Relationship of Ferritin to Symptom Ratings Children with Attention Deficit Hyperactivity Disorder: Effect of Comorbidity

Our aim was to investigate the relation between behavioral symptoms and hematological variables which are related with iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and reticulosite distribution width (RDW) in children and adolescents with pure Attention Deficit Hyperactivity Disorder (ADHD) or ADHD comorbid with other psychiatric disorders. The sample consisted of 151 subjects with ADHD, 45 of these subjects had other comorbid conditions. Conners Parent (CPRS) and Teacher Rating Scales (CTRS) were obtained. Comorbid ADHD subjects had lower mean hemoglogin and MCV. In the ADHD group in general, CPRS and CTRS Total scores were significantly negatively correlated with ferritin level. When only pure ADHD subjects were taken into account, the correlations did not reach statistical signifance. Overall, these results suggested that lower ferritin level was associated with higher behavioral problems reported by both parents and teachers. Presence of comorbid conditions might increase the effect of lower iron stores on behavioral measures.     

Sensory processing in children with Autism Spectrum Disorder: Relationship with non-verbal IQ,autism severity and Attention Deficit/Hyperactivity Disorder symptomatology

The main objective of this study was to analyze in a sample of children with ASD the relationship between sensory processing, social participation and praxis impairments and some of the child's characteristics, such as non-verbal IQ, severity of ASD symptoms and the number of ADHD symptoms (inattention and hyperactivity/impulsivity), both in the home and main-classroom environments. Participants were the parents and teachers of 41 children with ASD from 5 to 8 years old (M = 6.09). They completed the Sensory Processing Measure (SPM) to evaluate sensory processing, social participation and praxis; the Gilliam Autism Rating Scale (GARS-2) to evaluate autism severity; and a set of items (the DSM-IV-TR criteria) to evaluate the number of inattention and hyperactivity/impulsivity symptoms in the child. Non-verbal IQ – measured by the Raven's Coloured Progressive Matrices Test – did not show a relationship with any of the SPM variables. The SPM variables were significant predictors of autism severity and had similar weights in the two environments. In the case of ADHD symptoms, the SPM variables had a greater weight in the home than in the classroom environment, and they were significant predictors of both inattention and hyperactivity/impulsivity – especially inattention – only in the family context. The moderate association between inattention and auditory processing found in the main-classroom suggests the possible utility of certain measures aimed to simplify any classroom's acoustic environment.     

Self-esteem and anxiety in human figure drawing of Iranian children with ADHD

This study is aimed at investigating the self-esteem and anxiety of children with Attention Deficit/Hyperactivity Disorder compared with normal children by means of Draw-A-Person Test. 30 children with ADHD were selected from psychiatric clinics of Isfahan, Iran using multi-cluster sampling. 30 normal children were also selected from public schools of Isfahan by the same method. The results were analyzed using analysis of variance and Chi-square. In this research, six criteria were selected from Draw-A-Person Test. The results revealed significant differences between the performance of the children with ADHD and normal children in terms of size and line characteristic (P < 0.05). For the other criteria no significant difference was found between these groups. Based on this finding, some aspects of drawing may be more meaningful than other aspects in drawings of children with ADHD.     

Exploring the neural mechanisms that underlie motor difficulties in children with Attention Deficit Hyperactivity Disorder

Background: Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioural disorder of childhood. Motor performance appears to be impaired for an important sub-set of this population.

Objectives: This structured review draws attention to the neurological mechanisms that could potentially explain these difficulties.

Methods: In August 2010, Medline, PsychINFO and Embase databases were searched with keywords related to ADHD, neuroimaging modalities and motor performance.

Results: Four studies were retrieved that examined both motor performance and possible neural substrates. Each study explored different hypotheses and no common conclusion is emerging. The cortical activation dysregulation hypothesis, the cerebellar dysfunction hypothesis and the delayed white matter maturation hypothesis were proposed, applying combinations of motor observations and neuroimaging findings.

Conclusion: Published literature to date is insufficient to confirm specific hypotheses. Additional studies coupling discrete motor evaluations to neuroimaging techniques are needed in children with ADHD to better understand the neurobiological mechanisms of their motor difficulties.     

Young People’s Experience of ADHD and Stimulant Medication: A Qualitative Study for the NICE Guideline

Background: The NICE ADHD Guideline Group found a lack of research evidence on young people’s experiences with stimulant medications. The present study was commissioned to help fill this gap in the evidence base and to inform the Guideline. Method: Focus groups and 1:1 interviews with 16 UK young people with ADHD. Results: Young people were positive about taking medication, feeling that it reduced their disruptive behaviour and improved their peer relationships. Young people experienced stigma but this was related more to their symptomatic behaviours than to stimulant drug medication. Conclusions: The study’s findings helped to inform the NICE guideline on ADHD by providing evidence that young people’s experiences of medication were in general more positive than negative. All NICE Guidelines involving recommendations for the treatment of young people should draw on research evidence of young people’s experiences of treatments.     

Cluster analysis of child behavior checklists of 6 to 11-year-old males with varying degrees of behavior disorders

Achenbach Child Behavior Checklist ratings were collected on boys aged 6 to 11 years screened as not having significant behavior problems, as clinic-referred boys, and as boys diagnosed as having Attention Deficit-Hyperactivity Disorder alone or together with Oppositional-Defiant Disorder or Conduct Disorder. Cluster analysis resulted in a classification system related to DSM-III-R classification of the boys and parent self-report of mildly antisocial acts. Clusters also enhanced the ability of the instrument to detect Attention Deficit Hyperactivity Disorder and disruptive behavior disorders.     

Comorbidity for disruptive behavior disorders in psychiatrically hospitalized children

A variety of instruments were used to compare six groups of inpatient children: pure attention deficit disorder with hyperactivity (ADDH), pure conduct disorder (CD), pure oppositional defiant disorder (OD), ADDH+CD, and ADDH+OD, and a clinical control group who had no DBD diagnosis. Children with ADDH and CD or OD exhibited a greater degree of psychopathology. Children with CD and OD were more similar than different, indicating that perhaps a continuum of pathology exists between these diagnostic classifications.     

ADHD Rating Scale IV: psychometric properties from a multinational study as a clinician-administered instrument

The development of rating scales for attention-deficit/hyperactivity disorder (ADHD) has traditionally focused on parent-or teacher-rated scales. However, clinician-based instruments are valuable tools for assessing ADHD symptom severity. The ADHD Rating Scale IV (ADHD RS), clinician administered and scored, has been validated as a useful instrument to assess ADHD symptoms among American children and adolescents. In this study, we assessed the psychometric properties of the scale in a recent clinical trial conducted mainly in Europe with over 600 children and adolescents diagnosed with ADHD. The trial was conducted in 11 European countries plus Australia, Israel, and South Africa. Results based on data in the study indicate that this version of the scale has acceptable psychometric properties including inter-rater reliability, test-retest reliability, internal consistency, factor structure, convergent and divergent validity, discriminant validity, and responsiveness. There were low-to-moderate ceiling and floor effects. The psychometric properties were comparable with other validated scales for assessing ADHD symptom severity. These results were consistent across the 14 countries participating in this trial. Overall, the data from this study support the use of the ADHD RS as a clinician-rated instrument for assessing the severity of ADHD symptoms in children and adolescents in Europe.     

Social Skills and Behavior Problems in Children with Disabilities with and without Siblings

This study examined social skills and behavior of children with disabilities (CWD) and the impact of siblings on these behaviors. Eighty-five CWD diagnosed with Attention-Deficit Hyperactivity Disorder only (ADHD-o), Learning Disability or Learning Problems (LD/LP), ADHD and LD combined (ADHD/LD) or Spina Bifida (SB) and their siblings were evaluated using standardized social skills and behavior rating scales. The ADHD-o group had significantly lower social skills and more behavior problems than the other groups. There was no recognized effect of the sibling relationship on the social skills and behavioral problems of either the CWD or their siblings. Birth order of the sibling dyads and diagnos(es) of siblings did not have significant influence on the social skills or behavior of CWD. ADHD is a significant risk factor for poor social skills and behavior problems, even when compared with other diagnoses that carry an increased risk of these same problems.     

The Relationship Between Sensory Processing Patterns and Behavioural Responsiveness in Autistic Disorder: A Pilot Study

Sensory processing (SP) difficulties have been reported in as many as 95% of children with autism, however, empirical research examining the existence of specific patterns of SP difficulties within this population is scarce. Furthermore, little attention has been given to examining the relationship between SP and either the core symptoms or secondary manifestations of autism. In the current study, SP patterns in children with autistic disorder (AD) were investigated via a caregiver questionnaire and findings were correlated with the social, emotional and behavioural responsiveness of participants. Results indicated the presence of specific SP patterns in this sample of children with AD and several significant relationships were found between SP and social, emotional and behavioural function.     

Changes in EEG Spectrograms,Event-Related Potentials and Event-Related Desynchronization Induced by Relative Beta Training in ADHD Children

ABSTRACT

Background. During the last three decades EEG-based biofeedback (neurofeed-back) was used as an alternative treatment for reducing symptoms of ADHD. The goal of this study was to objectively assess the efficacy of biofeedback training by comparing spectrograms, ERPs and ERDs, measured before and after 20 sessions of neurotherapy in a group of ADHD children.

Method. Electroencephalogram (EEG), Event related potentials (ERPs) and event related synchronisation/desynchronisation (ERD/ERS) were recorded and computed in auditory GO/ NOGO task before and after 15–22 sessions of EEG biofeedback. Eighty-six ADHD children participated in the study. Each session consisted of 30 min of relative beta training. The patients were divided into two groups (good performers and poor performers) depending on their ability to elevate beta activity during sessions.

Results. Amplitude of late positive components of evoked potentials in response to NOGO stimuli increased, and event-related synchronisation in alpha frequency band measured at central areas decreased after the whole set of sessions of neurofeedback training in the group of good performers but did not change for the poor performers group. Evoked potential differences between post- and pre-treatment conditions for good performers were distributed over frontal-central areas, reflecting activation of frontal cortical areas associated with beta training.

Conclusion. Relative beta training with electrodes located above the frontal areas was associated with an increase of the late positive NOGO component. This activation likely indicates recovery of normal functioning of the executive system.     

Environmental enrichment improves cognitive deficits in Spontaneously Hypertensive Rats (SHR): Relevance for Attention Deficit/Hyperactivity Disorder (ADHD)

The interaction between genes and environment seems to be relevant for the development of Attention Deficit/Hyperactivity Disorder (ADHD), one of the most prevalent childhood psychiatric diseases. The occurrence of ADHD is typically associated with poor academic performance, probably reflecting learning difficulties and/or cognitive impulsiveness. The inbred Spontaneously Hypertensive Rats (SHR) strain has often been considered as an animal model of ADHD, since they ‘naturally’ display the main ADHD symptomatology. Although pharmacological agents improve SHR's cognitive deficits, little is known about the involvement of environmental factors in SHR disabilities and to what extent ‘protective’ non-pharmacological factors may be considered as strategy for ADHD prevention. Here we investigated whether the rearing environment during neurodevelopment may counteract later cognitive deficits presented by adult SHR. Wistar (WIS) rats were also used to investigate whether the putative effects of environmental enrichment depend on a specific genetic background. The animals were reared in enriched environment (EE) or standard environment (SE) from the post-natal day 21 until 3 months of age (adulthood) and tested for cognitive and non-cognitive phenotypes. EE improved SHR's performance in open field habituation, water maze spatial reference, social and object recognition tasks, while non-cognitive traits, such as nociception and hypertension, were not affected by EE. Response of WIS rats was generally not affected by the present EE. These results show that the general low cognitive performance presented by SHR rats strongly depends on the rearing environment and they may suggest modifications of the familial environment as a putative preventive strategy to cope with ADHD.     

Motor abilities of children and adolescents with a psychiatric condition: A systematic literature review

AIM: To summarize research regarding the motor abilities of children and adolescents who suffer from a common psychiatric condition.METHODS: In order to outline the current knowledge regarding the motor abilities of children and adolescents with autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders (DBD) and depression, a comprehensive systematic literature search was carried out using PubMed, Medline and ERIC databases. The databases were searched for relevant English language articles published between January 1990 and April 2014. Only studies that conducted a quantitative evaluation of motor ability and concerned individuals aged 0-18 years were included. A separate search was conducted for each disorder (ASD, ADHD, DBD, depression) in conjunction with each of the following keywords: (psycho/perceptuo) motor/movement skill(s), (psycho/perceptuo) motor/movement abilities, (psycho/perceptuo) motor/movement impairment, (psycho/perceptuo) motor/movement problem(s), motor function, motor coordination, motor performance, motor deficit(s). To detect supplementary relevant literature, the reference lists of the retrieved articles were examined.RESULTS: The search strategy yielded 51 studies meeting the inclusion criteria. In total, 28 studies were included that examined the motor abilities of children and adolescents with ASD. All studies indicated that they performed below average on various standardized motor assessment instruments. The overall prevalence rate for impairment in motor abilities ranged from 33% to 100%. Twenty-seven studies examined the motor abilities of children and adolescents with ADHD. Depending on the type of motor assessment tool and the cut-off points used by different researchers, prevalence rates of impairment in motor abilities are highly variable and ranged from 8% to 73%. Remarkably, there is a paucity of research addressing the motor abilities of individuals with DBD or depression. Furthermore, methodological problems, such as measurement and comorbidity issues, complicate the generalization of the findings.CONCLUSION: Research suggests that motor impairment is highly prevalent in some psychiatric conditions, particularly ASD and ADHD. However, future work is necessary to draw sound conclusions.     

Social Problems Associated with ADHD vs. ODD in Children Referred for Friendship Problems

Four groups were composed of children referred for friendship problems (age range: 6 to 12 years old). One group was diagnosed with both Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional-Defiant Disorder (ODD), one group with ADHD only, one group with ODD only and one group with neither disorder. Parents and teachers were given questionnaires to rate the social behavior of each child. The groups differed significantly on one parent scale (Self-control) and one teacher scale (Aggression). Inspection of the items composing these scales suggested that some items measured social relationships with adults while other items measured peer relationships. Subsequent factor analysis separated peer and adult components. Analysis of subscales derived from factor analysis revealed the diagnosis of ADHD was associated with increases in classroom disruption and decreased resistance to provocation by peers, while the diagnosis of ODD was associated with increased in hostility towards peers, decreased resistance to provocation by peers and decreased respect for adults. Limitations of the study were: domains of social functioning assessed, sample size and diversity, and the absence of a comparison group with adequate peer relationships. Social skills programs should target social deficits associated with ODD and ADHD. The scales refined in the present study offer a convenient means of assessing peer dysfunction from the points of view of parents and teachers.     

ADHD and genetic syndromes

A high rate of Attention Deficit/Hyperactivity Disorder (ADHD)-like characteristics has been reported in a wide variety of disorders including syndromes with known genetic causes. In this article, we review the genetic and the neurobiological links between ADHD symptoms and some genetic syndromes such as: Fragile X Syndrome, Neurofibromatosis 1, DiGeorge Syndrome, Tuberous Sclerosis Complex, Turner Syndrome, Williams Syndrome and Klinefelter Syndrome. Although each syndrome may arise from different genetic abnormalities with multiple molecular functions, the effects of these abnormalities may give rise to common effects downstream in the biological pathways or neural circuits, resulting in the presentation of ADHD symptoms. Early diagnosis of ADHD allows for earlier treatment, and has the potential for a better outcome in children with genetic syndromes.     

Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD)

BackgroundSleep difficulties have been reported in up to 85% of children with Attention Deficit hyperactivity disorder (ADHD). Children with ADHD exhibit commonly sensory modulation difficulties (SMD) and experience more significant functional difficulties. Sleep difficulties have also been associated with SMD. The aim of this study was to evaluate whether SMD are associated with sleep difficulties in children with ADHD.MethodsWe assessed sleep difficulties using the Children's Sleep Habits Questionnaire, and SMD using the Short Sensory Profile (SSP) questionnaire. A total of 25 children with ADHD and atypical sensory profiles, 13 children with ADHD and typical sensory profiles and 38 children used as controls (all children aged 8–11 years) were included.ResultsSleep difficulties were detected in 86.4% of children with ADHD and atypical SSPs, as compared to 30.8% of children with ADHD and typical SSPs, and 16.7% of controls. A multivariate logistic regression revealed that children with ADHD and atypical SSPs had significantly increased odds for sleep difficulties as compared to controls (OR = 32.4; 95% CI 4.0–260.1, p = 0.001), while children with ADHD and typical SSPs were indistinguishable from controls. Suspected confounders (gender, age, mother's education, and stimulant therapy) did not contribute to sleep difficulties.ConclusionIn this pilot study, SMD were associated with sleep difficulties in children with ADHD.     

Sensory processing problems in children with ADHD, a systematic review

One of the most common psychiatric disorders in children is attention deficit hyperactivity disorder (ADHD). Its course and outcome are heterogeneous. Sensory processing problems impact the nature of response to daily events. ADHD and sensory problems may occur together and interact. No published review article about sensory processing problems in children with ADHD were found. A systematic search, conducted on Pub-Med (up to January 2010), and Google Scholar, yielded 255 abstracts on sensory processing problems in children including 11 studies about sensory problems in children with ADHD. Sensory processing problems in children with ADHD is not a well studied area. Sensory processing problems in children with ADHD are more common than in typically developing children. Findings do not support that ADHD subtypes are distinct disorders with regard to sensory processing problems. However, co-morbidity with oppositional defiant disorder and anxiety are predictors of more severe sensory processing problems in children with ADHD.     

Impaired engagement of the ventral attentional pathway in ADHD

In the cognitive theories of Attention Deficit Hyperactivity Disorder (ADHD) impaired behavioral adjustment has been linked to a deficit in learning to detect regularities or irregularities in the environment. In the neural level, the P3 component of event-related potential (ERP) is modulated by stimulus probability and has been suggested to index activation of the ventral attention network, which constitutes the reorienting system of the human brain. To explore the cortical basis of late positive ERP components and the engagement of the ventral attentional pathway in ADHD, we used ERP recordings complemented by spatiotemporally sensitive magnetoencephalography (MEG) measurements. We followed the activation evoked by frequent Go and infrequent NoGo stimuli in 10 ADHD adults and 13 control subjects. In the ERP recordings, a prominent positive deflection was detected after the infrequent visual stimuli (late positive component, LPC) in both subject groups. In ADHD adults the difference between the responses evoked by infrequent NoGo and frequent Go stimuli was markedly reduced compared to the control group during the LPC. The MEG recordings revealed that the activation detected during the LPC was localized bilaterally in the posterior temporal cortex. Activation of the left and right temporal regions was enhanced after infrequent NoGo stimuli in both subject groups. In ADHD adults, however, the effect of stimulus frequency was less pronounced. We suggest that the activation in the superior temporal cortices during the LPC reflects the action of ventral attention network. The engagement of this stimulus-driven reorienting system is defective in ADHD.