The importance of ADHD subtype classification for educational applications of DSM-V

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

Underlying deficits in inattention, hyperactivity, and/or impulsivity might contribute to suboptimal test-taking behaviours during language assessments that can lead to diagnostic errors. Considerations of potential medication effects on estimates of children's nonword repetition, sentence recall, tense-marking, and narrative abilities are warranted given long-standing enthusiasm for these indices to serve as clinical markers for developmental language disorder (DLD). A battery consisting of 1 nonverbal, 1 reading, and 6 verbal measures was administered twice to 26 children (6-9 years) with independently diagnosed combined-type attention-deficit/hyperactivity disorder (ADHD). All participants had been prescribed stimulant medications for the management of their ADHD symptoms and were assessed off- and on-medication, with order counter-balanced across participants. Half of the participants had concomitant DLD. Examiners were unaware of children's clinical status during assessments or when they were testing children who had received medication. Effect sizes were calculated for each measure. Significant score differences indicating a beneficial impact of stimulant medications on children's performances were observed on the recalling sentences subtest of the Clinical Evaluation of Language Fundamentals and the Picture Peabody Vocabulary Test. Adjustments may be needed when speech language pathologists use sentence recall or receptive vocabulary measures to make diagnostic decisions with children who have ADHD.

Exploring the Brain Lateralization in ADHD Based on Variability of Resting-State fMRI Signal

Objective: In this study, we investigate the brain lateralization in ADHD patients. Furthermore, we also explore the difference between male and female patients, and the difference among distinct ADHD subtypes, that is, ADHD-inattentive (ADHD-IA) and ADHD-combined (ADHD-C). Method: We employed the standard deviation to quantify the variability of resting-state functional magnetic resonance imaging (fMRI) signal and measure the lateralization index (LI). Results: ADHD patients showed significantly increased rightward lateralization in the inferior frontal gyrus (opercular), precuneus, and paracentral lobule, and decreased rightward lateralization in the insula. Compared with male patients, female patients showed significantly rightward lateralization in the putamen and lobule VII of cerebellar hemisphere. ADHD-C patients exhibited increased rightward lateralization in the inferior frontal gyrus (opercular), and decreased rightward lateralization in the inferior temporal gyrus, as compared with ADHD-IA. The LI was also found to be related to inattentive and hyper/impulsive scores. Conclusion: These key findings may aid in understanding the pathology of ADHD.

Functional Connectivity of Child and Adolescent Attention Deficit Hyperactivity Disorder Patients: Correlation with IQ

Attention deficit hyperactivity disorder (ADHD) is a pervasive neuropsychological disorder that affects both children and adolescents. Child and adolescent ADHD patients exhibit different behavioral symptoms such as hyperactivity and impulsivity, but not much connectivity research exists to help explain these differences. We analyzed openly accessible resting-state functional magnetic resonance imaging (rs-fMRI) data on 112 patients (28 child ADHD, 28 adolescent ADHD, 28 child normal control (NC), and 28 adolescent NC). We used group independent component analysis (ICA) and weighted degree values to identify interaction effects of age (child and adolescent) and symptom (ADHD and NC) in brain networks. The frontoparietal network showed significant interaction effects (p = 0.0068). The frontoparietal network is known to be related to hyperactive and impulsive behaviors. Intelligence quotient (IQ) is an important factor in ADHD, and we predicted IQ scores using the results of our connectivity analysis. IQ was predicted using degree centrality values of networks with significant interaction effects of age and symptom. Actual and predicted IQ scores demonstrated significant correlation values, with an error of about 10%. Our study might provide imaging biomarkers for future ADHD and intelligence studies.

Effects associated with on- and off-label stimulant treatment of core autism and ADHD symptoms exhibited by children with autism spectrum disorder

OBJECTIVE

Families of children with autism spectrum disorder are barraged by different treatment options. Some of these options have the support of empirical evidence while others do not. Stimulant treatments are typically utilized to treat symptoms of ADHD indicating an on-label use of such treatment.

METHODS

This study examines the association of stimulant treatment with the on- (symptoms of ADHD) and off- (symptoms of ASD) label symptoms among children with ASD via a non-clinical, population-based sample.

RESULTS

Results indicate no significant association of stimulant treatment with a reduction of on- or off-label symptoms among children with ASD.

CONCLUSION

Stimulant medications utilized in the treatment of DSM core symptoms of autism spectrum disorder would be considered an off-label use because there is limited evidence to support that stimulants are effective in treating core symptoms of ASD, which is supported by the results of the current study.

Connectivity differences between adult male and female patients with attention deficit hyperactivity disorder according to resting-state functional MRI

Attention deficit hyperactivity disorder (ADHD) is a pervasive psychiatric disorder that affects both children and adults. Adult male and female patients with ADHD are differentially affected, but few studies have explored the differences. The purpose of this study was to quantify differences between adult male and female patients with ADHD based on neuroimaging and connectivity analysis. Resting-state functional magnetic resonance imaging scans were obtained and preprocessed in 82 patients. Group-wise differences between male and female patients were quantified using degree centrality for different brain regions. The medial-, middle-, and inferior-frontal gyrus, superior parietal lobule, precuneus, supramarginal gyrus, superior- and middle-temporal gyrus, middle occipital gyrus, and cuneus were identified as regions with significant group-wise differences. The identified regions were correlated with clinical scores reflecting depression and anxiety and significant correlations were found. Adult ADHD patients exhibit different levels of depression and anxiety depending on sex, and our study provides insight into how changes in brain circuitry might differentially impact male and female ADHD patients.

Behavioral and Academic Progress of Children Displaying Substantive ADHD Behaviors in Special Education: A 1-Year Follow-up

OBJECTIVE

Exploring differences in behavioral and academic progress between children displaying substantive ADHD behaviors (M age of 9.4 years) in special schools (n = 38) and in inclusive education (n = 26). The contribution of pedagogical strategies to positive outcomes was also examined.

METHOD

Measurements used were the Teachers' Report Form, the Social Emotional Questionnaire, assessments of academic achievement, and the Pedagogical Methods Questionnaire. Mixed-model ANOVAs and Pearson's correlations were used to analyze the data.

RESULTS

Significant progress was found regarding disorder-specific problem behavior and in all academic areas, but no interaction effect was found between time and setting. Correlations indicated that positive behavior reinforcement and emotional support are the pedagogical strategies that contributed most to behavioral adaptation.

CONCLUSION

Children displaying substantive ADHD behaviors in both groups develop equally well in the areas of behavioral and academic functioning where significant progress was found.

Connectivity Analysis and Feature Classification in Attention Deficit Hyperactivity Disorder Sub-Types: A Task Functional Magnetic Resonance Imaging Study

Attention deficit hyperactivity disorder (ADHD) is a pervasive neuropsychiatric disorder. Patients with different ADHD subtypes show different behaviors under different stimuli and thus might require differential approaches to treatment. This study explores connectivity differences between ADHD subtypes and attempts to classify these subtypes based on neuroimaging features. A total of 34 patients (13 ADHD-IA and 21 ADHD-C subtypes) underwent functional magnetic resonance imaging (fMRI) with six task paradigms. Connectivity differences between ADHD subtypes were assessed for the whole brain in each task paradigm. Connectivity measures of the identified regions were used as features for the support vector machine classifier to distinguish between ADHD subtypes. The effectiveness of connectivity measures of the regions were tested by predicting ADHD-related Diagnostic and Statistical Manual of Mental Disorders (DSM) scores. Significant connectivity differences between ADHD subtypes were identified mainly in the frontal, cingulate, and parietal cortices and partially in the temporal, occipital cortices and cerebellum. Classifier accuracy for distinguishing between ADHD subtypes was 91.18 % for both gambling punishment and emotion task paradigms. Linear prediction under the two task paradigms showed significant correlation with DSM hyperactive/impulsive score. Our study identified important brain regions from connectivity analysis based on an fMRI paradigm using gambling punishment and emotion task paradigms. The regions and associated connectivity measures could serve as features to distinguish between ADHD subtypes.

ADHD medication vacations and parent-child interactions by gender

OBJECTIVE

The purpose of the current study was to examine medication vacations among children with ADHD according to parent-child dyads (e.g., mother-son, father-daughter, mother-daughter, and father-son).

METHOD

In a survey study of 259 parents of children with ADHD, the use of medication vacations according to parent-child sex dyads was examined.

RESULTS

Results of the current study suggest that fathers seem to report endorsing medication vacations more with their sons with ADHD as opposed to their daughters with ADHD. There did not seem to be any significant differences among mothers.

CONCLUSION

Results of the current study conclude with directions for future research and practice.

Parental perceptions of academic performance and attainment of children diagnosed with attention deficit hyperactivity disorder

We examined parental perceptions of academic performance and attainment of children with attention deficit hyperactivity disorder (ADHD) according to both parent and child gender along with the interaction of parent and child gender. The current study adds to the body of research by examining the perceptions of parents of children with ADHD according to both parent and child gender. The results indicate that fathers, on the whole, seemed less likely to consider ADHD to have negative academic implications for their children as compared with mothers. With regard to child gender, the fathers seemed less likely to consider ADHD to have negative academic implications for their sons over their daughters. The results suggest that interventions for parents of children with ADHD should be targeted to fathers with sons with ADHD.

Does long-term medication use improve the academic outcomes of youth with attention-deficit/hyperactivity disorder?

Youth with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience academic impairment, including lower grades than their peers and elevated risk for grade retention and school dropout. Medication is the most commonly used treatment for youth with ADHD, and it is therefore essential to understand the extent to which medication use improves long-term academic functioning. This paper reviews the literature on the relation between long-term medication use and the academic outcomes of youth with ADHD. A systematic literature search was conducted to identify pertinent studies published since 2000 that followed youth with ADHD for 3 or more years. Academic outcomes of interest included school grades, achievement test scores, and grade retention. Nine studies were identified reporting on eight distinct longitudinal samples (N across studies = 8,721). These studies demonstrate that long-term medication use is associated with improvements in standardized achievement scores. However, the magnitude of these improvements is small and the clinical or educational significance is questionable. Evidence for long-term improvements in school grades and grade retention is less compelling. This review highlights methodological considerations in providing directions for future research. The importance of using multiple sources to gather information about medication adherence is discussed, including use of methodologies such as electronic monitors, rather than relying solely on parent report or chart review. Future research should also examine a range of medication adherence definitions in order to determine whether age of onset, duration of use, dose, and/or consistency of use moderates the relation between long-term medication use and academic outcomes.

Pharmacotherapy and academic achievement among children with attention-deficit/hyperactivity disorder

This study examined the association of pharmacological treatments and academic achievement among children with attention-deficit/hyperactivity disorder (ADHD). Results examining the association of pharmacological treatments and academic achievement among children with ADHD are mixed. Our objective was to examine this association using structural equation modeling (SEM) techniques, which may be considered more sophisticated and advanced over traditional regression techniques. To achieve the purpose, we employed a sample of children with ADHD derived from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) data. The ECLS-K provides a large, community-based, nationally representative sample of children to examine across time with respect to academic achievement outcomes. The present study reveals a statistically nonsignificant association between pharmacological treatment and academic achievement among children with ADHD. These results derived from a large, community-based, nationally representative sample, using SEM techniques, may be considered highly generalizable.

Protopathic stimulant use among children with symptoms of ADHD

The purpose of the current study was to examine protopathic stimulant use among children with the symptoms of ADHD but do not have a diagnosis of ADHD. Protopathic or prodromal stimulant use refers to the use of stimulants by children with the symptoms of ADHD prior to a diagnosis of ADHD. In the current study, we examined children with the symptoms of ADHD who received stimulant treatment across time and with respect to several background variables. Our results indicate that these children who receive stimulant treatment without a diagnosis of ADHD are significantly more like to be eventually diagnosed with ADHD than not. Results also indicate that these children who receive stimulant treatment but do not yet have a diagnosis of ADHD are significantly more likely to have insurance that does not pay for diagnostic procedures. These results are discussed in view of treatment.