Attention-deficit hyperactivity disorder (ADHD)

The Use of fMRI Regional Analysis to Automatically Detect ADHD Through a 3D CNN-Based Approach

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a reduced attention span, hyperactivity, and impulsive behaviors, which typically manifest during childhood. This study employs functional magnetic resonance imaging (fMRI) to use spontaneous brain activity for classifying individuals with ADHD, focusing on a 3D convolutional neural network (CNN) architecture to facilitate the design of decision support systems. We developed a novel deep learning model based on 3D CNNs using the ADHD-200 database, which comprises datasets from NeuroImage (NI), New York University (NYU), and Peking University (PU). We used fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) data in three dimensions and performed a fivefold cross-validation to address the dataset imbalance. We aimed to verify the efficacy of our proposed 3D CNN by contrasting it with a fully connected neural network (FCNN) architecture. The 3D CNN achieved accuracy rates of 76.19% (NI), 69.92% (NYU), and 70.77% (PU) for fALFF data. The FCNN model yielded lower accuracy rates across all datasets. For generalizability, we trained on NI and NYU datasets and tested on PU. The 3D CNN achieved 69.48% accuracy on fALFF outperforming the FCNN. Our results demonstrate that using 3D CNNs for classifying fALFF data is an effective approach for diagnosing ADHD. Also, FCNN confirmed the efficiency of the designed model.

Control of sustained attention and impulsivity by Gq-protein signalling in parvalbumin interneurons of the anterior cingulate cortex

The anterior cingulate cortex (ACC) has been implicated in attention deficit hyperactivity disorder (ADHD). More specifically, an appropriate balance of excitatory and inhibitory activity in the ACC may be critical for the control of impulsivity, hyperactivity, and sustained attention which are centrally affected in ADHD. Hence, pharmacological augmentation of parvalbumin- (PV) or somatostatin-positive (Sst) inhibitory ACC interneurons could be a potential treatment strategy. We, therefore, tested whether stimulation of G_q-protein-coupled receptors (G_qPCRs) in these interneurons could improve attention or impulsivity assessed with the 5-choice-serial reaction-time task in male mice. When challenging impulse control behaviourally or pharmacologically, activation of the chemogenetic G_qPCR hM3Dq in ACC PV-cells caused a selective decrease of active erroneous-i.e. incorrect and premature-responses, indicating improved attentional and impulse control. When challenging attention, in contrast, omissions were increased, albeit without extension of reward latencies or decreases of attentional accuracy. These effects largely resembled those of the ADHD medication atomoxetine. Additionally, they were mostly independent of each other within individual animals. G_qPCR activation in ACC PV-cells also reduced hyperactivity. In contrast, if hM3Dq was activated in Sst-interneurons, no improvement of impulse control was observed, and a reduction of incorrect responses was only induced at high agonist levels and accompanied by reduced motivational drive. These results suggest that the activation of G_qPCRs expressed specifically in PV-cells of the ACC may be a viable strategy to improve certain aspects of sustained attention, impulsivity and hyperactivity in ADHD.

Linking ADHD and Behavioral Assessment Through Identification of Shared Diagnostic Task-Based Functional Connections

A mixed literature implicates atypical connectivity involving attentional, reward and task inhibition networks in ADHD. The neural mechanisms underlying the utility of behavioral tasks in ADHD diagnosis are likewise underexplored. We hypothesized that a machine-learning classifier may use task-based functional connectivity to compute a joint probability function that identifies connectivity signatures that accurately predict ADHD diagnosis and performance on a clinically-relevant behavioral task, providing an explicit neural mechanism linking behavioral phenotype to diagnosis. We analyzed archival MRI and behavioral data of 80 participants (64 male) who had completed the go/no-go task from the longitudinal follow-up of the Multimodal Treatment Study of ADHD (MTA 168) (mean age = 24 years). Cross-mutual information within a functionally-defined mask measured functional connectivity for each task run. Multilayer feedforward classifier models identified the subset of functional connections that predicted clinical diagnosis (ADHD vs. Control) and split-half performance on the Iowa Gambling Task (IGT). A sample of random models trained on functional connectivity profiles predicted validation set clinical diagnosis and IGT performance with 0.91 accuracy and d' > 2.9, indicating very high sensitivity and specificity. We identified the most diagnostic functional connections between visual and ventral attentional networks and the anterior default mode network. Our results show that task-based functional connectivity is a biomarker of ADHD. Our analytic framework provides a template approach that explicitly ties behavioral assessment measures to both clinical diagnosis, and functional connectivity. This may differentiate otherwise similar diagnoses, and promote more efficacious intervention strategies.

Pediatric ADHD symptom burden relates to distinct neural activity across executive function domains

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent childhood disorder marked by inattention and/or hyperactivity symptoms. ADHD may also relate to impaired executive function (EF), but is often studied in a single EF task per sample. The current study addresses the question of unique vs. overlapping relations in brain activity across multiple EF tasks and ADHD symptom burden. Three in-scanner tasks drawn from distinct EF domains (cognitive flexibility, working memory, and inhibition) were collected from children with and without an ADHD diagnosis (N = 63). Whole-brain activity and 11 regions of interest were correlated with parent reports of inattention and hyperactivity symptoms. Across the three EF domains, brain activity related to ADHD symptom burden, but the direction and location of these associations differed across tasks. Overall, activity in sensory and default mode network regions related to ADHD, and these relations did not consistently overlap across EF domains. We observed both distinct and overlapping patterns for inattention and hyperactivity symptoms. By studying multiple EF tasks in the same sample, we identified a heterogenous neural profile related to attention symptom burden in children. Our results inform ADHD characterization and treatment and explain some of the variable brain results related to EF and ADHD reported in the literature.

Gene-based analysis of ADHD using PASCAL: a biological insight into the novel associated genes

Background

Attention-Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder (NDD) which may significantly impact on the affected individual’s life. ADHD is acknowledged to have a high heritability component (70–80%). Recently, a meta-analysis of GWAS (Genome Wide Association Studies) has demonstrated the association of several independent loci. Our main aim here, is to apply PASCAL (pathway scoring algorithm), a new gene-based analysis (GBA) method, to the summary statistics obtained in this meta-analysis. PASCAL will take into account the linkage disequilibrium (LD) across genomic regions in a different way than the most commonly employed GBA methods (MAGMA or VEGAS (Versatile Gene-based Association Study)). In addition to PASCAL analysis a gene network and an enrichment analysis for KEGG and GO terms were carried out. Moreover, GENE2FUNC tool was employed to create gene expression heatmaps and to carry out a (DEG) (Differentially Expressed Gene) analysis using GTEX v7 and BrainSpan data.

Results

PASCAL results have revealed the association of new loci with ADHD and it has also highlighted other genes previously reported by MAGMA analysis. PASCAL was able to discover new associations at a gene level for ADHD: FEZF1 (p-value: 2.2 × 10^− 7) and FEZF1-AS1 (p-value: 4.58 × 10^− 7). In addition, PASCAL has been able to highlight association of other genes that share the same LD block with some previously reported ADHD susceptibility genes. Gene network analysis has revealed several interactors with the associated ADHD genes and different GO and KEGG terms have been associated. In addition, GENE2FUNC has demonstrated the existence of several up and down regulated expression clusters when the associated genes and their interactors were considered.

Conclusions

PASCAL has been revealed as an efficient tool to extract additional information from previous GWAS using their summary statistics. This study has identified novel ADHD associated genes that were not previously reported when other GBA methods were employed. Moreover, a biological insight into the biological function of the ADHD associated genes across brain regions and neurodevelopmental stages is provided.

Genetics and genetic counseling in psychiatry: Results from an opinion survey of professionals and users

Background

The heritability of several psychiatric disorders is high, and specific at‐risk variants have been identified. Therefore, genetic counseling and genetic testing can be prescribed to some psychiatric patients, but these services are not standardized for most of the population. The aims of the study were to gather opinions from mental health professionals and users regarding (a) the genetics of psychiatric disorders and (b) the usefulness of a genetic counseling unit in psychiatry.

Methods

The survey was conducted in the province of Tarragona (Spain), and we analyzed 152 valid questionnaires from professionals and 959 from users.

Results

Sixty‐one percent of professionals strongly believed that psychiatric disorders have a genetic basis, and 59% rated a genetic counseling unit in psychiatry as very or extremely useful. However, only a few professionals reported that patients asked them about the genetics of their diseases (12%) or the possibility of transmitting the disease to offspring (19%). Forty‐seven percent of users strongly believed that psychiatric disorders have a genetic basis, 30% responded that they talked with their families about the genetics of their diseases, and 43% were worried about transmitting the disease to offspring; however, only 14% reported that their psychiatrist had talked to them about this topic. Remarkably, 80% of users would consider a genetic counseling unit very or extremely useful.

Conclusions

The present study showed that mental health professionals were more aware of the genetic basis of psychiatric disorders than users, and both considered the implementation of a genetic counseling service very useful.

Frontal theta/beta ratio changes during TOVA in Egyptian ADHD children

Objective:

To spot the frontal theta/beta ratio alterations during Tests of Variance of Attention (TOVA) in Egyptian attention deficit hyperactivity disorder (ADHD) children.

Methods:

This is a cross sectional study performed in Clinical Neurophysiology Unit, Cairo University, Egypt. It included 2 groups, each of 52 children (one of them with ADHD and the other were normal control). EEG was recorded for every subject during normal relaxing circumstance with eyes opened as well as during TOVA.

Results:

Comparing both groups revealed statistically significant difference in the theta/beta ratio in both state (normal relaxing with eyes opened and during TOVA), also we found that the theta/beta ratio decreased in normal group (during concentration) while in the ADHD group it increased with a specific pattern.

Conclusion:

The theta/beta ratio can be of value in helping for differential diagnosis in patients presenting with mild ADHD.

Bupropion for attention deficit hyperactivity disorder (ADHD) in adults

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurobiological condition, characterised by behavioral and cognitive symptoms such as inattention, impulsivity and/or excessive activity. The syndrome is commonly accompanied by psychiatric comorbidities and is associated with educational and occupational underachievement.Although psychostimulant medications are the mainstay of treatment for ADHD, not all adults respond optimally to, or can tolerate, these medicines. Thus, alternative non-stimulant treatment approaches for ADHD have been explored. One of these alternatives is bupropion, an aminoketone antidepressant and non-competitive antagonism of nicotinic acetylcholine receptors. Bupropion is registered for the treatment of depression and smoking cessation, but is also used off-label to treat ADHD.

OBJECTIVES

To assess the effects and safety of bupropion for the treatment of adults with ADHD.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and seven other databases in February 2017. We also searched three trials registers and three online theses portals. In addition, we checked references of included studies and contacted study authors to identify potentially relevant studies that were missed by our search.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) that evaluated the effects (including adverse effects) of bupropion compared to placebo in adults with ADHD.

DATA COLLECTION AND ANALYSIS

Two review authors (WV, GB) independently screened records and extracted data using a data extraction sheet that we tested in a pilot study. We extracted all relevant data on study characteristics and results. We assessed risks of bias using the Cochrane 'Risk of bias' tool, and assessed the overall quality of evidence using the GRADE approach. We used a fixed-effect model to pool the results across studies.

MAIN RESULTS

We included six studies with a total of 438 participants. Five studies were conducted in the USA, and one in Iran. All studies evaluated a long-acting version of bupropion, with the dosage ranging from 150 mg up to 450 mg daily. Study intervention length varied from six to 10 weeks. Four studies explicitly excluded participants with psychiatric comorbidity and one study included only participants with opioid dependency. Four studies were funded by industry, but the impact of this on study results is unknown. Two studies were publicly funded and in one of these studies, the lead author was a consultant for several pharmaceutical companies and also received investigator-driven funding from two companies, however none of these companies manufacture bupropion. We judged none of the studies to be free of bias because for most risk of bias domains the study reports failed to provide sufficient details. Using the GRADE approach, we rated the overall quality of evidence as low. We downgraded the quality of the evidence because of serious risk of bias and serious imprecision due to small sample sizes.We found low-quality evidence that bupropion decreased the severity of ADHD symptoms (standardised mean difference -0.50, 95% confidence interval (CI) -0.86 to -0.15, 3 studies, 129 participants), and increased the proportion of participants achieving clinical improvement (risk ratio (RR) 1.50, 95% CI 1.13 to 1.99, 4 studies, 315 participants), and reporting an improvement on the Clinical Global Impression - Improvement scale (RR 1.78, 95% CI 1.27 to 2.50, 5 studies, 337 participants). There was low-quality evidence that the proportion of participants who withdrew due to any adverse effect was similar in the bupropion and placebo groups (RR 1.20, 95% CI 0.35 to 4.10, 3 studies, 253 participants). The results were very similar when using a random-effects model and when we analysed only studies that excluded participants with a psychiatric comorbidity.

AUTHORS' CONCLUSIONS

The findings of this review, which compared bupropion to placebo for adult ADHD, indicate a possible benefit of bupropion. We found low-quality evidence that bupropion decreased the severity of ADHD symptoms and moderately increased the proportion of participants achieving a significant clinical improvement in ADHD symptoms. Furthermore, we found low-quality evidence that the tolerability of bupropion is similar to that of placebo. In the pharmacological treatment of adults with ADHD, extended- or sustained-release bupropion may be an alternative to stimulants. The low-quality evidence indicates uncertainty with respect to the pooled effect estimates. Further research is very likely to change these estimates. More research is needed to reach more definite conclusions as well as clarifying the optimal target population for this medicine. Treatment response remains to be reported in a DSM5-diagnosed population. There is also a lack of knowledge on long-term outcomes.

Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis

BACKGROUND

Reports of frequent manifestation of allergic diseases in children with attention deficit hyperactivity disorder (ADHD) have been the subject of mounting clinical interest. However, evidence supporting the association between ADHD and allergies is inconsistent and has yet to be systematically reviewed. The objective of this study was to compile and assess available studies on the association between ADHD and allergic diseases in children.

METHODS

A comprehensive search using MEDLINE, EMBASE, the Cochrane library, and CINAHL databases was completed in 23 November 2015. The inclusion criteria for studies were that the research assessed allergic diseases in children, 18 years of age and younger, with a diagnosis of ADHD and that a distinct comparison group was incorporated. Any comparative studies, encompassing both randomized controlled trials and observational studies, were considered for inclusion. Two review authors independently assessed the quality of the selected studies by the use of validated assessment tools, performed data extraction and conducted meta-analysis according to Cochrane Collaboration guidelines.

RESULTS

Five eligible studies were included in this systematic review. Of these studies, three were case-control and two were cross sectional studies. A majority of information from the five studies was classified as having low or unclear risk of bias. The meta-analysis showed an association between children with ADHD and asthma compared with the control groups (OR: 1.80, 95% CI: 1.57 - 2.07; five studies, low quality of evidence), but did not indicate an association between food allergy and ADHD (OR: 1.13, 95% CI: 0.88 - 1.47; three studies very low quality of evidence). The odds of experiencing allergic rhinitis, atopic dermatitis, and allergic conjunctivitis were slightly higher in children with ADHD compared with control groups, though a substantial statistical heterogeneity was notable in the overall effect estimates.

CONCLUSIONS

The findings from this review and meta-analysis show that children with ADHD are more likely to have asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis than their counterparts. Interventions including strategies for managing allergies in children with ADHD would be beneficial.

Components of the folate metabolic pathway and ADHD core traits: an exploration in eastern Indian probands

We investigated role of the folate-homocysteine metabolic pathway in the etiology of attention-deficit hyperactivity disorder (ADHD) due to its importance in maintaining DNA integrity as well as neurotransmission. Functional gene variants in MTR (rs1805087), CBS (rs5742905), MTHFR (rs1801133 &rs1801131), MTHFD (rs2236225), RFC1 (rs1051266), plasma vitamin B12, folate and homocysteine were analyzed. rs1805087 'A' showed strong association with ADHD. Vitamin B12 deficiency of ADHD probands (P=0.01) correlated with rs1801133 'T' and rs1805087'GG'. Mild hyperhomocysteinemia (P=0.05) in the probands was associated with rs1805087 'AA'. Probands having rs1805087 'GG' and rs1051266 'G' was more inattentive. Hyperactivity-impulsivity score revealed association with rs5742905 'TT' and rs2236225 'CC', while rs1801133 'CC' showed association with inattentiveness and hyperactivity-impulsivity. rs1801131 exhibited strong synergistic interaction with rs1051266 and rs2236225. This indicated that the folate-homocysteine pathway gene variants may affect ADHD etiology through mild hyperhomocysteinemia and vitamin B12 deficiency, factors known to be associated with cognitive deficit.

[Study of genetic variants in the BDNF, COMT, DAT1 and SERT genes in Colombian children with attention deficit disorder]

BACKGROUND

Attention deficit and hyperactive disorder (ADHD) is highly prevalent among children in Bogota City. Both genetic and environmental factors play a very important role in the etiology of ADHD. However, to date few studies have addressed the association of genetic variants and ADHD in the Colombian population.

OBJECTIVES

To test the genetic association between polymorphisms in the DAT1, HTTLPR, COMT and BDNF genes and ADHD in a sample from Bogota City.

METHODS

We genotyped the most common polymorphisms in DAT1, SERT, COMT and BDNF genes associated with ADHD using conventional PCR followed by restriction fragment length polymorphism (RFLP) in 97 trios recruited in a medical center in Bogota. The transmission disequilibrium test (TDT) was used to determine the association between such genetic variants and ADHD.

RESULTS

The TDT analysis showed that no individual allele of any variant studied has a preferential transmission.

CONCLUSIONS

Our results suggest that the etiology of the ADHD may be complex and involves several genetic factors. Further studies in other candidate polymorphisms in a larger sample size will improve our knowledge of the ADHD in Colombian population.

Application of proteomics in diagnosis of ADHD, schizophrenia, major depression, and suicidal behavior

This report focuses on the application of different proteomic techniques in diagnosis and treatment of psychiatric disorders such as major depression, suicidal behavior, schizophrenia, and attention deficit/hyperactivity disorder (ADHD). Firstly, we briefly describe different analytic approaches that can be applied for the discovery of specific biomarkers for diagnosing the above disorders, as well as for monitoring the effect of their treatment. Secondly, we discussed the types of biomarkers in general used in biomedicine for characterizing different disorders and diseases. Next, the potential applications of these biomarkers for diagnosing and managing major depression, suicidal behavior, schizophrenia, and ADHD are discussed in details. Forensic aspects of these biomarkers for the above disorders are also considered. Finally, we discuss the potential of specific biomarkers for distinguishing between comorbid psychiatric disorders in clinical setup as well as their potential for understanding mechanisms underlying the disorders and in discovery of new treatment strategies.

The use of lisdexamfetamine dimesylate for the treatment of ADHD and other psychiatric disorders

Lisdexamfetamine dimesylate (LDX) is a long-acting oral prodrug stimulant. It is inactive until enzymatically hydrolyzed in the blood to active D-amphetamine. The pharmacological action of this compound involves blocking norepinephrine (NE) and dopamine reuptake into presynaptic neurons and promoting the release of NE and dopamine into the extraneuronal space. LDX has been approved for treating ADHD, which is the most common psychiatric disorder in children and adolescents. Also, LDX has been proposed for other psychiatric conditions related with dopaminergic and NE CNS. LDX is the first long-acting oral prodrug indicated for the treatment of ADHD in children (6-12 years), adolescents (13-17 years) and in adults in the USA and Canada, whereas, in Europe, LDX is licensed in several countries for the treatment of children and adolescents with ADHD who have had a clinically inadequate response to methylphenidate. This article covers the most important pharmacological aspects of LDX as well as data on the efficacy, tolerability and safety of this long-acting amphetamine prodrug collected from clinical studies recently published in the literature.

Innovations and recent trends in the treatment of ADHD

Initiatives to develop better-tolerated, more efficacious pharmacological agents with improved drug delivery systems have driven recent research in attention-deficit hyperactivity disorder (ADHD). While stimulants are the primary pharmacotherapy for ADHD, these drugs have a limited duration of action and a subset of patients will either fail to respond to these medications or have side effects that preclude their use. The development of atomoxetine, the first nonstimulant approved for ADHD, has been followed by additional innovative research, such as the methylphenidate transdermal system, modafinil, NRP-104 and cholinergic agents. This review highlights some of the recent trends in ADHD treatment and the current status of promising treatment options that may help to shape the future of ADHD treatment.

Association between childhood specific learning difficulties and school performance in adolescents with and without ADHD symptoms: a 16-year follow-up

OBJECTIVE

The authors investigated whether childhood specific learning difficulties (SLDs) predict later school performance in adolescents with ADHD symptoms (ADHDs) and how SLDs associate with educational aspirations.

METHOD

In the Northern Finland Birth Cohort 1986 (n = 9,432), data about children were collected using questionnaires for parents and teachers at ages 7 and 8 and for parents and adolescents at ages 15/16. Information on school performance was obtained from a national register.

RESULTS

The occurrence of SLDs at 8 years was 19.9% (n = 1,198), ADHDs at 15/16 years was 8.0% (n = 530), and comorbid ADHDs and SLDs was 3.0% (n = 179). Having ADHDs but not SLDs or having both was associated with a significantly lower mean value in school grades for theoretical subjects. Adolescents with comorbid ADHDs and SLDs repeated a grade more often, and their educational aspirations were less ambitious than those in other groups.

CONCLUSION

ADHDs and SLDs have a negative influence on academic achievements.

Hypotonia, jaundice, and Chiari malformations: relationships to executive functions

This article postulates that movement and action control are the underpinning of executive functioning. We selectively examine brain regions that have traditionally been almost exclusively understood as critical to the control and expression of movement-namely, the basal ganglia and the cerebellum. We first describe the relationship between movement and cognition. This is followed by a review of common developmental disorders that are known to exhibit abnormal executive functions and movement anomalies. Against that background, we examine hypotonia, neonatal jaundice, and Chiari I malformation, and we demonstrate why these are "at-risk" factors for neurodevelopmental disorders that can feature both motor control and executive function abnormalities. Our goal is to prepare the clinical neuropsychologist for gathering information about these features of a child's birth and developmental histories, while using this as a framework for interpreting test results and applying test data in a useful, practical way to guide descriptive diagnosis and treatment.

Hyperbilirubinemia: subcortical mechanisms of cognitive and behavioral dysfunction

Although development of the full syndrome of kernicterus is relatively rare, neonatal jaundice continues to occur frequently. Controversy remains concerning whether or not infants with moderate elevations in bilirubin are at risk for neurodevelopmental disorders in later childhood. Sites of brain pathology associated with bilirubin neurotoxicity are identified and well established. Based on these regions of brain involvement, we apply neuroscientific principles of brain-behavior relationships to predict types of cognitive features that may accompany hyperbilirubinemia. We address a range of neurodevelopmental abnormalities that can arise as a function of elevated neonatal bilirubin levels affecting these brain regions, even in the absence of full kernicterus syndrome. Moreover, we explain the neuropathologic mechanisms that would drive these abnormalities. We thus attempt to establish a blueprint for future investigations of these conditions, to improve neurodevelopmental outcomes.

"3 . . 2 . . 1 . . Impact [factor]: target [academic career] destroyed!": just another statistical casualty

"Publish or perish" is the time-honored "principle" for academicians who race to accumulate lines under the "publications" section of a curriculum vitae. The original intent of publication-to inform others of findings and further scientific knowledge-has been corrupted by factors including (1) exponential growth of journals and the journal industry, fueled in part by intrusion of the Internet into all aspects of academic life; and (2) adoption of journal metrics (rather than written content) as the measure of scientific quality. The proprietary Thomson Reuters Impact Factor is the most pernicious metric, having caused editors and publishers to change editorial practices to boost the number. At the same time, gullible administrators and government agencies have been persuaded that metrics for the journal in which materials are published can be used as a measure of the worth of individual investigators (and institutions) and their research efforts: simple numbers can be substituted for the burdensome effort required to read and assess research quality. Thus, granting of research funds, awarding of academic rank and tenure, and determination of salaries (including bonus payments) have become tied to manipulable journal metrics rather than the significance or quality of reported research. Therefore, it is no wonder that the integrity of science is more often being questioned. How should a young investigator approach the "publish or perish" dilemma? Performing sound research and preparing optimal materials for publication must remain the overriding goals: properly articulate the question addressed by the study; thoroughly document all methods and case information; carefully describe results including any conflicting or negative findings; discuss the importance of the findings along with how the results address the initial question and whether findings refute or confirm previous studies; prepare properly cited bibliographic references; list all author contributions, potential conflicts of interest, financial support, and required ethical approvals; and provide a catchy title and an abstract containing sufficient information that other investigators perusing scientific indices will be enticed to read the published article. Submit the completed manuscript to the most appropriate journal based on that journal's previously published content and relevance to the field of study regardless of journal metrics. On publication, notify investigators in the same field to ask for their comments on the work. Thus, an individual will become known for the quality of his or her work product and the worshiping of publication metrics will be unnecessary.

Identification and management of behavioral/mental health problems in primary care pediatrics: perceived strengths, challenges, and new delivery models

This study describes the experiences of and barriers for pediatricians in Kentucky in providing behavioral/mental health (B-MH) services in primary care settings. These data will serve as a foundation for improving service delivery. An online survey was completed by 70 pediatricians. Descriptive data are presented. More than 90% of the respondents said that they saw at least one patient a month with 1 of 10 specific B-MH diagnoses. Physicians' comfort with diagnosing and treating disorders varied widely by diagnosis, age-group, and drug classification. Major barriers to providing optimal care were inaccessibility of mental health professionals for consultation and referral, lack of communication, and lack of knowledge. Respondents were more likely to favor consultation and co-location models over an integration model of care delivery. Overall, the authors found that pediatricians are dealing with patients with B-MH problems for which they may not have been adequately trained. Communication and collaboration needs were identified.

An efficacy study of a combined parent and teacher management training programme for children with ADHD

BACKGROUND

Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder (ADHD) and/or oppositional defiant disorder (ODD) during the last few decades. Group format has often been used for parent training but single-subject designs are more common in teacher training. More studies have focussed on pre-school children than on older children, and a minority have been conducted in public mental health settings.

AIM

This study aimed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden.

METHOD

The intervention was a modified version of Barkley's programme. Children were randomized to an Intervention or a Control group. Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms, and about behavioural problems when the study started and at a 3-month follow-up.

RESULTS

RESULTS showed that the intervention resulted in a reduction of the number of children who met DSM-IV criteria for ADHD and/or ODD. Effects were more pronounced in the home setting than in the school setting, and were further accentuated when both parents and teachers of the same child took part in the intervention. Teachers with more problematic classroom situations benefited most from the intervention.

CONCLUSION

The programme, "Strategies in Everyday Life", has, in a regular clinical setting, demonstrated promising effects on children's disruptive behaviour, and a clinical implication was to recommend involving both parents and teachers in the programme.

Comorbidity of schizophrenia and adult attention-deficit hyperactivity disorder

OBJECTIVES

Adult ADHD is characterised by a plethora of comorbid conditions. However, the comorbidity of schizophrenia and ADHD does not seem to be a typical feature and is therefore under-researched.

OBJECTIVE

To identify adult patients with schizophrenia and comorbid ADHD and compare their symptomatology with schizophrenic patients without ADHD.

METHOD

Performance in specific neuropsychological tests (set shifting, selective and sustained attention, cognitive performance, and speed of information processing) was determined. Additionally, important demographic data and information about the patients' history such as the number of suicide attempts were gathered. Twenty-seven patients were involved in this study (14 male and 13 female). Fifteen patients were diagnosed with schizophrenia/no ADHD and twelve had both schizophrenia/ADHD.

RESULTS

We report here an increase in suicidal behaviour of patients with both schizophrenia and ADHD compared to schizophrenia only. A significant underperformance of the patients with ADHD comorbidity compared to patients with schizophrenia only was also determined.

CONCLUSIONS

The increased suicidal behaviour in patients with schizophrenia and ADHD suggests the need of further studies on mood regulation and suicidal ideations in these patients.

Coexisting disorders and academic achievement among children with ADHD

OBJECTIVE

ADHD is a commonly diagnosed neuropsychological disorder among school-aged children with reported high rates of coexisting or comorbid disorders. As ADHD has been associated with academic underachievement, the current study examines this association in view of the presence of coexisting disorders. The purpose of the current study is to examine the relationship between the presence of coexisting disorders and academic achievement among children with ADHD using a large, nationally representative, and community-based sample.

METHOD

To achieve this purpose, the presence of coexisting disorders with ADHD and academic achievement are examined across time utilizing latent growth models.

RESULTS

Our results indicate an inverse relationship between the presence of coexisting disorders and academic achievement across time among children diagnosed with ADHD.

CONCLUSION

The authors conclude that practitioners must be concerned with the presence of coexisting disorders for children with ADHD with respect to academic achievement as well as other behavioral and psychological outcomes.

Adaptation, expertise, and giftedness: towards an understanding of cortical, subcortical, and cerebellar network contributions

Current cortico-centric models of cognition lack a cohesive neuroanatomic framework that sufficiently considers overlapping levels of function, from "pathological" through "normal" to "gifted" or exceptional ability. While most cognitive theories presume an evolutionary context, few actively consider the process of adaptation, including concepts of neurodevelopment. Further, the frequent co-occurrence of "gifted" and "pathological" function is difficult to explain from a cortico-centric point of view. This comprehensive review paper proposes a framework that includes the brain's vertical organization and considers "giftedness" from an evolutionary and neurodevelopmental vantage point. We begin by discussing the current cortico-centric model of cognition and its relationship to intelligence. We then review an integrated, dual-tiered model of cognition that better explains the process of adaptation by simultaneously allowing for both stimulus-based processing and higher-order cognitive control. We consider the role of the basal ganglia within this model, particularly in relation to reward circuitry and instrumental learning. We review the important role of white matter tracts in relation to speed of adaptation and development of behavioral mastery. We examine the cerebellum's critical role in behavioral refinement and in cognitive and behavioral automation, particularly in relation to expertise and giftedness. We conclude this integrated model of brain function by considering the savant syndrome, which we believe is best understood within the context of a dual-tiered model of cognition that allows for automaticity in adaptation as well as higher-order executive control.

Automatic classification of hyperactive children: comparing multiple artificial intelligence approaches

Automatic classification of different behavioral disorders with many similarities (e.g. in symptoms) by using an automated approach will help psychiatrists to concentrate on correct disorder and its treatment as soon as possible, to avoid wasting time on diagnosis, and to increase the accuracy of diagnosis. In this study, we tried to differentiate and classify (diagnose) 306 children with many similar symptoms and different behavioral disorders such as ADHD, depression, anxiety, comorbid depression and anxiety and conduct disorder with high accuracy. Classification was based on the symptoms and their severity. With examining 16 different available classifiers, by using "Prtools", we have proposed nearest mean classifier as the most accurate classifier with 96.92% accuracy in this research.

Body mass index of children with attention-deficit/hyperactivity disorder

An association between overweight and attention-deficit/hyperactivity disorder (ADHD) in children was previously suggested. We examined the prevalence of overweight, anthropometric changes, and the effect of methylphenidate treatment in 275 children with ADHD without neurological comorbidities and in controls. Data were extracted from medical charts, for up to 17 months of follow-up. Height, weight, body mass index, and their z scores did not differ between the ADHD and control groups. Prevalence of overweight and obesity was lower in the ADHD group compared with controls (19% vs 35%, P = .02, and 7% vs 16%, P = .05, respectively). During a follow-up of up to 17 months, no significant changes in height or body mass index z scores were found, including in a subgroup of overweight children. We conclude that compared with local controls, children with ADHD have rates of overweight and obesity that are lower, but that are similar to national estimates. Methylphenidate treatment did not significantly affect height, weight, or overweight status.

Inattention, hyperactivity, impulsivity--epidemiology and correlations: a nationwide greek study from birth to 18 years

We examined the prevalence of inattention, hyperactivity, and impulsivity (attention-deficit hyperactivity disorder [ADHD]-like symptoms) at 7 and 18 years in a Greek birth cohort, and associated factors. Information was derived from a representative sample of 2695 Greek individuals followed-up from birth to18 years through 3 questionnaire surveys (1983, 1990, 2001). At 7 years, the prevalence of hyperactivity was 7%, inattention 9.5%, and impulsivity 7% for all children, while a significant decrease was observed at 18 years. Adverse perinatal factors, poor academic performance, fights or quarrels with peers, comorbidity, and a higher frequency of physical punishment and accidents during childhood were found to be associated with ADHD-like symptoms at 7 years. Factors identified to be related with these symptoms at 18 years included male gender, maternal stress, smoking during pregnancy, physical punishment, and psychological problems in childhood. These longitudinal findings provide significant information for health and educational planning in Greece and other countries.

A prospective observational study of attention-deficit/hyperactivity disorder in Central and Eastern Europe and Turkey: Symptom severity and treatment options in a paediatric population

Abstract Objective. This study investigates the relationship between treatment regimen, symptom severity, comorbidities and health outcomes of paediatric patients with attention-deficit/hyperactivity disorder (ADHD) in Central and Eastern Europe (CEE). Methods. Males and females aged 6-17 years with ADHD symptoms participated in this 12-month, prospective, observational, non-randomised study. Symptoms and comorbidities were assessed using the Child and Adolescent Symptom Inventory-4 Parent Checklists (CSI-4; ASI-4, categories L/O), and the Clinical Global Impressions-ADHD-Severity scale (CGI-ADHD-S). Baseline data are presented. Results. The study included 566 patients from Czech Republic, Hungary, Romania, Slovakia and Turkey. Psychiatrists made all diagnoses using The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV), World Health Organization International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), and "other" criteria (73, 27 and 0.4%, respectively). Patients were grouped into two cohorts based on whether they were prescribed psycho- and/or pharmacotherapy (n=443) or not (n=123). Patients receiving prescribed treatment were older and demonstrated higher symptom severity scores than those receiving no or "other" treatment. Most patients were prescribed conventional treatment for ADHD at baseline. Conclusions. Continued assessment of this population may aid the treatment and outcomes of ADHD in CEE.

Attention-deficit/hyperactivity disorder diagnosis, co-morbidities, treatment patterns, and quality of life in a pediatric population in central and eastern Europe and Asia

Attention deficit/hyperactivity disorder (ADHD) is often poorly understood, and treatment practices are variable. This 12-month, prospective, observational study provides information about the diagnosis, co-morbidities, treatment patterns, and quality of life (QOL) of patients aged 6-17 years with ADHD symptoms from eastern Asia and central and eastern Europe. Here, we present baseline data for the 1068 enrolled and eligible patients in the study (median age 8 years, 82.2% male). Patients were grouped into two cohorts based on whether they were prescribed psycho- and/or pharmacotherapy (n = 794) or not (n = 274) at study entry. On average, patients receiving treatment were significantly older (9.1 vs. 8.4 years, p < 0.001), more severely ill (Clinical Global Impressions [CGI]-ADHD-S, 4.6 vs. 4.2, p < 0.001; Child Symptom Inventory-4 Parent Checklist (CSI-4) ADHD:C, 35.2 vs. 31.9, p < 0.001), and had significantly higher CSI-4 symptom severity scores relating to various co-morbidities than patients not receiving treatment. At study initiation, patient's health-related QOL was significantly impaired as measured on the Child Health and Illness Profile-Child Edition (CHIP-CE) rating scale, with significantly more impairment in the treated group of patients for the Comfort, Risks Avoidance, and Achievement domains. These results provide a description of ADHD and treatment practices in these regions and establish a baseline for gauging changes over time in the study sample.

Gene expression of synaptosomal-associated protein 25 (SNAP-25) in the prefrontal cortex of the spontaneously hypertensive rat (SHR)

Dopamine is believed to play an important role in the etiology of attention-deficit/hyperactivity disorder (ADHD). In our previous study, we showed that gene expression of dopamine D4 receptor decreased in the spontaneously hypertensive rat (SHR) in the prefrontal cortex (PFC). In the present study, we explored the potential causes of dysfunction in the dopamine system in ADHD. It is the first time that neuronal activities in both juvenile SHR and WKY rats have been measured by functional MRI (fMRI). Our results showed that in PFC the Blood Oxygenation Level Dependent (BOLD) signal response in SHR was much higher than WKY under stressful situations. We tested the effects of acute and repeated administration of amphetamine on behavioral changes in SHR combined with the expression of the neuronal activity marker, c-fos, in the PFC. Meanwhile dopamine-related gene expression was measured in the PFC after repeated administration of amphetamine. We found that potential neuronal damage occurred through deficit of D2-like receptor protective functions in the PFC of the SHR. We also measured the expression of synaptosomal-associated protein 25 (SNAP-25) in SHR in PFC. The results showed decreased expression of SNAP-25 mRNA in the PFC of SHR; this defect disappeared after repeated injection of D-AMP.

Goal priming and the emotional experience of students with and without attention problems: an application of the emotional stroop task

The primary purpose of the present study is to evaluate the emotional experience of students with (n = 52) and without attention problems (n = 272) during an achievement task. A secondary purpose of the present study is to compare students' emotional response to various stimuli, when motivated by various achievement goals. Participants were randomly assigned into a mastery goal condition, a normative performance goal condition, and a non-normative performance goal condition. Results, using a latent means analysis, indicate that students with attention problems needed additional time to process emotion-loaded but not neutral words, providing evidence for an interference effect. Furthermore, students in the performance-normative, relative to the performance non-normative, condition showed a salient interference effect with respect to various emotion-loaded and neutral words.

Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist

Attention deficit/hyperactivity disorder (ADHD) is a common and impairing psychiatric condition, affecting significant numbers of children and adolescents. General psychiatrists serve, both by choice and out of necessity, in the assessment and treatment of children and adolescents who have ADHD and in the education of patients and their families. For many clinicians, however, there are numerous unanswered questions regarding the diagnosis and therapeutic interventions for ADHD. This article provides general psychiatrists with a practical overview and update on the assessment, diagnosis, and treatment of pediatric ADHD. Background information, recent relevant research, current evidence-based practice guidelines, and tips for clinical practice are reviewed in this article. The information is presented in a question-answer format.

A Comparison of Cognitive and Psychosocial Function for Males Within the ADHD Continuum

Two case studies are presented illustrating neurophysiological dysfunction suggesting input or output deficits in ADHD assessed across multiple domains. Data included child and family history, behavior ratings, information processing, speed, cognitive, neurophysiological, and academic function. Pretreatment data indicated impaired processing speed, excessive slow to fast wave ratios indicative of attentional disregulation, and poor psychosocial function evident in both children. Posttreatment assessment indicated improvement in slow to fast wave ratios and psychosocial functioning for both children. Additional improvement was also noted in cognitive and academic function in MH, the child with learning disabilities, and in processing speed for CX, the child with elevated cognitive function. Neurophysiological disregulation in ADHD may result in input or output impairment differentially affecting cognitive, academic, and psychosocial functioning. Heterogeneity within the ADHD continuum underscores the need for multifaceted assessment to guide diagnosis and treatment. In ADHD children nonresponsive to stimulants, neurofeedback can be a viable treatment to enhance attentional focus and on-task behavior.

A comprehensive approach to treating autism and attention-deficit hyperactivity disorder: a prepilot study

OBJECTIVES

The purpose of this study was to observe the effects of a multi dimensional treatment plan involving nutrition, environmental control, chelation, and behavioral/educational/physical/speech therapy to treat children with autistic spectrum disorder and attention-deficit hyperactivity (ADHD) disorder. This study is only a preliminary study, and its small size (10 patients) precludes statistical analysis of simultaneous multiple modal treatment regimes.

DESIGN

This was an open-label observational study. SETTINGS/LOCATION/SUBJECTS: This study examined 10 children aged 4-10 years old who had been diagnosed with both autistic spectrum disorder and ADHD by outside physicians or psychologists. These 10 children presented consecutively in an environmental medicine clinic in Buffalo, New York. The children were given comprehensive nutritional/environmental/chelation treatment for 3 to 6 months in addition to their usual behavioral, educational, speech, and physical therapies.

OUTCOME MEASURES

Study outcomes were measured by objective/subjective improvement as judged by physicians/parents/teachers. Outcomes were also measured by changes in urinary heavy metal burdens over time.

RESULTS

All 10 children showed significant improvement in many areas of social interaction, concentration, writing, language, and behavior. Urinary lead burden dropped significantly in all 10 children.

CONCLUSIONS

Autistic spectrum disorders and ADHD are complicated conditions that probably require multidimensional treatment strategies. Larger studies are needed to determine optimum treatment plans involving nutrition, environmental control, medication, and behavioral/education/speech/physical therapies.

Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V

Neuropsychological methods and techniques have much to offer in the evaluation of the individual suspected as having Attention-Deficit/Hyperactivity Disorder (ADHD). After a review of the historical evolution of the ADHD concept, incidence and prevalence, and DSM-IV criteria for diagnosis, especially as regards omission related to gender differences, and other associated cultural, familial, socioenvironmental, and subject influences, this paper describes a number of dilemmas and obstacles encountered in clinical practice. Included are the confounds associated with the wide range of possible comorbidities, the insufficiency of current DSM-IV criteria, the emergence of subtype differentiation and its impact on diagnosis and treatment. The complex relationship between neuropsychological constructs and ADHD, and obstacles to valid assessment are also addressed. The complexities associated with a thorough ADHD evaluation are viewed within an impressive and expansive existing scientific framework and recommendations are made for future directions.

Efficacy and safety of atomoxetine in adolescents with attention-deficit/hyperactivity disorder and major depression

This double-blind study examined efficacy and safety of atomoxetine (ATX; < or =1.8mg/kg per day) in adolescents aged 12-18 with Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of both attention-deficit/hyperactivity disorder (ADHD) and co-morbid major depressive disorder (MDD). Diagnoses were confirmed by the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version and persistently elevated scores on the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, Parent version, Investigator-administered and -scored (ADHDRS-IV-Parent:Inv, > or =1.5 standard deviations above age and gender norms) and Children's Depression Rating Scale-Revised (CDRS-R, > or = 40). Patients were treated for approximately 9 weeks with ATX (n = 72) or placebo (n = 70). Mean decrease in ADHDRS-IV-Parent:Inv total score was significantly greater in the ATX group (-13.3 +/- 10.0) compared with the placebo group (-5.1 +/- 9.9; p < 0.001). Mean CDRS-R score improvement was not significantly different between groups (ATX, -14.8 +/- 13.3; placebo, -12.8 +/- 10.4). Rates of treatment-emergent mania did not differ between groups (ATX, 0.0%; placebo, 1.5%). ATX treatment was associated with significantly more nausea and decreased appetite (p = 0.002; p = 0.003). No spontaneously reported adverse events involving suicidal ideation or suicidal behavior occurred in either group. ATX was an effective and safe treatment for ADHD in adolescents with ADHD and MDD. However, this trial showed no evidence for ATX of efficacy in treating MDD.