Prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms in preschool children: discrepancy between parent and teacher evaluations

The Importance of Physical Activity Variability and Its Relation with Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children

OBJECTIVES

There is a need to examine the utility of objective measures of attention-deficit/hyperactivity disorder (ADHD) symptoms in children. Objective measures of ADHD symptoms, such as physical activity, may provide a more nuanced assessment of behavior that can be used to augment traditional cross-informant ratings of ADHD symptoms by parents and teachers. The most widely used and researched technique for objectively capturing children's physical activity is accelerometry (i.e., the use of small devices that measure gravitational acceleration). The current study examined the unique and interactive effects of mean levels of physical activity (physical activity volume) and intra-individual variability in physical activity (physical activity variability), as measured by accelerometry, on teacher-reported ADHD symptoms (hyperactivity/impulsivity and inattention examined separately).

METHOD

One hundred seventy-six early elementary school students (Mage = 6.83, SD = 0.96, 53% male) from four midwestern schools and four northeastern schools were included. All were participants in a before-school intervention study involving physical activity or a sedentary classroom program. Data were collected using accelerometry during the intervention period and ADHD symptoms were reported by teachers following the intervention. Multiple regression models were used to examine the unique and interactive effects of physical activity volume and physical activity variability on ADHD symptoms.

RESULTS

Results demonstrated that physical activity volume was positively associated with hyperactive/impulsive symptoms, whereas physical activity variability was negatively associated with hyperactive/impulsive and inattentive symptoms. Additionally, when both physical activity variables were in the same model, only physical activity variability uniquely predicted ADHD symptoms after accounting for physical activity volume. Specifically, higher physical activity variability was linked with lower hyperactive/impulsive and inattentive symptoms.

CONCLUSION

Objective measures of physical activity volume and physical activity variability may enhance our understanding of physical activity patterns as they relate to ADHD symptoms. Future research should continue to investigate the usability of objective measures of physical activity, and especially physical activity variability, as a screener to identify children at risk for ADHD.

Impact of an oral health education program in Egyptian children with attention deficit hyperactivity disorder: A cross sectional study

AIM

This study was conducted to assess the oral health status in a group of Egyptian children, living with ADHD, before and after the implementation of an oral health education program.

METHODS

A total of 29 Egyptian children, aged 8-12 years old diagnosed with ADHD were enrolled in this study. Their oral health status was assessed using OHI-S. Oral health education program using audiovisual and verbal methods was addressed to the children and their caregivers. The children were advised to limit eating sugar to be once per week, and to brush their teeth twice a day. Modified Bass Technique of tooth brushing was demonstrated to the children using jaw model and toothbrush. A motivational visit was performed for the children after 1 month. At the end of the 3 months program, oral health status of the children was reassessed.

RESULTS

The results showed that there was a significant increase in cases with "Good" scores after the oral health education program (p < .001), moreover, there was a significant decrease of OHI-S scores after the program (p < .001).

CONCLUSION

The oral health education program was efficient in achieving improvement in the oral health status of children with ADHD.

Students with ADHD: Social Skills, Behavioral Problems, Academic Performance, and Family Resources

Abstract ADHD constitutes a developmental risk. The general aim was to identify social skills, behavior problems, academic performance and family resources of children with ADHD, with the specific aim being to compare students regarding indicators of ADHD and the use or not of medication. Participants were 43 Elementary Education I students (M=9.6 years, SD=1.5), 43 parents (M=39.1 years, SD=7.6) and 38 teachers (M=43.1 years, SD=8.4). The instruments used were the Inventory of Social Skills, Behavior Problems and Academic Competence (SSRS-BR), Conners’ Scale and the Inventory of Family Resources. The collection was carried out in public schools. The results showed that the students had scores higher than the reference sample in Behavior Problems and Social Skills and lower in classes of social skills and Academic Competence; the presence of family resources; and grades above 5.0 as a school mean. We concluded that there is a need for interventions with the studied population.

Application of the Instrumental Inequalities to a Mendelian Randomization Study With Multiple Proposed Instruments

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Investigators often support the validity of Mendelian randomization (MR) studies, an instrumental variable approach proposing genetic variants as instruments, via. subject matter knowledge. However, the instrumental variable model implies certain inequalities, offering an empirical method of falsifying (but not verifying) the underlying assumptions. Although these inequalities are said to detect only extreme assumption violations in practice, to our knowledge they have not been used in settings with multiple proposed instruments.

The prevalence of attention-deficit hyperactivity disorder and its related risk factors among children at elementary school in Shahroud

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is one of the most common reasons for visiting psychiatrists and psychologists. This study aimed to investigate the prevalence of ADHD and its related risk factors among children at elementary schools.

MATERIALS AND METHODS

This cross-sectional study focused on teachers and parents of 779 elementary students who were selected through stratified cluster random sampling; Conners Parent and Teacher Questionnaires were used to collecting data. The data were analyzed by the use of descriptive statistics (frequency and percentage), independent samples t-test, Chi-square, one-way ANOVA, and linear regression. The significant level was set at 0.05.

RESULTS

According to teachers' responses, the prevalence of ADHD among students in elementary schools was 4.4%, whereas parents reported a prevalence of 0.5%. There was a significant relationship between childhood ADHD and marital status of parents, fathers' smoking habits, previous experience of living in rural areas, children's previous history of having diseases and using the medicine, previous history of ADHD, and psychological problems in the family.

CONCLUSIONS

According to the study, teachers and parents suffer from a lack of knowledge about ADHD. Thus, the educational workshops and programs should be held for teachers, parents, and counselors to inform them about the procedures for timely diagnosis and treatment of ADHD.

Normative ADHD-RS-Preschool Data in a Community Sample in Spain

OBJECTIVE

The objective was to obtain normalized data from the ADHD Rating Scale-IV-Preschool Version (ADHD-RS-IV-P) in a Spanish sample.

METHOD

We translated and adapted the ADHD-RS-IV to our culture to obtain normalized data from a random representative sample of 1,426 Spanish preschool children (3 to <7 years old; 49.7% males). To analyze differences between evaluators, we used MANOVA. Internal consistency was assessed via Cronbach's alpha.

RESULTS

The mean age was 4.7 years old. There was a significant sex effect. The questionnaire had an internal consistency between .86 and .96 according to subscale and evaluator.

CONCLUSION

To evaluate ADHD in preschool children, it is necessary to use scores standardized by sex. Using a validated scale in schools and primary care centers may be useful for early detection of ADHD.

Distinct Methylphenidate-Evoked Response Measured Using Functional Near-Infrared Spectroscopy During Go/No-Go Task as a Supporting Differential Diagnostic Tool Between Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder Comorbid Children

Attention deficit/hyperactivity disorder (ADHD) has been frequently reported as co-occurring with autism spectrum disorder (ASD). However, ASD-comorbid ADHD is difficult to diagnose since clinically significant symptoms are similar in both disorders. Therefore, we propose a classification method of differentially recognizing the ASD-comorbid condition in ADHD children. The classification method was investigated based on functional brain imaging measured by near-infrared spectroscopy (NIRS) during a go/no-go task. Optimization and cross-validation of the classification method was carried out in medicated-naïve and methylphenidate (MPH) administered ADHD and ASD-comorbid ADHD children (randomized, double-blind, placebo-controlled, and crossover design) to select robust parameters and cut-off thresholds. The parameters could be defined as either single or averaged multi-channel task-evoked activations under an administration condition (i.e., pre-medication, post-MPH, and post-placebo). The ADHD children were distinguished by significantly high MPH-evoked activation in the right hemisphere near the midline vertex. The ASD-comorbid ADHD children tended to have low activation responses in all regions. High specificity (86 ± 4.1%; mean ± SD), sensitivity (93 ± 7.3%), and accuracy (82 ± 1.6%) were obtained using the activation of oxygenated-hemoglobin concentration change in right middle frontal, angular, and precentral gyri under MPH medication. Therefore, the significantly differing MPH-evoked responses are potentially effective features and as supporting differential diagnostic tools.

Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and a Case Report

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder, characterized by extremely short attention span, impulsivity with resultant behavioral problems. They are prone to trauma and frequent dental injuries. The behavioral issues, cognitive deficits, and short attention span pose a challenge to the dental health team. Management of these children requires several modifications in approach at all levels of prevention and treatment. This study reviews all the pertinent oral health issues in these children and also presents the case report of a 14-year-old boy diagnosed with ADHD.

How to cite this article: Sinha S, Praveen P, Rani SP, Anantharaj A. Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and a Case Report. Int J Clin Pediatr Dent 2018;11(3):254-259.

Prevalence of probable Attention-Deficit/Hyperactivity Disorder symptoms: result from a Spanish sample of children

Background

The aims of our study were to: (i) determine the prevalence of children aged 4 to 6 years with probable Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in the Spanish population; and (ii) analyse the association of probable ADHD symptoms with sex, age, type of school, origin (native or foreign) and socio-economic status in these children.

Methods

This cross-sectional study included 1189 children (4 to 6 years-old) from 21 primary schools in 19 towns from the Ciudad Real and Cuenca provinces, Castilla-La Mancha region, Spain. The ADHD Rating Scales IV for parents and teachers was administered to determine the probability of ADHD. The 90th percentile cut-off was used to establish the prevalence of inattention, hyperactivity/impulsivity and combined subtype.

Results

The prevalence of children with probable ADHD symptoms was 5.4% (2.6% inattention subtype symptoms, 1.5% hyperactivity/impulsivity subtype symptoms, and 1.3% combined subtype symptoms). Children aged 4 to 5 years showed a higher prevalence of probable ADHD in the inattention subtype symptoms and in total of all subtypes than children aged 6 years, and children with low socio-economic status reported a higher prevalence of probable ADHD symptoms (each subtype and total of all of them) than those with medium and high socio-economic status.

Conclusions

Early diagnosis and an understanding of the predictors of being probable ADHD are needed to direct appropriate identification and intervention efforts. These screening efforts should be especially addressed to vulnerable groups, particularly low socio-economic status families and younger children.

Relationship between parenting stress and informant discrepancies on symptoms of ADHD/ODD and internalizing behaviors in preschool children

Parent and teacher ratings of child behaviors are often discrepant, and these discrepancies may be correlated with parenting stress. The present study explored whether various parenting stress factors are associated with discrepancies between parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) as well as internalizing symptoms in preschool children. We recruited 299 Taiwanese preschool children (aged 4-6 years) from the community or via clinical referrals. A structural equation modeling was used to analyze the relationships among three factors derived from the Parenting Stress Index-Short Form and informant discrepancies on symptoms of inattention, hyperactivity/impulsivity, ODD, and internalizing behaviors. Scores reported by parents were higher for each of the symptoms examined than those reported by teachers, and the degree of agreement between informants ranged from low to moderate. The parental distress factor of parenting stress was associated only with parent ratings, whereas other factors of parenting stress-parent-child dysfunctional interaction and parents' stress resulted from their child's temperament-were correlated with both parent and teacher ratings. Only parental distress factor predicted informant discrepancies for all behavioral symptoms assessed. Our findings suggest that parental distress should be considered when parent rating scores show significant discrepancies from that of teacher rating scores.

Experiences of adolescents and young adults with ADHD in Hong Kong: treatment services and clinical management

BACKGROUND

Specialist services for the treatment of attention deficit hyperactivity disorder (ADHD) in adulthood in Hong Kong are yet to be developed. This study aims to explore the experiences of adolescents and young adults with ADHD in accessing treatment and services, coping with ADHD-related impairment, and their expectations of future treatment in Hong Kong.

METHOD

Qualitative interviews were conducted with a semi-structured guide. Forty young adult patients aged between 16 and 23 were included in the study. The interview recordings were transcribed verbatim and anonymised. Data were analysed with a thematic approach based on key principles of Grounded Theory.

RESULTS

Four meta-themes were developed: Accessing ADHD diagnosis and treatment services; ADHD-related impairment; Experience of ADHD treatments; and Attitudes and expectations of future ADHD treatment. The role of parents and schools were highly significant in accessing services for patients diagnosed with ADHD in childhood. In general, ADHD affected every aspect of patients' lives including academic outcome, employment, family and social relationships. Medications were the principal treatment for ADHD amongst the interviewees and were reported to be generally effective. Half of the patients received non-pharmacological treatments in childhood but these effects were reported to be temporary. There was general consensus that the needs of patients with ADHD could not be met by the current service. In particular, there is a lack of specialist service for adults with ADHD, follow-up by different clinicians, and insufficient provision of non-pharmacological treatments.

CONCLUSION

The findings suggest that further development of specialist ADHD services and non-pharmacological options for young adults are essential to meet their diverse needs with a holistic approach.

A clinical study of attention-deficit/hyperactivity disorder in preschool children--prevalence and differential diagnoses

OBJECTIVE

We aimed to examine (1) the prevalence and characteristics of ADHD in preschool children, and (2) differential diagnoses among children who display symptoms of inattention and hyperactivity-impulsivity in early childhood.

METHODS

The participants were children living in Kanie-cho, in Japan's Aichi Prefecture, who underwent their age 5 exams at the municipal health center between April 2009 and March 2011. We first extracted children who were observed to be inattentive or hyperactive-impulsive during their age 5 exams and considered as possibly having ADHD. We conducted follow-ups with these children using post-examination consultations, visits to preschools, and group rehabilitation. The results of the age 5 exams were combined with behavior observations and interview content obtained during subsequent follow-ups. A child psychiatrist and several clinical psychologists discussed these cases and made a diagnosis in accordance with the DSM-IV-TR.

RESULTS

91 (15.6%) of the 583 children selected were considered as possibly having ADHD; we were able to conduct follow-ups with 83 of the 91 children. Follow-up results showed that 34 children (5.8% of all participants) remained eligible for a diagnosis of ADHD. Diagnoses for the remaining children included: pervasive developmental disorders (six children, or 6.6% of suspected ADHD children), intellectual comprehension problems (four children, or 4.4%), anxiety disorders (seven children, or 7.7%), problems related to abuse or neglect (four children, or 4.4%), a suspended diagnosis for one child (1.1%), and unclear diagnoses for 29 children (31.9%).

CONCLUSIONS

ADHD tendencies in preschool children vary with changing situations and development, and the present study provides prevalence estimates that should prove useful in establishing a diagnostic baseline.

ADHD prevalence in Lebanese school-age population

OBJECTIVE

The authors conducted an epidemiological study in Lebanon to estimate ADHD prevalence in school-age population.

METHOD

They selected 1,000 children aged between 6 and 10 years, admitted in several schools in Lebanon. In each district, they randomly chose five schools, and in each school two classes. From each class, 10 children were included randomly in the population of the study. For each child, an ADHD-Rating Scale-IV School version was filled by a main teacher. The Home version was filled by the child's parents.

RESULTS

The prevalence of ADHD Inattentive subtype was 3 per 1,000, Hyperactive-Impulsive subtype 12 per 1,000, and ADHD Combined subtype 17 per 1,000. ADHD was significantly more prevalent in boys than in girls.

CONCLUSION

This is the first epidemiological study to be conducted in Lebanon to estimate the prevalence of ADHD among children.

The impact of attention on social functioning in survivors of pediatric acute lymphoblastic leukemia and brain tumors

BACKGROUND

The cognitive late effects experienced by many survivors of pediatric acute lymphoblastic leukemia (ALL) and brain tumors are well-established. The most commonly reported deficit is difficulty with attention. Problems with social functioning have also been identified, but their relationship with cognitive functioning is not well understood. This multi-site, cross-sectional study aimed to examine the impact of attention on social functioning.

PROCEDURE

Four hundred sixty nine survivors of ALL and brain tumors (55% ALL; 57% male) completed study procedures, including parent- and teacher-report measures of attention (Conners' Rating Scales, Revised) and parent-report of social functioning [Social Skills Rating System (SSRS)] as part of their screening evaluation for a large clinical trial. Survivors were 12.1 years of age and 4.9 years from the end of treatment at the time of study.

RESULTS

Results revealed that survivors' parent-reported attention problems were uniquely associated with their social functioning, relative to known demographic- and treatment-related risk factors. Teacher-reported attention problems, in contrast, were not, despite a significant correlation between the two. Deficits in intelligence and female gender were also significantly associated with poor social functioning.

CONCLUSIONS

Attention problems uniquely impact difficulties with social functioning in survivors of pediatric cancer. Future studies will need to further examine the relationship between attention and social functioning in survivors, particularly when assessed by teacher report. Pediatr Blood Cancer 2012; 59: 1290-1295. © 2012 Wiley Periodicals, Inc.

Prevalence of Attention-Deficit/Hyperactivity Disorder Symptoms in Preschool-aged Iranian Children

OBJECTIVE

The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms in Iranian preschool children based on evaluations by parents and teachers because a thorough understanding of epidemiologic features of ADHD symptoms in preschool children is important for prevention and management.

METHODS

Children between the ages of three and six attending kindergarten participated in this study. For the survey, 37 kindergartens were selected by multistage (stratified cluster random) sampling, consisting of 2213 children with a design effect equal to 1.5. A 19-item observer-rating questionnaire was generated to assess ADHD symptoms in children within the last 6 months. This questionnaire was used by both teachers and parents to assess ADHD behavior in participating children.

FINDINGS

Of 1403 children aged 3-6 years, 362 were classified as having ADHD symptoms according to their parent evaluation [25.8% (23.6-28.1%)] and 239 according to their teachers evaluation [17% (14.1-20.4%)]. Child rank among siblings, mother's education level, and interest in aggressive television programs were all independent explanatory variables according to parents' evaluation. Gender, parent education, child rank, single parent and interest in aggressive television programs were all independent explanatory variables according to teachers' evaluation.

CONCLUSION

Our findings reveal a large discrepancy in the prevalence of ADHD symptoms in preschool children based on evaluation by parents and teachers. Thus, it seems that the ADHD screening should be performed in multiple settings in order to identify children who need further investigations.

When parent and teacher ratings don't agree: the Tracking Adolescents' Individual Lives Survey (TRAILS)

OBJECTIVES

A commonly encountered situation for evaluating clinicians is a history of significant problems in one setting with little or no difficulties in another. This study aims to describe this phenomenon and to examine its relations with other child and family characteristics.

METHOD

A total of 1,730 children (mean age 11.05 years) was studied from the first wave of the Tracking Adolescents' Individual Lives Survey (TRAILS), a large population-based study of Dutch youth. Parent and teacher ratings of aggression, rule breaking, inattention, and hyperactivity were obtained. Children were assigned to groups according to the presence of clinically relevant problems at home only, at school only, or in both settings. The rate of setting specific problems was calculated and comparisons between groups were made.

RESULTS

Setting specific, especially home-specific, problems were quite common. Among children whom parents rated as having at least borderline-clinical problems, teachers reported clear or very clear behaviors at school at the following rates: aggression (22%), rule breaking (12.5%), inattention (55%), and hyperactivity/impulsivity (33%). Compared with the school-specific group, the home-specific group contained a significantly higher percentage of girls with regard to inattention or hyperactivity and a significantly lower percentage of girls with regards to rule breaking. Logistic regression analyses revealed that home- versus school-specific problems were related to sex, child effortful control, and parental stress.

CONCLUSION

Externalizing problems are frequently encountered only in one setting between home and school and are related to sex, child effortful control, and parental stress.

Parent and teacher ratings of attention during a year-long methylphenidate trial in children treated for cancer

OBJECTIVE

Longitudinally examine attention performance in childhood cancer survivors prescribed methylphenidate (MPH) to ameliorate cognitive late effects, comparing measures for inter-rater and inter-method discrepancies.

METHODS

Survivors of acute lymphoblastic leukemia (n = 33) or brain tumor (n = 35), mean age 11.11 ± 0.37 years, completed a 12-month, open-label trial of MPH. Conners' Parent and Teacher Rating Scales were completed at baseline, 1, 3, 6, and 12 months. The Conners' Continuous Performance Test (CPT) was completed at baseline and 12 months.

RESULTS

Improved attention was reported after 1 month of MPH (p < .05), with relative stability throughout the trial. Inter-rater agreement was low-to-moderate (ICC = -.06 to .46). Observer ratings correlated with select CPT indices at baseline (p < .05), but not at 12 months.

CONCLUSIONS

Childhood cancer survivors' attention improved after 1 month on MPH. Modest agreement between parents and teachers, and low-to-moderate correlations between behavior ratings and performance-based attention measures highlight a need for multimodal assessment.