The written expression abilities of adolescents with Attention-Deficit/Hyperactivity Disorder

Students with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience deficits in academic achievement. Written expression abilities in this population have not been extensively studied but existing prevalence estimates suggest that rates of comorbid writing underachievement may be substantially higher than rates of comorbid reading and mathematics underachievement. The current study examined written expression abilities in a school-based sample of 326 middle school age students with ADHD. The prevalence of written expression impairment, the associations between written expression and academic outcomes, and specific patterns of written expression were investigated. Students with ADHD in this sample experienced written expression impairment (17.2–22.4%) at a similar rate to reading impairment (17.0–24.3%) and at a slightly lower rate than mathematics impairment (24.7–36.3%). Students’ written expression abilities were significantly associated with school grades and parent ratings of academic functioning, above and beyond the influence of intelligence. Analyses of patterns suggest that students with ADHD exhibit greater deficits in written expression tasks requiring organization and attention to detail, especially in the context of a complex task.     

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.     

Resting-state EEG gamma activity in children with Attention-Deficit/Hyperactivity Disorder

Objective

Children with Attention-Deficit/Hyperactivity Disorder (AD/HD) have well-described abnormalities in the four traditional EEG bands. However, to date the gamma band has not been widely investigated. This study investigated resting-state EEG in children with AD/HD and matched controls, with a particular focus on gamma activity.

Method

Forty children with AD/HD, and 40 age- and sex-matched controls, participated. EEG was recorded from 19 sites during an eyes-closed resting condition and Fourier transformed to provide estimates for absolute and relative power in the delta, theta, alpha, beta and gamma bands.

Results

Children with AD/HD had elevated levels of absolute delta and theta power, and decreased levels of absolute beta and gamma power, compared to controls. With relative power measures, children with AD/HD showed enhanced delta and theta activity, with reduced alpha, beta and gamma activity. Inattention scores on the Conners’ Parent Rating Scale were negatively correlated with absolute gamma.

Conclusions

These patients demonstrate the typical EEG profile in the eyes-closed resting state, over the delta, theta, alpha and beta bands, associated with AD/HD. In addition, compared with controls, they demonstrate reduced absolute and relative gamma activity. These differences appear to contribute importantly to their dysfunctional stimulus processing, and impact their behavioural outcomes.

Significance

This resting-state study extends the well-established fast-wave EEG deficits in children with AD/HD to the gamma band, and links that to increased inattention, which is of special importance in understanding their cognitive-processing problems.     

Attention-Deficit/Hyperactivity Disorder and comorbidity in Brazil

Abstract. Objective: The aim of this study was to compare the pattern of comorbidity in referred samples of Attention-Deficit/Hyperactivity Disorder (ADHD) patients from two different geographic areas in Brazil. Methods: The diagnoses of ADHD and comorbid conditions, according to DSM-IV criteria, were achieved in both clinics through semi-structured interview methodology, complemented by clinical interviews with the children or adolescents and their parents. Results: We assessed 343 ADHD children and adolescents in Porto Alegre (capital of the southernmost state of the country) and 78 ADHD youths in Rio de Janeiro (capital of a southestern state). Although a significant difference in the prevalence of ADHD without comorbidity was detected between the two groups (p = 0.02), no significant difference was detected in the profile of comorbidities between them. Main ADHD comorbidities in both samples were: a) Oppositional Defiant Disorder (Porto Alegre = 39.1%; Rio de Janeiro = 51.3 %); b) Anxiety Disorders (Porto Alegre = 24.2%; Rio de Janeiro = 30.8 %); c) Conduct Disorder (Porto Alegre = 13.7%; Rio de Janeiro = 17.9 %); and d) Major Depression and/or Dysthymia (Porto Alegre = 11.4%; Rio de Janeiro = 10.3 %). Conclusions: Our results from clinical samples in a developing country with a diverse culture suggest the crosscultural validity of the ADHD comorbidity profile.     

Attention-Deficit/Hyperactivity Disorder and Transitional Aged Youth

Purpose of Review

Extensive research has been conducted on attention-deficit/hyperactivity disorder (ADHD) in children and adults; however, less is known about ADHD during the transition from childhood to adulthood. Transitional aged youth (TAY) with ADHD represents a particularly vulnerable population as their newfound independence and responsibility often coincides with the development of comorbid disorders. The purpose of this review is to provide an update on the evaluation, diagnosis, and treatment of TAY-ADHD.

Recent Findings

Recent studies discovering ADHD symptoms emerging in TAY call the classification of ADHD as a disorder necessarily developing in childhood into question. TAY-ADHD are also shown to be vulnerable to academic and social impairments, increased risky behavior, and comorbid psychiatric disorders. Due to the risk of stimulant diversion in TAY, providers are advised to take precaution when prescribing medication to this population. Recent studies demonstrating the efficacy of psychotherapy in conjunction with non-stimulant or extended release stimulant medication provide a feasible alternative.

Summary

This review highlights research on the course and evaluation of ADHD, impairments and comorbidities specific to TAY, and treatments tailored to address the unique challenges associated with TAY-ADHD.

     

Attention-Deficit/Hyperactivity Disorder in African American Youth

This article examines attention-deficit/hyperactivity disorder (ADHD) in African American youth. Tackling the myths and misinformation surrounding ADHD in the African American community can be one of the most difficult issues in mental illness circles. There is a lot of conflicting information about how African Americans are diagnosed, examined, and treated. This article clarifies some of the misconceptions and offers some comprehensibility to the issue of ADHD in African American youth. The incidence of ADHD is probably similar in African Americans and Caucasians. However, fewer African Americans are diagnosed with and treated for ADHD. That reality flies in the face of some perceptions in many African American communities. Reasons for this disparity have not been fully clarified and are most likely complex and numerous. Some barriers to treatment are driven by the beliefs of patients and their families, while others are the result of limitations in the health care system. Patient-driven obstacles to care include inadequate knowledge of symptoms, treatment, and consequences of untreated ADHD and fear of overdiagnosis and misdiagnosis. System-driven limitations include a lack of culturally competent health care providers, stereotyping or biases, and failure of clinicians to evaluate the child in multiple settings before diagnosis.     

Alpha-2 Adrenergic Receptors and Attention-Deficit/Hyperactivity Disorder

Pharmacologic management of attention-deficit/hyperactivity disorder (ADHD) has expanded beyond stimulant medications to include α-2 adrenergic agonists. These agents exert their actions through presynaptic stimulation and likely involve facilitation of dopamine and noradrenaline neurotransmission, both of which are thought to play critical roles in the pathophysiology of ADHD. Furthermore, frontostriatal dysfunction giving rise to neuropsychological weaknesses has been well-established in patients with ADHD and may explain how α-2 agents exert their beneficial effects. In the following review, we consider relevant neurobiological underpinnings of ADHD with respect to why α-2 agents may be effective in treating this condition. We also review new formulations of α-2 agonists, emerging data on their use in ADHD, and implications for clinical practice. Integrating knowledge of pathophysiologic mechanisms and mechanisms of drug action may inform our medication choices and facilitate treatment of ADHD and related disorders.     

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.     

Ginkgo biloba for Attention-Deficit/Hyperactivity Disorder in children and adolescents: A double blind,randomized controlled trial

Background

Although stimulants are highly effective in controlling the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), some children will not respond to, or are intolerant of stimulants. Thus, the desire for safe and effective nonstimulant medications has risen during the past several years. Ginkgo biloba has been suggested in the treatment of dementia and memory impairment. We hypothesized that G.biloba would be beneficial for treatment of ADHD, and this could be evaluated in a double blind, randomized, parallel group comparison of G.biloba (Ginko T.D.™ Tolidaru, Iran) and methylphenidate.

Methods

Fifty outpatients (39 boys and 11 girls) with a DSM-IV-TR diagnosis of ADHD were study population of this trial. Subjects were recruited from an outpatient child and adolescent clinic for a 6 week double blind, randomized clinical trial. All study subjects were randomly assigned to receive treatment using tablet of Ginko T.D.™ at a dose of 80–120 mg/day depending on weight (80 mg/day for < 30 kg and 120 mg/day for > 30 kg) (group 1) or methylphenidate at a dose of 20–30 mg/day depending on weight (20 mg/day for < 30 kg and 30 mg/day for > 30 kg (group 2) for a 6 week double blind, randomized clinical trial. The principal measure of outcome was the Teacher and Parent ADHD Rating Scale- IV. Patients were assessed at baseline and at 21 and 42 days after the medication started.

Results

Significant differences were observed between the two groups on the Parent and Teacher Rating Scale scores. The changes at the endpoint compared to baseline were: − 6.52 ± 11.43 (mean ± S.D.) and − 15.92 ± 11.44 (mean ± S.D.) for Ginko T.D.™ and methyphenidate, respectively for Parent ADHD Rating Scale. The changes at the endpoint compared to baseline were: − 0.84 ± 6.79 (mean ± S.D.) and − 14.04 ± 8.67 (mean ± S.D.) for Ginko T.D.™ and methyphenidate, respectively for Teacher ADHD Rating Scale.The difference between the Ginko T.D.™ and methylphenidate groups in the frequency of side effects was not significant except for decreased appetite, headache and insomnia that were observed more frequently in the methylphenidate group.

Conclusion

The results of this study suggest that administration of G.biloba was less effective than methylphenidate in the treatment of ADHD.