Consortium neuroscience of attention deficit/hyperactivity disorder and autism spectrum disorder: The ENIGMA adventure

Neuroimaging has been extensively used to study brain structure and function in individuals with attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) over the past decades. Two of the main shortcomings of the neuroimaging literature of these disorders are the small sample sizes employed and the heterogeneity of methods used. In 2013 and 2014, the ENIGMA‐ADHD and ENIGMA‐ASD working groups were respectively, founded with a common goal to address these limitations. Here, we provide a narrative review of the thus far completed and still ongoing projects of these working groups. Due to an implicitly hierarchical psychiatric diagnostic classification system, the fields of ADHD and ASD have developed largely in isolation, despite the considerable overlap in the occurrence of the disorders. The collaboration between the ENIGMA‐ADHD and ‐ASD working groups seeks to bring the neuroimaging efforts of the two disorders closer together. The outcomes of case–control studies of subcortical and cortical structures showed that subcortical volumes are similarly affected in ASD and ADHD, albeit with small effect sizes. Cortical analyses identified unique differences in each disorder, but also considerable overlap between the two, specifically in cortical thickness. Ongoing work is examining alternative research questions, such as brain laterality, prediction of case–control status, and anatomical heterogeneity. In brief, great strides have been made toward fulfilling the aims of the ENIGMA collaborations, while new ideas and follow‐up analyses continue that include more imaging modalities (diffusion MRI and resting‐state functional MRI), collaborations with other large databases, and samples with dual diagnoses.     

Psychometric properties of the French Version of the Social Responsiveness Scale in autism spectrum disorder with or without attention deficit hyperactivity disorder

ObjectivesThe Social Responsiveness Scale (SRS) is an instrument that is commonly used to screen for Autism Spectrum Disorder (ASD). Attention Deficit Hyperactive Disorder (ADHD) frequently occurs with ASD and both disorders share some phenotypic similarities. In the present study, we aimed to determine the psychometric properties of the French version of the Social Responsiveness Scale (SRS) and its 5 subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerisms) to discriminate between children with ADHD and those with ASD (differential diagnosis) and children with ADHD from those with a dual diagnosis of ADHD and ASD (comorbid diagnosis).MethodSRS total scores and the 5 subscores of the SRS were compared between 4 groups of children: ADHD (n = 32), ASD + ADHD (n = 30), ASD (n = 31) and typical neurodevelopment (TD; n = 30) children. The discriminant validity was estimated using the Area Under the ROC Curves (AUC).ResultsSRS Social cognition (AUC = 0.73) and Autistic mannerisms (AUC = 0.70) subscores were the most discriminating for differential diagnosis of ASD and ADHD. SRS total scores (AUC = 0.70), and Social communication (AUC = 0.66) and Autistic mannerisms (AUC = 0.75) subscores were the most discriminating for comorbid diagnosis of ASD among ADHD children.ConclusionThe SRS autistic mannerisms subscore was found to be clinically relevant for both differential diagnosis of ASD and ADHD and comorbid diagnoses of ASD among ADHD children but with a modest discriminant power.     

Promoting social skill use and generalization in children with autism spectrum disorder

Social skills training is a frequently utilized intervention for addressing social deficits of children with autism spectrum disorder (ASD). The current study investigated the effects of the Superheroes Social Skills program, a social skills training program consisting of multiple evidence-based practices, in promoting accurate demonstration of target social skills in both a training and generalized setting. Three children with ASD between the ages of 10 and 14 attended 10 social skills training sessions over five weeks, with social skills lessons targeting participation, conversation, perspective taking, and problem solving skills. A multiple probe design across behaviors and replicated across participants was utilized to evaluate accurate demonstration of target social skills. Results suggest improvement in skill accuracy in both the training and generalization settings. Indirect secondary measures of participant social functioning and parental stress were also collected and suggest improvements associated with social skills training.     

Relationship between the social functioning of children with autism spectrum disorders and their siblings’ competencies/problem behaviors

There is very little known about how sibling characteristics may influence the social functioning of a child with an autism spectrum disorder (ASD). The current study utilized data from the Simons Simplex Collection (SSC; n = 1355 children with ASD and 1351 siblings) to investigate this relationship. Phenotypic measures included (a) the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and the Vineland Adaptive Behavior Scales-II (VABS-II) for the probands with ASD and (b) the Social Communication Questionnaire (SCQ), the Social Responsiveness Scale (SRS), the Child Behavior Checklist (CBCL), and the VABS-II for siblings. Sibling data were first analyzed collectively, then analyzed by “older” and “younger” groups, relative to the age of the proband with ASD. Significant correlations were observed between probands’ and siblings’ VABS-II socialization domain scores; additional associations were noted between (a) probands’ VABS-II socialization domain scores and siblings’ CBCL internalizing subscale scores when only younger siblings were analyzed, and (b) probands’ ADOS Reciprocal Social Interaction (RSI) domain scores and the sibling SCQ scores when only older siblings were analyzed. These findings suggest that typically developing children may have a small yet meaningful influence on the prosocial development of their siblings with ASD. Limitations and future directions are discussed.     

Transferrin in korean children with attention deficit hyperactivity disorder

Objective

The aim of the present study was to investigate the relationship between iron, ferritin, transferrin, total iron binding capacity (TIBC), hemoglobin, mean corpuscular volume (MCV) mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in children with ADHD.

Methods

MethodsaaThe sample consisted of 48 ADHD children and sex and age matched control children (a couple of 28 boys, 22 girls; age 6-8 years; mean±SD, 6.98±0.39). We diagnosed ADHD according to DSM-IV. ADHD symptoms were evaluated subjectively with Conners'' Parent Rating Scales, Dupaul Parent ADHD Rating Scales. Subjects with ADHD and control were evaluated the hematology test including the iron, transferrin, MCV etc. Paired t test were used to evaluate the relation of a lot of hematology findings between ADHD and control group.

Results

The serum iron, ferritin, transferrin, TIBC, hemoglobin, MCV, MCH, and MCHC of ADHD group were respectively 80.92±33.33 ug/dL, 35.81±16.59 ng/mL, 248.42±44.15 mg/dL, 351.69±102.13 ug/dL, 12.78±0.71 g/dL, 82.94±2.58 fL, 27.18±1.12 uug, 32.79±1.12%. Otherwise the serum iron, ferritin, transferrin, TIBC, hemoglobin, MCV, MCH, and MCHC of control group were respectively 82.04±28.14 ug/dL, 37.05±18.28 ng/mL, 266.27±25.40 mg/dL, 352.77±89.54 ug/dL, 12.77±0.70 g/dL, 81.81±2.96 fL, 26.69±0.99 uug, 32.66±0.96%. A significant difference were found in the transferrin(t=2.63, p=0.011), MCV (t=2.19, p=0.034), and MCH (t=2.18, p=0.034).

Conclusion

These results suggested that lower transferrin levels might be related with ADHD symptoms.     

The fMRI success rate of children and adolescents: Typical development,epilepsy, attention deficit/hyperactivity disorder,and autism spectrum disorders

Functional magnetic resonance imaging (fMRI) in children is increasingly used in clinical application and in developmental research; however, little is known how pediatric patient and typically developing populations successfully complete studies. We examined pediatric success rates with epilepsy, attention deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and typically developing children (TYP). We also examined the affect of age, and, for ADHD populations, medication status on success rates. We defined a successful fMRI individual run when the data were interpretable and included in group statistics. For unsuccessful runs, datasets with excessive motion or floor task performance were categorized when possible. All clinical groups scanned less successfully than controls; medication status did not affect ADHD success (epilepsy, 80%; ADHD (off methylphenidate), 77%; ADHD (on methylphenidate), 81%; ASD, 70%; TYP, 87%). Ten to 18‐year‐old had a significantly greater scan success rate than 4‐ to 6‐year‐old; adolescents (13‐ to 18‐year‐old) demonstrated greater scan success rates than 7‐ to 9‐year‐old. Success rate for completing an entire battery of experimental runs (n = 2–6), varied between 50–59% for patient populations and 69% for TYP (79% when excluding 4‐ to 6‐year‐old). Success rate for completing one run from a battery was greater than 90% for all groups, except for ASD (81%). These data suggest 20–30% more children should be recruited in these patient groups, but only 10–20% for TYP for research studies. Studies with 4‐ to 6‐year‐olds may require 20–40% additional participants; studies with 10‐ to 18‐year‐olds may require 10–15% additional participants. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.     

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

BackgroundAttention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD.MethodADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2–5 from a large case-control study with ASD (n = 548), TD (n = 423), and DD (n = 180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales.ResultsMean hyperactivity subscale scores were lowest in children with TD (mean = 3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p < 0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = −5.63, p = 0.0005; Mullen visual reception scale = −2.94, p = 0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically.ConclusionThese results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.     

Efficacy of cognitive behavior therapy-based social skills intervention for school-aged boys with autism spectrum disorders

School-aged children with Autism Spectrum Disorders (ASD) experience significant difficulty with peer interaction. Research to identify the most effective strategies to address this difficulty has increased but more evidence is needed. Cognitive behavior therapy (CBT), which focuses on changing how a person thinks about social situations as well as how he behaves, is a promising approach. This study evaluated the efficacy of a 15 week CBT-based social skills intervention for boys aged 10–12 years diagnosed with an ASD. Boys with average or better IQ and receptive language skills were randomly assigned to either a control (n = 8) or intervention condition (n = 7). During intervention, boys attended weekly 2 h long group sessions focusing on self-monitoring skills, social perception and affective knowledge, conversation skills, social problem-solving, and friendship management skills. Comparison of the outcomes using repeated measures analyses indicated that boys receiving the intervention scored significantly better on measures of social perception, peer interaction, and social knowledge than boys who had not received intervention. There were no differences on general measures of socialization. The manualized intervention used in this study shows promise but replication with larger samples is needed.     

Common outcome,different pathways: Social information-processing deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder

Social functioning is a key domain of impairment in both autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). This review adopts the social information-processing model as the theoretical framework to compare and contrast the deficits of ASD and ADHD at each of the six steps of social information-processing. Both disorders show deficits at each step, but the nature and origins of the deficits are different. Thus, while both disorders exhibit a common outcome of social impairment, the exact pathways that each disorder traverses along the six steps of social information-processing are different. For ASD, there is a social knowledge/behaviour deficit arising from difficulties in social/emotional cue detection, encoding, and interpretation, leading to problems in joining and initiating social interaction. For ADHD, there is a performance deficit incurred by disruption arising from the ADHD symptoms of inattention and hyperactivity/impulsivity, while its acquisition capacity on social knowledge is relatively intact. The inattentive, intrusive, and impulsive behaviours of ADHD unsettle social interaction. Finally, this review proposes training targets for intervention along the six steps of the social information-processing model for ASD and ADHD, as well as areas for future research in further elucidating the social impairment of the two disorders.     

Smell identification function in children with attention deficit hyperactivity disorder

Objective

Deficits in olfactory function are common features in neurodegenerative and neuropsychiatric disorders. Olfactory processing is related to dopamine metabolism and orbitofrontal cortex functioning, both known to be involved in the neurobiology of ADHD. Some investigations suggested alterations in olfactory processing (identification and detection threshold) in patients with ADHD. Despite increasing knowledge, controversy about this topic still exists regarding children with ADHD. This study was conducted to help elucidate some of this controversy.

Methods

50 participants (8-15 years, mean=10.70±1.77) with ADHD were compared to 50 controls. The two groups were well matched for age, gender and Mean School Scores (MSS). We assessed odor identification and threshold through a smell test composed of two tests of identification and detection threshold. Odor detection threshold was assessed with the odorant phenyl ethyl alcohol solved in propylene glycol using a single staircase method. Odor identification was assessed with chemical essences of five common odorants.

Results

The mean Sensory Identification Score for children with ADHD and the control groups were 3.76 (1.06) and 4.46 (0.76), respectively (p<0.001). The mean for Sensory Threshold Score for ADHD and control group was 6.4 (3.35) and 9.75 (2.16), respectively (p<0.001).

Conclusion

This study replicated altered olfactory performance in ADHD. Substantial olfactory deficits across the two domains of identification and detection threshold are observed in children with ADHD. These deficits do not seem to be a result of olfactory task difficulty and are not influenced by age, gender and MSS. Further studies are required to investigate whether olfactory function can be used as a biological marker for early diagnosis, treatment and prognosis of ADHD.     

A review of treatments for deficits in social skills and self-help skills in autism spectrum disorder

Deficits in social skills and self-help skills present significant challenges for individuals diagnosed with autism spectrum disorders (ASD). Much research in Applied Behavior Analysis (ABA) has been devoted to treatments for deficits in social skills and there exist a number of extensive reviews on the research in this area. Some research has also been conducted in the treatment of self-help skills although no comprehensive reviews of this research have been conducted. A combined acquisition of social and self-help kills is required by individuals diagnosed with ASD for successful independent living in society. The current literature review provides a comprehensive investigation and examination of studies focused on interventions for deficits in social skills or self-help skills in those with ASD. Twenty-two studies that met the inclusion criteria were chosen. Studies were categorised based on intervention. Key studies were defined as studies that added something novel to the literature, rather than replicating previous research. Each study was then evaluated on a number of aspects. All studies showed positive outcomes. Strengths, limitations and future recommendations are discussed.     

Self-esteem,social support,and life satisfaction in Chinese parents of children with autism spectrum disorder

PurposeThe current study examined self-esteem, social support, and life satisfaction in Chinese parents of children with autism spectrum disorder (ASD), and observed the mediation effects of social support on the relationship between self-esteem and life satisfaction.MethodsWe compared 118 Chinese parents of children with ASD to 122 demographic-matched parents of typically developing children on measures of self-esteem, social support, and life satisfaction using the Rosenberg Self-Esteem Scale (SES), Multidimensional Scale of Perceived Social Support (MSPSS), and Satisfaction with Life Scale (SWLS), respectively.ResultsParents of children with ASD scored significantly lower on self-esteem, social support, and life satisfaction than the controls (ps < 0.01), and social support partly mediated the relationship between self-esteem and life satisfaction in both groups. Hierarchical regressions indicated that after controlling for demographic variables, social support and self-esteem were significant predictors of life satisfaction in both groups but explained more variance in life satisfaction for the parents of children with ASD.ConclusionsSocial support and self-esteem play a more important role in life satisfaction for parents of children with ASD than those of typically developing children. Life satisfaction is positively related to higher household income, higher self-esteem, and stronger social support for parents. Self-esteem is likely to be associated with greater life satisfaction by means of greater social support. Future research and interventions should focus on fostering a more positive climate of social support for ASD families in China.     

Psychotherapy of attention deficit hyperactivity disorder in adults

In clinical practice many adult patients with attention deficit hyperactivity disorder (ADHD) ask for an additional psychotherapeutic intervention besides the medical therapy. In this paper we present a structured skill training program particularly tailored for adult patients with ADHD. The program is based on the principles of cognitive-behavioral treatment for borderline personality disorder developed by M. Linehan. It was modified to suit the special needs of adult patients with ADHD. In this exploratory pilot study we tested this program in a group setting. The following elements were presented: neurobiology of ADHD, mindfulness, chaos and control, behavior analysis, emotion regulation, depression, medication in ADHD, impulse control, stress management, dependency, ADHD in relationship and self respect. In an open study design patients were assessed clinically using psychometric scales (Attention Deficit Hyperactivity Disorder Checklist according to DSM-IV, 16 items of the SCL-90-R, Beck-Depression Inventory, visual analogue scale) prior to and following group therapy. This treatment resulted in positive outcomes in that patients improved on all psychometric scales. Received: 19 April 2002 / Accepted: 18 July 2002     

Long-term cardiovascular safety of psychostimulants in children with attention deficit hyperactivity disorder

Objective: Side effects are a concern during psychostimulant treatment. Unfortunately, many previous studies only investigated short-term effects of psychostimulants in laboratory settings which lack clinical daily routines.

Methods: We examined 1042 patient records of patients with attention deficit hyperactivity disorder (ADHD) who were referred to a pediatric-psychiatry practice over 12?years. Data analysis was based on 466 children with ADHD who were newly treated with psychostimulants and who were not in treatment for elevated blood pressure. We analysed blood pressure percentiles, heart rate and BMI percentiles.

Results: There was a decrease in systolic and diastolic blood pressure percentiles. Heart rate was not affected. BMI slightly declined in girls.

Conclusions: In general psychostimulants were safe. To further elucidate negative effects of psychostimulants, long-term controlled and randomized studies in naturalistic settings are of interest.     

孤独症谱系障碍与注意缺陷/多动障碍的核心特征与治疗

神经发育障碍是一组在发育阶段起病的疾病,代表性疾病是孤独症谱系障碍(ASD)和注意缺陷/多动障碍(ADHD)。ASD的核心特征是存在社交交流和社交互动的缺陷,重复的行为模式、兴趣或活动和功能损害。ADHD的核心特征是注意障碍、多动、冲动和功能损害。两者的风险因素都为遗传和环境。ASD的治疗方法包括行为分析,提供结构性环境和药物治疗。ADHD的治疗方法包括行为治疗和中枢兴奋性药物治疗。     

Increased levels of plasma glial-derived neurotrophic factor in children with attention deficit hyperactivity disorder

Abstract

Background: Recent evidence suggests that neurotrophic growth factor systems, including brain-derived neurotrophic factor, might be involved in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Glial cell line-derived neurotrophic factor (GDNF) is from the transforming growth factor-β family and is abundantly expressed in the central nervous system, where it plays a role in the development and function of hippocampal cells. To date, no association studies have been done between ADHD and GDNF. Thus, here we investigate the hypothesis that there are differences in plasma GDNF levels between children with ADHD and healthy controls. Methods: Plasma GDNF levels were measured in 86 drug-naïve children with ADHD and 128 healthy children. The severity of ADHD symptoms was determined by scores on the Korean ADHD Rating Scale (K-ARS) in patients and healthy controls. Results: The median plasma GDNF levels in ADHD patients was 74.0 (IQR: 23.4–280.1) pg/ml versus 24.6 (IQR: 14.5–87.3) pg/ml in healthy controls; thus the median plasma GDNF levels in ADHD patients were significantly higher than in healthy controls (Mann–Whitney U-test, P < 0.01). Plasma GDNF levels were correlated positively with K-ARS subscale scores (inattention, hyperactivity–impulsivity and total), determined by Spearman's correlation test in ADHD patients and healthy controls (r = 0.371, P < 0.01; r = 0.331, P < 0.01; and r = 0.379, P < 0.01, respectively). Conclusions: These findings suggest increased plasma GDNF levels in untreated ADHD patients. In addition, plasma GDNF levels had a significant positive correlation with inattention, hyperactivity–impulsivity and K-ARS total scores in ADHD patients and healthy controls. Further studies are required to determine the source and role of circulating GDNF in ADHD.