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Attention Deficit/Hyperactivity Disorder Across the Lifespan
Abstract
Attention deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder presenting for treatment in youth. ADHD is often chronic with prominent symptoms and impairment spanning into adulthood. ADHD is often associated with co-occurring anxiety, mood, and disruptive disorders, as well as substance abuse. The diagnosis of ADHD by careful review of symptoms and impairment is both reliable and valid. Recent genetic, imaging, neurochemistry, and neuropsychological data support the biological underpinning of the disorder. All aspects of an individual's life must be considered in the diagnosis and treatment of ADHD. Pharmacotherapy, including stimulants, antidepressants, and antihypertensives, plays a fundamental role in the management of ADHD across the lifespan.
... Children and adolescents with a predominantly inattentive presentation often share similar behavioral characteristics, such as: 1) they present quieter behavior, often being described as discreet, dreamy, and withdrawn [9,28]; 2) they change the subject suddenly during a conversation and give the impression that they are not paying full attention to what others are saying [27]; 3) they experience challenges in time planning, resulting in delays or advances in commitments [29]; 4) they face difficulties in completing tasks on time, as they typically need to remember what has to be done when starting a task [29]; 5) they generally have difficulty concentrating on activities such as reading and during classes [29]; 6) occasionally, they lose or forget objects, deadlines, and dates [29,30]; 7) they encounter some resistance when starting complex tasks that require organization and prolonged mental effort [29,30]; 8) they face challenges following rules during recreational activities and demonstrate an inclination to change tasks frequently [27]; 9) they can be easily distracted by their thoughts or by simple external stimuli [29]; 10) they often need more help to absorb school content, highlighting the importance of providing them with additional support outside the classroom for academic activities [27,28]; 11) they generally do not easily enter into conflicts with peers or family members, and they present fewer emotional and behavioral problems than individuals with other ADHD presentations [31]; and 12) in some cases, they may exhibit social isolation behaviors [27]. ...
... Children and adolescents with this ADHD presentation generally exhibit some common characteristics: 1) they are often involved in several activities simultaneously [28]; 2) usually, they show impatience when waiting their turn to do an activity or in queues [30,32]; 3) they often interrupt other people during a conversation and answer questions that are not finished [30,32]; 4) they like to move and have difficulty sitting still, which is why they often avoid monotonous activities and opt for more dynamic activities [27,32]; 5) sometimes, they make comments without analyzing their words, which can result in embarrassing or offensive situations [32]; 6) regarding emotions, they face challenges when dealing with frustrations, criticism, or rejection and sometimes have more explosive behaviors [28,32]; 7) sometimes, they may not follow instructions as expected and act impulsively, which suggests the importance of additional supervision in their activities [21,27]; 8) mood changes can occur and are influenced by several factors, both internal and external, reflecting the complexity of their emotional experiences [32]; 9) they often have difficulties at home or with less structured and targeted tasks [31]; 10) they tend to quickly lose interest in toys or activities that previously aroused great enthusiasm [32]; and 11) regarding sleep, persons with this ADHD presentation are more prone to increased nocturnal awakenings and parasomnias 2 [34]. [35] state that, although girls diagnosed with ADHD demonstrate fewer externalized behaviors compared to boys with the same diagnosis, hyperactivity often manifests itself more discreetly, such as fine motor restlessness, hair twirling, nail-biting, the frequent habit of doodling, and the feeling of inner restlessness. ...
... The impacts are commonly summarized and amplified by both symptom dimensions. In some cases: 1) they may present more psychiatric disorders [31]; 2) they are generally more prone to addictions, for example, to gambling and substances [31,37]; and 3) more frequently manifest compulsive behaviors, such as eating and buying a lot [37]. ...
Attention-deficit/hyperactivity disorder (ADHD) is characterized by challenges with attention, impulse control, and hyperactivity, with three clinical presentations: inattentive, hyperactive-impulsive, and combined. Integrating concepts from Socially Aware Design and Personas, this paper presents DSFlake, a model proposed in this work, to support interface designers in building personas to represent ADHD presentations. Furthermore, using DSFlake, we created three personas, ‘Charlote Jones’, ‘Alex Oliveira’, and ‘Yago Souza’, representing the three types of users. These personas were enriched with data from the literature, a database with information from children and adolescents diagnosed with ADHD, and responses from an online questionnaire explicitly created for this research. This work contributes to Human-Computer Interaction and inclusion studies by proposing the DSFlake model and three personas to represent persons with ADHD. This model can help interface designers, parents, teachers, and society by providing an empathetic understanding of the unique characteristics and potential challenges faced by children and adolescents with ADHD.
... Son diagnostic se fonde sur des critères cliniques qui sont dérivés de descriptions de comportements de l'enfant avec TDAH, avec peu d'adaptations au contexte de l'adulte. En conséquence, le TDAH de l'adulte est un trouble sous-diagnostiqué dans la population adulte Biederman et al., 2000). Pour combler cette lacune, les travaux exposés dans ce manuscrit de thèse proposent d'étendre la description clinique du TDAH de l'adulte à deux symptômes additionnels : le surplus de pensées et la dysrégulation émotionnelle (DE). ...
... Concernant les traitements non médicamenteux, les thérapies comportementales et cognitives et la psychoéducation ont démontré leur efficacité dans le TDAH de l'adulte (Hirvikoski et al., 2011(Hirvikoski et al., , 2015(Hirvikoski et al., , 2017Mongia INTRODUCTION notamment dans le cas de comorbidités (Daigre Blanco et al., 2009;Prada et al., 2014;Weibel et al., 2018). De plus, le respect strict des critères diagnostiques internationaux actuels contribue au sous-diagnostic du TDAH de l'adulte (Biederman et al., 2000). En effet, ces critères diagnostiques ont été établis sur la base des particularités comportementales observées chez l'enfant avec TDAH. ...
... Adultes, les patients expérimentent davantage de difficultés attentionnelles et organisationnelles Chang et al., 2013;Kessler et al., 2006;Larsson et al., 2011), liées au dysfonctionnement exécutif persistant (Barkley & Murphy, 2008 ;Kessler et al., 2010). L'hyperactivité est, quant à elle, plus subtile : progressivement internalisée, elle prend la forme d'un sentiment d'agitation interne (Biederman et al., 2000; et l'impulsivité comportementale s'amoindrit . Par ailleurs, il a été souligné que chez les adultes avec TDAH le nombre de symptômes est plus large que ce qui figure dans les classifications internationales (Adler et al., 2017). ...
Le surplus de pensées et la dysrégulation émotionnelle (DE) sont deux expressions cliniques sous-évaluées dans le Trouble du Déficit de l’Attention avec ou sans Hyperactivité (TDAH) de l’adulte. Bien que qu’ils ne soient pas spécifiques au TDAH, ces deux symptômes sont pourtant au coeur des plaintes des patients. L’objectif de ce travail de thèse était de reconsidérer le tableau clinique du TDAH de l’adulte en investiguant les particularités psychopathologiques et cognitives des symptômes de surplus de pensées et de DE. Pour cela, différents auto-questionnaires ainsi qu’une évaluation cognitive comprenant la tâche de fluences verbales ont été proposés à des adultes avec TDAH. Sur le plan psychopathologique, le surplus de pensées et la DE représentent des caractéristiques centrales de la présentation clinique du TDAH de l’adulte, indépendantes d’un trouble de l’humeur associé. De plus, ces deux symptômes sont fortement associés et entretiennent des liens étroits avec l’arousal. Sur le plan cognitif, le surplus de pensées et la DE sont sous-tendus par des atypies du fonctionnement exécutif.
... Although 8%-12% of the world has ADHD and twin studies suggest it is highly (76%) heritable, the disorder lacks an equivocal pattern of inheritance (Faraone et al. 2005). Childhood ADHD patients are more likely to smoke in adolescence and adulthood, are overall at least twice as likely to smoke, transition faster from infrequent to daily smoking, and have less success quitting (Wilens et al. 2002;Mitchell et al. 2018;Molina et al. 2018), suggesting ADHD and the proclivity to use certain drugs may be mechanistically related. ...
... However, smokers with ADHD have less success quitting than controls (Mitchell et al. 2018) and more severe withdrawal symptoms (Bidwell et al. 2018;McClernon et al. 2011). Importantly, adverse health outcomes are more prevalent in ADHD patients due to poor lifestyle choices, including smoking (Wilens et al. 2002). ...
Introduction
Attention‐deficit‐hyperactivity disorder (ADHD) is highly heritable and increases the likelihood of nicotine dependence (ND). The self‐medication hypothesis of nicotine use in ADHD proposes that ADHD patients seek nicotine for its ability to improve their symptoms, and they have less success quitting, possibly due to the worsening of ADHD symptoms in withdrawal.
Methods
The present analysis compared transcriptomic data from the brains of rodent models of ADHD and those of ND, with a focus on striatal gene expression. Differential expression analysis, pathway enrichment analysis, and gene‐network mapping identified signaling networks and candidate genes that may contribute to the high co‐occurrence between ADHD and ND.
Results
We identified novel differentially expressed genes (PRKAG2, MAPK1), and genes with known associations to either ADHD or ND (ANK3, CALD1, CHRNA4, CHRNA7, CMTM8, DLG4, DUSP6, GNG3, GNG11, GRIK5, GRINA2, GRM5, ICAM2, KCNJ6, PRKAB1, SNAP25, SYNPO, SYT1, VAMP2). In addition, synaptic transmission (hsa04728, R‐HAS‐112315, R‐HSA‐442755) and MAPK signaling pathways (hsa04010, hsa04014, hsa04015, R‐HSA‐5673001, R‐HSA‐5684996) were enriched in both ADHD and ND.
Conclusion
The signaling pathways implicated by this analysis mediate neurological mechanisms known to contribute to ND. The association of analogous differently expressed genes and common signaling pathways suggests an important causal relationship between ND and ADHD that may be clinically important.
... Children with all ADHD current presentation specifiers were eligible, given the instability of ADHD subtypes (Lahey et al., 2005;Valo & Tannock, 2010;Willcutt et al., 2012). To improve generalizability (Wilens et al., 2002), children with comorbidities were included. Our standard assessment battery also included norm-referenced child internalizing disorder screeners, and additional standardized measures were administered clinically as needed to inform differential diagnosis and accurate assessment of comorbidities (e.g., child clinical interviews, additional testing). ...
... Future work with larger samples of each ADHD presentation is needed to investigate whether different neurocognitive/executive functions may evoke differential increases in objectively measured hyperactivity across ADHD subgroups. Finally, while the inclusion of children with other forms of child psychopathology was considered a strength because it improves the generalizability of our findings (Wilens et al., 2002), the extent to which co-occurring disorders may suppress or exacerbate motor movement in children with ADHD remains unclear (Lea et al., 2018) despite our finding that the ADHD and non-ADHD groups did not differ in the rates of most of these common comorbidities. Future work using a larger neurotypical samples is necessary to investigate these relations. ...
Objective:
Hyperactivity is a core and impairing deficit in the clinical model of attention-deficit/hyperactivity disorder (ADHD). However, the extent to which hyperactivity in ADHD is evoked by cognitively challenging tasks in general or by demands on specific executive functions remains unclear.
Method:
A clinically evaluated and carefully phenotyped community-referred sample of 184 children ages 8-13 (M = 10.40, SD = 1.50; 61 girls) with ADHD (n = 119) and without ADHD (neurotypical children and children with psychiatric disorders other than ADHD) were administered multiple, counterbalanced executive (working memory, inhibitory control, set shifting) and nonexecutive tests. Objective measures of gross motor movement (hyperactivity) were obtained using actigraphy.
Results:
Using bifactor s-1 modeling, results indicate that children with ADHD demonstrate moderately elevated levels of motor movement relative to non-ADHD children. Additionally, findings indicated that hyperactivity in ADHD reflects the outcome of at least two similarly important factors: (a) a baseline level of elevated motor movement that is independent of environmental demands on their executive and nonexecutive cognitive abilities (d = 0.72); and (b) additional elevations attributable to demands placed on specific executive functions, with working memory and inhibition demands evoking similarly large, differential increases in movement for children with ADHD above and beyond their elevated baselines (Δd = 0.80).
Conclusions:
These findings suggests that executive function demands exacerbate, but do not fully explain, hyperactivity in ADHD, and/or there are at least two pathways to hyperactivity in ADHD-hyperactivity caused by environmental demands that challenge their underdeveloped executive functions, and hyperactivity caused by one or more other factors that need future research to identify. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
... Attention deficit hyperactivity disorder (ADHD) is one of children's most frequent neurodegenerative disorders [1]. It is characterized by difficulties paying attention, excessive activity, and a lack of self-con-trol [2]. ...
... hood [1,7,8]. ADHD is a multi-factorial disorder that is influenced by both genetic and environmental factors [9]. ...
Numerous researchers have examined the effect of diet on Attention Deficit Hyperactivity Disorder (ADHD). The purpose of this study is to compare the symptoms of ADHD in children fed horse milk versus conventionally fed cow's milk. Thirty patients aged 6 to 14 with ADHD were randomly selected and divided into two groups in this randomized double-blind crossover study. All patients completed a 45-day period of consuming 250 mL horse or cow milk, as well as continued Ritalin (1 mg/kg) treatment. The wash out period was considered one week. Symptoms are recorded using the Conners rating scale (CS). The CS of the parents decreased significantly (P value≤0.001) in the group that first received horse milk, but increased (P value=0.007) after consuming cow's milk. After consumption of horse milk, the parent's CS was significantly different from that of cow milk (P value= 0.001). Teachers' CS decreased significantly following horse milk consumption (P=0.001) and increased significantly following cow milk consumption (P=0.028) in this group. The average teacher's CS after cow milk differed significantly from that after horse milk (P value= 0.024). The CS of the parents did not change significantly (P value=0.913) in the group that first consumed cow's milk. However, it was significantly decreased (P value=0.004) after receiving horse milk. The CS of the teachers in this group did not change after the cow's milk (P value=0.282). However, following the administration of horse milk, the mean of CS decreased significantly (P=0.003). The average of the teacher's CS after consuming cow milk differed significantly from that of horse milk (P value= 0.010). In both groups, there was no significant difference in the mean of parents and teachers CS before and after the washout period (P>0.05). According to the study, horse milk consumption was significantly more effective than cow milk at lowering scores.
... Children with ADHD may have difficulty with learning in school, developing appropriate social skills, and managing frustration and aggression. 1 ADHD is also a developmental disorder whose presentation may change with maturation. There is often a decrease in overt hyperactivity and impulsivity with age, while attention problems are more likely to persist. 2 ...
... Medicated children with ADHD in this study demonstrated significant improvements in lower extremity reaction time, which agrees with most upper extremity investigations (Knights & Hinton, 1969;Gordon & Kantor , 1979;Reid & Borkowski, 1984;Beyer, 1999;Sheppard, et al., 2000). Investigators of this population have suggested that stimulants positively influence the nerve transmission of central processing mechanisms (Faraone & Doyle, 2001;Madras, Miller, & Fischman, 2002;Wilens, Biederman, & Spencer, 2002). Data from this study indicate that stimulants may enhance the speed of processing for lower extremity movement in children with ADHD. ...
Children with attention deficit hyperactivity disorder (ADHD) have been labeled as “inefficient movers”; however, little research has examined the effect of stimulant medication on lower extremity movements. 16 boys, 11 to 13 years old, with ADHD performed a lower-limb choice-response time task, both on and off medication. When nonmedicated, children had significantly slower reaction times to all three targets and significantly slower movement times for the contralateral and midline movements. For both conditions, children had significantly faster movement time when using the right leg than the left leg. These findings suggest that movement characteristics of children with ADHD are different under medicated and nonmedicated situations.
... Poor compliance to medication and discontinuity can hamper the improvement in the patient's symptoms. Up to 50% of adult ADHD patients are non-responders or unable and/or unwilling to tolerate the side effects of pharmacotherapy [22,23]. ...
Purpose of Review
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex neuropsychiatric condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. In adults, ADHD presents unique challenges in its diagnosis and management. This review updates the current landscape of non-pharmacological management of adult ADHD, with a specific focus on geriatric ADHD management.
Recent Findings
Psychotherapy remains the cornerstone of effective treatment for ADHD. Among the therapeutic modalities, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Metacognitive Therapy (MCT) have demonstrated considerable success. These therapies require specific adaptations, such as modifying session structure, focusing on adult-specific issues like time management and workplace challenges, and integrating techniques to meet the complex needs of the adult ADHD population. Additionally, support groups and mindfulness practices have shown to be effective, especially within the geriatric group. These methods help in cultivating a sense of community, enhancing coping strategies, and improving mental resilience. Emerging treatments such as hypnotherapy, Transcranial Magnetic Stimulation (TMS), neurofeedback, and dietary supplements are also discussed. While these treatments show potential, they currently require further empirical studies to better establish their effectiveness and optimal application in clinical settings.
Summary
This review emphasizes the importance of a tailored, multifaceted approach to managing adult ADHD through non-pharmacological means. By incorporating a range of therapeutic interventions, clinicians can better address the complex symptomatology and improve the overall quality of life for adults living with ADHD.
... Los estimulantes son utilizados como agentes de primera línea para niños y adultos con TDAH por la evidencia y eficacia, los más usados siendo metilfenidato (ritalina, metilfenidato clorhidrato, etc.), anfetaminas (dextroanfetamina, dextroanfetamina asociado a anfetamina) y dexanfetamina). Aunque varias personas no responden o reaccionan a los efectos de la medicación, los que sí responden suelen mostrar un 50% o menos reducción de síntomas principales del TDAH (4). ...
RESUMEN:
El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es un trastorno del neurodesarrollo caracterizado por niveles elevados de hiperactividad, impulsividad e inatención. La terapia cognitivo-conductual (TCC) y la medicación son tratamientos comunes para reducir los síntomas del TDAH. Se ha demostrado la efectividad de la terapia cognitiva-conductual (TCC) para la reducción de sus síntomas. Al igual, se evidenció la eficacia de la medicación, siendo intervención de primera línea para reducir sus síntomas característicos. Objetivos: Comparar la eficacia de la TCC sola versus la TCC combinada con medicación para la reducción de síntomas de TDAH en adultos. Material y métodos: Se realizó una búsqueda en PubMed utilizando términos específicos. Se seleccionaron y analizaron tres artículos según criterios de inclusión y exclusión detallados en tablas y un diagrama de flujo PRISMA. Resultados: Ambos tratamientos, TCC sola y TCC combinada con medicación, mostraron una reducción significativa de los síntomas de TDAH. No se encontraron diferencias significativas en la eficacia entre los dos enfoques durante el seguimiento. Conclusiones: La TCC es un tratamiento efectivo para la reducción de síntomas de TDAH en adultos, y la combinación con medicación no mostró una mejora adicional significativa.
... Previous investigations support stimulant therapy for ADHD among elderly persons (Pliszka, 2016;Timothy E. Wilens et al., 2002). According to previous investigations, the clinical benefits of stimulant medications are two-fold: a high response rate and improved focus and task performance. ...
... Previous investigations support stimulant therapy for ADHD among elderly persons (Pliszka, 2016;Timothy E. Wilens et al., 2002). According to previous investigations, the clinical benefits of stimulant medications are two-fold: a high response rate and improved focus and task performance. ...
Attention deficit and hyperactivity disorder (ADHD) remain a common neuropsychiatric complication in childhood rather than adulthood. However, recent cases of new diagnoses raise alarm over a potential increase in incidence in adulthood. This case series explores a 79-year-old woman with ADHD to capture insights into clinical practices, including diagnoses and treatments. This is a case report investigating a 79-year-old woman with a 20-year stint of self-medication to manage her ADHD. She presented at the clinic with a history of ADHD, but no symptoms at the time of incidence. Contrary to her knowledge, the Diagnostic and Statistical Manual, fifth edition, was used to determine her mental health and indicate a rational medication. The psychiatrists indicated Adderall XR and multivitamins to address her condition. The 79-year-old woman sought a legal prescription as she planned to relocate to France. She was diagnosed with ADHD, which is not a common incidence among adults and put on Adderall XR and multivitamins. Within four weeks, she reported remarkable improvement, including excellent task performance, concentration, and physical abilities. This case presents potential ADHD incidence in adulthood without awareness of symptoms among patients. A follow up confirmed improved task performance, concentration, alleviated hyperactivity, motor functions and attentiveness. These results set the differences in the effectiveness of unconventional and evidence-based interventions for ADHD among adults. It prompts policymakers to consider further investigations to establish a rational, evidence-based diagnosis and treatment. This case report marks the importance of evidence-based and rational drug use and disease management in adults. The old woman reported improved symptoms of ADHD following Adderall XR. Upon follow-up, psychiatrists indicated multivitamins to improve her well-being and improve her attentiveness. This combined therapy improved the woman’s motor functions, cognition concentration and task performance. This case represents common cases of unconventional treatments among patients and makes a clinical statement of adequate patient diagnosis and management of ADHD among adults. Keywords: Methylphenidate, ADHD Diagnosis in Seniors, Long-term ADHD, Adult ADHD, Stimulant Medication
... Attention deficit hyperactivity disorder (ADHD) is a developmental condition characterized by significant levels of inattention, impulsivity and hyperactivity (Halperin et al., 1992). This condition has been found to have a detrimental impact on individuals' academic, occupational, psychological and social spheres throughout their lifespan (Barkley et al., 1996;Wilens et al., 2002;Harpin, 2005). ...
Individuals diagnosed with attention deficit/hyperactivity disorder (ADHD) have been found to have impairments in multiple aspects of social cognition, thus including the attentional processing of socially relevant stimuli such as eye-gaze. However, to date, it remains unclear whether only the social-specific but not the domain-general directional components, elicited by eye-gaze are affected by ADHD symptomatology. To address this issue, the present study aimed to investigate the impact of ADHD-like traits on the social-specific attentional processing of eye-gaze. To this purpose, we conducted an online experiment with a sample of 140 healthy undergraduate participants who completed two self-reported questionnaires designed to assess ADHD-like traits, and a social variant of an interference spatial task known to effectively isolate the social-specific component of eye-gaze. To make our research plan transparent, our hypotheses, together with the plans of analyses, were registered before data exploration. Results showed that while the social-specific component of eye-gaze was evident in the sample, no significant correlation was found between this component and the measured ADHD-like traits. These results appear to contradict the intuition that the attentional processing of the social-specific components of eye-gaze may be impaired by ADHD symptomatology. However, further research involving children and clinical populations is needed in order to clarify this matter.
... Pessoas com TDAH comumente apresentam comorbidades na infância e adolescência. Até 50% delas podem desenvolver comorbidades, como: transtorno de ansiedade (cerca de 25%); transtorno opositor e desafiador e de conduta (30 a 50%); distúrbios de aprendizagem (10 a 25%); abuso de substâncias, cerca de 9 a 40% (Antshel & Olszewski, 2014;Molina et al., 2009;Wilens et al., 2002). ...
RESUMO: Transtorno do Déficit de Atenção com Hiperatividade (TDAH) é um transtorno do neurodesenvolvimento caracterizado por níveis prejudiciais de desatenção e/ou hiperatividade-impulsividade. Foram investigados resultados obtidos em pesquisas sobre impactos do TDAH ao adolescente e foi utilizada a recomendação PRISMA 2020. As bases de dados consultadas foram: APA PsycNet, Lilacs, Medline, PubMed Central, Scorpus, SciELO, a partir dos seguintes descritores: Transtorno do Déficit de Atenção e Hiperatividade, TDAH, Attention Deficit Hyperactivity Disorder, ADHD e Adolescente, Adolescentes, Adolescência, Adolescent, Teenager e Adolescence. Os critérios de inclusão foram: artigos publicados em periódicos entre janeiro de 2001 e janeiro de 2021, em português e inglês, completos e disponíveis online, estudos empíricos, revisados por pares, terem adolescentes como participantes e apresentarem no título, resumo ou corpo do texto os descritores referidos. Os dados foram tratados e organizados conforme check list (recomendação PRISMA 2020). Análises estatísticas descritivas foram realizadas com o Excel 2019. Para apresentar os resultados, utilizaram-se o fluxograma PRISMA, quadro e figuras. Incluíram-se 68 artigos que apontaram variedade de impactos negativos ao desenvolvimento do adolescente nas áreas sociais/relacionais, comportamentais, biológicas, neurológicas, cognitivas, psicológicas e psicopatológicas. Possível limitação desta revisão pode ser a não inclusão de artigos em outros idiomas, além do inglês e português. Os resultados sugerem multidimensionalidade dos impactos do TDAH ao adolescente, requerendo abordagem pluridimensional para evitar cronicidade, reduzindo seus efeitos ao desenvolvimento.
... Another study showed that there was a significant difference in terms number of head movements performed on the x-axis between patients with ADHD and controls, with a sensitivity of 82.6 and specificity of 79.5 (Ulberstad et al., 2020). Although it is known that hyperactivity decreases in adulthood (Wilens et al., 2002), a study in individuals with adult ADHD found that number of head movements, the duration of active head movement, and the extent of the head movement were significantly higher than that of the healthy group (Lis et al., 2010). In line with the results in the literature, we found that children with ADHD had higher angular changes associated with both the total head movements and the magnitude of their head movements on the x-axis. ...
Objective
We aimed to evaluate eye and head movements, which are objective parameters in ADHD. Method: While the children were watching the course video task, which included the relevant (teacher and smart board) and irrelevant (any regions outside the relevant area) areas of interest, their eye movements were evaluated through eye tracking, and video recordings were made simultaneous. Head position estimation was made using through video recordings. The proportion of total fixation duration on areas of interest (PFDAOI) and saccade count, amplitude, velocity for eye movements, number of total head movements and angular change of head movement in x-y-z axes for head movements were compared.
Results
Children with ADHD had lower PFDAOI on the relevant area, and had more saccade and head movements The angular change of head movement in the x-axis was higher in the ADHD group.
Conclusion
In the assessment of ADHD, the eye and head movements may be particulary useful.
... A recent national survey found that 4.2 percent of US workers had adult attention deficit and hyperactivity disorder (ADHD) resulting in $19.5 billion in lost human capital per annum [23]. Lifespan research suggests that the majority of children with ADHD continue to experience symptoms as adults [24][25][26][27][28][29]. Prevalence estimates of ADHD among adults in the United States vary according to the measurement criteria used, with estimates ranging from less than 10 percent to as high as 70 percent [24,26,27,30]. ...
This research study examines the associations between dimensions of emotional intelligence (EQ) and adult attention deficit (AAD) in order to provide a framework for future research. A total of 219 management students completed three measures of AAD and a multi-dimensional measure of EQ (Bar-on EQI). Product moment correlations were used to examine the univariate associations between dimensions of EQ and AAD, and multiple regression examined the simultaneous multivariate relationship. Both the global measure of EQ and the all the sub-dimensions of EQ were significantly correlated with three established measures of AAD (College ADHD Response Evaluation, Brown AAD Scale and the DSM-V items used to identify inattention), except for non-significant univariate relationships between Brown-AAD and both empathy and social responsibility. Self-regard, self-actualization, reality-testing and stress-tolerance displayed the strongest univariate correlations, while self-actualization, reality-testing, happiness and stress tolerance remained significant when a composite score of the standardized scores from the 3 measures of AAD was simultaneously regressed on all the dimensions of EQ. Further research is required to confirm the directionality of the associations which will help to address the question of whether enhancing emotional competency will help reduce AAD symptoms and associated performance challenges.
... Several children with ADHD also met the criteria for common comorbidities based on this comprehensive psychoeducational evaluation, including anxiety disorders (58%), oppositional-defiant disorder (21%), autism spectrum disorders (ASDs; 14%), and depressive disorders (7%). To improve generalizability, given that comorbidity is the norm rather than the exception for children with ADHD (Wilens et al., 2002), these children were retained in the sample. In addition, 20 children with ADHD screened positive for specific learning disorders in math (n = 12) and/or reading (n = 8). ...
Objective: Children with attention-deficit/hyperactivity disorder (ADHD) frequently demonstrate deficits in working memory and in multiple domains of math skills, including underdeveloped problem-solving and computation skills. The Baddeley model of working memory posits a multicomponent system, including a domain-general central executive and two domain-specific subsystems—phonological short-term memory and visuospatial short-term memory. Extant literature indicates a strong link between neurocognitive deficits in working/short-term memory and math skills; however, the extent to which each component of working/short-term memory may account for this relation is unclear. Method: The present study was the first to use bifactor (S·I-1) modeling to examine relations between each working/short-term memory subcomponent (i.e., central executive, phonological short-term memory, and visuospatial short-term memory), ADHD symptoms, and math skills in a clinically evaluated sample of 186 children ages 8–13 (Myears = 10.40, SD = 1.49; 62 girls; 69% White/non-Hispanic). Results: Structural equation modeling indicated that all three working/short-term memory components exert a significant and approximately equal effect on latent math skills (β = .29–.50, all p < .05) and together explain 56% of the variance in children’s math achievement (R² = .56). Exploratory analyses indicated that teacher-reported ADHD inattentive symptoms provided a small but significant contribution to predicting latent math skills (ΔR² = .07) and accounted for 24% of the central executive/math association. Conclusions: These findings suggest that math difficulties in children with ADHD and clinically evaluated children without ADHD are associated, in large part, with their neurocognitive vulnerabilities in working/short-term memory and, to a lesser extent, overt ADHD symptoms.
... A recent study of 262 adults with ASD presenting for psychotherapy at an outpatient psychotherapy clinic at a hospital in Germany found the five main reasons for seeking psychotherapy were depression (76%), interaction and social problems (48%), social anxiety (44%), problems coping with everyday life (44%), and anxiety (38%) (Lipinski, Blanke, Suenkel and Dziobek, 2019). Similarly, studies have estimated between 70-75% of adults with ADHD have at least one additional comorbid disorder (Wilens, Biederman and Spencer, 2002;Ramsay and Rostain, 2005). ...
This qualitative research study uses Interpretative Phenomenological Analysis (IPA) (Smith, Flowers & Larkin, 2009; Smith & Nizza, 2022) to explore how Transactional Analysis Psychotherapy can be used effectively with clients who are neurodivergent. It aimed to explore the lived experiences of participants, all of whom were neurodivergent and received psychotherapy as adults but who were undiagnosed in childhood. Participants all reported a sense of frustration, sadness, and shame regarding how others have responded to their neurodivergence and neurodivergent behaviours historically. This study aimed to look beyond the outward presenting behaviours to the underlying need and consider what neurodivergent clients may need, both from their psychotherapist and from their psychotherapy. This study suggests four main psychotherapeutic needs, identifies three main traps that psychotherapists may fall into when working with neurodivergent clients, and describes eight relational affirmations which are important to consider when working with neurodivergent clients.
... Several children with ADHD also met criteria for common comorbidities based on this comprehensive psychoeducational evaluation, including anxiety disorders (31.8%), oppositional defiant disorder (ODD; 10.4%), 1 autism spectrum disorders (6.5%), and depressive disorders (5.2%). To improve generalizability given that comorbidity is the norm rather than the exception for children with ADHD (Wilens et al., 2002), these children were retained in the sample. In addition, 34 children with ADHD screened positive for a single (n = 29) or multiple (n = 5) specific learning disorders in reading (n = 28) and/or math (n = 11). ...
The “simple view of reading” is an influential model of reading comprehension that asserts that children’s reading comprehension performance can be explained entirely by their decoding and language comprehension skills. Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit difficulty across all three of these reading domains on standardized achievement tests, yet it is unclear whether the simple view of reading is sufficient to explain reading comprehension performance for these children. The current study is the first to use multiple indicators and latent estimates to examine the veracity of key predictions from the simple view of reading in a clinically evaluated sample of 250 children with and without ADHD (ages 8–13, Mage = 10.29, SD = 1.47; 93 girls; 70% White/non-Hispanic). Results of the full-sample structural equation model revealed that decoding and language comprehension explained all (R² = .99) of the variance in reading comprehension for children with and without ADHD. Further, multigroup modeling (ADHD, non-ADHD) indicated that there was no difference in the quantity of variance explained for children with ADHD versus clinically evaluated children without ADHD and that the quantity of explained variance did not differ from 100% for either group. Sensitivity analyses indicated that these effects were generally robust to control for monomethod bias, time sampling error, and IQ. These findings are consistent with “simple view” predictions that decoding and language comprehension are both necessary and together sufficient for explaining children’s reading comprehension skills. The findings extend prior work by indicating that the “simple view” holds for both children with ADHD and clinically evaluated children without ADHD.
... Studies have found that the prevalence of IED is significantly higher among individuals with ADHD compared to those without ADHD. For example, one study found that the prevalence of IED was approximately six times higher among individuals with ADHD compared to those without ADHD [63]. ...
ADHD, a neurodevelopmental condition, is distinguished by a triad of symptoms including inattention, hyperactivity, and impulsivity. It is frequently accompanied by comorbidities such as anxiety, depression, and learning disabilities. As a result, clinicians often face challenges in accurately diagnosing ADHD and differentiating it from other conditions. As a prospective remedy for ADHD, scientists have investigated Transcranial Direct Current Stimulation (tDCS), a non-invasive technique of stimulating the brain. It involves applying low-intensity electrical currents to specific regions of the brain to modulate neural activity. This review paper aims to provide an overview of the comorbidities associated with ADHD and the differential diagnosis of the condition. It also explores the potential of tDCS as a treatment option for ADHD, including its mechanisms of action and efficacy in improving ADHD symptoms. The comorbidities discussed in this review include anxiety disorders, mood disorders, and substance use disorders. These comorbidities are frequently seen in individuals with ADHD and can complicate the diagnosis and treatment of the condition. The paper also highlights the importance of considering comorbidities when assessing ADHD, as well as the potential impact of these conditions on treatment outcomes. The differential diagnosis section of the paper explores conditions that can present with symptoms similar to ADHD, such as anxiety disorders, mood disorders, and learning disabilities. It emphasizes the need for a thorough assessment and differential diagnosis to identify ADHD and differentiate it from other conditions accurately. The final section of the paper discusses the potential of tDCS as a treatment option for ADHD. It examines the mechanisms of action of tDCS and its efficacy in improving ADHD symptoms, including attention, hyperactivity, and impulsivity. It also explores the potential for tDCS to improve comorbid conditions associated with ADHD. Overall, this review provides a comprehensive overview of comorbidities and differential diagnoses in ADHD and the potential of tDCS as a treatment option. The paper highlights the importance of a thorough assessment and personalized treatment plan for individuals with ADHD, particularly those with comorbidities.
... were the combined type, and in the case of adult ADHD, all subjects were the inattentive type. It is known that the combined type in child ADHD patients and the inattentive type in adult ADHD are majority subtype for each age-group, but this study also reflected the actual prevalence of subtypes (Wilens et al., 2002(Wilens et al., , 2009). Our analysis thus primarily represented the largest population of child ADHD and adult ADHD patients, respectively. ...
Attention-deficit/hyperactivity disorder (ADHD) is known to be associated with several diagnostic resting-state electroencephalography (EEG) patterns, including the theta/beta ratio, but no objective predictive markers for each medication. In this study, we explored EEG markers with which the therapeutic efficacy of medications could be estimated at the 1st clinical visit. Thirty-two ADHD patients and thirty-one healthy subjects participated in this study. EEG was recorded during eyes-closed resting conditions, and ADHD symptoms were scored before and after the therapeutic intervention (8 ± 2 weeks). Although comparing EEG patterns between ADHD patients and healthy subjects showed significant differences, EEG dynamics, e.g., theta/beta ratio, in ADHD patients
before and after MPH treatment were not significantly different despite improvements in ADHD symptoms. We demonstrated that MPH good responders and poor responders, defined by the efficacy
of MPH, had significantly different theta band power in right temporal areas, alpha in left occipital and frontal areas, and beta in left frontal areas. Moreover, we showed that MPH good responders had significant improvements toward normalization in several coherence measures after MPH treatment. Our study implies the possibility of these EEG indices as predictive markers for ADHD therapeutic efficacy.
... Currently, ADHD is primarily treated with medication, which indeed ameliorate many of the core ADHD symptoms . However, about third of the people (Banaschewski et al., 2004;Rabiner et al., 2010) with ADHD do not respond to medication or have adverse responses that prevent them from medication treatment (Aagaard & Hansen, 2011;Banaschewski et al., 2004;Charach & Fernandez, 2013;Rabiner et al., 2010;Wilens et al., 2002). Moreover, most individuals treated with medication continue to evidence some functional impairments (e.g., Swanson et al., 2011) and it seems that medication has less impact on everyday functional outcomes (Pelham et al., 2017). ...
Objective
The present study evaluated the near (attention) and far (reading, ADHD symptoms, learning, and quality of life) transfer effects of a Computerized Progressive Attention Training (CPAT) versus Mindfulness Based Stress Reduction (MBSR) practice among adults with ADHD compared to a passive group.
Method
Fifty-four adults participated in a non-fully randomized controlled trial. Participants in the intervention groups completed eight 2-hr weekly training sessions. Outcomes were assessed before, immediately after, and 4 months post-intervention, using objective tools: attention tests, eye-tracker, and subjective questionnaires.
Results
Both interventions showed near-transfer to various attention functions. The CPAT produced far-transfer effects to reading, ADHD symptoms, and learning while the MBSR improved the self-perceived quality of life. At follow-up, all improvements except for ADHD symptoms were preserved in the CPAT group. The MBSR group showed mixed preservations.
Conclusion
Both interventions have beneficial effects, however only the CPAT group exhibited improvements compared to the passive group.
... Desiring similar beneficial effects, the prevalence of non-medical usage of psychostimulants for neurocognitive enhancement by students is increasing on university campuses worldwide [9,10]. Thus, these medications are controlled substances with a high risk for abuse and illicit trafficking [11,12]. ...
Background:
Methylphenidate and atomoxetine are used for the treatment of attention-deficit/hyperactivity disorder (ADHD). Our previous studies established the validity of the 6-hydroxydopamine (6-OHDA) mouse model of ADHD and demonstrated hypersensitivity to pain, in line with clinical reports in ADHD patients. Acute methylphenidate treatment reduces hyperactivity and increases attention, but does not affect pain behaviors in this mouse model. Whereas atomoxetine has been shown to be effective against some symptoms of ADHD, nothing is known about its possible action on comorbid pain hypersensitivity. The objectives of the present research are (1) to investigate the effects of acute and chronic treatment with atomoxetine on ADHD-like symptoms and nociceptive thresholds, and (2) to explore the catecholaminergic systems underlying these effects.
Methods:
Sham and 6-OHDA cohorts of male mice were tested for hyperactivity (open field), attention and impulsivity (5-choice serial reaction time task test), and thermal (hot plate test) and mechanical (von Frey test) thresholds after acute or repeated treatment with vehicle or atomoxetine (1, 3 or 10 mg/kg).
Results:
Acute administration of atomoxetine (10 mg/kg) reduced the hyperactivity and impulsivity displayed by 6-OHDA mice, without affecting attention or nociception. However, atomoxetine administered at 3 mg/kg/day for 7 days alleviated the ADHD-like core symptoms and attenuated the hyperalgesic responses. Furthermore, hyperlocomotion and anti-hyperalgesic activity were antagonized with phentolamine, propranolol, and sulpiride pre-treatments.
Conclusion:
These findings demonstrated that when administered chronically, atomoxetine has a significant effect on ADHD-associated pain hypersensitization, likely mediated by both α- and β-adrenergic and D2/D3 dopaminergic receptors, and suggest new indications for atomoxetine that will need to be confirmed by well-designed clinical trials.
... Accompanying ADHD diagnosis in adulthood is functional impairment across domains, as reflected by poorer academic performance, unemployment, and social dysfunction (Shaw et al., 2012;Willoughby, 2003). Exacerbating academic, occupational, and social difficulties are high rates of psychiatric comorbidity (e.g., substance use, mood, and anxiety disorders) in adults with ADHD (Wilens et al., 2002). ...
This cross-sectional study compared adults diagnosed with Attention-Deficit/Hyperactivity Disorder-Inattentive (ADHD-I) and ADHD-Combined (ADHD-C) presentations with a non-ADHD group on verbal and visual learning and delayed recall using the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test-Revised (BVMT-R), respectively. Data from 380 predominately college student adult outpatients were used, with 155 who met criteria for ADHD-I, 165 who met criteria for ADHD-C, and 60 who did not meet criteria for ADHD but were diagnosed with a primary depressive or anxiety disorder or received no diagnosis. Each patient was administered the RAVLT and BVMT-R as part of a comprehensive neuropsychological evaluation. Significant main effects of study group were found, such that patients with ADHD-C demonstrated worse learning and delayed recall of both verbal and visual information than patients with ADHD-I and the non-ADHD group. Patients with ADHD-I performed comparably to the non-ADHD group, apart from visual learning and delayed recall. Notably, more patients in the ADHD groups had possible or probable learning and memory impairment compared to the non-ADHD group. Findings were consistent with previous research indicating that those with ADHD exhibit poorer verbal and visual learning and delayed recall than those without ADHD.
... Students with a mental health disorder (e.g., generalized anxiety disorder and depression) were included in the study to increase the representativeness of the results, thus addressing a limitation raised in previous studies of youth with ADHD [38] or giftedness [39,40]. In contrast, students whose assessment concluded autism spectrum disorder or intellectual disability (in the ADHD group) were excluded to avoid confounders specifically related to these disorders. ...
The potential for the misdiagnosis of giftedness as attention deficit/hyperactivity disorder (ADHD) has been well documented, as has the clinical diagnostic profile of individuals with both giftedness and ADHD. This study aimed to examine parents’ and teachers’ responses to the Conners 3 behavioral rating scale of gifted students with ADHD compared to gifted students without ADHD and non-gifted students with ADHD. Ninety-two children aged 6 to 16 years were included in the study. On the basis of clinical assessments utilizing the K-SADS, the WISC-V, and other neurocognitive tests, the students were split into three groups: gifted/ADHD (n = 35), ADHD (n = 35), and gifted (n = 22). The results revealed that mothers’, fathers’, and teachers’ responses to the Conners 3 rating scale distinguished well between the gifted group and the other two groups, but not between the gifted/ADHD and ADHD groups. The learning difficulties observed by teachers was the most significant element that distinguished gifted/ADHD students from non-gifted ADHD students. Other results indicated that mothers and fathers reported more inattention problems in their gifted/ADHD children than teachers. Additionally, mothers tended to observe more learning and executive function problems in their gifted/ADHD children than teachers did. These findings highlight the importance of multiple informants complementing each other in the assessment process for ADHD in a gifted context to counteract the masking effect between giftedness and ADHD.
... Sobanski et al. (2007) also find significantly higher emotional lability in people with ADHD compared to unaffected people [37]. Studies of the association of ADHD with mood disorders show high rates of comorbidity concerning major depression, dysthymia, and bipolar disease [9,12,38]. In the differential diagnosis of ADHD and mood disorders, the duration of symptoms is decisive. ...
The prevalence in adulthood is estimated to be approximately 5%. ADHD in adults is poorly understood and underestimated. Its symptoms must be taken into account in the differential diagnosis of mental disorders at these ages. This is why the specific approach and more studies on this disorder in adults should be carried out. Like in children symptoms can impair a variety of life functions, such as family relationships, financial situation, as well as training and professional life.
... Sobanski et al. (2007) also find significantly higher emotional lability in people with ADHD compared to unaffected people [37]. Studies of the association of ADHD with mood disorders show high rates of comorbidity concerning major depression, dysthymia, and bipolar disease [9,12,38]. In the differential diagnosis of ADHD and mood disorders, the duration of symptoms is decisive. ...
The prevalence in adulthood is estimated to be approximately 5%. ADHD in adults is poorly understood and underestimated. Its symptoms must be taken into account in the differential diagnosis of mental disorders at these ages. This is why the specific approach and more studies on this disorder in adults should be carried out. Like in children symptoms can impair a variety of life functions, such as family relationships, financial situation, as well as training and professional life.
... The etiology of ADHD is complicated, including genetic factors, the abnormal metabolism of neurotransmitters, heavy metal toxicity, food sensitivities, or nutritional problems etc. [5]. Recently, it is assumed that oxidative stress may play an important role in pathology of ADHD [6]. ...
... Recent studies suggest that pharmacological treatments for ADHD may have a beneficial effect on insomnia symptoms by improving daytime sleepiness (Boonstra et al., 2007;Surman et al., 2009;Surman and Roth, 2011;Tsai et al., 2019), especially ADHD stimulant medications . Meanwhile, previous research reported that insomnia symptoms can be induced as an adverse effect of ADHD medications (both stimulants and atomoxetine) (Adler et al., 2009;Kirov and Brand, 2014;Kooij and Bijlenga, 2013;Wilens et al., 2002), this adverse effect seeming to be mitigated after two months (Lecendreux and Cortese, 2007;Stein et al., 2012). ...
Background and objectives
: The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to evaluate the relationship between the remission of insomnia disorder and adult ADHD clinical severity, psychiatric and medical comorbidities, and the health-related quality of life (HRQoL) in a 6-month follow-up.
Methods
: Ninety-two adult patients with ADHD and insomnia disorder (52.2% males; mean age 39.5±11.0 years) were comprehensively assessed at baseline, 3 months, and 6 months of a follow-up period. The evaluation included semi-structured interviews (for ADHD and comorbidity assessment), the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of ADHD and insomnia disorder was performed according to DSM-5 criteria. At baseline and follow-up, psychoeducation/sleep hygiene and, if necessary, pharmacological were prescribed for insomnia.
Results
: Eighty-seven patients completed the 6-month follow-up. Insomnia disorder remission was reported in 72.4% of cases and was related to a greater improvement in ADHD symptoms and severity throughout the follow-up period. Additionally, an improvement in psychiatric comorbidities and better HRQoL were associated with insomnia disorder remission.
Conclusion
: The current study highlights that the treatment of insomnia disorder in ADHD adult patients may have an important role in the outcome of ADHD therapeutic approaches by reducing their severity.
... ADHD in adults was largely unrecognized prior to 2002 (82,83). Comorbidity clouds the diagnosis in adults, as well. ...
Background: The diagnosis of attention deficit hyperactivity disorder (ADHD) relies on history and observation, as no reliable biomarkers have been identified. In this study, we compared a large single diagnosis group of patients with ADHD (combined, inattentive, and hyperactive) to healthy controls using brain perfusion single-photon emission computed tomography (SPECT) imaging to determine specific brain regions which could serve as potential biomarkers to reliably distinguish ADHD.
Methods: In a retrospective analysis, subjects (n = 1,135) were obtained from a large multisite psychiatric database, where resting state (baseline) and on-task SPECT scans were obtained. Only baseline scans were analyzed in the present study. Subjects were separated into two groups – Group 1 (n = 1,006) was composed of patients who only met criteria for ADHD with no comorbid diagnoses, while a control group (n = 129) composed of individuals who did not meet criteria for any psychiatric diagnosis, brain injury, or substance use served as a non-matched control. SPECT regions of interests (ROIs) and visual readings were analyzed using binary logistic regression. Predicted probabilities from this analysis were inputted into a Receiver Operating Characteristic analysis to identify sensitivity, specificity, and accuracy.
Results: The baseline ROIs and visual readings show significant separations from healthy controls. Sensitivity of the visual reads was 100% while specificity was >97%. The sensitivity and specificity of the post-hoc ROI analysis were both 100%. Decreased perfusion was primarily seen in the orbitofrontal cortices, anterior cingulate gyri, areas of the prefrontal cortices, basal ganglia, and temporal lobes. In addition, ROI analysis revealed some unexpected areas with predictive value in distinguishing ADHD, such as cerebellar subregions and portions of the temporal lobes.
Conclusions: Brain perfusion SPECT distinguishes adult ADHD patients without comorbidities from healthy controls. Areas which were highly significantly different from control and thus may serve as biomarkers in baseline SPECT scans included: medial anterior prefrontal cortex, left anterior temporal lobe, and right insular cortex. Future studies of these potential biomarkers in ADHD patients with comorbidities are warranted.
... Children with any current ADHD presentation specifiers were eligible given the instability of ADHD subtypes (Lahey et al., 2005;Valo & Tannock, 2010;Willcutt et al., 2012). To improve generalizability (Wilens et al., 2002), children with comorbidities were included. Our standard assessment battery also included norm-referenced child internalizing disorder screeners, and additional standardized measures were administered clinically as needed to inform differential diagnosis and accurate assessment of comorbidities (e.g., child clinical interviews, additional testing). ...
Objective: Pediatric attention-deficit/hyperactivity disorder (ADHD) has been associated with impairments in executive functioning and academic writing skills. However, our understanding of the extent to which these children’s writing difficulties are related to their underdeveloped executive functions—and whether this relation is attributable to specific executive functions—is limited. Method: A clinically-evaluated and carefully-phenotyped sample of 91 children ages 8–13 (M = 10.60, SD = 1.25; 37 girls) were administered multiple, counterbalanced tests of the three core executive functions (working memory, inhibitory control, set shifting), assessed for ADHD symptoms via multiple-informant reports, and completed standardized, norm-referenced testing of three core writing skills (written expression, spelling, writing fluency). Results: Bias-corrected, bootstrapped conditional effects modeling indicated that underdeveloped working memory exerted significant direct effects on all three writing skills, as well as indirect effects on written expression and spelling via the ADHD symptoms pathway (all 95% CIs exclude 0.0). In contrast, inhibitory control uniquely predicted spelling difficulties only, set shifting was not associated directly or indirectly with any assessed writing skill, and ADHD symptoms failed to uniquely predict writing skills after controlling for working memory. This pattern of results replicated across informants (parent vs. teacher ADHD symptom ratings), and was robust to control for age, sex, socioeconomic status (SES), majority/minority race/ethnicity status, intellectual functioning (IQ), decoding skills, language skills, and learning disability status. Conclusion: These findings suggest multiple pathways to writing skill difficulties in children with ADHD, while suggesting that their overt behavioral symptoms may be less involved in their writing difficulties than their underlying neurocognitive vulnerabilities.
... Bei den an ADHS erkrankten Erwachsenen gleicht sich das Geschlechterverhältnis in etwa an. Dies wird in der Arbeit von Wilens und Kollegen auf das fehlende Erkennen der Erkrankungen bei Mädchen aufgrund der untypischeren Symptomatik in der Kindheit zurückgeführt (Wilens et al., 2002). Erwachsenenalter führenden Störung der Aufmerksamkeit und des impulsiven Verhaltens mit verstärkter innerer Unruhe (Barkley et al., 2008). ...
Das Ziel der vorliegenden Arbeit war die Untersuchung der Impulsivität bei adulten Patienten mit ADHS. Es wurden 19 adulte Patienten mit ADHS und 20 gesunde Kontrollprobanden, die nach Alter, Geschlecht und Schulabschluss vergleichbar waren, untersucht. Wir nutzten ein kognitives Set Shifting Paradigma und erfassten die Verhaltensdaten (Reaktionszeit und Fehler) sowie hirnphysiologische Änderungen mittels funktioneller Nahinfrarotspektroskopie (fNIRS). Als „Region of Interest“ (ROI) legten wir den dorsolateralen präfrontalen Kortex (dlPFC) fest. Zusätzlich erfolgte eine Selbsterfassung der Impulsivität mittels BIS 11, SPSRQ und UPPS Fragebogen. Auf der Verhaltensebene zeigten die Patienten mit ADHS im Vergleich zu den gesunden Kontrollprobanden eine verlängerte Reaktionszeit. Die Bearbeitung einer Shift Aufgabe führte bei beiden Probandengruppen zu einer verlängerten Reaktionszeit sowie einer erhöhten Fehlerzahl im Verhältnis zu einer No Shift Aufgabe. In der Erhebung der funktionellen Daten konnten wir einen signifikanten Unterschied zwischen den Gruppen im Bereich der ROI feststellen. Die gesunden Kontrollprobanden wiesen eine erhöhte Hirnaktivität im dlPFC auf. In den Fragebögen zur Selbsterfassung der Impulsivität erreichten die Patienten in den meisten Unterskalen Werte, die mit erhöhter Impulsivität einhergehen.
Abstract
The purpose of this study was to investigate the optimal challenge point for learning motor skills in children with and without attention deficit/hyperactivity disorder (ADHD). Ninety-six 9- to 10-year-old children, including 48 children with ADHD and 48 neurotypical children, were randomly assigned to one of four practice groups with varying levels of nominal and functional task difficulty. They performed 63 trials of a dart throwing task in the acquisition phase and 18 trials in the retention and transfer tests a day later. The results showed that neurotypical children outperformed children with ADHD in all phases of the study. Both groups improved in the acquisition phase and performed better in the retention and transfer tests. Interestingly, low nominal task difficulty was associated with better learning for both groups, despite lower average performance for children with ADHD. Thus, despite their performance differences, we did not find a difference in the effective challenge point between children with ADHD and their neurotypical peers.
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ADHD negatively affects the functionality of families and parents; however, no studies have examined the experiences of Turkish families with children diagnosed with ADHD. In this context, the present study aimed to explore the life experiences of Turkish parents with children diagnosed with ADHD. For this purpose, a descriptive phenomenological research design was used. Data were collected using a personal information and semi-structured interviews, while analysis was conducted using Giorgi’s phenomenological method. As a result of the content analysis, five main themes were identified, namely experiences regarding the diagnosis process, emotional reactions related to the diagnosis, experiences with social relations, influences of ADHD diagnosis on the family, and academic difficulties. In line with the results, it is suggested that mental health professionals and other related specialists should include the findings of parents’ life experiences in the treatment planning of children with ADHD and intervention programs should be developed for parents.
Attention deficit hyperactivity disorder (ADHD) is a highly prevalent disorder in adulthood. Deficits in executive functions and emotion regulation are common and persistent in ADHD. Therefore, they are not specific to the psychopathology of adult ADHD. They impair functioning and lead to negative social, family, and occupational quality of life outcomes. This chapter reviews executive function deficits and emotional dysregulation symptoms, including important theoretical issues. In addition, it examines the theoretical framework and the practical implications that are relevant to assessment measures of executive functions and emotional regulation symptoms. It continues with a description of several types of intervention that are currently used among adults with ADHD.
Attention deficiency hyperactive disorder (ADHD) is a neuropsychiatric disability characterized by attention problems, impulsivity, and hyperactivity that can affect education, working life, social relationships, and physical and mental health. Research shows a shortened life expectancy in adults with ADHD which has to do with impaired lifestyle habits. In the field of health sciences, it is important to alleviate suffering, promote health, and prevent ill health. The purpose of this chapter is to describe factors that affect the health and lifestyle of adults with ADHD. The method is a literature search. Adults with ADHD were affected by cognitive impairments that affected life to a large extent. Lifestyle habits with a sedentary lifestyle, poor diet, and drug use were more common in people with ADHD. In addition, comorbidity with both physical and mental health is common. Loneliness and deteriorating quality of life plague many people with ADHD. Combined treatment methods with psychosocial interventions are important. Health-promoting lifestyle programs where support for physical, mental, and social health is important. Conclusion: Research on lifestyle programs for adults with ADHD is lacking. There is some research that supports the idea that continuous health-promoting lifestyle programs based on interpersonal relationships, health education, and health discussions as well as cognitive support can be useful for lifestyle changes among people with ADHD.
Background: Accumulating evidence indicates that a variety of distal and proximal factors might impact a risk of suicide. However, the association between both groups of factors remains unknown. Therefore, in the present study, we aimed to investigate the interplay between distal and proximal correlates of the current suicidal ideation.
Methods: A total of 3000 individuals (aged 18 – 35 years, 41.7% males), who had reported a negative history of psychiatric treatment, were enrolled through an online computer-assisted web interview. Self-reports were administered to measure: 1) distal factors: a history of childhood trauma (CT), reading disabilities (RD), symptoms of attention-deficit/hyperactivity disorder (ADHD), lifetime history of non-suicidal self-injury (NSSI), lifetime problematic substance use as well as family history of schizophrenia and mood disorders; 2) proximal factors: depressive symptoms, psychotic-like experiences, (PLEs) and insomnia and 3) sociodemographic characteristics.
Results: Suicidal ideation was directly associated with unemployment, being single, higher level of RD, lifetime history of NSSI as well as higher severity of PLEs, depression and insomnia. The association of distal factors with suicidal ideation was fully (a history of CT and symptoms of ADHD) or partially (a history of NSSI and RD) mediated by proximal factors (PLEs, depression and insomnia).
Conclusions: Main findings from this study posit the role of distal factors related to neurodevelopmental disorders, CT and NSSI in shaping suicide risk. Their effects might be partially or fully mediated by depression, PLEs and insomnia.
Many neurological conditions have been treated using diet and metabolic therapy, including epilepsy, headaches, neurotrauma, Alzheimer’s, Parkinsonism, and sleep disorders. Both the lack of efficacy of pharmacological treatments and an inherent attraction to a more “natural” approach motivate people to use diverse nutrition to treat—or moreover relieve the symptoms of—such diseases. Using a low-carbohydrate, high-fat diet, the ketogenic diet has been around for over a century to treat children with refractory epilepsy. Research on a ketogenic diet for various metabolic, neurological, and neurodevelopmental diseases has lately increased in prominence. This thorough chapter objectively examines the possible therapeutic benefits of a ketogenic diet and ketogenic agents on neuropsychiatric and mental illnesses in humans and translationally viable animal models. According to preclinical studies, there is remarkable corroboration in the involvement of ketogenic diet in the treatment of a number of neuropsychiatric conditions in animals. There is some promising clinical evidence in the areas of schizophrenia, psychosis, and autism spectrum disorders, but it is restricted to case studies and pilot trials. The lack of randomized, controlled clinical trials makes it impossible to come to a definitive judgement regarding the efficacy of the ketogenic diet in the treatment of psychiatric diseases. This wide range of pathology suggests that energy metabolism, oxidative stress, and immune/inflammatory processes are all possible targets for ketogenic therapy in these conditions. While preclinical evidence suggests that the ketogenic diet and related compounds may be effective in treating a number of neurological and mental illnesses, more research, particularly randomized controlled clinical trials, is needed to determine their clinical usefulness and any possible side effects.KeywordsKetogenic dietNeuropsychiatric diseaseAutism spectrum disorderSchizophreniaOxidative stressEnergy metabolismInflammatory processes
COVID-19 affects emotional status and quality of life (QOL) as reported in various countries. Less is known about the relations between gender, emotional status, and QOL in vulnerable groups. The objectives of this study is to compare emotional status and QOL between women with and without ADHD, during COVID-19, to correlate between emotional status, daily life, and QOL of women with ADHD, and to predict their QOL by COVID-19 constraints and emotional status. This cross-sectional online survey included 46 with ADHD and 183 typically functioning women, aged 19 to 60, who completed the sociodemographic-health and daily life during COVID-19 questionnaires; the Depression, Anxiety, and Stress Scale – 21, and the WHOQOL-BREF. Women with ADHD had significantly higher stress and anxiety and lower physical and psychological QOL. Emotional status and daily constraints predicted their QOL. COVID-19 emotional impacts should receive greater attention in vulnerable groups, as women with ADHD, to enhance resilience, participation, and QOL.
Methylphenidate (MPD) is the most widely prescribed psychostimulant used in adolescents and adults to treat attention-deficit/hyperactivity disorder (ADHD). The recreational use of MPD is becoming more prevalent because of its ability to improve cognitive enhancement. The ventral tegmental area (VTA) of the brain is highly associated with reward, cognition and addiction to drugs including psychostimulants like MPD. The VTA neuronal activity was recorded alongside the horizontal behavioral activity from freely behaving non-anesthetized rats. Four adolescent and four adult groups were treated with either saline, 0.6, 2.5 and 10.0 mg/kg MPD. In both adolescent and adult animals, the animals responded to MPD in a dose-dependent manner, such that as the dose of MPD increased, more animals and more VTA unit responded to the drug. The same doses of MPD elicited in some animals’ behavioral and neuronal sensitization and in other animals’ behavioral and neuronal tolerance. In the 0.6 and 10.0 mg/kg MPD dose groups there were significant differences between the age groups for how many animals expressed behavioral sensitization and behavioral tolerance to chronic MPD exposure. Additionally, the animal’s behavioral response to MPD by excitation or attenuation of activity did not always correlate to the VTA neuronal response, and the age group with significantly higher behavioral response did not always correlate to the age group with significantly higher VTA neuronal responses for a given MPD dose. These findings differ from similar studies recorded from the prefrontal cortex (PFC), which exhibited behavioral response continuously directly correlated to PFC responses for increasing MPD doses. This demonstrates that unlike other areas of the brain, there is not a directly relationship between VTA firing and behavioral activity, suggesting that there is input or modulation of this area from elsewhere in the brain. Further investigation is needed to clearly understand the relationship between VTA firing rates and behavioral responses to different MPD doses, especially given the significant differences in response between young and adult animals and the increasing use of the drug in adolescent populations.
To characterize adults with comorbid attention-deficit/hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) with regard to cognitive functioning. Systematically, I examined neuropsychological performance on tasks measuring attention, working memory, and EF, using Scheffe' Test comparing patients with persistent ADHD-BPD (N = 12, female, mean age 31.5), BPD (N = 11, female, mean age 35), and healthy adults (N = 13, mean age 36.3). Compared to BPD, and healthy adults, patients with ADHD-BPD showed impaired attention, working memory, and EF. They were more impulsive and more variable in responding. ADHD- BPD patients show neuropsychological dysfunction. To conclude, adults with ADHD- BPD as a group are impaired on several cognitive domains. This provides a starting point to investigate individual differences in terms of impaired cognitive pathways.
The present study aimed to detect emotional dysregulation among ADHD adult female patients. The study was conducted on a sample of 15 females in the New Valley governorate, with a mean age of 31.56 (standard deviation = 10.40; ages 18-36 years). The initial research sample applied to a set of psychological tests that were relevant to the study variables (Diagnostic Interview for ADHD in adults, DIVA, The Wender-Utah Rating Scale, WURS, Barratt Impulsiveness Scale-11, and The difficulties in emotion regulation scale). The results revealed emotional dysregulation high rushing in the ADHD group.
أجريت الدراسة لتوصيف البالغين الذين يعانون من اضطراب ضعف ترکيز الانتباه المصحوب فرط النشاط (ADHD) المصاحب باضطراب الشخصية الحدية (ADHD-BPD) وبين مريضات اضطراب الشخصية الحدية (BPD). وتوضيح الأعراض المتعلقة باضطراب ADHD من أداء معرفي عصبي. ولقد حاولت الدراسة أن تبحث بشکل منهجي الأداء العصبي النفسي على اختبارات تقيس الانتباه والذاکرة العاملة والضبط التثبيطي وذلک باستخدام اختبار شيفيه لمقارنة أداء المرضى الذين يعانون من اضطراب ضعف ترکيز الانتباه/ فرط النشاط المصاحب باضطراب الشخصية الحدية (ADHD-BPD) (ن= 12، أنثى، متوسط العمر 31.5)، والشخصية الحدية (ن= 11، أنثى، متوسط العمر 35) والصحيحات (ن = 13، متوسط العمر 36.3). وبمقارنة مع مضطربات الشخصية الحدية، والصحيحات، وجد أن مريضات اضطراب ضعف ترکيز الانتباه المصحوب/ فرط النشاط المصاحب باضطراب الشخصية الحدية (ADHD-BPD) يعانون من ضعف الانتباه، والذاکرة العاملة، والوظيفة التنفيذية، وکانوا أکثر اندفاعة، وأکثر تفاوتا في الاستجابة. وأظهرت المريضات الاختلال العصبي النفسي من ضعف في العديد من المجالات المعرفية وهذا يوفر نقطة انطلاق لبحث الفروق الفردية من حيث ضعف المسارات المعرفية.
الکلمات المفتاحية: اضطراب ضعف ترکيز الانتباه/ فرط النشاط المصاحب باضطراب الشخصية الحدية (ADHD-BPD)، اضطراب الشخصية الحدية (BPD)، الأداء المعرفي العصبي.
Objective: Despite the increasing recognition of persistent ADHD into adulthood, there is a paucity of information available on its clinical presentation in adults. To this end, we evaluated ADHD symptoms in a large group of outpatient adults with ADHD attending to issues of psychiatric comorbidity, gender, and age. Methods: We assessed 149 clinically referred outpatient ADHD adults (mean age [±SD] of 37 ±11 years) using structured diagnostic interviews for psychopathology including current and childhood ADHD symptoms. Using DSM III-R symptoms, we determined DSM-IV subtypes by proxy. Results: Inattentive symptoms were most frequently endorsed in over 90% of ADHD adults. An assessment of current ADHD symptoms showed that 56% of adults had the combined ADHD subtype, 37% the inattentive only subtype, and 2% the hyperactive/impulsive subtype. Psychiatric comorbidity with ADHD was more prominent in adults with hyperactivity-impulsivity as part of their clinical picture. Whereas females had fewer childhood hyperactive-impulsive symptoms than males, there were no gender differences in their current ADHD presentation. Conclusion: Findings from the current study suggest that the vast majority of adults with ADHD present with prominent symptoms of inattention. Given that ADHD adults are presenting from multiple domains, clinicians should carefully query for the inattentive aspects of ADHD when evaluating these individuals.
Background: Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder (ADHD), but no longer-term tie, >4 months) investigations have compared these 2 treatments or their combination.
Methods: A group of 579 children with ADHD Combined Type, aged 7 to 9.9 years, were assigned to 13 months of medication management (titration followed by monthly visits); intensive behavioral treatment (parent, school, and child components, with therapist involvement gradually reduced over time); the two combined; or standard community care (treatments by community providers). Outcomes were assessed in multiple domains before and during treatment and at treatment end point (with the combined treatment and medication management groups continuing medication at all assessment points). Data were analyzed through intent to-treat random-effects regression procedures.
Results: All 4 groups showed sizable reductions in symptoms over time, with significant differences among them in degrees of change. For most ADHD symptoms, children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care. Combined and medication management treatments did not differ significantly on any direct comparisons, but in several instances (oppositional/aggressive symptoms, internalizing symptoms, teacher-rated social skills, parent-child relations, and reading achievement) combined treatment proved superior to intensive behavioral treatment and/or community care while medication management did not. Study medication strategies were superior to community care treatments, despite the fact that two thirds of community-treated subjects received medication during the study period.
Conclusions: For ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes.
Objective.-To deal with public and professional concern regarding possible overprescription of attention-deficit/hyperactivity disorder (ADHD) medications, particularly methylphenidate, by reviewing issues related to the diagnosis, optimal treatment, and actual care of ADHD patients and of evidence of patient misuse of ADHD medications. Data Sources.-Literature review using a National Library of Medicine database search far 1975 through March 1997 on the terms attention deficit disorder with hyperactivity methylphenidate, stimulants, and stimulant abuse and dependence, Relevant documents from the Drug Enforcement Administration were also reviewed. Study Selection.-All English-language studies dealing with children of elementary school through high school age were included. Data Extraction.-All searched articles were selected and were made available to coauthors for review, Additional articles known to coauthors were added to the initial list, and a consensus was developed among the coauthors regarding the articles most pertinent to the issues requested in the resolution calling for this report, Relevant information from these articles was included in the report. Data Synthesis.-Diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness, The criteria of what constitutes ADHD in children have broadened, and there is a growing appreciation of the persistence of ADHD into adolescence and adulthood, As a result, more children (especially girls), adolescents, and adults are being diagnosed and treated with stimulant medication, and children are being treated for longer periods of time, Epidemiologic studies using standardized diagnostic criteria suggest that 3% to 6% of the school-aged population (elementary through high school) may suffer from ADHD, although the percentage of US youth being treated for ADHD is al most at the lower end of this prevalence range, Pharmacotherapy, particularly use of stimulants, has been extensively studied and generally provides significant short-term symptomatic and academic improvement, There is little evidence that stimulant abuse or diversion is currently a major problem, particularly among those with ADHD, although recent trends suggest that this could increase with the expanding production and use of stimulants. Conclusions.-Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate by physicians.
Although behavioral evidence provides support for the notion that attention deficit-hyperactivity disorder (ADHD) is related to central nervous system dysfunction, there is little direct evidence to reveal which neurometabolic systems or brain structures are involved. Recent magnetic resonance imaging (MRI) studies suggest that, compared to nondisabled controls, ADHD children may have a smaller right frontal region. Morphometric analysis of MRI scans was used in this exploratory study to determine whether correlated regional variation might exist in the corpus callosum of children with ADHD. While all MRI scans were judged to be clinically normal, morphometric analysis revealed that, compared to nondisabled controls, ADHD children had a smaller corpus callosum, particularly in the region of the genu and splenium, and in the area just anterior to the splenium. Interhemispheric fibers in these regions interconnect the left and right frontal, occipital, parietal, and posterior temporal regions. These results suggest that subtle differences may exist in the brains of children with ADHD and that deviations in normal corticogenesis may underlie the behavioral manifestations of this disorder.
The cause of childhood hyperactivity (attention deficit-hyperactivity disorder) is unknown. We investigated the hypothesis that cerebral glucose metabolism might differ between normal adults (controls) and adults with histories of hyperactivity in childhood who continued to have symptoms. Each patient was also the biologic parent of a hyperactive child. None of the adults had ever been treated with stimulant medication. To measure cerebral glucose metabolism, we administered 148 to 185 MBq (4 to 5 mCi) of [18F]fluoro-2-deoxy-D-glucose intravenously to 50 normal adults and 25 hyperactive adults while they performed an auditory-attention task. Images were obtained for 30 minutes with a Scanditronix positron-emission tomograph with a resolution of 5 to 6 mm. Whole-brain and regional rates of glucose metabolism were measured with computer assistance by two trained research assistants, working independently, who were blinded to the subjects' status (control or hyperactive).
Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls (mean +/- SD, 9.05 +/- 1.20 mg per minute per 100 g vs. 9.85 +/- 1.68 mg per minute per 100 g; P = 0.034). In the adults with hyperactivity, glucose metabolism was significantly reduced, as compared with the values for the controls, in 30 of 60 specific regions of the brain (P less than 0.05). Among the regions of the brain with the greatest reductions in glucose metabolism were the premotor cortex and the superior prefrontal cortex. When the seven women with hyperactivity or the six patients with learning disabilities were omitted from the analysis, the results were similar.
Glucose metabolism, both global and regional, was reduced in adults who had been hyperactive since childhood. The largest reductions were in the premotor cortex and the superior prefrontal cortex--areas earlier shown to be involved in the control of attention and motor activity.
Attention-deficit hyperactivity disorder (ADHD) has been shown to be familial and heritable, in previous studies. As with most psychiatric disorders, examination of pedigrees has not revealed a consistent Mendelian mode of transmission. The response of ADHD patients to medications that inhibit the dopamine transporter, including methylphenidate, amphetamine, pemoline, and bupropion, led us to consider the dopamine transporter as a primary candidate gene for ADHD. To avoid effects of population stratification and to avoid the problem of classification of relatives with other psychiatric disorders as affected or unaffected, we used the haplotype-based haplotype relative risk (HHRR) method to test for association between a VNTR polymorphism at the dopamine transporter locus (DAT1) and DSM-III-R-diagnosed ADHD (N = 49) and undifferentiated attention-deficit disorder (UADD) (N = 8) in trios composed of father, mother, and affected offspring. HHRR analysis revealed significant association between ADHD/UADD and the 480-bp DAT1 allele (chi 2 7.51, 1 df, P = .006). When cases of UADD were dropped from the analysis, similar results were found (Chi 2 7.29, 1 df, P = .007). If these findings are replicated, molecular analysis of the dopamine transporter gene may identify mutations that increase susceptibility to ADHD/UADD. Biochemical analysis of such mutations may lead to development of more effective therapeutic interventions.
The frequency and severity of 17 side effects presumably associated with stimulant medication were assessed during a rigorous, triple-blind, placebo-controlled, crossover evaluation of methylphenidate, 0.3 and 0.5 mg/kg twice a day, in 83 children with attention deficit hyperactivity disorder. Side effects were rated by parents and teachers at the end of each weekly drug condition. Three children (3.6%) had side effects that were sufficiently serious to warrant immediate discontinuation of medication. Parent ratings indicated that only the side effects of decreased appetite, insomnia, stomachaches, and headaches increased significantly in frequency and severity during the two active medication doses as compared with the placebo condition. Fewer than half of the children experienced these side effects and among those who did, ratings of mean severity remained in the mild range. Teacher ratings showed little change over drug conditions, except on ratings of staring, sadness, and anxiety, which declined with increasing dose of medication. Surprisingly, a high frequency of these behavior side effects were reported during the placebo condition. Stimulant medication within this therapeutic range, therefore, results in few, generally mild side effects. However, the wide variation in individual responses and the high rate of these behaviors during placebo treatment argue for the systematic monitoring of side effects before and during pediatric trials of stimulant medication.
Amphetamines are among the oldest compounds available in the United States. Amphetamine (AMPH) was first synthesized in 1887 and found in the 1920s to be a potential alternative to ephedrine which had been running in short supply for the treatment of asthma (Alles, 1928). It was available without prescription to the public for the treatment of asthma first as a benzedrine inhaler and then as benzedrine tablets (Goff & Ciraulo, 1991). Similarly, methamphetamine was synthesized and made available to the public at approximately the same time.
Background
There are few controlled studies of methylphenidate hydrochloride in adults with attentiondeficit hyperactivity disorder (ADHD), and their results have been equivocal. The discrepancies among these studies may be related to low doses, diagnostic uncertainties, and lack of attention to comorbid disorders.
Methods
We conducted a randomized, 7-week, placebo-controlled, crossover study of methylphenidate in 23 adult patients with DSM-III-R ADHD using standardized instruments for diagnosis, separate assessments of ADHD and depressive and anxiety symptoms, and a robust daily dose of methylphenidate hydrochloride, 1.0 mg/kg per day.
Results
We found a marked therapeutic response for methylphenidate treatment of ADHD symptoms that exceeded the placebo response (78% vs 4%, P<.0001). Response to methylphenidate was independent of gender, psychiatric comorbidity with anxiety or moderate depression, or family history of psychiatric disorders.
Conclusion
Robust doses of methylphenidate are effective in the treatment of adult ADHD.
Objective:
The paucity of data concerning the longterm natural history of attention-deficit hyperactivity disorder (ADHD), a common childhood psychiatric disorder, prompted a longitudinal study to investigate the adult sequelae of the childhood disorder.Design:
Prospective study, follow-up intervals ranging from 13 to 19 years (mean, 16 years), with blind systematic clinical assessments.Subjects:
Ninety-one white males (mean age, 26 years), representing 88% of a cohort systematically diagnosed as hyperactive in childhood, and 95 (95%) of comparison cases of similar race, gender, age, whose teachers had voiced no complaints about their school behavior in childhood.Results:
Probands had significantly higher rates than comparisons of ADHD symptoms (11% vs 1%), antisocial personality disorders (18% vs 2%), and drug abuse disor- ders (16% vs 4%). Significant comorbidity occurred between antisocial and drug disorders. Educational and occupational achievements were significantly compromised in the probands. These disadvantages were independent of psychiatric status. We did not find increased rates of affective or anxiety disorders in the probands.Conclusions:
Childhood ADHD predicts specific adult psychiatric disorders, namely antisocial and drug abuse disorders. In the adolescent outcome of this cohort, we found that these disturbances were dependent on the continuation of ADHD symptoms. In contrast, in adulthood, antisocial and drug disorders appeared, in part, independent of sustained ADHD. In addition, regardless of psychiatric status, ADHD placed children at relative risk for educational and vocational disadvantage. The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders.
• We investigated the prevalence of DSM-III disorders in 792 children aged 11 years from the general population and found an overall prevalence of disorder of 17.6% with a sex ratio (boys-girls) of 1.7:1. The most prevalent disorders were attention deficit, oppositional, and separation anxiety disorders, and the least prevalent were depression and social phobia. Conduct disorder, overanxious disorder, and simple phobia had intermediate prevalences. Pervasive disorders, reported by more than one source, had an overall prevalence of 7.3%. Examination of background behavioral data disclosed that children identified at 11 years as having multiple disorders had a history of behavior problems since 5 years of age on parent and teacher reports. Fifty-five percent of the disorders occurred in combination with one or more other disorders, and 45% as a single disorder.
• We report a prospective longitudinal study of 101 male adolescents (ages 16 to 23 years) who had been diagnosed hyperactive in childhood (ages 6 to 12 years), compared with 100 normal controls. The DSM-III diagnoses were made blind to group membership. Information was obtained for 98% of the original cohort. The full attention deficit disorder with hyperactivity (ADDH) syndrome persisted in 31% of the probands vs in 3% of the controls. The only other two conditions that distinguished the groups significantly were conduct and substance use disorders. These disorders aggregated significantly among the probands with continued ADDH. The results indicate that the greatest risk factor for the development of antisocial behavior and drug abuse is the maintenance of ADDH symptoms. Substance use disorders followed the onset of conduct disorder in the overwhelming majority of the cases.
Validity of the distinction between oppositional disorder (OD) and attention deficit disorder with hyperactivity (ADDH) was examined in a sample of 6- to 12-year-old boys with behavior problems. Problem identification, cognitive/attentional, family context, and behavioral symptom differences were examined among nine boys with OD only, 20 with ADDH, 40 with comorbid OD and ADDH, and 28 with neither disruptive behavior disorder. Systematic comparisons of groups including and excluding the OD and ADDH diagnoses were undertaken to determine the existence of pure OD and pure ADDH disorder effects. The most consistent result was the lack of evidence for either pure OD or pure ADDH effects. Most of the significant findings reflected differences between the nondisruptive (neither) and comorbid groups. The results support the importance of comorbidity, but they provide little support for disorder-specific distinctions between oppositional and attention deficit disorders.
Ten previously untreated adults with attention deficit hyperactivity disorder (ADHD) were investigated before and after 4 weeks of treatment with a dose of 3×5 mg methylphenidate/d by single photon emission computed tomography (SPECT) with [Tc–99m]TRODAT-1, the first Tc-99m labelled SPECT ligand specifically binding to the dopamine transporter (DAT). For semiquantitative evaluation of the DAT, specific binding ([STR–BKG]/BKG) was calculated in the striatum (STR) with the cerebellum used as background (BKG). The patients with ADHD presented with increased specific binding of Tc-99m-TRODAT-1 to the DAT as compared with age and sex matched controls ([STR–BKG]/BKG 1.43±0.18 vs. 1.22±0.05, P<0.001). After treatment with methylphenidate specific binding decreased in all patients ([STR–BKG]/BKG 1.02±0.23, P<0.001). Thus, for the first time it could be demonstrated using SPECT that methylphenidate lowers increased striatal DAT availability in adults suffering from ADHD.
Twenty-two adolescents with attention deficit disorder participated in a double-blind, active drug and placebo cross over study with methylphenidate. Sixteen of the children responded positively to medication as measured by improvement on the Conners' abbreviated teacher questionnaire, as well as improvement on daily narratives of the youngsters' behavior and school performance provided by their teachers. It is concluded that adolescents with signs and symptoms consistent with attention deficit disorder do respond to stimulant medication and that the use of a double-blind assessment is practical in the determination of drug response.
Objective:
Children and adolescents with attention-deficit hyperactivity disorder (ADHD), with or without psychostimulant treatment, frequently suffer from sleep disturbances. This report evaluates the use of clonidine in the treatment of sleep disturbances associated with ADHD.
Method:
A systematic search of a computerized database in an outpatient pediatric psychopharmacology unit of patients treated with clonidine for ADHD-associated sleep disturbances (N = 62; 42 children and 20 adolescents) was performed. Patients were rated retrospectively about the type and severity of sleep disturbances at baseline and after treatment with clonidine.
Results:
A majority of patients (85%) treated with clonidine for ADHD-associated sleep disturbances were considered to be much to very much improved by the National Institute of Mental Health global assessment of improvement (sleep). Nighttime clonidine doses ranged from 50 to 800 micrograms (mean +/- SEM; 157 +/- 14 micrograms), and subjects received clonidine for 35.5 +/- 3.5 months. There was no association between response and age group, gender, comorbidity, or concurrent pharmacotherapy. Children and adolescents with ADHD with baseline, medicine-induced, or medicine-exacerbated sleep disturbances responded equally well to clonidine treatment. Mild adverse effects were reported in 19 subjects (31%).
Conclusions:
These findings suggest that clonidine may be an effective agent for sleep disturbances associated with ADHD, or its treatment, and warrant further controlled investigations.
Objective:
To compare the characteristics and correlates of mania in referred adolescents and to determine whether attention-deficit hyperactivity disorder (ADHD) is a marker of very early onset mania.
Method:
From 637 consecutive admissions, 68 children (< or = 12 years) and 42 adolescents (> 13 years) who satisfied criteria for mania were recruited. These were compared with the 527 nonmanic referrals and 100 normal controls.
Results:
With the exception of comorbidity with ADHD, there were more similarities than differences between the children and adolescents with mania in course and correlates. There was an inverse relationship between the rates of comorbid ADHD and age of onset of mania: higher in manic children intermediate in adolescents with childhood-onset mania, and lower in adolescents with adolescent-onset mania.
Conclusions:
ADHD is more common in childhood-onset compared with adolescent-onset cases of bipolar disorder, suggesting that in some cases, ADHD may signal a very early onset of bipolar disorder. Clinical similarities between the child- and adolescent-onset cases provide evidence for the clinical validity of childhood-onset mania.
Dopamine transporter density was measured in vivo in six adult patients with attention deficit hyperactivity disorder. We have shown a 70% increase in age-corrected dopamine transporter density in patients with attention hyperactivity disorder compared with healthy controls.
To deal with public and professional concern regarding possible overprescription of attention-deficit/hyperactivity disorder (ADHD) medications, particularly methylphenidate, by reviewing issues related to the diagnosis, optimal treatment, and actual care of ADHD patients and of evidence of patient misuse of ADHD medications.
Literature review using a National Library of Medicine database search for 1975 through March 1997 on the terms attention deficit disorder with hyperactivity, methylphenidate, stimulants, and stimulant abuse and dependence. Relevant documents from the Drug Enforcement Administration were also reviewed.
All English-language studies dealing with children of elementary school through high school age were included.
All searched articles were selected and were made available to coauthors for review. Additional articles known to coauthors were added to the initial list, and a consensus was developed among the coauthors regarding the articles most pertinent to the issues requested in the resolution calling for this report. Relevant information from these articles was included in the report.
Diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness. The criteria of what constitutes ADHD in children have broadened, and there is a growing appreciation of the persistence of ADHD into adolescence and adulthood. As a result, more children (especially girls), adolescents, and adults are being diagnosed and treated with stimulant medication, and children are being treated for longer periods of time. Epidemiologic studies using standardized diagnostic criteria suggest that 3% to 6% of the school-aged population (elementary through high school) may suffer from ADHD, although the percentage of US youth being treated for ADHD is at most at the lower end of this prevalence range. Pharmacotherapy, particularly use of stimulants, has been extensively studied and generally provides significant short-term symptomatic and academic improvement. There is little evidence that stimulant abuse or diversion is currently a major problem, particularly among those with ADHD, although recent trends suggest that this could increase with the expanding production and use of stimulants.
Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate by physicians.
ABSTRACT Children and adolescents with attention deficit disorders (usually with comorbid conditions), who had shown inadequate therapeutic responses to methylphenidate, were treated by the addition of fluoxetine to methylphenidate. After 8 weeks in open trial, all 32 patients showed positive therapeutic responses in attention, behavior, and affect. Thirty of the 32 children showed clinically significant responses and the other two had statistically but not clinically significant responses. After 12 weeks of treatment, one patient showed a deterioration in clinical status. The children had improved report card grades in major academic subjects {p < 0.0001), and showed significant improvements (p < 0.0001) on the Children's Global Assessment Scale (C-GAS), Conners Parents Rating Scales (CPRS), and Children's Depression Inventory (CDI). Children who initially appeared more impaired on the C-GAS, CDI, CPRS, and GPA showed more improvement on the combined regimen. No significant side effects were observed, using a gradual elevation of fluoxetine dosage. About 40% of the patients showed substantial clinical effects with doses of fluoxetine below 20 mg daily. These preliminary results suggest that fluoxetine and methylphenidate in combination may be safe and effective for some children with attention-deficit hyperactivity disorder (and with comorbid anxiety or depressive symptoms) who do not show adequate responses to methylphenidate or fluoxetine alone.
Nicotinic acetylcholine receptors have been found to be important for maintaining optimal performance on a variety of cognitive tasks. In humans, nicotine-induced improvement of rapid information processing is particularly well documented. In experimental animals nicotine has been found to improve learning and memory on a variety of tasks, while the nicotinic antagonist mecamylamine has been found to impair memory performance. Nicotine has been found to be effective in attenuating memory deficits resulting from lesions of the septohippocampal pathway or aging in experimental animals. Nicotinic receptors are decreased in the cortex of patients with Alzheimer's disease. Preliminary studies have found that some aspects of the cognitive deficit in Alzheimer's disease can be attenuated by nicotine. Nicotine may prove to be useful therapeutic treatment for this and other types of dementia.
Psychopharmacological treatment of attention-deficit hyperactivity disorder (ADHD), is well established. The central nervous system stimulants, especially dextroamphetamine and methylphenidate, are the drugs of choice. Response is rapid, consistent and predictable. Most children respond to one or the other when a trial of both stimulants are given across wide dose ranges (Elia et al. 1991). The efficacy of pemoline is also well established, but its variable onset and duration of action in children has made it a secondary treatment. Tricyclic antidepressants also produce rapid behavioral effects in ADHD, at doses less than those used for depression. Adverse effects are a limiting factor for continued treatment as well as the fact that beneficial effects are often short-lived.
This article reviews cognitive training studies that have been carried out with children with attention deficit-hyperactivity disorder (ADHD) during the past decade. The efficacy of cognitive training as a single intervention and as an adjunct to stimulant treatment is discussed. The impact of training on the cognitive, academic, and behavioral functioning of youngsters with ADHD is summarized. Although this treatment modality is inherently appealing, there is little empirical support for its clinical utility with children with hyperactivity.
A rare case is described where an adolescent with attention deficit hyperactivity disorder diagnosed in childhood subsequently developed alcohol and drug abuse. He later developed intranasal methylphenidate abuse and dependence after realizing that urine drug screens were expected to be positive for prescribed methylphenidate. This report is to alert physicians to the rare possibility of intranasal methylphenidate abuse in chemically dependent teenagers treated for ADHD and also to the possibility of group methylphenidate abuse at special education schools where many teenagers may be treated with stimulant medication.
Attention deficit hyperactivity disorder is a heterogeneous disorder of unknown etiology. Little is known about the comorbidity of this disorder with disorders other than conduct. Therefore, the authors made a systematic search of the psychiatric and psychological literature for empirical studies dealing with the comorbidity of attention deficit hyperactivity disorder with other disorders.
The search terms included hyperactivity, hyperkinesis, attention deficit disorder, and attention deficit hyperactivity disorder, cross-referenced with antisocial disorder (aggression, conduct disorder, antisocial disorder), depression (depression, mania, depressive disorder, bipolar), anxiety (anxiety disorder, anxiety), learning problems (learning, learning disability, academic achievement), substance abuse (alcoholism, drug abuse), mental retardation, and Tourette's disorder.
The literature supports considerable comorbidity of attention deficit hyperactivity disorder with conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, learning disabilities, and other disorders, such as mental retardation, Tourette's syndrome, and borderline personality disorder.
Subgroups of children with attention deficit hyperactivity disorder might be delineated on the basis of the disorder's comorbidity with other disorders. These subgroups may have differing risk factors, clinical courses, and pharmacological responses. Thus, their proper identification may lead to refinements in preventive and treatment strategies. Investigation of these issues should help to clarify the etiology, course, and outcome of attention deficit hyperactivity disorder.
Reports of adolescent outcome in attention deficit hyperactivity disorder have uniformly indicated high rates of behavioral problems including cognitive impairment. Dysfunction is markedly reduced in adulthood, but the pattern of outcome remains unchanged except for failure to document cognitive deficits. In adulthood, dysfunction is characterized by antisocial personality and substance (nonalcohol) use disorders. These are in turn associated with criminality. The little existing information on girls with attention deficit hyperactivity disorder does not suggest a worse outcome than for boys. Attempts to identify the children most likely to have a poor outcome have been largely unsuccessful.
The frequency and severity of 17 side effects presumably associated with stimulant medication were assessed during a rigorous, triple-blind, placebo-controlled, crossover evaluation of methylphenidate, 0.3 and 0.5 mg/kg twice a day, in 83 children with attention deficit hyperactivity disorder. Side effects were rated by parents and teachers at the end of each weekly drug condition. Three children (3.6%) had side effects that were sufficiently serious to warrant immediate discontinuation of medication. Parent ratings indicated that only the side effects of decreased appetite, insomnia, stomachaches, and headaches increased significantly in frequency and severity during the two active medication doses as compared with the placebo condition. Fewer than half of the children experienced these side effects and among those who did, ratings of mean severity remained in the mild range. Teacher ratings showed little change over drug conditions, except on ratings of staring, sadness, and anxiety, which declined with increasing dose of medication. Parent ratings indicated that only the side effects of decreased appetite, insomnia, stomachaches, and headaches increased significantly in frequency and severity during the two active medication doses as compared with the placebo condition. Fewer than half of the children experienced these side effects and among those who did, ratings of mean severity remained in the mild range. Teacher ratings showed little change over drug conditions, except on ratings of staring, sadness, and anxiety, which declined with increasing dose of medication. Surprisingly, a high frequency of these behavior side effects were reported during the placebo condition. Stimulant medication within this therapeutic range, therefore, results in few, generally mild side effects.(ABSTRACT TRUNCATED AT 250 WORDS)
We investigated the prevalence of DSM-III disorders in 792 children aged 11 years from the general population and found an overall prevalence of disorder of 17.6% with a sex ratio (boys-girls) of 1.7:1. The most prevalent disorders were attention deficit, oppositional, and separation anxiety disorders, and the least prevalent were depression and social phobia. Conduct disorder, overanxious disorder, and simple phobia had intermediate prevalences. Pervasive disorders, reported by more than one source, had an overall prevalence of 7.3%. Examination of background behavioral data disclosed that children identified at 11 years as having multiple disorders had a history of behavior problems since 5 years of age on parent and teacher reports. Fifty-five percent of the disorders occurred in combination with one or more other disorders, and 45% as a single disorder.
The effects of 0.3 mg/kg methylphenidate were compared for 12 ADD boys and 12 ADD girls participating in a summer treatment program for children with behavior and/or learning problems. Previous investigations have suggested that ADD girls may differ from ADD boys in some important respects. No information exists regarding whether the effects of the most common treatment for these children, methylphenidate, has comparable effects on boys and girls. The boys and girls were matched for age and IQ. The results revealed equivalent and beneficial effects of methylphenidate for both boys and girls. Methylphenidate therefore would appear to be as useful a treatment for ADD girls as for ADD boys.
In a representative sample of 570 13-yr-old twins, higher hyperactivity scores from parent and teacher ratings were associated with male sex, lower intelligence, inattention, specific learning problems, and behavioural deviance (mainly antisocial). This pattern of correlates also characterized all three hyperactivity categories: to a marked degree in pervasive hyperactivity; less markedly in school hyperactivity; and least markedly in home hyperactivity. Children with pervasive hyperactivity had more attentional and educational problems than non-hyperactive children who were pervasively antisocial. By contrast, children with school or home hyperactivity resembled non-hyperactive children who were situationally antisocial. These findings cast doubt on the validity of combining situational and pervasive hyperactivity into a single diagnostic category such as Attentional Deficit Disorder with Hyperactivity (ADDH).
This is a fifteen year prospective controlled study of the non-medical drug and alcohol use and antisocial behaviour of 61 hyperactives, and 41 matched control subjects, (mean age 25 years). The data was collected from detailed interviews with the subjects as well as computerized court records to verify subjects reports. Generally hyperactives did not differ significantly from controls on current drug and alcohol use and antisocial behaviour. However one sees trends of greater drug alcohol and antisocial involvement in the hyperactive group. All the subjects who have antisocial behaviour at 15 year follow-up (mean age 25) had early and persistent histories of antisocial behaviour beginning at initial assessment (mean age 8) or at 5 year follow-up (mean age 13). However many hyperactives do not continue their antisocial behaviour into adulthood (mean age 25). There thus appears to be a small subgroup of hyperactive subjects who have more negative outcomes with significantly greater social, emotional and psychological difficulties. It is this subgroup which we need to identify early and treat vigorously.
Ten children ages 8–13 years with attention deficit disorder and hyperactivity (ADDH) completed a double-blind placebo-controlled crossover trial consisting of clonidine for 8 weeks and placebo for 4 weeks. The diagnosis was established through a standardized clinical interview with parents and children by two child psychiatrists and behavior ratings by parents and teachers. Parents' behavior ratings showed that 7 of the 10 children clearly benefited from clonidine. The total score of behavior ratings on Conners' Scale for the group diminished from pretreatment levels of 66.85 ± 5.75 (mean ± S.E.) to 43.00 ± 6.29 by the end of active clonidine treatment (p = 0.001). Parents rated as the greatest improvement in factors comprising the Hyperactivity Index, and Conduct Problems. Of the 8 children on whom teachers' ratings were completed, 7 improved with clonidine. Teachers' overall ratings for the ADDH group before clondidine were 49.00 ± 5.2 and decreased to 25.79 ± 1.3 by the last 2 weeks of active treatment (p = 0.001). Teachers' ratings of the “Hyperactivity Index” decreased even more significantly (1.99 ± 0.16) to 1.12 ± 0.06 by the end of active clondidine treatment (p = 0.001). The major side effect was sleepiness, which diminished in all but one child by the third week of treatment. Clonidine appears to be a safe, effective medication for a subgroup of children with symptoms of ADDH. Its effectiveness suggests the importance of the norepinephrine system in the pathophysiology of the cognitive and behavioral disturbances in some children with ADDH.Journal of the American Academy of Child Psychiatry, 24, 5:617–629, 1985.
In 29 hyperactive children, dextroamphetamine (10 or 15 mg per day) and methylphenidate (30 or 40 mg per day) caused suppression of weight gain. Mean yearly weight gain of nine children on medication for two years was 1.8 kg as compared to the expected gain of 3.1 kg. Depression of growth in height varied in degree; however, children whose growth was depressed also had proportional depression of growth in height. Thirteen children who took stimulant drugs for nine or more months showed a rebound weight gain when medication was abruptly stopped. Dextroamphetamine inhibition of weight gain was not related to dose and was significantly greater than that observed with methylphenidate. Daily doses of 20 mg of methylphenidate did not inhibit weight gain.
1. The administration of the nicotinic cholinergic agonists dimethylphenylpiperazinium iodide (DMPP) or nicotine caused a concentration dependent release of [3H] dopamine, [3H]5-hydroxytryptamine as well as endogenous dopamine and 5-hydroxytryptamine from superfused slices of rat striatum. 2. Release of both labelled and non-labelled transmitter was antagonized by the nicotinic antagonist, hexamethonium but not the muscarinic antagonist, atropine. 3. The present study provides additional evidence that nicotinic-cholinergic receptors are present in the mammalian central nervous system. 4. Activation of these nicotinic-cholinergic receptors in the striatum results in the release of both dopamine and 5-hydroxytryptamine.
The outcome for children diagnosed as hyperactive is viewed as an important perspective in validating the disorder. Accordingly, a review of 17 follow-up and 7 follow-back studies is presented that assesses the available evidence relating to this issue. In follow-back studies, Ss were chosen and assessed on the basis of past information (i.e., a diagnosis of hyperactivity contained in medical records) that they were hyperactive in childhood. Methodological problems are identified and discussed. In particular, it is noted that all of the follow-up studies failed to use psychiatric controls; this makes it difficult to draw conclusions about the diagnostic validity of the concept of hyperactivity. Four of the follow-back studies did use psychiatric controls, but conclusions are limited by the atypical nature of their S groups. It has been demonstrated, however, that hyperactives in late adolescence and early adulthood, as compared with normal controls, experience difficulties in many areas of social functioning and personal well-being. (71 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors evaluated the association between attention deficit hyperactivity disorder (ADHD) and psychoactive substance use disorders in adults with ADHD, attending to comorbidity with mood, anxiety, and antisocial disorders. It was hypothesized that psychiatric comorbidity would be a risk factor for psychoactive substance use disorders.
Findings for 120 referred adults with a clinical diagnosis of childhood-onset ADHD were compared with those for non-ADHD adult comparison subjects (N = 268). All childhood and adult diagnoses were obtained by structured psychiatric interviews for DSM-III-R.
There was a significantly higher lifetime risk for psychoactive substance use disorders in the ADHD adults than in the comparison subjects (52% versus 27%). Although the two groups did not differ in the rate of alcohol use disorders, the ADHD adults had significantly higher rates of drug and drug plus alcohol use disorders than the comparison subjects. ADHD significantly increased the risk for substance use disorders independently of psychiatric comorbidity. Antisocial disorders significantly increased the risk for substance use disorders independently of ADHD status. Mood and anxiety disorders increased the risk for substance use disorders in both the ADHD and comparison subjects, but more demonstrably in the comparison subjects.
Although psychiatric comorbidity increased the risk for psychoactive substance use disorders in adults with ADHD, by itself ADHD was a significant risk factor for substance use disorders. More information is needed to further delineate risk and protective factors mediating the development of substance use disorders in persons with ADHD.
This study assesses the effect of attention-deficit hyperactivity disorder (ADHD) and gender on cerebral glucose metabolism (CMRglu), using positron emission tomography and 18F-fluorodeoxyglucose.
Nineteen normal (6 females; 14.3 +/- 1.3 years old) and 20 ADHD adolescents (5 females; 14.7 +/- 1.6 years old) participated in the study. An auditory continuous performance task was used during the 30-minute uptake of 18F-fluorodeoxyglucose.
There were no statistically significant differences in global or regional CMRglu between ADHD (N = 20) and normal (N = 19) adolescents. However, the global CMRglu in ADHD girls (N = 5) was 15.0% lower than in normal girls (N = 6) (p = .04), while global CMRglu in ADHD boys was not different than in normal boys. Furthermore, global CMRglu in ADHD girls was 19.6% lower than in ADHD boys (p = .02) and was not different between normal girls and normal boys. Clinical rating scales did not differentiate ADHD girls from ADHD boys, nor normal girls from normal boys.
The greater brain metabolism abnormalities in females than males strongly stress that more attention be given to the study of girls with ADHD.
By means of quantitative neuroanatomic imaging the authors assessed the hypothesis that there are structural brain abnormalities relevant to frontal lobe circuitry in children with attention deficit hyperactivity disorder (ADHD).
The midsagittal cross-sectional area of the corpus callosum, divided into seven sections, was measured from magnetic resonance images of 18 boys with ADHD and 18 carefully matched normal boys.
Two anterior regions, the rostrum and the rostral body, were found to have significantly smaller areas in the ADHD group. These areas correlated in the expected direction with teacher and parent ratings of hyperactivity/impulsivity.
This finding supports theories of abnormal frontal lobe development and function in ADHD.
The authors examined the effects of chronic stimulant treatment on cerebral glucose metabolism in adults diagnosed with attention deficit hyperactivity disorder (ADHD), who were studied by means of positron emission tomography (PET) with [18F]fluorodeoxyglucose as the tracer.
Each subject received two PET scans, the first before drug treatment and the second after treatment with daily oral doses, individually titrated for clinical effect, of either methylphenidate (N = 19) or d-amphetamine (N = 18) for a minimum of 6 weeks. The subjects completed behavioral self-report measures before and at the end of the medication period.
Neither stimulant medication changed global, or whole-brain, metabolism, although both drugs increased systolic blood pressure. Metabolism in only two of the 60 brain regions sampled was changed by methylphenidate, while d-amphetamine exhibited no effect on regional metabolism. Both drugs were associated with significant improvement in behavior, as evidenced by improved ratings for restlessness and ability to maintain attention.
While the present study does not demonstrate any robust metabolic effects of chronic stimulant treatment, the behavioral data strongly indicate that methylphenidate and d-amphetamine are effective agents for the treatment of adults with ADHD.
The neurologic basis of attention deficit-hyperactivity disorder (ADHD) is poorly understood. Based on previous studies that have implicated metabolic deficiencies in the caudate-striatal region in ADHD, we employed magnetic resonance imaging to investigate patterns of morphology of the head of the caudate nucleus in normal and ADHD children. In normal children, 72.7% evidenced a left-larger-than-right (L > R) pattern of asymmetry, whereas 63.6% of the ADHD children had the reverse (L < R) pattern of asymmetry of the head of the caudate nucleus. This reversal of normal asymmetry in ADHD children was due to a significantly smaller left caudate nucleus. The reversal in asymmetry of the head of the caudate was most notable in ADHD males. These results suggest that normal (L > R) morphologic asymmetry in the region of the caudate nucleus may be related to asymmetries observed in neurotransmitter systems implicated in ADHD. The behavioral symptoms of ADHD may reflect disinhibition from normal levels of dominant hemispheric control, possibly correlated with deviations in asymmetric caudate-striatal morphology and deficiencies in associated neurotransmitter systems.
Although attention deficit hyperactivity disorder is a common disorder of childhood, its status as a disorder in adults is not clear. The authors reasoned that if the adult diagnosis of the disorder is a valid clinical entity, it should be similar to the childhood disorder with regard to patterns of psychiatric and cognitive findings.
Eighty-four adults with a clinical diagnosis of childhood-onset attention deficit hyperactivity disorder confirmed by structured interview who were referred for treatment were studied. Findings were compared with those from a preexisting study group of referred children with attention deficit hyperactivity disorder, nonreferred adult relatives of those children who also had attention deficit hyperactivity disorder, and adults without the disorder who were relatives of normal children. Subjects were evaluated with a comprehensive battery of psychiatric, cognitive, and psychosocial assessments.
The referred and nonreferred adults with attention deficit hyperactivity disorder were similar to one another but more disturbed and impaired than the comparison subjects without the disorder. The pattern of psychopathology, cognition, and functioning among the adults with attention deficit hyperactivity disorder approximated the findings for children with the disorder.
These results show that referred and nonreferred adults with attention deficit hyperactivity disorder have a pattern of demographic, psychosocial, psychiatric, and cognitive features that mirrors well-documented findings among children with the disorder. These findings further support the validity of the diagnosis for adults.
The purpose of the study was to examine comorbidity in the context of child and adolescent depression.
The authors reviewed recent epidemiological studies using standardized interviews and DSM-III or DSM-III-R criteria.
There was a high rate of comorbidity in children and adolescents with major depressive disorders or dysthymia. Comorbidity with conduct disorder/oppositional defiant disorder ranged from 21% to 83%; comorbidity with anxiety disorder ranged from 30% to 75%; and comorbidity with attention deficit disorder ranged from 0% to 57.1%. Rates of depressive comorbidity found in community studies were similar to the rates found in clinical studies. In almost all cases, the disorders were more common in depressed children than expected by chance, and the rates of other disorders in depressed children were higher than the rates of depression in those with depression.
The mechanisms by which comorbidity occurs are obscure at present. Several possibilities and their implications for nosology, epidemiology, and treatment research are discussed.
Patients with bipolar disorder differ from patients with unipolar depression by having family histories of mania with an earlier onset and by having more episodes over a lifetime. This study was designed to determine whether additional aspects of course of illness, the presence of medical diseases, childhood traits, and other familial illnesses separate the two groups.
In a large collaborative study, consecutively admitted bipolar and unipolar patients were systematically given clinical interviews. Data were collected on medical diseases and childhood behavioral traits. Systematic family history and family study data were also obtained. The patients were studied every 6 months for 5 years.
The group of bipolar patients had an earlier onset, a more acute onset, more total episodes, and more familial mania and were more likely to be male. These differences were relatively independent of each other. The bipolar patients were also more likely to have shown traits of hyperactivity as children. The unipolar patients had a significantly greater number of lifetime medical/surgical interventions than the bipolar patients, even when age was controlled. Alcoholism was more frequently found in the families of the bipolar patients, even when alcoholism in the probands was controlled; however, this difference was not significant.
This study supports the usefulness of distinguishing between bipolar and unipolar patients in treatment and research studies.