Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity

BACKGROUND: In children, attention-deficit/hyperactivity disorder (ADHD), tic disorder (TD), and their coexistence (ADHD + TD comorbidity) are very common and clinically important. Associated sleep patterns and their clinical role are still insufficiently investigated. This study aimed at characterizing these sleep patterns in children with ADHD, TD, and ADHD + TD comorbidity and determining whether, in ADHD + TD, the factors ADHD and TD may affect the sleep pattern in an independent (additive) or in a complex (interactive) manner. METHOD: By means of polysomnography, sleep patterns were investigated in 4 groups of unmedicated 8.0-16.4-year-old children (healthy controls, ADHD-only, TD-only, and ADHD + TD). Each group consisted of 18 subjects matched for age, gender, and intelligence. RESULTS: ADHD was primarily characterized by increase in rapid eye movement (REM) sleep, whereas TD patients displayed lower sleep efficiency and elevated arousal index in sleep. In children with ADHD + TD, both effects appeared. No interaction between the ADHD and TD factors was found for any of the sleep parameters. Significant correlations between sleep patterns and clinical symptoms were found. CONCLUSIONS: ADHD and TD are characterized by specific sleep alterations. When coexisting, the two disorders alter the sleep pattern in an additive manner, suggesting a high impact on clinical and therapeutic perspectives.     

Motor disorders and attention-deficit/hyperactivity disorder

Motor and perceptual output problems were associated with hyperactivity before ADHD was described in North America. Many European pediatricians continue to consider these deficits along with inattention and hyperactivity to be part of one disorder. Motor deficits are an associated neurodevelopmental deficit in a substantial number of ADHD patients. In order for the patients' need to be addressed, pediatricians must be able to recognize motor coordination deficits and make appropriate recommendations to the patients' caregivers.     

Neural and behavioral correlates of expectancy violations in attention-deficit hyperactivity disorder

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neuropsychiatric disorder in childhood with established problems in cognitive control and associated fronto-striatal circuitry. More recently, fronto-cerebellar circuits have been implicated in this disorder. Both of these circuits are important in predicting the occurrence and timing of behaviorally relevant events and in detecting violations of these predictions. Therefore, we hypothesized that the ability to predict the occurrence of frequent events would be compromised in ADHD, as well as the ability to adapt behavior when expectancy was violated. METHODS: We used rapid, mixed-trial, event-related functional magnetic resonance imaging (fMRI) to examine cognitive and neural processes in two independent samples of children and adolescents with ADHD and matched controls. Subjects performed a variation of a go-no/go task where the predictability of stimulus identity (what) and timing (when) was manipulated. RESULTS: Behaviorally, children and adolescents with ADHD had increased variability in reaction times, and decreased benefit in reaction time when events were predictable. Differences in accuracy between groups were most reliable for temporally unpredictable trials. Functional imaging results from both samples showed that relative to the control children and adolescents, individuals with ADHD had diminished cerebellar activity to violations of stimulus timing and diminished ventral prefrontal and anterior cingulate activity to violations in stimulus timing and identity. CONCLUSIONS: These findings are consistent with the view that disruptive behaviors in inappropriate contexts, a major criterion in diagnosing ADHD, may be related to an impaired ability to predict temporal and contextual cues in the environment, thus hindering the ability to alter behavior when they change. This ability requires intact fronto-cerebellar, as well as fronto-striatal circuitry.     

Enhancing behavioral and social skill functioning in children newly diagnosed with attention-deficit hyperactivity disorder in a pediatric setting

The objective of this study was to evaluate the effectiveness of an 8-week behavioral and social skill (BSS) class for children newly diagnosed with attention-deficit hyperactivity disorder (ADHD) and their parents, initiating stimulant treatment in primary care. The subjects were 100 children, aged 5 to 12 years, recently diagnosed with ADHD and treated with stimulant medication, and their parents or guardians. Eligible families were randomly assigned to an intervention group (IG: n = 59) or control group (CG: n = 41). The BSS function of each child was assessed using DuPaul's ADHD Parent Rating Scale (18-item) and Child Attention Profile (12-item) during blinded baseline and follow-up interviews. Parent discipline practice was assessed using a five-item inventory based on Likert-scale ratings during identical periods. Computerized pharmacy records were used to track psychostimulant use over time. IG children exhibited significantly lower parent-rated ADHD symptoms, whereas IG parents reported significantly better and more consistent discipline practices compared with CG parents across time. No significant differences were found between groups in Child Attention Profile scores across time. Psychostimulant use did not significantly differ between groups across time. BSS training was well accepted and seemed to significantly improve BSS functioning among IG children in the home setting only.     

Comparison of internalizing and externalizing symptoms in children with attention-deficit hyperactivity disorder with and without comorbid tic disorder.

This study examined the relation between internalizing and externalizing symptoms in two groups of prepubertal boys (with and without multiple chronic tic disorder) with diagnosed attention-deficit hyperactivity disorder (ADHD). Parents and teachers completed the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF), respectively. Children were carefully evaluated for the absence of a chronic tic disorder. Boys with ADHD and chronic multiple tic disorder (ADHD/+tics) received significantly higher (p = .0032, Bonferroni correction) scores for the Anxious/Depressed, Thought Problems, and Attention Problem scales of the CBCL and the Delinquent Behavior, Thought Problems, and Somatic Complaints scales of the TRF than did boys without chronic tic disorder (ADHD/-tics). Although many of the individual items that differentiated (p < .05) the two groups of boys pertained to behaviors that characterize motor tics, obsessions, or compulsions, the ADHD/+tics group exhibited higher rates of anxious behavior (CBCL) and obscene language (TRF) than did the ADHD/-tics group. Anxiety/depressive symptoms were associated with aggressive/oppositional behavior in both samples. Children with mild tic disorder were more similar (CBCL) to ADHD/-tics boys than they were to children with more severe tic disorder. The relatively higher rate of comorbidity in the ADHD/+tics group suggests that tics may be a marker for more severe symptomatology in clinic-referred samples of children with ADHD. Furthermore, these data suggest that it is not the presence, per se, but rather the severity of tic disorder that is associated with higher rates of emotional and behavioral disturbances.     

Response to methylphenidate in boys with attention-deficit hyperactivity disorder

The response to methylphenidate was examined in 36 boys, aged 7-11 y, with attention-deficit hyperactivity disorder (ADHD) in a double-blind, placebo-controlled, crossover design. Hyperactivity and conduct problems were significantly reduced during methylphenidate treatment. Stimulant medication was associated with improvements on tests of sustained attention, working memory and motor steadiness. When individual changes were studied, it was found that 83% showed a significant improvement in their hyperactivity at home or at school, and for 60% their levels of hyperactive behaviour were within the normal range. High levels of hyperactivity at school and relatively low age were significant predictors of normalization of hyperactivity in at least one setting. However, these predictors could only classify correctly 71% of the children. In clinical practice a trial with stimulants is indicated in ADHD children who show symptoms that are sufficiently severe to cause impairment at home and at school.     

Behavioural problems and attention-deficit hyperactivity disorder in children with enuresis: a literature review

Nearly all studies on the co-morbidity between enuresis and psychopathology in children suggest an increased prevalence of behavioural disorders in general and of attention-deficit hyperactivity disorder (ADHD) in particular. Depending strongly on characteristics of the study design, the extent to which this prevalence is increased fluctuates heavily. In the current literature review we found a lack of standardization in the definitions of both enuresis and psychopathology, which makes comparison of research findings difficult. A series of confounding factors that possibly bias study results is also covered. Psychopathology in enuresis seems to be associated with older age, male gender, low socio-economic status and admission to specialized (university) paediatric clinics. Research that fails to report or to control for these factors will not be able to make generalizations to the total population of enuretic children. It is highly important for paediatricians to be aware of the effect of these methodological factors in order to read critically and appreciate the co-morbidity studies on the one hand and to understand better the association between enuresis and psychopathology on the other hand. Future research would benefit from diagnoses based on international diagnostic classification systems made within a well-defined sample.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Sensitivity to interference and response contingencies in attention-deficit/hyperactivity disorder

BACKGROUND: Current theories on ADHD suggest executive and motivational deficits, but it remains unclear whether these are separate deficits or a unitary deficit. METHOD: ADHD children and matched controls performed on a hybrid disjunctive-choice reaction time task in which target stimuli could be surrounded by flankers signaling either the appropriate response, the competing response, or response inhibition. The task was performed under three conditions; reward only, reward and occasional punishment, and equal probability of reward and punishment. Heart rate and skin conductance measures were taken during task performance. RESULTS: Contrary to control children, ADHD children slowed their responses when flankers cueing the appropriate response surrounded the stimulus. Flankers cueing incorrect responses further slowed ADHD children relative to control children. ADHD children also responded less accurately under the threat of punishment. Phasic heart rate did not differ between groups, but immediate reward feedback induced greater heart rate responses in control than in ADHD children. Contrary to expectations, groups did not differ in skin conductance responses. CONCLUSIONS: ADHD children appear deficient in approach tendencies in the presence of imminent reward, rather than unresponsive to punishment or negative feedback. Executive inhibition and motivational inhibition seemed to exert separate effects on behavior of children with ADHD.     

动态脑电图在儿童注意缺陷多动障碍中的应用价值

目的探讨动态脑电图检查在儿童注意缺陷多动障碍临床诊治中的应用价值。方法对179例注意缺陷多动障碍患儿进行常规脑电图检查,其中117例同时行动态脑电图检查并作出评价。结果常规脑电图正常162例,异常17例,其中11例为轻度异常,6例有痫样活动;异常率9.5%。动态脑电图正常96例,异常21例,其中轻度异常9例,有痫样活动12例;异常率17.9%。结论早期运用动态脑电图可以提高注意缺陷多动障碍患儿共患癫痫的检出率,对注意缺陷多动障碍患儿临床控制病情及改善预后有一定的参考意义。