Attention deficit hyperactivity disorder and comorbidity: A review of literature

The Association Between the Impact of COVID-19 and Internalizing Problems Among Children and Adolescents with ADHD: The Moderating Role of Parental Anxiety

Previous research has identified an increase in internalizing problems during the COVID-19 pandemic in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Additionally, it has been observed that parents of children with ADHD had elevated levels of anxiety during the pandemic. The current study aimed to longitudinally assess whether the impact of COVID-19 was associated with internalizing problems in children and adolescents with ADHD during the middle (Time 1-Spring 2021 [T1]) and end (Time 2-Fall/Winter 2022 [T2]) of the pandemic, and whether parental anxiety moderated this relationship over time. Canadian parents of youth with ADHD (aged 3-18 years old) completed online questionnaires assessing their child's depression and anxiety symptoms, their own anxiety symptoms, and the pandemic's impact on their child, both at T1 (N = 278) and T2 (N = 89). The results indicated that the impact of COVID-19 on children at T1 was a unique predictor of child internalizing problems at T1 but not at T2. While parental anxiety did not moderate this association cross-sectionally, it was a significant moderator longitudinally. More specifically, low parental anxiety at T1 positively moderated the association between the COVID-19 impact on children at T1 and child internalizing problems at T2. The results highlight the importance of providing on-going psychological support for children and adolescents with ADHD and emphasize the need to aid parents in effectively supporting their children during the process of pandemic recovery.

Healthcare resource utilization and costs associated with psychiatric comorbidities in pediatric patients with attention-deficit/hyperactivity disorder: a claims-based case-cohort study

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) has been shown to pose considerable clinical and economic burden; however, research quantifying the excess burden attributable to common psychiatric comorbidities of ADHD among pediatric patients is scarce. This study assessed the impact of anxiety and depression on healthcare resource utilization (HRU) and healthcare costs in pediatric patients with ADHD in the United States.

METHODS

Patients with ADHD aged 6-17 years were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was the date of initiation of a randomly selected ADHD treatment. Patients with ≥ 1 diagnosis for anxiety and/or depression during both the baseline (6 months pre-index) and study period (12 months post-index) were classified in the ADHD+anxiety/depression cohort; those without diagnoses for anxiety nor depression during both periods were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts. All-cause HRU and healthcare costs during the study period were compared using regression analyses. Cost analyses were also performed in subgroups by comorbid conditions.

RESULTS

The reweighted ADHD-only cohort (N = 204,723) and ADHD+anxiety/depression cohort (N = 66,231) had similar characteristics (mean age: 11.9 years; 72.8% male; 56.2% had combined inattentive and hyperactive ADHD type). The ADHD+anxiety/depression cohort had higher HRU than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 10.3; emergency room visits: 1.6; outpatient visits: 2.3; specialist visits: 5.3; and psychotherapy visits: 6.1; all p < 0.001). The higher HRU translated to greater all-cause healthcare costs; the mean per-patient-per-year (PPPY) costs in the ADHD-only cohort vs. ADHD+anxiety/depression cohort was $3,988 vs. $8,682 (p < 0.001). All-cause healthcare costs were highest when both comorbidities were present; among patients with ADHD who had only anxiety, only depression, and both anxiety and depression, the mean all-cause healthcare costs were $7,309, $9,901, and $13,785 PPPY, respectively (all p < 0.001).

CONCLUSIONS

Comorbid anxiety and depression was associated with significantly increased risk of HRU and higher healthcare costs among pediatric patients with ADHD; the presence of both comorbid conditions resulted in 3.5 times higher costs relative to ADHD alone. These findings underscore the need to co-manage ADHD and psychiatric comorbidities to help mitigate the substantial burden borne by patients and the healthcare system.

Reciprocal relations between dimensions of attention-deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sample

BACKGROUND

Symptoms of anxiety and attention-deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD-inattention and hyperactivity-impulsivity-are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown.

METHODS

Two birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross-lagged panel model, adjusting for all unobserved time-invariant confounding effects.

RESULTS

In girls, increased inattention, but not hyperactivity-impulsivity, predicted increased anxiety 2 years later across all time-points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity-impulsivity. In boys, increased hyperactivity-impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity-impulsivity.

CONCLUSIONS

The two ADHD dimensions were differentially related to anxiety, and the relations were sex-specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity-impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time-points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity-impulsivity may reduce anxiety risk in boys during late childhood (at ages 8-10).

Amygdala Volume is Associated with ADHD Risk and Severity Beyond Comorbidities in Adolescents: Clinical Testing of Brain Chart Reference Standards

Understanding atypicalities in ADHD brain correlates is a step towards better understanding ADHD etiology. Efforts to map atypicalities at the level of brain structure have been hindered by the absence of normative reference standards. Recent publication of brain charts allows for assessment of individual variation relative to age- and sex-adjusted reference standards and thus estimation not only of case-control differences but also of intraindividual prediction.

METHODS

Aim was to examine, whether brain charts can be applied in a sample of adolescents (N = 140, 38% female) to determine whether atypical brain subcortical and total volumes are associated with ADHD at-risk status and severity of parent-rated symptoms, accounting for self-rated anxiety and depression, and parent-rated oppositional defiant disorder (ODD) as well as motion.

RESULTS

Smaller bilateral amygdala volume was associated with ADHD at-risk status, beyond effects of comorbidities and motion, and smaller bilateral amygdala volume was associated with inattention and hyperactivity/impulsivity, beyond effects of comorbidities except for ODD symptoms, and motion.

CONCLUSIONS

Individual differences in amygdala volume meaningfully add to estimating ADHD risk and severity. Conceptually, amygdalar involvement is consistent with behavioral and functional imaging data on atypical reinforcement sensitivity as a marker of ADHD-related risk. Methodologically, results show that brain chart reference standards can be applied to address clinically informative, focused and specific questions.

Racial-Ethnic Differences in ADHD Diagnosis and Treatment During Adolescence and Early Adulthood

OBJECTIVE

This study examined racial-ethnic differences in attention-deficit hyperactivity disorder (ADHD) diagnosis and treatment during adolescence and early adulthood.

METHODS

A national health care claims database was used to identify a cohort of 4,216,757 commercially insured youths with at least 1 year of coverage during 2014-2019. Racial-ethnic differences in the prevalence of visits with a recorded ADHD diagnosis (identified through ICD-9-CM and ICD-10-CM codes) and of ADHD treatment (identified through medical claims for psychosocial treatments and pharmacy claims for ADHD medications) were examined. Period prevalence rates were determined within five age categories, stratified by race-ethnicity. Poisson regression with a natural log link was used within each age category to estimate prevalence ratios (PRs) comparing prevalence in each racially and ethnically minoritized group with prevalence in the White group.

RESULTS

The overall prevalence of ADHD diagnosis was 9.1% at ages 12-14 and 5.3% at ages 24-25. In each age category, Asian, Black, and Hispanic youths had lower prevalence of ADHD diagnosis than did White youths (PR=0.29-0.77). Among youths with an ADHD diagnosis, relative racial-ethnic differences in treatment were small (PR=0.92-1.03).

CONCLUSIONS

Throughout adolescence and early adulthood, racially and ethnically minoritized youths were less likely than White youths to have health care visits with recorded ADHD diagnoses and, among those with diagnoses, were also slightly less likely to receive treatment. More research is needed to understand the processes underlying these differences and their potential health consequences among racially and ethnically minoritized youths.

The impacts associated with having ADHD: an umbrella review

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD.

Methods

An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications.

Results

Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality.

Discussion

This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning.

Registration

International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).

Using caffeine as a chemical means to induce flow states

Flow is an intrinsically rewarding state characterised by positive affect and total task absorption. Because cognitive and physical performance are optimal in flow, chemical means to facilitate this state are appealing. Caffeine, a non-selective adenosine receptor antagonist, has been emphasized as a potential flow-inducer. Thus, we review the psychological and biological effects of caffeine that, conceptually, enhance flow. Caffeine may facilitate flow through various effects, including: i) upregulation of dopamine D1/D2 receptor affinity in reward-associated brain areas, leading to greater energetic arousal and 'wanting'; ii) protection of dopaminergic neurons; iii) increases in norepinephrine release and alertness, which offset sleep-deprivation and hypoarousal; iv) heightening of parasympathetic high frequency heart rate variability, resulting in improved cortical stress appraisal, v) modification of striatal endocannabinoid-CB1 receptor-signalling, leading to enhanced stress tolerance; and vi) changes in brain network activity in favour of executive function and flow. We also discuss the application of caffeine to treat attention deficit hyperactivity disorder and caveats. We hope to inspire studies assessing the use of caffeine to induce flow.

Aggressiveness in Italian Children with ADHD: MAOA Gene Polymorphism Involvement

ADHD is a neurodevelopmental disorder that children and adults can develop. A complex interplay of genetic and environmental factors may underlie interindividual variability in ADHD and potentially related aggressive behavior. Using high-resolution molecular biology techniques, we investigated the impact of some MAOA and SLC6A4 variations on ADHD and aggressive behavior in a group of 80 Italian children with ADHD and in 80 healthy controls. We found that homozygous genotypes of MAOA rs6323 and rs1137070 were associated with an increased risk of ADHD (p = 0.02 and p = 0.03, respectively), whereas the heterozygous genotypes (GT of rs6323 and CT of rs1137030) (p = 0.0002 and p = 0.0006) were strongly linked to a lower risk of developing this disorder. In patients with aggressive behavior, we highlighted only a weak negative association of both MAOA polymorphisms (heterozygous genotypes) with aggressiveness, suggesting that these genotypes may be protective towards specific changes in behavior (p = 0.05). Interestingly, an increase in the GG genotype of rs6323 (p = 0.01) and a decrease in GT genotype (p = 0.0005) was also found in patients without aggressive behavior compared to controls. Regarding 5HTT gene genotyping, no allele and genotype differences have been detected among patients and controls. Our work shows that defining a genetic profile of ADHD may help in the early detection of patients who are more vulnerable to ADHD and/or antisocial and aggressive behavior and to design precision-targeted therapies.

The High Rates of Comorbidity among Neurodevelopmental Disorders: Reconsidering the Clinical Utility of Distinct Diagnostic Categories

The boundaries between neurodevelopmental disorders are often indistinct, even among specialists. But do these boundaries exist, or do experts struggle to distinguish and categorize symptoms in order to arrive at a dominant diagnosis while comorbidity continually leaves questions about where each disorder ends and begins? What should be reconsidered? The introduction of the term 'spectrum of neurodevelopmental disorders' could pave the way for a re-appraisal of the clinical continuum of neurodevelopmental disorders. This study aims to highlight the problems that emerge in the field of the differential diagnosis of neurodevelopmental disorders and propose a renegotiation of the distinctiveness criteria.

Genetic contribution to the comorbidity between attention-deficit/hyperactivity disorder and substance use disorders

We characterized the genetic architecture of the attention-deficit hyperactivity disorder-substance use disorder (ADHD-SUD) relationship by investigating genetic correlation, causality, pleiotropy, and common polygenic risk. Summary statistics from genome-wide association studies (GWAS) were used to investigate ADHD (Neff = 51,568), cannabis use disorder (CanUD, Neff = 161,053), opioid use disorder (OUD, Neff = 57,120), problematic alcohol use (PAU, Neff = 502,272), and problematic tobacco use (PTU, Neff = 97,836). ADHD, CanUD, and OUD GWAS meta-analyses included cohorts with case definitions based on different diagnostic criteria. PAU GWAS combined information related to alcohol use disorder, alcohol dependence, and the items related to alcohol problematic consequences assessed by the alcohol use disorders identification test. PTU GWAS was generated a multi-trait analysis including information regarding Fagerström Test for Nicotine Dependence and cigarettes per day. Linkage disequilibrium score regression analyses indicated positive genetic correlation with CanUD, OUD, PAU, and PTU. Genomic structural equation modeling showed that these genetic correlations were related to two latent factors: one including ADHD, CanUD, and PTU and the other with OUD and PAU. The evidence of a causal effect of PAU and PTU on ADHD was stronger than the reverse in the two-sample Mendelian randomization analysis. Conversely, similar strength of evidence was found between ADHD and CanUD. CADM2 rs62250713 was a pleiotropic SNP between ADHD and all SUDs. We found seven, one, and twenty-eight pleiotropic variants between ADHD and CanUD, PAU, and PTU, respectively. Finally, OUD, CanUD, and PAU PRS were associated with increased odds of ADHD. Our findings demonstrated the contribution of multiple pleiotropic mechanisms to the comorbidity between ADHD and SUDs.

The bidirectional relationship between head injuries and conduct problems: longitudinal modelling of a population-based birth cohort study

Childhood head injuries and conduct problems increase the risk of aggression and criminality and are well-known correlates. However, the direction and timing of their association and the role of their demographic risk factors remain unclear. This study investigates the bidirectional links between both from 3 to 17 years while revealing common and unique demographic risks. A total of 8,603 participants (50.2% female; 83% White ethnicity) from the Millennium Cohort Study were analysed at 6 timepoints from age 3 to 17. Conduct problems were parent-reported for ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ) and head injuries at ages 3 to 14. A cross-lagged path model estimated the longitudinal bidirectional effects between the two whilst salient demographic risks were modelled cumulatively at three ecological levels (child, mother, and household). Conduct problems at age 5 promoted head injuries between 5 and 7 (Z = 0.07; SE = 0.03; 95% CI, 0.02-0.13), and head injuries at ages 7 to 11 promoted conduct problems at age 14 (ß = .0.06; SE = .0.03; 95% CI, 0.01-0.12). Head injuries were associated with direct child-level risk at age 3, whereas conduct problems were associated with direct risks from all ecological levels until 17 years. The findings suggest a sensitive period at 5-11 years for the bidirectional relationship shared between head injuries and conduct problems. They suggest that demographic risks for increased head injuries play an earlier role than they do for conduct problems. Both findings have implications for intervention timing.

Executive control training for adolescents with ADHD: Study protocol for a randomised controlled trial

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental conditions diagnosed during childhood and adolescence. In addition to the commonly observed symptoms of inattention, hyperactivity, and impulsivity, individuals with ADHD often experience impairments in executive functions (EFs). Goal management training (GMT) is a cognitive remediation intervention targeting EFs, with empirical support from studies with adult populations, including ADHD. The objective of the upcoming trial is to assess the effectiveness of GMT for adolescents with ADHD.

METHODS

This pre-registered protocol outlines a multi-centre randomised controlled trial (RCT) comparing GMT to treatment as usual (TAU) to improve EFs. We aim to recruit 120 participants, aged 12 to 18 years, recently diagnosed with ADHD. Participants will be randomly allocated to the group-based GMT intervention in addition to TAU, or the TAU condition, through block randomisation with site stratification. GMT will be delivered in groups of four to six participants, with weekly two-hour sessions for seven weeks, complemented by separate parent and teacher sessions. TAU is standard community mental health treatment. The primary outcome measure will be parent-reported EF assessed with the Behaviour Rating Inventory of Executive Function 2 (BRIEF-2). Secondary outcomes will include ADHD symptom measures, social functioning, quality of life, and neuropsychological tests (attention span, inhibition, working memory, and visuo-motor speed). The outcome assessments will be conducted at baseline, 12 weeks, 12 months, and 24 months post-treatment.

CONCLUSION

The study findings will contribute to determine the effectiveness of a non-pharmacological ADHD treatment, including outcome trajectories up to 24 months post-treatment.

Behavior Rating Inventory of Executive Function in Preschool (BRIEF-P) and Attention-Deficit and Hyperactivity Disorders (ADHD): A Systematic Review and Meta-Analysis of Floor and Ceiling Effects

BACKGROUND

ADHD is a neurodevelopmental disorder that is accompanied by executive challenges.

OBJECTIVES

To obtain evidence of the usefulness of the BRIEF-P and to analyze the possible ceiling and floor effect of its scores in the assessment of executive function in preschoolers with signs compatible with a possible diagnosis of ADHD.

METHOD

A search was performed in Science Direct, NCBI (PubMed), and ProQuest Education Journals during the period 2012-2022. We included studies that evaluated samples of individuals with symptomatology compatible with ADHD, with an age range between 2 and 6 years, published in English or Spanish. Of a total of 2538 articles, only seven met the inclusion criteria. The risk of bias was assessed using the QUADAS-2 questionnaire. The main variables were age and executive functioning.

CONCLUSIONS

Executive deficits in early-age individuals with symptoms compatible with ADHD are more extensive than just deficits in working memory. A floor effect has been found in tests associated with hot executive functions and a ceiling effect in cold executive functions. This makes it necessary to use different tests to assess executive performance in preschoolers with ADHD-compatible symptomatology and to design intervention proposals accordingly. The BRIEF-P is an instrument that facilitates obtaining a sensitive and discriminative executive profile, although it should be used in combination with other neuropsychological performance tests.

Association of Psychopharmacological Medication Preference with Autistic Traits and Emotion Regulation in ADHD

Background

This study intends to evaluate the relationship between medication switching and autistic traits, emotion dysregulation, and methylphenidate side effects in children with attention deficit hyperactivity disorder (ADHD).

Methods

Children with ADHD, ages 9-18, treated with methylphenidate (MTP) (n = 23), and switched to atomoxetine (ATX) (n = 20) were included. All participants were interviewed with K-SADS-PL to confirm ADHD diagnosis and exclude comorbid psychiatric disorders. The participants then completed Difficulty in Emotion Regulation Scale (DERS) and Autism-Spectrum Quotient (AQ) and their parents completed Autism Spectrum Screening Questionnaire (ASSQ) and Barkley Stimulant Side Effect Rating Scale(BSSERS).

Results

The MTP group scored higher than the ATX group in ASSQ, AQ, and the lack of emotional clarity subscale of DERS, while the ATX group had higher scores in the emotional non-acceptance subscale of DERS. No differences were found between the MTP and ATX groups in methylphenidate side-effect severity. Multiple regression analyses revealed that non-acceptance of emotions predicted the switch to ATX while lack of emotional clarity predicted the maintenance of MTP therapy, rather than autistic traits.

Conclusions

This study highlights emotion regulation difficulties and how different emotional profiles may influence medication selection in children with ADHD.

Nourishing the Cognition with Millets: A Comprehensive Review of Their Nutritional Impact and Potential as Cognitive Enhancers

Cognition is the mental processes and abilities involved in acquiring, storing, retrieving and using it for decision making. Cognitive decline due to aging, lifestyle factor, chronic health conditions, genetic, and environmental factors are rising global concern and propose a potential threat to the cognitive health. The nutritional imbalance has led to increase in cognitive disorders around the world. Millets can be a nutritional intervention for promoting cognitive health and preventing cognitive decline. Millets has abundant phenolic compounds, flavonoids, and antioxidants to protect against oxidative stress-induced cognitive impairment. Millets exert neuroprotective effects by modulating pathways involved in neuronal-survival, synaptic-plasticity, and release of brain-derived neurotrophic factor. Millets demonstrates anti-inflammatory properties by regulating inflammatory-pathways and suppressing cytokines associated with cognitive impairment. Millets maintain healthy gut microbiota by producing metabolites such as short-chain fatty acids, which influence brain function and cognition. However, further research is needed to elucidate the underlying mechanisms and on optimizing the proportion do exploit its potential. Implementing millet-based dietary strategies through public health initiatives and educational programs can be a practical approach to support cognitive health across populations. Harnessing the potential of millets as a nutritional intervention offers a promising avenue for promoting cognitive health and improving the quality of life.

Psychiatric Comorbidities and Schizophrenia in Youths With Attention-Deficit/Hyperactivity Disorder

Importance

The association between attention-deficit/hyperactivity disorder (ADHD) and schizophrenia has received increased attention; however, evidence on the association between psychiatric comorbidities and subsequent schizophrenia in patients with ADHD is limited.

Objective

To investigate the risk of being diagnosed with schizophrenia in children and adolescents with ADHD considering the presence of psychiatric comorbidity.

Design, Setting, and Participants

This was a population-based, retrospective cohort study using the Health Insurance Review and Assessment claims database from January 1, 2007, to December 31, 2019. Participants were children and adolescents aged 5 to 19 years who received an ADHD diagnosis between January 1, 2010, and December 31, 2018, in the nationwide claims data of Korea. Data were analyzed from January 2010 to December 2019.

Interventions or Exposures

The presence of psychiatric comorbidity was assessed from diagnosis records within 1 year before ADHD diagnosis. Comorbidities were further categorized according to the number of comorbidities and specific comorbid disorders.

Main Outcomes and Measures

Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs, examining the association between psychiatric comorbidities and the risk of being diagnosed with schizophrenia. Furthermore, the occurrence of psychiatric comorbidity during the follow-up period was explored among patients without psychiatric comorbidity at baseline.

Results

A total of 211 705 patients with newly diagnosed ADHD were included. A total of 157 272 patients (74.3%) were male, and the age of 5 to 9 years showed the highest distribution (115 081 patients [54.4%]). Patients with psychiatric comorbidity had a significantly higher risk of being diagnosed with schizophrenia than those without (adjusted HR, 2.14; 95% CI, 2.05-2.23). The association between schizophrenia and psychiatric comorbidity became progressively greater with the increasing number of comorbidities. Several individual psychiatric disorders showed an association with development of schizophrenia, with ASD, intellectual disability, tic disorder, depression, and bipolar disorder being the top 5 disorders most associated. Furthermore, 3244 patients (73.8%) without psychiatric comorbidities experienced the emergence of other psychiatric disorders before schizophrenia occurrence.

Conclusions and Relevance

In this retrospective cohort study involving children and adolescents with ADHD, the presence of psychiatric comorbidity in patients with ADHD was associated with an increased risk of being diagnosed with schizophrenia, with an increased risk observed in multiple comorbidities and a wide variety of comorbidities. These findings highlight the significance of assessing and managing psychiatric comorbidities in patients with ADHD to decrease subsequent schizophrenia risk and allow for early intervention.

Attention-deficit/hyperactive-impulsive disorder symptoms among grade 1 students with reading disorder in Thailand

BACKGROUND

Reading disorder is the most common comorbid condition with attention-deficit/hyperactive-impulsive disorder (ADHD) in school-aged children.

PURPOSE

This study compared symptoms of ADHD among children in grade 1 at risk of reading disorder with children not at risk.

METHODS

This cross-sectional study included 703 students in grade 1 aged 6-8 years from 8 schools in Pathumthani Province, Thailand, in 2019. Reading disorder was assessed using tools developed by Vibulpatanavong and Evans for Thai teachers, whereas the Thai parent and teacher versions of the Swanson, Nolan, and Pelham IV Rating Scale (SNAP-IV) was used to evaluate ADHD symptoms. Demographic data were collected from parents using a self-reported questionnaire.

RESULTS

Among the 703 students with almost equal number of male (n=350) and female (n=353), and the average age of 6.56±0.57 years, 95 (13.51%) were classified (significantly male) at risk of reading disorder. The mean SNAP-IV scores of children with reading disorder reported by parents and teachers (20.23±10.95 and 20.75±15.08, respectively) were significantly higher than those of neurotypical children (16.04 ±8.59 and 9.00±10.14, respectively, P<0.05). Of the 95 students with reading disorder reported by parents and teachers, 29 (30.53%) and 20 (21.05%) respectively, were defined as having ADHD according to the standard cutoff SNAP-IV scores, which were significantly higher than 608 neurotypical students at 108 (17.76%) and 20 (5.59%) (P<0.05). The odds ratios of children with reading disorder having ADHD symptoms according to teacher reports were 3.32 (95% confidence interval [CI], 1.14-9.67; P<0.05), 3.75 (95% CI, 1.60-8.79; P<0.05), and 4.41 (95% CI, 1.20-16.15; P<0.05) for inattentive, hyperactive, and combined presentations, respectively.

CONCLUSION

Grade 1 students with reading disorder had a significantly higher prevalence of ADHD symptoms than neurotypical students. Therefore, children with reading disorders should undergo ADHD assessments and receive proactive intervention.

Elevated EEG heartbeat-evoked potentials in adolescents with more ADHD symptoms

INTRODUCTION

Symptoms of attention deficit hyperactivity disorder (ADHD) are associated with a variety of mental abnormalities, but little is known about the perception and processing of internal signals, i.e., interoception, in individuals with ADHD symptoms. This study aimed to investigate the association between ADHD symptoms and the heartbeat-evoked potential (HEP), known as a neural correlate of automatic interoceptive processing of cardiac signals, in adolescents.

METHODS

HEPs of 47 healthy adolescent participants (53.2 % female) with a mean age of 14.29 years were measured during an emotional face recognition task. In addition, participants completed a self-report screening for ADHD symptoms.

RESULTS

ADHD symptoms were positively related to the HEP activity during the task in three of eight EEG sectors in the left hemisphere, as well as in all sectors in the right hemisphere.

DISCUSSION

This study is the first to demonstrate preliminary a relationship between the strength of HEP activity and ADHD symptoms in awake subjects. This finding of higher HEP amplitudes in subjects with more ADHD symptoms can be interpreted in terms of (i) increased arousal, (ii) altered neural processing of internal processes in an emotion-relevant task, and (iii) a misaligned precision-weighting process of task-irrelevant stimuli according to the predictive coding framework. These different interpretations could be reflected by previous studies showing heterogeneity of psychological deficits in individuals with ADHD symptoms. However, the generalizability to patients with diagnosed ADHD is limited due to the measurement tool for ADHD symptoms and the sample characteristics.

Attention-deficit hyperactivity disorder and youth's emotion dysregulation: A systematic review of fMRI studies

A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.

White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review of 129 diffusion imaging studies with meta-analysis

Aberrant anatomical brain connections in attention-deficit/hyperactivity disorder (ADHD) are reported inconsistently across diffusion weighted imaging (DWI) studies. Based on a pre-registered protocol (Prospero: CRD42021259192), we searched PubMed, Ovid, and Web of Knowledge until 26/03/2022 to conduct a systematic review of DWI studies. We performed a quality assessment based on imaging acquisition, preprocessing, and analysis. Using signed differential mapping, we meta-analyzed a subset of the retrieved studies amenable to quantitative evidence synthesis, i.e., tract-based spatial statistics (TBSS) studies, in individuals of any age and, separately, in children, adults, and high-quality datasets. Finally, we conducted meta-regressions to test the effect of age, sex, and medication-naïvety. We included 129 studies (6739 ADHD participants and 6476 controls), of which 25 TBSS studies provided peak coordinates for case-control differences in fractional anisotropy (FA)(32 datasets) and 18 in mean diffusivity (MD)(23 datasets). The systematic review highlighted white matter alterations (especially reduced FA) in projection, commissural and association pathways of individuals with ADHD, which were associated with symptom severity and cognitive deficits. The meta-analysis showed a consistent reduced FA in the splenium and body of the corpus callosum, extending to the cingulum. Lower FA was related to older age, and case-control differences did not survive in the pediatric meta-analysis. About 68% of studies were of low quality, mainly due to acquisitions with non-isotropic voxels or lack of motion correction; and the sensitivity analysis in high-quality datasets yielded no significant results. Findings suggest prominent alterations in posterior interhemispheric connections subserving cognitive and motor functions affected in ADHD, although these might be influenced by non-optimal acquisition parameters/preprocessing. Absence of findings in children may be related to the late development of callosal fibers, which may enhance case-control differences in adulthood. Clinicodemographic and methodological differences were major barriers to consistency and comparability among studies, and should be addressed in future investigations.

The Risk of Methylphenidate Pharmacotherapy for Adults with ADHD

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. It was once thought to be a disorder affecting only children, but in those undiagnosed in childhood, symptoms do not disappear with age. There is now a growing recognition of the late diagnosis and treatment of adults with ADHD. The first-line drug in pharmacotherapy is methylphenidate, and information about its adverse effects, when used by adults, has not been as extensively described as in children. The aim of this article was to review the literature describing the risks of methylphenidate therapy for adults with ADHD. A total of 19 articles-15 clinical trials and 4 case reports presenting rare side effects resulting from methylphenidate therapy, such as reversible ischemic stroke, myocardial infarction, and psychotic episodes, were analyzed. The analysis from clinical trials included 3458 adult patients with ADHD and described the most common side effects, psychiatric adverse events, effects of methylphenidate treatment on sleep, laboratory results, body mass, and cardiovascular symptoms. Methylphenidate treatment is well tolerated, with side effects described, according to severity, as mild to moderate. We conclude that pharmacotherapy is not risk-free and methylphenidate, due to its side effects, may not be the first drug of choice for every patient.

Linked head injury and conduct problem symptom pathways from early childhood to adolescence and their associated risks: Evidence from the millennium cohort study

Conduct problems and head injuries increase the risk of delinquency and share a bidirectional association. However, how they link across development is unknown. The present study aimed to identify their linked developmental pathways and associated risk factors. Latent class analysis was modeled from Millennium Cohort Study data (n = 8,600) to identify linked pathways of conduct problem symptoms and head injuries. Head injuries were parent-reported from ages 3 to 14 and conduct problems from ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ). Multinomial logistic regression then identified various risk factors associated with pathway membership. Four distinct pathways were identified. Most participants displayed low-level conduct problem symptoms and head injuries (n = 6,422; 74.7%). Three groups were characterized by clinically relevant levels of conduct problem symptoms and high-risk head injuries in childhood (n = 1,422; 16.5%), adolescence (n = 567; 6.6%), or persistent across development (n = 189; 2.2%). These clinically relevant pathways were associated with negative maternal parenting styles. These findings demonstrate how pathways of conduct problem symptoms are uniquely linked with distinct head injury pathways. Suggestions for general preventative intervention targets include early maternal negative parenting styles. Pathway-specific interventions are also required targeting cumulative risk at different ecological levels.

Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: n = 421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD = 332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR) = 1.96; 95% confidence interval (CI) = 1.19-2.23, Q = 140.74, P Q < 0.001, I 2 = 97.2%). When restricted among adults, the heterogeneity declined to null (OR = 1.73; 95% CI = 1.14-2.62, Q = 6.28, P Q = 0.10, I 2 = 6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.

Molecular Mechanisms Underlying NMDARs Dysfunction and Their Role in ADHD Pathogenesis

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, although the aetiology of ADHD is not yet understood. One proposed theory for developing ADHD is N-methyl-D-aspartate receptors (NMDARs) dysfunction. NMDARs are involved in regulating synaptic plasticity and memory function in the brain. Abnormal expression or polymorphism of some genes associated with ADHD results in NMDAR dysfunction. Correspondingly, NMDAR malfunction in animal models results in ADHD-like symptoms, such as impulsivity and hyperactivity. Currently, there are no drugs for ADHD that specifically target NMDARs. However, NMDAR-stabilizing drugs have shown promise in improving ADHD symptoms with fewer side effects than the currently most widely used psychostimulant in ADHD treatment, methylphenidate. In this review, we outline the molecular and genetic basis of NMDAR malfunction and how it affects the course of ADHD. We also present new therapeutic options related to treating ADHD by targeting NMDAR.

Intersectionality and Social Security Age-18 Redetermination: Reducing the Stress and Trauma of Transition for Black Transition-Age Youth with Disabilities

Greater attention is being paid to the transition to adulthood for youth with disabilities. We are also at a period of reckoning with the vestiges of slavery, Jim Crow, and a lack of constitutional protections for Black-identifying persons. The contemporary impact of inequitable access to opportunities, services, and supports that would improve the quality of life of racialized Black individuals has added consequences for Black youth with disabilities. A sub-population of youth with disabilities receives monthly support in the form of Supplemental Security Income (SSI), with a disproportionate number of Black-identifying youth qualifying for SSI. Such youth are impacted by the intersectionality of racism, disability, and poverty. The outcome of an SSI age-18 redetermination can be precarious and occurs in the backdrop of these intersectional forces, impacting the life course of racialized Black youth and their families on a scale that is concerning. The authors describe the time frames of pre age-18 redetermination, age-18 redetermination and post age-18 redetermination in the contexts of intersectionality and transition, and articulate what type of services and supports can reduce the experience of chronic stress in the lives of racialized Black youth facing an SSI age-18 redetermination, and thereby improve the outcomes of these youth as they transition to adulthood.

Sensory processing abilities and their impact on disease severity in children with attention-deficit hyperactivity disorder

Objectives

Although several studies have shown sensory processing abnormalities in pediatric subjects with attention-deficit hyperactivity disorder (ADHD), there is significant heterogeneity among their results.

Materials and Methods

This study was performed to compare the sensory processing abilities of children and adolescents with and without ADHD aged 6-15 years and to correlate the sensory processing problems in these patients, with the symptom profile and severity of ADHD. While child sensory profile-2 (SP-2) was used to assess, the sensory processing abilities of ADHD patients, revised Connor's parent rating scale revised, Malin's intelligence scale for Indian children, grade level assessment device, and child behavior checklist were used to assess ADHD symptom severity, intelligence, learning, and behavioral problems, respectively.

Results

A total of 66 ADHD patients enrolled (60 boys), 22 (28%), 7 (9%), and 49 (63%) cases were the ADHD-hyperactive-impulsive (ADHD-HI), ADHD-inattentive, and ADHD-combined (ADHD-C) types, respectively, and 33 typically developing controls. The ADHD patients had a significantly low raw score on most of the factors, sections, and response patterns of SP-2 (P < 0.05), but only four and one ADHD patients had auditory and visual processing scores outside the normal clinical range. There was a trend toward higher scores in the children with ADHD-C and ADHD-HI subtypes. There was a moderate negative correlation between hyperactivity/impulsivity T-score and auditory processing scores in the SP (P < 0.05, r = -0.43). We observed a negative correlation, although weak, between visual processing scores and hyperactivity/impulsivity and a positive correlation between the severity of conduct disorder-related problems, oppositional defiant problems, anxiety problems, and auditory as well as tactile processing scores (P < 0.05). In the quadrant score summary, the scores for all four types, that is, sensory sensitivity, low registration, sensation avoiding, and sensation seeking, were significantly more in the ADHD group, as compared to healthy controls.

Conclusion

Sensory processing abilities in ADHD children differ from that of typically developing children when objectively assessed, although most of the ADHD children had scores in the clinically normal range. The sensory processing profile also has an impact on the severity and comorbidity profile of ADHD patients.

Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome

OBJECTIVE

The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients.

METHOD

An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology.

RESULTS

Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected "cognitive disengagement syndrome" (CDS) to replace "SCT" as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science.

CONCLUSION

It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.

Exploring Barriers and Facilitators to Physical Activity in Adults with ADHD: A Qualitative Investigation

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by executive dysfunction. Physical activity (PA) may improve executive dysfunction; however, specific barriers and facilitators to PA participation for adults with ADHD have not been formally documented, which was the aim of the present study. Thirty adults with ADHD completed virtual semi-structured interviews, which were analyzed thematically and guided by the Theoretical Domains Framework. Expressions of both barriers and facilitators to PA were identified. Themes such as executive dysfunction (described as forgetfulness, difficulty with sustained focus, and time management), poor self-esteem, and lack of motivation were seen as barriers to PA. Key facilitators were tied to the benefits of being physically active including improvements in executive functioning, mood, and mental health during and after activity, as well as the enjoyment of being active with others. To better support adults with ADHD in initiating physical activity, it is crucial to develop unique resources that are tailored to their specific needs. These resources should be designed to minimize barriers and maximize facilitators, while also supporting the awareness and acceptance of neurodiverse experiences.

Latent structure of working memory and emotion regulation in pediatric ADHD

Working memory is a key cognitive function that is often implicated in ADHD and may represent an underlying cognitive endophenotype of the disorder. Working memory is related to emotion regulation, which is a common area of impairment in children with ADHD. Given the high rate of comorbid diagnoses with ADHD, children with comorbid internalizing, externalizing, and developmental disorders may present with variable working memory profiles and subsequent emotion regulation deficits. This study aimed to adequately characterize the latent structure of working memory impairments and emotional regulation outcomes in a clinical sample of children ages 6-16 with ADHD. This study also examined the interplay between the identified working memory/emotion regulation patterns, demographic characteristics, and the role of comorbid diagnoses. Results highlighted two distinct, invariant, unrestricted classes of working memory/emotion regulation. Class 1 (Average; 62% of the sample) had significantly lower digit-span scores, and generally persevered emotion regulation functioning per parent/teacher report. Class 2 (Emotionally Dysregulated) had average working memory scores, and elevated emotion regulation problems. The working memory indicators had small correlations with parents (and not teacher) measures of emotion regulation. Finally, latent class membership did not differ by comorbid diagnosis, age, gender, or verbal IQ. Findings elucidate heterogeneity in common domains affected by ADHD and suggest that this heterogeneity may not be due to demographic/comorbidity factors. The role of varying information reports is discussed, and potential assessment and treatment implications are highlighted.

Treatment Patterns Among Patients with Attention-Deficit/Hyperactivity Disorder and Comorbid Anxiety and/or Depression in the United States: A Retrospective Claims Analysis

INTRODUCTION

Patients with attention-deficit/hyperactivity disorder (ADHD) often have psychiatric comorbidities that may confound diagnosis and affect treatment outcomes and costs. The current study described treatment patterns and healthcare costs among patients with ADHD and comorbid anxiety and/or depression in the United States (USA).

METHODS

Patients with ADHD initiating pharmacological treatments were identified from IBM MarketScan Data (2014-2018). The index date was the first observed ADHD treatment. Comorbidity profiles (anxiety and/or depression) were assessed during the 6-month baseline period. Treatment changes (discontinuation, switch, add-on, drop) were examined during the 12-month study period. Adjusted odds ratios (ORs) of experiencing a treatment change were estimated. Adjusted annual healthcare costs were compared between patients with and without treatment changes.

RESULTS

Among 172,010 patients with ADHD (children [aged 6-12] N = 49,756; adolescents [aged 13-17] N = 29,093; adults [aged 18 +] N = 93,161), the proportion of patients with anxiety and depression increased from childhood to adulthood (anxiety 11.0%, 17.7%, 23.0%; depression 3.4%, 15.7%, 19.0%; anxiety and/or depression 12.9%, 25.4%, 32.2%). Compared with patients without the comorbidity profile, those with the comorbidity profile experienced a significantly higher odds of a treatment change (ORs [children, adolescents, adults] 1.37, 1.19, 1.19 for those with anxiety; 1.37, 1.30, 1.29 for those with depression; and 1.39, 1.25, 1.21 for those with anxiety and/or depression). Excess costs associated with a treatment change were generally higher with more treatment changes. Among patients with three or more treatment changes, annual excess costs per child, adolescent, and adult were $2234, $6557, and $3891 for those with anxiety; $4595, $3966, and $4997 for those with depression; and $2733, $5082, and $3483 for those with anxiety and/or depression.

CONCLUSIONS

Over 12 months, patients with ADHD and comorbid anxiety and/or depression were significantly more likely to experience a treatment change than those without these psychiatric comorbidities and incurred higher excess costs with additional treatment changes.

Current and Future Directions of Drug Delivery for the Treatment of Mental Illnesses

Mental illnesses including anxiety disorders, autism spectrum disorder, post-traumatic stress disorder, schizophrenia, depression, and others exact an immense toll on the healthcare system and society at large. Depression alone impacts 21 million adults and costs over $200 billion annually in the United States. However, pharmaceutical strategies to treat mental illnesses are lagging behind drug development in many other disease areas. Because many of the shortcomings of therapeutics for mental illness relate to delivery problems, drug delivery technologies have the potential to radically improve the effectiveness of therapeutics for these diseases. This review describes the current pharmacotherapeutic approaches to treating mental illnesses as well as drug delivery approaches that have improved existing therapies. Approaches to improve drug bioavailability, provide controlled release of therapeutics, and enable drug targeting to the central nervous system (CNS) will be highlighted. Moreover, next-generation delivery approaches such as environmentally-controlled release and interval/sequential drug release will be addressed. Based on the evolving landscape of the treatment of mental illnesses, the nascent field of drug delivery in mental health has tremendous potential for growth in terms of both economic and patient impact.

Co-designed Mindful Parenting for Parents of Children with ADHD: A Pilot and Feasibility Study

This mixed-methods single arm pilot study examined the feasibility, acceptability, and preliminary outcomes of a co-designed mindful parenting intervention for parents of children with ADHD, Parents that Mind (PTM). The 5-week parent-only intervention comprised two face-to-face group retreats and 5 weeks home practice. Eighteen parents of children with ADHD participated in PTM, completing self-report questionnaires and semi-structured interviews. Indicating high acceptability, 100% of parents interviewed reported PTM was helpful and they would recommend PTM. High feasibility of parents attending one face-to-face retreat was observed, with all parents attending the first retreat, however intervention adherence was challenging, with 55% of parents attending the second retreat. Barriers to intervention adherence included: lack of time, work commitments, illness and exhaustion. Quantitative data indicate promising preliminary effects for parents and children. Addressing the barriers raised by parents in this pilot appear necessary, before examining efficacy in a blinded RCT.

Emotional problems in preschool and school-aged children with neurodevelopmental disorders in Spain: EPINED epidemiological project

BACKGROUND

Children with neurodevelopmental disorders (NDD) are often at risk of developing emotional problems.

AIMS AND METHODS

The co-occurrence of anxiety and depression with ASD and/or ADHD was determined by exploring the association with children's clinical and neuropsychological functioning and their parent's mental health. To this end, we assessed 295 preschoolers (PRE; 4-5 years old) and 486 school-aged children (SCH; 10-11 years old) in Tarragona, Spain. NDD diagnoses were based on DSM-5. Emotional problems were assessed using Achenbach's scales.

RESULTS

Emotional problems (PRE: 36%-78%; SCH: 32%-81%) were more common and more severe in participants with NDD than in controls and children in the ASD + ADHD school-aged group were the most affected. In ADHD, emotional problems were associated with more severe symptoms of attention deficit (PRE) and hyperactivity/impulsivity (SCH). In ASD + ADHD, emotional problems showed a trend of association with more severe ASD repetitive behaviours and impaired working memory, whereas in ASD were associated with greater overall ASD severity.

CONCLUSIONS AND IMPLICATIONS

Children with NDD are vulnerable to emotional problems, which become more prevalent and interfering with age. Early detection and intervention aimed at tackling emotional problems can improve NDD prognosis.

Pharmacotherapy May Attenuate the Risk of Child Abuse in Attention-Deficit/Hyperactivity Disorder from the Real-World Evidence

Objective: Psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), may serve as a risk factor for child abuse. Methods: This study aimed to evaluate the association between children and adolescents with ADHD diagnosis and the risk of child abuse. The effectiveness of a pharmacological intervention on reducing the risk of child abuse was also assessed. A nationwide, population-based, retrospective with a matched-cohort study design was used. Data were from the National Health Insurance Research Database of Taiwan over a 15-year period (2000-2015). Results: Increased risk of child abuse in the ADHD group was noticed and the adjusted hazard ratio (HR) was 1.797 (95% confidence interval [CI] = 1.245-2.388, p < 0.001). The Kaplan-Meier analysis showed a significantly higher cumulative incidence in the ADHD group over the 15-year period (Log-rank test p < 0.001). ADHD patients with other psychiatric comorbidities had a higher risk of child abuse. Pharmacological treatment of either methylphenidate or atomoxetine was associated with a reduced risk of child abuse. The total adjusted HR was 1.466 (95% CI = 1.077-1.883, p < 0.001) in medicine group compared with the controls. Conclusions: ADHD was associated with a subsequent risk of child abuse in Taiwan. Pharmacological treatment could reduce the risk of child abuse in ADHD patients.

Post-treatment symptomatic improvement of the eastern Indian ADHD probands is influenced by CYP2D6 genetic variations

OBJECTIVES

Symptomatic remediation from attention deficit hyperactivity disorder (ADHD)-associated traits is achieved by treatment with methylphenidate (MPH)/atomoxetine (ATX). We have analyzed the association of functional CYP2D6 variations, rs1065852, rs3892097, rs1135840, and rs1058164, with ADHD in the Indian subjects.

METHODS

Subjects were recruited following the Diagnostic and Statistical Manual for Mental Disorders. Trait scores were obtained from the Conner's Parents Rating Scale-Revised. After obtaining informed consent, blood was collected for DNA isolation, and genotyping was performed by PCR or TaqMan-based methods. Probands were treated with MPH or ATX based on age, symptoms, and drug availability. Treatment outcome was assessed using a structured questionnaire. Data obtained was analyzed to identify the association of CYP2D6 variations and the SLC6A3 rs28363170 with the treatment outcome.

RESULTS

The frequency of rs1135840 "G" and rs1065852 "G" was higher in the male ADHD probands. Bias in parental transmission (p=0.007) and association with higher trait scores were observed for rs1065852 "A". Independent influence of rs1065852 on ADHD was also observed. Probands carrying rs1065852 'GG', rs1135840 'CG', and rs28363170 10R exhibited significant symptomatic improvement with MPH, while probands with rs1135840 'CC' and rs28363170 9R showed improvement after ATX treatment.

CONCLUSIONS

ADHD probands having specific CYP2D6 genetic variations respond differentially to pharmaceutical intervention.

Attention-Deficit/Hyperactivity Disorder Across the Spectrum: From Childhood to Adulthood

Attention-deficit hyperactivity disorder is a neurodevelopmental disorder involving dysregulation of multiple neural circuits, manifesting in symptoms such as inattention, impulsivity, and hyperactivity. Diagnosis requires onset of symptoms before age 12 years. However, symptoms often persist throughout lifetime, although they may change over time. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition formally lists the clinical criteria. Management involves pharmacologic agents, such as stimulant and/or nonstimulant medications, and providers should monitor closely for any adverse effects. Nonpharmacologic interventions may be implemented and can be used in conjunction with pharmacotherapy, although medications should be at the forefront of treatment.

Epigenome-wide DNA methylation in externalizing behaviours: A review and combined analysis

DNA methylation (DNAm) is one of the most frequently studied epigenetic mechanisms facilitating the interplay of genomic and environmental factors, which can contribute to externalizing behaviours and related psychiatric disorders. Previous epigenome-wide association studies (EWAS) for externalizing behaviours have been limited in sample size, and, therefore, candidate genes and biomarkers with robust evidence are still lacking. We 1) performed a systematic literature review of EWAS of attention-deficit/hyperactivity disorder (ADHD)- and aggression-related behaviours conducted in peripheral tissue and cord blood and 2) combined the most strongly associated DNAm sites observed in individual studies (p < 10^-3) to identify candidate genes and biological systems for ADHD and aggressive behaviours. We observed enrichment for neuronal processes and neuronal cell marker genes for ADHD. Astrocyte and granulocytes cell markers among genes annotated to DNAm sites were relevant for both ADHD and aggression-related behaviours. Only 1 % of the most significant epigenetic findings for ADHD/ADHD symptoms were likely to be directly explained by genetic factors involved in ADHD. Finally, we discuss how the field would greatly benefit from larger sample sizes and harmonization of assessment instruments.

A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis

OBJECTIVE

To map the effect of motor-based interventions on motor skills in children with ADHD.

METHOD

A systematic literature search was performed in Pubmed, Web of Science, and the SCOPUS database (last search: October 30th 2022). Methodological quality was assessed using the PEDro-scale and the quality of evidence was determined with the GRADE-method. Meta-analysis was performed when at least five studies were available.

RESULTS

Thirteen studies (7 RCTs) satisfied the inclusion criteria, five of which were eligible for meta-analysis. Only one of the included studies reached the low risk of bias threshold. Comparing different motor-based interventions to any non-motor control intervention showed large motor skill improvements (SMD = 1.46; 95% CI = [1.00;1.93]; I² = 47.07%). The most effective type of motor-based intervention and the optimal treatment parameters could not be determined yet.

CONCLUSION

Motor-based interventions in general seem to improve motor skills in children with ADHD. Additional RCTs are needed to increase current low GRADE confidence.

Noradrenergic Modulation of Learned and Innate Behaviors in Dopamine Transporter Knockout Rats by Guanfacine

Investigation of the precise mechanisms of attention deficit and hyperactivity disorder (ADHD) and other dopamine-associated conditions is crucial for the development of new treatment approaches. In this study, we assessed the effects of repeated and acute administration of α2A-adrenoceptor agonist guanfacine on innate and learned forms of behavior of dopamine transporter knockout (DAT-KO) rats to evaluate the possible noradrenergic modulation of behavioral deficits. DAT-KO and wild type rats were trained in the Hebb-Williams maze to perform spatial working memory tasks. Innate behavior was evaluated via pre pulse inhibition (PPI). Brain activity of the prefrontal cortex and the striatum was assessed. Repeated administration of GF improved the spatial working memory task fulfillment and PPI in DAT-KO rats, and led to specific changes in the power spectra and coherence of brain activity. Our data indicate that both repeated and acute treatment with a non-stimulant noradrenergic drug lead to improvements in the behavior of DAT-KO rats. This study further supports the role of the intricate balance of norepinephrine and dopamine in the regulation of attention. The observed compensatory effect of guanfacine on the behavior of hyperdopaminergic rats may be used in the development of combined treatments to support the dopamine-norepinephrine balance.

ADHD and eating disorders in childhood and adolescence: An updated minireview

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with overactivity, inattention, and impulsivity as core characteristics. Recent studies suggest that 20 % of children with ADHD also develop eating disorders (EDs), including anorexia nervosa, bulimia nervosa and binge eating disorder. However, little is still known about the association between ADHD and EDs through childhood and adolescence. Therefore, in the present work, we aimed at summarizing the studies investigating ADHD and EDs in childhood and adolescence over the last 10 years.

METHODS

A bibliographic search on PubMed was performed and only studies that considered participants with a clinical diagnosis of ADHD, patients with an additional diagnosis of EDs and patients under 18 years old were included. A total of 7 studies were retrieved and included in the review.

RESULTS

The majority of the reviewed studies (N = 5) found an association between ADHD and EDs, while the remaining, which focused on EDs symptomatology, reported either lower ED symptoms in ADHD sample or no association between ADHD and EDs.

LIMITATIONS

the majority of studies were cross-sectional and therefore did not allow to explore the longitudinal casual relation between ADHD and EDs in the developmental age range considered.

CONCLUSIONS

This review suggests that children and adolescents with ADHD should be monitored for EDs. However, more work is still needed to better understand the clinical implications of the comorbidity between ADHD and EDs and its prospective impact on the life of children and adolescents with ADHD.

An overview on neurobiology and therapeutics of attention-deficit/hyperactivity disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent psychiatric condition characterized by developmentally inappropriate symptoms of inattention and/or hyperactivity/impulsivity, which leads to impairments in the social, academic, and professional contexts. ADHD diagnosis relies solely on clinical assessment based on symptom evaluation and is sometimes challenging due to the substantial heterogeneity of the disorder in terms of clinical and pathophysiological aspects. Despite the difficulties imposed by the high complexity of ADHD etiology, the growing body of research and technological advances provide good perspectives for understanding the neurobiology of the disorder. Such knowledge is essential to refining diagnosis and identifying new therapeutic options to optimize treatment outcomes and associated impairments, leading to improvements in all domains of patient care. This review is intended to be an updated outline that addresses the etiological and neurobiological aspects of ADHD and its treatment, considering the impact of the "omics" era on disentangling the multifactorial architecture of ADHD.

Multivariate analyses of molecular genetic associations between childhood psychopathology and adult mood disorders and related traits

Ubiquitous associations have been detected between different types of childhood psychopathology and polygenic risk scores based on adult psychiatric disorders and related adult outcomes, indicating that genetic factors partly explain the association between childhood psychopathology and adult outcomes. However, these analyses in general do not take into account the correlations between the adult trait and disorder polygenic risk scores. This study aimed to further clarify the influence of genetic factors on associations between childhood psychopathology and adult outcomes by accounting for these correlations. Using a multivariate multivariable regression, we analyzed associations of childhood attention-deficit/hyperactivity disorder (ADHD), internalizing, and social problems, with polygenic scores (PGS) of adult disorders and traits including major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI), derived for 20,539 children aged 8.5-10.5 years. After correcting for correlations between the adult phenotypes, major depression PGS were associated with all three childhood traits, that is, ADHD, internalizing, and social problems. In addition, BMI PGS were associated with ADHD symptoms and social problems, while neuroticism PGS were only associated with internalizing problems and educational attainment PGS were only associated with ADHD symptoms. PGS of bipolar disorder, subjective well-being, and insomnia were not associated with any childhood traits. Our findings suggest that associations between childhood psychopathology and adult traits like insomnia and subjective well-being may be primarily driven by genetic factors that influence adult major depression. Additionally, specific childhood phenotypes are genetically associated with educational attainment, BMI and neuroticism.

[The problem of comorbid disorders in attention deficit hyperactivity disorder in children and adolescents: clinical cases]

The problem of comorbid disorders in attention deficit hyperactivity disorder (ADHD) is considered, which occur in at least 60% of patients and lead to additional difficulties in intra-family, school and social adaptation. Children and adolescents with ADHD have a wide range of neurological and somatic disorders caused by complex polygenic pathogenetic mechanisms. Among the pathologies associated with ADHD in this cohort of children, neurotic and anxiety manifestations, motor disorders: dyspraxia, discoordination, impaired gross and fine motor skills, tics, behavioral disorders, enuresis, tension cephalgia are common disorders. Treatment of ADHD should be pathogenetic, taking into account the main symptoms of ADHD and manifestations of comorbid disorders, since it is quite long. When choosing pharmacotherapy, it is preferable to use drugs with verified efficacy not only in the correction of ADHD, but also concomitant behavioral, motor and emotional disorders. Also an important aspect in the pediatric clinic is the use of drugs with a reliable safety profile.

A three-pronged analysis confirms the association of the serotoninergic system with attention deficit hyperactivity disorder

BACKGROUND

The serotonin transporter (SERT), encoded by the solute carrier family 6 number 4 (SLC6A4) gene, controls serotonin (5-HT) availability and is essential for the regulation of behavioral traits. Two SLC6A4 genetic variants, 5-HTTLPR and STin2, were widely investigated in patients with various neurobehavioral disorders, including attention deficit hyperactivity disorder (ADHD).

METHODS

We analyzed the association of the 5-HTTLPR (L/S) and STin2 (10/12) variants, plasma 5-HT, and 5-hydroxyindole acetic acid (5-HIAA), as well as SERT messenger RNA (mRNA) with ADHD in the eastern Indian subjects. Nuclear families with ADHD probands (n = 274) and ethnically matched controls (n = 367) were recruited following the Diagnostic and Statistical Manual of Mental Disorders. Behavioral traits, executive function, and intelligence quotient (IQ) of the probands were assessed using the Conner's Parent Rating Scale - Revised, Parental Account of Children's Symptoms (PACS), Barkley Deficit in Executive Functioning-Child and Adolescent Scale, and Wechsler Intelligence Scale for Children-III, respectively. After obtaining informed written consent, peripheral blood was collected to analyze genetic variants, plasma 5-HT, 5-HIAA, and SERT mRNA expression.

RESULTS

ADHD probands showed a higher frequency of the 5-HTTLPR "L" allele and "L/L" genotype (P < 0.05), lower 5-HIAA level, and higher SERT mRNA expression. Scores for behavioral problems and hyperactivity were higher in the presence of the "S" allele and "S/S" genotype, while executive deficit was higher in the presence of the "L" allele. IQ score was lower in the presence of the STin2 "12" allele and L-12 haplotype.

CONCLUSION

Data obtained indicate a significant association of the serotoninergic system with ADHD, warranting further in-depth investigation.

Better characterization of attention and hyperactivity/impulsivity in children with ADHD: The key to understanding the underlying white matter microstructure

The apparent increase in the prevalence of the attention deficit hyperactivity disorder (ADHD) diagnosis raises many questions regarding the variability of the subjective diagnostic method. This comprehensive review reports findings in studies assessing white matter (WM) bundles in diffusion MRI and symptom severity in children with ADHD. These studies suggested the involvement of the connections between the frontal, parietal, and basal ganglia regions. This review discusses the limitations surrounding diffusion tensor imaging (DTI) and suggests novel imaging techniques allowing for a more reliable representation of the underlying biology. We propose a more inclusive approach to studying ADHD that includes known endophenotypes within the ADHD diagnosis. Aligned with the Research Domain Criteria Initiative, we also propose to investigate attentional capabilities and impulsive behaviours outside of the borders of the diagnosis. We support the existing hypothesis that ADHD originates from a developmental error and propose that it could lead to an accumulation in time of abnormalities in WM microstructure and pathways. Finally, state-of-the-art diffusion processing and novel artificial intelligence approaches would be beneficial to fully understand the pathophysiology of ADHD.

Prevalence of Lower Urinary Tract Symptoms in Children with Attention-Deficit/Hyperactivity Disorder: Comparison of Hospital and Population-Based Cohorts of 13,000 Patients

Background: This study investigates the prevalence of lower urinary tract symptoms (LUTS) in school-age children with Attention-Deficit/Hyperactivity Disorder (ADHD) based on hospital-based and population-based cohorts. Methods: The hospital-based sample comprised 42 children with ADHD and 65 without ADHD aged 6−12 years. Voiding dysfunction was assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. We compared the baseline data, DVSS score, and uroflowmetry between the two groups. For the population-based cohort in the national insurance database, we included 6526 children aged 6−12 years, whose claims record included the diagnosis of ADHD, and another 6526 control subjects matched by gender and age. We compared the presence of LUTS diagnosis codes between the two groups. Results: Our results showed that, for the hospital-based cohort, the mean total DVSS score and the proportion of significant LUTS in children in the ADHD group were significantly higher than in subjects in the non-ADHD group. The DVSS subscales showed that the item “I cannot wait when I have to pee” item was significantly higher in the ADHD group (1.62 ± 1.17 vs. 0.90 ± 1.09, p = 0.002). For the population-based cohort, children with ADHD had a significantly higher likelihood of storage symptoms (5.53% vs. 2.91%, p < 0.001) and enuresis (3.28% vs. 1.95%, p < 0.001) compared with those of the no ADHD group. Conclusions: Children with ADHD have a higher prevalence of significant LUTS, especially storage symptoms and enuresis, than children without ADHD. The observed correlations between ADHD and LUTS provided the supporting evidence to evaluate the concomitant voiding dysfunction in children with ADHD.

Psychopathology of attention deficit/hyperactivity disorder: from an inflammatory perspective

Background

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattentiveness, hyperactivity and impulsivity, which may affect one’s cognitive and psychosocial functioning. This review gives an overview of ADHD, particularly from an aetiological and clinical perspective. It also critically examines current evidence on the role of inflammation in ADHD and consolidates key findings in this area of research.

Results

The exact cause of ADHD remains unknown, and the aetiology of the disorder is believed to be multifactorial. Numerous genetic and environmental factors have been linked to the development of ADHD. Like many psychiatric disorders, ADHD has been associated with inflammation that occurs locally and peripherally. A growing body of evidence shows that maternal inflammatory status during pregnancy is associated with diagnosis of ADHD in the offspring, whereas oxidative stress, inflammatory biochemical markers and immune-mediated diseases have been observed in individuals with ADHD.

Conclusions

The underlying inflammatory processes and mechanisms in ADHD are not clearly understood. Therefore, further exploration is warranted in future research. This has clinical implications as inflammation may be a potential target in the treatment of ADHD.

Seeking Overlapping Neuroanatomical Alterations between Dyslexia and Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Replication Study

The present work is a replication article based on the paper “Are there shared neural correlates between dyslexia and ADHD? A meta-analysis of voxel-based morphometry studies” by McGrath and Stoodley (2019). In the original research, the authors used activation likelihood estimation (ALE), a technique to perform coordinate-based meta-analysis (CBMA), to investigate the existence of brain regions undergoing gray matter alteration in association with both attention-deficit/hyper-activity disorder (ADHD) and dyslexia. Here, the same voxel-based morphometry dataset was analyzed, while using the permutation-subject images version of signed differential mapping (PSI-SDM) in place of ALE. Overall, the replication converged with the original paper in showing a limited overlap between the two conditions. In particular, no significant effect was found for dyslexia, therefore precluding any form of comparison between the two disorders. The possible influences of biological sex, age, and medication status were also ruled out. Our findings are in line with literature about gray matter alteration associated with ADHD and dyslexia, often showing conflicting results. Therefore, although neuropsychological and clinical evidence suggest some convergence between ADHD and dyslexia, more future research is sorely needed to reach a consensus on the neuroimaging domain in terms of patterns of gray matter alteration.

Effects of Twenty Hours of Neurofeedback-Based Neuropsychotherapy on the Executive Functions and Achievements among ADHD Children

Objective. Neurofeedback can reduce ADHD symptoms; however, current programs are relatively long, with fewer concerns about executive function (EF). The present study aimed to investigate a 20-hour combined computerized training neurofeedback program. Methods. Fifty ADHD children were randomly assigned to either the experimental group (EXP) or the wait-list control group (CON), who took training after the post-tests. The EF measures were the Tower of London (ToL), Wisconsin Card Sorting Test (WCST), and Comprehensive Nonverbal Attention Test (CNAT). SNAP-IV and questionnaires reported by parents constituted the behavioral measures. Two-way repeated-measures ANOVA and bootstrapping dependent t-tests were also used. Results. The F-tests revealed the interaction effects on ADHD symptoms and math scores. The EXP had increased the ToL scores, decreased the error and perseverative error rates on WCST, as well as the dysexecutive index on CNAT in the t-test. Conclusions. The training effects were related to behavioral symptoms and functions, EFs, and generalized achievement performances. We suggest that future studies could apply to different patients and examine the maintenance of the program.