AIM To investigate suicidality and attention-deficit/hyperactivity disorder(ADHD), this paper aims to systematically review the literature as an extension of previous reviews.METHODS We searched five databases(Ovid ME...AIM To investigate suicidality and attention-deficit/hyperactivity disorder(ADHD), this paper aims to systematically review the literature as an extension of previous reviews.METHODS We searched five databases(Ovid MEDLINE, Psychinfo, PubM ed, Scopus, Web of Science) with two categories of search terms:(1) suicide; suicidal; suicide behavior; suicide attempt; suicidal thought; and(2) ADHD. RESULTS The search resulted 26 articles. There is a positive association between ADHD and suicidality in both sexes and in all age groups. Comorbid disorders mediate between suicidality and ADHD. CONCLUSION Recognizing ADHD, comorbid conditions and suicidality is important in prevention.展开更多
BACKGROUND High risk of alcohol and drug use disorders in people with attentiondeficit/hyperactivity disorder(ADHD)calls for exploratory research of relationships with clinical features of ADHD.AIM To estimate prevale...BACKGROUND High risk of alcohol and drug use disorders in people with attentiondeficit/hyperactivity disorder(ADHD)calls for exploratory research of relationships with clinical features of ADHD.AIM To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation,in adults with ADHD.METHODS This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo,Norway(2014-2018).Five-hundred and fifty-eight eligible patients diagnosed with ADHD(Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria)agreed to participate.Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview(MINI).Dependence and abuse were merged into“use”disorder as in MINI version 7.0/DSM-5.Questions were related both to lifetime and the past 12-mo.ADHD severity was assessed by the Adult ADHD Self Report Scale(ASRS).Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately.Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale-Self Report.RESULTS The 12-mo prevalence was 5.3%for alcohol use disorder and 13.7%for drug use disorder.The lifetime prevalence was 12.0%for alcohol use disorder and 27.7%for drug use disorder.Men had higher rates of both alcohol use disorder and drug use disorder compared to women.The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes.The drugs most participants reported having used were(in descending order):Amphetamine(19.1%),cannabis(17.1%),cocaine or ecstasy(7.4%),benzodiazepines(7.4%),and heroin or other opioids(2.9%).Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity.Lifetime alcohol use disorder,on the other hand,was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.CONCLUSION Patients with ADHD have a high lifetime prevalence of drug use disorder,which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.展开更多
BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterog...BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterogeneity.AIM To use generalized structural equation modeling(GSEM)to show how the heterogeneous nature of hyperactivity/impulsivity(H/I)symptoms in ADHD,irritable oppositional defiant disorder(ODD),and the presentation of aggression in children interferes with treatment responses in ADHD.METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests.ODD scores from the Swanson,Nolan,and Pelham,version IV scale were obtained.The child behavior checklist(CBCL)and parent’s satisfaction questionnaire were completed.The relationships were analyzed by GSEM.RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD,ODD symptoms,and childhood aggressive behavior.ODD directly mediated ADHD symptom severity.The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494%[=exp(2.602)]in children with comorbid ADHD and ODD[odds ratio(OR)=2.602,95%confidence interval(CI):1.832-3.373,P=0.000]after adjusting for the effects of other factors.Childhood aggression mediated ODD symptom severity.The chance of reaching remission based on ODD symptoms was lowered by 11.000%[=1-exp(-0.117)]in children with more severe baseline symptoms of aggression based on the CBCL score at study entry[OR=-0.117,95%CI:(-0.190)-(-0.044),P=0.002].CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity.More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment,e.g.,symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.展开更多
Prefrontal dysfunction in patients with attention-deficit/hyperactivity disorder (AD/HD) has been repeatedly detected on a behavioral level, and various brain-imaging studies have elucidated the pathophysiology of AD/...Prefrontal dysfunction in patients with attention-deficit/hyperactivity disorder (AD/HD) has been repeatedly detected on a behavioral level, and various brain-imaging studies have elucidated the pathophysiology of AD/HD. Recent advances in near-infrared spectroscopy (NIRS) have enabled noninvasive investigations of brain function in various mental disorders, especially major depression, schizophrenia, and bipolar disorder. The objective of this preliminary study was to use NIRS to evaluate changes in frontal lobe blood flow in post childhood or adult patients with AD/HD symptoms. The subjects included five patients with a range of mental disorders and AD/HD symptoms, and a matched (age, sex, and dominant hand) control group of five healthy subjects. We compared the changes in cerebral blood flow during verbal fluency tasks between the two groups. The duration of the elevated oxygenated hemoglobin was notably shorter in the AD/HD group than that in the healthy control group. We suggest that the shorter elevation durations of oxygenated hemoglobin concentrations might be a biological indicator for post childhood or adult AD/HD or of impaired executive functioning.展开更多
Aims: This study was designed to verify the proportion of Japanese adults with pervasive developmental disorder (PDD) who met the diagnostic criteria (other than E) for attention-deficit/hyperactivity disorder (ADHD) ...Aims: This study was designed to verify the proportion of Japanese adults with pervasive developmental disorder (PDD) who met the diagnostic criteria (other than E) for attention-deficit/hyperactivity disorder (ADHD) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Furthermore, we examined to what extent adults with PDD think that they exhibit ADHD symptoms. Methods: We developed an original Japanese self-report questionnaire to determine the presence or absence of 18 symptoms from the diagnostic criteria for ADHD in the DSM-IV-TR. We administered the questionnaire to 64 adults with high-functioning PDD (45 men and 19 women) and 21 adults with ADHD (10 men and 11 women), aged 18 to 59 years, with a full-scale intelligence quotient ≥75. Target patients were evaluated for ADHD by their psychiatrists. Results: Twenty-nine (45.3%) adults with PDD also had ADHD. The percentage of these adults who had over six perceived inattention symptoms from the DSM-IV-TR was 96.6%. The percentage of these adults who had over six perceived hyperactivity-impulsivity symptoms was 65.5%. Thirty-five (55.6%) adults with PDD responded that they were aware of having ADHD symptoms at the level of the relevant diagnostic criteria. Conclusions: The present study is the first to examine the frequency of objective and perceived ADHD symptoms in adults with PDD in Japan. Our results show that both objective and perceived ADHD symptoms frequently appear in a large number of adults with PDD. This suggests that it is necessary to attend to concomitant ADHD symptoms in the medical care of adults with PDD.展开更多
Objective: The present study compared results on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) among adult patients with attention-deficit/hyperactivity disorder (AD/HD) and those with Asperger’s disorder (A...Objective: The present study compared results on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) among adult patients with attention-deficit/hyperactivity disorder (AD/HD) and those with Asperger’s disorder (AD). Method: WAIS-R results were compared between 16 adults with AD/HD (8 men and 8 women;mean age, 33.81 years;mean full-scale IQ, 101.5) and 15 adults with AD (12 men and 3 women;mean age, 30.93 years;mean full-scale IQ, 104.6). Results: Verbal IQ was significantly higher than performance IQ in the AD group. Among various subtests, scores were the highest for similarities in the AD/HD group and for block design in the AD group. Picture completion test scores were the lowest scores obtained in both groups. A comparison of subtest scores between the AD/HD and AD groups showed scores for information to be significantly higher in the AD group than in the AD/HD group. Conclusions: Our results suggest that there are no differences in verbal IQ, performance IQ, and full-scale IQ scores (except for scores on the information subtest) among adult patients with AD/HD compared with adult patients with AD.展开更多
Background: Informed consent forms and clinical study participation explanations contain many specialized words including medical terms that are difficult to understand. The difficulty is particularly obvious for chil...Background: Informed consent forms and clinical study participation explanations contain many specialized words including medical terms that are difficult to understand. The difficulty is particularly obvious for children with developmental disorders who show attention or similar problems. This study quantitatively evaluated the decision-making ability of these children using the Wechsler Intelligence Scale for Children-III (WISC-III) as a preliminary study for a multi-faceted investigation that would also use physiological indices. Methods: Participants were 11 children with Attention Deficit/Hyperactivity Disorder (AD/HD). The WISC-III was used for quantitative evaluation of their decision-making ability. Results of intelligence quotients (IQs), group indices, and subtest scores were analyzed. Results: The mean Performance IQ was four points lower than the mean Verbal IQ. The mean score for the Processing Speed index was lower by more than one standard deviation (SD). The mean scores for the Coding and Object Assembly subtests were lower by more than two SDs. Conclusion: The WISC-III results for IQ and group indices suggested the efficacy of auditory explanations. In addition, the subtest results suggested the necessity to pay sufficient attention to risk-benefit weighting in explanations. These findings suggested that the decision-making ability of children with AD/HD could be assessed using the WISC-III.展开更多
Attention-deficit/hyperactivity disorder(ADHD)often co-occurs with substance use(SU)and/or substance use disorder(SUD).Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate dia...Attention-deficit/hyperactivity disorder(ADHD)often co-occurs with substance use(SU)and/or substance use disorder(SUD).Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment.This can be further complicated by the context in which services are delivered.Also,when working with young people and adults with co-existing ADHD and SU/SUD,there is uncertainty among healthcare practitioners on how best to meet their needs.In February 2022,the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues.Following presentations providing attendees with an overview of the literature,group discussions were held synthesizing research evidence and clinical experience.Topics included:(1)A review of substances and reasons for use/misuse;(2)identification,assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services;and(3)identification,assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services.Discussions highlighted inter-service barriers and fragmentation of care.It was concluded that a multimodal and multi-agency approach is needed.The consensus group generated a table of practice recommendations providing guidance on:identification and assessment;pharmacological and psychological treatment;and multi-agency interventions.展开更多
BACKGROUND Attention-deficit/hyperactivity disorder(ADHD)is one of the most common disorders in child and adolescent psychiatry,with a prevalence of more than 5%.Despite extensive research on ADHD in the last 10 to 20...BACKGROUND Attention-deficit/hyperactivity disorder(ADHD)is one of the most common disorders in child and adolescent psychiatry,with a prevalence of more than 5%.Despite extensive research on ADHD in the last 10 to 20 years,effective treatments are still lacking.Instead,the concept of ADHD seems to have become broader and more heterogeneous.Therefore,the diagnosis and treatment of ADHD remains challenging for clinicians.AIM To investigate the effects of a multimodal integrated intervention for children with ADHD.METHODS Between March 2019 and September 2020,a total of 100 children with ADHD who were diagnosed and treated at our hospital were assessed for eligibility,two of whom revoked their consent.A case-control study was conducted in which the children were equally assigned,using a randomized number table,to either a medication group(methylphenidate hydrochloride extended-release tablets and atomoxetine hydrochloride tablets)or a multimodal integrated intervention group(medication+parent training+behavior modification+sensory integration therapy+sand tray therapy),with 49 patients in each group.The clinical endpoint was the efficacy of the different intervention modalities.RESULTS The two groups of children with ADHD had comparable patient characteristics(P>0.05).Multimodal integrated intervention resulted in a significantly higher treatment efficacy(91.84%)than medication alone(75.51%)(P<0.05).Children who received the multimodal integrated intervention showed lower scores in the Conners Parent Symptom Questionnaire and the Weiss Functional Impairment Rating Scale than those treated with medication alone(P<0.05).The Sensory Integration Scale scores of children in the multimodal integrated intervention group were higher than those of children in the medication group(P<0.05).Children who received the multimodal integrated intervention had higher compliance and family satisfaction and a lower incidence of adverse events than those treated with medication alone(P<0.05).CONCLUSION Multimodal integrated intervention effectively alleviated symptoms associated with ADHD in children.It enhanced their memory and attention with high safety and parental satisfaction,demonstrating good potential for clinical promotion.展开更多
Background Cortical functional network alterations have been widely accepted as the neural basis of attention-deficit/hyperactivity disorder(ADHD).Recently,white matter has also been recognized as a novel neuroimaging...Background Cortical functional network alterations have been widely accepted as the neural basis of attention-deficit/hyperactivity disorder(ADHD).Recently,white matter has also been recognized as a novel neuroimaging marker of psychopathology and has been used as a complement to cortical functional networks to investigate brain–behavior relationships.However,disorder-specific features of white matter functional networks(WMFNs)are less well understood than those of gray matter functional networks.In the current study,we constructed WMFNs using a new strategy to characterize behavior-related network features in ADHD.Methods We recruited 46 drug-nale boys with ADHD and 46 typically developing(TD)boys,and used clustering analysis on restingstate functional magnetic resonance imaging data to generate WMFNs in each group.Intrinsic activity within each network was extracted,and the associations between network activity and behavior measures were assessed using correlation analysis.Results Nine WMFNs were identified for both ADHD and TD participants.However,boys with ADHD showed a splitting of the inferior corticospinal–cerebellar network and lacked a cognitive control network.In addition,boys with ADHD showed increased activity in the dorsal attention network and somatomotor network,which correlated positively with attention problems and hyperactivity symptom scores,respectively,while they presented decreased activity in the frontoparietal network and frontostriatal network in association with poorer performance in response inhibition,working memory,and verbal fluency.Conclusions We discovered a dual pattern of white matter network activity in drug-nale ADHD boys,with hyperactive symptom-related networks and hypoactive cognitive networks.These findings characterize two distinct types of WMFN in ADHD psychopathology.展开更多
WT5HZ] Objective: [WT5BZ]To study the effect and side effects of Duodongning (DDN), a traditional Chinese medicine (TCM) granule in treating attention deficit/hyperactivity disorder (ADHD). [WT5HZ]Methods:[WT5BZ] Doub...WT5HZ] Objective: [WT5BZ]To study the effect and side effects of Duodongning (DDN), a traditional Chinese medicine (TCM) granule in treating attention deficit/hyperactivity disorder (ADHD). [WT5HZ]Methods:[WT5BZ] Double blind method was used to compare DDN with ritalin for ADHD in clinical practice from December 1995 to December 1996. The total number of cases was 70. [WT5HZ]Results:[WT5BZ] There were 37 cases in DDN group, with 17 cases (45.9%) markedly effective, 16 cases (43.2%) effective, the Conners hyperactive index (HI) 2.01±0.83 (before treatment), 1.17±0.76 (after 4 weeks’ treatment); and there were 33 cases in the ritalin group, with 15 cases (45.5%) markedly effective, 14 cases (42.4%) effective, HI 2.07±0.91 (before treatment), 1.47±0.79 (after 4 weeks’ treatment). Insignificant difference existed between the effectiveness in these 2 groups ( P > 0.05). The chief side effects were 3 cases (8.1%) of anorexia in DDN group, and 7 cases (21.2%) in ritalin group. [WT5HZ]Conclusion:[WT5BZ] The effect of DDN is not significantly different from that of ritalin, and the side effects in ritalin group were more than those in DDN group. [WT5FZ]展开更多
In spite of the fact that the legal system adopted in Brazil is codified on the Roman tradition, there is no specific protection in law for people suffering from Attention Deficit Disorder (ADD). In contrast, the law ...In spite of the fact that the legal system adopted in Brazil is codified on the Roman tradition, there is no specific protection in law for people suffering from Attention Deficit Disorder (ADD). In contrast, the law of the United States is largely derived from the common law system and there are two federal laws that guarantee a free appropriate public education and provide services to eligible students with disabilities. They are: Section 504 and Individuals with Disabilities Education Act2. The American Legal System reflects the social demand based on epidemiological studies. In the present investigation, we studied the prevalence of attention disorders in Brazil. The sample included 239 students, rated regarding attention problems with a checklist filled by 45 different teachers. As left-handers show greater problems in the impulsive-hyperactivity domain, we investigated the influence of gender on attention problems using handedness as a covariate. Hand preference was assessed by direct observation. A student was classified into the ADD group if he (she) was rated maximum score in at least six questions concerning impulsivity, hyperactivity, and inattention. Sixty-eight students (28% of the total sample) were included in the ADD group. The percentage of males was found to be greater in ADD group as compared to the percentage of males in the normal-control group. The gender effect was not explained by handedness. Our data is similar with other studies. For instance, the rate of ADD symptoms among indigenous students from the Brazilian Amazon was found to be 24.5%. In Brazilian juvenile offenders, the percentage was 33%. The differences with other studies are discussed considering sampling procedures. In accordance with the tradition of the Roman system, we urgently need Federal specific laws to deal with this public health problem. We must convert into specific laws, the Convention on the Rights of Persons with Disabilities (United Nations) that was recently ratified in Brazil.展开更多
Attention-deficit/hyperactivity disorder(ADHD)has been conceptualized as a brain dysconnectivity disorder.In the past decade,noninvasive diffusion magnetic resonance imaging(dMRI)studies have demonstrated that individ...Attention-deficit/hyperactivity disorder(ADHD)has been conceptualized as a brain dysconnectivity disorder.In the past decade,noninvasive diffusion magnetic resonance imaging(dMRI)studies have demonstrated that individuals with ADHD have alterations in the white matter structural connectome,and that these alterations are associated with core symptoms and cognitive deficits in patients.This review aims to summarize recent dMRI-based structural connectome studies in ADHD from voxel-,tractography-,and network-based perspectives.Voxel-and tractography-based studies have demonstrated disrupted microstructural properties predominantly located in the frontostriatal tracts,the corpus callosum,the corticospinal tracts,and the cingulum bundle in patients with ADHD.Network-based studies have suggested abnormal global and local efficiency as well as nodal properties in the prefrontal and parietal regions in the ADHD structural connectomes.The altered structural connectomes in those with ADHD provide significant signatures for prediction of symptoms and diagnostic classification.These studies suggest that abnormalities in the structural connectome may be one of the neural underpinnings of ADHD psychopathology and show potential for establishing imaging biomarkers in clinical evaluation.However,given that there are inconsistent findings across studies due to sample heterogeneity and analysis method variations,these ADHD-related white matter alterations are still far from informing clinical practice.Future studies with larger and more homogeneous samples are needed to validate the consistency of current results;advanced dMRI techniques can help to generatemuchmore precise estimation of whitematter pathways and assure specific fiber configurations;and finally,dimensional analysis frameworks can deepen our understanding of the neurobiology underlying ADHD.展开更多
基金supported by OTKA K108336 grantthe János Bolyai Research Scholarship of the Hungarian Academy of Sciences.
文摘AIM To investigate suicidality and attention-deficit/hyperactivity disorder(ADHD), this paper aims to systematically review the literature as an extension of previous reviews.METHODS We searched five databases(Ovid MEDLINE, Psychinfo, PubM ed, Scopus, Web of Science) with two categories of search terms:(1) suicide; suicidal; suicide behavior; suicide attempt; suicidal thought; and(2) ADHD. RESULTS The search resulted 26 articles. There is a positive association between ADHD and suicidality in both sexes and in all age groups. Comorbid disorders mediate between suicidality and ADHD. CONCLUSION Recognizing ADHD, comorbid conditions and suicidality is important in prevention.
文摘BACKGROUND High risk of alcohol and drug use disorders in people with attentiondeficit/hyperactivity disorder(ADHD)calls for exploratory research of relationships with clinical features of ADHD.AIM To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation,in adults with ADHD.METHODS This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo,Norway(2014-2018).Five-hundred and fifty-eight eligible patients diagnosed with ADHD(Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria)agreed to participate.Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview(MINI).Dependence and abuse were merged into“use”disorder as in MINI version 7.0/DSM-5.Questions were related both to lifetime and the past 12-mo.ADHD severity was assessed by the Adult ADHD Self Report Scale(ASRS).Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately.Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale-Self Report.RESULTS The 12-mo prevalence was 5.3%for alcohol use disorder and 13.7%for drug use disorder.The lifetime prevalence was 12.0%for alcohol use disorder and 27.7%for drug use disorder.Men had higher rates of both alcohol use disorder and drug use disorder compared to women.The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes.The drugs most participants reported having used were(in descending order):Amphetamine(19.1%),cannabis(17.1%),cocaine or ecstasy(7.4%),benzodiazepines(7.4%),and heroin or other opioids(2.9%).Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity.Lifetime alcohol use disorder,on the other hand,was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.CONCLUSION Patients with ADHD have a high lifetime prevalence of drug use disorder,which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.
文摘BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterogeneity.AIM To use generalized structural equation modeling(GSEM)to show how the heterogeneous nature of hyperactivity/impulsivity(H/I)symptoms in ADHD,irritable oppositional defiant disorder(ODD),and the presentation of aggression in children interferes with treatment responses in ADHD.METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests.ODD scores from the Swanson,Nolan,and Pelham,version IV scale were obtained.The child behavior checklist(CBCL)and parent’s satisfaction questionnaire were completed.The relationships were analyzed by GSEM.RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD,ODD symptoms,and childhood aggressive behavior.ODD directly mediated ADHD symptom severity.The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494%[=exp(2.602)]in children with comorbid ADHD and ODD[odds ratio(OR)=2.602,95%confidence interval(CI):1.832-3.373,P=0.000]after adjusting for the effects of other factors.Childhood aggression mediated ODD symptom severity.The chance of reaching remission based on ODD symptoms was lowered by 11.000%[=1-exp(-0.117)]in children with more severe baseline symptoms of aggression based on the CBCL score at study entry[OR=-0.117,95%CI:(-0.190)-(-0.044),P=0.002].CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity.More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment,e.g.,symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.
文摘Prefrontal dysfunction in patients with attention-deficit/hyperactivity disorder (AD/HD) has been repeatedly detected on a behavioral level, and various brain-imaging studies have elucidated the pathophysiology of AD/HD. Recent advances in near-infrared spectroscopy (NIRS) have enabled noninvasive investigations of brain function in various mental disorders, especially major depression, schizophrenia, and bipolar disorder. The objective of this preliminary study was to use NIRS to evaluate changes in frontal lobe blood flow in post childhood or adult patients with AD/HD symptoms. The subjects included five patients with a range of mental disorders and AD/HD symptoms, and a matched (age, sex, and dominant hand) control group of five healthy subjects. We compared the changes in cerebral blood flow during verbal fluency tasks between the two groups. The duration of the elevated oxygenated hemoglobin was notably shorter in the AD/HD group than that in the healthy control group. We suggest that the shorter elevation durations of oxygenated hemoglobin concentrations might be a biological indicator for post childhood or adult AD/HD or of impaired executive functioning.
文摘Aims: This study was designed to verify the proportion of Japanese adults with pervasive developmental disorder (PDD) who met the diagnostic criteria (other than E) for attention-deficit/hyperactivity disorder (ADHD) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Furthermore, we examined to what extent adults with PDD think that they exhibit ADHD symptoms. Methods: We developed an original Japanese self-report questionnaire to determine the presence or absence of 18 symptoms from the diagnostic criteria for ADHD in the DSM-IV-TR. We administered the questionnaire to 64 adults with high-functioning PDD (45 men and 19 women) and 21 adults with ADHD (10 men and 11 women), aged 18 to 59 years, with a full-scale intelligence quotient ≥75. Target patients were evaluated for ADHD by their psychiatrists. Results: Twenty-nine (45.3%) adults with PDD also had ADHD. The percentage of these adults who had over six perceived inattention symptoms from the DSM-IV-TR was 96.6%. The percentage of these adults who had over six perceived hyperactivity-impulsivity symptoms was 65.5%. Thirty-five (55.6%) adults with PDD responded that they were aware of having ADHD symptoms at the level of the relevant diagnostic criteria. Conclusions: The present study is the first to examine the frequency of objective and perceived ADHD symptoms in adults with PDD in Japan. Our results show that both objective and perceived ADHD symptoms frequently appear in a large number of adults with PDD. This suggests that it is necessary to attend to concomitant ADHD symptoms in the medical care of adults with PDD.
文摘Objective: The present study compared results on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) among adult patients with attention-deficit/hyperactivity disorder (AD/HD) and those with Asperger’s disorder (AD). Method: WAIS-R results were compared between 16 adults with AD/HD (8 men and 8 women;mean age, 33.81 years;mean full-scale IQ, 101.5) and 15 adults with AD (12 men and 3 women;mean age, 30.93 years;mean full-scale IQ, 104.6). Results: Verbal IQ was significantly higher than performance IQ in the AD group. Among various subtests, scores were the highest for similarities in the AD/HD group and for block design in the AD group. Picture completion test scores were the lowest scores obtained in both groups. A comparison of subtest scores between the AD/HD and AD groups showed scores for information to be significantly higher in the AD group than in the AD/HD group. Conclusions: Our results suggest that there are no differences in verbal IQ, performance IQ, and full-scale IQ scores (except for scores on the information subtest) among adult patients with AD/HD compared with adult patients with AD.
文摘Background: Informed consent forms and clinical study participation explanations contain many specialized words including medical terms that are difficult to understand. The difficulty is particularly obvious for children with developmental disorders who show attention or similar problems. This study quantitatively evaluated the decision-making ability of these children using the Wechsler Intelligence Scale for Children-III (WISC-III) as a preliminary study for a multi-faceted investigation that would also use physiological indices. Methods: Participants were 11 children with Attention Deficit/Hyperactivity Disorder (AD/HD). The WISC-III was used for quantitative evaluation of their decision-making ability. Results of intelligence quotients (IQs), group indices, and subtest scores were analyzed. Results: The mean Performance IQ was four points lower than the mean Verbal IQ. The mean score for the Processing Speed index was lower by more than one standard deviation (SD). The mean scores for the Coding and Object Assembly subtests were lower by more than two SDs. Conclusion: The WISC-III results for IQ and group indices suggested the efficacy of auditory explanations. In addition, the subtest results suggested the necessity to pay sufficient attention to risk-benefit weighting in explanations. These findings suggested that the decision-making ability of children with AD/HD could be assessed using the WISC-III.
文摘Attention-deficit/hyperactivity disorder(ADHD)often co-occurs with substance use(SU)and/or substance use disorder(SUD).Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment.This can be further complicated by the context in which services are delivered.Also,when working with young people and adults with co-existing ADHD and SU/SUD,there is uncertainty among healthcare practitioners on how best to meet their needs.In February 2022,the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues.Following presentations providing attendees with an overview of the literature,group discussions were held synthesizing research evidence and clinical experience.Topics included:(1)A review of substances and reasons for use/misuse;(2)identification,assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services;and(3)identification,assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services.Discussions highlighted inter-service barriers and fragmentation of care.It was concluded that a multimodal and multi-agency approach is needed.The consensus group generated a table of practice recommendations providing guidance on:identification and assessment;pharmacological and psychological treatment;and multi-agency interventions.
基金Supported by Ningbo Medical Key Fostering Discipline Child Health Science,No.2022-F26Ningbo Science and Technology Plan Project Public Welfare Plan,No.2019C50099.
文摘BACKGROUND Attention-deficit/hyperactivity disorder(ADHD)is one of the most common disorders in child and adolescent psychiatry,with a prevalence of more than 5%.Despite extensive research on ADHD in the last 10 to 20 years,effective treatments are still lacking.Instead,the concept of ADHD seems to have become broader and more heterogeneous.Therefore,the diagnosis and treatment of ADHD remains challenging for clinicians.AIM To investigate the effects of a multimodal integrated intervention for children with ADHD.METHODS Between March 2019 and September 2020,a total of 100 children with ADHD who were diagnosed and treated at our hospital were assessed for eligibility,two of whom revoked their consent.A case-control study was conducted in which the children were equally assigned,using a randomized number table,to either a medication group(methylphenidate hydrochloride extended-release tablets and atomoxetine hydrochloride tablets)or a multimodal integrated intervention group(medication+parent training+behavior modification+sensory integration therapy+sand tray therapy),with 49 patients in each group.The clinical endpoint was the efficacy of the different intervention modalities.RESULTS The two groups of children with ADHD had comparable patient characteristics(P>0.05).Multimodal integrated intervention resulted in a significantly higher treatment efficacy(91.84%)than medication alone(75.51%)(P<0.05).Children who received the multimodal integrated intervention showed lower scores in the Conners Parent Symptom Questionnaire and the Weiss Functional Impairment Rating Scale than those treated with medication alone(P<0.05).The Sensory Integration Scale scores of children in the multimodal integrated intervention group were higher than those of children in the medication group(P<0.05).Children who received the multimodal integrated intervention had higher compliance and family satisfaction and a lower incidence of adverse events than those treated with medication alone(P<0.05).CONCLUSION Multimodal integrated intervention effectively alleviated symptoms associated with ADHD in children.It enhanced their memory and attention with high safety and parental satisfaction,demonstrating good potential for clinical promotion.
基金The study was supported by the 1.3.5 Project for Disciplines of Excellence,West China Hospital of Sichuan University,China(grant no.ZYJC21041)the Clinical and Translational Research Fund of Chinese Academy of Medical Sciences(grant no.2021-I2MC&TB-097)the Science and Technology Project of Chengdu City,China(grant no.2019-YF05-00509-SN).
文摘Background Cortical functional network alterations have been widely accepted as the neural basis of attention-deficit/hyperactivity disorder(ADHD).Recently,white matter has also been recognized as a novel neuroimaging marker of psychopathology and has been used as a complement to cortical functional networks to investigate brain–behavior relationships.However,disorder-specific features of white matter functional networks(WMFNs)are less well understood than those of gray matter functional networks.In the current study,we constructed WMFNs using a new strategy to characterize behavior-related network features in ADHD.Methods We recruited 46 drug-nale boys with ADHD and 46 typically developing(TD)boys,and used clustering analysis on restingstate functional magnetic resonance imaging data to generate WMFNs in each group.Intrinsic activity within each network was extracted,and the associations between network activity and behavior measures were assessed using correlation analysis.Results Nine WMFNs were identified for both ADHD and TD participants.However,boys with ADHD showed a splitting of the inferior corticospinal–cerebellar network and lacked a cognitive control network.In addition,boys with ADHD showed increased activity in the dorsal attention network and somatomotor network,which correlated positively with attention problems and hyperactivity symptom scores,respectively,while they presented decreased activity in the frontoparietal network and frontostriatal network in association with poorer performance in response inhibition,working memory,and verbal fluency.Conclusions We discovered a dual pattern of white matter network activity in drug-nale ADHD boys,with hyperactive symptom-related networks and hypoactive cognitive networks.These findings characterize two distinct types of WMFN in ADHD psychopathology.
文摘WT5HZ] Objective: [WT5BZ]To study the effect and side effects of Duodongning (DDN), a traditional Chinese medicine (TCM) granule in treating attention deficit/hyperactivity disorder (ADHD). [WT5HZ]Methods:[WT5BZ] Double blind method was used to compare DDN with ritalin for ADHD in clinical practice from December 1995 to December 1996. The total number of cases was 70. [WT5HZ]Results:[WT5BZ] There were 37 cases in DDN group, with 17 cases (45.9%) markedly effective, 16 cases (43.2%) effective, the Conners hyperactive index (HI) 2.01±0.83 (before treatment), 1.17±0.76 (after 4 weeks’ treatment); and there were 33 cases in the ritalin group, with 15 cases (45.5%) markedly effective, 14 cases (42.4%) effective, HI 2.07±0.91 (before treatment), 1.47±0.79 (after 4 weeks’ treatment). Insignificant difference existed between the effectiveness in these 2 groups ( P > 0.05). The chief side effects were 3 cases (8.1%) of anorexia in DDN group, and 7 cases (21.2%) in ritalin group. [WT5HZ]Conclusion:[WT5BZ] The effect of DDN is not significantly different from that of ritalin, and the side effects in ritalin group were more than those in DDN group. [WT5FZ]
文摘In spite of the fact that the legal system adopted in Brazil is codified on the Roman tradition, there is no specific protection in law for people suffering from Attention Deficit Disorder (ADD). In contrast, the law of the United States is largely derived from the common law system and there are two federal laws that guarantee a free appropriate public education and provide services to eligible students with disabilities. They are: Section 504 and Individuals with Disabilities Education Act2. The American Legal System reflects the social demand based on epidemiological studies. In the present investigation, we studied the prevalence of attention disorders in Brazil. The sample included 239 students, rated regarding attention problems with a checklist filled by 45 different teachers. As left-handers show greater problems in the impulsive-hyperactivity domain, we investigated the influence of gender on attention problems using handedness as a covariate. Hand preference was assessed by direct observation. A student was classified into the ADD group if he (she) was rated maximum score in at least six questions concerning impulsivity, hyperactivity, and inattention. Sixty-eight students (28% of the total sample) were included in the ADD group. The percentage of males was found to be greater in ADD group as compared to the percentage of males in the normal-control group. The gender effect was not explained by handedness. Our data is similar with other studies. For instance, the rate of ADD symptoms among indigenous students from the Brazilian Amazon was found to be 24.5%. In Brazilian juvenile offenders, the percentage was 33%. The differences with other studies are discussed considering sampling procedures. In accordance with the tradition of the Roman system, we urgently need Federal specific laws to deal with this public health problem. We must convert into specific laws, the Convention on the Rights of Persons with Disabilities (United Nations) that was recently ratified in Brazil.
基金supported by the National Natural Science Foundation of China(Nos.82021004,81620108016,31221003)Changjiang Scholar Professorship Award(No.T2015027).
文摘Attention-deficit/hyperactivity disorder(ADHD)has been conceptualized as a brain dysconnectivity disorder.In the past decade,noninvasive diffusion magnetic resonance imaging(dMRI)studies have demonstrated that individuals with ADHD have alterations in the white matter structural connectome,and that these alterations are associated with core symptoms and cognitive deficits in patients.This review aims to summarize recent dMRI-based structural connectome studies in ADHD from voxel-,tractography-,and network-based perspectives.Voxel-and tractography-based studies have demonstrated disrupted microstructural properties predominantly located in the frontostriatal tracts,the corpus callosum,the corticospinal tracts,and the cingulum bundle in patients with ADHD.Network-based studies have suggested abnormal global and local efficiency as well as nodal properties in the prefrontal and parietal regions in the ADHD structural connectomes.The altered structural connectomes in those with ADHD provide significant signatures for prediction of symptoms and diagnostic classification.These studies suggest that abnormalities in the structural connectome may be one of the neural underpinnings of ADHD psychopathology and show potential for establishing imaging biomarkers in clinical evaluation.However,given that there are inconsistent findings across studies due to sample heterogeneity and analysis method variations,these ADHD-related white matter alterations are still far from informing clinical practice.Future studies with larger and more homogeneous samples are needed to validate the consistency of current results;advanced dMRI techniques can help to generatemuchmore precise estimation of whitematter pathways and assure specific fiber configurations;and finally,dimensional analysis frameworks can deepen our understanding of the neurobiology underlying ADHD.
