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Bryant BR, Sisk MR, McGuire JF. Efficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024:2823863. [PMID: 39312259 PMCID: PMC11420825 DOI: 10.1001/jamapediatrics.2024.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/26/2024] [Indexed: 09/26/2024]
Abstract
Importance Anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) affect up to 20% of children and adolescents. Despite demonstrated efficacy, evidence-based treatments for these conditions are often inaccessible; innovative solutions are essential to meet the demand for pediatric mental health care. Objective To examine the efficacy and moderators of gamified DMHIs for anxiety, depression, and ADHD in randomized clinical trials (RCTs) for children and adolescents. Data Sources A systematic search of PubMed, PsycInfo, and Web of Science was conducted for RCTs published before March 20, 2024. Study Selection RCTs that evaluated the efficacy of gamified DMHIs for treating pediatric ADHD, depression, or anxiety were included. Studies were excluded if they did not use a gamified DMHI, provide sufficient data for effect sizes, or were unavailable in English. Data Extraction and Synthesis Efficacy data were extracted from rating scales for ADHD, depression, and anxiety. Extracted moderator variables included participant characteristics (eg, age and sex), intervention characteristics (eg, delivery modality and time limit), and trial design characteristics (eg, outcome measure and risk of bias). Main Outcomes and Measures The primary outcome was change in ADHD, depression, or anxiety severity in the treatment group compared to the control group. Hedges g quantified treatment effects. Results The search strategy identified 27 RCTs that included 2911 participants across ADHD, depression, and anxiety disorders. There were modest significant effects of gamified DMHIs on ADHD (g, 0.28; 95% CI, 0.09 to 0.48) and depression (g, 0.28; 95% CI, 0.08 to 0.47) but small, nonsignificant effects for anxiety disorders (g, 0.07; 95% CI, -0.02 to 0.17). Moderator analyses revealed that DMHIs for ADHD delivered on a computer and those RCTs that had a greater preponderance of male participants produced larger treatment effects. DMHIs for depressive disorders that used preset time limits for gamified DMHIs also exhibited larger treatment effects. Conclusions and Relevance The findings suggest a benefit of gamified DMHIs for youth with ADHD or depressive disorder. Pediatricians and other health care professionals have new information about novel, accessible, and efficacious options for pediatric mental health care.
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Affiliation(s)
- Barry R. Bryant
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan R. Sisk
- Department of Psychiatry, University of Alabama at Birmingham Heersink School of Medicine, Birmingham
| | - Joseph F. McGuire
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Augustin M, Mall V, Licata-Dandel M. ADHD Symptoms in Middle Childhood: The Role of Child Attachment and Maternal Emotional Availability in an Inpatient Clinical Sample. Eur J Investig Health Psychol Educ 2024; 14:1572-1584. [PMID: 38921070 PMCID: PMC11202776 DOI: 10.3390/ejihpe14060104] [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: 04/30/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Child ADHD symptoms are highly prevalent in middle childhood, alongside impairment in social functioning. The parent-child relationship has been shown to play an important role; however, studies investigating specific facets of the parent-child relationship in ADHD symptomatology in middle childhood have been neglected. We assumed that higher ADHD symptoms were associated with both (1) lower maternal emotional availability (EA) and (2) lower child attachment security. Moreover, (3) we aimed to explore which specific EA dimensions were associated with ADHD symptoms. METHODS In a socio-pediatric clinic in Germany, 71 inpatient mother-child dyads (child age: M = 7.70, SD = 1.06; n = 54 boys) were assessed. Clinical data about child ADHD symptoms (Child Behavior Checklist 6-18 subscale "attention deficit/hyperactivity problems"), maternal EA (free play), and child attachment representation (Attachment Story Completion Task, GEV-B) were analyzed cross-sectionally. RESULTS Controlling for child oppositional behavior and sex, child ADHD symptoms were associated with overall maternal EA, and more specifically non-hostility, but not with child attachment representation. CONCLUSIONS Our results imply that the role of parent-child interaction quality should be considered in the treatment of ADHD. Bidirectional effects cannot be ruled out.
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Affiliation(s)
- Michaela Augustin
- Social Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Heiglhofstr. 69, 81377 Munich, Germany; (V.M.); (M.L.-D.)
| | - Volker Mall
- Social Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Heiglhofstr. 69, 81377 Munich, Germany; (V.M.); (M.L.-D.)
- German Center for Child and Adolescent Health (DZKJ), Partner Site Munich, Heiglhofstr. 69, 81377 Munich, Germany
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Maria Licata-Dandel
- Social Pediatrics, TUM School of Medicine and Health, Technical University of Munich, Heiglhofstr. 69, 81377 Munich, Germany; (V.M.); (M.L.-D.)
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
- Department of Psychology, Charlotte Fresenius University, Infanteriestr. 11a, 80797 Munich, Germany
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3
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Kable JA, Coles CD, Holton JE, Kalberg WO, May PA, Chambers CD, Bandoli G. Characteristics of the Symptoms of the Proposed ND-PAE Disorder in First Grade Children in a Community Sample. Child Psychiatry Hum Dev 2024; 55:426-438. [PMID: 36042156 PMCID: PMC10874642 DOI: 10.1007/s10578-022-01414-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
The proposed symptoms for Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) were evaluated in children who participated in the Collaboration on Fetal Alcohol Spectrum Disorders Prevalence study. Children "at-risk" for ND-PAE (n = 204) were contrasted to children with no prenatal alcohol exposure, alcohol-related dysmorphia or growth deficits (n = 908). Symptoms were defined based on neuropsychological testing using two diagnostic threshold levels (1.0 and 1.5 STD). Individuals at risk for ND-PAE had higher endorsement rates of the self-regulation and adaptive impairments at the 1.0 threshold and of the neurocognitive and self-regulation impairments at the 1.5 threshold. Endorsement of the disorder significantly differed at the 1.0 threshold. Receiver operating characteristic curve analysis indicated that having an IQ below 70 was not predictive of the diagnosis but modifications of the IQ criterion improved predictive validity. Discrimination validity was poor without documentation of PAE which continues to be a necessity for a diagnosis of ND-PAE.
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Affiliation(s)
- Julie A Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer E Holton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Philip A May
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gretchen Bandoli
- School of Medicine, University of California, San Diego, La Jolla, USA
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4
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Lee SH, Chia S, Chou TL, Gau SSF. Sex differences in medication-naïve adults with attention-deficit/hyperactivity disorder: a counting Stroop functional MRI study. Biol Psychol 2023; 179:108552. [PMID: 37028795 DOI: 10.1016/j.biopsycho.2023.108552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Emerging evidence supports deficits in executive functions in the fronto-striato-parietal network in individuals with attention-deficit/hyperactivity disorder (ADHD). However, most functional studies recruited men with ADHD only, leaving it unclear whether executive deficits are also demonstrated in women with ADHD. Thus, we used functional magnetic resonance imaging to examine the sex differences in a counting Stroop task that explored interference control. The sample consisted of 55 medication-naïve adults with ADHD (28 men, 27 women) and 52 healthy controls (HC, 26 men, 26 women). The Conners' Continuous Performance Test further evaluated the performance of focused attention (standard deviation of the reaction time, RTSD) and vigilance (the reaction time change across different inter-stimulus intervals, RTISI). First, for the main effect of diagnosis, compared to the HC group, the ADHD group showed less activation in the caudate nucleus and inferior frontal gyrus (IFG). Second, for the main effect of sex, no significant effects were found. Third, a diagnosis-by-sex interaction indicated that the magnitude of ADHD-HC difference was greater for women than men in the right IFG and precuneus, reflecting greater difficulties for ADHD women to resolve interference. Conversely, no significant brain activation showed greater ADHD-HC difference in men than women. Also, reduced right IFG and precuneus activation was negatively associated with the scores assessing focused attention and vigilance in ADHD women, indicating that the attentional abilities are disrupted in ADHD women. Abnormalities in the frontoparietal areas may represent the main difference between ADHD women and ADHD men.
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Bucsea O, Kosmerly S, Rogers MA. Effects of Mothers’ Parenting Sense of Competence and Child Gender on Academic Readiness in Preschool Children with Symptoms of ADHD. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2022. [DOI: 10.1080/15377903.2021.2012862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Oana Bucsea
- York University, Toronto, Ottawa, ON, Canada
| | - Stacey Kosmerly
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Maria A. Rogers
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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6
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Kable JA, Coles CD, Keen CL, Uriu-Adams JY, Jones KL, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers CD. The impact of micronutrient supplementation in alcohol-exposed pregnancies on reaction time responses of preschoolers in Ukraine. Alcohol 2022; 99:49-58. [PMID: 34942330 PMCID: PMC8844237 DOI: 10.1016/j.alcohol.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) on attentional regulation skills was explored in a randomized clinical trial conducted in Ukraine. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to one of three groups [No study-provided supplements, Multivitamin/Mineral Supplement (MVM), or MVM plus Choline]. Their offspring were seen in the preschool period and a reaction time task was administered. Participants were asked to press a response button as quickly as possible as 30 stimuli from the same category (animals) were presented consecutively and then followed by six stimuli from a novel category (vehicles). Number correct, mean latency of the response over trials, and variability in the latency were analyzed separately by sex. During the initial animal trials, boys whose mothers received MVM during pregnancy had more correct responses and reduced response latency compared to boys whose mothers had no MVM treatment. During vehicle trials, maternal choline supplementation was associated with increased response speed in males without a PAE history. Females receiving supplements did not show the same benefits from micronutrient supplementation and were more adversely impacted by prenatal alcohol exposure. Relationships between maternal levels of choline, betaine, and dimethylglycine (DMG) and task performance were also assessed. Although no effects were found for choline after adjusting for multiple comparisons, lower baseline DMG level was associated with greater accuracy and shorter latency of responses in the initial animal trials and shorter latency in the vehicle trials in female preschoolers. Level of betaine in Trimester 3 was associated with reduced variability in the latency of male responses during the animal trials. Maternal micronutrient supplementation in pregnancy appears to improve preschool reaction time performance, but the effects varied as a function of sex and PAE exposure status.
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Affiliation(s)
- JA Kable
- Departments of Psychiatry and Behavioral Science, Emory University School of Medicine,,Pediatrics, Emory University School of Medicine
| | - CD Coles
- Departments of Psychiatry and Behavioral Science, Emory University School of Medicine,,Pediatrics, Emory University School of Medicine
| | - CL Keen
- Department of Nutrition, University of California, Davis
| | - JY Uriu-Adams
- Department of Nutrition, University of California, Davis
| | - KL Jones
- Departments of Pediatrics, University of California San Diego,,Family Medicine and Public Health, University of California San Diego
| | - L Yevtushok
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine,,Lviv National Medical University, Lviv, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - Y Kulikovsky
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - N. Zymak-Zakutnya
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - Iryna Dubchak
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - D Akhmedzhanova
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - W Wertelecki
- Departments of Pediatrics, University of California San Diego,,OMNI-Net Ukraine Birth Defects Program
| | - CD Chambers
- Departments of Pediatrics, University of California San Diego,,Family Medicine and Public Health, University of California San Diego
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Kohno M, Dennis LE, McCready H, Schwartz DL, Hoffman WF, Korthuis PT. A preliminary randomized clinical trial of naltrexone reduces striatal resting state functional connectivity in people with methamphetamine use disorder. Drug Alcohol Depend 2018; 192:186-192. [PMID: 30266003 PMCID: PMC6200637 DOI: 10.1016/j.drugalcdep.2018.07.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Naltrexone has been shown to attenuate craving and the subjective effects of methamphetamine. Although naltrexone has modulatory effects on neural activity at dopaminergic synapses, the effect on striatal connectivity is unclear. As methamphetamine use is associated with greater resting-state functional connectivity (RSFC) in the dopaminergic system, we examined whether extended-release naltrexone (XR-NTX) can normalize striatal connectivity and whether changes in RSFC are associated with changes in craving and methamphetamine use. METHODS Thirty-seven participants in or seeking treatment for methamphetamine use disorder took part in this clinical trial at a university-based research clinic between May 2013 and March 2015 (Clinicaltrials.gov NCT01822132). Participants were randomized by a random number generator to a single four-week injection of XR-NTX or placebo. Functional magnetic resonance imaging (fMRI) and self-reported measures of craving and methamphetamine use were conducted before and after double-blinded randomization. FINDINGS There was a significant reduction in methamphetamine use in the naltrexone group and a significant treatment-by-time interaction on RSFC between the ventral striatum, amygdala, hippocampus, and midbrain. Connectivity was significantly reduced over time in participants randomized to naltrexone but unchanged in those randomized to placebo (p < 0.05, whole-brain corrected). Interactions between treatment and changes in connectivity show that significant reductions in connectivity were associated with reductions in methamphetamine use. CONCLUSIONS Neurobiological deficits associated with methamphetamine use may undermine the efficacy of pharmacotherapies that directly target the dopamine reward system. Naltrexone, via antagonism of indirect mu-opioid effects on dopamine neurons, may attenuate reward system connectivity and aid in methamphetamine use treatment.
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Affiliation(s)
- Milky Kohno
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA; Methamphetamine Abuse Research Center, Oregon Health and Science University and Veterans Affairs Portland Health Care System, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA.
| | - Laura E Dennis
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Holly McCready
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Daniel L Schwartz
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Advanced Imaging Research Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
| | - William F Hoffman
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA; Mental Health Division, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA; Methamphetamine Abuse Research Center, Oregon Health and Science University and Veterans Affairs Portland Health Care System, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
| | - P Todd Korthuis
- Section of Addiction Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
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8
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Alexandre JL, Lange AM, Bilenberg N, Gorrissen AM, Søbye N, Lambek R. The ADHD rating scale-IV preschool version: Factor structure, reliability, validity, and standardisation in a Danish community sample. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 78:125-135. [PMID: 29853334 DOI: 10.1016/j.ridd.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/27/2018] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND ADHD is a debilitating disorder with symptoms often appearing in early childhood. To facilitate early identification, developmentally appropriate and validated assessment tools for the preschool-age are needed. AIMS The current study aims to examine the psychometric properties of the ADHD Rating Scale (RS)-IV Preschool Version (-P) in a Danish community sample and provide national standardisation data. METHODS AND PROCEDURES Parents (n = 916) and kindergarten teachers (n = 275) of preschool children, aged 3-5 years, completed the ADHD RS-IV-P. OUTCOMES AND RESULTS Confirmatory factor analysis indicated that a three-factor model (inattention, hyperactivity, and impulsivity) best fit the data regardless of rater. Scales generally showed acceptable internal consistency, test-retest reliability, inter-rater reliability, and criterion validity. Boys received higher ratings on the ADHD RS-IV-P than girls and younger preschool children were rated as more inattentive than older preschool children. CONCLUSIONS AND IMPLICATIONS Our findings support the reliability and validity of the ADHD RS-IV-P and a three-factor model of ADHD. However, high factor correlations and similarity in model fit suggest that more research is needed to clarify the organisation of ADHD symptoms in preschool children. Furthermore, the external validity of separate ADHD dimensions at this age should be examined.
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Affiliation(s)
- Julie Lysdal Alexandre
- Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark; Research Department, Centre for Child & Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, 8340 Risskov, Denmark
| | - Anne-Mette Lange
- Research Department, Centre for Child & Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, 8340 Risskov, Denmark
| | - Niels Bilenberg
- Child and Adolescent Psychiatric Dept., Odense, Mental Health Hospital and University Clinic, Region of Southern Denmark, University of Southern Denmark, Denmark
| | - Anne Mette Gorrissen
- Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Natasja Søbye
- Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Rikke Lambek
- Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark.
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Abebe HT, Tan FES, van Breukelen GJP, Berger MPF. JMASM45: A computer program for Bayesian D-optimal binary repeated measurements designs (Matlab). JOURNAL OF MODERN APPLIED STATISTICAL METHODS 2017. [DOI: 10.22237/jmasm/1493599020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Kohno M, Dennis LE, McCready H, Hoffman WF. Executive Control and Striatal Resting-State Network Interact with Risk Factors to Influence Treatment Outcomes in Alcohol-Use Disorder. Front Psychiatry 2017; 8:182. [PMID: 28993741 PMCID: PMC5622290 DOI: 10.3389/fpsyt.2017.00182] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022] Open
Abstract
Alterations within mesocorticolimbic terminal regions commonly occur with alcohol use disorder (AUD). As pathological drug-seeking behavior may arise as a consequence of alcohol-induced neuroadaptations, it is critical to understand how such changes increase the likelihood of relapse. This report examined resting-state functional connectivity (RSFC) using both a seed-based and model-free approach in individuals in treatment for AUD and how dysregulation of network connectivity contributes to treatment outcomes. In order to provide a mechanism by which neural networks promote relapse, interactive effects of mesocorticolimbic connectivity and AUD risk factors in treatment completers and non-completers were examined. AUD group showed stronger RSFC between striatum, insula, and anterior cingulate cortex than controls. Within the AUD group, non-completers compared to completers showed enhanced RSFC between (1) striatum-insula, (2) executive control network (ECN)-amygdala, and (3) basal ganglia/salience network and striatum, precuneus, and insula. Completers showed enhanced RSFC between striatum-right dorsolateral prefrontal cortex. Furthermore, completers and non-completers differed in relationships between RSFC and relapse risk factors, where non-completers exhibited positive associations between craving intensity and RSFC of striatum-insula and ECN-amygdala. These findings provide evidence for interactions between corticolimbic connectivity in AUD and craving and establish an important link between network connectivity and dynamic risk factors that contribute to relapse. Results demonstrate that relapse vulnerability is attributed to craving dysregulation manifested by enhanced connectivity in striato-limbic regions and diminished corticostriatal connectivity.
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Affiliation(s)
- Milky Kohno
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States.,Methamphetamine Abuse Research Center, Portland, OR, United States
| | - Laura E Dennis
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States.,Methamphetamine Abuse Research Center, Portland, OR, United States
| | - Holly McCready
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States.,Methamphetamine Abuse Research Center, Portland, OR, United States
| | - William F Hoffman
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States.,Methamphetamine Abuse Research Center, Portland, OR, United States.,Mental Health and Clinical Neurosciences Division, Portland, OR, United States.,Research Service Veterans Affairs Portland Healthcare System, Portland, OR, United States
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11
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Kohno M, Nurmi EL, Laughlin CP, Morales AM, Gail EH, Hellemann GS, London ED. Functional Genetic Variation in Dopamine Signaling Moderates Prefrontal Cortical Activity During Risky Decision Making. Neuropsychopharmacology 2016; 41:695-703. [PMID: 26119471 PMCID: PMC4707816 DOI: 10.1038/npp.2015.192] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 01/08/2023]
Abstract
Brain imaging has revealed links between prefrontal activity during risky decision-making and striatal dopamine receptors. Specifically, striatal dopamine D2-like receptor availability is correlated with risk-taking behavior and sensitivity of prefrontal activation to risk in the Balloon Analogue Risk Task (BART). The extent to which these associations, involving a single neurochemical measure, reflect more general effects of dopaminergic functioning on risky decision making, however, is unknown. Here, 65 healthy participants provided genotypes and performed the BART during functional magnetic resonance imaging. For each participant, dopamine function was assessed using a gene composite score combining known functional variation across five genes involved in dopaminergic signaling: DRD2, DRD3, DRD4, DAT1, and COMT. The gene composite score was negatively related to dorsolateral prefrontal cortical function during risky decision making, and nonlinearly related to earnings on the task. Iterative permutations of all possible allelic variations (7777 allelic combinations) was tested on brain function in an independently defined region of the prefrontal cortex and confirmed empirical validity of the composite score, which yielded stronger association than 95% of all other possible combinations. The gene composite score also accounted for a greater proportion of variability in neural and behavioral measures than the independent effects of each gene variant, indicating that the combined effects of functional dopamine pathway genes can provide a robust assessment, presumably reflecting the cumulative and potentially interactive effects on brain function. Our findings support the view that the links between dopaminergic signaling, prefrontal function, and decision making vary as a function of dopamine signaling capacity.
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Affiliation(s)
- Milky Kohno
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Erika L Nurmi
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher P Laughlin
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Angelica M Morales
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Emma H Gail
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute, University of California Los Angeles, Los Angeles, CA, USA,Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA,Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA,Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024-1759, USA, Tel: +310 825 0606, Fax: +310 825 0812, E-mail:
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12
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Karakaş S, Doğutepe Dinçer E, Özkan Ceylan A, Tileylioğlu E, Karakaş HM, Talı ET. Functional MRI compliance in children with attention deficit hyperactivity disorder. Diagn Interv Radiol 2015; 21:85-92. [PMID: 25519454 DOI: 10.5152/dir.2014.14006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to test the effect of prescan training and orientation in functional magnetic resonance imaging (fMRI) in children with attention deficit hyperactivity disorder (ADHD) and to investigate whether fMRI compliance was modified by state anxiety. METHODS Subjects included 77 males aged 6-12 years; there were 53 patients in the ADHD group and 24 participants in the healthy control group. Exclusion criteria included neurological and/or psychiatric comorbidities (other than ADHD), the use of psychoactive drugs, and an intelligence quotient outside the normal range. Children were individually subjected to prescan orientation and training. Data were acquired using a 1.5 Tesla scanner and an 8-channel head coil. Functional scans were performed using a standard neurocognitive task. RESULTS The neurocognitive task led to reliable fMRI maps. Compliance was not significantly different between ADHD and control groups based on success, failure, and repetition rates of fMRI. Compliance of ADHD patients with extreme levels of anxiety was also not significantly different. CONCLUSION The fMRI compliance of ADHD children is typically lower than that of healthy children. However, compliance can be increased to the level of age-matched healthy control children by addressing concerns about the technical and procedural aspects of fMRI, providing orientation programs, and performing on-task training. In patients thus trained, compliance does not change with the level of state anxiety suggesting that the anxiety hypothesis of fMRI compliance is not supported.
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Affiliation(s)
- Sirel Karakaş
- Department of Psychology, Cyprus International University, Nicosia, Turkish Republic of Northern Cyprus.
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Neuhaus JM, Scott AJ, Wild CJ, Jiang Y, McCulloch CE, Boylan R. Likelihood-based analysis of longitudinal data from outcome-related sampling designs. Biometrics 2013; 70:44-52. [PMID: 24571396 DOI: 10.1111/biom.12108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/01/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
Investigators commonly gather longitudinal data to assess changes in responses over time and to relate these changes to within-subject changes in predictors. With rare or expensive outcomes such as uncommon diseases and costly radiologic measurements, outcome-dependent, and more generally outcome-related, sampling plans can improve estimation efficiency and reduce cost. Longitudinal follow up of subjects gathered in an initial outcome-related sample can then be used to study the trajectories of responses over time and to assess the association of changes in predictors within subjects with change in response. In this article, we develop two likelihood-based approaches for fitting generalized linear mixed models (GLMMs) to longitudinal data from a wide variety of outcome-related sampling designs. The first is an extension of the semi-parametric maximum likelihood approach developed in Neuhaus, Scott and Wild (2002, Biometrika 89, 23-37) and Neuhaus, Scott and Wild (2006, Biometrics 62, 488-494) and applies quite generally. The second approach is an adaptation of standard conditional likelihood methods and is limited to random intercept models with a canonical link. Data from a study of attention deficit hyperactivity disorder in children motivates the work and illustrates the findings.
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Affiliation(s)
- John M Neuhaus
- Division of Biostatistics, University of California, San Francisco, California 94143-0560, U.S.A
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Martel MM. Individual differences in attention deficit hyperactivity disorder symptoms and associated executive dysfunction and traits: sex, ethnicity, and family income. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2013; 83:165-75. [PMID: 23889009 DOI: 10.1111/ajop.12034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The goal of the present investigation was to investigate sex, ethnic, and socioeconomic status (SES) influences on attention deficit hyperactivity disorder (ADHD) symptoms and risk markers, including executive dysfunction and temperament traits. Participants were 109 children who were 3 to 6 years old (64% male; 36% ethnic minority) and their primary caregivers and teachers who completed a multistage, multi-informant screening, and diagnostic procedure. Parents completed a diagnostic interview and diagnostic and temperament questionnaires, teachers completed questionnaires, and children completed cognitive control tasks. Because of targeted overrecruitment of clinical cases, 56% of children in the sample were diagnosed with ADHD. Results suggested minimal sex differences, but prominent ethnic differences, in ADHD symptoms and temperament and executive function risk markers. Further, low family income was associated with increased ADHD symptoms and more temperament and executive function risk markers, and low family income explained many ethnic differences in ADHD symptoms and these risk markers. There were prominent interactions among child sex, ethnicity, and family income. Thus, study results suggest that children with multiple individual difference demographic risk factors (e.g., such as being male and ethnic minority) are at highly increased risk of ADHD symptoms and associated risk markers in the temperament and executive function domains.
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Abstract
Women are relatively protected against schizophrenia. The illness has a similar rate in women and men, but it starts later in women and is less severe. It is tempting to attribute this to the neuroprotective effect of estrogen, but the story is not straightforward and contains many unknowns. Women begin their schizophrenia trajectory later in development compared with men and this probably accounts for their relatively superior prognosis. Estrogen agonists are potential therapeutic agents but need to be proven safe, and the timing of administration may be crucial. This article examines what is known about estrogen and the development of schizophrenia.
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Affiliation(s)
- Mary V Seeman
- Centre for Addiction and Mental Health, University of Toronto 250 College St. Toronto, Ontario, Canada.
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Jenahi E, Khalil MS, Bella H. Prevalence of attention deficit hyperactivity symptoms in female schoolchildren in Saudi Arabia. Ann Saudi Med 2012; 32:462-8. [PMID: 22871613 PMCID: PMC6080992 DOI: 10.5144/0256-4947.2012.462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Attention deficit hyperactivity disorder (ADHD) is the most commonly seen developmental disorder, with significant impacts on the child's social, psychological, and scholastic functioning. The aim of this study was to determine the prevalence and sociodemographic correlates of ADHD in female primary schoolchildren. DESIGN AND SETTING A cross-sectional study conducted in Al-Khobar Town, Eastern Saudi Arabia. METHODS A random sample of six primary schools for girls was chosen, from which samples of 1009 students were selected by systematic random sampling, with ages ranging between 6 and 15 years (mean and standard deviation, 9.2 [1.9]). All subjects were screened for different types of ADHD using the Attention Deficit Disorders Evaluation Scale. RESULTS The overall prevalence of ADHD was 3.5%. The prevalence of children with ADHD/inattentive type was 2.1% and the prevalence of children with ADHD/hyperactive-impulsive type was 5.6%. This rate decreased significantly with increase in age. The prevalence was higher in government school students, among Saudi citizens, later born siblings, higher number of siblings, and lower parental education. CONCLUSIONS It was concluded that the prevalence of ADHD in female primary schoolchildren is comparable with what has been reported in other studies. Some demographic factors should be taken into consideration when interpreting this result. Implications and recommendations to the concerned authorities are outlined to improve the health and educational care services to help these children.
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Affiliation(s)
- Elham Jenahi
- Al Babtain Cardiac Center, Dammam Central Hospital, Dammam, Saudi Arabia
| | - Mohamed S. Khalil
- Department of Psychiatry, College of Medicine, University of Dammam, Dammam, Saudi Arabia
| | - Hassan Bella
- Department of Family and Community Medicine, College of Medicine, University of Dammam, Dammam, Saudi Arabia
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Feniman MR, Rissatto ACS, Lauris JRP, Mondelli MFCG. Applicability of the free field Sustained Auditory Attention Ability Test (SAAAT). Int Arch Otorhinolaryngol 2012; 16:269-77. [PMID: 25991945 PMCID: PMC4432542 DOI: 10.7162/s1809-97772012000200017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/25/2011] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The attention is an underlying neuropsychology function to all the cognitive processes. The auditory deficiency compromises the normal development of the child, modifying diverse auditory abilities, including the attention. OBJECTIVE to compare the performance of children in the Test of the Ability of Auditory Attention Support, as for the different forms of application (auricular phones and free field), sort and, application order. METHOD 40 children (7 years old) voluntary with typical development had participated, divided in two groups: G1 and G2, composites of 20 children each. The application of the THAAS in the G1 if gave first with auricular phones and after that in free field and the G2 the process was inverse. The evaluation consisted in: specific questionnaire, auditory tests and application of the THAAS. RESULTS It did not have significant difference how much to the sort. For the THAAS with phones, the G1 presented greater amount of errors of carelessness and total punctuation. For the THAAS in field it had a significant difference of the G2 for the monitoring decrease. How much to the application form, the G1 demonstrated a bigger number of errors when it was used phones. The G2 did not demonstrate difference. CONCLUSION It had viability in the application of the THAAS in Free Field, being able to be adopted the same used normative values for the conventional way of evaluation.
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Affiliation(s)
- Mariza Ribeiro Feniman
- Post-Doctorate in Audiology - Univeristy of Cincinnati, Ohio, USA. Head of Department of Speech-FOB-USP. Professor, Department of Speech Pathology, FOB / USP.
| | | | - José Roberto Pereira Lauris
- Freedom of teaching. Associate Professor, Department of Pediatric Dentistry, Orthodontics and Public Health, Faculty of Dentistry of Bauru, University of Sao Paulo, FOB / USP.
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Abstract
ADHD was once thought of as a predominantly male disorder. While this may be true for ADHD in childhood, extant research suggests that the number of women with ADHD may be nearly equal to that of men with the disorder (Faraone et al., 2000). There is accumulating research which clearly indicates subtle but important sex differences exist in the symptom profile, neuropathology and clinical course of ADHD. Compared to males with ADHD, females with ADHD are more prone to have difficulties with inattentive symptoms than hyperactive and impulsive symptoms, and females often receive a diagnosis of ADHD significantly later than do males (Gaub & Carlson, 1997; Gershon, 2002a, 2002b). Emerging evidence suggests differences exist in the neuropathology of ADHD, and there are hormonal factors which may play an important role in understanding ADHD in females. Although research demonstrates females with ADHD differ from males in important ways, little research exists that evaluates differences in treatment response. Given the subtle but important differences in presentation and developmental course of ADHD, it is essential that both clinical practice and research be informed by awareness of these differences in order to better identify and promote improved quality of care to girls and women with ADHD.
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Babinski DE, Pelham WE, Molina BSG, Waschbusch DA, Gnagy EM, Yu J, Sibley MH, Biswas A. Women with Childhood ADHD: Comparisons by Diagnostic Group and Gender. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2011; 33:420-429. [PMID: 22228922 PMCID: PMC3251258 DOI: 10.1007/s10862-011-9247-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study compared adult women with childhood ADHD to adult women without childhood ADHD and to adult men with childhood ADHD. The participants, all from a larger longitudinal study, included 30 women and 30 men (approximately age 23 to 24) with childhood ADHD, and 27 women without ADHD. Women with childhood ADHD were matched to comparison women on age, ethnicity, and parental education, and to men with childhood ADHD on age, ethnicity, and IQ. Self- and parent-reports of internalizing, interpersonal, academic, and job impairment, as well as substance use and delinquency indicated group differences on measures of self-esteem, interpersonal and vocational functioning, as well as substance use. Follow-up planned comparison tests revealed that almost all of these differences emerged by diagnostic status, and not by gender. This study adds to research on the negative adult outcomes of ADHD and demonstrates that the outcomes of men and women with childhood ADHD are relatively similar.
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Affiliation(s)
- Dara E. Babinski
- Center for Children and Families, Florida International University, AHC 1, Room 146, 11200 SW 8th Street, Miami, FL 33186, USA
- State University of New York at Buffalo, Buffalo, NY, USA
| | - William E. Pelham
- Center for Children and Families, Florida International University, AHC 1, Room 146, 11200 SW 8th Street, Miami, FL 33186, USA
| | | | - Daniel A. Waschbusch
- Center for Children and Families, Florida International University, AHC 1, Room 146, 11200 SW 8th Street, Miami, FL 33186, USA
| | - Elizabeth M. Gnagy
- Center for Children and Families, Florida International University, AHC 1, Room 146, 11200 SW 8th Street, Miami, FL 33186, USA
| | - Jihnhee Yu
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Margaret H. Sibley
- Center for Children and Families, Florida International University, AHC 1, Room 146, 11200 SW 8th Street, Miami, FL 33186, USA
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Aparajita Biswas
- Center for Children and Families, Florida International University, AHC 1, Room 146, 11200 SW 8th Street, Miami, FL 33186, USA
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Sonnby K, Åslund C, Leppert J, Nilsson KW. Symptoms of ADHD and depression in a large adolescent population: co-occurring symptoms and associations to experiences of sexual abuse. Nord J Psychiatry 2011; 65:315-22. [PMID: 21189056 DOI: 10.3109/08039488.2010.545894] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Symptoms of either attention-deficit hyperactivity disorder (ADHD) or depression constitute the most common reasons for contact with child and adolescent psychiatry. The development of psychiatric symptoms can be explained by a combination of environmental stress events and genetic vulnerability. One common form of environmental stress with high impact on health is sexual abuse. AIMS To investigate the prevalence and co-occurrence of symptoms of ADHD and depression in relation to experiences of sexual abuse in a large adolescent general population. METHOD All 15- and 18-year-old students (n = 4910) in the Swedish county of Vestmanland answered a school-based screening instrument including the six-question ADHD self-rating scale (ASRS), the Depression Self-Rating Scale (DSRS) and questions relating to experiences of sexual abuse. RESULTS The prevalence of co-occurring symptoms of ADHD and depression was 2.4% (boys 1.0%, girls 3.9%). The prevalence of experience of any sexual abuse was 20.9% (boys 13.3%, girls 28.7%). Of those with co-occurring symptoms, 48% of the boys and 47% of the girls reported a history of sexual abuse. CONCLUSIONS School-based screening for co-occurring symptoms of ADHD and depression might be a method that identifies students at psychiatric and psychosocial risk.
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Affiliation(s)
- Karin Sonnby
- Centre for Clinical Research, Uppsala University, Central Hospital, 721 89 Västerås, and The Child and Adolescent Psychiatry Unit, Central Hospital, 721 89 Västerås, Sweden.
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Lanza HI, Drabick DAG. Family routine moderates the relation between child impulsivity and oppositional defiant disorder symptoms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:83-94. [PMID: 20690009 DOI: 10.1007/s10802-010-9447-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although child impulsivity is associated with oppositional defiant disorder (ODD) symptoms, few studies have examined whether family processes moderate this association. To address this gap, we tested whether child-reported family routine moderated the relation between child hyperactivity/impulsivity (HI) and ODD symptoms among a sample of low-income, urban, ethnic-minority children (N = 87, 51% male). Child HI and ODD symptoms were assessed using parent and teacher reports. HI also was indexed by a laboratory task. Family routine was assessed using child self-report. Hierarchical regression analyses indicated that family routine moderated child HI. Among children with higher levels of teacher-reported HI symptoms, lower levels of family routine were associated with higher levels of teacher-reported ODD symptoms compared to children with lower levels of teacher-reported HI symptoms. Children who self-reported higher levels of family routine were rated as low on teacher-reported ODD symptoms, regardless of teacher-reported HI levels. Parent report and laboratory measures of child HI did not produce significant interactions. Lower levels of family routine may confer risk for ODD symptoms among low-income, urban, ethnic-minority children experiencing higher levels of HI.
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Affiliation(s)
- H Isabella Lanza
- Department of Psychology, Temple University, Philadelphia, PA, USA.
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22
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Use of mental health services and unmet needs for socially-at-risk. Spanish children and adolescents. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00001032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractReported one-year prevalence of service use due to mental disorders in children and adolescents from the general population varies according to country, organization of services, and services considered. Among factors associated with use of services, the literature lists parental and school personnel's perception of problems, having a psychiatric diagnosis (especially externalizing), symptom severity, comorbid disorders, functional impairment, family burden, family environment or being a boy (Cabiya et al., 2006; Farmer et al., 2003; Sayal, 2004). A better understanding of these factors may help to optimize access to services of children needing help.
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Abstract
Attention-deficit hyperactivity disorder (ADHD) is recognized to exist in males and females although the literature supports a higher prevalence in males. However, when girls are diagnosed with ADHD, they are more often diagnosed as predominantly inattentive than boys with ADHD. This article provides a review of gender differences noted across the lifespan. Males and females with ADHD are more similar than different, and generally ADHD profiles are not sex specific. Small gender differences have been found: adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD; rates of depression and anxiety may be higher, and physical aggression and other externalizing behaviors lower in girls and women with ADHD. Men with ADHD seem to be incarcerated more often than women with ADHD. However, many studies suffer from small sample sizes, referral biases, differences in diagnostic procedures, and possible rater influences. Treatments are reviewed and discussed with reference to the reported gender differences in functioning and the global deficits noted in all samples. The data available so far suggest that treatments are likely to be equally effective in males and females. However, referral bias is a problem, in that females with ADHD are less likely to be referred for treatment than males with ADHD. Future research should include equal representation of both sexes in samples such that sex by treatment analyses can be routinely conducted.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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Abstract
Attention deficit hyperactivity disorder (ADHD), a neurobiological disorder, affects millions of individuals and can significantly impact an individual's life course. Research guidelines used in assessment, diagnosis, and treatment have focused primarily on Caucasian males generating, in part, the need to redress how gender and other contextual factors are considered. Consequently many women and persons from diverse cultural groups can be ignored or misdiagnosed. Undiagnosed and untreated women with ADHD are therefore limited in their potential to flourish socially, academically, interpersonally, and in their family roles. This case example of a 38-year-old African American woman illustrates how her life journey was affected by undiagnosed ADHD.
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Affiliation(s)
- Roberta Waite
- School of Nursing, Drexel University, Philadelphia, Pennsylvania 19102, USA.
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Schildcrout JS, Rathouz PJ. Longitudinal studies of binary response data following case-control and stratified case-control sampling: design and analysis. Biometrics 2009; 66:365-73. [PMID: 19673861 DOI: 10.1111/j.1541-0420.2009.01306.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We discuss design and analysis of longitudinal studies after case-control sampling, wherein interest is in the relationship between a longitudinal binary response that is related to the sampling (case-control) variable, and a set of covariates. We propose a semiparametric modeling framework based on a marginal longitudinal binary response model and an ancillary model for subjects' case-control status. In this approach, the analyst must posit the population prevalence of being a case, which is then used to compute an offset term in the ancillary model. Parameter estimates from this model are used to compute offsets for the longitudinal response model. Examining the impact of population prevalence and ancillary model misspecification, we show that time-invariant covariate parameter estimates, other than the intercept, are reasonably robust, but intercept and time-varying covariate parameter estimates can be sensitive to such misspecification. We study design and analysis issues impacting study efficiency, namely: choice of sampling variable and the strength of its relationship to the response, sample stratification, choice of working covariance weighting, and degree of flexibility of the ancillary model. The research is motivated by a longitudinal study following case-control sampling of the time course of attention deficit hyperactivity disorder (ADHD) symptoms.
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Affiliation(s)
- Jonathan S Schildcrout
- Departments of Biostatistics and Anesthesiology, Vanderbilt University School of Medicine, 1161 21st Avenue South, S-2323 Medical Center North, Nashville, Tennessee 37232, USA.
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Viewing preschool disruptive behavior disorders and attention-deficit/hyperactivity disorder through a developmental lens: what we know and what we need to know. Child Adolesc Psychiatr Clin N Am 2009; 18:627-43. [PMID: 19486842 PMCID: PMC10171091 DOI: 10.1016/j.chc.2009.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Empirical investigation into disruptive behavior disorders (DBDs) and attention deficit/hyperactivity disorder (ADHD) in early childhood has expanded considerably during the past decade. Although there have been considerable gains in the understanding of the presentation and course of these psychiatric disorders in early childhood, the lack of a developmental framework to guide nosologic issues likely impedes progress in this area. The authors propose that enhanced developmental sensitivity in defining symptoms of DBDs and ADHD may shed light on outstanding issues in the field. In particular, developmental specification may enhance specificity, sensitivity, and stability of DBDs and ADHD symptoms as well as inform our understanding of which type of treatment works best for whom. This article provides an overview of these critical issues.
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Sagvolden T, Dasbanerjee T, Zhang-James Y, Middleton F, Faraone S. Behavioral and genetic evidence for a novel animal model of Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype. Behav Brain Funct 2008; 4:56. [PMID: 19046438 PMCID: PMC2628673 DOI: 10.1186/1744-9081-4-56] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/01/2008] [Indexed: 11/10/2022] Open
Abstract
Background According to DSM-IV there are three subtypes of Attention-Deficit/Hyperactivity Disorder, namely: ADHD predominantly inattentive type (ADHD-PI), ADHD predominantly Hyperactive-Impulsive Type (ADHD-HI), and ADHD combined type (ADHD-C). These subtypes may represent distinct neurobehavioral disorders of childhood onset with separate etiologies. The diagnosis of ADHD is behaviorally based; therefore, investigations into its possible etiologies should be based in behavior. Animal models of ADHD demonstrate construct validity when they accurately reproduce elements of the etiology, biochemistry, symptoms, and treatment of the disorder. Spontaneously hypertensive rats (SHR) fulfill many of the validation criteria and compare well with clinical cases of ADHD-C. The present study describes a novel rat model of the predominantly inattentive subtype (ADHD-PI). Methods ADHD-like behavior was tested with a visual discrimination task measuring overactivity, impulsiveness and inattentiveness. Several strains with varied genetic background were needed to determine what constitutes a normal comparison. Five groups of rats were used: SHR/NCrl spontaneously hypertensive and WKY/NCrl Wistar/Kyoto rats from Charles River; SD/NTac Sprague Dawley and WH/HanTac Wistar rats from Taconic Europe; and WKY/NHsd Wistar/Kyoto rats from Harlan. DNA was analyzed to determine background differences in the strains by PCR genotyping of eight highly polymorphic microsatellite markers and 2625 single nucleotide polymorphisms (SNPs). Results Compared to appropriate comparison strains (WKY/NHsd and SD/NTac rats), SHR/NCrl showed ADHD-C-like behavior: striking overactivity and poor sustained attention. Compared to WKY/NHsd rats, WKY/NCrl rats showed inattention, but no overactivity or impulsiveness. WH/HanTac rats deviated significantly from the other control groups by being more active and less attentive than the WKY/NHsd and SD/NTac rats. We also found substantial genomic differences between the WKY/NCrl and WKY/NHsd rats for eight short tandem repeat loci and 2625 SNPs. About 33.5 percent of the genome differs between the two WKY rat substrains, with large stretches of divergence on each chromosome. Discussion These data provide solid behavioral and genetic evidence that the WKY/NCrl and WKY/NHsd rats should be considered as separate substrains. Moreover, the behavioral features of the WKY/NCrl rat indicate that it should be a useful model for ADHD-PI, the primarily inattentive subtype of ADHD. The SD/NTac and the WH/HanTac rats show significant genetic and/or behavioral differences from WKY/NHsd rats and appear not to be appropriate controls in studies using the SHR/NCrl. The present results support the conclusion that SHR/NCrl is the best validated animal model of ADHD-C. The overactivity, impulsiveness and deficient sustained attention of the SHR/NCrl strain are independent behaviors. Thus, overactivity does not account for this strain's impulsiveness and deficient sustained attention. Finally, the present study shows that great care has to be exercised to select the model and comparison groups.
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Affiliation(s)
- T Sagvolden
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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Martel MM, Gobrogge KL, Breedlove SM, Nigg JT. Masculinized finger-length ratios of boys, but not girls, are associated with attention-deficit/hyperactivity disorder. Behav Neurosci 2008; 122:273-81. [PMID: 18410167 DOI: 10.1037/0735-7044.122.2.273] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gonadal hormones may exert permanent organizational effects on sexually dimorphic finger-length ratios and sexually dimorphic behavior expressed in childhood attention deficit-hyperactivity disorder (ADHD). This study extended recent work examining associations between finger-length ratios (specifically, 2D:4D) and ADHD in a well-characterized, clinically diagnosed, community-recruited sample of boys and girls. A multistage, diagnostic procedure was utilized to identify 113 children with ADHD and 137 non-ADHD comparison children. Right-hand digit ratios showed significant mean differences by gender, as well as associations with ADHD diagnosis. Boys with ADHD had more masculinized digit ratios than control-group boys. More masculine right 2D:4D and 3D:4D ratios were correlated with parent- and teacher-rated inattentive and hyperactive-impulsive symptoms in boys but not in girls. Masculinized finger-length ratios were associated with hyperactive-impulsive and oppositional- defiant symptoms, but associations were largest with symptoms of inattention. It is concluded that prenatal, organizational effects of gonadal hormones may play a role in the development of ADHD and contribute to explaining sex differences in the prevalence rates of this childhood disorder.
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Affiliation(s)
- Michelle M Martel
- Department of Psychology, Michigan State University, East Lansing 48823-1116, USA.
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29
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Rucklidge JJ. Gender differences in ADHD: implications for psychosocial treatments. Expert Rev Neurother 2008; 8:643-55. [PMID: 18416665 DOI: 10.1586/14737175.8.4.643] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has now been recognized to exist in both males and females, albeit the literature supports a higher prevalence in males. However, when girls are diagnosed with ADHD, they are more often diagnosed as predominantly inattentive than boys with ADHD. This paper provides a review of gender differences noted across the lifespan in terms of psychosocial functioning, cognitive abilities and psychiatric comorbidities. Males and females with ADHD are more similar than different, and generally symptoms of ADHD are not sex specific. Small gender differences have been found: adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD, but these differences tend to disappear by adulthood; rates of depression and anxiety may be higher (especially in adolescence) while physical aggression and other externalizing behaviors may be lower in girls and women with ADHD, although not all studies support these findings (e.g., non-referred samples show similar rates of coexisting psychiatric disorders between boys and girls with ADHD). However, many studies suffer from small sample sizes, referral biases, differences in diagnostic procedures and possible rater influences. Psychosocial treatments are reviewed and discussed with reference to the reported gender differences in functioning as well as the global deficits noted in all samples. Although the data available so far suggest that psychosocial treatments are likely to be equally effective in males and females, this conclusion is based more on the small number of gender differences noted in overall functioning and less on empirical research on treatment by sex effects and the moderating role of sex, an effect only investigated by the Multi-modal Treatment Study of ADHD group, to date. Future research should include equal representation of both sexes in samples such that treatment analyses by gender can be routinely conducted.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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Hoza B. Peer functioning in children with ADHD. ACTA ACUST UNITED AC 2007; 7:101-6. [PMID: 17261489 PMCID: PMC2572031 DOI: 10.1016/j.ambp.2006.04.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Revised: 03/21/2006] [Accepted: 04/01/2006] [Indexed: 10/23/2022]
Abstract
This article describes what is currently known about the peer relationships of children with attention-deficit/hyperactivity disorder (ADHD). This topic is addressed both from the perspective of how ADHD initially contributes to problematic relationships with peers, and also from the perspective of how peers' reactions to these problems may serve to maintain them. Given the limited improvement typically obtained in treatment studies that use peer report measures as outcomes with ADHD samples and the well-documented predictive validity of peer reports for later adjustment, the need for more intensive interventions and novel approaches to address the peer problems of children with ADHD is emphasized.
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Affiliation(s)
- Betsy Hoza
- Department of Psychology, University of Vermont, Burlington, VT 05405, USA.
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Lahey BB, Hartung CM, Loney J, Pelham WE, Chronis AM, Lee SS. Are there sex differences in the predictive validity of DSM-IV ADHD among younger children? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2007; 36:113-26. [PMID: 17484685 DOI: 10.1080/15374410701274066] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We assessed the predictive validity of attention-deficit/hyperactivity disorder (ADHD) in 20 girls and 98 boys who met the Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for ADHD at 4 to 6 years of age compared to 24 female and 102 male comparison children. Over the next 8 years, both girls and boys who met criteria for ADHD in Year 1 exhibited more ADHD symptoms and impairment than same-sex comparison children. Effect sizes were consistently large, indicating that the diagnosis of ADHD at 4 to 6 years of age has predictive validity for both sexes. Both girls and boys with ADHD in Year 1 also exhibited higher levels of symptoms of conduct disorder, major depression, and anxiety disorders in early adolescence than same-sex comparison children, controlling levels of the same symptoms in Year 1. This indicates both substantial homotypic and heterotypic continuity for ADHD in both sexes, but significant interactions with time indicated that childhood ADHD predicts more steeply rising symptoms of anxiety and depression during early adolescence in girls than in boys.
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Affiliation(s)
- Benjamin B Lahey
- Department of Health Studies and Psychiatry, University of Chicago, Chicago, IL 60637, USA.
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Leyfer OT, Woodruff-Borden J, Klein-Tasman BP, Fricke JS, Mervis CB. Prevalence of psychiatric disorders in 4 to 16-year-olds with Williams syndrome. Am J Med Genet B Neuropsychiatr Genet 2006; 141B:615-22. [PMID: 16823805 PMCID: PMC2561212 DOI: 10.1002/ajmg.b.30344] [Citation(s) in RCA: 188] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The prevalence of a range of DSM-IV psychiatric disorders in a sample of 119 4-16-year-old children with Williams syndrome (WS) was assessed using a structured diagnostic interview with their parents. Most children (80.7%) met criteria for at least one DSM-IV diagnosis. The most prevalent diagnoses were Attention Deficit/Hyperactivity Disorder (ADHD; 64.7%) and Specific Phobia (53.8%). There was a significant shift in Predominant Type of ADHD as a function of CA, from Combined for the youngest group (ages 4-6 years) to Inattentive for the oldest group (ages 11-16 years). The prevalence of Generalized Anxiety Disorder (GAD) increased significantly with age. These findings are another step toward defining the behavioral phenotype of WS.
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Affiliation(s)
- Ovsanna T Leyfer
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky 40292, USA.
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Willcutt EG, Carlson CL. The diagnostic validity of attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cnr.2005.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Desman C, Petermann F. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS): Wie valide sind die Subtypen? KINDHEIT UND ENTWICKLUNG 2005. [DOI: 10.1026/0942-5403.14.4.244] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Bereits mit Erscheinen des DSM-IV wurde die Validität der dort benannten Subtypen der ADHS hinterfragt. Hinzu kommt eine abweichende Subgruppenbildung in der ICD-10. Seitdem sind die Subtypen in verschiedenen Zusammenhängen untersucht worden. Dabei festgestellte Unterschiede und Gemeinsamkeiten der Subtypen werden aus sechs Perspektiven (verhaltensbezogen, genetisch, geschlechtsspezifisch, entwicklungsbezogen, neurobiologisch, neuropsychologisch) betrachtet, um Informationen über mögliche notwendige Veränderungen im DSM-V zu erlangen. Die Befunde legen zunächst nahe, sich bei zukünftigen Klassifikationskriterien nicht auf die Verhaltensebene zu beschränken, sondern insbesondere neuropsychologische aber auch neurobiologische Aspekte einzubeziehen. So wird unter Berücksichtigung dieser Ebenen für den bisherigen vorwiegend unaufmerksamen Subtyp eine weitere Differenzierung angedeutet: in eine Gruppe mit verlangsamtem kognitiven Tempo, die eventuell sogar eine eigenständige Störung darstellt, sowie einen vorwiegend unaufmerksamen Subtyp der ADHS, der aber schwache Symptome der Hyperaktivität und Impulsivität aufweist. Des Weiteren deutet sich zwar auf einigen Ebenen ein eigenständiger Subtyp ADHS mit komorbiden Störungen des Sozialverhaltens beziehungsweise einer Hyperkinetischen Störung des Sozialverhaltens an. Jedoch sind Befunde anderer Ebenen noch nicht eindeutig und somit ist weitere Forschung notwendig. Zudem scheinen gesonderte Kriterien für die Geschlechter nicht erforderlich, vielmehr sollte stärker beachtet werden, dass auch Mädchen diese Störung aufweisen können. Abschließend werden Implikationen für zukünftige Klassifikationen und ihre Bedeutung für unterschiedliche Behandlungsverfahren diskutiert.
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Affiliation(s)
- Christiane Desman
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen
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Abstract
OBJECTIVE To examine gender differences among children meeting symptom criteria for DSM-IV attention-deficit/hyperactivity disorder (ADHD) identified in a nationally representative sample of Australian children. METHOD From 2,404 children aged 6 to 13 years, 225 boys and 99 girls with ADHD symptoms were identified using the parent version of the Diagnostic Interview Schedule for Children and compared on parent reports of children's behavioral problems and impairment. RESULTS When ADHD types were collapsed into a single group, boys and girls did not differ on core symptoms, comorbidity, and impairment with the exception that girls rated higher on somatic complaints and boys had poorer school functioning. However, gender patterns were found to vary across ADHD type on impairment measures of social problems, schoolwork difficulties, and self-esteem, with boys being generally rated as more impaired in the combined and hyperactive-impulsive groups but equally or less impaired in the inattentive group. CONCLUSIONS The findings suggest the possibility of gender-specific risks associated with high levels of inattentive and hyperactive-impulsive symptoms indicating that ADHD subtype membership should be considered when conducting ADHD gender comparisons.
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Affiliation(s)
- Brian W Graetz
- Research and Evaluation Unit, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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Zalecki CA, Hinshaw SP. Overt and relational aggression in girls with attention deficit hyperactivity disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2004; 33:125-37. [PMID: 15028547 DOI: 10.1207/s15374424jccp3301_12] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We employed a multi-informant approach to examine attention deficit hyperactivity disorder (ADHD) subtype differences, as well as ADHD versus comparison group differences, in overt aggression, relational aggression, and peer regard related to such aggression. Participants included 228 girls (ages 6 to 12 years) diagnosed with either ADHD-Combined (ADHD-C; n = 93), ADHD-Inattentive (ADHD-I; n = 47), or nondiagnosed comparisons (n = 88) who attended research-based summer camp programs. Girls with ADHD-C exhibited higher rates of overt and relational aggression than did girls with ADHD-I, who in turn exhibited higher rates than comparison girls. For the ADHD-C subgroup, aggressive behavior was associated with both negative peer regard and lack of positive peer regard; for the ADHD-I subgroup, aggressive behavior was related to negative peer regard but not to positive peer regard. Controlling for subtype, relational aggression contributed incremental variance in peer regard over and above overt aggression, but effects for the latter were stronger. We discuss the importance of overt versus relational aggression for girls with ADHD as well as disparities in findings according to informant sources.
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Affiliation(s)
- Christine A Zalecki
- Department of Psychology, University of California, Berkeley, CA 94720-1650, USA
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Lowe N, Kirley A, Hawi Z, Sham P, Wickham H, Kratochvil CJ, Smith SD, Lee SY, Levy F, Kent L, Middle F, Rohde LA, Roman T, Tahir E, Yazgan Y, Asherson P, Mill J, Thapar A, Payton A, Todd RD, Stephens T, Ebstein RP, Manor I, Barr CL, Wigg KG, Sinke RJ, Buitelaar JK, Smalley SL, Nelson SF, Biederman J, Faraone SV, Gill M. Joint analysis of the DRD5 marker concludes association with attention-deficit/hyperactivity disorder confined to the predominantly inattentive and combined subtypes. Am J Hum Genet 2004; 74:348-56. [PMID: 14732906 PMCID: PMC1181932 DOI: 10.1086/381561] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 11/19/2003] [Indexed: 11/03/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable, heterogeneous disorder of early onset, consisting of a triad of symptoms: inattention, hyperactivity, and impulsivity. The disorder has a significant genetic component, and theories of etiology include abnormalities in the dopaminergic system, with DRD4, DAT1, SNAP25, and DRD5 being implicated as major susceptibility genes. An initial report of association between ADHD and the common 148-bp allele of a microsatellite marker located 18.5 kb from the DRD5 gene has been followed by several studies showing nonsignificant trends toward association with the same allele. To establish the postulated association of the (CA)(n) repeat with ADHD, we collected genotypic information from 14 independent samples of probands and their parents, analyzed them individually and, in the absence of heterogeneity, analyzed them as a joint sample. The joint analysis showed association with the DRD5 locus (P=.00005; odds ratio 1.24; 95% confidence interval 1.12-1.38). This association appears to be confined to the predominantly inattentive and combined clinical subtypes.
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Affiliation(s)
- Naomi Lowe
- Department of Genetics, Trinity College, Dublin 2, Ireland.
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Sonuga-Barke EJS, Dalen L, Remington B. Do executive deficits and delay aversion make independent contributions to preschool attention-deficit/hyperactivity disorder symptoms? J Am Acad Child Adolesc Psychiatry 2003; 42:1335-42. [PMID: 14566171 DOI: 10.1097/01.chi.0000087564.34977.21] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test whether deficits in executive function and delay aversion make independent contributions to levels of attention-deficit/hyperactivity disorder (ADHD) symptoms exhibited by preschool children. METHOD One hundred fifty-six children between 3 and 5.5 years old (78 girls and 78 boys) selected from the community completed an age-appropriate battery of tests measuring working memory, set shifting, planning, delay of gratification, and preference for delayed rewards. Parents completed a clinical interview about their children's ADHD symptoms. RESULTS Analysis of test performance revealed two factors: executive dysfunction and delay aversion. Multivariate analysis demonstrated that when other factors (i.e., age, IQ, and conduct problems) were controlled, executive dysfunction and delay aversion each made significant independent contributions to predictions of ADHD symptoms. CONCLUSIONS Preschool ADHD symptoms are psychologically heterogeneous. Executive dysfunction and delay aversion may represent two distinct and early appearing neurodevelopmental bases for ADHD symptoms.
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