Association of inattention with slow-spindle density in sleep EEG of children with attention deficit-hyperactivity disorder

ObjectiveWe evaluated the power of slow sleep spindles during sleep stage 2 to clarify their relationship with executive function, especially with attention, in children with attention deficit-hyperactivity disorder (ADHD).MethodsSubjects were 21 children with ADHD and 18 aged-matched, typically developing children (TDC). ADHD subjects were divided into groups of only ADHD and ADHD + autism spectrum disorder (ASD). We employed the Continuous Performance Test (CPT) to measure attention. We focused on sleep spindle frequencies (12–14 Hz) in sleep stage 2 and performed a power spectral analysis using fast Fourier transform techniques and compared sleep spindles with the variability of reaction time in CPT.ResultsIn the CPT, reaction variabilities in ADHD and ADHD + ASD significantly differed from those in TDC. Twelve-hertz spindles were mainly distributed in the frontal pole and frontal area and 14-Hz spindles in the central area. The ratio of 12-Hz frontal spindle power was higher in ADHD than in TDC, especially in ADHD + ASD. Significant correlation between the ratio of 12-Hz spindles and reaction time variability was observed.ConclusionsTwelve-hertz frontal spindle EEG activity may have positive associations with sustained attention function. Slow frontal spindles may be useful as a biomarker of inattention in children with ADHD.     

综合干预对注意缺陷多动障碍患儿的远期疗效分析

目的探讨综合干预和哌醋甲酯治疗注意缺陷多动障碍患儿(ADHD)的远期疗效。方法将门诊90例ADHD患儿随机分为观察组(药物治疗联合生物反馈、感觉统合训练)与对照组(单用药物组),多动症状控制后停止治疗,半年后评估。结果观察组10例(22.2%)患儿重现多动症状,对照组21例(46.7%)患儿重现多动症状;两组学习成绩、评分因子冲动-多动、焦虑、多动指数、瑞文智商(IQ)、记忆商(WMS)、知觉组织因子商(PoIQ)、记忆/注意力因子商(M/CIQ)比较有显著性差异。结论综合干预对ADHD的远期疗效较好。     

文拉法辛治疗注意缺陷多动障碍的疗效观察

目的观察文拉法辛治疗注意缺陷多动障碍的有效性和安全性。方法采用随机临床开放实验,对符合CCMD-3诊断标准的37例注意缺陷多动障碍患儿给予文拉法辛非固定剂量,平均107．25mg／d,共治疗6周;分别于治疗前、治疗后2、4和6周末采用儿童多动指数（IOWA Conners）、儿童大体评定量表（CGAS）评定疗效,不良反应量表评定药物的不良反应。结果37例患者治疗后CGAS评分有明显好转。不良反应轻微。结论文拉法辛不良反应较少,安全性好,是一种治疗注意缺陷多动障碍的有效药物。     

236例注意缺陷与多动障碍患者20年随访的结果

目的　研究注意缺陷与多动障碍儿童在成年后的结局。方法　使用中国精神障碍分类与诊断标准第三版 (CCMD - 3)对 2 0年前流行病学调查发现的注意缺陷与多动障碍患者进行随访 ,并与正常人群作对照分析。结果　 2 36例注意缺陷与多动障碍患者 ,2 0年后有 2 0 8%症状完全消失 ,79 2 %有残留症状 ,11 4 %仍符合注意缺陷与多动障碍诊断标准。其社会经济状况差 ,罹患人格障碍、酒依赖、海洛因依赖者较多 ,与对照组比较有显著性差异。结论　注意缺陷与多动障碍儿童在成年后有不同结局     

注意缺陷多动障碍儿童患者的事件相关电位研究

目的　研究注意缺陷多动障碍 (ADHD)儿童患者的事件相关电位 (ERP)主要成分 (P2 、N2 、P3 潜伏期与波幅 )。方法　用DSM Ⅳ诊断标准确定ADHD病例组 ,以年龄、性别 1:1匹配正常儿童为对照组。对所有儿童应用听觉Oddball模式诱发ERP ,记录主要成分进行分析比较。结果　ADHD组靶刺激计数正确率显著低于对照组 (P <0 .0 1) ;ADHD组P2 、N2 潜伏期显著延长 (P <0 .0 5 ) ;P3 潜伏期显著延长 (P <0 .0 1) ;N1～P2峰峰值显著低于对照组 (P <0 .0 5 ) ;两次记录P3 波重复性显著低于对照组 (P <0 .0 5 )。结论　ADHD患儿主动注意功能减弱 ,被动注意亢进 ,抗干扰能力减弱。其额前区功能可能受损     

注意缺陷多动障碍儿童的智力水平分析

目的　测试ADHD儿童的智力水平及分测验结构。方法　采用韦氏儿童智力量表 (C WISC)对 12 9名ADHD患儿和 87名正常儿童进行智力评估。结果　ADHD患儿的智商多在正常范围或边缘水平 ,但VIQ与PIQ之间的平衡性较差。结论　ADHD患儿的智商较正常儿童平均水平为低 ,且智力发展不平衡者较多 ,二组差异有显著性意义。     

Rapid improvement in academic grades following methylphenidate treatment in attention-deficit hyperactivity disorder

In the present study a 16 week comparison study was conducted of behavioral, cognitive and educational measures in school-age Taiwanese children with attention-deficit hyperactivity disorder (ADHD) receiving open-label methylphenidate (MPH). Subjects include 14 male and five female ADHD children. They received MPH twice per day continuously for 16 weeks. Measures of behavior, cognitive function (Wisconsin Card Sorting Test, Tower of London and Continuous Performance Test), Chinese and arithmetic learning achievement were compared with those of their baseline condition. After MPH, 68-78% of children showed improving behavior in classroom and at home. Among the neuropsychological tests, only the percentage of preservative error was improved (P = 0.022). Approximately 61-66% of children had improvement in academic learning (P = 0.013 for Chinese, 0.004 for arithmetic). The MPH treatment demonstrated improvement in domains of classroom/home behaviors and academic performance, but showed minimal change on neuropsychological functioning in Taiwanese ADHD children. The finding of academic gain was unexpected, which might be due to the greater interest in achievement and better compliance to cultural expectations by Taiwanese versus Western students, which translated into more rapid improvement in academic performance.     

Amphetamine-induced chorea in attention deficit-hyperactivity disorder.

Attention deficit-hyperactivity disorder (ADHD) is treated frequently with stimulants in both children and adults. While tics are occasional complications of stimulant therapy, chorea is reported rarely. We describe an adult ADHD patient who developed chorea upon dose escalation of mixed amphetamine salts, which resolved on discontinuation of the drug.     

Effects of stimulants and atomoxetine on cortisol levels in children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) have lower diurnal cortisol levels than non-ADHD comparison subjects. Aiming at elucidating the effects of medications used to treat ADHD, we investigated saliva cortisol in children with ADHD: 20 without medication, 147 on methylphenidate, and 21 on atomoxetine. The only significant finding was that children on atomoxetine had higher cortisol levels at bedtime than unmedicated children.     

Associations between symptoms of attention deficit hyperactivity disorder, depression, and suicide in Korean female adolescents

The objective of this study was to examine the associations between symptoms of attention-deficit/hyperactivity disorder (ADHD), depression, and suicide in Korean female adolescents. It was hypothesized that the relationship between ADHD symptoms and suicidal ideation would be mediated by the level of depressive symptoms. Seven hundred and eighty-eight high school girls completed the Conners/Wells Adolescent Self-Report Scale: Short Form, Children's Depression Inventory, and Reynolds Suicidal Ideation Questionnaire. Path analyses were conducted using the statistical program, AMOS version 4.0, to determine the best fitting model. The conduct, cognitive, and hyperactivity problems of the ADHD symptoms in each domain were associated positively with the depressive symptoms, with the depressive symptoms being associated with suicidal ideation. This initially proposed model represented an acceptable fit to the data (root mean square error of approximation, RMSEA=0.077; normed fit index, NFI=0.998; non-NFI, NNFI=0.990; comparative fit index, CFI=0.998). The inclusion of a direct path from the conduct problems of ADHD symptoms to suicidal ideation significantly improved the model fit (RMSEA=0, NFI=1, NNFI=1, CFI=1). The results of our study suggest that depressive symptoms partially mediate the relationship between ADHD symptoms and suicidal ideation, and that the conduct problems of ADHD symptoms are associated with suicidal ideation both directly and indirectly via the depressive symptoms in Korean female adolescents.     

Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members

The validity of the six-question World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was assessed in a sample of subscribers to a large health plan in the US. A convenience subsample of 668 subscribers was administered the ASRS Screener twice to assess test-retest reliability and then a third time in conjunction with a clinical interviewer for DSM-IV adult ADHD. The data were weighted to adjust for discrepancies between the sample and the population on socio-demographics and past medical claims. Internal consistency reliability of the continuous ASRS Screener was in the range 0.63-0.72 and test-retest reliability (Pearson correlations) in the range 0.58-0.77. A four-category version The ASRS Screener had strong concordance with clinician diagnoses, with an area under the receiver operating characteristic curve (AUC) of 0.90. The brevity and ability to discriminate DSM-IV cases from non-cases make the six-question ASRS Screener attractive for use both in community epidemiological surveys and in clinical outreach and case-finding initiatives.     

Sensitivity of the Test of Memory and Learning to Attention and Memory Deficits in Children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) exhibit a number of cognitive deficits. The current study compared patterns of attention, learning, and memory impairment on the Test of Memory and Learning (TOMAL) between 80 children with ADHD and 80 normal comparisons who were matched for age and gender. Results demonstrated that children with ADHD performed significantly worse than matched controls on the Attention/Concentration Index and the Sequential Recall Index. ROC analysis indicated that these two indexes had good classification accuracy with AUCs of.76 and.77 respectively. There were also group differences on the other index scores except the Associative Recall Index. Factor analysis of the ADHD sample extracted five factors, including an Attention factor that significantly correlated with performance on nonverbal memory tasks. Significant correlations between the TOMAL Index scores and tests of intelligence and visuomotor integration supported the convergent and discriminant validity of the test. These results provide support for the criterion validity of the TOMAL in assessing neurocognitive deficits in children with ADHD.     

Does exposure to maternal smoking during pregnancy affect the clinical features of ADHD? Results from a controlled study

Objectives. Exposure to maternal smoking during pregnancy may be a significant risk factor for attention-deficit/hyperactivity disorder (ADHD) independently of family history of ADHD. The main aim of this study was to examine whether the clinical profile of ADHD differs between children with and without exposure to maternal smoking during pregnancy. Methods. This was a case–control study of boys and girls with and without ADHD ascertained from psychiatric and paediatric sources. Maternal smoking during pregnancy was defined by interviews with subjects’ mothers. Main outcome measures were ADHD symptoms and associated clinical features in children with and without exposure to maternal smoking during pregnancy. Results. No significant differences were found between ADHD children with and without exposure to maternal smoking during pregnancy on clinical characteristics. When these analyses were repeated in the subgroup of subjects without parental history of ADHD, there were also no statistically significant differences found. Conclusions. Despite adequate statistical power, no significant differences were found between ADHD children with and without exposure in the clinical features of ADHD and associated disorders. Results provide support for the notion that ADHD cases resulting from exposure to maternal smoking during pregnancy have similar clinical profiles as other ADHD cases.     

Brain biochemical effects of methylphenidate treatment using proton magnetic spectroscopy in youth with attention-deficit hyperactivity disorder: a controlled pilot study

Introduction: This study conducted spectroscopic analyses using proton (1H) Magnetic Resonance Spectroscopy (at 4 Tesla) in a sample of adolescents with Attention Deficit Hyperactivity Disorder (ADHD), before and after treatment with extended release methylphenidate (OROS MPH), as compared to a sample of healthy comparators. Aims: The main aim of this study is to use 1H MRS to measure differences in brain biochemistry between adolescents with and without ADHD, and to assess changes in cerebral biochemistry, before and after stimulant treatment in ADHD youth. Results: Subjects with ADHD were medically healthy adolescents treated in an open label fashion with OROS MPH (mean dose: 54 mg/day; 0.90 mg/kg/day). Subjects with ADHD were scanned before and after OROS MPH treatment. Healthy comparators were scanned once. Magnetic resonance (MR) spectroscopy studies were performed on a 4.0 T Varian Unity/Inova MR scanner; proton spectra were acquired from the Anterior Cingulate Cortex (ACC). Data were analyzed using MANOVA and repeated measurement ANOVA. Higher metabolite ratios (Glutamate/myo‐inositol, Glutamine/myo‐inositol, Glutamate + Glutamine/myo‐inositol) were observed in the ACC in untreated ADHD subjects as compared to controls, and to treated ADHD youth; these group differences did not reach the a priori threshold for statistical significance. Conclusions: These preliminary findings suggest the presence of glutamatergic abnormalities in adolescents with ADHD, which may normalize with MPH treatment. Larger sample, controlled studies are needed to confirm these preliminary findings.     

Gestational and postnatal tobacco smoke exposure as predictor of ADHD, comorbid ODD/CD, and treatment response in the MTA

Objective: To examine relationships among early smoke exposure (ESE), attention-deficit/hyperactivity disorder (ADHD), oppositional-defiant or conduct disorder (ODD/CD), and whether ESE affects symptom severity, comorbidity, and later treatment response. Study design: The Multimodal Treatment Study of Children with ADHD (MTA) had 468 children with ADHD and 279 others from the same classrooms (local normative comparison group, LNCG) with smoke-exposure data. We compared ESE as ‘gestational’ or ‘postnatal’ (ambient house smoke only, without gestational) between ADHD and LNCG, and tested its association with ADHD severity, comorbid ODD/CD, methylphenidate response, and differential treatment response to four randomly assigned treatments. Results: About 1/3 more ADHD than LNCG children had ESE (both types), but association with gestational smoke attenuated from P=0.024 to 0.094 when subjects with comorbid ODD/CD were excluded, although total smoke exposure retained significance (P=0.006). In the MTA/ADHD participants, comorbid ODD/CD, and parent/teacher-rated ADHD and ODD symptom severity were not associated with gestational smoking, but severity of ODD was associated with postnatal smoke, and for boys only, ADHD severity at 14 months associated with postnatal smoke. When ODD and CD were ‘unbundled’, CD was associated (P=0.005) with gestational smoke. Neither ESE moderated response to methylphenidate, optimal dose, 2-year growth slowing, or differential ODD symptom response to 14-months of 4 randomly assigned treatments. However, for ADHD symptoms, postnatal smoke moderated (P=0.008) the 14-month advantage of behavioral treatment (Beh) over community-treated comparison (CC): postnatally exposed boys benefited relatively more from Beh (d>0.5). ADHD symptom improvement also showed significant interaction of sex with gestational (P=0.015) and postnatal (P=0.044) smoke moderator effect for the contrast of MTA medication algorithm vs. Beh and CC: smoke-exposed girls did not show the usual algorithm superiority. Conclusions: These findings suggest possible moderating effects of postnatal ESE on the advantage of intensive behavioral treatment and sex-differential moderating effects of ESE on the advantage of intensive medication over behavioral treatment. This exploratory result requires replication. The findings do not convincingly support the hypothesis that the association of gestational smoking with offspring ADHD is accounted for by comorbid ODD/CD.