1
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Becker P, Rask M, Safipour J, Gunnarsson AB. Selfcare Strategies Shown to Be Useful in Daily Life for Adults Diagnosed with Attention Deficit Hyperactivity Disorder - A Systematic Review. Issues Ment Health Nurs 2023; 44:825-833. [PMID: 37669505 DOI: 10.1080/01612840.2023.2234477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Adults with ADHD experience a wide range of difficulties in daily life, and RNs and other healthcare professionals need to know how to support them. The aim was to conduct a systematic review of which selfcare strategies adults with ADHD use and need in order to manage daily life. A literature review based on the PRISMA model was performed, and seven articles with a qualitative design were found. Data were analyzed with thematic analysis. The analysis generated one major theme Enabling ways to manage the consequences of disability in daily life based on three subthemes; Establishing ways of acting to help yourself, Finding encouraging and helping relationships, and Using external aids for managing daily life. Professionals may benefit from knowing about these selfcare strategies when meeting people with ADHD.
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Affiliation(s)
- Petra Becker
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Jalal Safipour
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - A Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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2
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Xu XP, Wang W, Wan S, Xiao CF. Convergence mechanism of mindfulness intervention in treating attention deficit hyperactivity disorder: Clues from current evidence. World J Clin Cases 2022; 10:9219-9227. [PMID: 36159418 PMCID: PMC9477656 DOI: 10.12998/wjcc.v10.i26.9219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/26/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
This paper reviews the underlying evidence for various aspects of the convergence mechanism of mindfulness intervention in attention deficit hyperactivity disorder (ADHD). There may be compatibility among various ADHD remission models and the therapeutic mechanism of mindfulness intervention in ADHD may be mainly via the convergence mechanism. However, neuroimaging-based analysis of the mechanisms of mindfulness intervention in treating ADHD is lacking. Differences in the efficacy of various subtypes of mindfulness intervention, and corresponding specific imaging changes need further investigation. Future research may focus on the neuroimaging features of specific mindfulness intervention subtypes.
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Affiliation(s)
- Xin-Peng Xu
- Universal Scientific Education and Research Network, Beijing 100088, China
| | - Wei Wang
- Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Song Wan
- Universal Scientific Education and Research Network, Beijing 100088, China
| | - Chun-Feng Xiao
- Universal Scientific Education and Research Network, Beijing 100088, China
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3
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Haddad HW, Hankey PB, Ko J, Eswani Z, Bhatti P, Edinoff AN, Kaye AM, Kaye AD. Viloxazine, a Non-stimulant Norepinephrine Reuptake Inhibitor, for the Treatment of Attention Deficit Hyperactivity Disorder: A 3 Year Update. Health Psychol Res 2022; 10:37018. [PMID: 35910243 DOI: 10.52965/001c.37018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Current treatment options for ADHD include pharmacological treatment (stimulants, non-stimulants, anti-depressants, anti-psychotics), psychological treatment (behavioral therapy with or without parent training, cognitive training, neurofeedback), and complementary and alternative therapies (vitamin supplementation, exercise). Central nervous system (CNS) stimulants are the primary pharmacological therapy used in treatment; however, these stimulant drugs carry a high potential for abuse and severe psychological/physical dependence. Viloxazine, a non-stimulant medication without evidence of drug dependence, is a selective norepinephrine reuptake inhibitor that has historically been prescribed as an anti-depressant medication. The extended-release (ER) form was approved by the US Food and Drug Administration (FDA) in April 2021 for the treatment of ADHD in pediatric patients aged 6-17 years. Phase 2 and 3 randomized control trials have demonstrated significant efficacy of viloxazine in improving ADHD symptoms versus placebo. Related to its long-standing use as an antidepressant, the safety profile and pharmacokinetics of viloxazine are well understood. Viloxazine appears to be a suitable alternative to current standard-of-care pharmacotherapy for ADHD, but the further investigation remains to be done in comparing its efficacy to that of current treatments.
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Affiliation(s)
| | | | | | - Zahaan Eswani
- Louisiana State University Health Science Center Shreveport
| | | | - Amber N Edinoff
- Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport
| | - Adam M Kaye
- Thomas J. Long School of Pharmacy and Health Sciences
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Science Center Shreveport
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4
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Fan HY, Sun CK, Cheng YS, Chung W, Tzang RF, Chiu HJ, Ho CN, Hung KC. A pilot meta-analysis on self-reported efficacy of neurofeedback for adolescents and adults with ADHD. Sci Rep 2022; 12:9958. [PMID: 35705685 PMCID: PMC9200800 DOI: 10.1038/s41598-022-14220-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/02/2022] [Indexed: 12/31/2022] Open
Abstract
Self-reported effectiveness of electroencephalogram-based neurofeedback (EEG-NF) against the core symptoms of attention-deficit hyperactivity disorder (ADHD) in adolescents/adults remains unclear. We searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to August 2021 for randomized clinical trials (RCTs) of EEG-NF with self-reported ADHD symptom ratings. Comparators included participants on waitlist/treatment as usual (TAU) or receiving other interventions. Of the 279 participants (mean age = 23.48; range: 6-60) in five eligible RCTs, 183 received EEG-NF treatment. Forest plot demonstrated no difference in inattention (SMD = -0.11, 95% CI -0.39-0.18, p = 0.46), total score (SMD = -0.08, 95% CI -0.36-0.2, p = 0.56), and hyperactivity/impulsivity (SMD = 0.01, 95% CI -0.23-0.25, p = 0.91) between EEG-NF and comparison groups. Nevertheless, compared with waitlist/TAU, EEG-NF showed better improvement in inattention (SMD = -0.48, 95% CI -0.9--0.06, p = 0.03) but not hyperactivity/impulsivity (SMD = -0.03, 95% CI -0.45-0.38, p = 0.87). Follow-up 6-12 months demonstrated no difference in inattention (SMD = -0.01, 95% CI -0.41-0.38, p = 0.94), total score (SMD = 0.22, 95% CI -0.08-0.52, p = 0.15), and hyperactivity/impulsivity (SMD = -0.01, 95% CI -0.27-0.26, p = 0.96) between the two groups. Dropout rate also showed no difference (RR = 1.05, 95% CI 0.82-1.33, p = 0.72). Our results support EEG-NF for improving inattention in adolescents/young adults, although its effectiveness against hyperactivity/impulsivity remains inconclusive.
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Affiliation(s)
- Hsin-Yi Fan
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ais Home, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ais Home, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Weilun Chung
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ais Home, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Hsien-Jane Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan.
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5
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Cutando L, Puighermanal E, Castell L, Tarot P, Bertaso F, Bonnavion P, Kerchove d'Exaerde A, Isingrini E, Galante M, Dallerac G, Pascoli V, Lüscher C, Giros B, Valjent E. Regulation of GluA1 phosphorylation by d-amphetamine and methylphenidate in the cerebellum. Addict Biol 2021; 26:e12995. [PMID: 33368923 DOI: 10.1111/adb.12995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 01/14/2023]
Abstract
Prescription stimulants, such as d-amphetamine or methylphenidate are used to treat suffering from attention-deficit hyperactivity disorder (ADHD). They potently release dopamine (DA) and norepinephrine (NE) and cause phosphorylation of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor subunit GluA1 in the striatum. Whether other brain regions are also affected remains elusive. Here, we demonstrate that d-amphetamine and methylphenidate increase phosphorylation at Ser845 (pS845-GluA1) in the membrane fraction of mouse cerebellum homogenate. We identify Bergmann glial cells as the source of pS845-GluA1 and demonstrate a requirement for intact NE release. Consequently, d-amphetamine-induced pS845-GluA1 was prevented by β1-adenoreceptor antagonist, whereas the blockade of DA D1 receptor had no effect. Together, these results indicate that NE regulates GluA1 phosphorylation in Bergmann glial cells in response to prescription stimulants.
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Affiliation(s)
- Laura Cutando
- IGF University of Montpellier, CNRS, Inserm Montpellier France
| | - Emma Puighermanal
- IGF University of Montpellier, CNRS, Inserm Montpellier France
- Neurosciences Institute, Department of Cell Biology, Physiology and Immunology Autonomous University of Barcelona Barcelona Spain
| | - Laia Castell
- IGF University of Montpellier, CNRS, Inserm Montpellier France
| | - Pauline Tarot
- IGF University of Montpellier, CNRS, Inserm Montpellier France
| | | | - Patricia Bonnavion
- Laboratory of Neurophysiology, ULB Neuroscience Institute Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Alban Kerchove d'Exaerde
- Laboratory of Neurophysiology, ULB Neuroscience Institute Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Elsa Isingrini
- Integrative Neuroscience and Cognition Center University of Paris, CNRS Paris France
- Department of Psychiatry, Douglas Hospital McGill University Montreal Quebec Canada
| | - Micaela Galante
- Pharmacologie et Biochimie de la Synapse, Institut des Neurosciences Paris‐Saclay University of Paris‐Saclay, University of Paris‐Sud, CNRS, UMR Orsay France
| | - Glenn Dallerac
- Pharmacologie et Biochimie de la Synapse, Institut des Neurosciences Paris‐Saclay University of Paris‐Saclay, University of Paris‐Sud, CNRS, UMR Orsay France
| | - Vincent Pascoli
- Department of Basic Neurosciences, Medical Faculty University of Geneva Geneva Switzerland
| | - Christian Lüscher
- Department of Basic Neurosciences, Medical Faculty University of Geneva Geneva Switzerland
| | - Bruno Giros
- Integrative Neuroscience and Cognition Center University of Paris, CNRS Paris France
- Department of Psychiatry, Douglas Hospital McGill University Montreal Quebec Canada
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6
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Nordby ES, Gilje S, Jensen DA, Sørensen L, Stige SH. Goal management training for adults with ADHD - clients' experiences with a group-based intervention. BMC Psychiatry 2021; 21:113. [PMID: 33607969 PMCID: PMC7893765 DOI: 10.1186/s12888-021-03114-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. METHOD We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. RESULTS Our analysis identified three main themes. The participants' starting point captured the participants' motivation and expectations prior to treatment. The ambiguity of the group - the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - "I am not alone"; The personal cost of participating in the group - "At times it was a hot mess"; and The group supported the learning experience - "We worked with it together"). The group promoted positive change - How the group affected the participants' everyday lives consisted of two sub-themes (Managing ADHD in daily life - "It's much easier to handle everyday life", and Personal growth - "Gaining new perspectives"). CONCLUSION The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one's focus. This study expands existing knowledge by exploring clients' experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.
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Affiliation(s)
- Emilie S. Nordby
- grid.7914.b0000 0004 1936 7443Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Sigrid Gilje
- grid.459157.b0000 0004 0389 7802Department of Mental Health and Addiction, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Daniel A. Jensen
- grid.7914.b0000 0004 1936 7443Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway ,grid.489983.70000000406467461Betanien Hospital, Bergen, Norway
| | - Lin Sørensen
- grid.7914.b0000 0004 1936 7443Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Signe H. Stige
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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7
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Press Y, Punchik B, Kagan E, Berzak A, Freud T, Dwolatzky T. Methylphenidate for Mild Cognitive Impairment: An Exploratory 3-Day, Randomized, Double-Blind, Placebo-Controlled Trial. Front Med (Lausanne) 2021; 8:594228. [PMID: 33634145 PMCID: PMC7900434 DOI: 10.3389/fmed.2021.594228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/18/2021] [Indexed: 01/31/2023] Open
Abstract
Background: To evaluate the efficacy, safety and tolerability of methylphenidate (MPH) for cognitive function in older patients with mild cognitive impairment (MCI). Methods: Male and female subjects aged 65 years and older with a clinical diagnosis MCI were included in an exploratory randomized, double-blind, placebo-controlled trial. Eligible subjects were assigned to either treatment with immediate-release MPH or placebo. The active compound was administered in an increasing-dose stepwise fashion, namely 10 mg MPH on day 1, 20 mg on day 2, and 30 mg on day 3. Subjects remained under observation for 4 h following drug administration and were monitored for changes in blood pressure and for adverse events. Cognitive outcome measures included the Montreal Cognitive Assessment (MoCA) and the Neurotrax Mindstreams computerized cognitive assessment battery. Results: Of 17 subjects enrolled, 15 subjects completed the study, 7 in the active MPH group and 8 in the placebo group. The average age of the participants was 76.1 ± 6.6 years and 10 (66.7%) were men. Following the final dose a significant benefit on memory (predominantly non-verbal memory) was found in the MPH group. While 12 adverse events were reported, they were all rated as mild to moderate. Conclusions: Our finding of modest beneficial effects of MPH on memory tests in older subjects with MCI in this exploratory study is of interest and should be investigated in further studies.
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Affiliation(s)
- Yan Press
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Ella Kagan
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Alexander Berzak
- Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzvi Dwolatzky
- Geriatric Unit, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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8
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Lam AP, de Sordi D, Müller HHO, Lam MC, Carl A, Kohse KP, Philipsen A. Aggravation of symptom severity in adult attention-deficit/hyperactivity disorder by latent Toxoplasma gondii infection: a case-control study. Sci Rep 2020; 10:14382. [PMID: 32873854 PMCID: PMC7463265 DOI: 10.1038/s41598-020-71084-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/06/2020] [Indexed: 11/09/2022] Open
Abstract
Toxoplasma gondii (T. gondii) has a high worldwide prevalence and an underestimated impact on neuropsychiatric disorders. Previous studies related T. gondii to disorders associated with the dysfunctional dopaminergic system. However, an association between T. gondii infection and adult attention-deficit/hyperactivity disorder (ADHD) has not yet been studied. In a sex- and age-matched case-control study, we investigated the seropositivity, serointensity, and avidity of latent T. gondii infection in adult ADHD patients and examined the influence of those variables on the symptomatology of ADHD. Of 140 participants, 20.0% were seropositive for anti-T. gondii IgG and 0% for anti-T. gondii IgM. T. gondii seropositivity was associated with 2.8-fold increase in the odds of ADHD in a confounder-adjusted multivariable analysis. Age and consumption of raw/undercooked meat were confirmed as significant predictors of T. gondii seropositivity. Multiple linear regression analysis of self-rated ADHD-related symptom severity in all participants revealed a significant association with T. gondii seropositivity, elevated IgG titers (serointensity), and stronger anti-T. gondii IgG avidity. Overall symptom severity was increased in seropositive ADHD patients compared to seronegative subjects with ADHD. In particular, hyperactivity was significantly associated with serointensity. We conclude that there is a high rate of T. gondii seropositivity in adults with ADHD. Additionally, our results suggest a clinical impact of latent T. gondii infection on ADHD-related symptoms in a serointensity- and avidity-dependent manner.
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Affiliation(s)
- Alexandra P Lam
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany. .,School of Medicine and Health Sciences, Medical Campus University of Oldenburg, Oldenburg, Germany.
| | - Dominik de Sordi
- Division of Epidemiology and Biometry, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Helge H O Müller
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,School of Medicine and Health Sciences, Medical Campus University of Oldenburg, Oldenburg, Germany.,Department of Psychiatry and Psychotherapy, Chair of Integrative Psychiatry and Psychotherapy, Witten/Herdecke University, Gemeinschaftskrankenhaus Herdecke, Witten/Herdecke, Germany
| | - Martin C Lam
- School of Medicine and Health Sciences, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Angelika Carl
- Institute for Laboratory Diagnostics and Microbiology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Klaus P Kohse
- Institute for Laboratory Diagnostics and Microbiology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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9
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Cherkasova MV, French LR, Syer CA, Cousins L, Galina H, Ahmadi-Kashani Y, Hechtman L. Efficacy of Cognitive Behavioral Therapy With and Without Medication for Adults With ADHD: A Randomized Clinical Trial. J Atten Disord 2020; 24:889-903. [PMID: 28413900 DOI: 10.1177/1087054716671197] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Recent trials have demonstrated efficacy of cognitive behavioral therapy (CBT) in medicated adults with ADHD. Efficacy of CBT in unmedicated versus medicated adults remains mostly unknown. We evaluated the effects of group CBT alone versus combined with medication on ADHD symptoms and functional outcomes in adult patients. Method: Eighty-eight adults with ADHD received 12 manualized group CBT sessions, accompanied by individual coaching, either without (n = 46) or with (n = 42) medication. Treatment effects were evaluated following treatment and 3-month and 6-month follow-up using un-blinded self-report and observer ratings. Results: CBT + medication resulted in greater improvements than CBT alone in ADHD symptoms, organizational skills, and self-esteem. Group differences diminished over follow-up, as the CBT alone group continued improving, while the combined group maintained the gains. Conclusion: CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.
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Affiliation(s)
| | - Lisa R French
- Renfrew Educational Services, Calgary, Alberta, Canada
| | | | - Lorne Cousins
- Clinical Psychologist in Private Practice, Montreal, Quebec, Canada
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10
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Psychological Treatments in Adult ADHD: A Systematic Review. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09794-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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11
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Effects of Acute Aerobic Exercise on Response Inhibition in Adult Patients with ADHD. Sci Rep 2019; 9:19884. [PMID: 31882652 PMCID: PMC6934617 DOI: 10.1038/s41598-019-56332-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022] Open
Abstract
Previous studies suggest beneficial effects of aerobic exercise on executive functions, which are a core deficit in ADHD. The aim of the present fMRI study was to investigate acute effects of aerobic exercise on inhibitory control and related brain activation in adult patients with ADHD. 23 patients and 23 matched healthy controls performed on a Go/No-go task in an MRI scanner, following both, an exercise condition involving 30 min of cycling at moderate intensity, and a control condition. ADHD patients compared to healthy controls showed increased brain activation during successful inhibition in the exercise compared to the control condition in parietal, temporal, and occipital regions. Exercise did not improve behavioral performance in either group, but in ADHD patients, exercise-related increases in brain activation and behavioral task performance (i.e., correct inhibition rate) negatively correlated with correct inhibition rate in the control condition. Thus, patients with worse inhibition performance showed stronger exercise-related enhancements, indicating that the lack of improvements on the behavioral level for the whole patient group could be due to ceiling effects. Our findings might be an important step in understanding the neural basis of exercise effects and could, in the long term, help in developing alternative treatment approaches for ADHD.
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12
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Laikowski MM, Reisdorfer F, Moura S. NAChR α4β2 Subtype and their Relation with Nicotine Addiction, Cognition, Depression and Hyperactivity Disorder. Curr Med Chem 2019; 26:3792-3811. [PMID: 29637850 DOI: 10.2174/0929867325666180410105135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/27/2017] [Accepted: 04/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neuronal α4β2 nAChRs are receptors involved in the role of neurotransmitters regulation and release, and this ionic channel participates in biological process of memory, learning and attention. This work aims to review the structure and functioning of the α4β2 nAChR emphasizing its role in the treatment of associated diseases like nicotine addiction and underlying pathologies such as cognition, depression and attention-deficit hyperactivity disorder. METHODS The authors realized extensive bibliographic research using the descriptors "Nicotine Receptor α4β2" and "cognition", "depression", "attention-deficit hyperactivity disorder", besides cross-references of the selected articles and after analysis of references in the specific literature. RESULTS As results, it was that found 179 relevant articles presenting the main molecules with affinity to nAChR α4β2 related to the cited diseases. The α4β2 nAChR subtype is a remarkable therapeutic target since this is the most abundant receptor in the central nervous system. CONCLUSION In summary, this review presents perspectives on the pharmacology and therapeutic targeting of α4β2 nAChRs for the treatment of cognition and diseases like nicotine dependence, depression and attention-deficit hyperactivity disorder.
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Affiliation(s)
- Manuela M Laikowski
- Laboratory of Natural and Synthetics Products, University of Caxias do Sul, Caxias do Sul, Brazil
| | - Fávero Reisdorfer
- Laboratory of Drug Development and Quality Control, University Federal of Pampa, Brazil
| | - Sidnei Moura
- Laboratory of Natural and Synthetics Products, University of Caxias do Sul, Caxias do Sul, Brazil
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13
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Basic processes as foundations of cognitive impairment in adult ADHD. J Neural Transm (Vienna) 2019; 126:1347-1362. [PMID: 31321549 PMCID: PMC6764934 DOI: 10.1007/s00702-019-02049-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/11/2019] [Indexed: 12/23/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) in adulthood is associated with impairment of multiple aspects of cognition which adversely affect the individual's everyday functioning. However, little is known about how these impairments are intertwined. This study explores whether impairments in basic processes (processing speed and distractibility) in adults with ADHD explain impairments in higher order functions, namely executive functions, memory, and complex attention. Furthermore, it is explored whether pharmacological treatment with methylphenidate (MPH) affects basic processes and higher order functions. A between-subjects design compared patients with ADHD without stimulant drug treatment (N = 55) and patients with ADHD treated with MPH (N = 31) with a healthy control group (N = 80). A neuropsychological test battery assessing basic processes and higher order functions was administered. Hierarchical logistic regression analyses were performed to evaluate the contribution of basic processes to impairments in higher order functions. Patients with ADHD not treated with MPH showed impairments in basic processes and higher order functions compared to controls. The impairments in basic processes explained 41-43% of impairments in executive functions, 27-29% in memory, and 56-74% in complex attention. In patients with ADHD treated with MPH, basic processes were not impaired and did not contribute significantly to impairments of higher order functions. Basic processes may constitute part of the foundation of cognitive impairments in adult ADHD. MPH may improve cognitive performance, presumably through improving basic processes. Applying this information could optimize neuropsychological assessments and inform treatment strategies by targeting basic processes.
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Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2018; 268:321-335. [PMID: 29356899 DOI: 10.1007/s00406-018-0868-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mindfulness training is a promising treatment approach in adult ADHD. However, there has not yet been a randomized controlled trial comparing mindfulness to an active control condition. In this study, we assessed the efficacy of a mindfulness training program (MAP) compared to structured psychoeducation (PE). METHODS After randomization 81 medication-free adult ADHD patients participated either in an 8-week MAP or PE group program. At baseline (T1), after 8 weeks (T2) and after 8 months (T3), severity of ADHD and associated symptoms (depression, general psychopathology, quality of life) were measured with the Conner's ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Brief Symptom Inventory (BSI) and the SF-36 by self and blind observer ratings. RESULTS Both groups showed significant pre-post improvements in observer-rated Inattention scale (p < .001, partial η2 = 0.18) and in associated symptomatology, which persisted through 6 months of follow-up. There were no significant differences regarding symptom reduction between the treatment groups. Women benefited more compared to men irrespective of treatment group. Men showed the most pronounced changes under MAP. CONCLUSIONS In the current study, MAP was not superior to PE regarding symptom reduction in adult ADHD. Both interventions, mindfulness meditation and PE, were efficacious in reducing symptom load in adult ADHD. Furthermore in exploratory post hoc tests the study provides evidence for a potential gender-specific treatment response in adult ADHD.
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15
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López-Pinar C, Martínez-Sanchís S, Carbonell-Vayá E, Fenollar-Cortés J, Sánchez-Meca J. Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. Front Psychol 2018; 9:638. [PMID: 29780342 PMCID: PMC5946687 DOI: 10.3389/fpsyg.2018.00638] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/16/2018] [Indexed: 01/23/2023] Open
Abstract
Background: Recent evidence suggests that psychosocial treatments, particularly cognitive-behavioral therapy (CBT), are effective interventions for adult attention deficit hyperactivity disorder (ADHD). The objective of this review was to determine the long-term efficacy of psychosocial interventions in improving clinically relevant variables, including ADHD core symptoms, clinical global impression (CGI), and global functioning. Methods: In total, nine randomized controlled trials and three uncontrolled single-group pretest-posttest studies were included. The data from these studies were combined using the inverse variance method. Heterogeneity and risk of bias were assessed. Subgroup analyses and meta-regressions were performed, to determine the influence of different potential moderator variables (risk of bias, medication status, follow-up length, therapy type and setting, and control group type) on effect size (ES) estimates. Results: Up to 680 of a total of 1,073 participants assessed pre-treatment were retained at follow-up. Treatment groups showed greater improvement than control groups in self-reported total ADHD symptoms, inattention, and hyperactivity/impulsivity, in addition to CGI and global functioning. Blind assessors also reported a large ES in within-subject outcomes. Studies using dialectical behavioral therapy (DBT) in a group setting, with active control matching, and that were rated as having an unclear risk of bias, achieved significantly lower ES estimates for most outcomes. Treatment effectiveness, according to the CGI measure, and global functioning were significantly increased when the percentage of medicated participants was greater. Conclusions: Our results indicate that the post-treatment gains reported in previous reviews are sustained for at least 12 months. Nevertheless, these results must be interpreted with caution, because of a high level of heterogeneity among studies and the risk of bias observed in the majority of outcomes. Thus, these findings indicate that psychological interventions are a highly valuable and stable clinical tool for the treatment of core symptoms and global functioning in adults with ADHD.
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Affiliation(s)
| | | | | | | | - Julio Sánchez-Meca
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
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16
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Nunes F, Pochmann D, Almeida AS, Marques DM, Porciúncula LDO. Differential Behavioral and Biochemical Responses to Caffeine in Male and Female Rats from a Validated Model of Attention Deficit and Hyperactivity Disorder. Mol Neurobiol 2018; 55:8486-8498. [PMID: 29557061 DOI: 10.1007/s12035-018-1000-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/07/2018] [Indexed: 01/01/2023]
Abstract
Epidemiological studies suggest sex differences in attention deficit and hyperactivity disorder (ADHD) symptomatology. The potential benefits of caffeine have been reported in the management of ADHD, but its effects were not properly addressed with respect to sex differences. The present study examined the effects of caffeine (0.3 g/L) administered since childhood in the behavior and brain-derived neurotrophic factor (BDNF) and its related proteins in both sexes of a rat model of ADHD (spontaneously hypertensive rats-SHR). Hyperlocomotion, recognition, and spatial memory disturbances were observed in adolescent SHR rats from both sexes. However, females showed lack of habituation and worsened spatial memory. Although caffeine was effective against recognition memory impairment in both sexes, spatial memory was recovered only in female SHR rats. Besides, female SHR rats showed exacerbated hyperlocomotion after caffeine treatment. SHR rats from both sexes presented increases in the BDNF, truncated and phospho-TrkB receptors and also phospho-CREB levels in the hippocampus. Caffeine normalized BDNF in males and truncated TrkB receptor at both sexes. These findings provide insight into the potential of caffeine against fully cognitive impairment displayed by females in the ADHD model. Besides, our data revealed that caffeine intake since childhood attenuated behavioral alterations in the ADHD model associated with changes in BDNF and TrkB receptors in the hippocampus.
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Affiliation(s)
- Fernanda Nunes
- Laboratory of Studies on the Purinergic System, Department of Biochemistry, Health and Basic Sciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Daniela Pochmann
- Laboratory of Studies on the Purinergic System, Department of Biochemistry, Health and Basic Sciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Amanda Staldoni Almeida
- Laboratory of Studies on the Purinergic System, Department of Biochemistry, Health and Basic Sciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | | | - Lisiane de Oliveira Porciúncula
- Laboratory of Studies on the Purinergic System, Department of Biochemistry, Health and Basic Sciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil.
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17
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Psychological issues and problematic use of smartphone: ADHD's moderating role in the associations among loneliness, need for social assurance, need for immediate connection, and problematic use of smartphone. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2017.11.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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18
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Solanto MV, Surman CB, Alvir JMJ. The efficacy of cognitive-behavioral therapy for older adults with ADHD: a randomized controlled trial. ACTA ACUST UNITED AC 2018; 10:223-235. [PMID: 29492784 DOI: 10.1007/s12402-018-0253-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Abstract
Older adults with ADHD exhibit significant functional impairment, yet there is little research to guide clinicians in evidence-based care of these adults. This study examined response to treatment in older adults who participated in a previous study of the efficacy of cognitive-behavioral treatment (CBT) in adult ADHD. It was hypothesized that older adults would respond less well to CBT than younger adults, given the cognitive demands of the treatment. As described in the original publication, 88 adults who met DSM-IV criteria for ADHD were randomized to receive either a manualized 12-week CBT group intervention targeting executive dysfunction or a parallel Support group. In the current study, outcomes for 26 adults, aged 50 or older, were compared with those of 55 younger adults with respect to inattentive symptoms assessed on a structured interview by a blind clinician, as well as on ratings by self and/or collateral on measures of attention, executive dysfunction, and comorbidity. Contrary to the hypothesis, older and younger adults were equally responsive to CBT on measures of attention. The older adults also responded as well to Support as to CBT on several outcome measures. The results provide preliminary evidence that CBT is an effective intervention for older adults with ADHD. The unexpected response to support highlights a possible age-specificity of effective therapeutic intervention that requires further investigation.
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Affiliation(s)
- Mary V Solanto
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA. .,Division of Developmental and Behavioral Pediatrics, Hofstra-Northwell School of Medicine, 1983 Marcus Avenue, Suite 130, Lake Success, NY, 11042, USA.
| | - Craig B Surman
- Department of Psychiatry, The Massachusetts General Hospital, Boston, MS, USA
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Bruchhage MMK, Bucci MP, Becker EBE. Cerebellar involvement in autism and ADHD. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:61-72. [PMID: 29891077 DOI: 10.1016/b978-0-444-64189-2.00004-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The cerebellum has long been known for its importance in motor learning and coordination. However, increasing evidence supports a role for the cerebellum in cognition and emotion. Consistent with a role in cognitive functions, the cerebellum has emerged as one of the key brain regions affected in nonmotor disorders, including autism spectrum disorder and attention deficit-hyperactivity disorder. Here, we discuss behavioral, postmortem, genetic, and neuroimaging studies in humans in order to understand the cerebellar contributions to the pathogenesis of both disorders. We also review relevant animal model findings.
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Affiliation(s)
- Muriel M K Bruchhage
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Maria-Pia Bucci
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Esther B E Becker
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
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20
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Marcelle ET, Ho EJ, Kaplan MS, Adler LA, Castellanos FX, Milham MP. Cogmed Working Memory Training Presents Unique Implementation Challenges in Adults With ADHD. Front Psychiatry 2018; 9:388. [PMID: 30210370 PMCID: PMC6121173 DOI: 10.3389/fpsyt.2018.00388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/02/2018] [Indexed: 12/04/2022] Open
Abstract
Cogmed Working Memory Training (CWMT), an online cognitive training program developed for children, is an increasingly popular non-pharmacological intervention for ADHD amongst all ages, despite limited supporting evidence. The initial objective of the present work was to examine the short- and long-term impacts of CWMT on brain function in adults with ADHD. However, during the conduct of our study, we experienced multiple levels of failures in recruitment and retention that signaled potential concerns about the suitability of CWMT for adults with ADHD. This perspective piece aims to describe the difficulties we encountered in the context of studies examining the efficacy of CWMT in comparable populations. We trace these difficulties to the limited tolerability of the current CWMT structure for adults with ADHD, and review similar limitations in the literature. We suggest that efficacy of CWMT in children may be due in large part to close monitoring and scaffolding provided by clinicians and caregivers. For CWMT to have viability for widespread use in adults, greater support and structure will be needed for users to improve the likelihood of adherence. We discuss implications and considerations for future efforts in both research and clinical practice.
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Affiliation(s)
- Enitan T Marcelle
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Center for the Developing Brain, Child Mind Institute, New York, NY, United States.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Erica J Ho
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States.,Department of Psychology, Yale University, New Haven, CT, United States
| | - Michelle S Kaplan
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States.,ADHD and Behavior Disorders Center, Child Mind Institute, New York, NY, United States
| | - Lenard A Adler
- Department of Psychiatry, Langone Medical Center, School of Medicine, New York University New York, NY, United States.,Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States
| | - F Xavier Castellanos
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States.,Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States
| | - Michael P Milham
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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21
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Corbisiero S, Bitto H, Newark P, Abt-Mörstedt B, Elsässer M, Buchli-Kammermann J, Künne S, Nyberg E, Hofecker-Fallahpour M, Stieglitz RD. A Comparison of Cognitive-Behavioral Therapy and Pharmacotherapy vs. Pharmacotherapy Alone in Adults With Attention-Deficit/Hyperactivity Disorder (ADHD)-A Randomized Controlled Trial. Front Psychiatry 2018; 9:571. [PMID: 30505283 PMCID: PMC6250816 DOI: 10.3389/fpsyt.2018.00571] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
In the treatment of adult attention-deficit/hyperactivity disorder (ADHD) the importance of psychological interventions in combination with pharmacotherapy is widely accepted in contemporary clinical routine. The natural course of the disorder seems to justify additional psychological interventions because even in patients who are highly compliant to pharmacotherapy full remission is not always achieved. The aim of the present study was to analyze the contribution of psychotherapy to the treatment of adult ADHD patients. In a randomized controlled study, the efficacy of a combined treatment of psychotherapy with pharmacotherapy is compared to pharmacological intervention alone. After initiation and stabilization of treatment with methylphenidate (MPH) in all subjects randomization to the two different treatment conditions was done. Afterwards both groups underwent treatment for about 10-12 weeks, the experimental group receiving sessions of cognitive-behavioral therapy (CBT) whereas the control group only received medication and standard clinical management (SCM). ADHD symptoms differed statistically during time but not between the two different treatment conditions. This result was the same for the single ADHD symptoms-inattention, hyperactivity, impulsivity, and emotional symptoms-and also for impairment. Individual standardized ADHD specific CBT program was not able to outperform SCM.
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Affiliation(s)
- Salvatore Corbisiero
- Division of Clinical Psychology and Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Hannes Bitto
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Patricia Newark
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Beatrice Abt-Mörstedt
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Marina Elsässer
- Division of Clinical Psychology and Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Jacqueline Buchli-Kammermann
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
| | - Sven Künne
- Division of Clinical Psychology and Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Elisabeth Nyberg
- Division of Clinical Psychology and Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Maria Hofecker-Fallahpour
- Division of Clinical Psychology and Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Division of Clinical Psychology and Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland.,Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland
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22
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Computerized Progressive Attention Training (CPAT) vs. Active Control in Adults with ADHD. JOURNAL OF COGNITIVE ENHANCEMENT 2017. [DOI: 10.1007/s41465-017-0056-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Mitchell JT, McIntyre EM, English JS, Dennis MF, Beckham JC, Kollins SH. A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. J Atten Disord 2017; 21:1105-1120. [PMID: 24305060 PMCID: PMC4045650 DOI: 10.1177/1087054713513328] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample. METHOD Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment ( n = 11) or waitlist group ( n = 9). RESULTS Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks. CONCLUSION Findings support preliminary treatment efficacy, though require larger trials.
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Affiliation(s)
- John T. Mitchell
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | | | - Joseph S. English
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - Michelle F. Dennis
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences,Durham, NC Veterans Affairs Medical Center
| | - Jean C. Beckham
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences,Durham, NC Veterans Affairs Medical Center,Mid-Atlantic Mental Illness Research Education and Clinical Center
| | - Scott H. Kollins
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
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Pedersen P, Bjerrum M, Larsen P, Bjerrum S, Pedersen J, Peters M. Nutritional interventions to reduce symptoms in children and adults with attention deficit hyperactivity disorder: a scoping review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2265-2269. [PMID: 28902693 DOI: 10.11124/jbisrir-2016-003134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this scoping review is to examine and map reported nutritional interventions and their outcomes in relieving symptoms of attention deficit hyperactivity disorder (ADHD) in the daily lives of children and adults. A further objective is to determine if experiences of people diagnosed with ADHD, their relatives or staff in being on a diet or having to eat or avoid eating specific food items have been reported in the existing literature.Specifically the scoping review questions are.
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Affiliation(s)
- Preben Pedersen
- 1Danish Center of Systematic Review, a Joanna Briggs Institute Center of Excellence, Danish Centre of Clinical Guidelines, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark 2Department of Nursing Science, Institute of Public Health, Aarhus University, Aarhus, Denmark 3Psychiatric Clinic, Knudrisgade, Aarhus, Denmark 4AAU Libraries, Aalborg University, Aalborg, Denmark 5Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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25
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Schönenberg M, Wiedemann E, Schneidt A, Scheeff J, Logemann A, Keune PM, Hautzinger M. Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: a triple-blind, randomised, controlled trial. Lancet Psychiatry 2017; 4:673-684. [PMID: 28803030 DOI: 10.1016/s2215-0366(17)30291-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many studies suggest that electroencephalographic (EEG) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder (ADHD). However, numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial. The present trial examined the efficacy (compared with sham neurofeedback) and efficiency (compared with meta-cognitive therapy) of a standard EEG neurofeedback protocol in adults with ADHD. METHODS We did a concurrent, triple-blind, randomised, controlled trial using authorised deception in adults with ADHD from one centre (University of Tübingen) in Tübingen, Germany. Participants were eligible if they fulfilled the DSM-IV-TR criteria for ADHD, were aged between 18 years and 60 years, and had no or stable use of medication for at least 2 months with no intention to change. We excluded participants who had comorbid schizophrenia or schizoaffective disorder, bipolar disorder, borderline personality disorder, epilepsy, or traumatic brain injury; substance abuse or dependence; or current or planned other psychological treatment. Those eligible were randomly assigned to three groups: a neurofeedback group which received 30 verum θ-to-β neurofeedback sessions over 15 weeks, a sham neurofeedback group which received 15 sham followed by 15 verum θ-to-β neurofeedback sessions over 15 weeks, or a meta-cognitive group therapy group which received 12 sessions over 12 weeks. Participants were assigned equally to one of the three interventions through a computerised minimisation randomisation procedure stratified by sex, age, and baseline symptom severity of ADHD. Participants were masked as to whether they were receiving neurofeedback or sham neurofeedback, but those receiving meta-cognitive therapy were aware of their treatment. Clinical assessors (ie, those assessing outcomes) and research staff who did the neurofeedback training were masked to participants' randomisation status only for neurofeedback and sham neurofeedback. The primary outcome was symptom score on the Conners' adult ADHD rating scale, assessed before treatment, at midtreatment (after 8 weeks), after treatment (after 16 weeks), and 6 months later. All individuals with at least one observation after randomisation were included in the analyses. This trial is registered with ClinicalTrials.gov, number NCT01883765. FINDINGS Between Feb 1, 2013, and Dec 1, 2015, 761 people were assessed for eligibility. 656 (86%) were excluded and 118 (15%) were eligible for participation in this study. Eligible participants were randomly assigned to neurofeedback (38 [32%]), sham neurofeedback (39 [33%]), or meta-cognitive therapy (41 [35%]). 37 (97%) individuals for neurofeedback, 38 (97%) for sham neurofeedback, and 38 (93%) for meta-cognitive therapy were included in analyses. Self-reported ADHD symptoms decreased substantially for all treatment groups (B=-2·58 [95% CI -3·48 to -1·68]; p<0·0001) between pretreatment and the end of 6 month follow-up, independent of treatment condition (neurofeedback vs sham neurofeedback B=-0·89 [95% CI -2·14 to 0·37], p=0·168; neurofeedback vs meta-cognitive therapy -0·30 [-1·55 to 0·95], p=0·639). No treatment-related or trial-related serious adverse events were reported. INTERPRETATION Our findings suggest that neurofeedback training is not superior to a sham condition or group psychotherapy. All three treatments were equivalently effective in reducing ADHD symptoms. This first randomised, sham-controlled trial did not show any specific effects of neurofeedback on ADHD symptoms in adults. FUNDING German Research Foundation.
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Affiliation(s)
- Michael Schönenberg
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany.
| | - Eva Wiedemann
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Alexander Schneidt
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Jonathan Scheeff
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | | | - Philipp M Keune
- Department of Physiological Psychology, University of Bamberg, Bamberg, Germany; Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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Schoeman R, Liebenberg R. The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder. THE SOUTH AFRICAN JOURNAL OF PSYCHIATRY : SAJP : THE JOURNAL OF THE SOCIETY OF PSYCHIATRISTS OF SOUTH AFRICA 2017. [PMID: 30263194 DOI: 10.4102/sajpsychiatry.v23i0.1060.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/26/2022]
Abstract
Disclaimer These guidelines do not aim to provide a comprehensive review of all the pertinent literature comprising the evidence base and, as such, should be utilised in conjunction with other guidelines as well as the responsibility of practitioners to maintain a high level of personal knowledge and expertise. Despite the known efficacy of treatment and the substantial costs of untreated attention-deficit/hyperactivity disorder (ADHD), access to healthcare and treatment is not a given for many patients in South Africa (SA). In SA, there is poor identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited in emerging markets and in SA psychiatrists, and patients do not have access to the medication armamentarium available in established markets. Furthermore, the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines. These guidelines should therefore not be seen as a policy document. The process The South African Society of Psychiatrists' Special Interest Group (SIG) for adult ADHD was launched on 25 September 2015, with doctors Rykie Liebenberg and Renata Schoeman as convenor and co-convenor, respectively. The overall objective of the ADHD SIG is to improve the basket of care available to patients with ADHD. This is only possible through a combined and concerted effort of individuals with a special interest in and passion for ADHD to improve knowledge about and funding for the care of individuals with the disorder. One of the specific aims of the ADHD SIG was to develop South African guidelines for the diagnosis and treatment of adult ADHD specifically and update guidelines for the treatment of child, adolescent and adult ADHD. Dr Schoeman has recently completed her MBA at the University of Stellenbosch Business School with a thesis entitled 'A funding model proposal for private health insurance for adult attention-deficit/hyperactivity disorder in the South African context'. This is first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD. Dr Schoeman was tasked by the SIG with the drafting of guidelines. Dr Liebenberg provided valuable input. The guidelines were then circulated to the SIG members, as well as the Chair of the Public Sector SIG, for written feedback and evidence-based suggestions which were then incorporated into the guidelines. The final guidelines were circulated for written approval by the SIG members, followed by formal approval at a SIG meeting held on 14 August 2016, after which it was submitted to the South African Society of Psychiatrists (SASOP) and Psychiatry Management Group (PsychMG) boards for recommendation and ratification.
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Affiliation(s)
- Renata Schoeman
- Stellenbosch University Business School, Stellenbosch University, South Africa.,Private Practice, South Africa
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Schoeman R, Liebenberg R. The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder. S Afr J Psychiatr 2017; 23:1060. [PMID: 30263194 PMCID: PMC6138063 DOI: 10.4102/sajpsychiatry.v23i0.1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/13/2017] [Indexed: 12/16/2022] Open
Abstract
DISCLAIMER These guidelines do not aim to provide a comprehensive review of all the pertinent literature comprising the evidence base and, as such, should be utilised in conjunction with other guidelines as well as the responsibility of practitioners to maintain a high level of personal knowledge and expertise. Despite the known efficacy of treatment and the substantial costs of untreated attention-deficit/hyperactivity disorder (ADHD), access to healthcare and treatment is not a given for many patients in South Africa (SA). In SA, there is poor identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited in emerging markets and in SA psychiatrists, and patients do not have access to the medication armamentarium available in established markets. Furthermore, the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines. These guidelines should therefore not be seen as a policy document. THE PROCESS The South African Society of Psychiatrists' Special Interest Group (SIG) for adult ADHD was launched on 25 September 2015, with doctors Rykie Liebenberg and Renata Schoeman as convenor and co-convenor, respectively. The overall objective of the ADHD SIG is to improve the basket of care available to patients with ADHD. This is only possible through a combined and concerted effort of individuals with a special interest in and passion for ADHD to improve knowledge about and funding for the care of individuals with the disorder. One of the specific aims of the ADHD SIG was to develop South African guidelines for the diagnosis and treatment of adult ADHD specifically and update guidelines for the treatment of child, adolescent and adult ADHD. Dr Schoeman has recently completed her MBA at the University of Stellenbosch Business School with a thesis entitled 'A funding model proposal for private health insurance for adult attention-deficit/hyperactivity disorder in the South African context'. This is first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD. Dr Schoeman was tasked by the SIG with the drafting of guidelines. Dr Liebenberg provided valuable input. The guidelines were then circulated to the SIG members, as well as the Chair of the Public Sector SIG, for written feedback and evidence-based suggestions which were then incorporated into the guidelines. The final guidelines were circulated for written approval by the SIG members, followed by formal approval at a SIG meeting held on 14 August 2016, after which it was submitted to the South African Society of Psychiatrists (SASOP) and Psychiatry Management Group (PsychMG) boards for recommendation and ratification.
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Affiliation(s)
- Renata Schoeman
- Stellenbosch University Business School, Stellenbosch University, South Africa
- Private Practice, South Africa
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Kim EJ, Kim Y, Seo WS, Lee SH, Park EJ, Bae SM, Shin D. The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (I) - Clinical Presentation and Comorbidity -. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Eun Jin Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yunsin Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Wan Seok Seo
- Department of Psychiatry, Yeungnam University School of Medicine, Daegu, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eun Jin Park
- Department of Psychiatry, Inje University School of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Seung-Min Bae
- Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea
| | - Dongwon Shin
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Altszuler AR, Page TF, Gnagy EM, Coxe S, Arrieta A, Molina BSG, Pelham WE. Financial Dependence of Young Adults with Childhood ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 44:1217-29. [PMID: 26542688 DOI: 10.1007/s10802-015-0093-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study used data from the Pittsburgh ADHD Longitudinal Study (PALS) to evaluate financial outcomes of young adults (YA) with ADHD relative to comparisons. Participants for this study included 309 individuals who had been diagnosed with ADHD (DSM-III-R or DSM-IV) in childhood and 208 comparison YA without childhood ADHD diagnoses (total N = 517) who were followed through age 25. Participants were predominately male (88 %) and Caucasian (84 %). Diagnostic interviews were conducted in childhood. Young adults and their parents reported on financial outcomes and a number of predictor variables. Young adults with ADHD experienced greater financial dependence on family members (p < 0.05) and the welfare system (p < 0.01) and had lower earnings (p < 0.05) than comparisons. ADHD diagnostic status, education attainment, and delinquency were significant predictors of financial outcomes. A projection of lifetime earnings indicated that ADHD group participants could expect to earn $543,000-$616,000 less over their lifetimes than comparisons. Due to the propensity of individuals with ADHD to underreport problems, the data are likely to be underestimates. These findings support the need for interventions to improve labor market outcomes as well as the development of interventions that target the management of personal finances for individuals with ADHD in young adulthood.
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Affiliation(s)
- Amy R Altszuler
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
| | - Timothy F Page
- Department of Health Policy and Management, Florida International University, 11200 SW 8th St., AHC5 447, Miami, FL, 33199, USA.
| | - Elizabeth M Gnagy
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
| | - Stefany Coxe
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
| | - Alejandro Arrieta
- Department of Health Policy and Management, Florida International University, 11200 SW 8th St., AHC5 447, Miami, FL, 33199, USA
| | - Brooke S G Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - William E Pelham
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St AHC1 140, Miami, FL, 33199, USA
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Motaghinejad M, Motevalian M, Shabab B. Possible involvements of glutamate and adrenergic receptors on acute toxicity of methylphenidate in isolated hippocampus and cerebral cortex of adult rats. Fundam Clin Pharmacol 2016; 31:208-225. [DOI: 10.1111/fcp.12250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Majid Motaghinejad
- Razi Drug Research Center & Pharmacology Department; School of Medicine; Iran University of Medical Sciences; Hemmat Highway, Beside Milad Tower, P.O. Box: 14496-14525 Tehran Iran
| | - Manijeh Motevalian
- Razi Drug Research Center & Pharmacology Department; School of Medicine; Iran University of Medical Sciences; Hemmat Highway, Beside Milad Tower, P.O. Box: 14496-14525 Tehran Iran
| | - Behnaz Shabab
- Solid Dosage Form Department; Iran Hormone Pharmaceutical Company; 13185-1767 Tehran Iran
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Motaghinejad M, Motevalian M, Shabab B, Fatima S. Effects of acute doses of methylphenidate on inflammation and oxidative stress in isolated hippocampus and cerebral cortex of adult rats. J Neural Transm (Vienna) 2016; 124:121-131. [DOI: 10.1007/s00702-016-1623-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/08/2016] [Indexed: 12/18/2022]
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Hasan CMM, Islam MM, Mahib MMR, Arju MAC. Prevalence and assessment of biochemical parameters of attention-deficit hyperactivity disorder children in Bangladesh. J Basic Clin Pharm 2016; 7:70-4. [PMID: 27330258 PMCID: PMC4910470 DOI: 10.4103/0976-0105.183261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background and Objectives: This study aimed to evaluate some new biochemical parameters that help ensuring the early and precise diagnosis of attention-deficit hyperactivity disorder (ADHD) in blood plasma. Design and Settings: A prospective study conducted with patients scheduled for some new biochemical parameters that help ensuring the early and precise diagnosis of ADHD in blood plasma in a Child Development Center of the Chittagong, Bangladesh. Materials and Methods: The study was carried out at two levels. The first level was questionnaire on personal data and disease history while the second was on biochemical examination of the plasma ammonia and lactate status. A total of 100 children (age range 2 years 4 months to 12 years 6 months, mean age 7 years 5 months) were investigated in this study among 75 were male and 25 were female. This study was conducted in Chittagong Maa-O-Shishu General Hospital, Bangladesh. Results: We observed that the level of plasma ammonia and lactate were higher in ADHD children (36-60 μmol/L; P < 0.05 and 22-30 μmol/L; P < 0.05, respectively) compare to a reference value. The prevalence of ADHD is higher in male (75%) than in female (25%) with a ratio of 3:1. Consanguinity increases the risk of having ADHD in the next generation. Conclusion: This study concludes that there might be a correlation between ADHD and increased level of plasma ammonia and lactate level, and those might be an important parameter in the diagnosis of ADHD patients.
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Affiliation(s)
| | - Mohammad Monirul Islam
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, Bangladesh
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Bucci MP, Stordeur C, Acquaviva E, Peyre H, Delorme R. Postural Instability in Children with ADHD Is Improved by Methylphenidate. Front Neurosci 2016; 10:163. [PMID: 27199629 PMCID: PMC4854903 DOI: 10.3389/fnins.2016.00163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
HIGHLIGHTSBoth spatial and temporal analyses of the Center of Pressure demonstrate that children with ADHD have poorer postural control than typically developing sex-, age-, and IQ-matched children. Poor sensory integration in postural control could partially explained the deficits in postural stability in children with ADHD. MPH treatment improves postural performance in both spatial and temporal domains in children with ADHD. MPH improves postural control specifically when visual and proprioceptive inputs are misleading. Such improvement could be due to MPH effects on neurons, facilitating cerebellar processing of postural control.
The aim of this study was to examine postural control in children with ADHD and explore the effect of methylphenidate (MPH), using spatial and temporal analyses of the center of pressure (CoP). Thirty-eight children with ADHD (mean age 9.82 ± 0.37 years) and 38 sex- age- and IQ-matched children with typically development were examined. Postural stability was evaluated using the Multitest Equilibre machine (Framiral®) at inclusion and after 1 month of MPH in children with ADHD. Postural stability was assessed by recording under several conditions: with eyes open and fixed on a target, with eyes closed and with vision perturbed by optokinetic stimulation, on stable and unstable platforms. At inclusion, we observed poor spatial and temporal postural stability in children with ADHD. The spectral power index was higher in children with ADHD than in controls. Canceling time was shorter at low and medium frequencies of oscillation and longer at higher frequencies in children with ADHD. After 1 month of MPH, the surface area and mean velocity of the CoP decreased significantly under the most complex conditions (unstable platform in the absence of proprioceptive and visual inputs). The spectral power index decreased significantly after MPH while the canceling time did not change. Poor postural control in children with ADHD supports the hypothesis of cerebellar dysfunction in this disorder. Postural control could be improved by a more efficient processing of sensory inputs (a high-level process), as suggested by the decrease in spectral power index after MPH without changes in the canceling time (a low-level process).
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Affiliation(s)
- Maria P Bucci
- UMR 1141 Institut National de la Santé et de la Recherche Médicale-Université Paris Diderot, Robert Debré Hospital Paris, France
| | - Coline Stordeur
- Child and Adolescent Psychiatry Department, Robert Debré Hospital Paris, France
| | - Eric Acquaviva
- Child and Adolescent Psychiatry Department, Robert Debré Hospital Paris, France
| | - Hugo Peyre
- Child and Adolescent Psychiatry Department, Robert Debré Hospital Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré HospitalParis, France; Université Paris DiderotParis, France
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Skills training groups for men with ADHD in compulsory care due to substance use disorder: a feasibility study. ACTA ACUST UNITED AC 2016; 8:159-72. [DOI: 10.1007/s12402-016-0195-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 03/30/2016] [Indexed: 12/19/2022]
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Bachmann K, Lam AP, Philipsen A. Mindfulness-Based Cognitive Therapy and the Adult ADHD Brain: A Neuropsychotherapeutic Perspective. Front Psychiatry 2016; 7:117. [PMID: 27445873 PMCID: PMC4921925 DOI: 10.3389/fpsyt.2016.00117] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/14/2016] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a recognized serious mental disorder that often persists into adulthood. The symptoms and impairments associated with ADHD often cause significant mental suffering in affected individuals. ADHD has been associated with abnormal neuronal activity in various neuronal circuits, such as the dorsofrontostriatal, orbitofrontostriatal, and frontocerebellar circuits. Psychopharmacological treatment with methylphenidate hydrochloride is recommended as the first-line treatment for ADHD. It is assumed that medication ameliorates ADHD symptoms by improving the functioning of the brain areas affected in the condition. However, side effects, contraindications, or non-response can limit the effectiveness of a psychopharmacological treatment for ADHD. It is therefore necessary to develop non-pharmacological interventions that target neuronal mechanisms associated with the condition in the same way as pharmacological treatment. We think that mindfulness meditation employed as a neuropsychotherapeutic intervention could help patients with ADHD to regulate impaired brain functioning and thereby reduce ADHD symptoms. In this paper, we highlight the mechanisms of such mindfulness meditation, and thus provide a rationale for further research and treatment development from a neuropsychotherapeutic perspective. We conclude that mindfulness meditation employed as a neuropsychotherapeutic intervention in therapy is a promising treatment approach in ADHD.
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Affiliation(s)
- Katharina Bachmann
- School of Medicine & Health Sciences, University of Oldenburg , Oldenburg , Germany
| | - Alexandra P Lam
- School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany; Psychiatry and Psychotherapy, University Hospital, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Alexandra Philipsen
- School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany; Psychiatry and Psychotherapy, University Hospital, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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Murrell AR, Lester EG, Sandoz EK. Grounding Turbulent Minds: The Challenges of Mindfulness-Based Interventions for College Students With ADHD and How to Overcome Them. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2015. [DOI: 10.1080/87568225.2015.1074022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Young S, Khondoker M, Emilsson B, Sigurdsson JF, Philipp-Wiegmann F, Baldursson G, Olafsdottir H, Gudjonsson G. Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis. Psychol Med 2015; 45:2793-2804. [PMID: 26022103 PMCID: PMC4595859 DOI: 10.1017/s0033291715000756] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland. METHOD A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment. RESULTS CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time. CONCLUSIONS The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.
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Affiliation(s)
- S. Young
- Division of Brain Sciences, Department of Medicine, Centre for Mental Health, Imperial College London, London, UK
- Broadmoor Hospital, West London Mental Health NHS Trust, Crowthorne, UK
- Reykjavik University, Reykjavik, Iceland
| | - M. Khondoker
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - B. Emilsson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - J. F. Sigurdsson
- Reykjavik University, Reykjavik, Iceland
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - F. Philipp-Wiegmann
- Broadmoor Hospital, West London Mental Health NHS Trust, Crowthorne, UK
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - G. Baldursson
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - H. Olafsdottir
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - G. Gudjonsson
- Broadmoor Hospital, West London Mental Health NHS Trust, Crowthorne, UK
- Reykjavik University, Reykjavik, Iceland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Eddy LD, Will H. C, Broman-Fulks JJ, Michael KD. Brief Cognitive Behavioral Therapy for College Students With ADHD: A Case Series Report. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitchell JT, Zylowska L, Kollins SH. Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions. COGNITIVE AND BEHAVIORAL PRACTICE 2015; 22:172-191. [PMID: 25908900 DOI: 10.1016/j.cbpra.2014.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Research examining nonpharmacological interventions for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) has expanded in recent years and provides patients with more treatment options. Mindfulness-based training is an example of an intervention that is gaining promising preliminary empirical support and is increasingly administered in clinical settings. The aim of this review is to provide a rationale for the application of mindfulness to individuals diagnosed with ADHD, describe the current state of the empirical basis for mindfulness training in ADHD, and summarize a treatment approach specific to adults diagnosed with ADHD: the Mindful Awareness Practices (MAPs) for ADHD Program. Two case study examples are provided to demonstrate relevant clinical issues for practitioners interested in this approach. Directions for future research, including mindfulness meditation as a standalone treatment and as a complementary approach to cognitive-behavioral therapy, are provided.
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Affiliation(s)
- John T Mitchell
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - Lidia Zylowska
- University of California Santa Cruz ; University of California Los Angeles
| | - Scott H Kollins
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
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Davies MA, Stilley CS. Personality Traits in Adults With Attention Deficit Hyperactivity Disorder: Implications for Clinical Practice. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Potter AS, Schaubhut G, Shipman M. Targeting the nicotinic cholinergic system to treat attention-deficit/hyperactivity disorder: rationale and progress to date. CNS Drugs 2014; 28:1103-13. [PMID: 25349138 PMCID: PMC4487649 DOI: 10.1007/s40263-014-0208-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common chronic neurobehavioral disorder related to clinically significant levels of inattention, hyperactivity, and/or impulsivity. ADHD begins in childhood and symptoms persist into adulthood for the majority of those with the disorder. Associated features of ADHD include emotion dysregulation and cognitive impairments, which contribute to the considerable functional impairments in this disorder. Current approved treatments are reasonably effective; however, a significant need remains for new pharmacotherapies, both for individuals who do not achieve a full therapeutic response and for symptoms that are under-treated including cognition and emotion regulation. The striking relationship between ADHD and cigarette smoking and the known effects of nicotine on cognition has spurred research into the therapeutic potential of nicotinic agents for ADHD. Although there are no approved medications for ADHD that target nicotinic acetylcholine receptor (nAChR) function, results from many trials of nicotinic drugs are available and reviewed in this article. ADHD symptoms were reduced in the majority of published studies of nicotine and novel α4β2 nicotinic agonists in adult ADHD. The drugs were generally well tolerated, with mild to moderate side effects reported, which were largely consistent with cholinergic stimulation and included nausea, dizziness, and gastrointestinal distress. Within-subject crossover study designs were used in the majority of positive studies. This design may be particularly useful in ADHD trials because it minimizes variability in this notoriously heterogeneous diagnostic group. In addition, many studies found evidence for a beneficial effect of nicotinic stimulation on cognitive and emotional domains. Thus, targeting nAChRs in ADHD appears to have a modest clinical benefit in adult ADHD. Continued refinement of nAChR agonists with greater specificity and fewer side effects may lead to even more effective nAChR agonists for ADHD. Future clinical trials in ADHD should include direct measures of neuropsychological performance and emotion regulation.
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Affiliation(s)
- Alexandra S Potter
- Clinical Neuroscience Research Unit, University of Vermont College of Medicine, 1 South Prospect Street, Burlington, VT, 05401, USA,
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Fuermaier AB, Tucha L, Koerts J, Aschenbrenner S, Weisbrod M, Lange KW, Tucha O. Cognitive Complaints of Adults With Attention Deficit Hyperactivity Disorder. Clin Neuropsychol 2014; 28:1104-22. [DOI: 10.1080/13854046.2014.964325] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dittner AJ, Rimes KA, Russell AJ, Chalder T. Protocol for a proof of concept randomized controlled trial of cognitive-behavioural therapy for adult ADHD as a supplement to treatment as usual, compared with treatment as usual alone. BMC Psychiatry 2014; 14:248. [PMID: 25207986 PMCID: PMC4158100 DOI: 10.1186/s12888-014-0248-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/21/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND ADHD is prevalent in adults and frequently associated with impairment and distress. While medication is often the first line of treatment a high proportion of people with the condition are not fully treated by medication alone, cannot tolerate medication or do not wish to take it. Preliminary studies suggest that psychosocial approaches are a promising adjunctive or alternative treatment option. To date, individual cognitive-behaviour therapy (CBT) has been found to be efficacious in three randomized controlled trials (RCTs). There is a need for more RCTs to be carried out in order to replicate these results in different sites, to further investigate the acceptability and feasibility of CBT in this population and to further develop CBT approaches based on a psychological model. This randomized controlled trial investigates the efficacy of individual, formulation-based CBT when added to treatment-as-usual as compared with treatment as usual alone. METHODS/DESIGN Sixty patients with a diagnosis of adult ADHD attending a specialist clinic are randomly allocated to 1 of 2 treatments, 'Treatment as Usual' (TAU) or TAU plus 16 sessions individual CBT (TAU + CBT). In the TAU + CBT, the first 15 sessions take place over 30 weeks with a 16th 'follow-up' session at 42 weeks. Outcomes are assessed at 30 weeks and 42 weeks following randomization. The two primary outcomes are self-rated ADHD symptoms and functioning (occupational and social). Secondary outcomes include distress, mood, ADHD-related cognitions, ADHD-related behaviours and informant-rated ADHD symptoms. The primary analysis will include all participants for whom data is available and will use longitudinal regression models to compare treatments. Secondary outcomes will be analysed similarly. DISCUSSION The results of the study will provide information about a) whether CBT adds benefit over and above TAU for ADHD and, b) if CBT is found to be efficacious, potential mechanisms of change and predictors of efficacy. TRIAL REGISTRATION Current Controlled Trials ISRCTN03732556, assigned 04/11/2010.
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Affiliation(s)
- Antonia J Dittner
- King’s College London, King’s Health Partners, Behavioural and Developmental Psychiatry Clinical Academic Group, Maudsley Adult ADHD Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Katharine A Rimes
- King’s College London, King’s Health Partners, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ailsa J Russell
- King’s College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK and Department of Psychology, University of Bath, Bath, UK
| | - Trudie Chalder
- King’s College London, King’s Health Partners, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Whole-body vibration improves cognitive functions of an adult with ADHD. ACTA ACUST UNITED AC 2014; 6:211-20. [DOI: 10.1007/s12402-014-0149-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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Bucci MP, Seassau M, Larger S, Bui-Quoc E, Gerard CL. Effect of visual attention on postural control in children with attention-deficit/hyperactivity disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1292-1300. [PMID: 24691355 DOI: 10.1016/j.ridd.2014.03.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 06/03/2023]
Abstract
We compared the effect of oculomotor tasks on postural sway in two groups of ADHD children with and without methylphenidate (MPH) treatment against a group of control age-matched children. Fourteen MPH-untreated ADHD children, fourteen MPH-treated ADHD children and a group of control children participated to the study. Eye movements were recorded using a video-oculography system and postural sway measured with a force platform simultaneously. Children performed fixation, pursuits, pro- and anti-saccades. We analyzed the number of saccades during fixation, the number of catch-up saccades during pursuits, the latency of pro- and anti-saccades; the occurrence of errors in the anti-saccade task and the surface and mean velocity of the center of pressure (CoP). During the postural task, the quality of fixation was significantly worse in both groups of ADHD children with respect to control children; in contrast, the number of catch-up saccades during pursuits, the latency of pro-/anti-saccades and the rate of errors in the anti-saccade task did not differ in the three groups of children. The surface of the CoP in MPH-treated children was similar to that of control children, while MPH-untreated children showed larger postural sway. When performing any saccades, the surface of the CoP improved with respect to fixation or pursuits tasks. This study provides evidence of poor postural control in ADHD children, probably due to cerebellar deficiencies. Our study is also the first to show an improvement on postural sway in ADHD children performing saccadic eye movements.
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Affiliation(s)
- Maria Pia Bucci
- UMR1141, INSERM - Université Paris Diderot, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France.
| | - Magali Seassau
- e(ye)BRAIN, 1 bis rue Jean le Galleu, 94200 Ivry-sur-Seine, France(1)
| | - Sandrine Larger
- Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Robert Debré, 48 Boulevard Sérurier 75019 Paris, France
| | - Emmanuel Bui-Quoc
- Service d'Ophtalmologie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France
| | - Christophe-Loic Gerard
- Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Robert Debré, 48 Boulevard Sérurier 75019 Paris, France
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Fuermaier ABM, Tucha L, Koerts J, van Heuvelen MJG, van der Zee EA, Lange KW, Tucha O. Good vibrations--effects of whole body vibration on attention in healthy individuals and individuals with ADHD. PLoS One 2014; 9:e90747. [PMID: 24587412 PMCID: PMC3938804 DOI: 10.1371/journal.pone.0090747] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/06/2014] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Most of the current treatment strategies of ADHD are associated with a number of disadvantages which strengthen the need for alternative or additional approaches for the treatment of ADHD. In this respect, Whole Body Vibration (WBV) might be interesting as it was found to have beneficial effects on a variety of physiological measures. The present study explored the effects of WBV on attention of healthy individuals and adults diagnosed with ADHD. METHODS Eighty-three healthy individuals and seventeen adults diagnosed with ADHD participated in the study. WBV treatment was applied passively, while participants were sitting on a chair which was mounted on a vibrating platform. A repeated measure design was employed in order to explore potential effects of WBV treatment on attention within subjects. Attention (i.e. inhibitory control) was measured with a color-word interference paradigm. RESULTS A period of two minutes of WBV treatment had significant beneficial effects of small to medium size on attention of both healthy individuals and adults with ADHD. The effect of WBV treatment on attention did not differ significantly between groups. CONCLUSIONS WBV was demonstrated to improve cognitive performance of healthy individuals as well as of individuals with ADHD. WBV treatment is relatively inexpensive and easy to apply and might therefore be of potential relevance for clinical use. The application of WBV treatment as a cognitive enhancement strategy and as a potential treatment of cognitive impairments is discussed.
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Affiliation(s)
- Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Marieke J. G. van Heuvelen
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eddy A. van der Zee
- Center of Behaviour and Neuroscience, Department of Molecular Neurobiology, University of Groningen, Groningen, the Netherlands
| | - Klaus W. Lange
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
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Arnold VK, Feifel D, Earl CQ, Yang R, Adler LA. A 9-week, randomized, double-blind, placebo-controlled, parallel-group, dose-finding study to evaluate the efficacy and safety of modafinil as treatment for adults with ADHD. J Atten Disord 2014; 18:133-44. [PMID: 22617860 DOI: 10.1177/1087054712441969] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the efficacy and tolerability of modafinil at a range of doses, versus placebo, in alleviating symptoms of ADHD in adults. METHOD Adult patients with ADHD were randomized in 1:1:1:1:1 fashion to double-blind treatment with modafinil 255, 340, 425, or 510 mg daily or placebo for 9 weeks. The primary efficacy outcome was the change from baseline at final visit in the Adult ADHD Investigator Symptom Rating Scale (AISRS) total score. RESULTS A total of 338 patients were enrolled, of whom 330 received at least 1 dose of study medication (modafinil or placebo). No statistically significant difference in the AISRS total score was observed at final visit between any modafinil group and placebo; however, some observations among patients who completed the trial may warrant further investigation. CONCLUSION Modafinil was reasonably tolerated but did not demonstrate a benefit on ADHD symptoms in adults.
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Potter AS, Dunbar G, Mazzulla E, Hosford D, Newhouse PA. AZD3480, a novel nicotinic receptor agonist, for the treatment of attention-deficit/hyperactivity disorder in adults. Biol Psychiatry 2014; 75:207-14. [PMID: 23856296 DOI: 10.1016/j.biopsych.2013.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 05/31/2013] [Accepted: 06/02/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laboratory studies have found that acute stimulation of nicotinic acetylcholine receptors improves cognition in adult attention-deficit/hyperactivity disorder (ADHD). Clinical trials of nicotinic agonists have been mixed, underscoring the need to understand the mechanisms for individual differences in clinical response. Using cognitive models within a clinical trial framework may provide insight into these differences. METHODS This was a within-subjects, randomized, placebo-controlled double-blind trial of the nicotinic agonist AZD3480 (also termed TC-1734) at doses of 5 mg and 50 mg and placebo in adults with ADHD. The order of the 2-week treatment periods was randomized, and a 3-week wash out separated each drug treatment period. Response inhibition (Stop Signal Task [SST]) and clinical efficacy (Investigator Rated Conners Adult ADHD Rating Scale [CAARS-INV]) were the a priori primary outcome measures of cognitive and clinical effects. We hypothesized that AZD3480 treatment would improve SST performance and clinical symptoms (CAARS-INV Total ADHD Symptoms Score). RESULTS Thirty subjects were randomized, with 24 included in the intent-to-treat analyses. SST performance and total ADHD symptoms were significantly improved with 50 mg of AZD3480. CAARS-INV ratings of inattention, memory problems, and emotional lability/impulsivity were significantly improved with 50 mg of AZD3480. CONCLUSIONS These results support previous work suggesting that nicotinic agonists are viable as treatments for adult ADHD. Measuring cognitive endophenotypes related to both the disorder and mechanism of treatment may help further rational drug development for dimensional features that cross-cut psychiatric disorders.
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Affiliation(s)
- Alexandra S Potter
- Clinical Neuroscience Research Unit, Department of Psychiatry, The University of Vermont, Burlington, Vermont.
| | | | - Emily Mazzulla
- Clinical Neuroscience Research Unit, Department of Psychiatry, The University of Vermont, Burlington, Vermont
| | | | - Paul A Newhouse
- Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee
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Ramos-Quiroga JA, Corominas M, Castells X, Bosch R, Casas M. OROS methylphenidate for the treatment of adults with attention-deficit/hyperactivity disorder. Expert Rev Neurother 2014; 9:1121-31. [DOI: 10.1586/ern.09.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chandler ML. Psychotherapy for adult attention deficit/hyperactivity disorder: a comparison with cognitive behaviour therapy. J Psychiatr Ment Health Nurs 2013; 20:814-20. [PMID: 23506050 DOI: 10.1111/jpm.12023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 11/29/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD), a disorder generally associated with children, has become a valid disorder for adults in the last decade. The first line treatment of adult ADHD is medications, but historically there have been limitations to medication as the only treatment. Psychotherapy has become a feasible modality in the treatment of ADHD for those who have residual symptoms. The aim of this review of literature is to compare cognitive behaviour therapy with other psychotherapeutic treatment for effectiveness in improving symptoms of ADHD in adults and adolescences. The evidence-based practice approach by Stillwell et al. is adopted to guide the systematic review. The use of this small evidence utilization project that led to a synthesis of available research will provide direction for future research and expand knowledge in treatment for adult ADHD.
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Affiliation(s)
- M L Chandler
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
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