Attention Deficit Hyperactivity Disorder in Children and Adolescents Following Traumatic Brain Injury

To better characterize pediatric psychopathology after neurological insult, secondary attention deficit hyperactivity disorder (SADHD)-or ADHD that develops after traumatic brain injury (TBI)-and its clinical and neuroimaging correlates were investigated. Outcome data were available for 118 children, ages 5 through 14 at the time of hospitalization following TBI (severe TBI n = 37; mild-moderate TBI n = 57) and orthopedic injury (n = 24). Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, and family psychiatric history assessments were conducted on all participants. Severity of injury and neuroimaging lesion assessments were conducted on TBI participants only. The diagnosis of SADHD was mutually exclusive with preinjury ADHD, which occurred in 13 of 94 TBI participants and 4 of 24 orthopedic injury participants. SADHD occurred in 13 of 34 eligible participants with severe TBI but resolved in 4 of 13 of these participants. SADHD also occurred in 1 of 8 eligible moderate TBI participants, only in the presence of preinjury ADHD traits and 3 of 39 of eligible mild TBI cases. SADHD occurred in 1 of 20 of eligible participants with orthopedic injury without any brain injury. SADHD was significantly associated with TBI severity recorded by categorical and dimensional measures, intellectual and adaptive functioning deficits, and personality change due to TBI, but not with lesion area or location. These results suggest that SADHD is a clinically important syndrome after severe TBI in children and adolescents.     

Attention Deficit Hyperactivity Disorder and Enuresis in Children and Adolescents

The incidences of comorbid disorders and the status of neuropsychological executive functions were evaluated in two groups of patients aged 5–14 years: patients with attention deficit hyperactivity disorder (ADHD) in combination with enuresis (53 patients) and ADHD without enuresis (71 patients). Most cases of enuresis among patients of group 1 (50 of 53) had primary nocturnal enuresis. This group showed a significant increase in the total number of cases of comorbidity with such disorders as oppositional-defiant behavioral disorder, anxiety disorders, ticks, and encopresis, seen in 77.7% of cases as compared with 60.6% in group 2. The presence of enuresis in patients with ADHD was associated with a significant increase in the incidence of anxiety disorders (54.7% as compared with 39.4%). In addition, at age 5–9 years, patients with ADHD with enuresis had a tendency to a higher frequency of oppositional-defiant behavioral disorder and encopresis; those aged 10–14 years showed an increase in the proportion with obsessive-compulsive disorder and tics as compared with patients with ADHD without enuresis. Assessment of measures of executive functions using the Wisconsin card sorting test revealed no differences between patients of the two groups.     

Neuropsychological Deficit and Academic Performance in Children and Adolescents Following Traumatic Brain Injury

Evaluated the utility of neuropsychological testing in predictingacademic outcome in children 1 year following traumatic braininjury (TBI). Fifty-one schoolage children who were admittedto hospital after TBI were assessed with a battery of neuropsychologicalmeasures at 3 months postinjury. Academic achievement was assessedat 3 and 12 months postinjury. The neuropsychological batteryincluded intelligence testing and measures of memory, learning,and speed of information processing. Academic outcome was assessedin terms of post-TBI changes in reading, spelling, and arithmetic;changes in teacher ratings of school performance; and changein school placement. According to logistic regression analysis,change in placement from regular to special education at 1-yearpost-TBI was predicted by injury severity and by neuropsychologicalperformance at 3 months post-TBI. Findings suggest that neuropsychologicaltesting is useful in identifying children with special educationalneeds subsequent to TBI.     

Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents

This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.     

Efficacy of Strattera in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Children and adolescents (25 boys, nine girls, aged from six to 17 years) with attention deficit hyperactivity disorder (ADHD) were treated with Strattera at the optimal dose of 1.2 mg/day in out-patient conditions. After use of Strattera for three months, assessment of treatment efficacy demonstrated marked and moderate clinical effects in 78.1% of patients. Psychologists’ assessment indicated that 80% of children showed improvements in the volume and rate of switching of attention and almost 60% showed improvements in measures of the stability of attention. EEG studies showed decreases in the “index of slowing” in 70.2% of patients. Strattera was found to have good safety and tolerance in the treatment of children and adolescents with ADHD.     

Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder

The purpose of this research was to update the series of articles on evidence-based treatment for children and adolescents with attention deficit/hyperactivity disorder that have appeared in this journal (Evans, Owens & Bunford, 2014; Pelham & Fabiano, 2008; Pelham, Wheeler, & Chronis, 1998). We completed a systematic review of the literature published between 2012 and 2016 to establish levels of evidence for psychosocial treatments for these youth. We identified articles using criteria established by the Society of Clinical Child and Adolescent Psychology using keyword searches of abstracts and titles. Articles were classified according to a modified version of the Division 12 task force guidelines that was used in other reviews in this series. The results revealed that findings are becoming increasingly nuanced with variations in levels of evidence related to ages of the children and characteristics of the specific treatment. In addition, we focused our critique on generalization of treatment effects across settings and time and on sample diversity (with regard to ethnicity and levels of parent education) in relation to the population. Children of parents with higher levels of education than average appear to be overrepresented in the literature. Implications for future treatment development and evaluation and for dissemination research are discussed.     

注意缺陷多动障碍儿童认知功能的对照研究

目的：探讨注意缺陷多动障碍各亚型的认知功能。方法：对113名8—12岁注意缺陷多动障碍男童与83名正常儿童采用威斯康星卡片分类测验进行对照研究。结果：ADHD各型儿童的分类次数和概括力水平均低于对照组，并以混合型最低，而注意冲动型与混合型的持续性反应与持续性错误均明显高于对照组。在控制智力因素后，仍存在显著性差异。在ADHD各亚型间，以混合型最明显，其次为注意障碍型，三型之间除非持续性错误外。主要指标比较无显著性差异。结论：ADHD儿童存在认知功能损害，且不同亚型之间的损害程度不同。     

共患对立违抗性障碍的注意缺陷多动障碍儿童的认知特点研究

目的:探讨共患对立违抗性障碍(ODD)的注意缺陷多动障碍(ADHD)儿童的认知功能特点.方法:以单纯ADHD ODD、单纯ADHD和正常儿童各36例(性别、年龄与ADHD亚型组间匹配)为研究对象,采用龚耀先修订的韦氏儿童智力量表、韦氏记忆量表、数字划消、Stroop测验和瑞文标准推理测验对其智力、记忆力、注意力水平及执行功能进行评定.结果:两病例组的常识、类同、译码、言语智商、操作智商、全量表智商、A因子、C因子、经历定向、心智、再生、触觉、长时记忆、短时记忆、记忆商、瑞文标准推理测验标准分、Stroop测验A完成时间、C完成时间和总完成时间的测验成绩与正常对照组的差异具有显著性,两病例组间差异无显著性;正常组数字划消测验总分有显著高于两病例组(F＝2.521,P＝0.093)及平均失误率显著低于两病例组的趋势(χ2＝5.150,P＝0.076);ADHD组和正常对照组在算术、数字广度、积木、B因子、Stroop测验B完成时间和D完成时间上的差异具有显著性;ADHD ODD组的瑞文标准推理测验标准分有优于ADHD组的趋势(Z=-1.674,P=0.094).结论:伴或不伴ODD的ADHD儿童有着相似的认知模式,如扩大样本量,可能发现共患病组在某些认知功能上与纯ADHD组的差异.     

Executive Function Profile of Children With Attention Deficit Hyperactivity Disorder

We explored the neuropsychological profile for executive functions of children with attention deficit hyperactivity disorder (ADHD) to assess whether problems associated with the two most cited relevant processes-inhibition and attentional problems-were the core of any executive function difficulty. A battery of executive function tests was administered to 31 children with a clinical diagnosis of ADHD and to 33 normal control participants, all aged between 7 and 12. The executive function battery encompassed a number of tasks, selected because each had multiple measures: a sustained attention reaction time task, a related vigilance task, an adaptation of the Hayling Sentence Completion Test, an adaptation of the Brixton Spatial Rule Attainment Test, a Letter Fluency task, a number Stroop task, and an "n-back" working memory task. The overall pattern of the results fit well with those obtained in previous studies as far as abnormalities of the ADHD group in the domain of inhibitory processes, attentional functions, and executive functions. The children with ADHD, although performing well on baseline tasks, performed more poorly than the controls on all the experimental tasks with one borderline exception: Letter Fluency, where the children with ADHD showed a very different pattern than most adult frontal lobe subgroups. However, there was no specific impairment on measures of inhibitory processes. In addition, strategy generation and use were severely affected in the ADHD group. Particular findings fitted well with disorders of a high-level effort system and of a monitoring system.     

注意缺陷多动障碍临床亚型持续性注意力的比较

目的：比较注意缺陷多动障碍不同临床亚型儿童持续性注意力的差异。方法：符合DSM—Ⅳ注意缺陷多动障碍的90名儿童，分为注意缺陷为主型（ADHD—PI；44例）、多动-冲动为主型（ADHD—HI；14例）、混合型（ADHD—CT；36例），对3组患儿进行视听整合持续性操作测试，对视觉和听觉持续性注意力进行组间比较。结果：混合型和注意缺陷为主型的持续性注意力低于多动-冲动型，差异有统计学意义。结论：持续性注意力的损害以混合型最重，多动-冲动为主型最轻。     

注意缺陷多动障碍与多不饱和脂肪酸的关联性

注意缺陷多动障碍（Attention deficit hyperactivity disorder，ADHD）是一种常见的儿童行为障碍。近10年来，关注ADHD的病因和对其发病机制的研究，随着对精神疾病与脂肪酸之间关系的研究而不断深入，一系列多不饱和脂肪酸与精神分裂症、抑郁症和自杀未遂等精神疾病之间存在关联的研究相继被报道，多不饱和脂肪酸（Polyunsaturated fattyacid，PUFAs）与ADHD的研究成了一个新的热点。     

注意缺陷多动障碍儿童罗夏测验的反应特征分析

目的:探讨注意缺陷多动障碍(Attention deficit hyperactivity disorder,ADHD)儿童在罗夏测验中的表现特征及可能的投射机制。方法:采用国内修订版罗夏测验(Rorschach Inkblot Test,RIT),结合艾森克人格问卷(EPQ)对40名ADHD男童和40名对照组儿童进行了测试。结果:ADHD儿童在RIT变量Zf、COP、3r 2/R、Zd、X %、Sum6的得分低于对照组(P<0.05);而在变量AG、Lambda、Sh、X-%、SCZI、DEPI、CDI的得分高于对照组(P<0.05);两组儿童在RIT多个变量和EPQ各分量表之间存在相关。结论:ADHD儿童在RIT中表现出较多的在客体关系、情绪特质、自我功能和认知功能方面的缺陷,说明RIT可投射出ADHD儿童内心世界的一些特点,包括自我意识不良、人际关系不良、攻击性、情绪问题、认知过程和思维能力问题。     

注意缺陷多动障碍儿童的感觉统合能力与行为问题分析

目的:分析ADHD(AttentionDeficitHyperactivityDisorder)儿童的感觉统合能力与儿童行为问题的相关性。方法:应用儿童感觉统合能力发展评定量表和Conners儿童行为父母问卷评定65例ADHD儿童的感觉统合能力和行为问题。结果:87.7%的ADHD儿童伴有感觉统合失调,ADHD儿童多伴有品行障碍等行为问题;且不同程度感觉统合失调的ADHD儿童的心身问题和焦虑问题有统计学差异(P<0.01),ADHD儿童的感觉统合能力与儿童行为问题存在相关。结论:ADHD儿童多伴有感觉统合失调,且其感觉统合能力与儿童行为问题存在相关性。     

注意缺陷多动障碍儿童执行功能和工作记忆特点的初步探讨

目的:探讨我国注意缺陷多动障碍(ADHD)儿童的执行功能和工作记忆特征.方法:采用修订版威斯康星卡片分类测验(WCST)和韦氏记忆量表(WMS)中代表工作记忆的分测验,对汉族57例ADHD儿童和63例正常儿童进行测试.结果:①ADHD儿童在WCST中的持续性错误数(RPE)、总错误数.(RE)、持续性反应数(RP)、完成总应答数(BA)均多于对照组儿童(26.8±10.9/22.8±10.4、57.6±18.1/49.3±18.6、30.4±13.9/25.5±12.7、127.6±1.8/122.9±11.0,P=0.040、0.015、0.046、0.001),而完成分类数(CC)、正确应答数百分比(RCP)、概念化水平(RFP)均少于对照组儿童(2.9±1.5/3.8±1.8、55.0±14.0/60.5±13.4、40.8±17.6/47.8±17.7,P=0.003、0.028、0.033);②ADHD组顺背、倒背数字,数字广度、听故事理解、数字量表、积累量表得分低于对照组(7.5±1.3/8.0±1.3、4.3±1.2/4.9±1.7、11.7±1.9/13.5±2.8、6.4±3.1/8.8±3.3、9.1±2.7/10.8±3.6、9.2±3.1/11.0±2.5,P=0.025、0.029、0.001、01000、0.011、0.002);③控制年龄后,ADHD组的故事理解粗分、理解量表分、听看故事分均与WCST的总错误数、非持续性错误呈负相关(r=-0.32～-0.43,P<0.05),与完成分类数、正确应答数、正确应答数百分比、概念化水平呈正相关(r=0.32～0.39,P<0.05).结论:ADHD儿童存在执行功能、工作记忆等神经心理学功能缺陷,ADHD儿童的语音信息工作记忆存在缺陷;ADHD儿童的WCST成绩差与工作记忆能力缺陷有关.     

Use of Adaptol in the Treatment of Attention Deficit Hyperactivity Disorder in Children

The efficacy of Adaptol (a non-benzodiazepine tranquilizer) in the treatment of children with attention deficit hyperactivity disorder (ADHD) was studied. At a dose of 500 mg twice daily for one month, Adaptol decreased hyperactivity and impulsivity without producing significant changes in attention or reaction times (the authors emphasize the importance of this factor, as we are dealing with side effects often encountered when benzodiazepine tranquilizers are used). These results lead to the conclusion that Adaptol can be used in the treatment of ADHD as monotherapy in cases in which there is a predominance of hyperactivity/impulsivity and as a component of complex therapy in other types of the disorder, particularly when ADHD is combined with anxiety disorders.     

注意缺陷多动障碍儿童执行功能特征

目的:探讨注意缺陷多动障碍(ADHD)儿童执行功能的特征。方法:采用Stroop效应、视觉和听觉Go/No-Go反应、倒背数字、延缓期的空间位置记忆广度、伦敦塔任务和连线测验分别测试40例ADHD儿童和25例正常对照组儿童的反应抑制、语音工作记忆、视空间工作记忆、计划能力和定势转移能力。结果:1.ADHD儿童完成字义与字色相矛盾的字色命名时间较正常对照组儿童明显延长(P﹤0.05)。2.ADHD儿童完成视觉和听觉的Go/No-Go反应所犯错误数均较正常对照组儿童明显增多(P﹤0.01)。3.ADHD儿童倒背数字分数和延缓期的空间位置记忆广度均较正常对照组儿童明显低(P﹤0.01)。4.ADHD儿童完成两步、四步和五步伦敦塔任务的时间均较正常对照组儿童明显延长、犯错误数明显增多(P﹤0.05);而完成四步、五步伦敦塔任务的最初计划时间则较正常对照组儿童明显缩短(P﹤0.01)。5.ADHD儿童完成连线测验甲式的时间和犯错误数与正常对照组儿童无显著性差异(P﹥0.05),而完成乙式所需时间则较正常对照组儿童明显延长、犯错误数较正常对照组儿童明显增多(P﹤0.05)。结论:ADHD儿童存在反应抑制、语音工作记忆、视空间工作记忆、计划能力和定势转移能力等多项执行功能的缺陷。     

干扰强度对ADHD儿童干扰控制的影响

目的:考查干扰强度对ADHD儿童干扰控制的影响。方法:ADHD组和正常组各25名儿童参与了实验,使用数字Stroop范式,要求被试判断同时呈现的不同物理尺寸的两个数字数值的大小,并通过改变物理尺寸的大小,设置高低两种不同强度的干扰条件,考察在不同强度的干扰条件下,ADHD儿童的干扰控制特点。结果:在高干扰强度下,ADHD组的冲突效应量大于对照组;在低干扰强度下,ADHD组的冲突效应量小于对照组。结论:在高干扰强度条件下,ADHD儿童表现出干扰控制缺陷,在低干扰强度条件下,ADHD儿童未表现出干扰控制缺陷。