Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of...Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of children with attention deficit hyperactivity disorder are affected,and these symptoms may persist to adulthood if they are not treated.The diagnosis of attention deficit hyperactivity disorder is only based on symptoms and objective tests for attention deficit hyperactivity disorder are missing.Treatments for attention deficit hyperactivity disorder in children include medications,behavior therapy,counseling,and education services which can relieve many of the symptoms of attention deficit hyperactivity disorder but cannot cure it.There is a need for a molecular biomarker to distinguish attention deficit hyperactivity disorder from healthy subjects and other neurological conditions,which would allow for an earlier and more accurate diagnosis and appropriate treatment to be initiated.Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of attention deficit hyperactivity disorder.The recent studies reviewed had performed microRNA profiling in whole blood,white blood cells,blood plasma,and blood serum of children with attention deficit hyperactivity disorder.A large number of microRNAs were dysregulated when compared to healthy controls and with some overlap between individual studies.From the studies that had included a validation set of patients and controls,potential candidate biomarkers for attention deficit hyperactivity disorder in children could be miR-140-3p,let-7g-5p,-30e-5p,-223-3p,-142-5p,-486-5p,-151a-3p,-151a-5p,and-126-5p in total white blood cells,and miR-4516,-6090,-4763-3p,-4281,-4466,-101-3p,-130a-3p,-138-5p,-195-5p,and-106b-5p in blood serum.Further studies are warranted with children and adults with attention deficit hyperactivity disorder,and consideration should be given to utilizing rat models of attention deficit hyperactivity disorder.Animal studies could be used to confirm microRNA findings in human patients and to test the effects of targeting specific microRNAs on disease progression and behavior.展开更多
BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder(ADHD)is associated with adverse events,such as nausea and vomiting,dizziness,and sleep disturbances,and poor maintenance of late ADHD medicati...BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder(ADHD)is associated with adverse events,such as nausea and vomiting,dizziness,and sleep disturbances,and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients’social functioning.AIM To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD.METHODS A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group(methylphenidate hydrochloride and tomoxetine hydrochloride)or the non-pharmacological group(parental training,behavior modification,sensory integration therapy,and sand tray therapy),with 45 cases in each group.Outcome measures included treatment compliance,Swanson,Nolan,and Pelham,Version IV(SNAP-IV)scores,Conners Parent Symptom Questionnaire(PSQ)scores,and Weiss Functional Impairment Rating Scale(WFIRS)scores.RESULTS The non-pharmacological interventions resulted in significantly higher compliance in patients(95.56%)compared with medication(71.11%)(P<0.05).However,no significant differences in SNAP-IV and PSQ scores,in addition to the learning/school,social activities,and adventure activities of the WFIRS scores were observed between the two groups(P>0.05).Patients with non-pharmacological interventions showed higher WFIRS scores for family,daily life skills,and self-concept than those in the pharmacological group(P<0.05).CONCLUSION Non-pharmacological interventions,in contrast to the potential risks of adverse events after longterm medication,improve patient treatment compliance,alleviate patients’behavioral symptoms of attention,impulsivity,and hyperactivity,and improve their cognitive ability,thereby improving family relationships and patient self-evaluation.展开更多
Introduction: Attention deficit hyperactivity disorder (ADHD) is a little-studied psychiatric pathology in our countries, and particularly here in Benin. Objectives: To calculate the prevalence and identify the factor...Introduction: Attention deficit hyperactivity disorder (ADHD) is a little-studied psychiatric pathology in our countries, and particularly here in Benin. Objectives: To calculate the prevalence and identify the factors associated with attention deficit hyperactivity disorder among adults in the commune of Parakou in 2022. Methods: Cross-sectional, descriptive, analytical study including subjects aged 18 and over. ADHD was assessed with the Adult ADHD Self Report Scale (ARSR-v1.1) and consequences with the Weiss functional impairment rating scale (WFIRS-S). Results: A total of 456 people were included in the study. The mean age of those surveyed was 25.9 ± 11.6 years. The prevalence of ADHD symptoms among the adults surveyed was 6.8%. The clinical form of ADHD with a predominance of inattention had a prevalence of 3.3%. After multivariate analysis, the factor associated with the presence of ADHD symptoms in adults in the commune of Parakou was: a poor relationship with the subject’s partner (p = 0.031, ORa = 6.5 [1.18-35.68]). Conclusion: ADHD is present in the community of Parakou and needs further attention.展开更多
Objective:To explore the effect and mechanism of action of Celastrus paniculatus oil on the treatment of perinatal rats with attention deficit hyperactivity disorder.Methods:In the perinatal stage,the rats were either...Objective:To explore the effect and mechanism of action of Celastrus paniculatus oil on the treatment of perinatal rats with attention deficit hyperactivity disorder.Methods:In the perinatal stage,the rats were either isolated or administered with lead acetate to establish an animal model of attention deficit hyperactivity disorder.Atomoxetine served as the reference standard.Animals’behaviours were assessed through Y-maze,novel object preference,fear conditioning and residentintruder aggression tests.Oxidative stress parameters,bioamine concentration(dopamine,noradrenaline and 5-hydroxytryptamine),nerve growth factor,interleukin-6,nuclear factor-κB,and tumour necrosis factor(TNF)-αwere estimated.Synaptophysin immunohistochemical assay was performed.Results:Celastrus paniculatus oil significantly improved behavioural parameters in Y maze,novel object preference,discrimination index,fear conditioning and resident intruder aggressive tests.The treatment groups showed a decrease in malondialdehyde level.Changes in the levels of dopamine,noradrenaline,and serotonin were restored by Celastrus paniculatus oil.Celastrus paniculatus oil increased nerve growth factor and decreased interleukin-6,nuclear factor-κB,and TNF-α.Synaptophysin immunoreactivity was also improved by Celastrus paniculatus oil with alleviated reactive gliosis,degeneration,and vascular proliferation.Conclusions:This research shows the therapeutic potential of Celastrus paniculatus oil for the treatment of attention deficit hyperactivity disorder.展开更多
Background: Attention deficit hyperactivity disorder is a common pediatric neurobehavioral disorder often treated in the primary care setting. It shows a high and chronic level of inattention, impulsivity/hyperactivit...Background: Attention deficit hyperactivity disorder is a common pediatric neurobehavioral disorder often treated in the primary care setting. It shows a high and chronic level of inattention, impulsivity/hyperactivity and/or both, and can affect more than 2 million school-age children. The researchers are not sure about the exact causes of the disorder, but it seems that apart from genetic factors, perinatal factors seem to dynamically contribute to the development of the disorder. Purpose: The aim of this review was to investigate the perinatal and obstetric factors related to the development of the attention deficit hyperactivity disorder in childhood. Method: An online review of English language studies published from 2002 to 2020, using the Embase, PsychINFO, PubMed and Google Scholar databases. From 1100 studies only 17 were included in the review since they met the inclusion criteria. Conclusions: The results of the review showed that apart from heredity and genetic factors, various conditions in pregnancy or the mother’s way of life in pregnancy, adverse conditions in labor and infancy can contribute on their own or in combination to the development of the attention deficit hyperactivity disorder in childhood. Obstetric vigilance to detect risk factors in pregnancy in combination with the prevention of obstetric complications is the key in preventing attention deficit hyperactivity disorder.展开更多
Extensive research has now been conducted and published for the treatment of dementia or Alzheimer’s disease, traumatic brain injury (TBI) and other brain disorders using photobiomodulation (PBM), also known as low-l...Extensive research has now been conducted and published for the treatment of dementia or Alzheimer’s disease, traumatic brain injury (TBI) and other brain disorders using photobiomodulation (PBM), also known as low-level laser therapy (LLLT). However, minimal information is available regarding the use of LLLT for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). We have been using LLLT in our practice for over 15 years addressing chronic pain and injury issues. However, our work with brain injuries is more recent, and we have published three case studies, one describing a serious traumatic brain injury and two describing our success with dementia/Alzheimer’s disease and PTSD. Currently, there is very little published evidence regarding efficacious therapy for ADHD. The case studies presented here, suggest that LLLT can provide alleviation of these symptoms, with some improvement reported after just a single treatment, without any need for pharmaceutical intervention.展开更多
BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy child...BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.展开更多
This paper reviews the underlying evidence for various aspects of the convergence mechanism of mindfulness intervention in attention deficit hyperactivity disorder(ADHD).There may be compatibility among various ADHD r...This paper reviews the underlying evidence for various aspects of the convergence mechanism of mindfulness intervention in attention deficit hyperactivity disorder(ADHD).There may be compatibility among various ADHD remission models and the therapeutic mechanism of mindfulness intervention in ADHD may be mainly via the convergence mechanism.However,neuroimaging-based analysis of the mechanisms of mindfulness intervention in treating ADHD is lacking.Differences in the efficacy of various subtypes of mindfulness intervention,and corresponding specific imaging changes need further investigation.Future research may focus on the neuroimaging features of specific mindfulness intervention subtypes.展开更多
Attention deficit hyperactivity disorder(ADHD)is a common and impairing behavioral health disorder,impacting over 5%of children worldwide.There are multiple evidence-based pharmacological and psychosocial treatments f...Attention deficit hyperactivity disorder(ADHD)is a common and impairing behavioral health disorder,impacting over 5%of children worldwide.There are multiple evidence-based pharmacological and psychosocial treatments for ADHD,and greater service utilization is associated with improved acute and long-term outcomes.However,long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely.This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers.Families face a variety of structural and attitudinal barriers,ranging from cost and access to stigma and low self-efficacy to successfully implement change.There are multiple interventions that may enhance engagement with ADHD care including psychoeducation,integration of behavioral services in general medical settings,telehealth as well as specific adaptations to existing ADHD treatments,such as the use of motivational interviewing or shared decision making.Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers.Adding motivational interviewing,shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes.However,little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.展开更多
Objectives:Compare and relate the performance of schoolchildren with Attention Deficit Hyperactivity Disorder(ADHD)and with good academic performance in the visual-motor perceptual and reading processes.Method:Twenty ...Objectives:Compare and relate the performance of schoolchildren with Attention Deficit Hyperactivity Disorder(ADHD)and with good academic performance in the visual-motor perceptual and reading processes.Method:Twenty schoolchildren,of both genders,aged between nine and 11 years old,participated in this study.They were divided into two groups:Group I(GI):comprising 10 students diagnosed with ADHD;and Group II(GII):10 students with good academic performance paired according to gender,age group,and educational level with GI.All students were submitted to the Developmental Test of Visual Perception(DTVP 3)and Reading Processes Assessment Protocol(PROLEC).Results:There was lower performance of GI compared to GII in the subtests of copying,eye-hand coordination,and figure-ground in the standard score of general visual perception and visual-motor integration.GI presented lower performance in all reading processes except for the punctuation marks test.There was a statistically significant difference in the comparison between GI and GII regarding the classification of reading processes.A relationship was identified between the reading and visual perception subtests in the GI students,demonstrating a relationship between the visual perceptual motor skills and the reading processes in the group of students with ADHD.Conclusion:Schoolchildren with ADHD performed less well than their peers with good academic performance in the visual-motor perceptual and reading skills;such that the worse their performance in the visual-motor perceptual processes,the worse their performance in the reading processes.展开更多
This paper aims to provide an effective overview of ADHD(Attention Deficit Hyperactivity Disorder),so that educators and other individuals who may be involved in the treatment of ADHD patients,especially young patient...This paper aims to provide an effective overview of ADHD(Attention Deficit Hyperactivity Disorder),so that educators and other individuals who may be involved in the treatment of ADHD patients,especially young patients,can effectively obtain basic information about what is ADHD,the causes of ADHD,and the popular treatment methods of ADHD.Various literature and studies were referred to in this paper to review and compare different causes and treatments.Researches held distinct opinions about the causes of ADHD,and the debate focuses on the nature and nurture factors of ADHD.Some studies believe ADHD is inborn and genetic while other studies emphasize the importance of nurture factors during their life,such as the environment that patients grow up in and the lifestyle they have.Depending on distinct arguments,there developed different treatments like using medication to prevent the situation from deteriorating further and changing the environments that patients living in through taking interventions with the family.These arguments and treatments will be discussed in detail in this paper.展开更多
Deficiency in executive functioning is a core symptom of attention deficit hyperactivity disorder (ADHD). The brain part responsible for executive functions is the prefrontal cortex (PFC). Although drug-based interven...Deficiency in executive functioning is a core symptom of attention deficit hyperactivity disorder (ADHD). The brain part responsible for executive functions is the prefrontal cortex (PFC). Although drug-based interventions can improve PFC activity, reports on PFC activity being improved by behavioral treatment are lacking. We evaluated whether a summer treatment program (STP) administering comprehensive behavioral treatment would increase PFC activity in children with ADHD. We examined behavioral and neural changes in 20 children before and after the STP, conducted over a 2-week period. We asked the parents/guardians to complete the Swanson, Nolan, and Pelham IV scale to assess severity of ADHD. The main task evaluating executive control was the reverse Stroop task. To examine changes in physiological indices, we used near-infrared spectroscopy to measure changes in PFC activity. Subjective assessments by parents/guardians indicated that ADHD symptoms improved significantly. There was also significant improvement in the number of correct responses and interference rates in the reverse Stroop task. Furthermore, post-intervention PFC activity was significantly higher. These results suggest that the STP improved inhibitory control in executive function, which is considered as a key symptom of ADHD. The increase in PFC activity further suggests that the STP improves cognition through neural function.展开更多
Approximately 25%–50%of children with attention deficit hyperactivity disorder have sleep problems.The aim of this study is to compare the effect of horse milk with conventionally-fed cow’s milk on sleep disorders i...Approximately 25%–50%of children with attention deficit hyperactivity disorder have sleep problems.The aim of this study is to compare the effect of horse milk with conventionally-fed cow’s milk on sleep disorders in children with attention deficit hyperactivity disorder.In this randomized double-blind crossover study,30 patients with attention deficit hyperactivity disorder were randomly selected and divided into two groups.All patients underwent a 45-day period of horse milk consumption and a 45-day period of cow milk consumption and they continued their drug treatment.A one-week interval between two periods of milk consumption was considered as the washout period.The severity of sleep disorder in the studied patients was determined based on the short form of the Children’s Sleep Habits Questionnaire(CSHQ).Twenty-two(73.3%)male and eight(26.7%)female patients were included in this study.The mean age of the patients was 8.9 years.Our results showed that horse milk consumption improved the CSHQ score.For the group of patients consuming horse milk prior to cow milk,reductions of total CSHQ(P-value=0.001)and subscale 1(P-value<0.001)scores were significant.For the group of patients consuming cow milk first,in addition to the total CSHQ(P-value<0.001),subscale 3(P-value=0.001)and 4(P-value=0.009)dropped significantly.On the other hand,the results indicated that cow milk consumption increased the CSHQ score.Specifically,for the group of patients consuming horse milk first,the total CSHQ(P-value=0.001),subscale 3(P-value=0.016),and subscale 4(P-value=0.010)increased significantly.The mean values of the first,second,third,and fourth subscales of CSHQ before and after the washout period were not significantly different between the two groups.According to the study,consuming horse milk was significantly better than cow milk in improving the total score of CSHQ in children with attention deficit hyperactivity disorder.展开更多
The aim of this study was to describe the perceptions of everyday suffering among adults with attention deficit hyperactivity disorder (ADHD) and comorbid mental disease. Directed content analysis guided by Eriksson’...The aim of this study was to describe the perceptions of everyday suffering among adults with attention deficit hyperactivity disorder (ADHD) and comorbid mental disease. Directed content analysis guided by Eriksson’s theory on human suffering was performed on data from 20 individual interviews. Expressions of both suffering and well-being were identified;the former centred on loneliness and related to life, illness, and care, which supported Eriksson’s theory, whereas expressions of well-being related to ADHD diagnosis and supportive social relationships. Nevertheless, results indicate the need to expand those expressions in order to better contribute to developing a supportive rehabilitation regimen that can provide more interpersonal care.展开更多
Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperacti...Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder(ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.展开更多
Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperact...Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.展开更多
Attention deficit hyperactivity disorder(ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders(TD) are c...Attention deficit hyperactivity disorder(ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders(TD) are common co-morbidities in paediatric ADHD patients with or without pharmacotherapy treatment. There has been conflicting evidence of the role of psychostimulants in either precipitating or exacerbating TDs in ADHD patients. We carried out a literature review relating to the management of TDs in children and adolescents with ADHD through a comprehensive search of MEDLINE, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis(meta-analysis) was deemed appropriate. Metaanalysis of controlled trials does not support an association between new onset or worsening of tics and normal doses of psychostimulant use. Supratherapeutic doses of dextroamphetamine have been shown to exacerbate TD. Most tics are mild or moderate and respond to psychoeducation and behavioural management. Level A evidence support the use of alpha adrenergic agonists, including Clonidine and Guanfacine, reuptake noradrenenaline inhibitors(Atomoxetine) and stimulants(Methylphenidate and Dexamphetamines) for the treatment of Tics and comorbid ADHD. Priority should be given to the management of co-morbid Tourette's syndrome(TS) or severely disabling tics in children and adolescents with ADHD. Severe TDs may require antipsychotic treatment. Antipsychotics, especially Aripiprazole, are safe and effective treatment for TS or severe Tics, but they only moderately control the co-occurring ADHD symptomatology. Short vignettes of different common clinical scenarios are presented to help clinicians determine the most appropriate treatment to consider in each patient presenting with ADHD and co-morbid TDs.展开更多
AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24...AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.展开更多
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosin...Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents.This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders,learning disorders,externalising and internalising disorders.Challenges in screening for,diagnosing and managing comorbidity with ADHD are summarised.Also,methodological challenges and future directions in research in this interesting field are highlighted.展开更多
AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS...AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children(mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales(VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.RESULTS: Among 63 ADHD subjects, the majority of the subjects(92%) met full ADHD diagnostic criteria at least in one setting(parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings(parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found(95%CI:-0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these casepositives, which is considered as a fair agreement between CAPs and VADRSs(95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.CONCLUSION: CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition- ODD- may be underrecognized.展开更多
文摘Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of children with attention deficit hyperactivity disorder are affected,and these symptoms may persist to adulthood if they are not treated.The diagnosis of attention deficit hyperactivity disorder is only based on symptoms and objective tests for attention deficit hyperactivity disorder are missing.Treatments for attention deficit hyperactivity disorder in children include medications,behavior therapy,counseling,and education services which can relieve many of the symptoms of attention deficit hyperactivity disorder but cannot cure it.There is a need for a molecular biomarker to distinguish attention deficit hyperactivity disorder from healthy subjects and other neurological conditions,which would allow for an earlier and more accurate diagnosis and appropriate treatment to be initiated.Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of attention deficit hyperactivity disorder.The recent studies reviewed had performed microRNA profiling in whole blood,white blood cells,blood plasma,and blood serum of children with attention deficit hyperactivity disorder.A large number of microRNAs were dysregulated when compared to healthy controls and with some overlap between individual studies.From the studies that had included a validation set of patients and controls,potential candidate biomarkers for attention deficit hyperactivity disorder in children could be miR-140-3p,let-7g-5p,-30e-5p,-223-3p,-142-5p,-486-5p,-151a-3p,-151a-5p,and-126-5p in total white blood cells,and miR-4516,-6090,-4763-3p,-4281,-4466,-101-3p,-130a-3p,-138-5p,-195-5p,and-106b-5p in blood serum.Further studies are warranted with children and adults with attention deficit hyperactivity disorder,and consideration should be given to utilizing rat models of attention deficit hyperactivity disorder.Animal studies could be used to confirm microRNA findings in human patients and to test the effects of targeting specific microRNAs on disease progression and behavior.
基金Supported by Ningbo Science and Technology Plan Project Public Welfare Plan(Municipal Level),No:2019C50099Ningbo Medical Key Supporting Discipline Child Health Science,No:2022-F26。
文摘BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder(ADHD)is associated with adverse events,such as nausea and vomiting,dizziness,and sleep disturbances,and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients’social functioning.AIM To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD.METHODS A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group(methylphenidate hydrochloride and tomoxetine hydrochloride)or the non-pharmacological group(parental training,behavior modification,sensory integration therapy,and sand tray therapy),with 45 cases in each group.Outcome measures included treatment compliance,Swanson,Nolan,and Pelham,Version IV(SNAP-IV)scores,Conners Parent Symptom Questionnaire(PSQ)scores,and Weiss Functional Impairment Rating Scale(WFIRS)scores.RESULTS The non-pharmacological interventions resulted in significantly higher compliance in patients(95.56%)compared with medication(71.11%)(P<0.05).However,no significant differences in SNAP-IV and PSQ scores,in addition to the learning/school,social activities,and adventure activities of the WFIRS scores were observed between the two groups(P>0.05).Patients with non-pharmacological interventions showed higher WFIRS scores for family,daily life skills,and self-concept than those in the pharmacological group(P<0.05).CONCLUSION Non-pharmacological interventions,in contrast to the potential risks of adverse events after longterm medication,improve patient treatment compliance,alleviate patients’behavioral symptoms of attention,impulsivity,and hyperactivity,and improve their cognitive ability,thereby improving family relationships and patient self-evaluation.
文摘Introduction: Attention deficit hyperactivity disorder (ADHD) is a little-studied psychiatric pathology in our countries, and particularly here in Benin. Objectives: To calculate the prevalence and identify the factors associated with attention deficit hyperactivity disorder among adults in the commune of Parakou in 2022. Methods: Cross-sectional, descriptive, analytical study including subjects aged 18 and over. ADHD was assessed with the Adult ADHD Self Report Scale (ARSR-v1.1) and consequences with the Weiss functional impairment rating scale (WFIRS-S). Results: A total of 456 people were included in the study. The mean age of those surveyed was 25.9 ± 11.6 years. The prevalence of ADHD symptoms among the adults surveyed was 6.8%. The clinical form of ADHD with a predominance of inattention had a prevalence of 3.3%. After multivariate analysis, the factor associated with the presence of ADHD symptoms in adults in the commune of Parakou was: a poor relationship with the subject’s partner (p = 0.031, ORa = 6.5 [1.18-35.68]). Conclusion: ADHD is present in the community of Parakou and needs further attention.
基金We are thankful to The Gujarat Council on Science and Technology(GUJCOST)for providing financial support in form of minor research project(GUJCOST/MRP/2014-15/2592)
文摘Objective:To explore the effect and mechanism of action of Celastrus paniculatus oil on the treatment of perinatal rats with attention deficit hyperactivity disorder.Methods:In the perinatal stage,the rats were either isolated or administered with lead acetate to establish an animal model of attention deficit hyperactivity disorder.Atomoxetine served as the reference standard.Animals’behaviours were assessed through Y-maze,novel object preference,fear conditioning and residentintruder aggression tests.Oxidative stress parameters,bioamine concentration(dopamine,noradrenaline and 5-hydroxytryptamine),nerve growth factor,interleukin-6,nuclear factor-κB,and tumour necrosis factor(TNF)-αwere estimated.Synaptophysin immunohistochemical assay was performed.Results:Celastrus paniculatus oil significantly improved behavioural parameters in Y maze,novel object preference,discrimination index,fear conditioning and resident intruder aggressive tests.The treatment groups showed a decrease in malondialdehyde level.Changes in the levels of dopamine,noradrenaline,and serotonin were restored by Celastrus paniculatus oil.Celastrus paniculatus oil increased nerve growth factor and decreased interleukin-6,nuclear factor-κB,and TNF-α.Synaptophysin immunoreactivity was also improved by Celastrus paniculatus oil with alleviated reactive gliosis,degeneration,and vascular proliferation.Conclusions:This research shows the therapeutic potential of Celastrus paniculatus oil for the treatment of attention deficit hyperactivity disorder.
文摘Background: Attention deficit hyperactivity disorder is a common pediatric neurobehavioral disorder often treated in the primary care setting. It shows a high and chronic level of inattention, impulsivity/hyperactivity and/or both, and can affect more than 2 million school-age children. The researchers are not sure about the exact causes of the disorder, but it seems that apart from genetic factors, perinatal factors seem to dynamically contribute to the development of the disorder. Purpose: The aim of this review was to investigate the perinatal and obstetric factors related to the development of the attention deficit hyperactivity disorder in childhood. Method: An online review of English language studies published from 2002 to 2020, using the Embase, PsychINFO, PubMed and Google Scholar databases. From 1100 studies only 17 were included in the review since they met the inclusion criteria. Conclusions: The results of the review showed that apart from heredity and genetic factors, various conditions in pregnancy or the mother’s way of life in pregnancy, adverse conditions in labor and infancy can contribute on their own or in combination to the development of the attention deficit hyperactivity disorder in childhood. Obstetric vigilance to detect risk factors in pregnancy in combination with the prevention of obstetric complications is the key in preventing attention deficit hyperactivity disorder.
文摘Extensive research has now been conducted and published for the treatment of dementia or Alzheimer’s disease, traumatic brain injury (TBI) and other brain disorders using photobiomodulation (PBM), also known as low-level laser therapy (LLLT). However, minimal information is available regarding the use of LLLT for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). We have been using LLLT in our practice for over 15 years addressing chronic pain and injury issues. However, our work with brain injuries is more recent, and we have published three case studies, one describing a serious traumatic brain injury and two describing our success with dementia/Alzheimer’s disease and PTSD. Currently, there is very little published evidence regarding efficacious therapy for ADHD. The case studies presented here, suggest that LLLT can provide alleviation of these symptoms, with some improvement reported after just a single treatment, without any need for pharmaceutical intervention.
文摘BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.
文摘This paper reviews the underlying evidence for various aspects of the convergence mechanism of mindfulness intervention in attention deficit hyperactivity disorder(ADHD).There may be compatibility among various ADHD remission models and the therapeutic mechanism of mindfulness intervention in ADHD may be mainly via the convergence mechanism.However,neuroimaging-based analysis of the mechanisms of mindfulness intervention in treating ADHD is lacking.Differences in the efficacy of various subtypes of mindfulness intervention,and corresponding specific imaging changes need further investigation.Future research may focus on the neuroimaging features of specific mindfulness intervention subtypes.
文摘Attention deficit hyperactivity disorder(ADHD)is a common and impairing behavioral health disorder,impacting over 5%of children worldwide.There are multiple evidence-based pharmacological and psychosocial treatments for ADHD,and greater service utilization is associated with improved acute and long-term outcomes.However,long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely.This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers.Families face a variety of structural and attitudinal barriers,ranging from cost and access to stigma and low self-efficacy to successfully implement change.There are multiple interventions that may enhance engagement with ADHD care including psychoeducation,integration of behavioral services in general medical settings,telehealth as well as specific adaptations to existing ADHD treatments,such as the use of motivational interviewing or shared decision making.Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers.Adding motivational interviewing,shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes.However,little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.
文摘Objectives:Compare and relate the performance of schoolchildren with Attention Deficit Hyperactivity Disorder(ADHD)and with good academic performance in the visual-motor perceptual and reading processes.Method:Twenty schoolchildren,of both genders,aged between nine and 11 years old,participated in this study.They were divided into two groups:Group I(GI):comprising 10 students diagnosed with ADHD;and Group II(GII):10 students with good academic performance paired according to gender,age group,and educational level with GI.All students were submitted to the Developmental Test of Visual Perception(DTVP 3)and Reading Processes Assessment Protocol(PROLEC).Results:There was lower performance of GI compared to GII in the subtests of copying,eye-hand coordination,and figure-ground in the standard score of general visual perception and visual-motor integration.GI presented lower performance in all reading processes except for the punctuation marks test.There was a statistically significant difference in the comparison between GI and GII regarding the classification of reading processes.A relationship was identified between the reading and visual perception subtests in the GI students,demonstrating a relationship between the visual perceptual motor skills and the reading processes in the group of students with ADHD.Conclusion:Schoolchildren with ADHD performed less well than their peers with good academic performance in the visual-motor perceptual and reading skills;such that the worse their performance in the visual-motor perceptual processes,the worse their performance in the reading processes.
文摘This paper aims to provide an effective overview of ADHD(Attention Deficit Hyperactivity Disorder),so that educators and other individuals who may be involved in the treatment of ADHD patients,especially young patients,can effectively obtain basic information about what is ADHD,the causes of ADHD,and the popular treatment methods of ADHD.Various literature and studies were referred to in this paper to review and compare different causes and treatments.Researches held distinct opinions about the causes of ADHD,and the debate focuses on the nature and nurture factors of ADHD.Some studies believe ADHD is inborn and genetic while other studies emphasize the importance of nurture factors during their life,such as the environment that patients grow up in and the lifestyle they have.Depending on distinct arguments,there developed different treatments like using medication to prevent the situation from deteriorating further and changing the environments that patients living in through taking interventions with the family.These arguments and treatments will be discussed in detail in this paper.
文摘Deficiency in executive functioning is a core symptom of attention deficit hyperactivity disorder (ADHD). The brain part responsible for executive functions is the prefrontal cortex (PFC). Although drug-based interventions can improve PFC activity, reports on PFC activity being improved by behavioral treatment are lacking. We evaluated whether a summer treatment program (STP) administering comprehensive behavioral treatment would increase PFC activity in children with ADHD. We examined behavioral and neural changes in 20 children before and after the STP, conducted over a 2-week period. We asked the parents/guardians to complete the Swanson, Nolan, and Pelham IV scale to assess severity of ADHD. The main task evaluating executive control was the reverse Stroop task. To examine changes in physiological indices, we used near-infrared spectroscopy to measure changes in PFC activity. Subjective assessments by parents/guardians indicated that ADHD symptoms improved significantly. There was also significant improvement in the number of correct responses and interference rates in the reverse Stroop task. Furthermore, post-intervention PFC activity was significantly higher. These results suggest that the STP improved inhibitory control in executive function, which is considered as a key symptom of ADHD. The increase in PFC activity further suggests that the STP improves cognition through neural function.
基金This study was supported by Shahid Sadoughi University of Medical Sciences,Yazd,Iran.
文摘Approximately 25%–50%of children with attention deficit hyperactivity disorder have sleep problems.The aim of this study is to compare the effect of horse milk with conventionally-fed cow’s milk on sleep disorders in children with attention deficit hyperactivity disorder.In this randomized double-blind crossover study,30 patients with attention deficit hyperactivity disorder were randomly selected and divided into two groups.All patients underwent a 45-day period of horse milk consumption and a 45-day period of cow milk consumption and they continued their drug treatment.A one-week interval between two periods of milk consumption was considered as the washout period.The severity of sleep disorder in the studied patients was determined based on the short form of the Children’s Sleep Habits Questionnaire(CSHQ).Twenty-two(73.3%)male and eight(26.7%)female patients were included in this study.The mean age of the patients was 8.9 years.Our results showed that horse milk consumption improved the CSHQ score.For the group of patients consuming horse milk prior to cow milk,reductions of total CSHQ(P-value=0.001)and subscale 1(P-value<0.001)scores were significant.For the group of patients consuming cow milk first,in addition to the total CSHQ(P-value<0.001),subscale 3(P-value=0.001)and 4(P-value=0.009)dropped significantly.On the other hand,the results indicated that cow milk consumption increased the CSHQ score.Specifically,for the group of patients consuming horse milk first,the total CSHQ(P-value=0.001),subscale 3(P-value=0.016),and subscale 4(P-value=0.010)increased significantly.The mean values of the first,second,third,and fourth subscales of CSHQ before and after the washout period were not significantly different between the two groups.According to the study,consuming horse milk was significantly better than cow milk in improving the total score of CSHQ in children with attention deficit hyperactivity disorder.
文摘The aim of this study was to describe the perceptions of everyday suffering among adults with attention deficit hyperactivity disorder (ADHD) and comorbid mental disease. Directed content analysis guided by Eriksson’s theory on human suffering was performed on data from 20 individual interviews. Expressions of both suffering and well-being were identified;the former centred on loneliness and related to life, illness, and care, which supported Eriksson’s theory, whereas expressions of well-being related to ADHD diagnosis and supportive social relationships. Nevertheless, results indicate the need to expand those expressions in order to better contribute to developing a supportive rehabilitation regimen that can provide more interpersonal care.
文摘Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder(ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.
文摘Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.
文摘Attention deficit hyperactivity disorder(ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders(TD) are common co-morbidities in paediatric ADHD patients with or without pharmacotherapy treatment. There has been conflicting evidence of the role of psychostimulants in either precipitating or exacerbating TDs in ADHD patients. We carried out a literature review relating to the management of TDs in children and adolescents with ADHD through a comprehensive search of MEDLINE, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis(meta-analysis) was deemed appropriate. Metaanalysis of controlled trials does not support an association between new onset or worsening of tics and normal doses of psychostimulant use. Supratherapeutic doses of dextroamphetamine have been shown to exacerbate TD. Most tics are mild or moderate and respond to psychoeducation and behavioural management. Level A evidence support the use of alpha adrenergic agonists, including Clonidine and Guanfacine, reuptake noradrenenaline inhibitors(Atomoxetine) and stimulants(Methylphenidate and Dexamphetamines) for the treatment of Tics and comorbid ADHD. Priority should be given to the management of co-morbid Tourette's syndrome(TS) or severely disabling tics in children and adolescents with ADHD. Severe TDs may require antipsychotic treatment. Antipsychotics, especially Aripiprazole, are safe and effective treatment for TS or severe Tics, but they only moderately control the co-occurring ADHD symptomatology. Short vignettes of different common clinical scenarios are presented to help clinicians determine the most appropriate treatment to consider in each patient presenting with ADHD and co-morbid TDs.
文摘AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.
文摘Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents.This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders,learning disorders,externalising and internalising disorders.Challenges in screening for,diagnosing and managing comorbidity with ADHD are summarised.Also,methodological challenges and future directions in research in this interesting field are highlighted.
基金funding from NIMH, AHRQ, Marriott Foundation, Mayo Foundation
文摘AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children(mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales(VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.RESULTS: Among 63 ADHD subjects, the majority of the subjects(92%) met full ADHD diagnostic criteria at least in one setting(parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings(parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found(95%CI:-0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these casepositives, which is considered as a fair agreement between CAPs and VADRSs(95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.CONCLUSION: CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition- ODD- may be underrecognized.
