Autistic spectrum disorder,attention deficit hyperactivity disorder,and allergy: Is there a link? A nationwide study

Previous studies showed that both attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD) were associated separately with a higher risk of allergic diseases. However, the comorbid effect of ADHD and ASD on the risk of allergic diseases is still unknown. Using the Taiwan National Health Insurance Research Database, 5386 children aged less than 18 years with ADHD alone, 578 with ASD alone, 458 with ADHD + ASD, and 25,688 non-ADHD/ASD age- and sex-matched (1:4) controls were enrolled in our study. The prevalence of allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis, was evaluated among the four groups. Logistic regression analysis showed that the ADHD + ASD group (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 1.83–2.79), ADHD-alone group (OR: 1.81, 95% CI: 1.70–1.93), and ASD-alone group (OR: 1.24, 95% CI: 1.04–1.48) had an increased risk of allergic comorbidities compared to the control after adjusting age, sex, and level of urbanization. ASD children with more allergic comorbidities (≧3: OR: 2.57, 95% CI: 1.74–3.79; 2: OR: 2.00, 95% CI: 1.41–2.84; 1: OR: 1.60, 95% CI: 1.16–2.22) were associated with a greater likelihood of ADHD. Children with ADHD or ASD had an increased risk of allergic comorbidities, and those with both ADHD and ASD had the highest. These results may inspire more research to clarify the underlying mechanisms among ASD, ADHD, and allergic diseases.     

Is neonatal jaundice associated with autism spectrum disorder,attention deficit hyperactivity disorder,and other psychological development? A nationwide prospective study

Neonatal jaundice may cause the lifelong sequelae of central nerve system developmental disorders. However, the results are inconsistent. 2016 newborns with neonatal jaundice and 8064 age-/gender-matched (1:4) controls were enrolled during 1999–2000. Participants of autistic spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and other developmental disorders that occurred during the follow-up were identified. Newborns with neonatal jaundice had increased risks of developing ASD (hazard ratio [HR]: 1.75, 95% confidence interval [CI]: 1.05–2.90), any developmental delay (HR: 1.27, 95% CI: 1.02–1.58), and developmental speech or language disorder (HR: 1.41, 95% CI: 1.11–1.79). Newborn exposure to hyperbilirubinemia was related to the increased risk of developing ASD, any developmental delay, and developmental speech or language disorder in later life.     

Is there a cluster of high theta-beta ratio patients in attention deficit hyperactivity disorder?

ObjectiveIt has been suggested that there exists a subgroup of ADHD patients that have a high theta-beta ratio (TBR). The aim of this study was to analyze the distribution of TBR values in ADHD patients and validate the presence of a high-TBR cluster using objective metrics.MethodsThe TBR was extracted from eyes-open resting state EEG recordings of 363 ADHD patients, aged 5–21 years. The TBR distribution was estimated with three Bayesian Gaussian Mixture Models (BGMMs) with one, two, and three components, respectively. The pairwise comparison of BGMMs was carried out with deviance tests to identify the number of components that best represented the data.ResultsThe two-component BGMM modeled the TBR values significantly better than the one-component BGMM (p-value = 0.005). No significant difference was observed between the two-component and three-component BGMM (p-value = 0.850).ConclusionThese results suggest that there exist indeed two TBR clusters within the ADHD population.SignificanceThis work offers a global framework to understanding values found in the literature and suggest guidelines on how to compute theta-beta ratio values. Moreover, using objective data-driven method we confirm the existence of a high theta-beta ratio cluster.     

Is there a need to reformulate attention deficit hyperactivity disorder criteria in future nosologic classifications?

The development of classification systems in psychiatry has been a complex task. In clinical settings, these classification systems help communication about disorders among professionals and between them and their patients. In addition, a diagnosis based on these nosologic systems has a central role for mental health insurance policies. There is a recent interest in research opportunities for improving the nosology of attention deficit hyperactivity disorder (ADHD) in future classification systems like the DSM-V and the ICD-11. This article addresses the potential need to reformulate ADHD criteria in future nosologic classifications.     

Did goethe describe attention deficit hyperactivity disorder?

As early as 1846, the typical symptoms of attention deficit hyperactivity disorder (ADHD) were described by Heinrich Hoffmann (1809-1894). However, in Goethe's masterpiece Faust (1832), the character of Euphorion strongly suggests ADHD diagnosis.     

Is there a relationship between attention deficit/hyperactivity disorder and manic symptoms among children with mental retardation of unknown etiology?

Mental retardation (MR) is common and lifelong. In children and adolescents with MR, the rate of attention deficit/hyperactivity disorder (ADHD) and bipolar disorder is higher than that in the general population. However, there are no previous sufficient data that exist in establishing a relationship between ADHD and manic symptoms. The aim of the present study was to examine the relationship between manic symptoms and ADHD as well as oppositional-defiant disorder (ODD) and conduct disorder (CD) in children with MR of unknown etiology (MR-UE).A total of 167 children with MR-UE attending a rehabilitation and training school in Erzurum, Turkey, were included in the study. We administered the Child Disruptive Behavior Screening and Rating Scale related to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Young Mania Rating Scale–Parent Version (P-YMRS) to parents.The age range of children and adolescents with MR-UE was between 5 and 21 years, with a mean age of 11.13 ± 3.75 years. In total, 5.8% of children and adolescents with MR-UE showed a border intelligence quotient (IQ), with 58.4% having a mild IQ, 29.2% having a moderate IQ, and 6.6% having severe IQ. According to the Child Disruptive Behavior Screening and Rating Scale related to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 40.1% of children and adolescents with MR-UE had inattention, 19.9% had hyperactivity, 28.7% had ODD, and 13.3% had CD.A total of 7.2% of the children and adolescents with MR-UE had probable mania, and 1.8% had mania according to Young Mania Rating Scale–Parent Version. A positive correlation existed between the mean scores of Young Mania Rating Scale–Parent Version and the mean scores of inattention, hyperactivity, ODD, and CD (P = .000). Hyperactivity and ODD were predictors of being manic/probably manic.Diagnosing psychiatric disorders in children and adolescents with MR-UE is difficult but essential for better functioning. Manic symptoms and disruptive behaviors as well as ADHD symptoms were prevalent among children and adolescents with MR-UE and hyperactivity, and oppositional-defiant symptoms were predictors of manic symptoms in these patients.     

Sleep quality among adults with attention deficit hyperactivity disorder or autism spectrum disorder: which is the role of gender and chronotype?

Both Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) present increased prevalence rates of sleep difficulties, which persist into adulthood. However, it is still unclear whether in adults these disorders show specific sleep patterns and which role is played by comorbidities, circadian preferences and gender. This study aimed to describe and compare subjective measures of sleep in adults with ADHD and high-functioning ASD, in relation to the levels of anxiety and depression, chronotype and gender. In a sample of 136 adults (43 ADHD, 43 high-functioning ASD, 50 controls) subjective sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), and clinical scales were used to assess chronotype and the levels of anxiety and depression. The three groups showed a significant difference in the distribution of chronotypes, with greater prevalence of an Evening chronotype among ASD compared to controls. The MANCOVA using PSQI subscale scores as dependent variables and MEQ-SA score and depression range as covariates showed that the three groups significantly differ in quality, latency, efficiency, and dysfunction scores with a significant differences between ASD and ADHD in efficiency and dysfunction. Compared to men, women showed higher scores on PSQI total and quality subscale across the three groups and higher duration scores only within ASD group. Our results indicate that both ADHD and ASD adults show unique sleep disturbances and suggest that ASD patients, especially women, may display more pronounced disordered sleep.     

On the link between attention deficit/hyperactivity disorder and obesity: do comorbid oppositional defiant and conduct disorder matter?

The link between attention deficit/hyperactivity disorder (ADHD) and elevated body weight/obesity can be regarded as well established. Because oppositional defiant disorder (ODD)/conduct disorder (CD) has also been found to be associated with these characteristics and ADHD and ODD/CD often occur comorbidly, we investigated whether ODD/CD and ADHD are independently linked with body weight and obesity. The clinical records of 360 children, 257 (6–12 years) with diagnoses of ADHD, ODD/CD, or comorbid ADHD and ODD/CD and 103 children with adjustment disorder (as a control group) constituted the database. All children were seen for the first time in two outpatient psychiatric clinics. Associations of the psychiatric diagnoses (ADHD present vs. not present; ODD/CD present vs. not present) with the standard deviation scores (according to German reference data) of the child’s body mass index (BMI-SDS) and presence of obesity were analyzed by ANCOVA and hierarchical logistic regression analysis, respectively. Children with ODD/CD showed higher BMI-SDS (F = 7.67, p < 0.006) and rate of obesity (Wald = 4.12, p < 0.05, OR = 2.43) while controlling for ADHD comorbidity. While adjusting for ODD/CD comorbidity, the links between ADHD and BMI-SDS or obesity did not reach statistical significance. Given a cross validation of these findings, future (preferably prospective longitudinal) research should analyze the mediating mechanism between the psychiatric conditions and obesity. This knowledge could be helpful for preventive interventions.     

Does mindfulness meditation improve attention in attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder (ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.     

Which anxiety disorders may differentiate attention deficit hyperactivity disorder, combined type with dysthymic disorder from attention deficit hyperactivity disorder, combined type alone?

OBJECTIVE: Attention deficit hyperactivity disorder, combined type (ADHD-CT), dysthymic disorder, and anxiety disorders frequently co-occur in primary school age children, although there have been no published data describing their association. We investigated the association of anxiety, defined from a parent or child perspective, with primary school-age children with ADHD-CT with and without dysthymic disorder. METHOD: One hundred and forty-six medication na?ve children with ADHD-CT were studied. Two groups with and without dysthymic disorder were formed to compare parent and child reports of anxiety, using categorical and continuous measures of anxiety, using logistic regression. RESULTS: Separation anxiety disorder and social phobia were associated with primary school-age children with ADHD-CT and dysthymic disorder, compared to children with ADHD-CT without dysthymic disorder. CONCLUSIONS: The recognition of dysthymic disorder and anxiety disorders and their management in primary school-age children with ADHD-CT is generally poorly understood. The identification and elucidation of composite anxiety and depressive phenomena that may be systematically investigated through longitudinal studies of epidemiologically derived samples is needed in this particular group of children.     

Epilepsy and autism: is there a special relationship?

Increasingly, there has been an interest in the association between epilepsy and autism. The high frequency of autism in some of the early-onset developmental encephalopathic epilepsies is frequently cited as evidence of the relationship between autism and epilepsy. While these specific forms of epilepsy carry a higher-than-expected risk of autism, most, if not all, of the association may be due to intellectual disability (ID). The high prevalence of interictal EEG discharges in children with autism is also cited as further evidence although errors in the diagnosis of epilepsy seem to account for at least part of those findings. The prevalence of ID is substantially elevated in children with either epilepsy or autism. In the absence of ID, there is little evidence of a substantial, if any, increased risk of autism in children with epilepsy. Further, although the reported prevalence of autism has increased over the last several years, much of this increase may be attributable to changes in diagnostic practices, conceptualization of autism in the presence of ID, and laws requiring provision of services for children with autism. In the context of these temporal trends, any further efforts to tease apart the relationships between epilepsy, ID, and autism will have to address head-on the accuracy of diagnosis of all three conditions before we can determine whether there is, indeed, a special relationship between autism and epilepsy.     

Do candidate genes discriminate patients with an autism spectrum disorder from those with attention deficit/hyperactivity disorder and is there an effect of lifetime substance use disorders?

Abstract

Objective. Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are developmental disorders that overlap in a number of domains, sometimes complicating clinical distinction between both disorders. Although there is some evidence for a genetic overlap, there are no reports on genes that could differentiate between ASD and ADHD. Furthermore, it is not known whether this genetic overlap is influenced by co-morbid substance use disorders (SUD). Methods. A total of 110 adult patients with ASD (n=61) or ADHD (n=49) with or without a lifetime history of SUD participated in a study in which we genotyped polymorphisms in five known candidate genes for (one of) the disorders, i.e. the 5HTTLPR in SLC6A4/5-HTT, rs1800497 (TaqIA C>T) in DRD2, rs7794745 in CNTNAP2, rs1843809 in TPH2, and rs6565113 in CDH13. Genotyping was by Taqman-based analysis or by simple sequence length analysis, where appropriate. Results. ASD could be differentiated from ADHD with nominal statistical significance by the 5HTTLPR, and the polymorphisms in TPH2 and CNTNAP2. The results were independent of lifetime SUD status. Conclusions. Serotonergic genes could prove to play an important role in differentiating between ASD and ADHD, but the results of this exploratory study need replication.     

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.     

Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid?

OBJECTIVE: Diagnosing attention deficit hyperactivity disorder (ADHD) in adults is difficult when diagnosticians cannot establish an onset before the DSM-IV criterion of age 7 or if the number of symptoms recalled does not achieve DSM's diagnosis threshold. METHOD: The authors addressed the validity of DSM-IV's age-at-onset and symptom threshold criteria by comparing four groups of adults: 127 subjects with full ADHD who met all DSM-IV criteria for childhood-onset ADHD, 79 subjects with late-onset ADHD who met all criteria except the age-at-onset criterion, 41 subjects with subthreshold ADHD who did not meet full symptom criteria for ADHD, and 123 subjects without ADHD who did not meet any criteria. The authors hypothesized that subjects with late-onset and subthreshold ADHD would show patterns of psychiatric comorbidity, functional impairment, and familial transmission similar to those seen in subjects with full ADHD. RESULTS: Subjects with late-onset and full ADHD had similar patterns of psychiatric comorbidity, functional impairment, and familial transmission. Most children with late onset of ADHD (83%) were younger than 12. Subthreshold ADHD was milder and showed a different pattern of familial transmission than the other forms of ADHD. CONCLUSIONS: The data about the clinical features of probands and the pattern of transmission of ADHD among relatives found little evidence for the validity of subthreshold ADHD among such subjects, who reported a lifetime history of some symptoms that never met DSM-IV's threshold for diagnosis. In contrast, the results suggested that late-onset adult ADHD is valid and that DSM-IV's age-at-onset criterion is too stringent.     

Does a normalizing electroencephalogram in benign childhood epilepsy with centrotemporal spikes abort attention deficit hyperactivity disorder?

This retrospective study delineated the efficacy of antiepileptic drugs in preventing the need for methylphenidate in patients with benign childhood epilepsy with centrotemporal spikes and attention deficit hyperactivity disorder. Seventeen patients were identified. A reduction of electroencephalogram pathologic activity by more than 50% was achieved in some patients with the antiepileptic drugs levetiracetam, sulthiame, lamotrigine, clobazam, and valproic acid. Complete normalization was achieved in two patients with sulthiame. Improvement in attention along with the reduction of pathologic electroencephalogram activity was observed in four patients, two with sulthiame, and one each with lamotrigine and levetiracetam (which was ceased because of suicidal tendencies). However, this improvement in attention was either temporary or not significant enough to discontinue methylphenidate. Methylphenidate was eventually prescribed to all patients.