ADHD in the DSM-5-TR: What has changed and what has not

Expression Patterns of miRNAs in Egyptian Children with ADHD: Clinical Study with Correlation Analysis

ADHD has huge knowledge gaps concerning its etiology. MicroRNAs (miRNAs) provide promising diagnostic biomarkers of human pathophysiology and may be a novel therapeutic option. The aim was to investigate the levels of miR-34c-3p, miR-155, miR-138-1, miR-296-5p, and plasma brain-derived neurotrophic factor (BDNF) in a group of children with ADHD compared to neurotypicals and to explore correlations between these measures and some clinical data. The participants were children with ADHD in Group I (N = 41; age: 8.2 ± 2) and neurotypical ones in Group II (N = 40; age: 8.6 ± 2.5). Group I was subjected to clinical examination, the Stanford Binet intelligence scale-5, the preschool language scale, and Conner's parent rating scale-R. Measuring the expression levels of the miRNAs was performed by qRT-PCR for all participants. The BDNF level was measured by ELISA. The lowest scores on the IQ subtest were knowledge and working memory. No discrepancies were noticed between the receptive and expressive language ages. The highest scores on the Conner's scale were those for cognitive problems. Participants with ADHD exhibited higher plasma BDNF levels compared to controls (p = 0.0003). Expression patterns of only miR-34c-3p and miR-138-1 were downregulated with significant statistical differences (p˂0.01). However, expression levels of miR-296-5p showed negative correlation with the total scores of IQ (p = 0.03). MiR-34c-3p, miR-138-1, while BDNF showed good diagnostic potential. The downregulated levels of miR-34c-3p and miR-138-1, together with high BDNF levels, are suggested to be involved in the etiology of ADHD in Egyptian children. Gender differences influenced the expression patterns of miRNAs only in children with ADHD.

Comparison of self-esteem and quality of life in 8-12-year-old children with ADHD with and without learning disorders

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in school-aged children. Learning disorder (LD) is also one of the most important psychiatric disorders in children, which can often be associated with ADHD. In this study, we sought to compare self-esteem and quality of life in 8 to 12-year-old children with attention deficit/hyperactivity disorder with and without co-occurring learning disorders in order to emphasize the importance of attention and diagnosis in children with ADHD.

METHOD

Among the 8- to 12-year-old outpatients referred to the child and adolescent psychiatry clinic of Omid Babol Clinic, 120 children aged 8 to 12 years with attention deficit/hyperactivity disorder whose disease was diagnosed by a child and adolescent psychiatry subspecialist. Among the tools used to collect information was the Colorado Learning Difficulties Questionnaire by Wilcott et al. (CLDQ), five-scale self-esteem test of Pepe et al. (1989) for children and quality-of-life questionnaire for 8-12-year-old children (PedsQL).

RESULTS

This study investigated self-esteem and quality of life in children with ADHD (n = 120, 51.7% boys). Children with ADHD and learning disabilities reported significantly lower self-esteem and quality of life compared to those with ADHD alone.

CONCLUSION

Considering the relatively high probability of co-occurrence of ADHD and learning disorders, if one of them is diagnosed in a child, it is possible to look for other disorders in the child in order to avoid the more severe negative effects that this co-occurrence can have on the child by diagnosing it as soon as possible.

Adult ADHD: it is old and new at the same time - what is it?

Even though the number of studies aiming to improve comprehension of ADHD pathology has increased in recent years, there still is an urgent need for more effective studies, particularly in understanding adult ADHD, both at preclinical and clinical levels, due to the increasing evidence that adult ADHD is highly distinct and a different entity from childhood ADHD. This review paper outlines the symptoms, diagnostics, and neurobiological mechanisms of ADHD, with emphasis on how adult ADHD could be different from childhood-onset. Data show a difference in the environmental, genetic, epigenetic, and brain structural changes, when combined, could greatly impact the behavioral presentations and the severity of ADHD in adults. Furthermore, a crucial aspect in the quest to fully understand this disorder could be through longitudinal analysis. In this way, we will determine if and how the pathology and pharmacology of ADHD change with age. This goal could revolutionize our understanding of the disorder and address the weaknesses in the current clinical classification systems, improving the characterization and validity of ADHD diagnosis, specifically those in adults.

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.

Dopamine in the Regulation of Glucose Homeostasis, Pathogenesis of Type 2 Diabetes, and Chronic Conditions of Impaired Dopamine Activity/Metabolism: Implication for Pathophysiological and Therapeutic Purposes

Dopamine regulates several functions, such as voluntary movements, spatial memory, motivation, sleep, arousal, feeding, immune function, maternal behaviors, and lactation. Less clear is the role of dopamine in the pathophysiology of type 2 diabetes mellitus (T2D) and chronic complications and conditions frequently associated with it. This review summarizes recent evidence on the role of dopamine in regulating insular metabolism and activity, the pathophysiology of traditional chronic complications associated with T2D, the pathophysiological interconnection between T2D and chronic neurological and psychiatric disorders characterized by impaired dopamine activity/metabolism, and therapeutic implications. Reinforcing dopamine signaling is therapeutic in T2D, especially in patients with dopamine-related disorders, such as Parkinson's and Huntington's diseases, addictions, and attention-deficit/hyperactivity disorder. On the other hand, although specific trials are probably needed, certain medications approved for T2D (e.g., metformin, pioglitazone, incretin-based therapy, and gliflozins) may have a therapeutic role in such dopamine-related disorders due to anti-inflammatory and anti-oxidative effects, improvement in insulin signaling, neuroinflammation, mitochondrial dysfunction, autophagy, and apoptosis, restoration of striatal dopamine synthesis, and modulation of dopamine signaling associated with reward and hedonic eating. Last, targeting dopamine metabolism could have the potential for diagnostic and therapeutic purposes in chronic diabetes-related complications, such as diabetic retinopathy.

Subcortical structural covariance predicts symptoms in children with different subtypes of ADHD

Attention-deficit/hyperactivity disorder has increasingly been conceptualized as a disorder of abnormal brain connectivity. However, far less is known about the structural covariance in different subtypes of this disorder and how those differences may contribute to the symptomology of these subtypes. In this study, we used a combined volumetric-based methodology and structural covariance approach to investigate structural covariance of subcortical brain volume in attention-deficit/hyperactivity disorder-combined and attention-deficit/hyperactivity disorder-inattentive patients. In addition, a linear support vector machine was used to predict patient's attention-deficit/hyperactivity disorder symptoms. Results showed that compared with TD children, those with attention-deficit/hyperactivity disorder-combined exhibited decreased volume of both the left and right pallidum. Moreover, we found increased right hippocampal volume in attention-deficit/hyperactivity disorder-inattentive children. Furthermore and when compared with the TD group, both attention-deficit/hyperactivity disorder-combined and attention-deficit/hyperactivity disorder-inattentive groups showed greater nonhomologous inter-regional correlations. The abnormal structural covariance network in the attention-deficit/hyperactivity disorder-combined group was located in the left amygdala-left putamen/left pallidum/right pallidum and right pallidum-left pallidum; in the attention-deficit/hyperactivity disorder-inattentive group, this difference was noted in the left hippocampus-left amygdala/left putamen/right putamen and right hippocampus-left amygdala. Additionally, different combinations of abnormalities in subcortical structural covariance were predictive of symptom severity in different attention-deficit/hyperactivity disorder subtypes. Collectively, our findings demonstrated that structural covariance provided valuable diagnostic markers for attention-deficit/hyperactivity disorder subtypes.