Psychopathologic Profiles and Clusters in Tertiary Clinic Referred Patients with Adult Attention Deficit Hyperactivity Disorder: A Person-Centered Analysis

ObjectiveAdult attention deficit hyperactivity disorder (ADHD) has a heterogeneous clinical presentation with patients showing very frequent emotional problems. In the present study, patients with adult ADHD were subtyped based on their psychopathology using a person-centered approach. MethodsIn the present chart review study, detailed findings of psychological evaluation conducted as part of routine care were utilized. A total of 77 subjects with adult ADHD were included in the analysis. Detailed ADHD symptoms, psychiatric comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, and severity of mood and anxiety symptoms were evaluated in the person-centered analysis. ResultsThree clusters were generated using clustering analysis. DSM comorbid conditions did not significantly impact the clustering. Cluster 1 consisted of ADHD combined presentation (ADHD-C) with less mood symptoms, cluster 2 of ADHD predominantly inattentive presentation and cluster 3 of ADHD-C with significant mood symptoms. Patients in cluster 3 had adulthood functional impairment more frequently compared with patients in cluster 1. Patients in cluster 3 showed recurrent thoughts of death and suicidal ideation more frequently compared with patients in cluster 1. ConclusionFurther studies are needed to confirm the relationships observed in the present study.     

Neuropsychological and Behavioral Profiles in Attention-Deficit Hyperactivity Disorder Children of Parents with a History of Mood Disorders: A Pilot Study

Objective

We aimed to investigate the neurocognitive and behavioral endophenotypes of premorbid mood disorder. We compared intelligence, neuropsychological functioning, and behavioral problems among three groups: 1) a high-risk group [attention-deficit hyperactivity disorder (ADHD) children of parents with a history of a mood disorder], 2) a low-risk group (ADHD children of parents without a history of a mood disorder), and 3) normal comparison subjects.

Methods

We used the Korean Educational Development Institute Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R), the Stroop Color Word Interference Test (Stroop), the Wisconsin Card Sorting Test (WCST), and the Rey-Osterrieth Complex Figure Test (RCFT) as neurocognitive measures, and we used the Child Behavior Checklist (CBCL) as a behavioral measure. Performance on these neuropsychological tests and score on the CBCL of 18 high-risk children were compared to those of 20 low-risk children and 24 healthy children. We also assessed the children''s current mood state and familial functioning to control for the confounding effects of these variables.

Results

Compared to low-risk and healthy children, high-risk children were impaired on the Picture Completion and Stroop Word subtest and showed higher scores on the CBCL subscales representing internalizing symptoms. These significant group differences persisted even after adjustment for the children''s current mood state and familial functioning.

Conclusion

Neuropsychological deficits in the offspring of parents with a mood disorder may be associated with the current mood state rather than with innate characteristics, while their internalizing symptoms may partially stem from innate characteristics that are endophenotypes of a premorbid mood disorder.     

Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD)

BackgroundSleep difficulties have been reported in up to 85% of children with Attention Deficit hyperactivity disorder (ADHD). Children with ADHD exhibit commonly sensory modulation difficulties (SMD) and experience more significant functional difficulties. Sleep difficulties have also been associated with SMD. The aim of this study was to evaluate whether SMD are associated with sleep difficulties in children with ADHD.MethodsWe assessed sleep difficulties using the Children's Sleep Habits Questionnaire, and SMD using the Short Sensory Profile (SSP) questionnaire. A total of 25 children with ADHD and atypical sensory profiles, 13 children with ADHD and typical sensory profiles and 38 children used as controls (all children aged 8–11 years) were included.ResultsSleep difficulties were detected in 86.4% of children with ADHD and atypical SSPs, as compared to 30.8% of children with ADHD and typical SSPs, and 16.7% of controls. A multivariate logistic regression revealed that children with ADHD and atypical SSPs had significantly increased odds for sleep difficulties as compared to controls (OR = 32.4; 95% CI 4.0–260.1, p = 0.001), while children with ADHD and typical SSPs were indistinguishable from controls. Suspected confounders (gender, age, mother's education, and stimulant therapy) did not contribute to sleep difficulties.ConclusionIn this pilot study, SMD were associated with sleep difficulties in children with ADHD.     

Baduk (the Game of Go) Improved Cognitive Function and Brain Activity in Children with Attention Deficit Hyperactivity Disorder

Objective

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with the deficit in executive functions. Playing Go involves many aspect of cognitive function and we hypothesized that it would be effective for children with ADHD.

Methods

Seventeen drug naïve children with ADHD and seventeen age and sex matched comparison subjects were participated. Participants played Go under the instructor''s education for 2 hours/day, 5 days/week. Before and at the end of Go period, clinical symptoms, cognitive functions, and brain EEG were assessed with Dupaul''s ADHD scale (ARS), Child depression inventory (CDI), digit span, the Children''s Color Trails Test (CCTT), and 8-channel QEEG system (LXE3208, Laxtha Inc., Daejeon, Korea).

Results

There were significant improvements of ARS total score (z=2.93, p<0.01) and inattentive score (z=2.94, p<0.01) in children with ADHD. However, there was no significant change in hyperactivity score (z=1.33, p=0.18). There were improvement of digit total score (z=2.60, p<0.01; z=2.06, p=0.03), digit forward score (z=2.21, p=0.02; z=2.02, p=0.04) in both ADHD and healthy comparisons. In addition, ADHD children showed decreased time of CCTT-2 (z=2.21, p=0.03). The change of theta/beta right of prefrontal cortex during 16 weeks was greater in children with ADHD than in healthy comparisons (F=4.45, p=0.04). The change of right theta/beta in prefrontal cortex has a positive correlation with ARS-inattention score in children with ADHD (r=0.44, p=0.03).

Conclusion

We suggest that playing Go would be effective for children with ADHD by activating hypoarousal prefrontal function and enhancing executive function.     

Efficacy and safety of prolonged-release OROS methylphenidate in adults with attention deficit/hyperactivity disorder: A 13-week,randomized, double-blind,placebo-controlled,fixed-dose study

Abstract

Objectives. Methylphenidate (MPH) is effective for adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the efficacy and safety of OROS MPH in adults with ADHD. Methods. Randomized, double-blind study; 279 subjects received OROS MPH 54 or 72 mg/day, or placebo, for 13 weeks. Primary endpoint was the Conners’ Adult ADHD Rating Scale – Screening Version (CAARS-O:SV). Secondary outcomes included CAARS Self Report – Short Version (CAARS-S:S), Sheehan Disability Scale (SDS) and ADHD Impact Module – Adult (AIM-A). Results. Improvements in CAARS-O:SV were significantly greater with OROS MPH 72 mg vs. placebo (P = 0.0024). CAARS-S:S scores decreased significantly vs. placebo in both OROS MPH arms (P < 0.05). There was no significant change in SDS score from baseline in either treatment arm, although significant benefit vs. placebo was observed on several AIM-A subscales. Treatment was well tolerated. Conclusions. OROS MPH provided overall benefits in the treatment of adults with ADHD.     

Mind-Body Exercises (Yoga/Tai Chi) for Attention-Deficit/Hyperactivity Disorder: A Quantitative Evidence of Experimental Studies

Background: Attention-deficit/hyperactivity disorder (ADHD) is acommon pediatric psychiatric disorder. Although mindful exercises (Yoga andTai Chi) have been increasingly accepted as alternative medicine for ADHD,no meta-analytic review has been conducted on this topic. Objective: We systematically and critically evaluated the existing literature regarding the effects of thetwo most widely practiced mindful exercises on ADHD symptoms and social problems in children and adolescents with ADHD. Methods: Searching literaturedatabases included PubMed, Web of Science, Scope, China National KnowledgeInfrastructure and Wanfang. Only randomized controlled trials (RCT) and nonrandomized controlled studies (NRS) that investigated the beneficial effects ofYoga and/or Tai Chi for ADHD were included in this review. Two review authorsindependently performed literature search, data extraction, and study qualityassessment. Based on the random-effect model, standardized mean difference(SMD) reflects magnitude of mindful exercises was calculated. Results: Seveneligible studies (5 RCTs and 2 NRS) were included for meta-analysis. As compared to control groups, mindful exercises showed significant positive effectson attention (SMD = 0.93, 95% CI 0.39 to 1.48, p < 0.001, I2 = 36%), hyperactivity/impulsivity (SMD = 0.93, 95% CI 0.53 to 1.34, p < 0.001, I2 = 60.17%),overall symptoms of ADHD (SMD = 0.84, 95% CI 0.3 to 1.38, p < 0.05,I2 = 54.61%), and social problems (SMD = 0.49, 95% CI −0.01 to 0.98,p < 0.05, I2 = 0%). Conclusions: Yoga and Tai Chi may have the potential toalleviate the symptoms and social problems among children and adolescents withADHD. More robust studies with large sample sizes are needed to validate resultsof the present meta-analytical review.     

The Effects of Methylphenidate on Neural Substrates Associated with Interference Suppression in Children with ADHD: A Preliminary Study Using Event Related fMRI

Objective

The core deficit of attention deficit hyperactivity disorder (ADHD) is associated with frontal cortex and related circuitry. Children with ADHD and a medication history have shown atypical brain activation in prefrontal and striatal brain regions during cognitive challenge. We investigated two cognitive control operations such as interference suppression (IS) and response inhibition (RI) in children with ADHD. We also assessed the brain functions affected by the methylphenidate (MPH) effect by comparing the blood-oxygen level dependent (BOLD) signals in ADHD children on and off medication.

Methods

Eight children (9-11 years of age) with combined-type ADHD underwent rapid event-related functional magnetic resonance imaging (fMRI) during performance of a modified flanker task. Two fMRI (3.0 T) scans were conducted with a one week interval-one with MPH treatment and the other without. Functional maps were generated through group averaging and performance-based correlational analyses.

Results

Performances of the two cognitive control operations did not differ significantly between on-MPH and off-MPH status other than the reaction time to incongruent stimuli in ADHD children. In those affected by MPH treatment, an increased activation in the right prefrontal cortex during incongruent task was observed relative to a neutral trial in children with ADHD.

Conclusion

On the treatment of MPH, the ADHD children exhibited increased activation of the right frontal cortex during interference suppression. This finding suggested that MPH affected the right frontal cortex in ADHD compensating for a reduced level of interference suppression. Future studies will be required to ascertain the MPH effect of cognitive brain regions among large number of children with ADHD.     

Melatonin dispensing and polypharmacy rates for New Zealand children with autism or attention deficit hyperactivity disorders: A nationwide pharmacoepidemiological study

BackgroundChronic insomnia is common in children with autism and Attention Deficit Hyperactivity Disorder (ADHD). Melatonin is often used to treat childhood insomnia. However, it may interact with other medications being used to manage other symptoms. This pharmacoepidemiological study examined the rates of general and psychotropic polypharmacy among children with autism and/or ADHD, stratified by melatonin dispensing. The impact of sociodemographic and child characteristics on such dispensing was also examined.MethodLinked national health and pharmaceutical administrative data for children aged 0–18 years in 2019 was utilized. Overall and melatonin dispensing stratified polypharmacy rates were calculated. Ordinal logistic regression models were employed to compare groups and adjust for confounders.ResultsData were acquired for 10,209 children with autism (18.5% were dispensed melatonin), 5970 with ADHD (22.3% were dispensed melatonin), 2064 with autism and ADHD (29.9% were dispensed melatonin), and 1156,296 without a diagnosis of autism or ADHD (a control group; 0.5% dispensed melatonin). Relative to controls, rates of melatonin dispensing and polypharmacy were higher in children with autism and ADHD, and highest among those with both conditions. Children dispensed melatonin experienced the greatest rates of polypharmacy, especially if they had both autism and ADHD.ConclusionsChildren with autism and ADHD experience significant medication burden and potentially adverse interactions between psychotropic and sleep-related medication, raising important questions regarding their clinical care.     

Atomoxetine for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children with ADHD and dyslexia

Background

There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country.

The objective of the study

To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample.

Methods

The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study.

Results

The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning.

Conclusion

This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.     

Reading comprehension in adolescents with ADHD: Exploring the poor comprehender profile and individual differences in vocabulary and executive functions

The overall objective of this study was to investigate reading comprehension in youth with and without a prior diagnosis of attention-deficit hyperactivity disorder (ADHD). The first goal was to determine whether youth with and without ADHD matched in word reading ability exhibited differences in reading comprehension proficiency. The next goal was to determine whether good and poor comprehenders within the ADHD subgroup differed from each other on language and academic achievement measures. The third objective was to examine whether word recognition or oral vocabulary knowledge mediated the effect of ADHD symptoms on reading comprehension performance. Youth with ADHD scored significantly lower than the comparison youth on a standardized measure of reading comprehension. Relative to good comprehenders with ADHD, poor comprehenders with ADHD exhibited weaknesses in expressive vocabulary, mathematical reasoning, written expression, and exhibited more executive function (EF) difficulties as reported by the teacher. Expressive vocabulary and word reading, but not teacher EF ratings, accounted for unique variance in reading comprehension performance and mediated the relationship between ADHD symptoms and reading comprehension. Implications for further research and educational practice are discussed.