Controlled-release methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with a 3- to 4-fold increase in both driving-related accidents and associated injuries. Methylphenidate (MPH) is the most commonly prescribed psychostimulant medication for ADHD. It has been demonstrated to improve performance on a driving simulator. This study investigated whether a once-daily, long-acting, osmotic, controlled-release MPH formulation improves the driving performance of ADHD adolescents while driving their own car on an actual road segment. METHODS: Twelve ADHD-diagnosed male adolescent drivers (mean age, 17.8 years) prescribed a standard dose of 1.0 mg/kg (if they were not already taking methylphenidate) of controlled-release MPH participated in this repeated-measures crossover study. On 2 separate occasions (off/on medication randomized), participants drove a standard 16-mile road course incorporating rural, highway, and urban streets. A rater, blind to medication conditions, sat in the back seat and rated impulsive (eg, "cutting off" another driver) and inattentive (eg, drove past designated turn) driving errors. RESULTS: Impulsive driving errors were observed to occur rarely under both medication and no medication conditions. Inattentive driving errors were more common and were significantly reduced while the subject was on medication (4.6 versus 7.8; P <.01). The improvement in driving performance (change in number of errors recorded) from first to second testing was positively correlated with medication dosage (r = 0.60; P <.01). CONCLUSIONS: Once-daily controlled-release MPH improves real-life driving performance of adolescent males diagnosed with ADHD. In particular, it significantly reduces driving errors arising from inattention.     

Iron deficiency in children with attention-deficit/hyperactivity disorder

Iron deficiency in children with attention-deficit/hyperactivity disorder . Konofal E , Lecendreux M , Arnulf I & Mouren M-C. ( 2004 ) Archives of Pediatrics and Adolescent Medicine , 158 , 1113 – 1115 .     

Improving social adjustment in children with attention-deficit/hyperactivity disorder

OBJECTIVE: To determine if sending motivational letters would improve peer relations in children with social maladjustment and attention-deficit/hyperactivity disorder (ADHD). DESIGN: From a consecutive sample, a case series was followed up for 2 years. SETTING: Primary care, private physician, office-based practice. PATIENTS: Ninety-five children diagnosed as having ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria made up the consecutive sample. Twenty-one children qualified with a comorbid social maladjustment disorder with baseline t scores of 1.5 SDs or greater above the mean on the asocial domain of the Conners' Teacher Rating Scale. Seventeen children completed the study. There were no significant differences between these patients and those who did not complete the study (P = .55 for baseline score differences and P = .85 for age). INTERVENTIONS: In addition to conventional therapy for ADHD when children achieved a goal, such as an improved report card or better conduct, a personal letter about their success was mailed to them. Letters averaged 5 per student per year. MAIN OUTCOME MEASURES: The asocial domain of the Conners' Teacher Rating Scale was repeated during the next 2 school years for comparison. Statistical analysis was by a repeated-measures analysis of variance and Helmert contrasts. RESULTS: Of 17 students who completed the study, 16 improved on the Conners' Teacher Rating Scale asocial domain, and the results were statistically significant (P<.001). CONCLUSIONS: Difficulties with peer relations are commonly seen in children with ADHD. Sending motivational letters correlated with improved social adjustment in these children. The data suggest that busy practitioners might consider incorporating this successful, and time-efficient, intervention into their ADHD treatment regimens.     

儿童注意缺陷多动障碍诊断和治疗的研究

学龄期儿童注意缺陷多动障碍的发病率约为 11.5 % ,这对个人、家庭和社会产生深远的负面影响 ,故儿童注意缺陷多动障碍日益受到广泛重视 ,该文对目前国内外儿童注意缺陷多动障碍的诊断和治疗进展做一综述 ,拟为诊断和治疗儿童注意缺陷多动障碍提供帮助     

盐酸哌甲酯缓释片与盐酸托莫西汀对注意缺陷多动障碍患儿症状与执行功能的疗效研究

目的 比较盐酸哌甲酯缓释片(MPH)与盐酸托莫西汀(ATX)对注意缺陷多动障碍(ADHD)患儿症状及执行功能的改善效果,为临床干预提供更多依据。方法 选取2017—2019年上海交通大学医学院附属精神卫生中心儿少门诊未曾用药的ADHD患儿为研究对象。对建议服用药物的64名患儿,根据用药情况分为MPH组与ATX组。在基线、用药4周末、8周末及24周末评估症状得分及执行功能指标变化。采用斯诺佩量表(SNAP-Ⅳ)、Conners父母症状问卷(PSQ)对症状评估;Stroop测试、威斯康辛卡片分类测试、数字广度测试进行执行功能评估。结果 24周末两组ADHD患儿的症状得分及执行功能多个核心指标明显改善(P<0.05);两组患儿在基线、4周、8周及24周末的SNAP-Ⅳ量表评分、PSQ因子分、Stroop测验结果、WCST指标及背数的组间得分差异均无统计学意义(P>0.05)。结论 MPH与ATX均能持续改善ADHD的症状,提高执行功能表现。     

The implications of having attention-deficit/hyperactivity disorder in male adolescents with intellectual disability

Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. The purpose of this study was to demonstrate a correlation between social skills and ADHD among adolescents with intellectual disabilities (ID). The study concerns the specific cognitive and adaptive skills of adolescents dually diagnosed with mild intellectual disabilities and comorbid pathology as ADHD. Three age-and IQ-match groups (males, n = 12 in each group) were investigated. Group I--composed of adolescent diagnosed with mild ID, group II--adolescents diagnosed with ADHD, and group III--adolescents diagnosed with ID and ADHD. The instruments used in the study were Wechsler Intelligence Scale for Children (WISC, according to the chronological age of the subjects) and the short version of the Developmental Behavior Checklist (DBC). Results confirm that comorbidity is a factor differentiating. ADHD strongly increased the impairment of social skills, while behavioral disorders were less damaging in ID performance. The WISC and DBC instruments should be used with confidence in clinical and service settings, to allow a better assessment of co-occurrence morbidity in adolescents with ID. The interactions between intellectual disability and psychopathology behavior highlight the need to plan a more accurate diagnosis and appropriate rehabilitative intervention program, essential for improving the quality of life of the ID population.     

Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children --- United States, 2003 and 2007

Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder that typically begins in childhood and often persists into adulthood. ADHD is characterized by developmentally inappropriate levels of inattention and hyperactivity resulting in functional impairment in academic, family, and social settings. ADHD is the most commonly diagnosed neurobehavioral disorder of childhood, with previous reports documenting increasing trends in prevalence during the past decade and increases in ADHD medication use. National estimates of the number of children reported by their parents to have ever been diagnosed with ADHD and the percentage of children with ADHD currently taking ADHD medications were published in 2005 using data from the 2003 National Survey of Children's Health (NSCH). This report describes results from the second administration of NSCH in 2007, which indicated that the percentage of children aged 4-17 years with a parent-reported ADHD diagnosis (ever) increased from 7.8% to 9.5% during 2003-2007, representing a 21.8% increase in 4 years. The findings in this report help to further characterize the substantial impact of ADHD on families.     

父母小组培训对注意缺陷多动障碍儿童家庭干预的研究

[目的]探讨父母小组培训对注意缺陷多动障碍(attention-deficit/hyperactivity disorder,ADHD)儿童家,庭干预的研究,以促进ADHD规范治疗的作用.[方法]2006年3月～2007年1月期间初次诊断为ADHD的儿童280名,随机分为干预组146名和对照组134名.干预组家长参加父母小组培训班之后进行药物治疗;对照组未接受培训直接进行药物治疗.入组时及治疗1个月时分别评估两组家长对ADHD的认识及教育方式,比较前后变化,并比较两组之间使用药物治疗人数及药物治疗者中坚持随访2～12个月的人数.[结果]干预组的药物治疗率(50.7%)明显高于对照组(33.6%),(P＜0.01);在两组接受药物治疗者中,干预组的随访率(60.8%)也明显高于对照组(33.3%),(P＜0.01).家长干预前对ADHD的认识普遍较低,参加培训后对ADHD有了正确的认识,教育方式有所改进,并认为该方式对自己有帮助.对照组家长对ADHD的认识、教育方式前后比较差异无显著性.[结论]通过对门诊ADHD儿童家长进行培训,可以改善家长对ADHD的认知,使行为治疗基本策略走进家庭,提高药物治疗的依从性及长期随访率,从而促进对ADHD儿童的规范治疗;同时这样的培训模式促进了医息沟通和互动,家长易于接受,值得推广.     

儿童注意缺陷多动障碍服药依从性的影响因素及干预策略

注意缺陷多动障碍（AttentionDeficitHyperac—tivityDisorder,ADHD）是儿童期常见的认知行为发展性的精神障碍,其主要特征为与年龄不相称的注意力不集中、多动和冲动行为。目前ADHD的药物治疗国内外已达成共识,但在诸多因素的影响下,ADHD儿童服药依从性仍然较差。     

Efficacy of methylphenidate in bulimia nervosa comorbid with attention-deficit hyperactivity disorder: A case report

This case describes the beneficial effect on the binge eating component of bulimia nervosa of methylphenidate, which was prescribed to treat comorbid attention-deficit/hyperactivity disorder. Possible mechanisms of action are discussed. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 299–301, 1997.     

Antibiotic treatment patterns,costs, and resource utilization among patients with community acquired pneumonia: a US cohort study

Objectives: The current treatment options for patients with community-acquired pneumonia (CAP) often present a trade-off between the potential for treatment failure and safety concerns. We set out to investigate real-world outcomes associated with the use of currently available antimicrobial treatment options for CAP in both the outpatient and inpatient (non-intensive care unit [ICU]) settings.

Methods: This claims-based retrospective study included adult patients diagnosed with CAP and treated with antibiotic therapies, including any oral fluoroquinolone, macrolide, or beta-lactam monotherapy in the outpatient setting, and intravenous (IV) levofloxacin or IV azithromycin/ceftriaxone in the inpatient setting. Generalized linear model (GLM) regression was used to determine total charges for inpatient stay, the length of stay, and days of inpatient therapy. For outpatients, rates of adverse events (AEs), treatment failure, and hospitalization were compared by type of initial antibiotic therapy using logistic regression multivariate models that controlled for baseline characteristics.

Results: A total of 441,820 outpatients and 33,287 inpatients treated for CAP between 2007 and 2012 were included in this analysis. In the outpatient setting, fluoroquinolone therapy led to a higher rate of documented AEs (adjusted odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.20–1.25; p < 0.0001) but a lower rate of retreatment (adjusted OR: 0.9; 95% CI: 0.87–0.94; p < 0.0001) compared with macrolides. Both AEs and retreatment in these patients were associated with increased costs. For patients treated with the IV macrolide/beta-lactam combination compared with IV fluoroquinolone in the inpatient setting, a significantly longer length of stay in hospital (4.71 vs. 4.38 days; p < 0.0001) and greater overall costs ($3,535 more per stay; p < 0.0001) were observed.

Conclusion: In both the inpatient and outpatient settings, the development of additional efficacious treatment options that have a reduced AE burden for patients with CAP may be warranted.     

Dietary patterns and attention deficit hyperactivity disorder among Iranian children

ObjectiveThis study was conducted to assess the relation of major dietary patterns identified by factor analysis to attention-deficit/hyperactivity disorder (ADHD) in a group of Iranian school-age children.MethodsThis cross-sectional study was conducted in 375 school-age children in Tehran, Iran. We assessed usual dietary intakes by a semiquantitative food-frequency questionnaire. The presence of ADHD was diagnosed using the questionnaire of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Major dietary patterns were identified by factor analysis.ResultsThe prevalence of ADHD was 9.7% in this population. We identified four major dietary patterns: “healthy,” “Western,” “sweet,” and “fast food.” After controlling for potential confounders, children in the top quintile of the sweet dietary pattern score had greater odds for having ADHD compared with those in the lowest quintile (odds ratio 3.95, 95% confidence interval 1.16–15.31, P for trend = 0.03). Greater adherence to the fast-food dietary pattern was significantly associated with a higher risk of having ADHD (odds ratio 3.21, 95% confidence interval 1.05–10.90, P for trend = 0.03). No overall significant associations were seen between the healthy or Western dietary pattern and ADHD.ConclusionWe found significant independent associations between the sweet and fast-food dietary patterns and the prevalence of ADHD. Prospective studies are required to confirm these findings.     

注意缺陷多动障碍患儿242例分型诊断结果分析

[目的]对242例注意缺陷多动障碍（attention-deficit hyperactivity disorder,ADHD）儿童进行临床分型,探讨其可能存在的疾病规律和临床意义. [方法]对镇江城区小学生ADHD流行病学调查检出的242例ADHD儿童按DSM-Ⅳ量表同时作分型诊断与调查项目进行相关分析. [结果]ADHD患儿中注意缺陷为主型（predominantly inattentive type,PIT）为119例,占49.17%;多动冲动为主型（hyperactive-impulsive type,HIT）为36例,占14.88%;混合型（combine type,CT）为87例,占35.95%.各型均为男生多于女生,低年级HIT较高年级多;高年级PIT较低年级多.无论男生或女生PIT型随年龄增长均呈增高趋势,CT型均无明显改变,HIT型女生随年龄增长呈降低趋势,男生无明显改变.ADHD患儿中以PIT型最多,HIT型最少,CT居中. [结论]随着年龄增长,PIT型有逐渐增高趋势,提示对低年级HIT型患儿宣早期进行主动注意能力的培养和训练.环境心理影响因素与三个亚型之间无显著相关.     

The negative impact of attention-deficit/hyperactivity disorder on occupational health in adults and adolescents

Purpose

To review the negative effects of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood on work productivity and occupational health.

Methods

A review of the MEDLINE database was carried out to identify direct and indirect effects of ADHD on work, employment and occupational health.

Results

ADHD is associated with higher levels of unemployment versus controls. Adults with ADHD who are employed experience workplace impairment and reduced productivity, as well as behavioural issues such as irritability and low frustration tolerance. Adults with ADHD are also at increased risk of accidents, trauma and workplace injuries, particularly traffic accidents. Indirect effects of ADHD on occupational health include reduced educational achievement and increased rates of substance abuse and criminality. Overall, ADHD in adults has a substantial economic impact as a result of absenteeism and lost productivity. Psychoeducation, combined with stimulant medications if necessary, is recommended as first-line treatment for adults with ADHD. Limited data available suggest that stimulant treatment can improve work productivity and efficacy, and reduce the risks associated with driving, although further studies are necessary.

Conclusions

ADHD can affect the ability to gain and maintain employment and to work safely and productively. As ADHD is a treatable condition, patients, employers and physicians have a role to play in ensuring optimal occupational health.     

注意缺陷多动障碍共患病的诊断与治疗

注意缺陷多动障碍(ADHD)是儿童期常见的行为障碍之一,共患病率达48%,常见的共患病为对立违抗障碍、品行障碍、焦虑障碍、双相障碍、抑郁障碍、抽动障碍、孤独症谱系障碍、学习障碍、物质滥用等,现就ADHD的常见共患病进行介绍,结合相关指南对ADHD及其共患病的诊治进行讨论,以期为儿少科临床医师对该病的了解和处理提供帮助。     

Evaluation of dietary intake in children and college students with and without attention-deficit/hyperactivity disorder

Objectives: To evaluate dietary intake among individuals with and without attention-deficit hyperactivity disorder (ADHD), to evaluate the likelihood that those with ADHD have inadequate intakes.

Methods: Children, 7–12 years old, with (n?=?23) and without (n?=?22) ADHD, and college students, 18–25 years old, with (n?=?21) and without (n?=?30) ADHD comprised the samples. Children’s dietary intake was assessed by a registered dietitian using 24-hour recalls over 3 days. College students kept a detailed food record over three days. Dietary information for both groups was entered into the Nutrition Data Systems for Research database, and output was analyzed using SAS 9.4. Nutrient analyses included the Healthy Eating Index-2010, Micronutrient Index (as a measure of overall micronutrient intake), and individual amino acids necessary for neurotransmission. Logistic regression was used to model the association of nutrient intake with ADHD. Models were adjusted for age, sex, IQ (or GPA), and energy intake (or total protein intake) as appropriate. Significance was evaluated at P?=?0.05, and using the Benjamini–Hochberg corrected P-value for multiple comparisons.

Results: No evidence existed for reduced nutrient intake among those with ADHD compared to controls in either age group. Across both groups, inadequate intakes of vitamin D and potassium were reported in 95% of participants. Children largely met nutrient intake guidelines, while college students failed to meet these guidelines for nine nutrients. In regards to amino acid intake in children, an increased likelihood of having ADHD was associated with higher consumption of aspartate, OR?=?12.61 (P?=?0.01) and glycine OR?=?11.60 (P?=?0.05); and a reduced likelihood of ADHD with higher intakes of glutamate, OR?=?0.34 (P?=?0.03). Among young adults, none of the amino acids were significantly associated with ADHD, though glycine and tryptophan approached significance.

Discussion: Results fail to support the hypothesis that ADHD is driven solely by dietary micronutrient inadequacy. However, amino acids associated with neurotransmission, specifically those affecting glutamatergic neurotransmission, differed by ADHD status in children. Amino acids did not reliably vary among college students. Future larger scale studies are needed to further examine whether or not dietary intake of amino acids may be a modulating factor in ADHD.