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Symptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms.
We tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, Mage = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator.
Cross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R2 = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R2 = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores.
These data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.
Little is known about methylphenidate (MPH) use and mortality outcomes.
To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis.
This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 68 096 children and adolescents aged 4–17 years with an ADHD diagnosis and prescribed MPH between 2000 and 2010 were compared with 68 096 without an MPH prescription, matched on age, gender and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme or 31 December 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analysed using a repeated-measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide) and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan.
The MPH group had lower unadjusted all-cause, natural-, unnatural- and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all-cause mortality (adjusted hazard ratio AHR = 0.81, 95% CI 0.67–0.98, P = 0.027), delayed use of MPH was associated with higher mortality (AHR = 1.05, 95% CI 1.01–1.09) and longer MPH use was associated with lower mortality (AHR = 0.83, 95% CI 0.70–0.98).
MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.
Attention deficit hyperactivity disorder (ADHD) is the commonest disorder presenting to Child and Adolescent Mental Health Services in Ireland. This article considers the impact of the Covid-19 pandemic on the provision of mental health services for young people with ADHD with specific reference to the difficulties that have been experienced in ADMiRE, a specialist ADHD service in Dublin, since the outbreak of Covid-19 in Ireland. Current guidelines and alternative ways of ensuring adequate service provision are discussed. Restrictions to mitigate the spread of Covid-19 are likely to continue for many months, and child and adolescent mental health services need to find new ways to provide a sustainable service to young people in Ireland. There is a growing evidence base for the use of telepsychiatry in the assessment and management of ADHD. Factors that should be considered when developing a telepsychiatry service for children and adolescents with ADHD are highlighted.
Population-based analysis of regional and provincial data has permitted identification of areas for modeling innovative service delivery paradigms. Attention Deficit and Hyperactivity Disorder (ADHD) serves as an example. Within the same catchment region, comparing tertiary service utilization with provincial ADHD rates, we have identified a potential service gap. Potential to improve capacity based on a fiscally neutral model is discussed.
Annual data collected in the regional child and adolescent mental health program information system from 2002-2009 was used to describe characteristics of those referred with a provisional diagnosis of ADHD. Regional population-based utilization rates were compared to the region-adjusted provincial rates of ADHD.
As is typical, receiving a provisionally diagnosis of ADHD was significantly associated with longer wait for service and length of stay, being male and younger, greater comorbidity (e.g., conduct disorder), more behavioral problems and more problems at school. About half of the referrals came from community-based primary care physicians. Many children are diagnosed with ADHD by community physicians and relatively few receive specialized treatment.
Analysis of population-based service rates identify potentially large knowledge gap. Within this gap, the quality of service and fidelity to evidence-based practice in community-based treatment of ADHD are unknown. Community-based primary care practitioners have little specialized mental health training and may require support in delivering evidence-based care. To this end, we describe a model to address the identified service gap for ADHD.
Current study aimed to assess the possibility of prediction of continuous performance test in primary school children with attention deficit hyperactivity disorder, with parents and teacher reports of inattention, hyperactivity and oppositional behavior.
Fifteen school aged children with Attention Deficit Hyperactivity Disorder without co-morbid psychiatric disorders were selected from Roozbeh child and adolescent psychiatry clinic. Teachers and parent Conner's questionnaires, Continuous Performance Test and 4 class dictation scores were registered from each subject.
Commission errors were correlated with hyperactivity scale in the parent report (r=-0.50, p< 0.05), and with ADHD score (r=-0.49, p< 0.05). Omission error was correlated with inattention (r=0.66, p< 0.05) and ADHD score (r=0.51, p< 0.05) on teachers report. Reaction time was correlated with oppositional (r=0.51, p< 0.05) subscale in parents Conner's questionnaire. Dictation scores were correlated with inattention on parents report (r=-0.52, p< 0.05) and omission on Continuous Performance Test (r=-0.79, p< 0.05).
Current study reported a significant correlation between neuropsychological tests and questionnaires, in ADHD.
To determine the prevalence of teacher-rated ADHD symptoms in Italian first-graders.
1891 first-graders aged 6.6–7.4 years were evaluated using a 34-item DSM-IV-referenced ADHD teacher rating questionnaire which included all the 18 DSM-IV ADHD diagnostic criteria, some Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), depression and anxiety symptoms, and questions about the child's social and scholastic impairment.
Criteria for ADHD were met in 7.1% (n = 135) of the subjects (10.4% males and 3.8% females), 3.5% with the Inattentive subtype, 2.3% with the Hyperactive/Impulsive subtype and 1.3% with a Combined subtype. Internalizing (depression and/or anxiety) symptoms were reported in 25.9% of the subjects with ADHD symptoms, 17% showed externalizing symptoms (ODD or CD), and 12.6% showed both. Comorbid symptoms were 10 times more frequent than in subjects without ADHD symptoms. Inattentive subtype and scholastic impairment were more frequent in females, Hyperactive/Impulsive subtype and social impairment were more frequent in males.
Even though the real prevalence of ADHD in first graders is presumably lower than that found in the present study, this screening procedure might allow detecting those children who could benefit from referral for more comprehensive assessments.
To examine the link between symptoms of hyperactivity-inattention and conduct disorder in childhood, and the initiation of tobacco and cannabis use, controlling for other behavioral symptoms, temperament and environmental risk factors.
The sample (N = 1107 participants, aged 4 to 18 years at baseline) was recruited from the population-based longitudinal Gazel Youth study with a follow-up assessment 8 years later. Psychopathology, temperament, environmental variables, and initiation of tobacco and cannabis use were self-reported. Event time analyses were performed to assess the effects of childhood disruptive symptoms on age at first use of tobacco and cannabis.
Proportional hazard models revealed that participants with high levels of childhood symptoms of both hyperactivity-inattention and conduct disorder were at highest risk of early tobacco initiation (in males: hazard ratio [HR] = 2.05; confidence interval [CI]: 1.24–3.38; in females: HR = 2.01; CI: 1.31–3.09), and, in males, of early cannabis initiation (HR = 1.95; CI: 1.04–3.64). Temperament, through activity in both males and females and negative emotionality in females, was also associated to early substance use initiation.
Children who simultaneously have high levels of symptoms of hyperactivity-inattention and conduct disorder are at increased risk for early substance initiation. These associations may guide childhood health professionals to consider the liability for early substance initiation in high-risk groups.
This study describes and compares the behavior of hyperactive and control children playing video games.
Subjects and methods
The sample consisted of 29 ADHD children and 21 controls aged between 6 and 16 years playing video games. We used the Child Behavior Checklist and the Problem Videogame Playing scale (PVP scale). This instrument gives objective measures of problem use, which can be considered as an indication of addictive videogame playing. We designed a questionnaire for the parents, eliciting qualitative information about their child's videogame playing. There were no significant differences concerning frequency or duration of play between ADHD children and controls but differences were observed on the PVP scale. None of the controls scored above four whereas 10 hyperactive children answered affirmatively to five or more questions. These children presented a greater intensity of the disorder than the other ADHD children.
While no differences concerning video game use were found, ADHD children exhibited more problems associated with videogame playing. It seems that a subgroup of ADHD children could be vulnerable to developing dependence upon video games.
Adherence to a regular medication regimen may be challenging for adults with attention deficit hyperactivity disorder (ADHD). Some report taking psychostimulants on a pro re nata (PRN) basis. This review aims to establish the rate of adherence, and reasons for and consequences of non-adherence to medication for ADHD in adults, and to review literature on PRN dosing of psychostimulants in these patients. A systematic literature search was conducted. Four primary research studies have investigated the rate of adherence to medication in adults with ADHD. Mean adherence rate in two studies ranged from 52% to 87%. A number of possible reasons for poor adherence have been suggested. Prospective studies are needed to further define the rate of adherence and causes of poor adherence. Evidence examining whether differences in adherence affect clinical outcomes is equivocal. Therefore, caution should be applied to the assumption that maximising adherence to regular medication regimens will improve clinical outcomes. Two articles acknowledge that patients take medication on a PRN basis. Studies comparing the effectiveness of a regular and PRN regimen of psychostimulants are needed. If PRN dosing is as effective as a regular regimen, advantages might include enhanced doctor-patient communication, reduced side effects and cost savings.
There are no data on age-related pharmacotherapy for Attention Deficit Hyperactivity Disorder (ADHD) medication in children and adolescents in the most European countries. The main aim of this paper was to obtain that data for children and adolescents in Slovenia.
The number of ADHD drug prescriptions per patient was obtained from the health claims data on prescription drugs of the Health Insurance Institute of Slovenia for the study period (2003–2015). Three age groups were analyzed: 2–5 years, 6–12 years, and 13–17 years. Only immediate-release methylphenidate (IR-MPH), methylphenidate-osmotic release oral delivery system (OROS-MPH), and atomoxetine (ATX) were available and included in this study.
Less than 50% of patients in Slovenia were treated with medication. The number of patients treated with MPH in the 6–12 age group remained approximately the same between 2007 and 2015 (604–729 patients). In the 13–17 age group, however that number increased 2-fold between 2003 and 2015, from 288 to 555. The number of patients treated with ATX in the 6–12 age group age group increased from 20 to 163 between 2007 and 2015. The number was similar in the 13–17 age group, increasing from 10 to 165 in the same period. In 2015, 21% of the patients from all age groups in this study were treated with ATX.
The number of patients treated for ADHD increased rapidly in all age groups. Patients under the age of six are prescribed medication in Slovenia, which should be avoided.
The present research have done with concentration on examining the impact of selected and divided attention-shaping training in reinforcing attention and the academic improvement and self-efficacy of primary school children with attention deficit-hyperactivity disorder.
The research method was a quasi-experimental design with per- and post-test and follow-up with control group. Statistical society contained all of the primary school children with attention deficit-hyperactivity disorder in Rafsanjan City. Forty children with attention deficit-hyperactivity disorder were chosen by the method of random sampling and randomly assigned in control and experimental groups (20 children in experimental group and 20 children in control group). At first in pretest stage used academic self-efficacy questionnaire and the software of selected and divided attention. For measurements of academic improvement were used the scores of a teacher build test mathematic and spelling. Then, experimental group take 8 sessions education of selected and divided attention-shaping Training. The data were analyzed by analysis of variance with repeated measurement test.
Results of this research show that selected and divided attention training improved the amount of divided and selected attention and academical improvement of children < but it's not effective significantly on reaction time and academic self-efficacy of children with attention deficit disorder-hyperactivity.
Attention training can be effective to increase attention and academical achievement in children with ADHD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This study aimed to investigate the therapeutic effect of a combination of magnesium, calcium and zinc as a complementary treatment in a population of the children with ADHD in Zahedan.
Material and method
In this clinical trial, 40 patients with ADHD aged 6 to 12. The simple convenience sampling was done and the patients were randomly divided into two groups of receiving methylphenidate plus magnesium + zinc + calcium, and methylphenidate plus placebo.
The mean severities of the symptoms in the group treated with methylphenidate plus the supplements were 40/4 ± 2/4 before the treatment, and 19/5 ± 6/1 after 8 weeks of treatment (P < 0.001).
This study shows that zinc, magnesium and calcium supplement is useful in the treatment of ADHD and can be used to treat patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data.
Children (n = 93, mean age 7.3 +/− 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU.
Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009–0.01) while non-responders improved on none (p = 0.27–0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003).
Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.
The dopamine transporter gene (DAT1), striatal network dysfunction, and visual memory deficits have been consistently reported to be associated with attention-deficit/hyperactivity disorder (ADHD). This study aimed to examine the effects of the DAT1 rs27048 (C)/rs429699 (T) haplotype on striatal functional connectivity and visual memory performance in youths with ADHD.
After excluding those who had excessive head motion, a total of 96 drug-naïve youths with ADHD and 114 typically developing (TD) youths were assessed with the resting-state functional magnetic resonance imaging and the delayed matching to sample (DMS) task for visual memory. We examined the effects of ADHD, DAT1 CT haplotype, and the ADHD × CT haplotype interaction on the functional connectivity of five striatal seeds. We also correlated visual memory performance with the functional connectivity of striatal subregions, which showed significant diagnosis × genotype interactions.
Compared with TD youths, ADHD youths showed significant hypoconnectivity of the left dorsal caudate (DC) with bilateral sensorimotor clusters. Significant diagnosis × genotype interactions were found in the connectivity between the left DC and the right sensorimotor cluster, and between the right DC and the left dorsolateral prefrontal/bilateral anterior cingulate clusters. Furthermore, the connectivity of the left DC showing significant diagnosis × genotype interactions was associated with DMS performance in youths with ADHD who carried the DAT1 CT haplotype.
A novel gene-brain-behavior association between the left DC functional connectivity and visual memory performance in ADHD youths with the DAT1 rs27048 (C)/rs429699 (T) haplotype suggests a differential effect of DAT1 genotype altering specific brain function causing neuropsychological dysfunction in ADHD.
This study used repeated measures data to identify developmental profiles of elevated risk for ADHD (i.e., six or more inattentive and/or hyperactive-impulsive symptoms), with an interest in the age at which ADHD risk first emerged. Risk factors that were measured across the first 3 years of life were used to predict profile membership. Participants included 1,173 children who were drawn from the Family Life Project, an ongoing longitudinal study of children's development in low-income, nonmetropolitan communities. Four heuristic profiles of ADHD risk were identified. Approximately two thirds of children never exhibited elevated risk for ADHD. The remaining children were characterized by early childhood onset and persistent risk (5%), early childhood limited risk (10%), and middle childhood onset risk (19%). Pregnancy and delivery complications and harsh-intrusive caregiving behaviors operated as general risk for all ADHD profiles. Parental history of ADHD was uniquely predictive of early onset and persistent ADHD risk, and low primary caregiver education was uniquely predictive of early childhood limited ADHD risk. Results are discussed with respect to how changes to the age of onset criterion for ADHD in DSM5 may affect etiological research and the need for developmental models of ADHD that inform ADHD symptom persistence and desistance.
The Reinforcement Sensitivity Theory of Personality has as its main foundation a Behavioural Inhibition System (BIS), defined by anxiolytic drugs, in which high trait sensitivity should lead to internalising, anxiety, disorders. Conversely, it has been suggested that low BIS sensitivity would be a characteristic of externalising disorders. BIS output should lead to increased arousal and attention as well as behavioural inhibition. Here, therefore, we tested whether an externalising disorder, Attention Deficit Hyperactivity Disorder (ADHD), involves low BIS sensitivity. Goal-Conflict-Specific Rhythmicity (GCSR) in an auditory Stop Signal Task is a right frontal EEG biomarker of BIS function. We assessed children diagnosed with ADHD-I (inattentive) or ADHD-C (combined) and healthy control groups for GCSR in: a) an initial smaller study in Dunedin, New Zealand (population ~120,000: 15 control, 10 ADHD-I, 10 ADHD-C); and b) a main larger one in Tehran, Iran (population ~9 [city]-16 [metropolis] million: 27 control, 18 ADHD-I, 21 ADHD-C). GCSR was clear in controls (particularly at 6–7 Hz) and in ADHD-C (particularly at 8–9 Hz) but was reduced in ADHD-I. Reduced attention and arousal in ADHD-I could be due, in part, to BIS dysfunction. However, hyperactivity and impulsivity in ADHD-C are unlikely to reflect reduced BIS activity. Increased GCSR frequency in ADHD-C may be due to increased input to the BIS. BIS dysfunction may contribute to some aspects of ADHD (and potentially other externalising disorders) and to some differences between the ADHD subtypes but other prefrontal systems (and, e.g. dopamine) are also important.
The Barker hypothesis states that low birth weight (BW) is associated with higher risk of adult onset diseases, including mental disorders like schizophrenia, major depressive disorder (MDD), and attention deficit hyperactivity disorder (ADHD). The main criticism of this hypothesis is that evidence for it comes from observational studies. Specifically, observational evidence does not suffice for inferring causality, because the associations might reflect the effects of confounders. Mendelian randomization (MR) — a novel method that tests causality on the basis of genetic data — creates the unprecedented opportunity to probe the causality in the association between BW and mental disorders in observation studies. We used MR and summary statistics from recent large genome-wide association studies to test whether the association between BW and MDD, schizophrenia and ADHD is causal. We employed the inverse variance weighted (IVW) method in conjunction with several other approaches that are robust to possible assumption violations. MR-Egger was used to rule out horizontal pleiotropy. IVW showed that the association between BW and MDD, schizophrenia and ADHD is not causal (all p > .05). The results of all the other MR methods were similar and highly consistent. MR-Egger provided no evidence for pleiotropic effects biasing the estimates of the effects of BW on MDD (intercept = -0.004, SE = 0.005, p = .372), schizophrenia (intercept = 0.003, SE = 0.01, p = .769), or ADHD (intercept = 0.009, SE = 0.01, p = .357). Based on the current evidence, we refute the Barker hypothesis concerning the fetal origins of adult mental disorders. The discrepancy between our results and the results from observational studies may be explained by the effects of confounders in the observational studies, or by the existence of a small causal effect not detected in our study due to weak instruments. Our power analyses suggested that the upper bound for a potential causal effect of BW on mental disorders would likely not exceed an odds ratio of 1.2.
There appears to be a higher rate of prevalence of hyperkinetic disorder in the intellectual disability (ID) population, although there is a large variability in rates in previous studies. Hyperkinetic disorder can be a challenge to diagnose in a population with ID and can present a barrier to the development of the activities of daily living in an already vulnerable population.
Our objective was to examine the point prevalence of hyperkinetic disorder in the ID population in a community ID service and also to determine the prevalence of hyperkinetic disorder based on the level of ID.
A cross-sectional review of the Online Information Service ‘OLIS’ database was undertaken to establish the total number of patients with ID and those with comorbid hyperkinetic disorder. The overall point prevalence and prevalence based on the level of ID was calculated from the collected data.
The point prevalence of hyperkinetic disorder in the population with ID was similar to that found in studies in the general population at 3.1% in adults and 32.6% in children. When divided by the level of disability, the calculated point prevalence in both adults and children was highest in the population with mild ID and decreased as the level of disability increased.
This report contributes to previous research establishing the rates of hyperkinetic disorder in an ID population and establishes the point prevalence of hyperkinetic disorder in individuals diagnosed with ID in a clinical sample.
To examine the quality of life (QOL) of parents of children with a specific mental disorder (any age).
Relevant articles were searched using different databases. Articles were included that compared the QOL of parents with mentally-ill children to parents of healthy controls or norm values or provided the required data for this comparison. A meta-analysis was conducted to obtain an overall mean effect size estimate. Additional analyses were performed to assess publication bias and moderation.
Twenty-six out of 10 548 articles met the pre-defined inclusion criteria. Most of these studies focused on attention-deficit/hyperactivity disorder or autism spectrum disorder, used clinical samples that mainly included males and young children and studied the QOL of mothers. The meta-analysis revealed that parents of mentally-ill children are experiencing a clinically relevant reduction in their QOL relative to parents of healthy children and norm values (g = −0.66).
The compromised QOL of parents of mentally-ill children needs to be considered and addressed by health professionals who are in contact with them. The paper provides insights into existing research gaps and suggests improvements for subsequent work.
While the neuroanatomic substrates of symptoms of attention deficit hyperactivity disorder (ADHD) have been investigated, less is known about the neuroanatomic correlates of cognitive abilities pertinent to the disorder, particularly in adults. Here we define the neuroanatomic correlates of key cognitive abilities and determine if there are associations with histories of psychostimulant medication.
We acquired neuroanatomic magnetic resonance imaging data from 264 members of 60 families (mean age 29.5; s.d. 18.4, 116 with ADHD). Using linear mixed model regression, we tested for associations between cognitive abilities (working memory, information processing, intelligence, and attention), symptoms and both cortical and subcortical volumes.
Symptom severity was associated with spatial working memory (t = −3.77, p = 0.0002), processing speed (t = −2.95, p = 0.004) and a measure of impulsive responding (t = 2.19, p = 0.03); these associations did not vary with age (all p > 0.1). Neuroanatomic associations of cognition varied by task but centered on prefrontal, lateral parietal and temporal cortical regions, the thalamus and putamen. The neuroanatomic correlates of ADHD symptoms overlapped significantly with those of working memory (Dice's overlap coefficient: spatial, p = 0.003; verbal, p = 0.001) and information processing (p = 0.02). Psychostimulant medication history was associated with neither cognitive skills nor with a brain–cognition relationships.
Diagnostic differences in the cognitive profile of ADHD does not vary significantly with age; nor were cognitive differences associated with psychostimulant medication history. The neuroanatomic substrates of working memory and information overlapped with those for symptoms within these extended families, consistent with a pathophysiological role for these cognitive skills in familial ADHD.