Prevalence of attention deficit hyperactivity disorder in schoolchildren in Athens, Greece. Association of ADHD subtypes with social and academic impairment

The science of child and adolescent mental health in Greece: a nationwide systematic review

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Geographical variation in ADHD: do diagnoses reflect symptom levels?

Rates of ADHD diagnosis vary across regions in many countries. However, no prior study has investigated how much within-country geographic variation in ADHD diagnoses is explained by variation in ADHD symptom levels. We examine whether ADHD symptom levels explain variation in ADHD diagnoses among children and adolescents using nationwide survey and register data in Norway. Geographical variation in incidence of ADHD diagnosis was measured using Norwegian registry data from the child and adolescent mental health services for 2011-2016. Geographical variation in ADHD symptom levels in clinics' catchment areas was measured using data from the Norwegian mother, father and child cohort study for 2011-2016 (n = 39,850). Cross-sectional associations between ADHD symptom levels and the incidence of ADHD diagnoses were assessed with fractional response models. Geographical variation in ADHD diagnosis rates is much larger than what can be explained by geographical variation in ADHD symptoms levels. Treatment in the Norwegian child and adolescent mental health services is free, universally available upon referral, and practically without competition from the private sector. Factors beyond health care access and unequal symptom levels seem responsible for the geographical variation in ADHD diagnosis.

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.

Common and Unique Genetic Background between Attention-Deficit/Hyperactivity Disorder and Excessive Body Weight

Comorbidity studies show that children with ADHD have a higher risk of being overweight and obese than healthy children. This study aimed to assess the genetic alternations that differ between and are shared by ADHD and excessive body weight (EBW). The sample consisted of 743 Polish children aged between 6 and 17 years. We analyzed a unique set of genes and polymorphisms selected for ADHD and/or obesity based on gene prioritization tools. Polymorphisms in the KCNIP1, SLC1A3, MTHFR, ADRA2A, and SLC6A2 genes proved to be associated with the risk of ADHD in the studied population. The COMT gene polymorphism was one that specifically increased the risk of EBW in the ADHD group. Using the whole-exome sequencing technique, we have shown that the ADHD group contains rare and protein-truncating variants in the FBXL17, DBH, MTHFR, PCDH7, RSPH3, SPTBN1, and TNRC6C genes. In turn, variants in the ADRA2A, DYNC1H1, MAP1A, SEMA6D, and ZNF536 genes were specific for ADHD with EBW. In this way, we confirmed, at the molecular level, the existence of genes specifically predisposing to EBW in ADHD patients, which are associated with the biological pathways involved in the regulation of the reward system, intestinal microbiome, and muscle metabolism.

Predicting the Adult Clinical and Academic Outcomes in Boys With ADHD: A 7- to 10-Year Follow-Up Study in China

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and causes adverse effects on social functioning. The present study aimed to widely investigate the predictors, particularly childhood intelligence quotient (IQ) and family environment factors, on adult clinical and academic outcomes in boys with ADHD. Methods: A total of 101 boys with ADHD in a Chinese Han ADHD cohort were followed up 7-10 years later. Baseline ADHD symptoms were evaluated using the parent version of the ADHD Rating Scale-IV (ADHD-RS-IV) and the Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48). The intelligence of the child was tested by the China-Wechsler Intelligence Scale for Children (C-WISC), and family function was assessed by the Family Environment Scale-Chinese Edition (FES-CV). Adult ADHD persistence was defined using DSM-IV criteria for ADHD, and academic outcome fell into two categories: higher academic level group (studying in senior middle school or above) and lower academic level group (studying in vocational secondary schools or below). Results: Stepwise multiple logistic regression analysis revealed that the father's character, impulsive-hyperactive index as measured by the CPRS-48, and intellectual-cultural index as measured by the FES-CV independently predicted clinical outcomes in adults, with an AUC of 0.770 (p < 0.001, 95% CI = 0.678-0.863). The corresponding sensitivity and specificity were 0.743 and 0.727, respectively. The father's education level, family economic level, and verbal IQ (VIQ) on the C-WISC independently predicted adult academic outcomes, with an AUC of 0.870 (p < 0.001, 95% CI = 0.796-0.944). The corresponding sensitivity and specificity were 0.813 and 0.783, respectively. Conclusion: Initial ADHD symptom severity and IQ, father's character and education level, and family atmosphere and function affect adult clinical and academic outcomes. Addressing these areas early may help to improve the prognosis of ADHD into adulthood.

Correlations between Quality of Life, School Bullying, and Suicide in Adolescents with Attention-Deficit Hyperactivity Disorder

Although adolescents with attention-deficit hyperactivity disorder (ADHD) have a higher risk of suicidality and more problems related to school bullying, and quality of life (QoL) is reportedly associated with school bullying, suicide, and ADHD, no study has examined their correlation. This study examined the complex relationships between QoL, school bullying, suicide, and ADHD symptoms. A total of 203 adolescents with ADHD aged between 12 and 18 years were recruited. School bullying and QoL were examined using the Chinese version of the School Bullying Experience Questionnaire and the Taiwanese Quality of Life Questionnaire for Adolescents. Network model analysis was conducted to graphically present their relationships. We identified triangular correlations between school bullying, QoL, and suicidality, indicating possible pathways from school bullying to suicidality, and the originating or mediating roles of personal competence and psychological well-being. Furthermore, the ADHD symptoms of inattention and hyperactivity/impulsivity may differentially regulate these pathways. Longitudinal studies are warranted to confirm these findings.

The Conners 3-short forms: Evaluating the adequacy of brief versions to assess ADHD symptoms and related problems

The Conners' Rating Scales are widely used to assess attention deficit/hyperactivity disorder (ADHD) and related difficulties in children and adolescents. A short form of the scales is available, which, along with the several advantages of brief versions, also displays good psychometric properties. Nonetheless, no studies have confirmed them in cultural contexts different from the original one. The present study examined the psychometric properties of the Self-Report, Parent, and Teacher Conners 3-Short Forms in terms of reliability and validity in an Italian sample. Analyses were performed on 591 children and adolescents, 631 parents' ratings, and 325 teachers' ratings. To test for discriminative validity, ADHD clinical samples of 55 youth, 63 parents, and 15 teachers were compared to gender- and age-matched groups. Findings confirmed the original multidimensional structures and supported the Conners 3-Short Form scales as reliable and valid tools to assess ADHD and its main comorbid conditions.

[Comorbid cognitive impairments in children with nocturnal enuresis and their treatment]

AIM

To study comorbid cognitive impairments in children with enuresis and assess the efficacy and safety of cerebrolysin in treatment of comorbid pathology.

MATERIAL AND METHODS

Seventy patients, aged from 7 to 10 years, with the primary monosymtomatic form of enuresis were examined. Enuresis was assessed by the mean number of 'wet' nights per week. Neuropsychological tests were administered to measure short-term auditory-verbal and visual memory as well as SNAP-1V inattention and TOVA impulsivity. Electroencephalography was used as well.

RESULTS AND CONCLUSION

Children with enuresis performed lower on auditory-verbal and visual memory and attention tests compared to the patients of the control group. Electroencephalography showed activation deficit and synchronized effects of thalamic structures. The high efficacy of cerebrolysin (the improvement was seen in 80% of the patients) was demonstrated.

Inattentiveness and Language Abilities in Preschoolers: A Latent Profile Analysis

Growing evidence suggests that early symptoms of inattentiveness may affect the language development and academic success of young children. In the present study, we examined the extent to which profiles of inattentiveness and language could be discerned within a heterogeneous group of preschoolers attending early childhood special education programs (n = 461). Based on parent-reported observations of children's symptoms of inattentiveness and direct assessments of children's language skills (grammar, vocabulary, and narrative ability), three distinct profiles were identified. The three groups, representing levels of severity (at risk, almost average, above average), differed not only by their end of year performance, but also with respect to which their abilities changed over the course of the academic year. Children in the poorest performing profile had poorer mean scores in the spring of their preschool year on all measures, but exhibited patterns of gain that exceeded or equaled their peers in higher-performing groups, in the domains of vocabulary and grammar. Examination of subsequent kindergarten reading skills suggested that profile differences remained consistent. Findings underscore the associations between early symptoms of inattentiveness and language difficulties, and further indicate that these relations extend to the acquisition of early reading skills. Future research is needed to corroborate these findings with more robust measures of attention, and to understand the long-term associations between inattentiveness, language and literacy, and potential effects on these associations from early intervention.

Screening for ADHD in a Sample of Egyptian Adolescent School Students

OBJECTIVE

To screen for ADHD in a sample of Egyptian adolescent students, and study the distribution of different subtypes of ADHD, associated comorbidities, and sociodemographic correlates.

METHOD

A total of 925 adolescents were randomly selected and screened by the Conners-Wells' Adolescent Self-Report Scale-Short form (CASS:S), and potential cases were further assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime versions (K-SADS-PL).

RESULTS

A total of 87 students (9.4%) had potential ADHD diagnosis with evident preponderance in boys (13.8%, n = 58) than in girls (5.8%, n = 29) with a ratio of 2:1 ( p = .000, χ² = 17.328). The hyperactive-impulsive subtype comprised the majority of cases (54.7%, n = 41). Psychiatric comorbidity was invariably present (85.1%, n = 74). Nearly half the cases had poor academic achievement (43.7%, n = 34). Positive correlates included family history of psychiatric disorders, the order of birth, and parental disharmony.

CONCLUSION

ADHD is prevalent in Egyptian adolescents and is associated with high psychiatric comorbidity and a pronounced effect on academic performance.

Involvement of family environmental, behavioral, and social functional factors in children with attention-deficit/hyperactivity disorder

BACKGROUND

The objective of this study was to investigate relationships among family environmental characteristics, behavior problems, and social function impairments in children with ADHD.

METHODS

Among children from four primary schools in Shantou city of China, 132 who were diagnosed with ADHD were selected and 138 typically developing children were recruited from the same schools. These children were evaluated using the self-designed questionnaire, FES-CV, CPRS, CTRS, and WFIRS-P for familial environment, behavioral problems, and social function impairment measures. In addition, children's behavioral problems and functional impairments were evaluated using self-established field behavior observation method. Logistic regression model was used to estimate ORs and 95% CIs for ADHD risk with family environmental factors.

RESULTS

In the unconditional logistic model, ADHD risk in children was increased with parents' worse educational level, occupational status, and emotional stability with trend. Children with ADHD had lower scores on most subscales of FES-CV (P<0.01) but higher scores on Conflict subscale (P<0.001). Children with ADHD showed impairments on all the six WFIRS-P subscales tests (all P<0.001), and higher scores on the CPRS and CTRS scale subscales representing behavioral symptoms (all P<0.001 except Somatic Complaints), and more behavioral problems and functional impairments.

CONCLUSION

Compared with typically developing children, children with ADHD had worse family environment. Family characteristics especially parents' emotional unstability, lower education levels, and worse occupation status may increase ADHD risk in children. In addition, the behavioral problems and social functional impairments may interact with adverse family environmental factors in children with ADHD. Therefore, early interventions with focus onto the compromising factors can be useful for improving the social-behavioral functions of children with ADHD.

Microstructural abnormalities in the combined and inattentive subtypes of attention deficit hyperactivity disorder: a diffusion tensor imaging study

Previous research has demonstrated that there are specific white matter abnormalities in patients with attention deficit/hyperactivity disorder (ADHD). However, the results of these studies are not consistent, and one of the most important factors that affects the inconsistency of previous studies maybe the ADHD subtype. Different ADHD subtypes may have some overlapping microstructural damage, but they may also have unique microstructural abnormalities. The objective of this study was to investigate the microstructural abnormalities associated with two subtypes of ADHD: combined (ADHD-C) and inattentive (ADHD-I). Twenty-eight children with ADHD-C, 28 children with ADHD-I and 28 healthy children participated in this study. Fractional anisotropy (FA), radial diffusivity (RD) and axial diffusivity (AD) were used to analyze diffusion tensor imaging (DTI) data to provide specific information regarding abnormal brain areas. Our results demonstrated that ADHD-I is related to abnormalities in the temporo-occipital areas, while the combined subtype (ADHD-C) is related to abnormalities in the frontal-subcortical circuit, the fronto-limbic pathway, and the temporo-occipital areas. Moreover, an abnormality in the motor circuit may represent the main difference between the ADHD-I and ADHD-C subtypes.

Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours

Rising global rates of pathological Internet use (PIU) and related psychological impairments have gained considerable attention in recent years. In an effort to acquire evidence-based knowledge of this relationship, the main objective of this study was to investigate the association between PIU, psychopathology and self-destructive behaviours among school-based adolescents in eleven European countries. This cross-sectional study was implemented within the framework of the European Union project: Saving and Empowering Young Lives in Europe. A representative sample of 11,356 school-based adolescents (M/F: 4,856/6,500; mean age: 14.9) was included in the analyses. PIU was assessed using the Young's Diagnostic Questionnaire. Psychopathology was measured using the Beck Depression Inventory-II, Zung Self-Rating Anxiety Scale and Strengths and Difficulties Questionnaire. Self-destructive behaviours were evaluated by the Deliberate Self-Harm Inventory and Paykel Suicide Scale. Results showed that suicidal behaviours (suicidal ideation and suicide attempts), depression, anxiety, conduct problems and hyperactivity/inattention were significant and independent predictors of PIU. The correlation between PIU, conduct problems and hyperactivity/inattention was stronger among females, while the link between PIU and symptoms of depression, anxiety and peer relationship problems was stronger among males. The association between PIU, psychopathology and self-destructive behaviours was stronger in countries with a higher prevalence of PIU and suicide rates. These findings ascertain that psychopathology and suicidal behaviours are strongly related to PIU. This association is significantly influenced by gender and country suggesting socio-cultural influences. At the clinical and public health levels, targeting PIU among adolescents in the early stages could potentially lead to improvements of psychological well-being and a reduction of suicidal behaviours.