Symptom control in children and adolescents with attention-deficit/hyperactivity disorder on switching from immediate-release MPH to OROS® MPH

Abstract Aim The aim of this study was to assess the impact of switching from immediate-release (IR) methylphenidate (MPH) to OROS^? MPH (CONCERTA^?), a once-daily long-acting MPH formulation, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods Subjects with ADHD aged 6–16 (n=105),who were stably maintained on their current IR MPH regimen (10–60 mg/day), were switched to 18, 36 or 54mg OROS^? MPH once daily for 21 days, depending on pre-study daily MPH dose.ADHD symptoms were assessed by parents, teachers and investigators. Results By Day 21, parent/caregiver IOWA Conners ratings had decreased from baseline by 2.7 points to 5.2 (I/O), and by 1.8 points to 5.0 (O/D). Teacher IOWA Conners ratings were maintained. Decreases in IOWA Conners ratings are indicative of ADHD symptom improvement. Approximately 75% of parents and investigators rated therapy as good or excellent. OROS^? MPH therapy was well tolerated. Conclusions Switching from IR MPH to OROS^? MPH maintained and may have improved symptom control in children and adolescents with ADHD, during the course of this study. The changes in parent/caregiver IOWA Conners ratings suggest that OROS^? MPH improves symptom control in the after-school period. This is consistent with the 12-h duration of action previously demonstrated for OROS^? MPH.     

Atomoxetine treatment in children and adolescents with attention-deficit hyperactivity disorder: what are the long-term health-related quality-of-life outcomes?

OBJECTIVE: Numerous investigations have examined the efficacy of pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) in children. However, relatively few studies have addressed the impact of treatment on long-term subjective, psychosocial outcomes, such as health-related quality of life (HRQL). This study examines the long-term effects of pharmacological treatment with atomoxetine on HRQL in children and adolescents with ADHD. METHODS: Participants included 6- to 17-year-old children and adolescents (n = 912) with ADHD enrolled in a 24-month, multicenter, open-label trial of atomoxetine. Outcomes included clinician ratings of ADHD, parent ratings of ADHD, and a widely used measure of HRQL (The Child Health Questionnaire (CHQ)). Treatment response rates were calculated based on a CHQ improvement of at least 1 standard error of measurement. RESULTS: Significant improvements in HRQL were found following both acute and long-term treatment for psychosocial but not physical health. Of participants who completed treatment (n = 312 or 34.2% of those enrolled), 81% responded to acute treatment and 78% responded to long-term treatment. Improvements noted after acute treatment were maintained during long-term treatment with the majority of participants (86%) continuing to respond to treatment. CONCLUSIONS: Atomoxetine is associated with improvements in HRQL, and the improvements are generally stable over time.     

Short-term test–retest reliability of resting state fMRI metrics in children with and without attention-deficit/hyperactivity disorder

To date, only one study has examined test–retest reliability of resting state fMRI (R-fMRI) in children, none in clinical developing groups. Here, we assessed short-term test–retest reliability in a sample of 46 children (11–17.9 years) with attention-deficit/hyperactivity disorder (ADHD) and 57 typically developing children (TDC). Our primary test–retest reliability measure was the intraclass correlation coefficient (ICC), quantified for a range of R-fMRI metrics. We aimed to (1) survey reliability within and across diagnostic groups, and (2) compare voxel-wise ICC between groups. We found moderate-to-high ICC across all children and within groups, with higher-order functional networks showing greater ICC. Nearly all R-fMRI metrics exhibited significantly higher ICC in TDC than in children with ADHD for one or more regions. In particular, posterior cingulate and ventral precuneus exhibited group differences in ICC across multiple measures. In the context of overall moderate-to-high test–retest reliability in children, regional differences in ICC related to diagnostic groups likely reflect the underlying pathophysiology for ADHD. Our currently limited understanding of the factors contributing to inter- and intra-subject variability in ADHD underscores the need for large initiatives aimed at examining their impact on test–retest reliability in both clinical and developing populations.     

Maternal parenting styles and mother–child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder

We investigated mothering and mother–child interactions in adolescents with and without persistent attention-deficit/hyperactivity disorder (ADHD) in a sample of 190 adolescents with persistent DSM-IV ADHD, 147 without persistent ADHD, and 223 without ADHD. Both participants and their mothers received psychiatric interviews for diagnosis of ADHD and other mental disorders; and reported on the Parental Bonding Instrument about mother's parenting style, the Social Adjustment Inventory for Children and Adolescents for interactions with mothers and home behavioral problems. The mothers also reported on their ADHD and neurotic/depressive symptoms. Our results based on both informants showed that both ADHD groups obtained less affection/care and more overprotection and control from the mothers, and perceived less family support than those without ADHD. Child's inattention and comorbidity, and maternal depression were significantly correlated with decreased maternal affection/care and increased maternal controls; child's hyperactivity–impulsivity and maternal neurotic trait were significantly correlated with maternal overprotection; and child's inattention and comorbidity, and maternal neurotic/depressive symptoms were significantly correlated with impaired mother–child interactions and less family support. Our findings suggested that, regardless of persistence, childhood ADHD diagnosis, particularly inattention symptoms and comorbidity, combining with maternal neurotic/depressive symptoms was associated with impaired maternal process.     

Quantitative synthetic MRI reveals grey matter abnormalities in children with drug-naïve attention-deficit/hyperactivity disorder

Brain Imaging and Behavior - To investigate the quantitative profiles of brain grey matter (GM) in pediatric drug-naïve ADHD patients using synthetic magnetic resonance imaging (SyMRI). A...     

Is there an association between perinatal complications and attention-deficit/hyperactivity disorder-inattentive type in children and adolescents?

ObjectiveThe objective of the present study is to investigate the association between attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive type (ADHD-I) and prenatal, delivery and early postnatal complications (PDPC).MethodIn a case-control design, we assessed a sample of 124 children and adolescents with ADHD-I and 124 non-ADHD controls (6-17 years old) from both a non-referred (n = 200) and a clinical sample (n = 48). Cases and controls, matched by gender and age, were systematically evaluated through structured diagnostic interviews. Prenatal, delivery and early postnatal complications (PDPC), as well as potential confounders were evaluated by direct interview with biological mothers.ResultsConditional logistic regression analysis showed that children and adolescents whose mothers presented more PDPC had a significantly higher risk for ADHD-I (p = 0.005; OR = 1.25; CI 95%: 1.1-1.5).ConclusionsIn a case-control study, we expanded to ADHD-I previous findings suggesting the association between perinatal factors and broadly defined ADHD. Due to the preventable nature of some of these PDPC, our results have clear impact in public mental health policies.     

Assessment of growth in pharmacological treatment-naïve polish boys with attention-deficit/hyperactivity disorder

Abstract Objective: The objective of this study was to estimate the growth of pharmacological treatment-na?ve polish boys with attention-deficit/hyperactivity disorder (ADHD). Method: The sample included 135 boys (mean age: 11.67 years) with ADHD. The level of subjects' height, weight, and body mass index (BMI) was compared to the reference growth charts. Full estimation of measurement accuracy was provided. Regression analysis was used to estimate the biological and social factors contributing to the growth determination in the examined group. Results: There were no statistically significant differences between mean body height of boys with ADHD and standards of growth of Polish children. Separate analyses for body height of the examined boys aged 6-10, 11-15, and 16-18 years also gave no statistically significant results. Mean body weight (z=0.28) and BMI (z=0.25) in the total cohort were statistically higher than the norm. After categorization of the boys according to age, statistically significant differences were demonstrated only for weight in the age range of 6-10 years (z=0.31) and for BMI in the age range of 11-15y (z=0.42). The regression analysis showed the strongest relation between the subjects' growth and the parents' body size, newborn's condition (birth, body weight, and APGAR score), factors connected with lifestyle, and socio-economic status of the family. Conclusion: The study revealed that the height of drug-na?ve boys with ADHD was not significantly different from the norm. The investigation also showed a tendency for greater body weight and BMI in boys with ADHD in comparison with the growth charts, which may be manifested also in greater risk of overweight and obesity in this group. The results of research suggest the necessity to control for such variables as genetic, perinatal, socioeconomic, and psychosocial factors, which may affect children's development, in future research on the growth of children with ADHD.     

The clinical dilemma of using medications in substance-abusing adolescents and adults with attention-deficit/hyperactivity disorder: what does the literature tell us?

OBJECTIVE: Adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD) are increasingly recognized in clinical practice. The role of pharmacological treatment for ADHD in these comorbid individuals remains unclear. METHODS: A systematic review of the medical literature was conducted through PubMed, supplemented with data from scientific presentations, to evaluate the role of medication treatment of ADHD in substance abusing individuals with ADHD. Meta-analysis was used to evaluate the effects of medication therapy on ADHD and SUD outcomes in general, while specifically addressing trial design, trial duration, retention, class of medication, age group, concurrent psychotherapy, and outcome in both SUD and ADHD domains. RESULTS: Four studies in adolescents and five studies in adults with ADHD plus SUD were identified (two controlled and seven open studies; n = 222 subjects). The standard mean difference (SMD) indicated statistically significant improvements in ADHD and SUD that were not maintained when evaluating controlled studies only. Albeit limited by power, trial duration, retention rate, and age group did not influence outcome. No worsening of SUD or drug-drug interactions were observed in any of the studies. The results could not be accounted for by any single study or by publication bias. CONCLUSION: Treating ADHD pharmacologically in individuals with ADHD plus SUD has a moderate impact on ADHD and SUD that is not observed in controlled trials and does not result in worsening of SUD or adverse interactions specific to SUD. Further controlled trials evaluating the effect of novel combinations of psychotherapy and ADHD pharmacotherapy on SUD relapse in these groups are warranted.     

Phonological short-term memory and central executive processing in attention-deficit/hyperactivity disorder with/without dyslexia – evidence of cognitive overlap

Summary Attention-deficit/hyperactivity disorder (ADHD) with/without dyslexia was investigated using a double dissociation design. Neuropsychological performance representing the core deficits of the two disorders was measured in order to test the common deficit hypothesis. Phonological short-term memory, morpho-syntactical language, and central executive processing (manipulating and switching) tasks were administered to four groups of 10–14 year old children (ADHD-only n = 20, dyslexia-only n = 20, ADHD+dyslexia n = 20, and controls n = 19). Comparisons of performance on these tasks were carried out using 2 (ADHD yes/no) × 2 (dyslexia yes/no) factorial analyses of variance and covariance. Significant main effects were found for dyslexia (language processing functions) and for ADHD (EF switching). In the case of the EF manipulating a main effect for both dyslexia and ADHD was revealed. Effect sizes of mean performance indicated that all three impaired groups shared a common deficit in working memory which could reflect a cognitive overlap partly explaining the high rate of co-occurring dyslexia and ADHD. Correspondence: Aribert Rothenberger, Department of Child and Adolescent Psychiatry, University of Goettingen, von-Siebold-Strasse 5, 37075 Goettingen, Germany     

Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)?

OBJECTIVE: To determine age and gender specific administrative prevalence of ADHD (hyperkinetic disorder, HKD, and hyperkinetic conduct disorder, HKCD, according to ICD-10-based coding) in Germany in 2003, and to assess physician involvement in medical care. METHOD: Retrospective claims database analysis covering the insured population of Nordbaden, Germany (n = 2.238 million). RESULTS: A total of 11,875 subjects with a diagnosis of HKD/HKCD were identified (overall 12-month prevalence rate 0.53%). Prevalence was highest among children age 7-12 years (5.0%; boys, 7.2%; girls, 2.7%). Among adults age 20 years and higher, prevalence was 0.04% (males, 0.04%; females, 0.03%). 36.0% (13.0%) of children and adolescents and 33.5% (12.5%) of adults with a diagnosis of ADHD were seen by a specialized physician at least once (four times) during the year. Physician involvement by discipline was highly skewed. CONCLUSION: Diagnosis rates in children and adolescents exceeded those expected according to ICD-10 criteria, but matched DSM-IV-based estimates. In the adult population, ADHD was rarely detected. Most patients were not seen by a mental health specialist, and physician involvement was highly concentrated. Potential policy implications include a high need for expertise among pediatricians and general practitioners. The data indicate an urgent need for further research into health care utilization and quality.