Rethinking ADHD and LD in DSM-5: proposed changes in diagnostic criteria

Is There an Association Between Cesarean Section Delivery with Specific Learning Disabilities (SLD) or/and Attention-Deficit/Hyperactivity Disorder (ADHD)? A Cross-Sectional Study in Greek Population

BACKGROUND/OBJECTIVE

Learning difficulties (LDs) are lifelong neurodevelopmental disorders with multifactorial causes, including perinatal factors like mode of delivery. This study aims to explore whether cesarean section (CS) delivery is linked to the occurrence of specific learning disabilities (SLDs), attention-deficit/hyperactivity disorder (ADHD), or their comorbidity.

METHODS

An online questionnaire was distributed via Google Forms to Greek mothers and parents of children with and without diagnoses, shared through school-related groups and various Greek pages focused on child development, special education, and learning difficulties. Conducted over eight months (October 2023-May 2024), this cross-sectional study involved 256 children, 137 with LDs diagnoses, and 119 controls.

RESULTS

In total, 59.9% of CS-born children had a diagnosis, compared to 40.1% of those born vaginally (X²(1) = 4.19, p = 0.045). CS delivery was associated with a 68% increased likelihood of LDs (OR = 1.68, 95% CI [1.02, 2.76]), with higher risks for ADHD (OR = 2.25, 95% CI [1.06, 4.79]) and comorbid SLD/ADHD diagnoses (OR = 2.75, 95% CI [1.17, 6.46]). Stratified analyses showed birthweight and gestational age as effect modifiers rather than confounders. Key postnatal risk factors identified were family history (OR = 4.65, 95% CI [2.41, 8.94]) and language acquisition difficulties (OR = 5.28, 95% CI [1.36, 20.47]).

CONCLUSIONS

The findings suggest a possible association between CS and LDs, along with a novel link between CS and increased comorbidities. These results underscore the need for further research and provide valuable insights into how CS delivery may influence the risk of LDs, depending on the type of diagnosis.

Cognitive profiles and developmental variations in ADHD: A comparative analysis of childhood and adolescent diagnoses

This retrospective study investigates the cognitive profiles of individuals with ADHD, categorized by the age at which they were diagnosed-either during childhood or adolescence. The sample comprised 424 participants aged 6 to 20 years, with a predominance of males. Participants were assessed using a variety of neuropsychological standardized tests. The study found significant differences in cognitive performance between those diagnosed in childhood and those diagnosed in adolescence. Specifically, childhood diagnoses were associated with poorer performance in vigilance, selective attention, and motor control, while adolescent diagnoses were linked to lower scores in the environment's perception of their flexibility, working memory, and planning. Binary logistic regression analyses indicated that the neuropsychological profile for the combined ADHD subtype did not vary by age group, in contrast with the inattentive subtype, in which different cognitive constructs were identified serving as significant predictors. Findings suggest that the cognitive challenges associated with ADHD evolve with development, highlighting the need for age-appropriate diagnostic criteria and interventions.

Is There a Deficit in Product and Process of Handwriting in Children with Attention Deficit Hyperactivity Disorder? A Systematic Review and Recommendations for Future Research

Handwriting abnormalities in children with attention deficit hyperactivity disorder (ADHD) have sometimes been reported both (i) at the product level (i.e., quality/legibility of the written trace and speed of writing) and (ii) at the process level (i.e., dynamic and kinematic features, such as on-paper and in-air durations, pen pressure and velocity peaks, etc.). Conversely, other works have failed to reveal any differences between ADHD and typically developing children. The question of the presence and nature of handwriting deficits in ADHD remains open and merits an in-depth examination. The aim of this systematic review was, therefore, to identify studies that have investigated the product and/or process of handwriting in children with ADHD compared to typically developing individuals. This review was conducted and reported in accordance with the PRISMA statement. A literature search was carried out using three electronic databases. The methodological quality of the studies was systematically assessed using the Critical Appraisal Skills Program (CASP) criteria. Twenty-one articles were identified. Of these, 17 described handwriting quality/legibility, 12 focused on speed and 14 analyzed the handwriting process. All the studies (100%) with satisfactory methodology procedures reported an impaired product and process in children with ADHD, while 25% evidenced a difference in the speed of production. Most importantly, the studies differed widely in their methodological approaches. Substantial gaps remain, particularly with regard to ascertaining comorbidities, ADHD subtypes and the medical status of the included children. The lack of overall homogeneity in the samples calls for higher quality studies. We conclude with recommendations for further studies.

Personal Values and Sustained Attention as Predictors of Children's Helping Behavior in Middle Childhood

OBJECTIVE

This study tested the effect of personal values (motivation) and sustained attention (cognitive ability) on children's helping behavior.

METHOD

Children (N = 162, age range 8-9 years, mean = 8.81, SD =.43) completed value ranking and go/no-go tasks, and their helping behavior was examined.

RESULTS

Children who valued self-transcendence over self-enhancement helped more than others. Surprisingly, children's lack of sustained attention was associated with more helping among those who valued self-transcendence over self-enhancement or openness-to-change over conservation values. Valuing both self-transcendence and openness-to-change was also associated with more helping.

CONCLUSIONS

Children are more likely to help others if they value self-transcendence and openness to change. Notably, children's tendency to act upon these values may be facilitated (rather than obstructed by) low attention skills.

Discerning Developmental Dyscalculia and Neurodevelopmental Models of Numerical Cognition in a Disadvantaged Educational Context

Developmental Dyscalculia (DD) signifies a failure in representing quantities, which impairs the performance of basic math operations and schooling achievement during childhood. The lack of specificity in assessment measures and respective cut-offs are the most challenging factors to identify children with DD, particularly in disadvantaged educational contexts. This research is focused on a numerical cognition battery for children, designed to diagnose DD through 12 subtests. The aims of the present study were twofold: to examine the prevalence of DD in a country with generally low educational attainment, by comparing z-scores and percentiles, and to test three neurodevelopmental models of numerical cognition based on performance in this battery. Participants were 304 Brazilian school children aged 7–12 years of both sexes (143 girls), assessed by the Zareki-R. Performances on subtests and the total score increase with age without gender differences. The prevalence of DD was 4.6% using the fifth percentile and increased to 7.4% via z-score (in total 22 out of 304 children were diagnosed with DD). We suggest that a minus 1.5 standard deviation in the total score of the Zareki-R is a useful criterion in the clinical or educational context. Nevertheless, a percentile ≤ 5 seems more suitable for research purposes, especially in developing countries because the socioeconomic environment or/and educational background are strong confounder factors to diagnosis. The four-factor structure, based on von Aster and Shalev’s model of numerical cognition (Number Sense, Number Comprehension, Number Production and Calculation), was the best model, with significant correlations ranging from 0.89 to 0.97 at the 0.001 level.

Prenatal risk factors and genetic causes of ADHD in children

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is a common disease among children; it affected 5-7% of the population in 2015. ADHD is a multifactorial disease, and its etiology is still not clearly understood.

DATA SOURCES

This narrative review has been done by searching the PubMed and Embase databases using attention deficit/hyperactivity disorder, ADHD, risk factors; genetics; pediatrics; psychiatrics as keywords.

RESULTS

ADHD is considered to be a hereditary disorder in which genes play the fundamental role in the pathogenesis; however, findings from genetic-environmental studies support the hypothesis that genetic factors can exert effects on an individual's condition by determining his/her responses to environmental exposures, especially those during the prenatal stage.

CONCLUSION

ADHD is considered as a hereditary disorder in which genes and prenatal risk factors play fundamental roles in the pathogenesis.

Are Different Types of Learning Disorder Associated With Distinct Cognitive Functioning Profiles?

Introduction: DSM-5 presented a revised conceptualization of specific learning disorders (LD). Contrary to former versions, the various types of LD-i.e., mathematics disorder, reading disorder, and writing disorder-are not treated as distinct diagnostic entities but are integrated into one single LD category. In support of this new classification, it has been argued that the various types of LD overlap to a great extent in their cognitive functioning profiles and therefore do not exhibit a distinct set of cognitive causes. In contrast, ICD-11 still adheres to the idea of discrete categories and thus follows the specificity hypothesis of LD. Using latent profile analysis (LPA), we therefore tested the specificity of cognitive strengths and weaknesses in children with different types of LD. Secondly, we aimed at examining the extent to which observed LD characteristics (type and severity of LD as well as IQ-achievement discrepancy) were consistent with the membership of a given latent profile. Method: 302 German third-graders (134 girls; IQ ≥ 85; M age = 111.05 months; SD = 5.76) with single or comorbid types of LD in the domains of mathematics, reading, and spelling completed a wide range of domain-specific and domain-general cognitive functioning measures. Results: Five qualitative distinct profiles of cognitive strengths and weaknesses were identified. Profile 1 (23% of the sample) showed Comprehensive Cognitive Deficits, performing low in all measures except for naming speed, language, and inhibition. Profile 2 (21%) included children with a Double Deficit in Phonological Awareness and Phonological Short-term Memory. Profile 3 (20%) was characterized by a Double Deficit of Phonological Awareness and Naming Speed. Profile 4 (19%) included children with a Single Deficit in Attention, and profile 5 (17%) consisted of children without any cognitive deficits. Moreover, type and severity of LD as well as IQ-achievement discrepancy discriminated between the profiles, which is in line with the specificity hypothesis of LD. Discussion: Overall, the finding of specific associations between the LD types and the identified cognitive profiles supports the ICD-11 classification of LD. Yet, those inferences may not be valid for an individual child but need to be examined through comprehensive diagnostic.

Sluggish Cognitive Tempo and Neuropsychological Functioning

Sluggish cognitive tempo (SCT) is marked by impairments across social, emotional, and academic functioning, but few studies have examined the association between SCT and neuropsychological functioning. The present study examined the associations between SCT and measures of processing speed, executive function, attention, and reaction time. From a larger sample of 8,238 children and adolescents, a subsample of 928 children were overselected for symptoms of SCT or attention-deficit/hyperactivity disorder (ADHD) and compared to a matched control sample of 652 individuals without elevations of ADHD or SCT (age range = 5.9-15.4 years). Multiple regression analyses revealed that symptoms of SCT were independently associated with deficits in nearly all domains assessed by a battery of neuropsychological assessments, including slower processing speed, poorer working memory, decreased inhibition, poorer vigilance, and increased reaction time. Further, weaknesses in all five of these domains remained significant even after symptoms of ADHD-inattention, anxiety, and depression were controlled. These findings add to literature that supports the validity of SCT as a symptom profile separate from ADHD-inattention symptoms.

Differential Diagnosis of Sluggish Cognitive Tempo Symptoms in College Students

Objective: Sluggish cognitive tempo (SCT) refers to a set of symptoms that prior research has found to be related to several different psychological disorders, especially the predominantly inattentive presentation of ADHD. This study collected evidence relevant to the question of whether SCT is a distinct disorder. Method: College students (N = 910) completed measures of SCT, ADHD, depression, anxiety, sleep quality, and substance misuse. Results: Students reporting clinically high SCT (reporting at least five symptoms often or very often) had significantly higher levels and rates of other types of psychopathology. Moreover, when students reporting clinically significant levels of ADHD, depression, and anxiety symptoms, poor sleep quality, or hazardous levels of alcohol or cannabis use were removed, very few students reporting high SCT remained (only 4.8% of the original high-SCT group). Conclusion: SCT may be best thought of as a symptom set common to many types of psychopathology, and it may be caused by sleep problems or substance misuse as well.

The quandary of diagnosing mathematical difficulties in a generally low performing population

Brazilian students' mathematical achievement was repeatedly observed to fall below average levels of mathematical attainment in international studies such as PISA.

Objective

In this article, we argue that this general low level of mathematical attainment may interfere with the diagnosis of developmental dyscalculia when a psychometric criterion is used establishing an arbitrary cut-off (e.g., performance<percentile 10) may result in misleading diagnoses.

Methods

Therefore, the present study evaluated the performance of 706 Brazilian school children from 3^rd to 5^th grades on basic arithmetic operations addition, subtraction, and multiplication.

Results

In line with PISA results, children presented difficulties in all arithmetic operations investigated. Even after five years of formal schooling, less than half of 5^th graders performed perfectly on simple addition, subtraction, or multiplication problems.

Conclusions

As such, these data substantiate the argument that the sole use of a psychometric criterion might not be sensible to diagnose dyscalculia in the context of a generally low performing population, such as Brazilian children of our sample. When the majority of children perform poorly on the task at hand, it is hard to distinguish atypical from typical numerical development. As such, other diagnostic approaches, such as Response to Intervention, might be more suitable in such a context.

The Efficacy of Parent-Child Interaction Therapy (PCIT) in Children with Attention Problems, Hyperactivity, and Impulsivity in Dubai

Disruptive behaviors can be associated with significant functional impairment. Early intervention for young children is essential to prevent long-term consequences. Parent-Child Interaction Therapy (PCIT) is a psychotherapeutic intervention, which has shown to be effective for children with externalizing symptoms. We present the treatment course of PCIT for two kindergarten children. The first has Attention-Deficit/Hyperactivity Disorder (ADHD), and the second has frontal lobe epilepsy. Both presented with attention problems, hyperactivity, and impulsivity associated with significant impairment in multiple settings. Two certified PCIT therapists provided 17 sessions to the parents of the first patient and 25 sessions to the parents of the second patient. Most of the sessions were in-person; however, some were “virtual” due to the circumstances associated with the COVID-19 pandemic. Parents of both patients achieved the “mastery” criteria. In both cases, PCIT contributed to improving the disruptive behaviors. PCIT may serve as an effective therapeutic option for young children with externalizing symptoms in Dubai.

Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: an umbrella review

BACKGROUND

Many potential environmental risk factors, environmental protective factors, and peripheral biomarkers for ADHD have been investigated, but the consistency and magnitude of their effects are unclear. We aimed to systematically appraise the published evidence of association between potential risk factors, protective factors, or peripheral biomarkers, and ADHD.

METHODS

In this umbrella review of meta-analyses, we searched PubMed including MEDLINE, Embase, and the Cochrane Database of Systematic Reviews, from database inception to Oct 31, 2019, and screened the references of relevant articles. We included systematic reviews that provided meta-analyses of observational studies that examined associations of potential environmental risk factors, environmental protective factors, or peripheral biomarkers with diagnosis of ADHD. We included meta-analyses that used categorical ADHD diagnosis criteria according to DSM, hyperkinetic disorder according to ICD, or criteria that were less rigorous than DSM or ICD, such as self-report. We excluded articles that did not examine environmental risk factors, environmental protective factors, or peripheral biomarkers of ADHD; articles that did not include a meta-analysis; and articles that did not present enough data for re-analysis. We excluded non-human studies, primary studies, genetic studies, and conference abstracts. We calculated summary effect estimates (odds ratio [OR], relative risk [RR], weighted mean difference [WMD], Cohen's d, and Hedges' g), 95% CI, heterogeneity I² statistic, 95% prediction interval, small study effects, and excess significance biases. We did analyses under credibility ceilings, and assessed the quality of the meta-analyses with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). This study is registered with PROSPERO, number CRD42019145032.

FINDINGS

We identified 1839 articles, of which 35 were eligible for inclusion. These 35 articles yielded 63 meta-analyses encompassing 40 environmental risk factors and environmental protective factors (median cases 16 850, median population 91 954) and 23 peripheral biomarkers (median cases 175, median controls 187). Evidence of association was convincing (class I) for maternal pre-pregnancy obesity (OR 1·63, 95% CI 1·49 to 1·77), childhood eczema (1·31, 1·20 to 1·44), hypertensive disorders during pregnancy (1·29, 1·22 to 1·36), pre-eclampsia (1·28, 1·21 to 1·35), and maternal acetaminophen exposure during pregnancy (RR 1·25, 95% CI 1·17 to 1·34). Evidence of association was highly suggestive (class II) for maternal smoking during pregnancy (OR 1·6, 95% CI 1·45 to 1·76), childhood asthma (1·51, 1·4 to 1·63), maternal pre-pregnancy overweight (1·28, 1·21 to 1·35), and serum vitamin D (WMD -6·93, 95% CI -9·34 to -4·51).

INTERPRETATION

Maternal pre-pregnancy obesity and overweight; pre-eclampsia, hypertension, acetaminophen exposure, and smoking during pregnancy; and childhood atopic diseases were strongly associated with ADHD. Previous familial studies suggest that maternal pre-pregnancy obesity, overweight, and smoking during pregnancy are confounded by familial or genetic factors, and further high-quality studies are therefore required to establish causality.

FUNDING

None.

Prevalence and characteristics of South African treatment-seeking patients with substance use disorder and co-occurring attention-deficit/hyperactivity disorder

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) constitutes a significant risk factor for the development of Substance Use Disorders (SUDs). Individuals with both conditions use more substances, and the pattern of substance use seems to differ between individuals with and without ADHD.

RESEARCH AIM AND OBJECTIVES

To establish the prevalence of ADHD symptoms in adult South African treatment-seeking patients with SUD, and the pattern of substance use and presence of previous ADHD diagnoses and pharmacotherapy.

METHODS

Adult patients (N = 360) were recruited from rehabilitation facilities and screened using the ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1). Questions included demographics, substance consumption and current/historical use of ADHD-indicated medication.

RESULTS

A third (36.0%) of patients with SUD screened positive for ADHD - 14.6% had been diagnosed with ADHD prior to admission, and indicated pharmacotherapy, while 68.5% of those screened positive were not hitherto diagnosed with ADHD (p < 0.001). A statistical difference was found for polysubstance use with the ADHD group significantly being treated more frequently for use of more than one substance (p = 0.04).

CONCLUSIONS AND IMPLICATIONS

High rates of untreated and unrecognized ADHD were found among treatment-seeking SUD patients. Preventative strategies are crucial to reduce substance use and the development of SUD in individuals affected by ADHD.

Methylphenidate challenge test in adults with attention deficit/hyperactivity disorder (ADHD): Clinical effects and their predictors

OBJECTIVE

Adult and children attention deficit/hyperactivity disorder (ADHD) share similar symptoms and responses to drugs such as methylphenidate (MPH). Yet, in Europe, these drugs remain unlicensed for adults. We aimed to assess the effects of an acute MPH challenge on the four dimensions concentration, impulsivity, tension, and general well-being in ADHD adults, and identify predictors of improvement.

METHODS

Therapeutic Drug Monitoring was performed to measure MPH plasma levels. A Visual Analogue Scale was administered to patients before and after the acute MPH challenge to measure self-reported changes in the four dimensions.

RESULTS

After the acute MPH challenge, our 71 patients showed significant improvement in concentration and tension. The MPH challenge dose correlated with lower patients' age, greater side effects, increased concentration (p = .008) and decreased tension (p = .001). At multiple linear regression MPH plasma levels and absence of postdose side effects predicted concentration improvement, MPH plasma levels predicted tension improvement. MPH plasma levels were significantly higher in patients who reported an improvement in concentration, tension, and impulsivity compared to nonimprovers (p's from .001 to .004).

CONCLUSIONS

These findings point to the efficacy of MPH challenge in improving concentration and tension in adult ADHD, thus emphasizing the need for a broader treatment access for these patients.

Intellectual Profiles in Children With ADHD and Comorbid Learning and Motor Disorders

Objective: Neurodevelopmental disorders, including Reading Disorder, Disorder of Written Expression, and Developmental Coordination Disorder, often co-occur with ADHD. Although research has identified increased functional impairment in the presence of these comorbid diagnoses, few direct comparisons of intellectual profiles have been conducted. Thus, the present study examined Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) profiles of children with ADHD alone and with comorbid neurodevelopmental disorders. Method: Participants included 296 children with ADHD, ADHD with Developmental Coordination Disorder, and ADHD with Reading Disorder and/or Disorder of Written Expression. Results: Comparisons of these groups suggests children with ADHD and language-based Learning Disorders have poorer working memory than children with only ADHD. Furthermore, children with ADHD and Developmental Coordination Disorder perform relatively better on verbal compared with perceptual reasoning indexes. Conclusion: These intellectual profiles may have utility in identifying cognitive weaknesses inherent to these disorders and may be used to guide treatment intervention.

ADHD Symptoms in Adolescents' Everyday Life: Fluctuations and Symptom Structure Within and Between Individuals

Objective: This study investigated whether self-reported ADHD symptoms fluctuate substantially within adolescents from day to day, and examined the underlying symptom factor structure on a within- and between-person level. Method: Adolescents (N = 166) rated their ADHD symptoms over the phone on eight consecutive evenings (total ratings: n = 1,264). Results: ADHD symptoms showed substantial fluctuations within adolescents from day to day, as indicated by within-person standard deviations and intraclass correlation coefficients. Both a two-level factor model with three correlated factors (inattention, hyperactivity, impulsivity) and a two-level bifactor model with a general ADHD symptom factor and a specific inattention factor provided acceptable to good accounts of the structure underlying daily ADHD symptom ratings on the between- and the within-person level. Conclusion: The study demonstrates that adolescents' ADHD symptoms fluctuate from day to day and highlights the need for intensive diagnostic processes with repeated symptom assessments and interventions that address symptom fluctuations.

The influence of mindfulness meditation on inattention and physiological markers of stress on students with learning disabilities and/or attention deficit hyperactivity disorder

BACKGROUND

Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education.

AIMS

The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group.

METHODS

Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected.

RESULTS

Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group.

CONCLUSIONS

Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students.

Comparison of Neuropsychological Functioning Between Adults With Early- and Late-Onset DSM-5 ADHD

Objective: We aimed to compare the visually dependent neuropsychological functioning among adults with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD who recalled symptom onset by and after age 7 and non-ADHD controls. Method: We divided the participants, aged 17 to 40 years, into three groups-(a) ADHD, onset <7 years (early-onset, n = 142); (b) ADHD, onset between 7 and <12 years (late-onset, n = 41); (c) non-ADHD controls (n = 148)-and compared their neuropsychological functioning, measured by the Cambridge Neuropsychological Testing Automated Battery. Results: Both ADHD groups had deficits in attention and signal detectability, spatial working memory, and short-term spatial memory, but only the early-onset group showed deficits in alertness, set-shifting, and planning after controlling for age, sex, and psychiatric comorbidities. There was no statistical difference between the two ADHD groups in neuropsychological functioning. Conclusion:DSM-5 criteria for diagnosing adult ADHD are not too lax regarding neuropsychological functioning.

The Child Evaluation Checklist (CHECK): A Screening Questionnaire for Detecting Daily Functional "Red Flags" of Underrecognized Neurodevelopmental Disorders among Preschool Children

Background

Early identification of invisible comorbid neurodevelopmental disorders, such as specific learning disorders, attention deficit hyperactive disorders, and developmental coordination disorders, is crucial to improving children's daily functional deficits related to executive functions. However, a practical questionnaire to address parents' concerns is lacking.

Aims

To develop a reliable and valid assessment tool that can identify young children at risk for invisible underrecognized neurodevelopmental disorders. This article describes the development and standardization of the Child Evaluation Checklist (CHECK).

Methods and Procedures

Participants were 186 children aged 3 to 6 years: 91 with suspected invisible neurodevelopmental disorders, and 95 controls with typical development. Parents completed a demographic questionnaire, the CHECK, and the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P).

Outcomes and Results

The CHECK's construct validity indicated high internal consistency for each part (Part A: α = .94; Part B: α = .90) and moderate-to-high consistency for each of Part A's four factors. Significant correlations, as well as significant group differences, were found between the CHECK factors and BRIEF-P scores.

Conclusions and Implications

Use of the CHECK allows for timely identification of suspicious ("red flags") invisible neurodevelopmental disorders. It may support parents' sufficient awareness and knowledge to refer their children for comprehensive evaluation and intervention.

Validity and Reliability of the Dyslexia Checklist for Chinese Children

The study on developmental dyslexia (DD) has fairly matured in the past decades, even when there is a lack of a standardized and convenient instrument for dyslexia in the Chinese population. The purpose of this study was to assess the reliability and validity of the Dyslexia Checklist for Chinese Children (DCCC), which was administered to Chinese students in primary school. A total of 545 students from grades 2 through 6 were recruited in Wuhan to participate in this study. We used confirmatory factor analysis (CFA) to evaluate the structure validity of the DCCC. Concurrent validity was determined via correlations between the DCCC and the verbal comprehension index (VCI), and Chinese achievement. The reliability of the DCCC was assessed via test-retest reliability and internal consistency. The CFA suggested that the first order model with eight factors and 55 items fit the data well (RMSEA = 0.057, CFI = 0.930, and TLI = 0.925). The DCCC was negatively associated with VCI (r = −0.218) and Chinese achievement (r = −0.372). The test-retest reliability of the DCCC was 0.734, and the internal consistency of all subscales was above 0.752. The DCCC thus proved to have adequate validity and reliability to screen Chinese dyslexia among students in grades 2 through 6.

Characterization of two familial cases presenting with a syndromic specific learning disorder and carrying (17q;21q) unbalanced translocations

Chromosomal microarray (CMA) can detect pathogenic copy number variations in 15–20% of individuals with intellectual disability and in 10% of patients with autism spectrum disorders. The diagnostic rate in specific learning disorders (SLD) is unknown. Our study emphasizes the usefulness of CMA in the diagnostic workout assessment of familial SLD.

Neonatal systemic inflammation and the risk of low scores on measures of reading and mathematics achievement at age 10 years among children born extremely preterm

BACKGROUND

Difficulties with reading and math occur more commonly among children born extremely preterm than among children born at term. Reasons for this are unclear.

METHODS

We measured the concentrations of 27 inflammatory-related and neurotrophic/angiogenic proteins (angio-neurotrophic proteins) in multiple blood specimens collected a week apart during the first postnatal month from 660 children born before the 28th week of gestation who at age 10 years had an IQ ≥ 70 and a Wechsler Individual Achievement Test 3rd edition (WIAT-III) assessment. We identified four groups of children, those who had a Z-score ≤ -1 on the Word Reading assessment only, on the Numerical Operations assessment only, on both of these assessments, and on neither, which served as the referent group. We then modeled the risk of each learning limitation associated with a top quartile concentration of each protein, and with high and lower concentrations of multiple proteins.

RESULTS

The protein profile of low reading scores was confined to the third and fourth postnatal weeks when increased risks were associated with high concentrations of IL-8 and ICAM-1 in the presence of low concentrations of angio-neurotrophic proteins. The profile of low math scores was very similar, except it did not include ICAM-1. In contrast, the profile of low scores on both assessments was present in each of the first four postnatal weeks. The increased risks associated with high concentrations of TNF-α in the first two weeks and of IL-8 and ICAM-1 in the next two weeks were modulated down by high concentrations of angio-neurotrophic proteins.

CONCLUSIONS

High concentrations of angio-neurotrophic proteins appear to reduce/moderate the risk of each learning limitation associated with systemic inflammation. The three categories of limitations have protein profiles with some similarities, and yet some differences, too.

Trait Impulsivity and the Externalizing Spectrum

This article reviews evidence that trait impulsivity-expressed early in life as the hyperactive-impulsive and combined presentations of attention-deficit/hyperactivity disorder (ADHD)-is a bottom-up, subcortically mediated vulnerability to all externalizing disorders. This vulnerability arises from deficient mesolimbic dopamine responding, which imbues psychological states (irritability, discontentment) that motivate excessive approach behavior (hyperactivity, impulsivity). Through complex interactions with (a) aversive motivational states that arise from largely independent subcortical systems, (b) emotion regulatory mechanisms that arise from top-down, cortical modulation of subcortical neural function, and (c) environmental risk factors that shape and maintain emotion dysregulation, trait impulsivity confers vulnerability to increasingly severe externalizing behaviors across development. This perspective highlights the importance of identifying transdiagnostic neural vulnerabilities to psychopathology; dovetails with the hierarchical, latent structure of psychopathology; and suggests that progression along the externalizing spectrum is an ontogenic process whereby a common, multifactorially inherited trait interacts with endogenous and exogenous influences to yield increasingly intractable externalizing behaviors across development.

Early numeracy skills in preschool-aged children: a review of neurocognitive findings and implications for assessment and intervention

OBJECTIVES

The goals are to (1) provide a review of the typical and atypical development of early numeracy; (2) present what is known about the neurocognitive underpinnings of early numeracy; and (3) discuss the implications for early assessment and intervention.

METHOD

Studies on the development of typical and atypical early numeracy are reviewed with a particular focus on longitudinal findings including those from our work on spina bifida myelomeningocele. Implications of this research for assessment are presented. The paper ends with a discussion of early math interventions.

RESULTS

Learning to count, identify numbers, and compare and manipulate quantities are key early numeracy skills. These are powerful predictors of school-age mathematical learning and performance. General neurocognitive abilities such as working memory and language, are also important for the development of early numeracy. It is recommended that early assessment for risk of mathematical learning difficulties include tests of both early number knowledge and key neurocognitive abilities. Math-specific interventions are most effective for improving early numeracy. There is currently little evidence that training of general cognitive functions transfers to mathematical learning.

CONCLUSION

Understanding the development of early numeracy skills and their neurocognitive predictors offer important insights into early assessment and intervention for children at risk for or with mathematical learning difficulties.

Cognitive Clusters in Specific Learning Disorder

The heterogeneity among children with learning disabilities still represents a barrier and a challenge in their conceptualization. Although a dimensional approach has been gaining support, the categorical approach is still the most adopted, as in the recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The introduction of the single overarching diagnostic category of specific learning disorder (SLD) could underemphasize interindividual clinical differences regarding intracategory cognitive functioning and learning proficiency, according to current models of multiple cognitive deficits at the basis of neurodevelopmental disorders. The characterization of specific cognitive profiles associated with an already manifest SLD could help identify possible early cognitive markers of SLD risk and distinct trajectories of atypical cognitive development leading to SLD. In this perspective, we applied a cluster analysis to identify groups of children with a Diagnostic and Statistical Manual-based diagnosis of SLD with similar cognitive profiles and to describe the association between clusters and SLD subtypes. A sample of 205 children with a diagnosis of SLD were enrolled. Cluster analyses (agglomerative hierarchical and nonhierarchical iterative clustering technique) were used successively on 10 core subtests of the Wechsler Intelligence Scale for Children-Fourth Edition. The 4-cluster solution was adopted, and external validation found differences in terms of SLD subtype frequencies and learning proficiency among clusters. Clinical implications of these findings are discussed, tracing directions for further studies.

Attention Functioning Among Adolescents With Multiple Learning, Attentional, Behavioral, and Emotional Difficulties

Attention-deficit/hyperactivity disorder (ADHD) is characterized by high levels of inattention, hyperactivity, and impulsivity; however, these symptoms can result from a variety of reasons. To obtain a comprehensive understanding of the various difficulties of individuals with ADHD, especially when co-occurrence difficulties are present, it is essential to combine neuropsychological and subjective assessment tools. In the present field study the authors investigated a group of adolescents with multiple deficits (MD) using neuropsychological and subjective measures. Teachers' ratings verified extremely high levels of symptoms of oppositional behavior, inattention, hyperactivity-impulsivity, social problems, and emotional problems in this group. As expected, MD group participants showed decreased abilities to maintain attention on task for a long period of time, focus attention and effectively inhibit adjacent distractors, and resist conflicting irrelevant information. Importantly, although significant differences in the attention measures were observed at the group level, not all MD participants displayed deviant performance. Thus, we conclude that the heterogeneous group of adolescents with MD comprises individuals with primary attention deficits as well as those with other nonattentional deficits that show equivalent behavioral symptoms. Using neuropsychological tools can be useful in differentiating between different core deficits and in guiding appropriate interventions.

Specific Language Impairment: Evaluation and detection of differential psycholinguistic markers in phonology and morphosyntax in Spanish-speaking children

BACKGROUND

The diagnosis of Specific Language Impairment (SLI) is very complex, given the variety of clinical pictures described in this disorder. Knowledge about the linguistic markers of SLI can facilitate its differentiation from the normal profile of language development. These markers can also be used as tools that may improve diagnostic.

AIMS

To determine which psycholinguistic markers best discriminate Spanish-speaking children with SLI from children with typical language development.

METHOD AND PROCEDURE

The performance of 31 Spanish-speaking children with SLI was analysed using a battery of 13 psycholinguistic tasks organized into two areas: phonology and morphosyntax. The performance of the SLI group was compared to that of two subgroups of controls: aged matched (CA) and linguistically matched (CL).

OUTCOMES AND RESULTS

The data show that the SLI group performed worse than the CA subgroup on all 13 verbal tasks. However, the performance of the SLI group did not significantly differ from that of the CL subgroup on most (11/13) of the tasks. Stepwise discriminant analysis established the canonical function of three tasks (morphologic integration, sentence understanding and diadochokinesis) which significantly discriminated SLI from CA, with sensitivity 84% and specificity 90%.

CONCLUSIONS AND IMPLICATIONS

These results contribute to determining the psycholinguistic and clinical characteristics of SLI in Spanish-speaking children and provide some methods for screening assessment.

Validity of proposed DSM-5 ADHD impulsivity symptoms in children

The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.

Rapid Naming and Phonemic Awareness in Children With or Without Reading Disabilities and/or ADHD

Employing a large sample of children from Dutch regular elementary schools, this study assessed the contributing and discriminating values of reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD) to two types of phonological processing skills, phonemic awareness (PA) and rapid automatized naming (RAN). A second objective was to investigate whether comorbidity of RD and ADHD should be considered as an additive phenomenon as to RAN and PA. A total of 1,262 children, aged 8 to 13 years, were classified as RD ( n = 121), ADHD ( n = 17), comorbid (RD+ADHD; n = 16), or control ( n = 1,108). Phonological processing was assessed by standardized tests of PA and RAN. Disability groups were compared to each other and contrasted to the control group. Although results indicate substantial effects for all three disability groups on both types of phonological processing, and the RAN/PA compound measure in particular, effect sizes were considerably larger for the RD groups, as compared to the ADHD-only group. Theoretical and practical implications are discussed.

ADHD in context: Young adults' reports of the impact of occupational environment on the manifestation of ADHD

Does changing context play a role in the decline in ADHD symptoms in adulthood? Insufficient research has explored the functioning of adults with ADHD. As adults, individuals with ADHD have significantly more latitude to control aspects of their day-to-day environments. Do the new contexts young adults find themselves in alter their experience of ADHD? Are there particular occupational or educational contexts in which young adults report functioning better than others? To examine this issue, we conducted semi-structured interviews at four North American sites in 2010-11 with 125 young adults, originally diagnosed with ADHD as children, regarding their work and post-secondary educational environments. Many subjects describe their symptoms as context-dependent. In some contexts, participants report feeling better able to focus; in others, their symptoms-such as high energy levels-become strengths rather than liabilities. Modal descriptions included tasks that were stressful and challenging, novel and required multitasking, busy and fast-paced, physically demanding or hands-on, and/or intrinsically interesting. Consistent with a developmental psychopathology framework, ADHD is experienced as arising from an interaction between our subjects and their environments. These findings demonstrate the need to account for the role of context in our understanding of ADHD as a psychiatric disorder, especially as it manifests in young adulthood.

Adult attention-deficit hyperactivity disorder: key conceptual issues

For many years, attention-deficit hyperactivity disorder (ADHD) was thought to be a childhood-onset disorder that has a limited effect on adult psychopathology. However, the symptoms and impairments that define ADHD often affect the adult population, with similar responses to drugs such as methylphenidate, dexamphetamine, and atomoxetine, and psychosocial interventions, to those seen in children and adolescents. As a result, awareness of ADHD in adults has rapidly increased and new clinical practice has emerged across the world. Despite this progress, treatment of adult ADHD in Europe and many other regions of the world is not yet common practice, and diagnostic services are often unavailable or restricted to a few specialist centres. This situation is remarkable given the strong evidence base for safe and effective treatments. Here we address some of the key conceptual issues surrounding the diagnosis of ADHD relevant to practising health-care professionals working with adult populations. We conclude that ADHD should be recognised in the same way as other common adult mental health disorders, and that failure to recognise and treat ADHD is detrimental to the wellbeing of many patients seeking help for common mental health problems.

Pilot study of brain morphometry in a sample of Brazilian children with attention deficit hyperactivity disorder: influence of clinical presentation

PURPOSE

Currently, the diagnosis of attention deficit hyperactivity disorder (ADHD) rests on clinical criteria. Nonetheless, neuroimaging studies have demonstrated that children with ADHD have different cortical thickness and volume measures to typically developing children (TDC). In general, studies do not evaluate the influence of clinical presentation in the brain morphometry of ADHD children. Our objective was to perform a pilot study in order to evaluate cortical thickness and brain volume in a sample of Brazilian ADHD children and compare these to those of TDC, taking into account the influence of clinical presentation.

METHODS

We performed an analytic study comparing 17 drug-naïve ADHD children of both genders, aged between 7 and 10, and 16 TDC. ADHD subjects were first considered as one group and further separated based on clinical presentation.

RESULTS

The brain volume did not differ between patients and TDC. Smaller cortical thicknesses were identified on the left superior, medium and inferior temporal cortex, as well as in the left inferior parietal cortex. When compared to TDC, combined and inattentive ADHD presentations depicted smaller cortical thickness with high significance and power. The same magnitude of results was not observed when comparing inattentive ADHD and TDC.

CONCLUSIONS

In this pilot study, ADHD is associated with abnormalities involving the cortical thickness of the posterior attentional system. The cortical thickness in the left superior, medium and inferior temporal cortex, as well as in the left inferior parietal cortex may differ according to ADHD presentations.

WISC-IV Intellectual Profiles in Italian Children With Specific Learning Disorder and Related Impairments in Reading, Written Expression, and Mathematics

The fifth edition of theDiagnostic and Statistical Manual of Mental Disordersgrouped specific learning disabilities in the single diagnostic category of specific learning disorder (SLD), with specifiers for impairments in reading, written expression, and mathematics. This study aimed at investigating the intellectual profile, assessed with the fourth edition of theWechsler Intelligence Scale for Children(WISC-IV), of 172 children with a diagnosis of SLD, compared to 74 clinical referral controls. WISC-IV intellectual functioning in children with SLD was characterized by a significant discrepancy between general ability and cognitive proficiency (General Ability Index [GAI] > Cognitive Proficiency Index [CPI]), and worse performances on the Similarities, Digit Span, Letter-Number Sequencing, and Coding subtests, supporting models of multiple cognitive deficits at the basis of neurodevelopmental disorders as SLD. GAI was the best and more conservative measure provided by the WISC-IV to identify intellectual functioning in children with SLD, and the intellectual discrepancy between GAI and CPI could be considered a "cognitive sign" for the presence of SLD in a single diagnostic category. Cognitive deficits differed in subtypes of impairment (reading, written expression, and mathematics), supporting their distinction for empirical, educational, and rehabilitative purposes. These findings need further replication in larger samples and in comparison to typically developing children.

The written expression abilities of adolescents with Attention-Deficit/Hyperactivity Disorder

Students with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience deficits in academic achievement. Written expression abilities in this population have not been extensively studied but existing prevalence estimates suggest that rates of comorbid writing underachievement may be substantially higher than rates of comorbid reading and mathematics underachievement. The current study examined written expression abilities in a school-based sample of 326 middle school age students with ADHD. The prevalence of written expression impairment, the associations between written expression and academic outcomes, and specific patterns of written expression were investigated. Students with ADHD in this sample experienced written expression impairment (17.2-22.4%) at a similar rate to reading impairment (17.0-24.3%) and at a slightly lower rate than mathematics impairment (24.7-36.3%). Students' written expression abilities were significantly associated with school grades and parent ratings of academic functioning, above and beyond the influence of intelligence. Analyses of patterns suggest that students with ADHD exhibit greater deficits in written expression tasks requiring organization and attention to detail, especially in the context of a complex task.

What Is Specific and What Is Shared Between Numbers and Words?

Reading and spelling performance have a significant correlation with number transcoding, which is the ability to establish a relationship between the verbal and Arabic representations of numbers, when a conversion of numerical symbols from one notation to the other is necessary. The aim of the present study is to reveal shared and non-shared mechanisms involved in reading and writing of words and Arabic numerals in Brazilian school-aged children. One hundred and seventy-two children from second to fourth grades were evaluated. All of them had normal intelligence. We conducted a series of hierarchical regression models using scores on word spelling and reading single words and Arabic numerals, as dependent variables. As predictor variables we investigated intelligence, the phonological and visuospatial components of working memory (WM) and phonemic awareness. All of the writing and reading tasks (single word spelling and reading as well as number reading and number writing) were significantly correlated to each other. In the regression models, phonological WM was specifically associated to word reading. Phonemic awareness was the only cognitive variable that systematically predicted all of the school skills investigated, both numerical and word tasks. This suggests that phonemic awareness is a modular cognitive ability shared by several school tasks and might be an important factor associated to the comorbidity between dyslexia and dyscalculia.

A cross-sectional study to assess the prevalence of DSM-5 specific learning disorders in representative school samples from the second to sixth grade in Brazil

Little is known about specific learning disorder (SLD) in low- and middle-income countries (LMICs), and even less from representative school samples in small size cities outside huge urban centers. Few studies addressed the new DSM-5 criteria for SLDs. We investigated the prevalence of DSM-5 SLDs, their comorbidities and correlates in school samples of students from the second to sixth grades living in median cities from four different geographic regions in Brazil. A national test for academic performance covering reading, writing and mathematical abilities was applied. Psychiatric diagnoses were assessed by the K-SADS-PL applied to the primary caregiver. A total of 1618 children and adolescents were included in the study. The following prevalence rates of SLDs were found: 7.6% for global impairment, 5.4% for writing, 6.0% for arithmetic, and 7.5% for reading impairment. Attention-deficit/hyperactivity disorder (ADHD) was the only comorbidity significantly associated with SLD with global impairment (p = 0.031). Anxiety disorders and ADHD were associated with SLD with arithmetic impairment. Significant differences were detected in prevalence rates among cities, and several socio-demographic correlates (age, gender, IQ, and socioeconomic status) were significantly associated with SLD with global impairment in our sample. Careful validation and normatization of instruments to assess academic performance is a major problem in LMICs. As expected, we found a significant heterogeneity in prevalence rates of SLD according to geographic regions considering that Brazil is a country with a robust diversity. SLD with global and arithmetic impairment was significantly associated with psychiatric comorbidities.

Writing abilities longitudinally predict academic outcomes of adolescents with ADHD

Students with attention-deficit/hyperactivity disorder (ADHD) often experience a host of negative academic outcomes, and deficits in reading and mathematics abilities contribute to these academic impairments. Students with ADHD may also have difficulties with written expression, but there has been minimal research in this area and it is not clear whether written expression abilities uniquely contribute to the academic functioning of students with ADHD. The current study included a sample of 104 middle school students diagnosed with ADHD (Grades 6-8). Participants were followed longitudinally to evaluate whether written expression abilities at baseline predicted student grade point average (GPA) and parent ratings of academic impairment 18 months later, after controlling for reading ability and additional relevant covariates. Written expression abilities longitudinally predicted both academic outcomes above and beyond ADHD and oppositional defiant disorder symptoms, medication use, reading ability, and baseline values of GPA and parent-rated academic impairment. Follow-up analyses revealed that no single aspect of written expression was demonstrably more impactful on academic outcomes than the others, suggesting that writing as an entire process should be the focus of intervention. (PsycINFO Database Record

VI. The role of physical activity in reducing barriers to learning in children with developmental disorders

Emerging research suggests that physical activity may be an effective non-pharmaceutical intervention approach for childhood developmental disorders. Findings indicate that both single bouts of activity and chronic physical activity associate with improved mental health and classroom performance in children with attention-deficit/hyperactivity disorder and children with autism spectrum disorders. This review describes the research in this area and identifies limitations and challenges to the translation of these findings to promote physical activity in clinical practice and educational policy.

Specific Learning Disorders and ADHD: Current Issues in Diagnosis Across Clinical and Educational Settings

With the recent changes in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), this article provides a comprehensive review of two high-incidence disorders most commonly seen in childhood and adolescence: specific learning disorder (SLD) and attention-deficit/hyperactivity disorder (ADHD). Updates regarding comorbidity, shared neuropsychological factors, and reasons for the changes in diagnostic criteria are addressed. Although the revisions in the DSM-5 may allow for better diagnostic sensitivity based on the symptomology, specifiers, and the clinical features outlined, there continues to be challenges in operationalizing SLD and implementing consistent assessment practices among mental health professionals particularly when considering the Individuals with Disabilities Education Act (IDEA), which provides guidelines in the evaluation of SLD in school settings. Clinical and educational assessment implications are discussed with special attention to develop a collaborative approach between psychiatrists, psychologists, and educators when providing service delivery for children and adolescents with neurodevelopmental disabilities.

The impact of case definition on attention-deficit/hyperactivity disorder prevalence estimates in community-based samples of school-aged children

OBJECTIVE

To determine the impact of varying attention-deficit/hyperactivity disorder (ADHD) diagnostic criteria, including new DSM-5 criteria, on prevalence estimates.

METHOD

Parent and teacher reports identified high- and low-screen children with ADHD from elementary schools in 2 states that produced a diverse overall sample. The parent interview stage included the Diagnostic Interview Schedule for Children-IV (DISC-IV), and up to 4 additional follow-up interviews. Weighted prevalence estimates, accounting for complex sampling, quantified the impact of varying ADHD criteria using baseline and the final follow-up interview data.

RESULTS

At baseline 1,060 caregivers were interviewed; 656 had at least 1 follow-up interview. Teachers and parents reported 6 or more ADHD symptoms for 20.5% (95% CI = 18.1%-23.2%) and 29.8% (CI = 24.5%-35.6%) of children respectively, with criteria for impairment and onset by age 7 years (DSM-IV) reducing these proportions to 16.3% (CI = 14.7%-18.0%) and 17.5% (CI = 13.3%-22.8%); requiring at least 4 teacher-reported symptoms reduced the parent-reported prevalence to 8.9% (CI = 7.4%-10.6%). Revising age of onset to 12 years per DSM-5 increased the 8.9% estimate to 11.3% (CI = 9.5%-13.3%), with a similar increase seen at follow-up: 8.2% with age 7 onset (CI = 5.9%-11.2%) versus 13.0% (CI = 7.6%-21.4%) with onset by age 12. Reducing the number of symptoms required for those aged 17 and older increased the overall estimate to 13.1% (CI = 7.7%-21.5%).

CONCLUSION

These findings quantify the impact on prevalence estimates of varying case definition criteria for ADHD. Further research of impairment ratings and data from multiple informants is required to better inform clinicians conducting diagnostic assessments. DSM-5 changes in age of onset and number of symptoms required for older adolescents appear to increase prevalence estimates, although the full impact is uncertain due to the age of our sample.

Computer-based cognitive training for ADHD: a review of current evidence

There has been an increasing interest in and the use of computer-based cognitive training as a treatment of attention-deficit/hyperactivity disorder (ADHD). The authors' review of current evidence, based partly on a stringent meta-analysis of 6 randomized controlled trials (RCTs) published in 2013, and an overview of 8 recently published RCTs highlights the inconsistency of findings between trials and across blinded and nonblinded ADHD measures within trials. Based on this, they conclude that more evidence from well-blinded studies is required before cognitive training can be supported as a frontline treatment of core ADHD symptoms.

The new DSM-5 and its impact on the mental health care of children

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the premier resource in the diagnosis of mental health conditions, was published in June 2013. It contains many new diagnoses as well as changes to both the names and criteria for longstanding conditions. It is essential for pediatric nurses to understand the changes so that they can communicate effectively and advocate responsibly for their patients and families. This article discusses the changes, the criticisms voiced about them, and the implications for the pediatric nurse.

IQ of four-year-olds who go on to develop dyslexia

Do children who go on to develop dyslexia show normal verbal and nonverbal development before reading onset? According to the aptitude-achievement discrepancy model, dyslexia is defined as a discrepancy between intelligence and reading achievement. One of the underlying assumptions is that the general cognitive development of children who fail to learn to read has been normal. The current study tests this assumption. In addition, we investigated whether possible IQ deficits are uniquely related to later reading or are also related to arithmetic. Four-year-olds (N = 212) with and without familial risk for dyslexia were assessed on 10 IQ subtests. Reading and arithmetic skills were measured 4 years later, at the end of Grade 2. Relative to the controls, the at-risk group without dyslexia had subtle impairments only in the verbal domain, whereas the at-risk group with dyslexia lagged behind across IQ tasks. Nonverbal IQ was associated with both reading and arithmetic, whereas verbal IQ was uniquely related to later reading. The children who went on to develop dyslexia performed relatively poorly in both verbal and nonverbal abilities at age 4, which challenges the discrepancy model. Furthermore, we discuss possible causal and epiphenomenal models explaining the links between early IQ and later reading.