Drug preferences in illicit drug abusers with a childhood tendency of attention deficit/hyperactivity disorder: a study using the Wender Utah Rating Scale in a Japanese prison

The purpose of this study is to clarify the relationship between childhood tendencies of attention deficit/hyperactivity disorder (AD/HD) and illicit drug abuse in Japanese prisoners, and to clarify whether drug abusers with AD/HD prefer methamphetamine (MAP) more than other illicit drugs. The Japanese version of the Wender Utah Rating Scale (WURS), which is a self-reporting instrument to retrospectively identify childhood tendencies of AD/HD tendencies, was carried given to 413 prisoners without a drug addiction and 282 prisoners with a drug addiction (192, MAP; 53, toluene; and 37, cannabis). WURS scores were compared between prisoners with and without a drug addiction, and between MAP, toluene, and cannabis abusers. Consequently, prisoners with a drug addiction showed significantly higher WURS scores than those without the addiction (P < 0.001). Toluene abusers showed significantly higher WURS scores than cannabis abusers (P < 0.001), and included a higher proportion with scores over cut-off than MAP or cannabis abusers (P = 0.005). In conclusion, a close relationship existed between illicit drug abuse and childhood AD/HD tendencies. Drug-abusing prisoners with AD/HD tendencies were not prone to choose MAP over other illicit drugs.     

Childhood histories of attention-deficit hyperactivity disorders in Japanese methamphetamine and inhalant abusers: preliminary report

The present study examined childhood histories of attention-deficit hyperactivity disorder (ADHD) in 54 methamphetamine and 12 inhalant abusers using the Wender Utah Rating Scale. The inhalant abusers experienced initial drinking at a younger age than methamphetamine abusers (P=0.038). The Wender Utah Rating Scale score was significantly higher in the inhalant abusers than in the methamphetamine abusers (P=0.013) although 83.3% of inhalant and 55.6% of methamphetamine abusers had higher scores than the cut-off for ADHD. These findings suggest that drug abuse is associated with childhood ADHD, and that inhalant abusers have a higher incidence of childhood ADHD than methamphetamine abusers.     

The prevalence of features of attention deficit hyperactivity disorder in a special school in Ireland

Background The prevalence of features of attention deficit hyperactivity disorder (ADHD) in children with intellectual disabilities (ID) in Irish schools is unknown. The aim of this study was to examine the prevalence of features of ADHD in a special school, in order to ascertain the number of children who may need further assessment for ADHD. The study also explores the reliability of the Conners Teachers Rating Scale in this population. Method All teachers in a special school for children with ID were asked to complete the Conners Teachers Rating Scale and the Attention‐Distractibility, Inhibition–Excitation Classroom Assessment Rating Scale, for those children whose parents had consented for them to take part in this study. Consent was obtained for 84 children a response rate of 71%, between the ages of 5 and 18 (mean = 10.5 years; SD = 3.7). Results The Conners Teachers Rating Scale was found to be internally reliable and had a normal distribution with our results. Overall, 55.9% of participants (47/84) had markedly elevated scores (T > 69) for at least one of the target subscales, which were the ‘Hyperactivity’, ‘Inattention’ and the ‘ADHD Index’ subscales of the Conners Teachers Rating Scales. In addition, the findings would suggest that the Conners Teachers Rating Scale can be a useful screening tool in the population of school children with ID. Conclusions The study suggests that ADHD may be under diagnosed in children with ID. This has practical implications for the mental health needs of these children. It is recommended that further studies are carried out to determine the prevalence of ADHD in this population.     

Adolescent attention deficit hyperactivity disorder and susceptibility to psychosis in adulthood: a review of the literature and a phenomenological case report

Aim: In contrast to affective disorders, some forms of personality disorders and drug addiction, schizophrenia is commonly not considered to be a sequela of attention deficit hyperactivity disorder. However, attention deficit hyperactivity disorder and the prodromal stages of schizophrenia spectrum disorders do exhibit a number of common central features. To facilitate the early treatment of schizophrenic symptoms, the detection of discrete and subtle alterations in the prodromal stages of incipient psychoses is particularly important. Methods: We review the literature on the prodromal symptoms of psychosis and present a case report, in which a phenomenological approach was used to identify subtle alterations linked to anomalous self‐experience. Results: Using the Examination of Anomalous Self‐Experience symptom checklist, the case report presented here reveals attention deficit hyperactivity disorder symptoms in adolescence as a precursor state of psychosis in adulthood. Conclusions: The characteristics of this schizophrenia spectrum disorder case and its time course are derived from the specific distribution pattern of Examination of Anomalous Self‐Experience items. When treating adolescent attention deficit hyperactivity disorder patients, the rare possibility of the development of schizophrenia spectrum disorder from attention deficit hyperactivity disorder like symptoms should be kept in mind.     

Attention deficit hyperactivity disorder and suicide: a review of possible associations

OBJECTIVE: To review the evidence of a possible association between attention deficit hyperactivity disorder (ADHD) and suicide. DESIGN: We searched the electronic data bases: Medline, Psych LIT, between 1966 and March 2003 looking for articles on ADHD, attention deficit disorder, hyperactivity and suicide. RESULTS: An association of ADHD and completed suicide was found, especially for younger males. However, the evidence for any direct or independent link was modest with an overall suicide rate from long-term follow-up studies of ADHD of 0.63-0.78%. The estimated relative risk ratio, compared with US national suicide rates (males 5-24 years) is 2.91 (95% confidence interval 1.47-5.7, chi2 = 9.3, d.f. = 1, P = 0.002). ADHD appears to increase the risk of suicide in males via increasing severity of comorbid conditions, particularly conduct disorder (CD) and depression. CONCLUSION: Identification of those at risk, particularly males with comorbid ADHD, depression and CD, may represent a useful clinical means of reducing completed suicide.     

Multicomponent attention deficits in attention deficit hyperactivity disorder

The aim of this study was to examine the specific aspects of attention, such as selective attention, sustained attention, and short-term memory in children with attention deficit hyperactivity disorder, combined subtype (ADHD-C). A total of 40 children with a diagnosis of ADHD from the 4th edition of the Diagnostic and Statistical Manual, aged 6-11 years old were compared with 40 controls matched for age and gender on a battery of tests. Short-term memory span and attention was measured by Visual Aural Digit Span Test-Revised. Stroop test and the Turkish version of Cancellation Test were used to assess selective and sustained attention, respectively. In order to check for factor structure in two groups on the test scores, principal component analysis was conducted for both groups separately. Relative to the comparison children, children with ADHD showed significant deficits on tests that are related to different aspects of attention. The results are consistent with the theories explaining the biological basis of ADHD by scattered attention networks in the brain, which have reciprocal dynamic interactions. Further comparative studies are needed to elucidate whether the cognitive processes that are known to be assessed by these tests are specific to ADHD.     

Characteristics of adults with attention-deficit/hyperactivity disorder and past conduct disorder

Objective: DSM‐IV Attention‐deficit/hyperactivity disorder (ADHD) comorbid with DSM‐IV conduct disorder (CD) in childhood/adolescence has been proposed as a ‘distinct subtype’. The present study investigated subsequent psychopathological characteristics of this proposed subtype in adults. Method: Questionnaires were completed by 71 adults (mean age 29.6 years) with ADHD and their informants. Results: The 39 subjects with a history of past CD, when compared with the remaining subjects, were associated with significantly increased ratings of aspects of ADHD‐related impulsivity, with features of all three DSM‐IV ‘Clusters’ of personality disorders (PDs) (in particular of ‘Cluster B’ PDs) and with other psychopathology. Also, there were significant correlations between the number of endorsed past CD criteria and various self‐ratings of psychopathology. Conclusion: The results indicate the psychopathological characteristics of adults with a history of the proposed ‘ADHD with CD’ subtype. The findings are relevant to future studies of ADHD subtypes in adults.     

Adults with Tourette’s syndrome with and without attention deficit hyperactivity disorder

Objective: Comorbidity between Tourette’s syndrome (TS) and attention deficit hyperactivity disorder (ADHD) is high. In children, those with both TS+ADHD fare less well than those with TS‐only on measures of both psychopathology and behaviour. The objective of this study was to document such measures in adult patients. Method: Eighty adults with TS‐only were compared to 64 with TS+ADHD using a clinical interview and standardised measures of depression, anxiety and obsessionality. Results: The two groups were no different on measures of TS severity. TS+ADHD patients had significantly more depression, anxiety, obsessive–compulsive behaviour and maladaptive behaviours than patients with TS‐only. There were also significant differences in the incidence of copro‐ and echo‐phenomena and family history of ADHD. Conclusion: The finding of increased overall behavioural difficulties and psychopathology in adult patients with TS+ADHD when compared with TS‐only is in agreement with previous findings in children with TS. Appropriate treatment of ADHD in TS patients during childhood may prevent many behavioural problems in adulthood.     

Attention deficit hyperactivity symptoms and internet addiction

The objective of this study was to evaluate the relationship between attention deficit-hyperactivity/impulsivity symptoms and Internet addiction. In total, 535 elementary school students (264 boys, 271 girls; mean age, 11.0 +/- 1.0 years) were recruited. The presence or severity of Internet addiction was assessed by the Young's Internet Addiction test. Parents and teachers of the children completed the DuPaul's attention deficit hyperactivity disorder (ADHD) rating scale (ARS; Korean version, K-ARS) and Child Behavior Checklists. Children with the highest and lowest quartiles in K-ARS scores were defined to be in ADHD and non-ADHD groups, respectively. Five children (0.9%) met criteria for a definite Internet addiction and 75 children (14.0%) met criteria for a probable Internet addiction. K-ARS scores had significant positive correlations with Young's Internet Addiction test scores. The Internet addiction group had higher total scores of K-ARS and ADHD-related subcategories in the Child Behavior Checklists than the non-addiction group. The ADHD group had higher Internet addiction scores compared with the non-ADHD group. Therefore, significant associations have been found between the level of ADHD symptoms and the severity of Internet addiction in children. In addition, current findings suggest that the presence of ADHD symptoms, both in inattention and hyperactivity-impulsivity domains, may be one of the important risk factors for Internet addiction.     

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.     

Attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a challenging condition to diagnose and treat. For diagnosis, the clinician needs to establish the presence of ADHD on Diagnostic and Statistical Manual of Mental Disorders criteria requiring information from parents and teachers and considering both alternative diagnoses and co-occurring conditions. In the treatment of ADHD as a chronic illness, the clinician needs to educate the family about the condition and partner with them about treatment decisions. The 2 treatments with demonstrated efficacy for ADHD are medications (stimulant medications and a selective norepinephrine reuptake inhibiter) and behavior-modification programs.     

Differential brain activation during response inhibition in bipolar and attention-deficit hyperactivity disorders

Aim: To identify differential patterns of brain activation between adolescents with bipolar disorder and adolescents with attention‐deficit hyperactivity disorder (ADHD) to better understand the neurophysiology of both disorders. We hypothesized that subjects with ADHD would show altered activation in brain regions involved in executive and sustained attention. In contrast, we hypothesized that bipolar subjects would show altered brain activation in regions responsible for emotionally homeostasis, including the striatum and amygdala. Methods: Functional magnetic resonance imaging was performed during a continuous performance task with a response inhibition component in 11 adolescents with bipolar disorder during a manic episode, 10 adolescents with ADHD, and 13 healthy adolescents. Results: There were no differences in behavioural performance among the three groups. Compared with bipolar subjects, subjects with ADHD showed increased activation in the superior temporal lobe during successful response inhibition. Although bipolar subjects did not show activation differences in the striatum or amygdala compared with ADHD subjects, increased left parahippocampal activation in the bipolar group was associated with increased manic symptoms. Conclusions: The patterns of brain activation observed in the current study support divergent patterns of neurophysiological dysfunction in individuals with bipolar disorder as compared with those with ADHD. Therefore, the impulsive behaviour seen in both disorders may be the consequence of dysfunction in different brain regions, and further research may help identify neurobiological markers that are specific to each condition.     

Sleep quality in children with attention deficit hyperactivity disorder: An actigraphic study

Abstract  The aim of the present study was to compare the sleep of 12 children with attention deficit hyperactivity disorder (ADHD) with that of 12 normal controls. The children were examined in their natural environment, using continuous actigraphic monitoring over several consecutive nights, as well as undergoing subjective parental reports. It was hypothesized that children diagnosed with ADHD would suffer from reduced sleep quality than children without ADHD. This hypothesis was supported by the actigraphic measures, but not supported by the subjective parental reports. It was also found that the sleep quality of the two groups differed over the course of the night, which suggests a difference in sleep architecture. Various possible explanations for these findings, their implications regarding the relationship between sleep and ADHD, and the resulting treatment ramifications are discussed, and suggestions for further research are provided.     

Completed suicide, ideation and attempt in attention deficit hyperactivity disorder

Impey M, Heun R. Completed suicide, ideation and attempt in attention deficit hyperactivity disorder. Objective: Attention deficit hyperactivity disorder (ADHD) and suicidal behaviour are common conditions with significant social and emotional morbidity. Although completed suicide in ADHD has been assessed in a previous meta‐analysis, other domains of suicidal behaviour such as attempts and ideation have been documented only in individual studies. This review provides a comprehensive summary of the relationship between attention‐deficit and suicidality. Method: Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around suicidality, attention‐deficit and hyperactivity. Results: Twenty five papers were identified describing a relationship between ADHD and suicide. ADHD occurred more frequently in suicidal groups than controls, with most differences being statistically significant. The direction of results was consistent, with only one sample showing equivocal findings and one showing a reverse pattern. Attempts and ideation were more common in prediagnosed ADHD samples than controls. Three studies showed significant results only for men. Comorbidity had a large influence including delinquency and substance misuse. Conclusion: There is a positive relationship between ADHD and risk to self. More focussed research needs to take place on younger populations and those without comorbidity. This review highlights the importance of thorough risk assessment in the attention‐deficit population.     

亲子依恋与注意缺陷多动障碍关系的病例-对照研究

目的:探讨亲子依恋及家庭特征与学龄期儿童注意缺陷多动障碍(ADHD)关系。方法:分别对ADHD患儿(ADHD组,103例)及一般情况相匹配的正常儿童(对照组,103名)进行儿童依恋安全性量表(KSS)、一般家庭情况问卷及自制的严厉管教方式问卷调查;分析家庭特征、亲子依恋与ADHD的关系。结果:ADHD组母子及父子KSS分[(2.7±0.3),(2.7±0.5)]明显低于对照组[(3.0±0.3),(2.9±0.4)](P均0.01);两组母子KSS分与ADHD筛查量表中注意缺陷分(r=-0.21,P0.05;r=-0.30,P0.01)及多动/冲动分(r=-0.20,r=-0.21;P均0.05)负相关;Logistic回归分析显示,母子KSS分(OR=0.38,P=0.000)是ADHD保护性因素;父母对孩子学习重视程度低(OR=1.72,P=0.016)、父母管教态度不一致(OR=1.65,P=0.030)、母亲体罚孩子(OR=1.59,P=0.009)、家庭居住面积小(OR=1.49,P=0.019)、家长陪同完成作业(OR=1.44,P=0.035)是ADHD的危险因素。结论:母子依恋安全性下降、母亲体罚孩子等家庭特征与学龄期儿童ADHD密切相关。     

药物联合心理干预治疗儿童多动症患者疗效观察

目的:探讨药物联合心理干预对儿童多动症患者的疗效。方法:56例多动症患儿随机分为干预组(28例)和对照组(28例),对干预组予哌甲酯治疗外,实施6周心理干预(行为干预、家庭支持治疗及生物反馈);对照组仅予哌甲酯治疗。两组均于治疗开始及治疗6周实施Corners父母问卷测验。结果:治疗6周后,两组症状较治疗前均有改善,差异有统计学意义(P<0.01)。干预组较对照组品行问题、冲动多动问题、多动指数因子分进步更为明显(P<0.01)。结论:心理干预联合药物治疗比单独药物治疗可更好地改善多动症患儿的症状。     

Bupropion for adults with attention-deficit hyperactivity disorder: meta-analysis of randomized, placebo-controlled trials

Aim: The aim of this study was to systematically review the efficacy, acceptability and tolerability of bupropion in comparison to placebo. Only randomized‐controlled trials were included in the meta‐analysis. Methods: MEDLINE, EMBASE, CINHL, PsycINFO and Cochrane Controlled Trials Register were searched in October 2010. Study populations comprised adults with any subtype of attention‐deficit hyperactivity disorder, attention‐deficit disorder, hyperkinetic disorder, minimal brain dysfunction, minimal cerebral dysfunction or minor cerebral dysfunction. Efficacy outcomes were pooled mean changed scores of the ADHD rating scale (ADHD‐RS) and the overall response rates. The overall discontinuation rate was considered as the measure of acceptability. Results: A total of 349 participants (n for bupropion treatment = 175) in five published randomized, controlled trials were included. Bupropion sustained‐ or extended‐release was the experimental treatment in all studies. The pooled mean changed score of the ADHD‐RS of the bupropion‐treated group was greater than that of the placebo‐treated group with a weighted mean difference (95%CI) of 5.08 (3.13–7.03). The overall response rate of the bupropion‐treated group was significantly greater than that of placebo‐treated groups with a relative risk (95%CI) of 1.67 (1.23–2.26). However, the pooled overall discontinuation rate and the pooled discontinuation rate due to adverse events were not significantly different between groups with a relative risk (95%CI) of 1.11 (0.71–1.72) and 0.87 (0.08–9.79), respectively. Conclusion: The evidence suggests that bupropion is superior to placebo and effective for the treatment of ADHD in adults. However, its acceptability and tolerability were not significantly higher than those of placebo.     

注意缺陷/多动障碍儿童临床特征与单胺类神经递质研究

目的：探讨注意缺陷/多动障碍（ADHD）儿童的临床特征及血清单胺类神经递质水平的变化。方法：对32例ADHD儿童（研究组）和46名正常儿童（对照组）测评Piers-Harris儿童自我意识量表（PHCSS）、儿童焦虑性情绪障碍筛查表（SCRED）、儿童冲动量表（BIS）等,对其中30例ADHD儿童及36名正常儿童测量血清5-羟色胺（5-HT）、多巴胺（DA）、肾上腺素等的含量。结果：研究组PHCSS评分低于对照组（P〈0.01）;研究组SCRED和BIS评分均高于对照组（P〈0.001）。研究组血清5-HT低于对照组（P=0.002）。血清5-HT水平与冲动总分（r=-0.273）呈负相关;血清DA水平与运动分呈正相关（r=0.541）。结论：ADHD儿童具有多动、冲动、自我意识低等临床特征。而血清5-HT水平降低可能与ADHD的冲动控制困难特征有关。