Current Pharmacological Treatments for ADHD

Methylphenidate in Borderline Personality Disorder: Assessing Its Therapeutic Potential and Limitations

Impulsivity is increasingly recognized as a transdiagnostic feature that spans multiple psychiatric disorders, including borderline personality disorder (BPD), bipolar disorder, and substance use disorders. In BPD, impulsive behaviors manifest as substance misuse, risky sexual activity, self-injury, and other maladaptive patterns. This review article updates the clinical and preclinical literature to explore the biological and psychological bases of impulsivity in BPD and considers whether methylphenidate (MPH) can be used as a treatment in this context. Although no medication is specifically approved for BPD, limited evidence from patients with comorbid BPD and attention-deficit/hyperactivity disorder (ADHD) indicates that MPH may reduce impulsivity and improve key symptoms. In addition, real-world data indicate that MPH may be associated with better outcomes and a lower risk of suicidal behaviors in patients with BPD. Nevertheless, such evidence remains scant, particularly among those with a primary diagnosis of BPD without a diagnosis of ADHD. Larger, methodologically rigorous studies are needed to clarify the efficacy and safety of MPH in targeting impulsivity within this population. An improved understanding of dopaminergic mechanisms may eventually shed light on MPH's therapeutic role in BPD, although current data remain preliminary. Overall, recognizing impulsivity as a core symptom rather than focusing exclusively on diagnostic boundaries may facilitate more tailored and effective interventions for BPD.

AI-Driven Innovation in Skin Kinetics for Transdermal Drug Delivery: Overcoming Barriers and Enhancing Precision

Transdermal drug delivery systems (TDDS) offer an alternative to conventional oral and injectable drug administration by bypassing the gastrointestinal tract and liver metabolism, improving bioavailability, and minimizing systemic side effects. However, widespread adoption of TDDS is limited by challenges such as the skin's permeability barrier, particularly the stratum corneum, and the need for optimized formulations. Factors like skin type, hydration levels, and age further complicate the development of universally effective solutions. Advances in artificial intelligence (AI) address these challenges through predictive modeling and personalized medicine approaches. Machine learning models trained on extensive molecular datasets predict skin permeability and accelerate the selection of suitable drug candidates. AI-driven algorithms optimize formulations, including penetration enhancers and advanced delivery technologies like microneedles and liposomes, while ensuring safety and efficacy. Personalized TDDS design tailors drug delivery to individual patient profiles, enhancing therapeutic precision. Innovative systems, such as sensor-integrated patches, dynamically adjust drug release based on real-time feedback, ensuring optimal outcomes. AI also streamlines the pharmaceutical process, from disease diagnosis to the prediction of drug distribution in skin layers, enabling efficient formulation development. This review highlights AI's transformative role in TDDS, including applications of models such as Deep Neural Networks (DNN), Artificial Neural Networks (ANN), BioSIM, COMSOL, K-Nearest Neighbors (KNN), and Set Covering Machine (SVM). These technologies revolutionize TDDS for both skin and non-skin diseases, demonstrating AI's potential to overcome existing barriers and improve patient care through innovative drug delivery solutions.

Social cognition in autism and ADHD

Social cognition is a crucial capacity for social functioning. The last decades have seen a plethora of social cognition research in neurodevelopmental conditions, foremost autism and, to a lesser extent, ADHD, both characterized by social challenges. Social cognition is a multifaceted construct comprising various overlapping subdomains, such as Theory of Mind/mentalizing, emotion recognition, and social perception. Mechanisms underpinning social cognition are complex, including implicit and explicit, cognitive and affective, and hyper- and hypo-social information processing. This review explores the intricacies of social cognition in the context of autism and ADHD. Research indicates altered performance on social cognition tests in autism, compared to neurotypical groups, with social cognition alterations having a small but robust effect on the defining features of autism. The nature of such alterations in autism appears primarily in relation to implicit processing. ADHD groups show intermediate social cognition performance, appearing to be influenced by executive function difficulties. Social cognition varies with intellectual and verbal abilities and seems to improve with age in autism and ADHD. Social skills interventions in autism, and stimulant medication in ADHD have been shown to improve social cognition test performance, while mentalizing training effects in autism are less conclusive. A limitation of the field is that social cognition constructs and tests are not well delineated. Further, most research has been embedded in a nativist approach rather than a constructivist approach. The former has been questioned for ignoring environmental contributions, especially the dimension of mutual miscommunication between neurodivergent and neurotypical individuals.

Commentary: Using QbTest for monitoring pharmacological treatment response in ADHD - are we there yet?

Individuals with attention-deficit/hyperactivity disorder (ADHD) exhibit varied responses to pharmacological treatments (e.g. stimulants and non-stimulants). Accurately and promptly detecting treatment-related improvements, response failure, or deterioration poses significant challenges, as current monitoring primarily relies on subjective ratings. In this commentary, we critically evaluate the evidence supporting the use of QbTest for objectively monitoring ADHD treatment response in clinical practice. We also offer recommendations for future research, advocating for rigorous clinical trials and longitudinal studies to further explore the potential utilisation of QbTest and other tools for monitoring treatment responses in individuals with ADHD.

Efficacy of internet-based cognitive behavioral therapy for medicated adults with attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial

BACKGROUND

Cognitive behavioral therapy (CBT) is an effective treatment for adults with attention-deficit/hyperactivity disorder (ADHD), but its use is limited by poor accessibility and time constraints-barriers that internet-based CBT (iCBT) may help overcome. This trial aimed to explore the short- and long-term efficacy of iCBT in medicated adults with ADHD.

METHODS

Eighty-six adults with ADHD were randomized into two groups: the iCBT combined with medication group (iCBT+M, n = 43) and the medication-only group (n = 43). The iCBT+M group received 12 weeks of iCBT with ongoing medication, while the medication-only group continued with medication alone. The primary outcome was the change in ADHD symptoms. Secondary outcomes included emotional symptoms, executive function, quality of life, and global functioning. Outcomes were assessed at baseline, post-treatment (T1), 6-month (T2), and 12-month follow-up (T3). Mixed linear models were used to assess the differences in outcomes between the two groups at each follow-up point.

RESULTS

Compared to the medication-only group, the iCBT+M group showed greater improvements in ADHD symptoms (d = 0.50 at T1/T2, 0.59 at T3), executive function (d = 0.87 at T1, 0.49 at T2, 0.25 at T3), quality of life (d = -0.74 at T1, -0.59 at T2, -0.28 at T3), global functioning (d = 0.66 at T1, 0.85 at T2, 0.42 at T3), and anxiety (d = 0.43 at T1).

CONCLUSION

iCBT interventions may benefit medicated adults with ADHD by improving core symptoms, executive function, quality of life, and overall functioning, with effects sustained for 12 months.

Comparison of Insomnia, Depression, and Perceived Social Support among Individuals with Amphetamine Use Disorder (AUD) and Healthy Controls

Background

Compared to the general population, individuals with substance use disorders (SUD) report more frequently to suffer from sleep disturbances and symptoms of depression, and to perceive lower social support. Here, we investigated whether this pattern of mental health issues could be confirmed and replicated among individuals with amphetamine use disorder (AUD). We also assessed the degree of perceived social support from their families, friends and significant others, always compared to healthy controls (HC) of the general population.

Method

Individuals with AUD attending the Outpatient Department for Substance Abuse of the Kermanshah University of Medical Sciences (Kermanshah, Iran) (n = 468; 30.8% females; mean age: 29.16 years) and healthy controls (HC; n = 376; 34.6% females; mean age: 24.11 years) participated in the study. Participants completed a series of self-rating questionnaires covering sociodemographic information, symptoms of insomnia and depression, and perceived social support from their families, friends and significant others.

Results

Compared to HC, individuals with AUD reported higher scores for insomnia and depression, and lower scores for perceived social support (families; friends; significant others). Older age and higher severity scores for depression and insomnia were the predictors in the binary logistic regression model to identify individuals with AUD and HC with a precision of 97.4%.

Conclusions

Individuals with AUD additionally suffer from insomnia and depression, along with lower perceived social support. Given that standardized intervention programs for insomnia, depression and social competencies exist, such interventions might mitigate mental health issues among individuals with AUD and improve their psychosocial behavior.

A Review of Sex and Gender Factors in Stimulant Treatment for ADHD: Knowledge Gaps and Future Directions

OBJECTIVE

Stimulant medications are the primary pharmacological intervention for ADHD, yet our understanding of how sex and gender impact stimulant treatment outcomes remains limited. Clinical guidelines do not differ for female and male individuals despite possible sex and gender-related differences in effectiveness, adverse events, and pharmacokinetics. This theoretical framework identifies five key knowledge gaps relating to sex and gender effects in stimulant treatment.

METHOD

We investigate the stimulant treatment trajectories of girls and women with ADHD from diagnosis and prescription to daily use and outcomes. We examine the impact of reproductive life transitions and hormonal fluctuations and their interactions with gender socialization and gendered expectations on treatment effectiveness, stigma, and adherence.

RESULTS

By synthesizing existing literature, proposing testable predictions, and suggesting future research directions, we highlight the urgent need for studies that systematically investigate these factors.

CONCLUSION

Addressing these gaps could significantly improve treatment outcomes for girls and women with ADHD, particularly during biological and gender role transitions.

Exploring the Intersection of ADHD and Music: A Systematic Review

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent neurodevelopmental disorder, affecting both children and adults, which often leads to significant difficulties with attention, impulsivity, and working memory. These challenges can impact various cognitive and perceptual domains, including music perception and performance. Despite these difficulties, individuals with ADHD frequently engage with music, and previous research has shown that music listening can serve as a means of increasing stimulation and self-regulation. Moreover, music therapy has been explored as a potential treatment option for individuals with ADHD. As there is a lack of integrative reviews on the interaction between ADHD and music, the present review aimed to fill the gap in research. Following PRISMA guidelines, a comprehensive literature search was conducted across PsychInfo (Ovid), PubMed, and Web of Science. A narrative synthesis was conducted on 20 eligible studies published between 1981 and 2023, involving 1170 participants, of whom 830 had ADHD or ADD. The review identified three main areas of research: (1) music performance and processing in individuals with ADHD, (2) the use of music listening as a source of stimulation for those with ADHD, and (3) music-based interventions aimed at mitigating ADHD symptoms. The analysis revealed that individuals with ADHD often experience unique challenges in musical tasks, particularly those related to timing, rhythm, and complex auditory stimuli perception, though these deficits did not extend to rhythmic improvisation and musical expression. Most studies indicated that music listening positively affects various domains for individuals with ADHD. Furthermore, most studies of music therapy found that it can generate significant benefits for individuals with ADHD. The strength of these findings, however, was limited by inconsistencies among the studies, such as variations in ADHD diagnosis, comorbidities, medication use, and gender. Despite these limitations, this review provides a valuable foundation for future research on the interaction between ADHD and music.

Neuromodulation as a Potential Intervention for Children With Attention-Deficit/Hyperactivity Disorder

This review examines the therapeutic potential of neuromodulation methods, including neurofeedback, transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS), as non-pharmacological interventions for children with attention-deficit/hyperactivity disorder (ADHD). A comprehensive review of current studies was conducted, focusing on each technique's mechanism, application, and efficacy in managing ADHD symptoms and cognitive deficits. Studies included human participants with ADHD, evaluating changes in symptom severity and cognitive outcomes. Neurofeedback demonstrated efficacy in symptom reduction, particularly when combined with pharmacotherapy, yielding sustained improvements. tDCS showed moderate efficacy, especially in attention and impulsivity control; however, variability in protocols and pediatric response highlights the need for standardization. TMS exhibited mixed outcomes, with high-frequency TMS targeting the dorsolateral prefrontal cortex indicating potential cognitive benefits, though results were inconsistent across studies. Neuromodulation presents a promising complementary approach for ADHD treatment in children, potentially addressing limitations of pharmacotherapy. Future research should focus on optimizing stimulation parameters, increasing sample sizes, and refining methodologies to establish neuromodulation as part of standard ADHD treatment protocols.

Review of Clinical Considerations in the Management of Adolescents with ADHD During Ramadan

Background:

Fasting in Ramadan, a holy month in Islam, is considered a religious obligation to Muslims after puberty. Fasting during Ramadan entails abstinence from consuming food and liquids, as well as abstaining from other activities, including smoking and sexual activity, from dawn until sunset. Literature exists regarding the management of multiple medical conditions impacted by the month of fasting; however, limited literature exists to guide the management of Attention-Deficit/Hyperactivity Disorder (ADHD) during Ramadan.

Methods:

This systematic review employed a PUBMED search which was conducted using keywords ((ADHD) AND (Muslims)) OR ((ADHD) AND (FASTING)) OR ((ADHD) AND (RAMADAN)) OR ((RAMADAN) AND (MANAGEMENT)) and search strategies to find existing literature on ADHD management during Ramadan or while fasting.

Results:

Eight hundred and sixty-one results were obtained. Of these, full texts of clinical trials, systematic reviews, reviews, randomized control trials, and metaanalyses resulted in 303 results that were screened by title or abstract for relevance to the topic. The duplicate articles were removed. Eighty-nine results were incorporated into this paper, including full articles, book excerpts, and online articles.

Discussion:

Muslim adolescents may face challenges with academic and social functioning as they navigate psychosocial changes in the context of Ramadan. ADHD management options should be discussed with individuals who are planning to fast. Pharmacologic management options include continuing on the current regimen, dose adjustment to mitigate side effect exacerbation, a change in medication class, or a change in medication formulation. For severe cases or cases with comorbid conditions, continued fasting may not be recommended. In these cases, the patient should attempt to seek counsel with their community’s religious scholar in collaboration with their medication provider. Ultimately, there are limitations in the available data, and there is a need for further investigation into the impacts of fasting during Ramadan on individuals with ADHD and the effectiveness of interventions to promote treatment adherence.

Structure of the human dopamine transporter and mechanisms of inhibition

The neurotransmitter dopamine has central roles in mood, appetite, arousal and movement1. Despite its importance in brain physiology and function, and as a target for illicit and therapeutic drugs, the human dopamine transporter (hDAT) and mechanisms by which it is inhibited by small molecules and Zn2+ are without a high-resolution structural context. Here we determine the structure of hDAT in a tripartite complex with the competitive inhibitor and cocaine analogue, (-)-2-β-carbomethoxy-3-β-(4-fluorophenyl)tropane2 (β-CFT), the non-competitive inhibitor MRS72923 and Zn2+ (ref. 4). We show how β-CFT occupies the central site, approximately halfway across the membrane, stabilizing the transporter in an outward-open conformation. MRS7292 binds to a structurally uncharacterized allosteric site, adjacent to the extracellular vestibule, sequestered underneath the extracellular loop 4 (EL4) and adjacent to transmembrane helix 1b (TM1b), acting as a wedge, precluding movement of TM1b and closure of the extracellular gate. A Zn2+ ion further stabilizes the outward-facing conformation by coupling EL4 to EL2, TM7 and TM8, thus providing specific insights into how Zn2+ restrains the movement of EL4 relative to EL2 and inhibits transport activity.

Impact of stimulant treatment on refractive errors and pupil diameter in attention deficit hyperactivity disorder

PURPOSE

The relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake.

METHODS

A cohort of 100 participants, including 50 individuals with ADHD and 50 age- and sex-matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non-cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings.

RESULTS

We observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2(2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non-cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049).

CONCLUSIONS

Our study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter.

Add-On Bifidobacterium Bifidum Supplement in Children with Attention-Deficit/Hyperactivity Disorder: A 12-Week Randomized Double-Blind Placebo-Controlled Clinical Trial

We conducted a 12-week randomized double-blind placebo-controlled clinical trial to investigate the potential impact of Bifidobacterium bifidum (Bf-688) supplementation on attention-deficit/hyperactivity disorder (ADHD). Children with ADHD who were already receiving a stable dose of methylphenidate (MPH) treatment were enrolled and were randomly assigned to two groups: one receiving add-on Bf-688 (daily bacterial count of 5 × 109 CFUs) (n = 51) and the other receiving a placebo (n = 51). All participants underwent assessments using Conners' Continuous Performance Test (CPT) and Conners' Continuous Auditory Test of Attention (CATA). Additionally, fecal samples were collected at the beginning of the trial (week 0) and at the endpoint (week 12). Remarkably, the group receiving Bf-688 supplementation, but not the placebo group, exhibited significant improvements in omission errors in CPT as well as Hit reaction time in both CPT and CATA. Gut microbiome analysis revealed a significant increase in the Firmicutes to Bacteroidetes ratio (F/B ratio) only in the Bf-688 group. Furthermore, we identified significant negative correlations between N-Glycan biosynthesis and Hit reaction time in both CPT and CATA. Our results demonstrate that the probiotic Bf-688 supplement can enhance neuropsychological performance in children with ADHD, possibly by altering the composition of the gut microbiota, ultimately leading to reduced N-Glycan biosynthesis.

Emerging Treatments and Therapies for Autism Spectrum Disorder: A Narrative Review

The prevalence of autism spectrum disorder (ASD) has increased over the last decade. In this regard, many emerging therapies have been described as ASD therapies. Although ASD does not have a cure, there are several management options available that can help reduce symptom severity. ASD is highly variable and, therefore, standard treatment protocols and studies are challenging to perform. Many of these therapies also address comorbidities for which patients with ASD have an increased risk. These concurrent diagnoses can include psychiatric and neurological disorders, including attention deficit and hyperactivity disorder, anxiety disorders, and epilepsy, as well as gastrointestinal symptoms such as chronic constipation and diarrhea. Both the extensive list of ASD-associated disorders and adverse effects from commonly prescribed medications for patients with ASD can impact presenting symptomatology. It is important to keep these potential interactions in mind when considering additional drug treatments or complementary therapies. This review addresses current literature involving novel pharmacological treatments such as oxytocin, bumetanide, acetylcholinesterase inhibitors, and memantine. It also discusses additional therapies such as diet intervention, acupuncture, music therapy, melatonin, and the use of technology to aid education. Notably, several of these therapies require more long-term research to determine efficacy in specific ASD groups within this patient population.

The effects of chronic administration of stimulant and non-stimulant medications on executive functions in ADHD: A systematic review and meta-analysis

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with executive function deficits that are improved with medications. However, meta-analyses of stimulant effects on cognition have mostly tested single-dose effects, and there is no meta-analysis of non-stimulant effects. This systematic review and meta-analysis tested the clinically more relevant longer-term effects of Methylphenidate (20 studies; minimum 1 week) and Atomoxetine (8 studies; minimum 3 weeks) on reaction time, attention, inhibition, and working memory, searching papers on PubMed, Embase, Ovid MEDLINE, and PsycINFO. The meta-analysis of 18 studies in 1667 subjects showed that methylphenidate was superior to placebo in all cognitive domains with small to medium effect sizes (Hedges g of 0.34-0.59). The meta-analysis of atomoxetine included 7 studies in 829 subjects and showed no effects in working memory, but superior effects in the other domains with medium to large effect sizes (Hedge's g of 0.36-0.64). Meta-regression analysis showed no drug differences on cognitive effects. The meta-analyses show for the first time that chronic Methylphenidate and Atomoxetine have comparable effects of improving executive functions in people with ADHD.

The impacts associated with having ADHD: an umbrella review

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD.

Methods

An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications.

Results

Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality.

Discussion

This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning.

Registration

International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).

Discordance Between Psychiatric Diagnoses and Medication Use in Children and Adults With Autism Presenting in Crisis

Autistic individuals experience high rates of behavioral crises that present to healthcare providers for medication management. Co-occurring psychiatric conditions and psychotropic medication use are common among this patient population. Particularly for those with limited expressive language, evaluating for the presence of psychiatric and medical conditions that could contribute to distress is a critical component of crisis management. A records review study was completed on 126 autistic individuals for whom medical decision-making support was requested from The Huntsman Mental Health Institute Neurobehavior Consultation Service. Crisis manifestations and historical information were provided by the parent or caregiver through an online questionnaire. Nearly all individuals presented with behavioral (96.8%) and emotional (96.8%) symptoms; 97.6% received at least one co-occurring psychiatric diagnosis. Additionally, 75.4% of parents or caregivers endorsed the presence of a medical condition that they believed could be contributing to the crisis presentation. Most individuals (92.1%) were prescribed at least one psychotropic medication; 69.8% were taking an antipsychotic, suggesting a history of treatment resistance. The alignment between psychotropic medications and psychiatric diagnoses was evaluated in the context of prior studies and reviews on psychiatric management in autistic and neurotypical populations. Several individuals were taking a combination of medications that included both indicated and contraindicated medications for the psychiatric disorder diagnosed, likely contributing to treatment resistance. Identifying discordance between psychotropic medication use and psychiatric conditions present offers an opportunity to pursue better treatment outcomes for autistic individuals, particularly for those experiencing treatment-resistant agitation.

Attention deficit and hyperactivity disorder and use of psychostimulants in Aotearoa, New Zealand: exploring the treatment gap

Introduction Attention deficit and hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting about 7% of those aged up to 12 years, 5% of teenagers and 3% of adults. It is associated with poor academic performance, substance abuse, criminality, poor social functioning and other negative outcomes. Psychotherapeutic treatment is moderately successful, whereas pharmacotherapy with stimulant medication is more efficacious and is recommended in many international guidelines. Anecdotal evidence suggests underuse of these medications in Aotearoa, New Zealand. Aim To estimate how many patients with ADHD are prescribed psychostimulants in Aotearoa, New Zealand. Methods National prescribing data for dexamphetamine and methylphenidate in 2022 were obtained and matched against estimated prevalence of ADHD by age. Results There is a significant treatment gap for which inability to access first-line medication is likely to be the predominant explanation. Discussion The data suggest failure of our health system to provide reasonable health care for a significant number of people with ADHD, and results in inequity in outcomes. New approaches are needed that will increase access to first-line medication, yet maintain appropriateness of diagnosis and limit risk of medication diversion.

Management Strategies for Borderline Personality Disorder and Bipolar Disorder Comorbidities in Adults with ADHD: A Narrative Review

This narrative review examines two of the common comorbidities of attention-deficit/hyperactivity disorder, bipolar disorder (BD), and borderline personality disorder (BPD), which each share several common features with ADHD that can make assessment and diagnosis challenging. The review highlights some of the key symptomatic differences between adult ADHD and these disorders, allowing for more careful consideration before establishing a formal diagnosis. When the disorders are found to be comorbid, further complications may arise; thus, the review will also help to provide evidence-based treatment recommendations as well as suggestions on how to minimize adverse events. Incorporating evidence from systematic reviews, journal articles, randomized controlled trials, and case reports, this review highlights that the diagnosis of ADHD and some of its common comorbidities is challenging and requires full, in-depth assessment and management. The management strategies of these comorbidities will also be addressed, with emphasis on achieving mood stabilization for BD prior to initiating appropriate ADHD pharmacotherapy. Medications, specifically mood stabilizers, antipsychotics, and antidepressants, are fundamental in treating symptoms seen in BD and some cases of BPD, alongside psychotherapy and lifestyle modifications when appropriate. The review highlights the effectiveness of specific medications, including psychostimulants, atomoxetine, and bupropion, as add-on therapies to mood-stabilizing treatments for addressing ADHD symptoms in patients with these comorbidities. Despite limited research, the review will address various pharmacological and psychotherapeutic approaches for managing comorbid ADHD and BPD, emphasizing the need for further investigations to better understand the unique needs of this patient population.

[Physical growth and dietary characteristics of children with attention deficit hyperactivity disorder: a cross-sectional study]

OBJECTIVES

To investigate the physical growth and dietary characteristics of children with attention deficit hyperactivity disorder (ADHD), and to analyze their relationship with core symptoms of ADHD.

METHODS

A total of 268 children who were newly diagnosed with ADHD in Children's Hospital of Nanjing Medical University from June to December 2020 were included in the ADHD group, and 102 healthy children who underwent physical examination during the same period were selected as the control group. Physical evaluations and dietary surveys were conducted for both groups. ADHD diagnosis and scoring were performed according to the Diagnostic and Statistical Manual of Mental Disorders (5th edition). Factor analysis, Spearman correlation analysis, and mediation analysis were used to study the relationship between core symptoms of ADHD, dietary patterns, and physical growth.

RESULTS

The rate of overweight/obesity in the ADHD group was significantly higher than that in the control group (35.8% vs 21.6%, P<0.05). Three dietary patterns were extracted from the food frequency questionnaire: vegetarian dietary pattern, traditional dietary pattern, and snack/fast food pattern. The factor score for the snack/fast food pattern in the ADHD group was higher than that in the control group (P<0.05). There was a significant positive correlation between ADHD symptom scores, snack/fast food pattern factor scores, and body fat percentage (P<0.05). The mediation analysis showed that the snack/fast food pattern played a partial mediating role in the relationship between ADHD symptom scores and body fat percentage, with a mediation proportion of 26.66%.

CONCLUSIONS

The rate of overweight/obesity in children with ADHD is higher than that in non-ADHD children. Core symptoms of ADHD are related to dietary patterns and physical growth, with the snack/fast food pattern playing a partial mediating role in the relationship between core symptoms of ADHD and physical growth.

Recent Advancement of Medical Patch for Transdermal Drug Delivery

Transdermal patches are a non-invasive method of drug administration. It is an adhesive patch designed to deliver a specific dose of medication through the skin and into the bloodstream throughout the body. Transdermal drug delivery has several advantages over other routes of administration, for instance, it is less invasive, patient-friendly, and has the ability to bypass first-pass metabolism and the destructive acidic environment of the stomach that occurs upon the oral ingestion of drugs. For decades, transdermal patches have attracted attention and were used to deliver drugs such as nicotine, fentanyl, nitroglycerin, and clonidine to treat various diseases or conditions. Recently, this method is also being explored as a means of delivering biologics in various applications. Here, we review the existing literatures on the design and usage of medical patches in transdermal drug delivery, with a focus on the recent advances in innovation and technology that led to the emergence of smart, dissolvable/biodegradable, and high-loading/release, as well as 3D-printed patches.

Baseball injuries in adolescent athletes with ADHD

At the intersection of injury-prone sports such as baseball and conditions like ADHD that affect all aspects of life, there is a lack of research. This limits the availability of preventive care programs designed to target potential risks and promote a safe experience. In this retrospective cohort study, we assess the frequency of injury in youth baseball players with and without ADHD, along with further investigation into how treatment with stimulant medication may modify risk factors. The data for this study were obtained in deidentified, aggregate format from the TriNetX research database. We identified all patients under 25 years of age with a designation of baseball activity. Within this population, we separated patients by presence or absence of ADHD diagnosis, and then by stimulant usage. The studied outcomes were injuries commonly occurring in baseball, including fractures, sprains, and specific injury patterns. We identified 17,710 patients under 25 years old with designated baseball activity, 1,183 of which had a diagnosis of ADHD. Of these, 511 had a history of stimulant medication and 470 had no history of stimulant use. For most events (i.e., injuries), there were no statistical differences between cohorts. The overall ADHD cohort significantly differed from the Not ADHD cohort in 3 events: "thorax, abdomen, pelvis injuries," "ankle sprain," and "concussion." When athletes with ADHD received treatment, this trend reversed for select injuries: "any fracture", "head or neck injuries", "upper limb injuries", and "lower limb injuries" were less likely in ADHD athletes on stimulants. Given the ongoing debate around stimulant use in athletics, our study is relevant to many patients, providers, and the baseball community.

Animal Models of ADHD?

To describe animals that express abnormal behaviors as a model of Attention-Deficit Hyperactivity Disorder (ADHD) implies that the abnormalities are analogous to those expressed by ADHD patients. The diagnostic features of ADHD comprise inattentiveness, impulsivity, and hyperactivity and so these behaviors are fundamental for validation of any animal model of this disorder. Several experimental interventions such as neurotoxic lesion of neonatal rats with 6-hydroxydopamine (6-OHDA), genetic alterations, or selective inbreeding of rodents have produced animals that express each of these impairments to some extent. This article appraises the validity of claims that these procedures have produced a model of ADHD, which is essential if they are to be used to investigate the underlying cause(s) of ADHD and its abnormal neurobiology.