Megalographia in Children with Cerebellar Lesions and in Children with Attention-Deficit/Hyperactivity Disorder

Structural changes of the cerebellum have been reported in attention-deficit/hyperactivity disorder (ADHD) in several studies. The cerebellum is a structure essential for motor coordination and motor learning. Beside behavioral deficits, children with ADHD often show slight motor abnormalities. In the present study, handwriting was examined in both children with ADHD and children with cerebellar lesions. By writing the same sentence several times, letter height increased in the ADHD and cerebellar groups but not in controls. Comparable disorders of handwriting in cerebellar and ADHD children support previous studies, which suggest a contribution of cerebellar dysfunction to motor abnormalities in ADHD. However, an involvement of non-cerebellar dysfunctions in ADHD cannot be excluded.     

Motor Function in School-Aged Children with Attention-Deficit/Hyperactivity Disorder in Korea

Objective

Motor function critically influences daily activities and academic performance. We compared motor function in school-aged children with Attention-Deficit/Hyperactivity Disorder (ADHD) to that of normal children.

Methods

Participants were 58 children with ADHD [51 males, 7 females; mean age 9 years 6 months±2 years 0 months (SD)] and 70 normal controls [56 males, 14 females; mean age 9 years 2 months±1 years 7 months (SD)]. We assessed motor function with the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition.

Results

The ADHD group had a significantly lower total motor composite score (t=-9.32, p<0.001) than that of the control group. Standard scores of four motor-area composites such as fine manual control (t=-3.76, p<0.001), manual coordination (t=-6.87, p<0.001), body coordination (t=-7.14, p<0.001), and strength and agility (t=-8.54, p<0.1) were significantly lower in the ADHD group than those in the control group. Among the subtests, scores on fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, and strength were significantly lower in the ADHD group than those in the controls, whereas upper-limb coordination was not significantly different between the groups.

Conclusion

School-aged children with ADHD in Korea had significantly lower motor function compared to that of controls. Thus, it is suggested that appropriate target intervention for motor function is important in children with motor impairment in addition to pharmacotherapy or psychosocial therapy for improving the core symptoms.     

Correlation Between EEG Activity and Behavior in Children with Attention-Deficit/Hyperactivity Disorder

The aim of this study was to determine whether EEG activity in specific bands correlated with the core behavioral symptoms of children with attention-deficit/hyperactivity disorder (AD/HD). Sixty boys diagnosed with AD/HD Combined type and 60 age-matched male controls participated in this study. An EEG was recorded during an eyes-closed resting condition and relative power estimates in the delta, theta, alpha, and beta bands, and the theta/beta ratio, were calculated. The EEG measures of the AD/HD group were converted to z scores relative to the controls, and these were correlated with scores on the Conners' Rating Scale obtained from a parent. The AD/HD group had global increases in theta activity and the theta/beta ratio, increased frontal delta, with reduced global alpha and frontal beta activity. Frontal theta activity correlated with inattention, the theta/beta ratio correlated with hyperactivity-impulsivity, and both measures correlated with a Combined type diagnosis. EEG power anomalies in AD/HD are associated with specific symptom clusters in the disorder.     

Peripheral Vasculopathy Associated with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder

Psychostimulants (methylphenidate and amphetamine salt) are the pharmacologic treatment of choice for children with attention-deficit/hyperactivity disorder. However, psychostimulants have been linked to a variety of vascular problems, including peripheral vasculopathy. This article describes four boys with attention-deficit/hyperactivity disorder who developed vasculopathy during treatment with psychostimulants.     

Clinical Utility of EEG in Attention-Deficit/Hyperactivity Disorder: A Research Update

Psychiatric research applications of electroencephalography (EEG), the earliest approach to imaging human cortical brain activity, are attracting increasing scientific and clinical interest. For more than 40 years, EEG research has attempted to characterize and quantify the neurophysiology of attention-deficit/hyperactivity disorder (ADHD), most consistently associating it with increased frontocentral theta band activity and increased theta to beta (θ/β) power ratio during rest compared to non-ADHD controls. Recent reports suggest that while these EEG measures demonstrate strong discriminant validity for ADHD, significant EEG heterogeneity also exists across ADHD-diagnosed individuals. In particular, additional studies validating the use of the θ/β power ratio measure appear to be needed before it can be used for clinical diagnosis. In recent years, the number and the scientific quality of research reports on EEG-based neurofeedback (NF) for ADHD have grown considerably, although the studies reviewed here do not yet support NF training as a first-line, stand-alone treatment modality. In particular, more research is needed comparing NF to placebo control and other effective treatments for ADHD. Currently, after a long period of relative stasis, the neurophysiological specificity of measures used in EEG research is rapidly increasing. It is likely, therefore, that new EEG studies of ADHD using higher density recordings and new measures drawn from viewing EEG as a 3-dimensional functional imaging modality, as well as intensive re-analyses of existing EEG study data, can better characterize the neurophysiological differences between and within ADHD and non-ADHD subjects, and lead to more precise diagnostic measures and effective NF approaches.     

Treatment of Preschoolers with Attention-Deficit/Hyperactivity Disorder

This article reviews the current treatment literature for attention-deficit/hyperactivity disorder (ADHD) in preschoolers. Parent training studies show consistent behavioral improvements reported by teachers and observers as well as parents, with evidence of clinically significant improvement in ADHD symptoms for up to 2 years. Few other behavioral interventions have been evaluated, although data from a large psychosocial, multimodal intervention are forthcoming. There is evidence to support the benefit of immediate-release stimulant medication for up to 1 year; however, effects do not seem to be as large, and some of the side effects may be greater than for school-age children. With regard to nonstimulants such as atomoxetine, there are literally no controlled outcome data for children with ADHD who are younger than 5 years of age. Overall, a great deal remains to be learned about the safety and efficacy of pharmacotherapy in this age group. Fortunately, results of several large intervention studies will be available soon to better inform clinical practice.     

Use of Treatment Services for Attention-Deficit/Hyperactivity Disorder in Latino Children

This article reviews recent research that examines service use for attention-deficit/hyperactivity disorder among Latino children. Using MEDLINE, PsycInfo, and PubMed, literature searches were conducted for research published between January 2008 and April 2010 that specifically focused on Latino children or included a sufficient sample of Latino children and examined racial/ethnic differences between groups. Eight studies regarding general service use, treatment with medication, and parenting interventions were identified and are reviewed herein. Results of these studies highlight important factors associated with the continued mental health service use disparities among Latino children, such as parental attitudes toward service use. Results also provide much-needed data with regard to adapting and engaging Latino parents into parenting interventions. Suggestions for clinical practice and future research are discussed.     

Attention-Deficit/Hyperactivity Disorder and Telemental Health

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders diagnosed in children and adolescents (youth). ADHD is equally distributed geographically, but services are not. Access to expert evaluation and treatment remains limited for youth with ADHD living in rural areas, as well as for ethnic and racial minority youth. Telepsychiatry is a service delivery model with the potential to reach these youth and to develop collaborative models of care among local primary care physicians, remote telepsychiatrists, and local families. Care delivered through telepsychiatry can readily adhere to the practice parameters of the American Academy of Child and Adolescent Psychiatry. Work to date indicates that ADHD is the most common disorder treated through telepsychiatry. This article reviews the status of child and adolescent telepsychiatry, with particular focus on its potential to improve the care and outcomes of underserved populations of youth diagnosed with ADHD.     

Teacher Acceptability of Evidence-Based and Promising Treatments for Children with Attention-Deficit/Hyperactivity Disorder

This study examined teachers’ acceptability of evidence-based and promising treatments for children with attention-deficit/hyperactivity disorder (ADHD). Teachers (N = 156) from 11 elementary schools read a vignette describing a boy with symptoms typical of combined type ADHD. Using the Intervention Rating Profile-10, teachers rated the acceptability of three promising treatments (peer tutoring, self-reinforcement, and social skills) and three evidence-based treatments, both psychosocial (daily report card and time-out) and pharmacological (stimulant medication). Teacher factors, including teacher self-efficacy, were evaluated as predictors of treatment acceptability. The daily report card (DRC) received the highest mean acceptability rating among the treatments, and was rated significantly higher than 4 of 5 other treatments; the DRC was not rated significantly higher than the self-reinforcement strategy. Years of experience was predictive of acceptability in that more experienced teachers rated time-out as more acceptable than peer tutoring. Results replicate previous findings and uniquely indicate that promising treatments are considered as acceptable, and in some cases, more acceptable than evidence-based treatments for children with ADHD.     

Effects of Acute Exercise on Resting EEG in Children with Attention-Deficit/Hyperactivity Disorder

This two stage study examined the effects of acute exercise on resting electroencephalographic (EEG) patterns of children with attention-deficit hyperactivity disorder (ADHD). The first stage compared the neural oscillatory patterns of children with and without ADHD. Resting EEGs were recorded under an open-eyes condition from 24 boys with ADHD and 28 matched controls. The second stage of the study employed a randomized cross-over trial design. The 24 boys with ADHD engaged in a 30-min intervention that consisted of either running on a treadmill or watching a video on alternative days, with resting EEGs recorded before and after treatment. The first stage found that children with ADHD exhibited significantly higher theta/beta ratios over the midline electrodes sites than controls. The second stage further indicated that children with ADHD displayed smaller theta/beta ratios following the exercise condition compared with the video-watching condition. This finding suggests that acute exercise normalizes arousal and alertness of children with ADHD, as reflected in resting EEG readings.     

EEG Activity in Females with Attention-Deficit/Hyperactivity Disorder

Although Attention-Deficit/Hyperactivity Disorder (AD/HD) affects millions of females worldwide, our understanding of AD/HD continues to be based heavily on male-dominated research. Significant sex differences reported in the presentation and diagnosis of AD/HD can no longer be ignored; females with AD/HD are different from males with the disorder. Electroencephalography (EEG) is a valuable tool for measuring electro-cortical activity and has been found useful in AD/HD research. Preliminary studies have shown that females with AD/HD have EEG abnormalities different from those found in males with AD/HD. This article reviews the current literature on EEG activity of females with AD/HD and concludes that the lack of comprehensive research draws attention to the necessity for sex-specific EEG research within AD/HD populations.