Acute neuropsychological effects of methylphenidate in stimulant drug-naïve boys with ADHD II--broader executive and non-executive domains

Background: Accumulating evidence supports methylphenidate‐induced enhancement of neuropsychological functioning in attention deficit hyperactivity disorder (ADHD). The present study was designed to investigate the acute effects of the psychostimulant drug, methylphenidate (MPH), on neuropsychological performance in stimulant naïve boys with ADHD. Methods: Seventy‐three drug‐naïve boys (age 7–15) with ADHD (combined type) completed neuropsychological tasks from the CANTAB battery under randomised, placebo controlled, double‐blind conditions following an acute challenge with either placebo (n = 24), .3 (n = 25) or .6 (n = 24) mg/kg oral MPH. Results: MPH did not impair performance on any task. MPH (.6 mg/kg) lengthened response latencies on a task of Spatial Recognition, shortened response times on a Reaction Time task and restored performance on a Delayed Matching to Sample visual, non‐working memory task. Contrary to predictions, MPH did not enhance performance on tasks with a prominent executive component, including Go/NoGo, Spatial Working Memory, Stockings of Cambridge and Attentional Set shifting tasks. Conclusions: Acute administration of MPH to drug‐naïve boys with ADHD did not impair neuropsychological performance. Acute MPH enhanced performance on some aspects of non‐executive functioning. MPH‐induced slowing of responding on a relatively complex Spatial Recognition memory task and quickened responding on a reaction time task requiring less cognitive resources suggests that MPH may act by improving self‐regulatory ability. MPH may not exert its effects on neuropsychological functioning by enhancing executive processes.     

Attentional functions in children and adolescents with ADHD,depressive disorders,and the comorbid condition

Background: Attention‐deficit hyperactivity disorder (ADHD) and depressive disorders (DDs) often co‐occur in children and adolescents, but evidence on the respective influence of these disorders on attention parameters is inconsistent. This study examines the influence of DDs on ADHD in a model‐oriented approach that includes selectivity and intensity attention parameters. Methods: Ten‐ to fifteen‐year‐olds with ADHD (n = 63), DDs (n = 61), ADHD+DDs (n = 64), and healthy controls (n = 64) completed a battery of tests including five neuropsychological tasks (i.e., alertness, sustained attention, divided attention, go/no‐go, and attentional set‐shifting). Results: All clinical groups showed attentional problems, especially in more complex attentional tasks and in the intensity aspects of attention. We observed the most severe attentional impairments in children with ADHD that was independent from a comorbid DD. Conclusion: The clinical groups were significantly different from the healthy control group, especially in more complex attentional tasks and in the intensity aspects of attention. Some differences between ADHD, DDs and ADHD+DDs groups were detected on neuropsychological attentional performance, but the effects were not strong enough to differentiate the clinical groups from each other.     

Trouble du déficit de l’attention/hyperactivité avec ou sans troubles associés : mise en évidence de différences attentionnelles et exécutives

Background

Children with attention-deficit hyperactivity disorder (ADHD) manifest deficits in attentional and executive domains. Yet, although ADHD is often associated with other neurodevelopmental syndromes such as developmental dyslexia (DD) and developmental coordination disorder (DCD), very few studies exploring the impact of these associated disorders on cognitive abilities of children with ADHD are available. Whether and how these comorbid disorders may influence attentional and executive abilities among ADHD patients remained to be explored.

Psychiatric problems associated with subthreshold ADHD and disruptive behaviour diagnoses in teenagers

Aim: To study the coexistence of subthreshold diagnoses of both attention deficit hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBD) with other symptoms of child and adolescent psychiatric disorders as well as risk behaviours associated with smoking, alcohol and drug use. Methods: A population‐based sample of twins including 177 girls and 135 boys was interviewed using the Swedish version of Kiddie‐SADS Present and Lifetime Version (K‐SADS‐PL). Subthreshold diagnoses were compiled based on the ADHD and DBD criteria, where each criterion was assessed as ‘possible’ or ‘certain’ according to K‐SADS‐PL. The odds ratios (OR) between the subthreshold diagnoses and each of the screening questions in K‐SADS‐PL were calculated. Results: Subthreshold diagnoses of ADHD and DBD coexisted with the screening questions concerning depression, mania, panic attack, phobias, anorexia nervosa, motor tics and posttraumatic stress disorder (PTSD) in girls. In boys, these subthreshold diagnoses coexisted with symptoms of depression and PTSD. For both boys and girls, smoking and high alcohol consumption contributed to a high OR with regard to ADHD and DBD. Conclusion: Subthreshold diagnoses of ADHD and DBD were risk factors for several other psychiatric symptoms as well as smoking and high alcohol consumption. Thus, a broad clinical assessment is needed for adolescents with such preliminary diagnoses.     

The influence of sex on the course and psychiatric correlates of ADHD from childhood to adolescence: A longitudinal study

Background: Little is known about the influence of sex on the course of attention‐deficit/hyperactivity disorder (ADHD) and its comorbid psychiatric conditions. The purpose of this study was to examine the effect of sex on the course and psychiatric correlates of ADHD from childhood into adolescence. Methods: Two identically designed, longitudinal, case–control family studies of male and female probands with and without ADHD and their siblings were combined. All subjects were blindly assessed with structured diagnostic interviews. Among subjects with a lifetime history of ADHD (n = 471, mean age 11.5 ± 4.3 years at baseline), we used linear growth curve models to estimate the effect of time on the change in ADHD symptoms, and whether this effect differed by sex. We also we examined the effect of sex on the association between ADHD and the longitudinal progression of comorbid psychopathology using structural equation models. Results: We found no evidence that sex moderated the effect of age on ADHD symptoms; in both genders, age exhibited a similar effect on the decline of ADHD symptoms. However, the female sample demonstrated greater stability in comorbid psychopathology from childhood into adolescence. Furthermore, we found that the stability of comorbid psychopathology in females remained significant after accounting for the correlation between adolescent psychopathology and adolescent ADHD. In males, childhood and adolescent comorbid psychopathology were no longer correlated when adolescent ADHD was taken into account. Conclusions: Our findings indicate that while the course of ADHD across childhood and adolescence did not differ between males and females, patterns of psychiatric comorbidity were conditional on sex. Future studies should explicitly test how sex modifies the associations between ADHD and risk factors and ADHD and associated functional outcomes.     

Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population-based birth cohort study

Background: To evaluate associations between attention‐deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders using research‐identified incident cases of ADHD and population‐based controls. Methods: Subjects included a birth cohort of all children born 1976–1982 remaining in Rochester, MN after age five (n = 5,718). Among them we identified 379 ADHD incident cases and 758 age‐gender matched non‐ADHD controls, passively followed to age 19 years. All psychiatric diagnoses were identified and abstracted, but only those confirmed by qualified medical professionals were included in the analysis. For each psychiatric disorder, cumulative incidence rates for subjects with and without ADHD were estimated using the Kaplan–Meier method. Corresponding hazard ratios (HR) were estimated using Cox models adjusted for gender and mother’s age and education at the subject’s birth. The association between ADHD and the likelihood of having an internalizing or externalizing disorder was summarized by estimating odds ratios (OR). Results: Attention‐deficit/hyperactivity disorder was associated with a significantly increased risk of adjustment disorders (HR = 3.88), conduct/oppositional defiant disorder (HR = 9.54), mood disorders (HR = 3.67), anxiety disorders (HR = 2.94), tic disorders (HR = 6.53), eating disorders (HR = 5.68), personality disorders (HR = 5.80), and substance‐related disorders (HR = 4.03). When psychiatric comorbidities were classified on the internalization‐externalization dimension, ADHD was strongly associated with coexisting internalizing/externalizing (OR = 10.6), or externalizing‐only (OR = 10.0) disorders. Conclusion: This population‐based study confirms that children with ADHD are at significantly increased risk for a wide range of psychiatric disorders. Besides treating the ADHD, clinicians should identify and provide appropriate treatment for psychiatric comorbidities.     

Comorbidity of learning disorders: prevalence and familial transmission

Background: In order to fully specify the profiles of risk and protective factors of developmental disorders, a better understanding of the conditions under which they co‐occur is required. So far, empirical evidence on comorbidities of specific learning disorders in arithmetic, reading and spelling is scarce. Methods: Prevalence and gender ratios of specific learning disorders in arithmetic (AD), reading (RD), and spelling (SD) and their co‐occurrence were assessed in a large (N = 2586) population‐based sample of elementary school children and in a subsample of 293 children with at least one learning disorder (LD‐sample). A questionnaire on familial transmission was given to a subsample of 256 parents of children with a learning disorder and 146 typically developing children. Results: The rates of deficits in arithmetic, reading, or spelling were four to five times higher in samples already experiencing marked problems in one academic domain compared to the full population. Thus, comorbidity of learning disorders was confirmed in a fairly standard school population. Rates of co‐occurrence decreased for AD and RD, but not isolated SD when more stringent cutoff criteria were applied, suggesting that the comorbidity of arithmetic and spelling disorder may be more strongly biologically mediated than the comorbidity of arithmetic and reading disorder. We found a preponderance of girls with AD and boys with SD. These imbalanced gender ratios were especially marked for isolated problems, while for comorbid problems gender ratios were mostly balanced with the exception of deficits in arithmetic and reading (but not spelling) which were more typical for girls. The parental questionnaire provided evidence for disorder‐specific familial transmission and co‐segregation of arithmetic and literacy deficits. Conclusions: Comorbidities of learning disorders are not artificial. They are the result of a complex interplay between both general and disorder‐specific aetiological factors.     

Executive function deficits in preschool children with ADHD and DBD

Background: Impairments in executive functions (EF) are consistently associated with attention deficit hyperactivity disorder (ADHD) and to a lesser extent, with disruptive behavior disorder (DBD), that is, oppositional defiant disorder or conduct disorder, in school‐aged children. Recently, larger numbers of children with these disorders are diagnosed earlier in development, yet knowledge about impairments in clinically diagnosed preschool children and the role of comorbidity is limited. Therefore, the aim of the current study was to examine EF in clinically referred preschool children with a clinical diagnosis of ADHD, DBD and ADHD + DBD. Method: Participants were 202 children aged 3.5–5.5 years, 61 with ADHD only, 33 with DBD only, 52 with comorbid ADHD + DBD and 56 typically developing children. Five EF tasks were administered. Results: Confirmatory factor analysis showed that the two‐factor model (inhibition and working memory) fit the data better than a one‐factor model in this clinical sample. Preschoolers with ADHD displayed inhibition deficits, also after controlling for IQ. Likewise, preschoolers with DBD displayed impaired inhibition, but when IQ was controlled differences were carried mostly by the effect on the task where motivational demands were high (i.e. when tangible rewards were used). This pattern was also found in the interaction between ADHD and DBD; impaired inhibition in the comorbid group, however, was more severe than in the DBD group. Regarding working memory, few group differences were found. Conclusions: Clinically diagnosed preschool children with ADHD showed robust inhibition deficits, whereas preschool children with DBD showed impaired inhibition especially where motivational incentives were prominent. Severity of inhibition impairment in the comorbid group was similar to the ADHD group.     

Pulmonary hemorrhage in very low‐birthweight infants: Risk factors and management

Background: Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low‐birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH. Methods: Using the database of the Premature Baby Foundation of Taiwan, the mortality, risk factors and characteristics of VLBW infants with or without MPH were compared between 2000–2006 and 2007–2010. Results: Between January 2000 and December 2010, 399 VLBW infants were admitted to Kaohsiung Veterans General Hospital. Mean birthweight (BW) was 1099.6 ± 272.7 g, and mean gestational age (GA) was 28.7 ± 2.9 weeks. The overall survival rate was 84.2%. Sixteen (4%) had MPH: 11 in the first group (2000–2006; 18.2% survival rate), and five in the second group (2007–2010; 80% survival rate; P= 0.0000002). Infants with MPH had lower mean BW (864.9 ± 301.4 g, P= 0.0004), smaller mean GA (26.1 ± 2.0 weeks, P= 0.0002), significantly lower Apgar scores at 1 and 5 min, higher severity of respiratory distress syndrome (RDS; grades 3 or 4), and greater use of surfactant than infants without MPH. They also had more intraventricular hemorrhage and higher mortality. Conclusions: Smaller GA, lower BW, lower Apgar scores at 1 and 5 min, severe RDS (grades 3 or 4), and use of surfactant place VLBW infants at greater risk of MPH. Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival.     

The rCBF brain mapping in adolescent ADHD comorbid developmental coordination disorder and its changes after MPH challenging

BackgroundComorbid developmental coordination disorder (DCD) in the patients with attention-deficit hyperactivity disorder (ADHD) often complicated the treatment strategy. Methylphenidate (MPH) improves the coordination problem in patients with ADHD.AimThe study intended to investigate the pathophysiology and the mechanisms of MPH in comorbid DCD of the adolescents with ADHD.MethodsBrain images using technetium-99m ethyl cysteinate dimmer (^99mTc-ECD) single photon emission computed tomography (SPECT) were done in 10 drug-naïve adolescents with ADHD without DCD and 5 adolescents with ADHD comorbid DCD. The baseline rCBF and changes of rCBF after 10 mg MPH challenge between two groups were compared using statistical parametric mapping (SPM99) analysis.ResultsLower rCBF of bilateral frontal lobe, inferior parental lobe, and increased rCBF of right posterior cingulate gyrus, anterior lobe of cerebellum were found in ADHD comorbid DCD group compared to ADHD without DCD group. Decreased rCBF in the right occipital, inferior temporal lobe was found in ADHD comorbid DCD group after MPH while ADHD alone group revealed increased rCBF in bilateral occipital lobe.ConclusionsThe results help us understand the pathophysiology of DCD in ADHD adolescents. The different rCBF response to MPH provides a clue for future intervention of DCD in ADHD adolescents.     

Kana reading disability and Das–Naglieri Cognitive Assessment System findings in children with attention deficit hyperactivity disorder

Background: Epidemiological and clinical studies suggest that attention deficit hyperactivity disorder (ADHD) and reading disability co‐occur more frequently than would be expected by chance. The purposes of this study were to (i) assess the frequency of Japanese syllabary (Kana) reading disability (RD) and (ii) measure the psychometric properties of the Das–Naglieri Cognitive Assessment System (DN‐CAS) in a clinic‐referred sample of Japanese children with ADHD. Methods: Twenty children with ADHD aged 8–13 years were evaluated using both Kana reading tasks and the DN‐CAS. Results: Seven children (35%) showed excessive reading time in at least two of four Kana reading tasks and were diagnosed as ADHD plus RD. The children with ADHD plus RD took significantly longer to read a single mora, four‐syllable words, and short sentences. There was no significant difference in the time it took the children with ADHD plus RD to read four‐syllable non‐words compared to the children with ADHD only. The children with ADHD plus RD had significantly lower simultaneous‐processing scores in the DN‐CAS compared to children with ADHD but not RD. Conclusion: Children with ADHD should be given Kana reading tasks because RD is highly comorbid with ADHD. DN‐CAS is a useful method for evaluating cognitive processing in children with ADHD with or without RD.     

Determination of risk factors affecting mortality in patients with gastrointestinal perforation after pediatric liver transplantation

Gastrointestinal perforation (GIP) is one of the most serious complications occurring after liver transplantation (LT), especially in pediatric patients. This study aimed to determine the risk factors affecting mortality in pediatric patients with GIP after LT. GIP developed in 37 (10%) of 370 pediatric patients who underwent LT at our institute. Patients were divided into two groups: alive (n = 22) or dead (n = 15), and both groups were compared in terms of demographic and clinical parameters using univariate analysis. There was no statistically significant difference between groups in either demographic or clinical parameters, except for perforation site (P = 0.001) and median follow‐up (P = 0.001). Stomas arose in 17 (45.9%) patients: 76% of patients with stomas and 45% of those without survived (P = 0.052). Kaplan‐Meier analysis indicated that patients with stomas had a significantly higher overall survival (P = 0.029) and that patients with duodenal and colonic perforation had a significantly lower overall survival. Multivariate analysis showed that re‐perforation was an independent risk factor for mortality (P = 0.035; OR: 17.674; 95% CI for OR: 1.233‐253.32). Although there are many options for management of GIP, including primary repair, resection plus anastomosis, and resection plus end or loop ostomy, gastrointestinal diversion is still the best option.     

Perinatal risk factors interacting with catechol O‐methyltransferase and the serotonin transporter gene predict ASD symptoms in children with ADHD

Background: Symptoms of autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) often co‐occur. Given the previously found familiality of ASD symptoms in children with ADHD, addressing these symptoms may be useful for genetic association studies, especially for candidate gene findings that have not been consistently replicated for ADHD. Methods: We studied the association of the catechol O‐methyltransferase (COMT) Val158Met polymorphism and the serotonin transporter (SLC6A4/SERT/5‐HTT) 5‐HTTLPR insertion/deletion polymorphism with ASD symptoms in children with ADHD, and whether these polymorphisms would interact with pre‐ and perinatal risk factors, i.e., maternal smoking during pregnancy and low birth weight. Analyses were performed using linear regression in 207 Dutch participants with combined type ADHD of the International Multicenter ADHD Genetics (IMAGE) study, and repeated in an independent ADHD sample (n = 439) selected from the TRracking Adolescents’ Individual Lives Survey (TRAILS). Dependent variables were the total and subscale scores of the Children’s Social Behavior Questionnaire (CSBQ). Results: No significant main effects of COMT Val158Met, 5‐HTTLPR, maternal smoking during pregnancy and low birth weight on ASD symptoms were found. However, the COMT Val/Val genotype interacted with maternal smoking during pregnancy in increasing stereotyped behavior in the IMAGE sample (p = .008); this interaction reached significance in the TRAILS sample after correction for confounders (p = .02). In the IMAGE sample, the 5‐HTTLPR S/S genotype interacted with maternal smoking during pregnancy, increasing problems in social interaction (p = .02), and also interacted with low birth weight, increasing rigid behavior (p = .03). Findings for 5‐HTTLPR in the TRAILS sample were similar, albeit for related CSBQ subscales. Conclusions: These findings suggest gene–environment interaction effects on ASD symptoms in children with ADHD.     

Methylphenidate improves reading performance in children with attention deficit hyperactivity disorder and comorbid dyslexia: an unblinded clinical trial.

Attention Deficit Hyperactivity Disorder (ADHD) and dyslexia are frequently co-occurring disorders. Although methylphenidate (MPH) is the primary treatment for ADHD, the effect on reading in children with these comorbid problems is not yet known. This study was an unblinded clinical trial to evaluate the reading performance before and after treatment with MPH. Reading performance was compared with General Linear Model repeated measures between three groups: (1) an experimental group of children with both ADHD and dyslexia (N = 24), (2) a control group of children with ADHD (N = 9) and (3) a control group of children with dyslexia (N = 10). MPH improved reading performance significantly stronger in the experimental group than in the control groups; the number of correctly read words increased to a larger extent. In conclusion, MPH proved to be an aid in the reading process of children with ADHD and comorbid dyslexia by improving the learning conditions, but MPH cannot cure the reading disorder. Future research should study the effect of MPH on reading in a double-blind clinical trial.     

The interplay between expressed parental anxiety and infant behavioural inhibition predicts infant avoidance in a social referencing paradigm

Background: Anxiety aggregates in families. Environmental factors, such as modelling of anxious behaviours, are assumed to play a causal role in the development of child anxiety. We investigated the predictive value of paternal and maternal anxiety (lifetime anxiety disorders and expressed parental anxiety) on infants’ fear and avoidance during encounters with social and nonsocial novel stimuli in a social referencing (SR) paradigm. Methods: A total of 122 12‐month‐old infants participated in this study separately with their fathers and mothers (parents with lifetime: social anxiety disorders [n = 47], other types of anxiety disorders [n = 33], comorbid social and other types of anxiety disorders [n = 52] and without anxiety disorders [n = 112]). Infants were confronted with a stranger and a mechanical dinosaur as novel stimuli in two SR situations. Infants’ avoidance as well as fear and parents’ expressed anxiety were observed. Infants’ behavioural inhibition (BI) was separately observed in structured tasks. Results: Parental lifetime anxiety disorders did not significantly predict infant fear or avoidance. Expressed parental anxiety interacted with BI to significantly predict infant avoidance, revealing a positive association between expressed parental anxiety and infant avoidance among infants with moderate‐to‐high BI. The association between infant avoidance and expressed parental anxiety was not significantly different for mothers and fathers, pointing to an equally important role of fathers at this young age. Infant fear was significantly predicted by infant BI, but not by expressed parental anxiety. Conclusions: Infants with a temperamental disposition for anxiety (BI) may learn from both paternal and maternal anxious signals and become avoidant towards novelty when their parents express anxiety. This link between expressed parental anxiety and infant avoidance for moderate‐to‐high BI children, that seems to hold across contexts and to be independent of lifetime parental anxiety disorders, may be a mechanism explaining early intergenerational transmission of anxiety.     

A neurophysiological marker of impaired preparation in an 11‐year follow‐up study of attention‐deficit/hyperactivity disorder (ADHD)

Background: This longitudinal electrophysiological study investigated the course of multiple impaired cognitive brain functions in attention‐deficit/hyperactivity disorder (ADHD) from childhood to adulthood by comparing developmental trajectories of individuals with ADHD and typically developing controls. Methods: Subjects with ADHD (N = 11) and normal controls (N = 12) diagnosed in childhood [mean age ADHD/CTRL = 10.9 years [SD 1.72]/10.0 years (SD 1.03)] were followed up after 1.1 and 2.4 years, and as young adults [ADHD/CTRL: 21.9 years (SD 1.46)/21.1 years (SD 1.29)]. At all four times, event‐related potential (ERP) maps were recorded during a cued continuous performance test (CPT). We focused on residual deficits as adults, and on developmental trajectories (time and time × group effects) for CPT performance and attentional (Cue P300), preparatory (CNV: contingent negative variation) and inhibitory (NoGo P300) ERP components. Results: All ERP components developed without significant time × group interactions. Only the CNV remained reduced in the ADHD group, although 8/11 individuals no longer met a full ADHD diagnosis as adults. Cue P300 and NoGo P300 group differences became nonsignificant in early adulthood. The CNV parameters correlated with reaction time (RT) and RT‐SD. Perceptual sensitivity improved and the groups’ trajectories converged with development, while RT‐SD continued to be elevated in adult ADHD subjects. Conclusions: Attentional and preparatory deficits in ADHD continue into adulthood, and the attenuated CNV appears to reflect a particularly stable ADHD marker. Although some deficit reductions may have gone undetected due to small sample size, the findings challenge those developmental lag models postulating that most ADHD‐related deficits become negligible with brain maturation.     

Association of neonatal hyperbilirubinemia with uridine diphosphate‐glucuronosyltransferase 1A1 gene polymorphisms: Meta‐analysis

Background: Recent reports have suggested that genetic factors, including mutations in the coding region or promoter of uridine diphosphate‐glucuronosyltransferase 1A1 (UGT1A1) may increase the risk of development of neonatal hyperbilirubinemia, but the relationship has not been evaluated on systematic review or meta‐analysis. Methods: A meta‐analysis of observational studies reporting effect estimates and 95% confidence intervals (95%CI) was conducted on the association between UGT1A1 polymorphisms and neonatal hyperbilirubinemia. Results: A total of 27 eligible studies were identified. In total, 17 studies focused on the association of neonatal hyperbilirubinemia with UGT1A1 Gly71Arg polymorphisms, which indicated that these polymorphisms were associated with an increased risk of neonatal hyperbilirubinemia (A/A+G/A vs G/G: odds ratio [OR], 2.70; P= 0.00; 95%CI: 2.22–3.29; I²= 0.0%; P_{heterogeneity}= 0.55). Subgroup analyses by ethnicity validated this correlation in Asian, but not in Caucasian, populations (OR, 1.74; P= 0.10; 95%CI: 0.90–3.35; I²= 0.00%; P_{heterogeneity}= 0.67). Furthermore, 18 studies focused on the association of neonatal hyperbilirubinemia with UGT1A1 TATA promoter polymorphisms. These studies concluded that TATA promoter variants were not associated with an increased risk of neonatal hyperbilirubinemia (7/7 + 6/7 vs 6/6: OR, 1.13; P= 0.23; 95%CI: 0.93–1.37; I²= 80.0%; P_{heterogeneity}= 0.00). Conclusion: UGT1A1 Gly71Arg polymorphisms are a risk factor for developing neonatal hyperbilirubinemia in Asian, but not Caucasian, subjects. UGT1A1 TATA promoter polymorphisms were not associated with an increased risk of neonatal hyperbilirubinemia in Asian subjects, but results from the Caucasian population were conflicting and require further epidemiological investigation.     

Poor performance in physical education - a risk factor for bully victimization. A case-control study

Aim: Poor social skills are a risk factor for becoming bullied, which could explain why this frequently occurs to children with autism spectrum disorders (ASD) and attention‐deficit hyperactivity disorder (ADHD). Poor social skills tend to coexist with clumsiness. According to a pilot study, poor performance in physical education (PE) was correlated with bully victimization. Methods: Sixty‐nine healthy university students reported performance in PE and bully victimization in childhood. In addition, the participants responded to questionnaires for ADHD and ASDs to assess personality traits related to increased risk for bully victimization. Results: Below average performance in PE was a risk factor of being bullied in school with an odds ratio of 3.6 [95% confidence interval: 1.23–10.5; p = 0.017]. Strong correlations between poor performance in PE and long duration of victimization (p = 0.007) and poor performance in PE and high frequency of victimization (p = 0.008) were found. Autistic traits were related to performance below average in PE. Conclusion: Poor motor skills are a strong risk factor for becoming bullied. Prevention programmes that identify, protect and empower the clumsy children could be an important step to avoid bullying of the most vulnerable children.     

Game‐based peripheral biofeedback for stress assessment in children

Background: Peripheral biofeedback is considered to be an efficient method for assessment and stress mitigation in children. The aim of the present study was to assess the levels of stress and stress mitigation in healthy school children (HSC), in children with cystic fibrosis (CF), general anxiety (GA) and attention‐deficit–hyperactivity disorder (ADHD). Methods: Each investigated group (HSC, CF, GA, ADHD) consisted of 30 school‐aged children from both sexes. Psychological characteristics were evaluated on Eysenck Personality Questionnaire (EPQ). The lie scale was used to determine participant honesty. Four biofeedback games using a pulls detector were applied for assessment of the stress levels as well as to evaluate ability to relax. Results: EPQ found more psychopathological traits (P < 0.001) and less extroversion (P < 0.001) in children with GA and ADHD. In addition, high neurotic tendencies were found in children with CF (P < 0.01) and GA (P < 0.01). Unexpectedly, the lie scale was lower in ADHD children (P < 0.01) than in all other groups (HSC, CF, GA). The Magic blocks score was significantly different in relaxation levels between control and CF children (P < 0.05). Speed in the game Canal was significantly different in relaxation levels between healthy controls and all other groups, but no changes in pulls, as a relaxation measure, were found during the game. The CF group had much more commissions stemming from impulsivity (t= 5.71, P < 0.01), while the GA and ADHD children had more inattention omissions (P < 0.05). Strong negative correlation between age and pulls (r= 0.49, P= 0.003) and strong negative correlation between age and omissions (r=?0.86, P= 0.029) were found among all groups analyzed. Conclusions: The ability to learn stress mediation is correlated with age. All three groups of children had significantly lower relaxation levels when compared to healthy controls. Relaxation was more difficult for children with GA or ADHD, and easier for children with CF.