and vice versa. Leveraging this enrichment, we identified 19 novel ADHD risk loci and 40 novel BD risk loci at condFDR <0.05. Further, we identified five loci jointly associated with ADHD and BD (conjFDR < 0.05). Interestingly, these five loci show concordant directions of effect for ADHD and BD. These results highlight a shared underlying genetic risk for ADHD and BD which may help to explain the high comorbidity rates and difficulties in differentiating between ADHD and BD in the clinic. Improving our understanding of the underlying genetic architecture of these disorders may aid in the development of novel stratification tools to help reduce these diagnostic difficulties.

Capacity of the CCC-2 to Discriminate ASD from Other Neurodevelopmental Disorders

The Children’s Communication Checklist (CCC-2) has demonstrated its usefulness as an instrument to assess discrepancies between the use of structural dimensions of language and the pragmatic and sociointeractive uses of language. The aims of the present paper are: (1) to test the capacity of the Galician adaptation of the CCC-2 to discriminate the linguistic profiles of children with different disorders and (2) to test whether the capacity of the CCC-2 to discriminate the linguistic abilities of children with different disorders is the same at different ages: earlier development and later development. The sample is of 117 children previously diagnosed with different disorders: autism spectrum disorder (ASD), developmental language disorder (DLD), attention deficit with hyperactivity disorder (ADHD), Down syndrome children (DS) and typically developing children (TD). The children were divided into two different age groups: from 4 to 6 and from 7 to 16 years of age. The results indicate that the Galician CCC-2 (1) accurately identified children with and without communicative impairments, (2) distinguished between profiles with a predominance of pragmatic (ASD and ADHD) and structural disorders (DS and DLD) and (3) distinguished between different profiles of pragmatic impairment. The CCC-2 equally identified these profiles at both earlier and later ages. The Galician CCC-2 seems to be a useful instrument for differentiating among different clinical groups and for assessing pragmatic disorders from an early age, which can be valuable for planning early intervention.

The profile of pragmatic language impairments in children with ADHD: A systematic review

This systematic review synthesizes the empirical literature examining pragmatic language in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Using a taxonomy of pragmatic language, we compared the pragmatic language profiles of children with ADHD to those of typically developing (TD) children and children with autism. Three databases were searched up to October 2019: PsychInfo; PubMed; and CSA Linguistics and Language Behavior Abstracts. We included 34 studies reporting on 2,845 children (ADHD = 1,407; TD = 1,058; autism = 380). Quality and risk of bias assessments included sample size and representativeness; measure reliability and validity; and missing data management. Children with ADHD were found to have higher rates of pragmatic difficulties than their TD peers. Specific difficulties were identified with inappropriate initiation, presupposition, social discourse, and narrative coherence. Children with ADHD appear to differ from those with autism in the degree of their pragmatic language impairments. General language skills contribute to, but do not explain, pragmatic difficulties in samples of children with ADHD. Though the extant evidence is limited, a preliminary profile of the pragmatic language impairments in children with ADHD is indicated. This supports a call for evidence-based interventions that include pragmatic language skills training.

Investigating the Role of Inattention and/or Hyperactivity/impulsivity in Language and Social Functioning Using a Dimensional Approach

The current study parsed out the distinct components of attention-deficit/hyperactivity disorder (ADHD) symptomatology to examine differential relations with language and social ability. Using a research domain criteria (RDoC) framework, we administered standardized tests and previously developed and validated questionnaires to assess levels of inattention and/or hyperactivity/impulsivity symptomatology, language, social responsivity and social competency in 98 young adults. Those with higher inattention and/or hyperactivity/impulsivity symptomatology had reduced language comprehension, social responsivity, and social competency. Inattention and hyperactivity/impulsivity both predicted language comprehension, but not language production. Interestingly, inattention uniquely contributed to social responsiveness and social competency, but hyperactivity/impulsivity did not. Findings suggest that inattention and/or hyperactivity/impulsivity symptoms, inattention in particular, may be especially important for social skills programs geared towards individuals with attention limitations.

Family and developmental history of ADHD patients: a structured clinical routine interview identifies a significant profile

Similar to other neurodevelopmental disorders, the diagnosis of attention-deficit hyperactivity disorder (ADHD) is based on clinical and psychosocial assessment. This assessment is performed in clinical practice using the clinical routine interview technique. Domains of the clinical routine interview are, among others, present symptoms, history of present illness and family and developmental history. Family and developmental history are important parts in the diagnostic process of ADHD. In contrast to the domains of present symptoms and history of present illness, there are currently no structured interviews or rating scales available to thoroughly assess family and developmental history in ADHD. The aim of the study was to assess the profile of operationalized data from a structured clinical routine interview addressing family and developmental history from ADHD patients and control participants. A structured interview to assess family and developmental history was derived from the guidelines used at different university hospitals for Child and Adolescent Psychiatry as well as from the descriptions in leading textbooks. Based on these guidelines and descriptions, the interview was an optimization of possible questions. Clinical data were obtained from parents of male patients who had the diagnosis of ADHD between the ages of 12-17 years (n = 44), and of healthy controls (n = 41). Non-metric data were operationalized into three categories, 0-normal behavior, 1-minor pathological behavior, 2-major pathological behavior. ADHD patients express a profile that significantly differs from control participants. Comparison of significant items with the empirical ADHD literature indicates strong agreement. Our findings support the importance and feasibility of the clinical routine interview in family and developmental history in the context of diagnosing ADHD.

Resting-state network dysconnectivity in ADHD: A system-neuroscience-based meta-analysis

OBJECTIVES

Neuroimaging studies report altered resting-state functional connectivity in attention deficit/hyperactivity disorder (ADHD) across multiple brain systems. However, there is inconsistency among individual studies.

METHODS

We meta-analyzed seed-based resting state studies of ADHD connectivity within and between four established resting state brain networks (default mode, cognitive control, salience, affective/motivational) using Multilevel Kernel Density Analysis method.

RESULTS

Twenty studies with 944 ADHD patients and 1121 controls were included in the analysis. Compared to controls, ADHD was associated with disrupted within-default mode network (DMN) connectivity - reduced in the core (i.e. posterior cingulate cortex seed) but elevated in the dorsal medial prefrontal cortex sub-system (i.e. temporal pole-inferior frontal gyrus). Connectivity was elevated between nodes in the cognitive control system. When the analysis was restricted to children and adolescents, additional reduced connectivity was detected between DMN and cognitive control and affective/motivational and salience networks.

CONCLUSIONS

Our data are consistent with the hypothesis that paediatric ADHD is a DMN-dysconnectivity disorder with reduced connectivity both within the core DMN sub-system and between that system and a broad set of nodes in systems involved in cognition and motivation.

Executive Functions and Morphosyntax: Distinguishing DLD From ADHD in French-Speaking Children

Attention deficit hyperactivity disorder (ADHD) is commonly associated with deficits in executive functions executive functions (EF), but children with this disorder frequently demonstrate co-occurring morphosyntactic impairment when assessed using standardized tests. On the other hand, children with developmental language disorder (DLD), a population defined by impaired linguistic functioning, are often diagnosed with comorbid EF deficits. We investigated EF and morphosyntax in 60 French-speaking children aged six to 12: 20 with typical development (TD), 20 with ADHD, and 20 with DLD. To obtain an EF profile for the different cognitive groups, we used standardized tests to assess lower-order EF skills, (i) selective attention and (ii) short-term memory capacity, and higher-order EF skills, (i) working memory capacity and (ii) attention shifting. To test morphosyntax, we used (i) a standardized omnibus test that elicited a variety of complex structures and (ii) a more fine-grained probe test that assessed the production of third person object clitic pronouns, a clinical marker of DLD in French. Children with ADHD and DLD were associated with different EF and morphosyntactic profiles: children in the ADHD group demonstrated higher-order EF weakness and difficulty on the omnibus morphosyntax task, whereas children with DLD showed both lower- and higher-order limitations and struggled with both morphosyntax tasks. Our findings indicate that deficits in morphosyntax are not characteristic of ADHD but that the performance of children with ADHD can mimic morphosyntactic impairment when all-encompassing omnibus tests evaluating various and unpredictable structures are used. If morphosyntax is tested using reliable markers of atypical language development and external cognitive-load factors are optimally reduced, there are significant discrepancies in the observed ADHD-DLD outcomes. Clinical implications that include perspectives for the differential diagnosis of ADHD and DLD are discussed.

ADHD: Current Concepts and Treatments in Children and Adolescents

Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between "primary" and "secondary" ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base.

Identification of Genetic Loci Shared Between Attention-Deficit/Hyperactivity Disorder, Intelligence, and Educational Attainment

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is consistently associated with lower levels of educational attainment. A recent large genome-wide association study identified common gene variants associated with ADHD, but most of the genetic architecture remains unknown.

METHODS

We analyzed independent genome-wide association study summary statistics for ADHD (19,099 cases and 34,194 controls), educational attainment (N = 842,499), and general intelligence (N = 269,867) using a conditional/conjunctional false discovery rate (FDR) statistical framework that increases power of discovery by conditioning the FDR on overlapping associations. The genetic variants identified were characterized in terms of function, expression, and biological processes.

RESULTS

We identified 58 linkage disequilibrium-independent ADHD-associated loci (conditional FDR < 0.01), of which 30 were shared between ADHD and educational attainment or general intelligence (conjunctional FDR < 0.01) and 46 were novel risk loci for ADHD.

CONCLUSIONS

These results expand on previous genetic and epidemiological studies and support the hypothesis of a shared genetic basis between these phenotypes. Although the clinical utility of the identified loci remains to be determined, they can be used as resources to guide future studies aiming to disentangle the complex etiologies of ADHD, educational attainment, and general intelligence.

Cochlear implant outcomes in children with attention-deficit/hyperactivity disorder: Comparison with controls

OBJECTIVES

The coincidence of attention-deficit/hyperactivity disorder (ADHD) and hearing loss in the children has adverse effects in speech, cognition, communication and motor development. This can influence cochlear implant (CI) outcomes negatively. The aim of this study was to compare auditory, language, speech, cognition, communication and motor outcomes between CI children with versus without ADHD.

METHODS

Nineteen CI children with ADHD and twenty-three age and gender matched children without ADHD at the Shiraz CI center ranging in age from 37 to 60 months were participated in this cross-sectional study. The developmental quotient in auditory, receptive and expressive language, speech and cognition skills was evaluated through Newsha Developmental Scale. The Persian version of the Ages and Stages Questionnaire (ASQ) was used to assess children's developmental status in fine and gross movements, communication, problem solving, and personal-social domains. A comparison of the results between two groups was made by the Mann-Whitney test.

RESULTS

CI children with ADHD had significantly lower Newsha developmental quotients in cases of auditory, receptive and expressive language, speech and cognition skills compared to the control group (P = 0.027 to <0.001). A significant difference was observed between children with and without ADHD in fine and gross movements, communication, problem solving, and personal-social domains of ASQ at 60 months (P = 0.029 to 0.003).

CONCLUSION

Children with ADHD showed decreased ability in auditory, language, speech, cognition, motor and communication skills following CI compared to children without ADHD. It can guide clinician to provide these children with more specific rehabilitation program to improve their skills.

Use of medication for attention-deficit/hyperactivity disorder and risk of unintentional injuries in children and adolescents with co-occurring neurodevelopmental disorders

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in Sweden in children and adolescents with ADHD, including those with co-occurring NDs.

METHODS

Using a linkage of several national registers via the unique personal identification number, we identified individuals with a diagnosis of ADHD and of other NDs, including autism spectrum disorder, intellectual disability, communication disorders, learning disorders and motor disorders. The primary outcome was unintentional injuries. Secondary outcome was traumatic brain injury (TBI). Individuals were followed from January 1st 2006 or their 5th birthday or the date of the first unintentional injury, whichever came last, to December 31st 2013 or their 18th birthday or death, whichever came first. We compared the rate of injuries during periods on-treatment with the rate of injuries during periods off-treatment within the same individual using stratified Cox regression to calculate hazard ratio (HR) with 95% confidence intervals (CIs).

RESULTS

For children and adolescents with ADHD (N = 9,421) the rate of any unintentional injuries (HR = 0.85; 95% CI = 0.78-0.92) and TBIs (HR = 0.27; 95% CIs = 0.20-0.38) during medicated periods was lower than during non-medicated periods. Similar results were found among individuals with co-occurring NDs (N = 2,986), for unintentional injuries (HR = 0.88; 95% CI = 0.77-1.01) and for TBIs (HR = 0.27; 95% CI = 0.16-0.44).

CONCLUSIONS

Beneficial effects of ADHD medication may extend beyond reduction of ADHD core symptoms to prevention of unintentional injuries in children and adolescents, including individuals with co-occurring NDs.

Genetic Intersections of Language and Neuropsychiatric Conditions

PURPOSE OF REVIEW

To better understand the shared basis of language and mental health, this review examines the behavioral and neurobiological features of aberrant language in five major neuropsychiatric conditions. Special attention is paid to genes implicated in both language and neuropsychiatric disorders, as they reveal biological domains likely to underpin the processes controlling both.

RECENT FINDINGS

Abnormal language and communication are common manifestations of neuropsychiatric conditions, and children with impaired language are more likely to develop psychiatric disorders than their peers. Major themes in the genetics of both language and psychiatry include master transcriptional regulators, like FOXP2; key developmental regulators, like AUTS2; and mediators of neurotransmission, like GRIN2A and CACNA1C.

Transdiagnostic associations across communication, cognitive, and behavioural problems in a developmentally at-risk population: a network approach

BACKGROUND

Communication, behavioural, and executive function problems often co-occur in childhood. Previous attempts to identify the origins of these comorbidities have typically relied on comparisons of different deficit groups and/or latent variable models. Here we apply a network approach to a heterogeneous sample of struggling learners to conceptualise these comorbidities as a dynamic system of interacting difficulties.

METHODS

714 children struggling with attention, learning, and/or memory were included. The sample consisted of children with both diagnosed (41%) and undiagnosed difficulties. The conditional independence network of parent ratings of everyday behaviour, cognition, and communication was estimated.

RESULTS

A clustering coefficient identified four interconnected areas of difficulty: (1) structural language and learning; (2) pragmatics and peer relationships; (3) behavioural and emotional problems; and (4) cognitive skills. Emotional and behavioural symptoms shared multiple direct connections with pragmatic abilities and cognitive problems, but not with structural language skills or learning problems. Poor structural language and cognitive skills were associated with learning problems. Centrality indices highlighted working memory and language coherence as symptoms bridging different problem areas.

CONCLUSION

The network model identified four areas of difficulty and potential bridging symptoms. Although the current analytic framework does not provide causal evidence, it is possible that bridging symptoms may be the origins of comorbidities observed on a dimensional level; problems in these areas may cascade and activate problems in other areas of the network. The potential value of applying a dynamic systems network approach to symptoms of developmental disorders is discussed.

AdCom study-adolescent communication group therapy for externalising disorders

BACKGROUND

Communication difficulties are associated with oppositional symptoms in young people. We hypothesise that a communication group intervention will reduce oppositional symptoms in young people. Previous research on communication and social skills training in young people with externalising disorders is limited.

AIMS

We aimed to (1) develop and describe a group communication intervention to promote social competence in adolescents with behaviour difficulties, for use in CAMHS with those with attention-deficit/hyperactivity disorder (ADHD)/externalising disorders, and (2) collect pilot data on the effectiveness of this intervention.

METHODS

We developed and delivered a programme of eight sessions to eight adolescents aged 12 to 13 years. We describe the intervention and challenges running the programme. We present pilot study data on pre- and post-oppositional symptoms.

RESULTS

Our programme was relatively well attended; pilot data indicated a small reduction in oppositional symptoms in all participants. Challenges in running the group were noted.

CONCLUSIONS

Our pilot study data suggest that further research is needed to study the effects of a communication group intervention on oppositional symptoms in a larger number of adolescents.

Reading and writing difficulties and self-rated health among Danish adolescents: cross-sectional study from the FOCA cohort

BACKGROUND

People struggling with reading and writing difficulties may have poor odds of achieving a good and healthy life. Reading and writing difficulties are independent risk factors for not completing education and unemployment, which are essential in order to obtain a good and healthy life. Therefore, the purpose of this study was to investigate the association between reading and writing difficulties and self-rated health among adolescents, and to investigate how mental health mediates the association.

METHODS

A cross-sectional study was performed based on the FOCA cohort, a Danish population-based survey among 9th grade pupils, mainly aged 15- and 16-years old, gathered during the first months of 2017. The study population contained 9748 pupils. The dependent variable was a yes-or-no answer to experiencing limitations in every-day life due to reading and writing difficulties. The independent variable was measured with the SF-36 self-rated health question, dichotomised in high (very good, excellent) and low (good, fair, poor). A logistic regression model was applied.

RESULTS

Among the study population 953 (9.8%) pupils reported having reading and writing difficulties. The adjusted OR of having a low self-rated health was significantly higher among adolescents with reading and writing difficulties than without (1.37 (95% CI: 1.14-1.66)). Loneliness and perceived stress, explained a minor part of the association, OR attenuated from 1.77 (95% CI: 1.51-2.09) in the crude model to 1.47 (95% CI: 1.23-1.74) in a more adjusted model.

CONCLUSION

Adolescents with reading and writing difficulties are not only struggling with reading and writing difficulties but experiencing also low self-rated health. Mental health only explained a minor part of this association. To clarify whether causal relationship between reading and writing difficulties and self-rated health may exist, longitudinal studies are needed. If support for the hypothesised causality is found early identification of reading and writing difficulties is important, to prevent future health inequality in adolescents with reading and writing difficulties.