Adult Attention Deficit Hyperactivity Disorder in an Anxiety Disorders Population

Adult Attention Deficit Hyperactivity Disorder (ADHD) is a life‐long, chronic disorder, which has its onset in childhood and is associated with significant functional impairment. ADHD appears to be highly comorbid with other psychiatric disorders, however, literature is lacking concerning ADHD/anxiety comorbidity. To that end, we examined the prevalence of ADHD in an anxiety disorder sample. Consecutive patients referred to an anxiety disorders clinic completed a variety of anxiety disorder self‐report measures as well as the Adult ADHD self‐report scale and were clinically assessed using the Structured Clinical Interview for DSM‐IV, and the ADHD module of the Mini International Neuropsychiatric Interview. Of the 129 patients assessed, the rate of adult ADHD was 27.9%. The mean age of the sample was 33.1 ± 12.5 years, and the mean baseline CGI‐S was 4.6 ± 1.1 (moderate to marked severity). The majority of the sample was female (63.6%) and single (49.5%). The most common comorbid disorders associated with ADHD were major depressive disorder (53.8%), social phobia (38.5%), generalized anxiety disorder (23.1%), and impulse control disorders (30.8%). Individuals with ADHD had higher symptom severity scores for obsessive‐compulsive disorder, (P≤ 0.05) and for GAD (P≤ 0.05) and reported a significantly earlier age of onset for depression as compared to those without (P≤ 0.05). The prevalence of adult ADHD was higher in our anxiety disorders clinic sample than found in the general population. Clinical implications of these findings are discussed.     

Psychopathologic Profiles and Clusters in Tertiary Clinic Referred Patients with Adult Attention Deficit Hyperactivity Disorder: A Person-Centered Analysis

ObjectiveAdult attention deficit hyperactivity disorder (ADHD) has a heterogeneous clinical presentation with patients showing very frequent emotional problems. In the present study, patients with adult ADHD were subtyped based on their psychopathology using a person-centered approach. MethodsIn the present chart review study, detailed findings of psychological evaluation conducted as part of routine care were utilized. A total of 77 subjects with adult ADHD were included in the analysis. Detailed ADHD symptoms, psychiatric comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, and severity of mood and anxiety symptoms were evaluated in the person-centered analysis. ResultsThree clusters were generated using clustering analysis. DSM comorbid conditions did not significantly impact the clustering. Cluster 1 consisted of ADHD combined presentation (ADHD-C) with less mood symptoms, cluster 2 of ADHD predominantly inattentive presentation and cluster 3 of ADHD-C with significant mood symptoms. Patients in cluster 3 had adulthood functional impairment more frequently compared with patients in cluster 1. Patients in cluster 3 showed recurrent thoughts of death and suicidal ideation more frequently compared with patients in cluster 1. ConclusionFurther studies are needed to confirm the relationships observed in the present study.     

Medium-term Outcome of Children Given Stimulants for Attention Deficit Hyperactivity Disorder

Many studies have demonstrated the short-term efficacy of stimulant drugs in decreasing the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). However, long-term studies have not shown a similar effect. In this study, we report an audit of the medium-term outcome of 50 children with ADHD referred to a mental health service and treated with stimulants for at least 6 months. A poor outcome group was identified consisting of 30% of the children. As a group, they received a significantly higher dose of stimulant. More studies, with prospective design, are required to examine the medium-term outcome of children with ADHD on medication.     

注意缺陷多动障碍患儿的SPECT研究

目的 探讨注意缺陷多动障碍(ADHD)儿童脑血流改变与临床症状及智力的关系。方法用非采血法SPECT显像法测定65例ADHD及20例正常组全脑血流(CBF)、左右脑血流量及局部脑血流量,并分析其与临床症状及智力水平的相关性。结果 ①40％ADHD存在rCBF降低,降低区域分布频率为额叶>丘脑,尾状核>颞叶>枕叶、顶叶。②ADHD患儿临床症状越严重,CBF血流量降低越明显,两者呈正相关(r=0.4618,P<0.05)。③CBF血流量降低越显著,ADHD患儿智力水平越低下(r=0.5614,P<0.05)。结论 注意缺陷多动障碍患儿脑血流改变与临床症状及智力水平有一定相关性。     

Baduk (the Game of Go) Improved Cognitive Function and Brain Activity in Children with Attention Deficit Hyperactivity Disorder

Objective

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with the deficit in executive functions. Playing Go involves many aspect of cognitive function and we hypothesized that it would be effective for children with ADHD.

Methods

Seventeen drug naïve children with ADHD and seventeen age and sex matched comparison subjects were participated. Participants played Go under the instructor''s education for 2 hours/day, 5 days/week. Before and at the end of Go period, clinical symptoms, cognitive functions, and brain EEG were assessed with Dupaul''s ADHD scale (ARS), Child depression inventory (CDI), digit span, the Children''s Color Trails Test (CCTT), and 8-channel QEEG system (LXE3208, Laxtha Inc., Daejeon, Korea).

Results

There were significant improvements of ARS total score (z=2.93, p<0.01) and inattentive score (z=2.94, p<0.01) in children with ADHD. However, there was no significant change in hyperactivity score (z=1.33, p=0.18). There were improvement of digit total score (z=2.60, p<0.01; z=2.06, p=0.03), digit forward score (z=2.21, p=0.02; z=2.02, p=0.04) in both ADHD and healthy comparisons. In addition, ADHD children showed decreased time of CCTT-2 (z=2.21, p=0.03). The change of theta/beta right of prefrontal cortex during 16 weeks was greater in children with ADHD than in healthy comparisons (F=4.45, p=0.04). The change of right theta/beta in prefrontal cortex has a positive correlation with ARS-inattention score in children with ADHD (r=0.44, p=0.03).

Conclusion

We suggest that playing Go would be effective for children with ADHD by activating hypoarousal prefrontal function and enhancing executive function.     

Evaluation of Oxidative Metabolism in Child and Adolescent Patients with Attention Deficit Hyperactivity Disorder

Objective

Oxidative metabolism is impaired in several medical conditions including psychiatric disorders, and this imbalance may be involved in the etiology of these diseases. The present study evaluated oxidative balance in pediatric and adolescent patients with attention deficit hyperactivity disorder (ADHD).

Methods

The study included 48 children and adolescents (34 male, 14 female) with ADHD who had no neurological, systemic, or comorbid psychiatric disorders, with the exception of oppositional defiant disorder (ODD), and 24 sex- and age-matched healthy controls (17 male and seven female).

Results

TAS was significantly lower, and TOS and OSI were significantly higher in patients with ADHD than in healthy controls. Total antioxidant levels were lower in patients with comorbid ODD than in those with no comorbidity. No difference was found in TOS or OSI among the ADHD subtypes; however, TAS was higher in the attention-deficient subtype.

Conclusion

Our findings demonstrated that oxidative balance is impaired and oxidative stress is increased in children and adolescents with ADHD. This results are consistent with those of previous studies.     

Methylphenidate and Interpersonal Relationships of Children with Attention Deficit Hyperactivity Disorder

Abstract: In order to clarify the effects of methylphenidate on interpersonal relationships of children with attention deficit hyperactivity disorder (ADHD), data from sociometric tests conducted in 28 classes to which ADHD children belonged was analyzed, comparing patients who had a history of methylphenidate treatment with those who had not. It was suggested that ADHD children with a history of methylphenidate treatment had more favorable votes and fewer unfavorable ones than those without it. However, there were more isolated children among ADHD children with methylphenidate treatment than in those without it. The results are discussed in the light of previous findings in the literature and a hypothesis for methylphenidate induced isolation is proposed.     

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.     

Personality Characteristics of Mothers of Children with Attention Deficit Hyperactivity Disorder as Assessed by the Minnesota Multiphasic Personality Inventory

Objective

The current study investigated the personality characteristics of mothers of children with attention deficit hyperactivity disorder (ADHD) using the Minnesota Multiphasic Personality Inventory (MMPI).

Methods

Fifty mothers (average age of 38.1±4.2 years) of children with ADHD not having comorbidity (37 boys, 13 girls; average age of 8.5±1.9 years) and 59 mothers (average age of 38.1±2.7 years) of comparison children (37 boys, 13 girls; average age of 8.1±1.5 years) completed the Korean version of the MMPI. Only mothers whose psychiatric health was verified by the Structured Clinical Interview for axis-I DSM-IV disorders (SCID-IV) were included in current study.

Results

After controlling for maternal age, maternal education level, children''s gender, age, and total and verbal intelligence quotient (IQ), the MMPI scores of the mothers of children with ADHD were significantly higher on the depression (D), hysteria (Hy) and psychasthenia (Pt) scales than those of the mothers of children in the comparison group.

Conclusion

These results suggested that even psychologically healthy mothers of children with ADHD alone might be depressed, histrionic and anxious.     

Cognitive Function in Childhood Epilepsy: Importance of Attention Deficit Hyperactivity Disorder

Background and Purpose

To determine how cognitive function is related to epilepsy classification and comorbid attention deficit hyperactivity disorder (ADHD) in children with newly diagnosed epilepsy of genetic or unknown etiology.

Methods

The medical records of children aged 6-16 years with newly diagnosed epilepsy of genetic or unknown etiology were reviewed retrospectively. The Korean Education Development Institute-Wechsler Intelligence Scale for Children and the Comprehensive Attention Test were used to evaluate intelligence and attention/executive function, respectively.

Results

The data of a total of 149 children, 103 with focal seizures and 46 with generalized seizures, were reviewed. The prevalence of ADHD was 49.2% (59 out of 120 examined patients), and ADHD patients exhibited significantly worse auditory selective attention, flanker test results, and spatial working memory. Patients with generalized seizures exhibited significantly worse auditory selective and sustained attention than patients with focal seizures. In patients with generalized seizures, sustained attention, flanker test findings, and spatial working memory were found to be affected by ADHD, and auditory selective and sustained attention were significantly worse in patients with benign childhood epilepsy with centrotemporal spikes and ADHD than in their counterparts without ADHD.

Conclusions

Cognitive processes are affected by seizure type and comorbid ADHD. Proper characterization of these neuropsychiatric impairments may allow earlier intervention during the disease course.     

Bupropion SR vs. Methylphenidate vs. Placebo for Attention Deficit Hyperactivity Disorder in Adults

Despite the increasing recognition of attention-deficit hyperactivity disorder (ADHD) in adults, there are few controlled trials demonstrating the effectiveness of pharmacological treatments, particularly with nonstimulants. One controlled trial found bupropion SR more effective than placebo in the treatment of ADHD adults. We conducted a controlled study to contrast the effectiveness of bupropion SR and methylphenidate to placebo in ADHD adults. A randomized, double-blind, parallel design was used in this study. Following a 7-day placebo lead-in, 30 ADHD (DSM-IV) subjects (18–60 years old) were randomized to bupropion, methylphenidate, or placebo for 7 weeks. Methylphenidate was titrated over 1 week to a maximum dose of 0.9 mg/kg/d divided into 3 doses while bupropion was titrated over 2 weeks to a maximum dose of 200 mg A.M. and 100 mg P.M. Response rates based on Clinical Global Impression improvement ratings in patients receiving bupropion, methylphenidate, and placebo were 64, 50, and 27%, respectively. The difference in response rates between active treatment and placebo was not statistically significant (p = 0.14). Neuropsychological testing demonstrated trends favoring drug treatment on measures of immediate recall and verbal fluency. While bupropion SR may be a viable clinical alternative for adults with ADHD, further investigation is needed.     

颈内动脉重度狭窄患者视网膜神经纤维层与神经节细胞复合体的改变

目的 探讨颈内动脉狭窄患者视盘周围视网膜神经纤维层（peripapillary r etinal n erve f iber l ayer, pRNFL）、黄斑区神经节细胞复合体（ganglion cell complex,GCC）厚度的改变,RNFL缺损、GCC丢失比 例的情况。 方法 回顾分析2015年7月-2016年7月在首都医科大学附属北京天坛医院诊治的单侧颈内动脉重度 狭窄（≥70%）或闭塞患者的病例资料,并纳入经颈动脉超声检查明确颈内动脉无明显狭窄的健康者 作为对照组,通过光学相干断层扫描（optical coherence tomography,OCT）检测病例组及对照组双眼 pRNFL及GCC厚度、RNFL缺损、GCC丢失比例。比较病例组狭窄同侧眼和对侧眼及对照组右眼的上述 数据的差异。 结果 共入组56例颈内动脉狭窄患者和56例对照组。颈内动脉狭窄同侧眼的p R N F L平均厚 度、黄斑区GCC平均厚度[（99.44±14.60）μm,（92.61±10.63）μm]较对侧眼[（107.01±9.96）μm, （96.48±9.73）μm]均薄（P =0.008,P =0.047）;较正常对照组眼的pRNFL平均厚度、黄斑区GCC平均 厚度（[ 110.47±6.48）μm,（96.86±5.00）μm]均薄（P=0.001,P=0.013）。狭窄同侧眼出现RNFL缺损、 GCC丢失的比例（33.9%,53.6%）较对侧眼（12.5%,26.8%）均显著增高（P =0.007,P =0.004）。 结论 颈内动脉重度狭窄可导致pRNFL和GCC厚度变薄,通过OCT检查可以更早发现颈内动脉狭窄对 眼部血供的影响。     

EEG development in Attention Deficit Hyperactivity Disorder: From child to adult

ObjectiveAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders found in children. While an extensive literature has documented the EEG in this clinical population, few studies have investigated EEG throughout the lifespan in ADHD. This study aimed to investigate EEG maturational changes, in subjects with ADHD combined type, that spanned from childhood into adulthood.MethodTwenty five male adults with ADHD were assessed between the ages of 8–12 years and again as adults. At both ages, an EEG was recorded during an eyes-closed resting period, and power estimates were calculated for relative delta, theta, alpha and beta.ResultsAt the childhood assessment, the ADHD subjects had elevated posterior delta. Relative theta was elevated, with diminished alpha activity across all sites. Significant maturational changes were observed, with reductions in the delta and theta bands, and increases in the alpha and beta bands across all electrodes. In adulthood, relative to controls, diminished frontal delta and elevated global theta activity were apparent.ConclusionsSubstantial developmental changes occurred in the EEG of these subjects. These results identify important issues when using EEG as part of the diagnosis for ADHD.SignificanceThis study is the first to explore EEG changes from childhood to adulthood over an 11 year period in the same subjects with ADHD.     

Retinal thickness in patients with mild cognitive impairment and Alzheimer's disease

Objectives

Mild cognitive impairment (MCI) may represent a transition to early Alzheimer's disease (AD). The retinal nerve fiber layer (RNFL) is composed of axons originating in retinal ganglion cells that eventually form the optic nerves. Previous studies have shown that degenerative changes occur in optic nerve fibers and manifested as thinning of RNFL in patients with AD. The objective of this study was to assess the relationship between MCI, AD and loss of RNFL.

Patients and methods

In this study, patients fulfilling diagnostic criteria for MCI (n = 24), AD (n = 30) and cognitively normal age-matched controls (n = 24) have undergone neuro-ophthalmologic and optical coherence tomography (OCT) examinations to measure RNFL thickness.

Results

There was a significant decrease in RNFL thickness in both study groups (AD and MCI) compared to the control group, particularly in the inferior quadrants of the optic nerve head, while the superior quadrants were significantly thinner only in AD. Although AD patients may have more severe changes than MCI cases, the differences were statistically nonsignificant. Furthermore among AD patients, there was no relation to the severity of the dementia.

Conclusions

Our data confirm the retinal involvement in AD, as reflected by loss of axons in the optic nerves.     

Association between Dopamine D4 Receptor Gene Polymorphism and Scores on a Continuous Performance Test in Korean Children with Attention Deficit Hyperactivity Disorder

Objective

The aim of this study was to evaluate the association between a variable number of tandem repeats polymorphism at the dopamine D4 receptor gene (DRD4) and the performance of children with attention deficit hyperactivity disorder (ADHD) in a continuous performance test (CPT).

Methods

This study included 72 ADHD children (mean age=9.39±2.05 years) who were recruited from one child psychiatric clinic. The omission errors, commission errors, reaction time and reaction standardization in the CPT were computed. The number of 48-base pairs tandem repeats in the exon III of DRD4 was analyzed in a blind manner.

Results

The homozygosity of the 4-repeat allele at DRD4 was significantly associated with fewer commission errors (t=2.364, df=28.685, p=0.025) and standard deviation of reaction time (t=2.351, df=24.648, p=0.027) even after adjusting for age. The results of analyses of CPT measured values among three groups showed that the group with higher frequency of the 4-repeat allele showed a lower mean score of commission errors (F=4.268, df=2, p=0.018).

Conclusion

These results suggest a protective role of 4-repeat allele of the DRD4 polymorphisms on commission errors in the CPT in children with ADHD.     

Adherence with Electronic Monitoring and Symptoms in Children with Attention Deficit Hyperactivity Disorder

Objective

The primary aim of this study was to compare electronic monitoring with other measures of adherence to Osmotic-controlled Release Oral delivery System methylphenidate in children with attention-deficit hyperactivity disorder (ADHD). The secondary aim was to analyze the relationships between adherence and clinical factors, including ADHD symptoms.

Methods

Thirty-nine children diagnosed with ADHD were monitored for adherence to medication over the course of eight weeks. Medication adherence was assessed using the Medication Event Monitoring System (MEMS), which is a bottle cap with a microprocessor that records all instances and times that the bottle is opened; patient self-report; clinician rating; and pill count. Information, including demographic and clinical characteristics, symptom rating scale, and psychological test results, were also collected. The relationships between adherence and clinical factors, including ADHD rating scores of baseline and of the changes, were assessed.

Results

The rate of non-adherence measured by the MEMS was found to be 46.2%, which was considerably higher than those of the patient self-report (17.9%), clinician rating (31.7%), and pill count (12.8%) of non-adherence. The rate of adherence measured by the MEMS was not significantly associated with baseline symptom severity or symptom changes over the eight weeks, although non-adherent group showed more severe baseline symptoms and inferior improvement.

Conclusion

Adherence as measured by the MEMS showed a discrepancy with other measures of adherence in patients with ADHD. The symptom severity and level of improvement were not related to adherence with MEMS. Further studies are needed to evaluate the variables that may impact medication adherence in children with ADHD.