Thyroid function in a population of children with attention deficit hyperactivity disorder

To determine the prevalence of thyroid hormone abnormalities and generalized resistance to thyroid hormone in a population of children with attention deficit hyperactivity disorder (ADHD) as compared to reference ranges determined from a control population and hence to determine if routine thyroid hormone screening in children with non-familial ADHD is indicated.

Method:

Children attending the State Child Development Centre in Perth, Western Australia with ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) provided the study population. The control population consisted of 353 normal children with a history of allergy in whom radioallergosorbent (RAST) testing was being performed.

Results:

The prevalence of thyroid hormone abnormalities in the study population was 2.3% (95% CI 0.6%, 5.7%). There were no cases of generalized resistance to thyroid hormone. The prevalence of thyroid hormone abnormalities in the general population of children and adolescents has been reported to vary between 1 and 3.7%.

Conclusion:

Routine thyroid hormone screening is not indicated in children with non-familial ADHD.     

Disentangling the Overlap between Tourette's Disorder and ADHD

Objective : To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. Method : The sample consisted of children with Tourette's syndrome with ADHD( N = 79), children with Tourette's syndrome without ADHD ( N = 18), children with ADHD ( N = 563), psychiatrically referred children ( N = 212), and healthy controls ( N = 140). Results: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. Conclusions: These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.     

多巴胺转运体基因多态性与注意缺陷多动障碍的关联性研究

【目的】探讨多巴胺转运体(DAT1)基因3^ 端40bp可变数串联重复(variable number of tandem repeat，VNTR)多态性与注意缺陷多动障碍(attention deficit hyperactivity dimmer，ADHD)之间的关系。【方法】运用聚合酶连反应(PCR)和VNTR多态性分析技术对西安地区汉族人群中54例符合DSM-Ⅳ诊断标准的ADHD儿童和其父母进行DAT1基因3^ 端40bpVNTR多态性检测，采用基于单体型的单体型相对风险(haplotype-based haplotype relative risk，HHRR)和传递不平衡检验(trarksmission disequilibrium test，TDT)等统计方法进行ADHD与DAT1基因多态性的关联分析。【结果】①所测人群中DAT1的40bpVNTR多态性表现出7～11倍重复的5种等位基因，其中最常见的等位基因为10倍重复的480bp片段，占90．7％。共检出6种基因型，其中最常见的基因型为480bp／480bp，占82．1％。②对54个ADHD核心家系进行HHRR和TDT关联分析，未显示出ADHD和DAT1基因存在关联。【结论】在西安地区汉族人群中DAT1基因与ADHD之间无显著性关联，DAT1基因多态性中的10倍重复等位基因可能不是ADHD的遗传危险因素。     

注意力缺陷及注意缺陷多动障碍患儿局部脑血流灌注的研究

【目的】探讨注意缺陷／多动障碍(ADHD)各亚型局部脑血流(rCBF)特点以及与不同临床类型的关系。【方法】用单光子发射计算机断层扫描(SPECT)测定了40例ADHD患儿和11例正常儿童rCBF灌注情况。【结果】定性分析结果显示，ADHD患儿低疋BF灌注量的发生率(57．5％)高于正常儿童(9％)，低灌注部位涉及额叶、颞叶、枕叶和丘脑，以额叶发生率最高；伴有多动一冲动组低rCBF注量的发生率(66．7％)高于注意缺陷组(47．3％)，同时，伴有多动一冲动组中在所有疋BF降低的脑区中，左侧占14例次，右侧占10例次，左右侧rCBF差异有显著性。【结论】额叶rCBF降低与ADHD行为抑制缺陷相关，同时左侧脑区血流下降与病情的严重程度相关。     

Behavioral outcome including attention deficit hyperactivity disorder/hyperactivity disorder and minor neurological signs in perinatal high-risk newborns at 4−6 years of age with relation to risk factors

BACKGROUND: Diagnostic problems with the criteria of attention deficit hyperactivity disorder (ADHD) in the Diagnostic Statistical Manual, 4th edn, have been identified. The aim of this study was to clarify whether the minor neurological signs test (MNT) the authors had previously reported was a predictor for the criteria of ADHD or hyperactivity disorder (HD) in perinatal risk children at 4-6 years of age and what kind of risk factors related to MNT. METHODS: A total of 136 children discharged from neonatal intensive care units were examined at the age of 4-6 years by a developmental neuropediatrician using both MNT and diagnostic criteria of DSM-IV ADHD/ICD-10 (International Classification of Diseases, 10th edn) HD. SPSS base and professional were used for statistical analysis. RESULTS: On comparison of diagnostic criteria between ADHD (11.0%) and HD (27.5%), the incidence in the same subjects showed significant difference. MNT scores showed significant correlation with criteria of ADHD (P < 0.01) and HD (P < 0.05). Diagnostic validity of MNT for predicting ADHD was demonstrated with 78% sensitivity and 79% specificity. High positive rates on MNT did not show a significant difference between the very low birthweight (VLBW) and non-low birthweight (NLBW) groups. Behavioral outcome with relation to risk factors were analyzed using multiple regression analysis. Apgar 5 in the NLBW group and toxemia of pregnancy and small for gestational age (SGA) in VLBW group were highly correlated with behavioral outcome. CONCLUSIONS: Minor neurological signs test score was a significant predictor for criteria of ADHD and HD. High incidences of positive MNT were suspected in not only VLBW children but also NLBW children and Apgar 5 in NLBW children and toxemia of pregnancy and SGA in VLBW children influenced behavioral outcome.     

不同亚型注意缺陷多动障碍患儿脑电活动的特征

[目的]探讨儿童注意缺陷多动障碍（attention deficit hyperactivity disorder,ADHD）三个亚型儿童及正常对照组儿童脑电活动的特征.[方法]将门诊符合DSM-Ⅳ诊断标准的110例ADHD儿童分为注意缺陷为主型（PI）49例,多动或冲动为主型（HI）19例,混合型（CT）42例,对照组儿童35例,对其进行脑电图检查并进行比较.[结果]ADHD组儿童脑电频率明显慢于正常对照组（P＜0.05）.三个亚型ADHD患儿中HI型脑电频率最慢,PI型频率最快,三个亚型间两两比较差异有非常显著性（P＜0.01）.HI型内右前额、右额部及右枕部的脑电频率明显慢于左半球（P＜0.05）.三个亚型在右枕部的脑电频率均慢于左半球.[结论]ADHD存在有一定的神经生理基础,其发病机制可能与大脑发育不成熟有关.     

二十二碳-6烯酸对注意缺陷多动障碍患儿神经生化及行为影响的研究

【目的】探讨二十二碳-6烯酸（DoCosahexaenoiCacid，DHA）对注意缺陷多动障碍（attention deficit hyperactivitydisorder，ADHD）患儿神经生化及行为影响，观察补充DHA对ADHD患儿症状行为的改变情况。【方法】通过对确诊的ADHD儿童补充DHA，检测其血清中多巴胺（dopamine，DA）、5-羟色胺（5-hydroxytryptamine，5HT）以及促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）的水平在服用前后的变化，并分析这些变化对ADHD儿童行为改变的影响。【结果】①ADHD儿童血清DA、5-HT、ACTH含量在服用前后差异均有显著性（P〈0．05）。男童血清DA、ACTH水平，女童血清5-HT、ACTH水平，中学生血清DA、5-HT水平在服用前后差异也均有显著性。②服用后儿童行为问题检出率12．5％，低于服用前的37．9％（P〈0．05）。6～16岁ADHD男童Achenbach儿童行为量表（Child Behavior Checklist，CBCL）行为得分在补充DHA后有所改善（P〈0．05）。③DA水平与多动指数水平呈负相关（r=-0．300，P〈0．05）；5-HT水平与注意缺陷指数水平存在负相关（r=-0．434，P〈0．05）；ACTH水平与注意缺陷指数水平存在边缘正相关（r=0．236，P=0．047）。【结论】DHA对ADHD患儿DA、5-HT及ACTH水平有一定调控作用，对改善其临床症状有一定疗效。     

Cortical cholinergic inputs mediate processing capacity: effects of 192 IgG-saporin-induced lesions on olfactory span performance

An olfactory span task that required rats to discriminate an olfactory stimulus added to an increasing list of such stimuli (nonmatching-to-sample; NMTS) was employed to assess the role of the basal forebrain cholinergic system in the animals' olfactory working memory capacity. A separate group of animals was trained in a matching-to-sample (MTS) version of this task that did not tax span performance. NMTS animals required significantly more sessions to reach an olfactory span of 18 stimuli than MTS rats. Infusions of the cholino-immunotoxin 192 IgG-saporin into the basal forebrain resulted in decreases of cortical acetylcholinesterase (AChE)-positive fibre density ranging from 80% in frontodorsal and frontoparietal regions to 35% in the pyriform cortex and 24% in the olfactory bulb. Postsurgery span performance was significantly reduced in lesioned NMTS but not MTS animals. Span performance in lesioned NMTS animals recovered following 4 weeks of postoperative training; however, these animals' span remained vulnerable to the effects of increased intertrial intervals. The distribution of errors in lesioned animals indicated a recency effect. In NMTS animals, olfactory span performance during the initial two postoperative weeks correlated significantly with AChE-positive fibre density in neocortical but not olfactory areas. The privileged, automatic processing of olfactory stimuli in rats may have contributed to the transience of the lesion effect. The results support the crucial role of cortical cholinergic input in the mediation of aspects of processing capacity.     

Adolescent hyperactivity and general psychopathology

The aim of this study was to explore the relationship between activity and psychopathology in adolescents. A total of 289 high school students completed the Symptom Check List-90-R (SCL-90-R) and Wender Utah Rating Scale (WURS) in December 1998. The WURS was used to measure the students' activity level and the SCL-90-R was used as a measure of general psychopathology. Forty-one students (14.18%) scored higher than 46, the cut-off point for differentiation of attention deficit hyperactivity disorder (ADHD) from the general population according to Ward's report, in the WURS (WURS(+)). The WURS(+) students scored significantly higher than the WURS(-) students in all the subscales of SCL-90-R. The prevalence rate of adolescent WURS(+) in this study is 14.18%. This result shows that ADHD adolescents have overlapping symptoms with depression.