What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention.     

Influence of methylphenidate on motor performance and attention in children with developmental coordination disorder and attention deficit hyperactive disorder

Individuals with attention deficit hyperactive disorder (ADHD) often have coexisting developmental coordination disorder (DCD). The positive therapeutic effect of methylphenidate on ADHD symptoms is well documented, but its effects on motor coordination are less studied. We assessed the influence of methylphenidate on motor performance in children with comorbid DCD and ADHD. Participants were 30 children (24 boys) aged 5.10–12.7 years diagnosed with both DCD and ADHD. Conners’ Parent Rating Scale was used to reaffirm ADHD diagnosis and the Developmental Coordination Disorder Questionnaire was used to diagnose DCD. The Movement Assessment Battery for Children-2 and the online continuous performance test were administrated to all participants twice, with and without methylphenidate. The tests were administered on two separate days in a blind design. Motor performance and attention scores were significantly better with methylphenidate than without it (p < 0.001 for improvement in the Movement Assessment Battery for Children-2 and p < 0.006 for the online continuous performance test scores).The findings suggest that methylphenidate improves both attention and motor coordination in children with coexisting DCD and ADHD. More research is needed to disentangle the causality of the improvement effect and whether improvement in motor coordination is directly affected by methylphenidate or mediated by improvement in attention.     

Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children

We aimed to determine whether it is possible to discriminate between children with attention deficit hyperactivity disorder (ADHD) and children with reactive attachment disorder (RAD) using standardized assessment tools for RAD. The study involved 107 children: 38 with a diagnosis of RAD and 30 with ADHD were recruited through community child and adolescent mental health services (CAMHS) and specialist ADHD clinics. In addition, 39 typically developing children were recruited through family practice. Clinicians were trained to use a standardized assessment package for RAD using a DVD with brief follow-up support. Discriminant function analysis was used to identify the items in the standardized assessment package that best discriminated between children with ADHD and children with RAD. Clinicians’ ratings of RAD symptoms were reliable, particularly when focusing on eight core DSM-IV symptoms of RAD. Certain parent-report symptoms were highly discriminatory between children with ADHD and children with RAD. These symptoms included “cuddliness with strangers” and “comfort-seeking with strangers”. A semi-structured interview with parents, observation of the child in the waiting room and teacher report of RAD symptoms aided diagnostic discrimination between the groups. Clinical diagnosis of RAD can be made reliably by clinicians, especially when focusing on eight core RAD symptoms. Clear discrimination can be made between children with RAD and children with ADHD.     

Motor and gestural performance in children with autism spectrum disorders, developmental coordination disorder, and/or attention deficit hyperactivity disorder.

Motor and gestural skills of children with autism spectrum disorders (ASD), developmental coordination disorder (DCD), and/or attention deficit hyperactivity disorder (ADHD) were investigated. A total of 49 children with ASD, 46 children with DCD, 38 children with DCD+ADHD, 27 children with ADHD, and 78 typically developing control children participated. Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency Short Form, and gestural skills were assessed using a test that required children to produce meaningful gestures to command and imitation. Children with ASD, DCD, and DCD+ADHD were significantly impaired on motor coordination skills; however, only children with ASD showed a generalized impairment in gestural performance. Examination of types of gestural errors revealed that children with ASD made significantly more incorrect action and orientation errors to command, and significantly more orientation and distortion errors to imitation than children with DCD, DCD+ADHD, ADHD, and typically developing control children. These findings suggest that gestural impairments displayed by the children with ASD were not solely attributable to deficits in motor coordination skills.     

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。     

成人注意缺陷多动障碍临床特点的初步分析

目的初步分析我国成人注意缺陷多动障碍(ADHD)患者的症状特点、共病及社会功能情况。方法对6～16岁曾就诊于我院的88例符合美国精神障碍诊断与统计手册第4版(DSM-IV)的ADHD患儿在≥18岁时采用DSM-IV配套的定式会谈工具进行再评估,以满足成人ADHD诊断标准者59例为研究组,对照组为29例不满足ADHD诊断标准且GAF评分70分者,比较两组临床特点的不同。结果成人ADHD临床分型以ADHD-I为主,占86.4%(51/59);"经常"出现的症状依次是:"组织事情有困难"(98.3%)、"逃避需要大量持续用脑的任务"(96.6%)、"不能注意细节"(94.9%)、"很难遵从指令且完不成工作"(96.6%)、"注意持续时间短"(88.1%)和"因外界刺激而分心"(72.9%)。成人ADHD中共患任何一种DSM-Ⅳ轴Ⅰ或轴Ⅱ障碍者66.1%(39/59),其中39.0%(23/59)至少共患一种轴Ⅰ精神障碍,49.2%(29/59)至少共患一种轴Ⅱ障碍。成人ADHD组功能大体评定量表得分明显低于对照组(t=12.96,P0.001),74.6%(44/59)出现轻或中度社会功能损害。结论成人ADHD的临床表现以注意缺陷型为主,共患其他精神障碍及人格障碍较多,总体社会功能相对较差。     

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。     

The interference of local over global information processing in children with attention deficit hyperactivity disorder of the inattentive type

A classic finding in perception of compound patterns is normal individuals cannot skip global analysis in local-oriented processing, but they can successfully resist local analysis in global-oriented processing-the so-called global interference [1]. Recently, studies examining the role of brain hemisphere activity in the Navon task have indicated that the processing of global and local information can be, respectively, attributed to the right and left hemispheres. Moreover, many neuroimaging researches have revealed that certain core symptoms of attention deficit hyperactivity disorder (ADHD) are related to dysfunction of right hemisphere. These findings imply that global interference will be substantially less evident, and possibly even replaced by local interference in ADHD. The present study compared the performance of children with and without attention deficit hyperactivity disorder of the inattentive type (ADHD-I) in the processing of global and local information to examine the local interference hypothesis in ADHD. An ADHD-I group (n=15) and a paired control group (n=19) completed tasks using two versions of the Navon task, one requiring divided attention, in which no information was given to participants regarding the level at which a target would appear, and the other requiring selective attention, in which participants were instructed to attend to either the local or the global level. The results showed that children with ADHD-I exhibited local interference, regardless of which attention procedure was used. These results support the weak right hemisphere hypothesis in ADHD, and provide evidence against the deficit hypotheses for ADHD in the DSM-IV criteria [29], which postulates that inattention symptoms may manifest as a failure to provide close attention to details.     

Attention deficits and clumsiness in Swedish 7-year-old children

A population study of 409 seven-year-old children in a middle-sized Swedish town was performed. All children were examined by the same doctor and evaluated by means of parent interview, motor examinations, and teacher reports on behaviour in the classroom. Follow-up was carried out 8 months later. The rate of severe problems in the fields of attention deficit-hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and deficits in attention, motor control, and perception (DAMP) (the combination of ADHD and DCD) was 6.1%, with boys being affected more frequently than girls. There was considerable overlap between ADHD and DCD, with about half of each diagnostic group also meeting criteria for the other diagnosis. Attention deficits at diagnosis strongly predicted attention deficits at follow-up. If parents had noted attention deficits in the home setting, then teachers almost always independently agreed that there were similar problems in the classroom. However, the reverse did not always apply. Clumsiness also showed striking stability over time. The diagnosis of DAMP, particularly severe DAMP, had a stronger association with classroom dysfunction and with high Conners scores than did diagnoses of ADHD or DCD. It is concluded that DAMP may be a clinically valid diagnostic construct.     

Comorbid Depressive Disorders in ADHD: The Role of ADHD Severity,Subtypes and Familial Psychiatric Disorders

Objective

To evaluate the presence of Major Depressive Disorder (MDD) and Dysthymic Disorder (DD) in a sample of Italian children with Attention Deficit Hyperactivity Disorder (ADHD) and to explore specific features of comorbid depressive disorders in ADHD.

Methods

Three hundred and sixty-six consecutive, drug-naïve Caucasian Italian outpatients with ADHD were recruited and comorbid disorders were evaluated using DSM-IV-TR criteria. To evaluate ADHD severity, parents of all children filled out the ADHD Rating Scale. Thirty-seven children with comorbid MDD or DD were compared with 118 children with comorbid conduct disorder and 122 without comorbidity for age, sex, IQ level, family psychiatric history, and ADHD subtypes and severity.

Results

42 of the ADHD children displayed comorbid depressive disorders: 16 exhibited MDD, 21 DD, and 5 both MDD and DD. The frequency of hyperactive-impulsive subtypes was significantly lower in ADHD children with depressive disorders, than in those without any comorbidity. ADHD children with depressive disorders showed a higher number of familial psychiatric disorders and higher score in the Inattentive scale of the ADHD Rating Scale, than children without any comorbidity. No differences were found for age, sex and IQ level between the three groups.

Conclusion

Consistent with previous studies in other countries, depressive disorders affect a significant proportion of ADHD children in Italy. Patient assessment and subsequent treatment should take into consideration the possible presence of this comorbidity, which could specifically increase the severity of ADHD attention problems.     

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。     

Prevalence of childhood attention deficit hyperactivity disorder in opiate-dependent adults

Background. There is a clear association between childhood attention deficit hyperactivity disorder and substance use disorders in adulthood. Symptoms of attention deficit disorder may also persist into adulthood. The study aimed to determine the prevalence of childhood ADHD in a sample of treatment seeking opiate-dependent adults. Methods. Treatment-seeking opiate-dependent subjects completed the Utah adult ADHD screening test and the self-report early delinquency scale. Results. A total of 15% were “likely” and 49 were “highly likely” to have suffered ADHD in childhood. The averages scores for the delinquency scales were over 6 times those reported from population norms. Conclusion. Symptoms of childhood ADHD is common in adults with opiate dependence. The residual symptoms in adults should be investigated as may be amenable to newer treatments for adult attention deficit disorder.     

Adults’ Versus Children’s Perceptions of a Child with Autism or Attention Deficit Hyperactivity Disorder

The present study examined public perceptions toward children with autism or with attention deficit hyperactivity disorder (ADHD). A convenience sample was used consisting of 30 children (7–12-year-olds) and 30 adults. Participants read a stereotyped scenario featuring either a child with autism, a child with ADHD, or a normal child. Child participants were significantly more likely than adults to (a) express dislike/avoidance toward a child described with either stereotypic autistic or ADHD behaviors, and (b) perceive the child with ADHD as unlike themselves. However, child participants and adults were equally likely to see the autistic child as unlike themselves. Reasons for the different perceptions of children and adults may include differences in perceived threat and in categorization.     

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235) = 8.9, p < 0.001; by child report, F(3,236) = 5.6, p = 0.001) and depression (parent report, F(3,236) = 23.7, p < 0.001; child report, F(3,238) = 9.9, p < 0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.     

A comparison of patterns of sensory processing in children with and without developmental disabilities

This study compared the patterns of sensory processing among children with autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD), and children without disabilities. Parents reported on the frequency of sensory processing issues by completing the Chinese Sensory Profile (CSP). Children with disabilities (ASD or ADHD) exhibited significantly more sensory processing issues than children without disabilities. The results of GLM and discriminant analyses showed that the CSP effectively differentiated between children with and without developmental disabilities. But it failed to identify major differences in sensory processing issues between children with either ASD or ADHD. Sensory processing issues could be one of many criteria that characterize and differentiate the features of children with different developmental disabilities. Although no significant gender differences in sensory processing issues appeared, age was a significant cofounding factor in evaluating sensory processing. Children without disabilities showed some small decreases in sensory processing issues as they aged from 6 to 12 years old. Children with ASD showed some decrease in sensory processing issues over the span of their childhood, while children with ADHD showed a significant increase in auditory processing issues as well as small increases in many aspects of sensory processing.     

托莫西汀治疗儿童注意力缺陷多动障碍研究进展

为探讨托莫西汀对儿童注意力缺陷多动障碍(ADHD)的疗效,本文对托莫西汀治疗儿童ADHD的研究进行综述。通过阐述ADHD发病机制和治疗方案,总结托莫西汀治疗儿童ADHD的效果和安全性,并与哌甲酯、安慰剂治疗的效果进行比较,为ADHD临床治疗提供参考。     

How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder?

AIM: To investigate child and adolescent psychiatrists’ (CAPs) attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children (mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales (VADRSs), CAPs’ diagnoses of ADHD and ODD, and CAPs’ treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs’ ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs’ treatment recommendations against established ADHD and ODD guidelines. RESULTS: Among 63 ADHD subjects, the majority of the subjects (92%) met full ADHD diagnostic criteria at least in one setting (parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings (parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found (95%CI: -0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these case-positives, which is considered as a fair agreement between CAPs and VADRSs (95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy. CONCLUSION: CAPs’ ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD’s most common comorbid condition - ODD - may be under-recognized.     

Sleep-disordered breathing and behavior in three risk groups: preliminary findings from parental reports

Sleep-related breathing disorders may cause excessive daytime sleepiness, cognitive impairment, and behavior problems in children and adolescents. Adenotonsillar enlargement (AT) is known to be a significant risk factor for these disorders, which have also been reported in several patients with Down syndrome (DS). Children with attention deficit disorder/hyperactivity (ADD) show behavior problems that may be related to disturbed nocturnal sleep in some. To evaluate the relationships among these disorders and symptoms, parents of 29 school-aged children with AT, 70 with DS and 48 of their siblings (DS-SIB), and 21 with ADD completed a 20-item screening questionnaire covering nocturnal sleep symptoms and daytime behavior problems. Nocturnal symptoms of sleep-related breathing disorders — snoring, breathing pauses during sleep — were reported more commonly by parents of AT and DS children. However, parents of two of the ADD children reported significant signs of sleep-related breathing disorders. Daytime behavior problems were more common in ADD and AT than in the DS group. Bedwetting reports did not distinguish groups. Direct comparisons of DS and DS-SIB groups showed that more DS were mouth breathers, snored, stopped breathing at night, and were sleepy in the daytime. These findings underscore the importance of obtaining a history of nocturnal sleep from parents of children with AT and DS, as well as those with disrupted daytime behavior.     

Comparing the executive attention of adult females with ADHD to that of females with sensory modulation disorder (SMD) under aversive and non-aversive auditory conditions

Certain behavioral expressions of sensory modulation disorder (SMD) such as distractibility, hyperactivity, and impulsivity are often similar to those of attention deficit/hyperactivity disorder (ADHD) in pediatric and adult populations. There is also a high comorbidity rate between these two diagnoses and absence of research regarding the objective neuropsychological differentiation between them. In the present study we employed a factorial design which enabled us to: (a) systematically examine the effects of SMD and ADHD on executive attention in a sample of adult females using a Stroop-like task, and (b) measure the effect of aversive conditions (sounds) on executive attention. The experimental measures used were the Stroop-like Location – Direction Task (SLDT) to assess executive attention and the battery of aversiveness to sounds (BAS), a standardized measure of aversive sounds that was developed for this study and enabled individual customization of aversive auditory sounds. Results revealed, as expected, a specific core deficit in executive attention for the ADHD factor. In addition to that, the present study provides an important, pioneering finding of SMD impairment in a unique combination of a cognitively demanding task with aversive sounds, providing preliminary objective evidence differentiating SMD from ADHD.