Attention-deficit hyperactivity disorder in girls - Epidemiology and management
ABSTRACT Attention-deficit hyperactivity disorder (ADHD) in girls is a topic of growing research and clinical interest. For many years, girls with ADHD have been ignored and overshadowed by hyperkinetic and impulsive boys, but they are now attracting interest in an effort to understand the similarities and differences in the prevalence, symptoms, familial risk, comorbidities and treatment of ADHD in the two sexes. A review of past and current literature finds that the symptoms of ADHD are not sex specific, but that identification of girls with ADHD is hampered by parental and teacher bias, and confusion. Girls are more likely to be inattentive without being hyperactive or impulsive, compared with boys. Girls and boys share the same familial risk patterns, as well as similar, although not identical, comorbidity or impairment patterns. The risk of non-treatment is as great in girls as it is in boys; up to 70-80% of identified children will have persistent symptoms and impairment that extends into adolescence and adulthood. Treatment modalities are equally effective in girls and boys. Stimulants, non-stimulants and behavioural modalities are the mainstays of effective treatment.
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ABSTRACT: Long-acting medications have been developed and approved for use in the treatment of attention-deficit hyperactivity disorder (ADHD). These compounds are intended to optimize and maintain symptoms control throughout the day. We tested prolonged effects of osmotic-release oral system methylphenidate on both attention and inhibition, in the late afternoon. A double-blind, randomized, placebo-controlled study was conducted in 36 boys (7-12 years) with ADHD and 40 typically developing children. The ADHD children received an individualized dose of placebo or osmotic-release oral system methylphenidate. They were tested about 8 hours after taking with 2 continuous performance tests (continuous performance test–X [CPT-X] and continuous performance test–AX [CPT-AX]) and a counting Stroop. A positive effect of osmotic-release oral system methylphenidate was present in CPT-AX with faster and less variable reaction times under osmotic-release oral system methylphenidate than under placebo, and no difference with typically developing children. In the counting Stroop, we found a decreased interference with osmotic-release oral system methylphenidate but no difference between children with ADHD under placebo and typically developing children.Journal of Child Neurology 10/2014; DOI:10.1177/0883073814550498 · 1.67 Impact Factor
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ABSTRACT: Mice lacking functional neurokinin-1 receptors (NK1R-/-) display behavioural abnormalities resembling attention deficit hyperactivity disorder (ADHD): locomotor hyperactivity, impulsivity and inattentiveness. The preferred ligand for NK1R, substance P, is metabolised by angiotensin converting enzyme (ACE), which forms part of the brain renin angiotensin system (BRAS). In view of evidence that the BRAS modulates locomotor activity and cognitive performance, we tested the effects of drugs that target the BRAS on these behaviours in NK1R-/- and wildtype mice. We first tested the effects of the ACE inhibitor, captopril, on locomotor activity. Because there are well-established sex differences in both ADHD and ACE activity, we compared the effects of captopril in both male and female mice. Locomotor hyperactivity was evident in male NK1R-/- mice, only, and this was abolished by treatment with captopril. By contrast, male wildtypes and females of both genotypes were unaffected by ACE inhibition. We then investigated the effects of angiotensin AT1 (losartan) and AT2 (PD 123319) receptor antagonists on the locomotor activity of male NK1R-/- and wildtype mice. Both antagonists increased the locomotor activity of NK1R-/- mice, but neither affected the wildtypes. Finally, we tested the effects of captopril on the performance of male NK1R-/- and wildtype mice in the 5-choice serial reaction-time task (5-CSRTT) and found that ACE inhibition prevented the impulsivity of NK1R-/- mice. These results indicate that certain behaviours, disrupted in ADHD, are influenced by an interaction between the BRAS and NK1R, and suggest that ACE inhibitors could provide a novel treatment for this disorder. Copyright © 2015. Published by Elsevier B.V.European Neuropsychopharmacology 02/2015; 32. DOI:10.1016/j.euroneuro.2015.01.013 · 5.40 Impact Factor
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ABSTRACT: ZET: Dikkat eksikliği hiperaktivite bozukluğu tanılı çocuk ve ergenlerde P50 duyusal kapılama ve metilfenidat tedavisinin P50 duyusal kapılama üzerine etkisi Amaç: P50 ölçümünün duyusal kapılama mekanizmasını yansıttığı ve insanlarda aşırı bilgi yüklenmesini önlediği düşünülmektedir. Dikkat eksikliği hiperaktivite bozukluğu (DEHB) hastalarında P50 işitsel olayla ilişkili yanıtın baskı-lanmasında yetersizlik olabilir. Bu araştırmanın amaçları P50 işitsel olayla ilişkili yanıtın baskılanmasını ve DEHB tanılı çocuk ve ergenlerde metilfenidat tedavisinin P50 paramet-releri üzerine olan etkilerinin ortaya konmasıdır. Yöntem: Araştırmaya DSM-IV tanı ölçütlerine göre DEHB (bileşik tip) tanısı konmuş, 9-14 yaşları arasında ilaç tedavisi verilmeyen 22 çocuk ve ergenle, 9-12 yaşları arasında zihinsel ve bedensel olarak sağlıklı 18 çocuk alınmıştır. Öncelikle ilaç tedavisi verilmeyen DEHB ve kontrol grubunda P50 değerleri ölçüldü. Bu ölçüm sonrası DEHB grubuna 10 mg metilfenidat verildi ve 1 saat sonra DEHB grubunda P50 ölçümü tekrarlan-dı. Kontrol grubunda P50 uygulaması tekrarlanmadı. Bulgular: DEHB ve sağlıklı kontrol grubu arasında P50 test latansı, test amplitütü ve P50 oranları açısından belirgin düzeyde anlamlı fark saptanmıştır. DEHB grubunda metil-fenidat öncesi ve metilfenidat verildikten sonra yapılan ölçümlerde koşullanma latansı, test latansı, test amplitütü ve P50 oranları açısından belirgin düzeyde anlamlı fark bulunmuştur. Sonuç: Bu araştırmanın sonuçları DEHB ile P50 arasında bir ilişki olduğuna ve metilfenidat uygulanmasının P50 baskılanma düzeyini artırdığına işaret etmektedir. Bu araş-tırma DEHB olan çocuk ve ergenlerde duyusal kapılamayı değerlendiren ilk çalışma olduğundan bir ön çalışma olarak görülmeli dir. Bu nedenle daha geniş örneklem sayılı araş-tırmalara gereksinim olduğu düşünülmektedir. Anahtar sözcükler: Dikkat eksikliği hiperaktivite bozuklu-ğu, çocuklar, P50, duyusal kapılama Kli nik Psi ko far ma ko lo ji Bül te ni 2011;21:42-48 ABS TRACT: P50 sensory gating in children and adolescents with ADHD and effects of methylphenidate administration on P50 sensory gating Objective: The P50 is thought to reflect a sensory gating mechanism and prevent information overload in humans. Failure to inhibit the P50 auditory event evoked response can occur in attention deficit hyperactivity disorder (ADHD) patients. The aims of the present study were to examine the inhibition of the P50 auditory event evoked potential and the effects of methyphenidate administration on P50 parameters in children and adolescents diagnosed with ADHD. Methods: Twenty-two drug-free subjects, aged 9-14, who were diagnosed with ADHD (the combined type) according to the DSM-IV criteria, and 18 mentally and physically healthy subjects, aged 9-12, were included in the study. First, P50 parameters were measured in drug-free ADHD subjects and healthy controls. Following this measurement, 10 mg of methylphenidate was administered to the ADHD group. The P50 measurement was repeated 1 hour following methylphenidate administration in the ADHD subjects. The healthy control group was not re-examined. Results: A significant difference was found in P50 test latency, test amplitude, and P50 ratio values between the ADHD group and healthy controls. Significant differences were also found in conditioning latency, test latency, test amplitude, and P50 ratio values between before and after methyphenidate administration in the ADHD group. Conclusions: The results of the present study point out an association between P50 and ADHD and they also show that methyphenidate administration increases the P50 suppression level. Since, this is the first study evaluating sensory gating in children and adolescents with ADHD, it should be considered as a preliminary study. Further studies with large study samples are warranted.Bulletin of Clinical Psychopharmacology 03/2011; DOI:10.5350/KPB-BCP201121107 · 0.37 Impact Factor