注意缺陷多动障碍儿童的额叶反应抑制功能研究

目的使用近红外光学成像（fNIRS）技术研究注意缺陷多动障碍（ADHD）儿童的额叶反应抑制功能。方法采用GO-NOGO任务对19例ADHD儿童和14名健康对照进行测试,用CW5的fNIRS系统进行同步扫描。结果对照组在NOGO任务刺激时前额叶氧合血红蛋白浓度增加强于ADHD组（F=2.11,P〈0.01）;而在GO任务刺激时两组间前额叶氧合血红蛋白值变化无明显的差异（F=0.82,P=0.73）。结论 ADHD患儿的反应抑制功能不足,并且与额叶功能低下有关。     

注意缺陷多动障碍的功能神经成像研究

本文就功能神经成像技术如PET、SPECT、fMRI对注意缺陷多动障碍患者的大脑代谢和局部脑血流及神经生化的研究进行综述，结果提示ADHD所涉及的脑区为前额叶、顶叶、颞叶、扣带回，纹状体，基底节等区域。另外也表明注意缺陷障碍的成人的功能神经影像方面不同于儿童。     

注意缺陷/多动障碍诊断标准的研究☆

目的使用DSM-Ⅳ中注意缺陷/多动障碍(AD/HD)诊断标准对一组多动综合征和一组无多动的儿童进行诊断,探讨DSM-Ⅳ的分布特征及在我国的适用性.方法多动组为就诊的多动症儿童,符合临床诊断和ICD-10诊断标准,共92例.对照组无多动的学校儿童96名.由家长填DSM-Ⅳ诊断表.结果在188名儿童中,符合DSM-ⅣAD/HD诊断99例,多动组87例(94.57%),对照组12例(12.5%),后者包括单纯注意障碍、学习障碍、情绪障碍及无问题的儿童.如以临床诊断/ICD-10为金标准,DSM-Ⅳ的诊断灵敏度为94.57%,特异度87.50%,诊断一致性为0.91.结论中国多动症儿童的多动/冲动症状难以达到DSM-Ⅳ的标准;DSM-Ⅳ标准扩大了诊断范围,主要是注意障碍为主型.在使用DSM-Ⅳ诊断时应考虑民族、文化、年龄、性别因素.     

注意缺陷/多动障碍诊断标准的研究

目的 使用ＤＳＭ－Ⅳ中注意缺陷／多动障碍（ＡＤ／ＨＤ）诊断标准对一组多动综合征和一组无多动的儿童进行诊断,探讨ＤＳＭ－Ⅳ的分布特征及在我国的适用性。方法 多动组：为就诊的多动症儿童,符合临床诊断和ＩＣＤ－１０诊断标准,共９２例。对照组：无多动的学校儿童９６名。由家长填ＤＳＭ－Ⅳ诊断表。结果 在１８８名儿童中,符合ＤＳＭ－Ⅳ ＡＤ／ＨＤ诊断９９例,多动组８７例（９４．５７％）,对照组１２例（１２．５％）,后者包括单纯注意障碍、学习障碍。情绪障碍及无问题的儿童。如以临床诊断／ＩＣＤ－１０为金标准,ＤＳＭ－Ⅳ的诊断灵敏度为９４．５７％,特异度８７．５０％,诊断一致性为０．９１． 结论 中国多动症儿童的多动／冲动症状难以达到ＤＳＭ－Ⅳ的标准;ＤＳＭ－Ⅳ标准扩大了诊断范围,主要是注意障碍为主型。在使用ＤＳＭ－Ⅳ诊断时应考虑民族、文化、年龄、性别因素。     

儿童注意缺陷多动障碍的几种诊断方法探讨

目的　探讨儿童注意缺陷多动障碍 (ADHD)的诊断方法。方法　对家长或教师认为“多动”的 6～ 1 1岁儿童 1 98例 ,采用美国《精神障碍诊断和统计手册》第 4版 (DSM Ⅳ )的标准、持续性注意测验 (CAT)、Conners父母症状问卷 (PSQ)和简明症状问卷 (ASQ)分别作诊断。结果　 4种方法诊断为ADHD的分别有 1 1 0例、1 0 5例、1 0 5例和 95例 ,相应占 55 6 %、53 0 %、53 0 %和 4 8 0 %。后三者分别与前者比较均无显著差异 ( χ2 值分别为 0 2 5、0 .2 5和 2 2 8,P均大于 0 0 5)。CAT、PSQ和ASQ与DSM Ⅳ诊断比较 ,分别有 96 2 %、95 3%和 95 8%为符合与基本符合。CAT的敏感性、特异性和准确性分别为 91 8%、95 5%和 93 4 % ,PSQ的三项相应为 90 9%、94 3%和 92 4 % ,ASQ的三项相应为 77 3%、88 6 %和 82 3%。结论　CAT和PSQ的敏感性、特异性和准确性分别相近或高于目前最常用的ASQ(CAT三项的 χ2 分别为 8 91、2 79和 1 1 4 7,PSQ三项的 χ2 分别为 7 6 4、1 82和 9 1 6 ,P均分别为小于 0 0 5、大于 0 0 5和小于 0 0 5)。对DSM Ⅳ诊断标准具有较客观的补充作用 ,值得试用以至推广应用     

注意缺陷多动障碍的功能神经成像研究

本文就功能神经成像技术如PET、SPECT、fMRI对注意缺陷多动障碍患者的大脑代谢和局部脑血流及神经生化的研究进行综述 ,结果提示ADHD所涉及的脑区为前额叶、顶叶、颞叶、扣带回 ,纹状体 ,基底节等区域。另外也表明注意缺陷障碍的成人的功能神经影像方面不同于儿童。     

注意缺陷多动障碍儿童气质特征的研究

目的探讨注意缺陷多动障碍(ADHD)儿童的气质特征.方法采用中国学龄儿童气质量表对50例8～12岁ADHD患儿进行测查,并与中国常模(n=4350)进行比较.结果ADHD组与常模组的气质类型分布有高度显著性差异(P＜0.01),患儿中麻烦型及中间近麻烦型的比例明显高.ADHD组的活动水平、节律性、适应性、反应强度、心境、持久性、注意转移、反应阈等气质维度的得分与常模组比较有显著性差异.结论ADHD儿童的气质可能有其独特性,应根据其气质特征制定相应的干预方案.     

儿童注意缺陷多动障碍遗传学研究进展

本文综述了近年来儿童注意缺陷多动障碍分子遗传学的研究情况。     

注意缺陷多动障碍儿童的睡眠研究进展

本文就注意缺陷多动障碍儿童的睡眠变化、评估方法、睡眠相关疾病及临床处理等进行了综述。     

注意缺陷多动障碍儿童认知状况对照研究

目的探讨探讨注意缺陷多动障碍（attention—deficit hyperactivity disorder,ADHD）儿童的认知结构特点。方法对40例ADHD儿童（研究组）及与其人口学资料相匹配的107名健康儿童（对照组）采用GO／NOGO任务、字母版2-back工作记忆任务、韦氏记忆量表（WMS—C）中的数字广度及词汇流畅性测试比较两组间认知功能的差异。结果研究组在GO／NOGO任务的错误数、2-back工作记忆的反应时、WMS—C中的词汇流畅性方面均差于对照组（P〈0．05）。结论ADHD儿童存在认知功能的损伤,为今后ADHD儿童认知功能受损的神经机制研究提供证据。     

Issues in the diagnosis of attention-deficit/hyperactivity disorder in children

This paper provides a brief overview of the nature of attention-deficit/hyperactivity disorder (ADHD) in children and the current criteria used in its clinical diagnosis. While the disorder continues to be viewed as one of inattention and/or hyperactive-impulsive behavior, theories of ADHD are beginning to focus more on poor inhibition and deficient executive functioning (self-regulation) as being central to the disorder. Problems have been identified by research pertaining to the clinical diagnostic criteria outlined in the DSM-IV that, at present, remain unresolved. Clinicians should be aware of these problems and the adjustments that need to be made to them when dealing with special populations that were not represented in the field trials used to develop these criteria.     

Aggression in children with attention-deficit/hyperactivity disorder

Research shows that aggression is an important associated feature of attention-deficit/hyperactivity disorder (ADHD) and is important in understanding the impact of the disorder and its treatment. The occurrence of aggressive behavior in combination with ADHD does not appear to be spurious and the severity and/or presence of aggression and ADHD may significantly impact long-term prognosis. This article defines subtypes of aggression in relation to ADHD, identifies individual differences contributing to aggressive behavior in children with ADHD and discusses selected possible underlying mechanisms of aggression in ADHD, as well as current and emerging treatment approaches. Although aggressive behavior in children with ADHD is common, the reasons for this are not yet well understood. Multidisciplinary research should focus on investigating underlying mechanisms related to aggression in ADHD, as well as the utility of various treatment modalities.     

Assessment and diagnosis of attention-deficit/hyperactivity disorder

ADHD is the most common psychiatric disorder of childhood (3% to 5% of children) with continued morbidity into adolescence (85%) and adulthood (50% to 70%). It is a condition associated with widespread significant impairment in academic, occupational, social, and emotional functioning. It is also a condition with a broad extensive differential diagnosis as well as a high rate of comorbidity. There is no diagnostically definitive test for ADHD. Therefore, assessments for ADHD need to be comprehensive and should involve multiple domains, informants, methods, and settings. The comprehensive assessment needs to determine whether the subject has ADHD or another disorder. Thus, evaluation of various organic conditions, functional disorders, developmental status, situational, environmental, and family problems should all be explored. The clinical interview of the child and family is one of the cornerstones of the assessment process. A comprehensive medical history and examination, psychoeducational tests, and school-related evaluation, as well as a view of the child's social and emotional functioning, are also crucial. A wide array of rating scales, tests, and measures have been developed (see Table 1) to aid in the systematic standardized assessment of the various deficits associated with ADHD. None of these tests is definitive, however. Recent development of tests of executive functioning, neuroimaging, and genetics may provide more exact diagnostic guidelines in the future. Current DSM-IV criteria are phenomenologic rather than etiologic and are much more relevant and appropriate for children with ADHD compared with adolescents and adults. A comprehensive assessment involving various domains of functioning (academic, social, emotional, physical, and familial) provide not only more accurate diagnosis but also directions as to what difficulties exist and what multifaceted treatment plan is needed to produce current improvement and long-term positive outcome.     

Proton spectroscopy in medication-free pediatric attention-deficit/hyperactivity disorder.

BACKGROUND: The frontal-striatal pathway has been previously implicated in the neuropathology of attention-deficit/hyperactivity disorder (ADHD). Hence, we used proton magnetic resonance spectroscopy (1H-MRS) to examine metabolite levels in the prefrontal cortex of children with ADHD. METHODS: Nine age- and gender-matched case-control pairs were examined, ages 7 to 16 years. A long-echo 1H-MRS scan was acquired from the right prefrontal cortex and left striatum in all subjects. Compounds that can be visualized with 1H-MRS include N-acetyl-aspartate (NAA), glutamate/glutamine/gamma-aminobutyric acid (Glx), creatine/phosphocreatine (Cr), and choline compounds (Cho). RESULTS: Frontal-striatal glutamatergic resonances were elevated in the children with ADHD as compared to healthy control subjects. No differences were noted in NAA, Cho, or Cr metabolite ratios. CONCLUSIONS: These findings suggest that frontal-striatal Glx resonances may be increased in children with ADHD in comparison with healthy control subjects.     

Sleep disturbances in children with attention-deficit/hyperactivity disorder

In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities.     

Chemosensory processing in children with attention-deficit/hyperactivity disorder

BackgroundIn attention-deficit/hyperactivity disorder (ADHD) not only deficits in dopamine-related cognitive functioning have been found but also a lower dopamine-sensitive olfactory threshold. The aim of the present study was to proof that only olfactory but not trigeminal sensitivity is increased in ADHD. Structural magnetic resonance imaging (MRI) was used to show increased olfactory bulb (OB) volume- a structure which is strongly shaped by olfactory performance through the mechanism of neuroplasticity (e.g. synaptogenesis). To elucidate whether cortical mechanisms are involved in altered olfaction in ADHD, functional MRI (fMRI) was introduced.MethodsA total of 18 boys with ADHD and 17 healthy controls (aged 7–12) were included in the study. Olfactory as well as trigeminal detection thresholds were examined. OB sizes were measured by means of structural MRI and an analysis of effective functional (fMRI) coupling of primary olfactory cortex was conducted. The frontal piriform cortex (fPIR) was chosen as seed region because of its importance in processing both trigeminal and olfactory stimuli as well as having profound influence on inner OB-signaling.ResultsIncreased olfactory sensitivity as well as an increase in OB volume was found in ADHD. There were no group differences in sensitivity towards a trigeminal stimulus. Compared to healthy controls, the fPIR in ADHD was more positively coupled with structures belonging to the salience network during olfactory and, to a lesser extent, during trigeminal stimulation.ConclusionsOlfactory functioning is superior in subjects with ADHD. The observed increase in OB volume may relate to higher olfactory sensitivity in terms of neuroplasticity. During the processing of chemosensory stimuli, the primary olfactory cortex in ADHD is differently coupled to higher cortical structures which might indicate an altered top-down influence on OB structure and function.     

Open-label amantadine in children with attention-deficit/hyperactivity disorder

OBJECTIVES: The purpose of this study was to explore the possible efficacy and tolerability of amantadine in the treatment of attention-deficit/hyperactivity disorder (ADHD) in stimulant-na?ve children. METHODS: Twenty four children (5-13 years old) with Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ADHD (4 inattentive, 2 hyperactive, and 18 combined type) entered a 6-week open-label treatment with amantadine (50-150 mg) given as a single morning dose. Parent and teacher ADHD rating scales and the parent Child Behavior Checklist (CBCL) were administered at baseline and at week 6. RESULTS: Twenty three subjects completed the 6-week treatment. One child dropped out at week 2 because of persistent headache, and another 12 children reported adverse effects, most commonly transient appetite decrease. The parent ADHD score decreased from mean 41.04 +/- D 6.9 at baseline to 28.9 +/- 8.7 at week 6 (p < 0.001, effect size d = 1.5), and the teacher ADHD score from 35.8 +/- 9.6 to 26.2 +/- 9.5 (p < 0.001, effect size d = 1.0). Response rate (a 25% or greater decline in ADHD score) was 58% based on parents and 46% based on teachers. CONCLUSIONS: These data suggest that amantadine has acceptable acute tolerability at single doses up to 150 mg/day and is possibly efficacious in decreasing ADHD symptoms, although its activity appears to be more modest than that of stimulant medications.     

GW320659 for the treatment of attention-deficit/hyperactivity disorder in children

OBJECTIVE: To assess the safety, tolerability, and efficacy of GW320659, a chemically novel inhibitor of norepinephrine and dopamine reuptake, in pediatric attention-deficit/hyperactivity disorder (ADHD). METHOD: This was a multicenter, open-label, dose-titration study of seven daily dose levels of GW320659: 1.25, 2.5, 5, 7.5,10,12.5, and 15 mg. Treatment began with the lowest dose of GW320659 and increased weekly until subjects (mean age 9.1 years) achieved a maximum acceptable dose. Subjects remained at their maximum acceptable dose for a 4-week treatment period. The key efficacy end-point was clinical response (Clinical Global Impressions of Improvement score of 1 or 2 and an improvement of 5 or more points on at least one of the Conners Parent or Teacher Rating Scales Tscore). Other end-points included assessments of safety and of quality of life using the Child Health Questionnaire Parent Form 28 (CHQ-PF28). RESULTS: Fifty-one subjects entered the titration phase and 46 subjects completed the study. During the treatment phase, these 46 subjects received a mean dose of 14.2 mg/day and the maximum exposure to GW320659 was 11 weeks. At the end of the treatment period, 76% of subjects showed improvement with GW320659 and there were significant improvements in 7 of the 12 subscales of the CHQ-PF28 compared with baseline (p < .05). Adverse events were generally mild; only five subjects required downward titration because of adverse events (three psychiatric, one neurological and urological, one cardiovascular), and no subject withdrew because of adverse events. CONCLUSIONS: GW320659 may have clinically relevant efficacy in pediatric ADHD and was well tolerated in this short-term initial study in children.     

DSM-V and the future diagnosis of attention-deficit/hyperactivity disorder

In general, recommendations for the DSM-V and future diagnoses of psychiatric disorders include a dimensional approach to complement the standard categorical approach. For the assessment of attention-deficit/hyperactivity disorder (ADHD), dimensional approaches to supplement the rigid categorical approach of the DSM-IV abound. Historically, dimensions based on severity of symptoms of ADHD and severity of general psychopathology have been used. General dimensional approaches described by a workgroup organized by the American Psychiatric Association are reviewed to provide background and context for a discussion of old and new dimensional approaches to complement future categorical diagnosis of ADHD in the DSM-V.