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Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci 2022; 16:900981. [PMID: 35874653 PMCID: PMC9299434 DOI: 10.3389/fnbeh.2022.900981] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.
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Affiliation(s)
- Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Arthur Caye
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nina Christmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent National Health System Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, NY, United States
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Markus Gleitz
- Medice Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sandra Kooij
- Amsterdam University Medical Center, Location VUMc, Amsterdam, Netherlands.,PsyQ, Expertise Center Adult ADHD, The Hague, Netherlands
| | - Douglas Teixeira Leffa
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mark Stein
- Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Department of Public Health, Johns Hopkins University, Baltimore, MA, United States
| | - Yanki Yazgan
- GuzelGunler Clinic, Istanbul, Turkey.,Yale Child Study Center, New Haven, CT, United States
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Neurocenter, Saarland, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.,School for Child and Adolescent Cognitive Behavioural Therapy, University Hospital of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Cox LE, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Ogg RJ, Jeha S, Willard VW, Huang L, Zhang H, Conklin HM. Feasibility and acceptability of a remotely administered computerized intervention to address cognitive late effects among childhood cancer survivors. Neurooncol Pract 2015; 2:78-87. [PMID: 27054041 DOI: 10.1093/nop/npu036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Childhood cancer survivors frequently develop working memory (WM) deficits as a result of disease and treatment. Medication-based and therapist-delivered interventions are promising but have limitations. Computerized interventions completed at home may be more appealing for survivors. We evaluated the feasibility and acceptability of a remotely administered, computerized WM intervention (Cogmed) for pediatric cancer survivors using a single-blind, randomized, wait-list control design. METHODS Of 80 qualifying patients, 12 were excluded or declined to participate. Participants randomized to intervention (n = 34/68) included survivors of childhood brain tumors (32%) or acute lymphoblastic leukemia (ALL; 68%) between the ages of 8 and 16 years ([Formula: see text] = 12.2) who were at least 1 year post therapy ([Formula: see text] = 5.0). The majority of brain tumor participants were treated with cranial radiation therapy (72.7%), whereas most of the ALL participants were treated with chemotherapy only (87%). Participants completed 25 WM training sessions over 5-9 weeks at home with weekly phone-based coaching. RESULTS Participants lived in 16 states. Compliance was strong, with 30 of the 34 participants (88%) completing intervention. Almost all participants completed pre- and postintervention neuroimaging exams (91% and 93%, respectively). Families had the necessary skills to utilize the computer program successfully. Caregivers reported they were generally able to find time to complete training (63%), viewed training as beneficial (70%), and would recommend this intervention to others (93%). CONCLUSIONS Cogmed is a feasible and acceptable intervention for childhood cancer survivors. It is a viable option for survivors who do not live in close proximity to cancer care centers. Efficacy and neural correlates of change are currently being evaluated.
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Affiliation(s)
- Lauren E Cox
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Jason M Ashford
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Kellie N Clark
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Karen Martin-Elbahesh
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Kristina K Hardy
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Thomas E Merchant
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Robert J Ogg
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Sima Jeha
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Victoria W Willard
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Lu Huang
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Hui Zhang
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
| | - Heather M Conklin
- Department of Psychology , St Jude Children's Research Hospital , Memphis, Tennessee (L.E.C., J.M.A., K.N.C., K.M-E., V.W.W., H.M.C.); Division of Radiation Oncology , St. Jude Children's Research Hospital, Memphis, Tennessee (T.E.M.); Division of Translational Imaging Research , St Jude Children's Research Hospital , Memphis, Tennessee (R.J.O.); Department of Oncology , St Jude Children's Research Hospital , Memphis, Tennessee (S.J.); Department of Biostatistics , St Jude Children's Research Hospital , Memphis, Tennessee (L.H., H.Z.); Center for Neuroscience and Behavioral Medicine , Neuropsychology Division, Children's National Medical Center , Washington, DC (K.K.H.); Department of Psychiatry and Behavioral Science , George Washington University School of Medicine , Washington, DC (K.K.H)
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