Emotional dysregulation in children with attention-deficit/hyperactivity disorder

Transdiagnostic Attentional Deficits Are Associated with Depressive and Externalizing Symptoms in Children and Adolescents with Neuropsychiatric Disorders

OBJECTIVE

Although inattention, impulsivity, and impairments to vigilance are most associated with attention-deficit/hyperactivity disorder (ADHD), transdiagnostic attentional deficits are prevalent across all psychiatric disorders. To further elucidate this relationship, the present study investigated parent-reported neuropsychiatric symptom correlates of attention deficits using the factor structure of the Conners' Continuous Performance Test (CPT-II), a neuropsychological test of attention.

METHOD

Two-hundred and eighteen children and adolescents (7-21 years old) completed the CPT-II as part of standard clinical protocol during outpatient pediatric neuropsychology visits. The factor structure of the CPT-II was determined with a principal component analysis (PCA) using Promax rotation. Pearson correlation analyses and regression models examined the relationship between the generated factor structure, parent-reported clinical symptoms, and pre-determined clinical diagnoses.

RESULTS

Results from the PCA suggested a three-factor model best supported the structure of the CPT-II, and were subsequently defined as inattention, impulsivity, and vigilance. Performance-based inattention was significantly correlated with parent-reported hyperactivity, aggression, conduct problems, and depression. Parent-reported depressive symptoms and conduct problems were the strongest correlates of performance-based inattention, not hyperactivity or aggression. Performance-based inattention was significantly associated with an ADHD diagnosis but not a depression or anxiety diagnosis.

CONCLUSIONS

Findings suggest attentional deficits are not specific to any one disorder. To enhance the identification, classification, and treatment of neuropsychiatric disorders, both researchers and clinicians alike must diminish the importance of categorical approaches to child/adolescent psychopathology and continue to consider the dimensionality of transdiagnostic characteristics such as inattention.

A Descriptive Study on the Vocal Behaviors in Children With Attention Deficit Hyperactivity Disorder: Vocal Hygiene Knowledge and Phonotraumatic Behaviors

AIM

This study aimed to investigate the level of vocal hygiene knowledge and phonotraumatic behaviors in children diagnosed with attention deficit hyperactivity disorder (ADHD).

METHODS

The study included 25 children with ADHD, aged 8-11 years, and 25 age- and sex-matched typically developing children and their caregivers. All children were considered nondysphonic based on a Pediatric Voice Handicap Index (pVHI) score of <13. The children completed the Vocal Hygiene Knowledge Level Form, which was developed by the authors. Parents completed the Checklist Form, Conners's Parent Rating Scale-Revised Short Form, pVHI, and the Pediatric Phonotrauma Assessment Questions for Parents Form developed by the authors.

RESULTS

Children with ADHD had more frequent phonotraumatic behaviors than typically developing children (P = 0.014). There was no significant difference in vocal hygiene knowledge between the two groups (P = 0.162).

CONCLUSION

Although children with ADHD had similar levels of vocal hygiene knowledge compared to typically developing children, they had higher rates of phonotraumatic behaviors. These findings indicate a higher risk of dysphonia in children with ADHD. It is suggested that the results of the present study may increase the awareness of voice professions in developing preventive approaches for vocal health in children with ADHD.

[Formula: see text] Sensory processing, executive function, and behavior in children with ADHD

The relationship between sensory processing, executive function, and behavior in children with Attention Deficit/Hyperactivity Disorder (ADHD) is far from clear. The aim of this study was to examine the mediating role of executive function in the relationship between sensory processing and behavior in ADHD. Sixty-three children (51 boys), aged between 7 and 14 years participated in this study. Caregivers completed the Sensory Profile 2 (SP-2), the Behavior Rating Inventory of Executive Function 2 (BRIEF-2), and the Child Behavior Checklist (CBCL) to assess sensory processing, executive function, and behavior, respectively. Positive and significant associations were found between sensory processing, executive function, and behavioral problems. In addition, positive indirect effects between sensory processing and behavior were mediated by executive function. These findings add to other evidence on neurodevelopmental disorders, suggesting that sensory processing may be a foundational aspect related to executive function, which in turn affects behavior in ADHD.

Effects of the Early Start Denver Model on emotional dysregulation and behavior problems in children with Autism spectrum disorder : Effects of the early start Denver model on emotional dysregulation and behavior problems in Chinese children with Autism spectrum disorder

BACKGROUND

Most previous studies have focused on the clinical efficacy after intervention of ESDM, particularly in core symptoms. However, only a few have paid attention to the effectiveness of ESDM on emotional dysregulation and behavior problems in children with ASD. This study aimed to explore the effect of the ESDM on addressing emotional dysregulation and behavior problems in children with ASD in China, as well as its correlation with core symptoms of ASD.

METHODS

A total of 319 children aged 1.5 to 5 years were included in this study and received treatment based on the ESDM intervention program Baseline assessment (T0) was conducted before intervention, including Children Behavior Checklist (CBCL), Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS). All children with ASD were examined in the assessment (T1) after 12 weeks of treatment. Emotional dysregulation and behavior problems in children with ASD were measured using CBCL, while ABC and CARS were used to evaluate the core symptoms.

RESULTS

In the T1 assessment, the core symptoms of children with ASD in ABC and CARS showed significant differences. Subscale scores of ABC and the severity of CARS, including senses, relationships, stereotypes objects to use, self-help and social also exhibited significant differences. The children showed significant differences in both total score and subscale scores of CBCL(P < 0.05), which included emotionally/reactive, anxious/depressed, somatic complaints, withdrawal, sleep problems, attention problems, aggressive behavior, internalization and externalization. The children demonstrated significant differences in scores of CBCL-AAA (P < 0.05), taking into account the combined total of attention, aggression and anxious/depressed CBCL T scores. In addition, a consistent positive correlation was observed between the overall scores of CBCL and the core symptoms of children with ASD as indicated by ABC and CARS in both T0 and T1(P < 0.01). In T0, the CBCL-AAA scores were positively associated with the core symptoms of children with ASD as reflected by CARS(P < 0.01), as well as senses of ABC( P < 0.05). During T1, a noteworthy significant positive correlation was observed between the CBCL-AAA scores and the core symptoms of children with ASD as indicated by both ABC and CARS assessment (P < 0.05).

CONCLUSIONS

Children with ASD benefit from ESDM, not only in terms of improving their core symptoms, but also in terms of improving their emotional dysregulation and behavior problems, and ESDM could be considered as one of the early treatment options for overall psychological promotion. The core symptoms of children with ASD are significantly associated with emotional dysregulation and behavior problems in young children, both cross-sectionally and prospectively for the short term over time. Emotional dysregulation and behavior problems represent an important comorbidity, and could be considered as potential treatment targets for treatment for improving emotional stability in ASD.

Physiological parameters to support attention deficit hyperactivity disorder diagnosis in children: a multiparametric approach

Introduction

Attention deficit hyperactivity disorder (ADHD) is a high-prevalent neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity, frequently co-occurring with other psychiatric and medical conditions. Current diagnosis is time-consuming and often delays effective treatment; to date, no valid biomarker has been identified to facilitate this process. Research has linked the core symptoms of ADHD to autonomic dysfunction resulting from impaired arousal modulation, which contributes to physiological abnormalities that may serve as useful biomarkers for the disorder. While recent research has explored alternative objective assessment tools, few have specifically focused on studying ADHD autonomic dysregulation through physiological parameters. This study aimed to design a multiparametric physiological model to support ADHD diagnosis.

Methods

In this observational study we non-invasively analyzed heart rate variability (HRV), electrodermal activity (EDA), respiration, and skin temperature parameters of 69 treatment-naïve ADHD children and 29 typically developing (TD) controls (7-12 years old). To identify the most relevant parameters to discriminate ADHD children from controls, we explored the physiological behavior at baseline and during a sustained attention task and applied a logistic regression procedure.

Results

ADHD children showed increased HRV and lower EDA at baseline. The stress-inducing task elicits higher reactivity for EDA, pulse arrival time (PAT), and respiratory frequency in the ADHD group. The final classification model included 4 physiological parameters and was adjusted by gender and age. A good capacity to discriminate between ADHD children and TD controls was obtained, with an accuracy rate of 85.5% and an AUC of 0.95.

Discussion

Our findings suggest that a multiparametric physiological model constitutes an accurate tool that can be easily employed to support ADHD diagnosis in clinical practice. The discrimination capacity of the model may be analyzed in larger samples to confirm the possibility of generalization.

Investigating Attention Deficit Hyperactivity Disorder Symptoms, Emotional Dysregulation and Family Functioning in Children: A Community-Based Study in Elementary Schools in Surabaya, Indonesia

Objectives

Research on emotional dysregulation related to attention deficit hyperactivity disorder (ADHD) symptoms and its effects on family functioning in children is scarce. This is the first study conducted in Indonesia to examine the intricate relationships between ADHD symptoms, emotional regulation, and family functioning in children.

Methods

A cross-sectional survey was conducted involving primary caregivers of children aged 9-13 years old across three elementary schools in Surabaya, using validated questionnaires comprising the Indonesian ADHD Rating Scale, Emotion Regulation Checklist, and Family APGAR scale.

Results

The findings revealed a positive association between ADHD features and the emotional lability/negativity subscale (ERLN) (r=0.528; p<0.001), but not the emotion regulation subscale (EREG). Moreover, family functioning positively correlated with ERLN (r= -0.269; p=0.003) and negatively correlated with EREG (r=0.331; p<0.001). Parental education emerged as a significant demographic factor, with higher education levels linked to better emotion regulation (r=0.297; p=0.001).

Conclusion

These findings underscore the importance of addressing ADHD symptoms and emotional dysregulation in children in order to enhance family functioning and overall well-being. Implications for future research and interventions targeting emotion regulation, especially in children with ADHD and their families, are also discussed.

Dimensionality of Oppositional Defiant Disorder Symptoms Across Elementary-School Grades

Various models of the dimensionality of behaviors associated with Oppositional Defiant Disorder (ODD) have been proposed or reported. Many of these models describe ODD-related behaviors in either two- or three-factor models. The purpose of the study was to determine which of the models of ODD-related behaviors demonstrated the best fit using teacher report of 15,521 children across eight grade levels and to examine measurement invariance of the model across grades. Confirmatory factor analyses were conducted to determine which of the models demonstrated best fit of teacher-reported ODD-related behaviors across eight grades. A two-factor model from a preliminary analysis of a subset of the current data demonstrated a better model fit than any of the existing six models examined and demonstrated measurement invariance across all grades. Across all of the models, affective and behavioral symptoms loaded onto separate factors, which may be an important consideration to inform future clinical and empirical work.

A Narrative Review of the Efficacy of Interventions for Emotional Dysregulation, and Underlying Bio-Psycho-Social Factors

In this narrative, comprehensive, and updated review of the literature, we summarize evidence about the effectiveness of interventions aimed at reducing emotion dysregulation and improving emotion regulation in children, adolescents, and adults. After introducing emotion dysregulation and emotion regulation from a theoretical standpoint, we discuss the factors commonly associated with emotion regulation, including neurobiological and neuropsychological mechanisms, and the role of childhood adverse experiences and psycho-social factors in the onset of emotion dysregulation. We then present evidence about pharmacological and non-pharmacological interventions aiming at improving emotion dysregulation and promoting emotion regulation across the lifespan. Although our review was not intended as a traditional systematic review, and the search was only restricted to systematic reviews and meta-analyses, we highlighted important implications and provided recommendations for clinical practice and future research in this field.

Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome

This study aims to investigate the predictive and mediating relationships between emotion dysregulation, internalizing disorders, family functionality, loneliness preference, and executive functions (EF) in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome (ADHD + CDS). This study included 176 children and adolescents (92 boys, 84 girls) who were diagnosed with ADHD + CDS according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist, between ages 8 -12 (M = 10, SD = 1.52) with a convenience sampling method. The solitude scale for children, difficulties in emotion dysregulation scale, Child Behavior Checklist, Barkley Sluggish Cognitive Tempo Scale, Family assessment device, and CNS Vital Signs test were used. The results showed that difficulty in emotion regulation, preference for loneliness, internalizing disorders and CDS symptom severity did not have a mediating effect between family functionality and EF. Still, emotion dysregulation mediates the relationship between EF and internalizing disorders by itself and through loneliness preference. Also, preference for loneliness and emotion dysregulation had a mediating effect between family functionality and internalizing disorders. Finally, it was found that the effect of emotion regulation difficulty, loneliness preference, and internalizing disorders had a mediating role between CDS symptom severity and family functionality. In conclusion, the information obtained from this study on the etiology of CDS may guide future studies.

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.

Association of Psychopharmacological Medication Preference with Autistic Traits and Emotion Regulation in ADHD

Background

This study intends to evaluate the relationship between medication switching and autistic traits, emotion dysregulation, and methylphenidate side effects in children with attention deficit hyperactivity disorder (ADHD).

Methods

Children with ADHD, ages 9-18, treated with methylphenidate (MTP) (n = 23), and switched to atomoxetine (ATX) (n = 20) were included. All participants were interviewed with K-SADS-PL to confirm ADHD diagnosis and exclude comorbid psychiatric disorders. The participants then completed Difficulty in Emotion Regulation Scale (DERS) and Autism-Spectrum Quotient (AQ) and their parents completed Autism Spectrum Screening Questionnaire (ASSQ) and Barkley Stimulant Side Effect Rating Scale(BSSERS).

Results

The MTP group scored higher than the ATX group in ASSQ, AQ, and the lack of emotional clarity subscale of DERS, while the ATX group had higher scores in the emotional non-acceptance subscale of DERS. No differences were found between the MTP and ATX groups in methylphenidate side-effect severity. Multiple regression analyses revealed that non-acceptance of emotions predicted the switch to ATX while lack of emotional clarity predicted the maintenance of MTP therapy, rather than autistic traits.

Conclusions

This study highlights emotion regulation difficulties and how different emotional profiles may influence medication selection in children with ADHD.

[The mediating role of emotion regulation strategies between symptoms and anxiety problems in children with attention deficit hyperactivity disorder]

OBJECTIVES

To study the mediating role of emotion regulation strategies between symptoms and anxiety problems in children with attention deficit hyperactivity disorder (ADHD).

METHODS

Convenience cluster sampling was performed to select 435 eligible children with ADHD from 10 211 students in 10 elementary schools in Kashgar of Xinjiang Uygur Autonomous Region. SNAP-IV Assessment Scale, Emotion Regulation Questionnaire for Children and Adolescents, and Conners Parent Symptoms Questionnaire were used to obtain relevant information. The Spearman correlation analysis and the moderated mediation method were used for data analysis.

RESULTS

For the children with ADHD, the score of cognitive reappraisal was negatively correlated with the scores of symptoms and anxiety problems (rs=-0.254 and -0.270 respectively, P<0.001), and the score of symptoms was positively correlated with the score of anxiety problems (rs=0.329, P<0.001). The analysis of mediating effect showed that cognitive reappraisal played a partial mediating role between symptoms and anxiety problems, with a 95% confidence interval of 0.008-0.027, and the mediating effect accounted for 16.10% of the total effect. In addition, sex played a regulatory role in this mediation model (P<0.001).

CONCLUSIONS

Cognitive reappraisal plays a mediating role between symptoms and anxiety problems in children with ADHD, while sex regulates the relationship of symptoms with cognitive reappraisal and anxiety problems in these children.

Associations Between Attention Deficit Hyperactivity Disorder Symptom Dimensions and Disordered Eating Symptoms in Adolescence: A Population-Based Twin Study

Although bivariate associations between attention-deficit/hyperactivity disorder (ADHD) and eating disorders in adolescent girls and boys have been previously identified, the mechanistic link underlying the symptom-level associations remains unclear. We evaluated shared genetic and environmental influences on ADHD symptoms and disordered eating in 819 female and 756 male twins from the Swedish TCHAD cohort using bivariate models. Common additive genetic and unique environmental effects accounted for majority of ADHD and disordered eating associations in a differential manner. For girls, the strongest genetic correlation was observed for cognitive/inattention problems-bulimia (0.54), with genetic factors accounting for 67% of the phenotypic correlation. For boys, the strongest genetic correlations were observed for conduct problems-bulimia and hyperactivity-bulimia (~ 0.54), accounting for 83% and 95% of the phenotypic correlation, respectively. As per our findings, the risk of comorbidity and shared genetics highlights the need for preventative measures and specialized treatment for ADHD and disordered eating in both sexes.

Examining the structural equation modeling between intrinsic-motivation, emotion regulation and AHDH: the mediating role of problem-solving, time-management, and behavioral-inhibition

Although Executive Functions has been considered as the main correlation of ADHD few studies have examined the effect of EFs on ADHD symptoms, in the samples with ADHD. This study aimed to examine the structure of EFs on ADHD students in a hypothesized model. After careful screening of ADHD among 1368 university students (with stratified and multistage cluster sampling), out of them, 211 students with ADHD diagnosis were selected purposefully. They received scales on their emotion regulation, motivation, adult ADHD, deficits in EFs, and diagnostic interview. Emotion regulation and intrinsic motivation were considered as input; behavioral-inhibition, time-management, and problem-solving were the mediators and ADHD subscales were as the output variables. Results showed that the model adequately fit the data. The model fit indices were χ2 = 27.081, df = 1, CFI = 0.99, GFI = 0.97, and PGFI = 0.02. The direct effects of intrinsic-motivation and emotion-regulation on all three mediators and indirect effects of them to ADHD subscales were significant. Based on the results, time-management mediated the relationship between motivation and emotion regulation and ADHD. Among EFs, emotion-regulation and intrinsic-motivation had fundamental influence to other aspects of EFs factors such as behavioral-inhibition, time-management, problem-solving, and attention deficit/hyperactivity disorder.

A randomized controlled trial of a new intervention in early symptomatic syndromes eliciting neurodevelopmental clinical examinations: PR-ESSENCE

The need for effective intervention programs for youth with neurodevelopmental problems (ESSENCE) and challenging behaviour is great. This study examines Problem Resolution in ESSENCE (PR-ESSENCE), a newly developed model in which children and parents develop mutual problem resolution strategies. Ten-week randomized controlled trial of PR-ESSENCE for children and adolescents aged 5-18 years, compared to treatment as usual. Outcomes were assessed at baseline and randomized period endpoint. Primary outcome was the Clinical Global Impression-Improvement scale (CGI-I) rated by blinded assessors. Secondary outcomes were rated by parents-SNAP-IV, Eyberg Child Behavior Inventory (ECBI), Relationship Problems Questionnaire, Family Burden of Illness Module, and children-Beck Youth Inventories (BYI). ClinicalTrials.gov identifier: NCT03780413. The study enrolled 108 participants (active n = 72; controls n = 36, randomized 2:1), of whom 95 completed the randomized period. No clinically significant group differences were found in baseline characteristics. More than half had autism and 80% had ADD or ADHD. Large treatment effects were seen on CGI-I (ITT analysis, Effect Size 1.48). Treatment responders, much/very much improved on CGI-I, were 51.4% in active group and 5.6% of controls. Effect sizes were medium to large in parent ratings on SNAP-IV (ODD and ADHD symptoms), ECBI (behaviour problems), and in BYI child self-ratings of disruptive behaviour. PR-ESSENCE treatment improved global symptoms and functioning (CGI-I), behaviour problems, ADHD and ODD symptoms, and disruptive behaviour. Treatment effects were at least equivalent to those in previous studies of well-established Parent Management Training and Collaborative Problem Solving programs.

Emotional and sensory dysregulation as a possible missing link in attention deficit hyperactivity disorder: A review

Attention Deficit Hyperactivity Disorder (ADHD) is a common developmental disorder affecting 5-7% of adults and children. We surveyed the literature to examine ADHD through three pillars: developmental characteristics, symptomatology, and treatment strategies. Firstly, in terms of developmental characterstics, early life stress may increase the risk of developing ADHD symptoms according to animal models' research. Secondly, the current core symptoms of ADHD are comprised of inattention, hyperactivity, and impulsivity. However, the up-to-date literature indicates individuals with ADHD experience emotional and sensory dysregulation as well, which early-life stress may also increase the risk of. Finally, we discuss the therapeutic benefits of methylphenidate on both the current core ADHD symptoms and the sensory and emotional dysregulation found in those with ADHD. In summation, we surveyed the recent literature to analyze (i) the potential role of early-life stress in ADHD development, (ii) the involvement of emotional and sensory dysregulation in ADHD symptomatology and finally, (iii) the therapeutic intervention with methylphenidate, aiming to reduce the potential effect of early life stress in ADHD, and mainly emotional and sensory dysregulation. The apparent but currently less recognized additional symptoms of emotional and sensory dysregulation in ADHD call for further investigation of these possible causes and thus increasing treatments efficacy in individuals with ADHD.

Emotion Regulation Choice in Internet Addiction: Less Reappraisal, Lower Frontal Alpha Asymmetry

Individuals with internet addiction (IA) show difficulties in emotion regulation. However, they could effectively employ emotion regulation strategies when instructed. We speculate that this discrepancy might be caused by maladaptive emotion regulation choices. Recent studies indicated that decreased activity of the left frontal cortex could be a neural marker of reappraisal use. To address this problem, individuals with IA (n = 17, IA group) and healthy individuals (n = 23, healthy control [HC] group) were required to choose an emotion regulation strategy between reappraisal and distraction to regulate their emotions varying in emotional intensity and valence. We also compared the resting state frontal alpha asymmetry (FAA) of these 2 groups. The results replicated more choices of reappraisal in low- versus high-intensity emotional contexts across groups. More importantly, the IA group chose reappraisal less frequently compared with the HC group, irrespective of emotional intensity. Furthermore, we found individuals with IA have lower FAA than healthy controls, and FAA shows a positive correlation with the use of reappraisal. These findings suggest that IA alters individuals' patterns of emotion regulation choice and impairs frontal activities, causing difficulties in emotion regulation.

Methylphenidate Use for Emotional Dysregulation in Children and Adolescents with ADHD and ADHD and ASD: A Naturalistic Study

Emotional dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD). Nonetheless, research on ADHD in children with autism spectrum disorder (ASD) and ADHD is still ongoing. Several studies suggest that methylphenidate (MPH) may be effective for ED in ADHD, while there is not enough evidence about its use in ASD with comorbid ADHD. This naturalistic study aims to investigate the effectiveness of immediate- and extended-release MPH in the treatment of ED in 70 children and adolescents (6–18 years), with a diagnosis of ADHD (n = 41) and of ASD with comorbid ADHD (n = 29), using the Child Behavior Checklist—Attention/Aggressive/Anxious (CBCL-AAA). Their parents completed the CBCL twice—first during the summer medication-free period, that is, at least one month after drug interruption; and again after three months of treatment restart. Results demonstrate that MPH is associated with a statistically significant reduction in ED in ADHD and ASD, without substantial adverse events, supporting the use of psychostimulants for the treatment of ED in these neurodevelopmental disorders.

Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED.

METHODS

Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder).

DISCUSSION

Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population.

TRIAL REGISTRATION

Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.

Deficient Emotional Self-Regulation and Sleep Problems in ADHD with and without Pharmacological Treatment

OBJECTIVE

The purpose of this study is to analyse DESR and its influence on sleep parameters in three different groups of children and adolescents: a group newly diagnosed with ADHD naïve, a group with ADHD under pharmacological treatment and a control group.

METHOD

Subjects were a total of 327 children and adolescents. Two groups diagnosed with ADHD: 108 medication-naïve and 80 under pharmacological treatment; and one group with 136 healthy subjects. DESR was defined using anxious/depressed, attention problems and aggressive behaviors (AAA) scales from the Child Behavior Checklist (CBCL), and sleep through the Sleep Disturbance Scale for Children.

RESULTS

Significant differences were found comparing the three groups (p = .001), with a significantly higher profile on DESR in ADHD subjects, especially those who did not undergo treatment, and a positive correlation between DESR and sleep.

CONCLUSION

Children and adolescents with ADHD without treatment present higher DESR than healthy controls and consequently higher sleep problems.

Dysregulation profile (DP) as a transdiagnostic psychopathological factor in clinically referred children - comparisons between disorders and latent structure

BACKGROUND

Dysregulation Profile (DP) describes the psychopathological construct of concurrent impairments in the ability to regulate emotion, behaviour, and cognition measured by the Child Behaviour Checklist (CBCL). Such transdiagnostic dimensions of psychopathology play an important role in addition to core symptoms of psychiatric diagnosis in clinical practice. Evaluation of DP in children with different mental disorders may improve our understanding and treatment of both contents.

METHODS

911 clinically referred children between 6 and 18 years were investigated. The sample consisted of five 'pure' disorders groups, that is, tic disorder (TIC), anxiety disorder, obsessive compulsive disorder, depression, Attention Deficit Hyperactivity Disorder (ADHD), and two comorbid disorder group, that is, ADHD + TIC and ADHD + oppositional defiant disorder (ODD). DP level and latent structure were compared across groups.

RESULTS

The rate of severe/abnormal dysregulation rates varied from 15% to 44% when the 210 cut-off was used, and 5% to 18% when stringent cut-off was used (i.e. ≥70 on all DP-subscales). The most affected population were children with comorbid ADHD with ODD/TIC, while least were those with TIC only. Five different latent phenotypes of DP were found.

CONCLUSION

DP above clinical cut-off level widely exists in clinically referred children in parallel to core symptoms of their diagnosis, especially among children with comorbidities. During clinical assessment it would be worth to clarify the role of DP-related problems within the general psychosocial impairment of the patient to improve a personalized approach.

White matter microstructural integrity correlates of emotion dysregulation in children with ADHD: A diffusion imaging tractography study

BACKGROUND

Emotion dysregulation (ED) is prevalent in youths with attention-deficit hyperactivity disorder (ADHD) and causes more social impairment and poor adaptive function. Alterations in the integrity of white matter (WM) tracts might have important implications for affective processing related to ED. However, little is known about the WM correlates underpinning ED in ADHD.

METHODS

Using diffusion spectrum image tractography, we obtained generalized fractional anisotropy (GFA) values of 76 WM tracts in 77 children with ADHD and 105 typically developing controls (TDC). ED severity was defined by the dysregulation profile from the child behavior checklist. Canonical correlation analysis (CCA) was performed to identify modes that relate WM microstructural property to ED severity and cognitive measures.

RESULTS

The application of CCA identified one significant mode (r = 0.638, FWE-corrected p = 0.046) of interdependencies between WM property patterns and diagnosis, ADHD total symptom levels, dysregulation by diagnosis interaction, and full-scale intellectual quotient (FIQ). GFA values of 19 WM tracts that were linked to affective-processing, sensory-processing and integration, and cognitive control circuitry were positively correlated with ED severity in TDC but negatively correlated with ED severity in ADHD. ADHD symptom severity and diagnosis were negatively associated with the GFA patterns of this set of tract bundles. In contrast, FIQ was positively correlated with this set of tract bundles.

CONCLUSIONS

This study used the CCA to show that children with ADHD and TDC had distinct multivariate associations between ED severity (diagnosis by ED interaction) and microstructural property in a set of WM tracts. These tracts interconnect the cortical regions that are principally involved in emotion processing, integration, and cognitive control in multiple brain systems. The WM microstructure integrity impairment might be an essential correlate of emotion dysregulation in ADHD.

The association between adverse childhood experiences and mental health problems in young offenders

High rates of adverse childhood experiences (ACEs, e.g., abuse and neglect) have been found in young offenders. Furthermore, ACEs seem to increase the risk of developing relevant mental health problems, in non-offending juveniles and adults. However, this association has only seldomly been addressed in offending juveniles and young adults. The present study aimed at evaluating the prevalence of ACEs and mental health problems as well as their association within a sample of male and female young offenders. Altogether, 161 adolescent and young adult offenders (16.8% females) from the youth detention center Worms (Germany) filled out questionnaires concerning ACEs and mental health problems with a focus on attention-deficit/hyperactivity disorder and intermittent explosive disorder. Considerable rates of mental health problems were found, e.g., a prevalence of 35.9% was found for intermittent explosive disorder. Furthermore, a greater proportion of the female offenders fell into the clinically significant category for somatic complaints, anxiety/depression, and attention problems than the male offenders. Female young offenders also reported more frequently about all forms of ACEs compared to the male offenders. Latent class analysis defined three subtypes of young offenders depending on their individual ACE patterns: (1) low ACEs, (2) mainly neglectful ACEs, and (3) multiple ACEs. ACEs were significantly associated with the occurrence of both internalizing and externalizing mental health disturbances, with the multiple-ACE subtype being most likely to report about significant mental health problems. The results of the present study point towards the relevance to routinely assess ACEs in young offenders to identify possible precursors of mental health problems and of future criminal behaviors.

Affective Dysregulation in Children Is Associated With Difficulties in Response Control in Emotional Ambiguous Situations

BACKGROUND

Affective dysregulation (AD), or synonymously "irritability," is a transdiagnostic construct that serves as a diagnostic criterion in various childhood mental disorders. It is characterized by severe or persistent outbursts of anger and aggression. Emotional self-regulation is highly dependent on the ability to process relevant and ignore conflicting emotional information. Understanding neurophysiological mechanisms underlying impairment in AD may provide a starting point for research on pharmacological treatment options and evaluation of psychotherapeutic intervention.

METHODS

A total of 120 children 8 to 12 years of age (63 with AD and 57 typically developing) were examined using an emotional Stroop task. Signal-decomposed electroencephalographic recordings providing information about the affected sensory-perceptual, response selection, or motor information processing stage were combined with source localization.

RESULTS

Behavioral performance revealed dysfunctional cognitive-emotional conflict monitoring in children with AD, suggesting difficulties in differentiating between conflicting and nonconflicting cognitive-emotional information. This was confirmed by the electroencephalographic data showing that they cannot intensify response selection processes during conflicting cognitive-emotional situations. Typically developing children were able to do so and activated a functional-neuroanatomical network comprising the left inferior parietal cortex (Brodmann area 40), right middle frontal (Brodmann area 10), and right inferior/orbitofrontal (Brodmann area 47) regions. Purely sensory-perceptual selection and motor execution processes were not modulated in AD, as evidenced by Bayesian analyses.

CONCLUSIONS

Behavioral and electroencephalogram data suggest that children with AD cannot adequately modulate controlled response selection processes given emotionally ambiguous information. Which neurotransmitter systems underlie these deficits and how they can be improved are important questions for future research.

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.

The Relationship between the Theory of Mind Skills and Disorder Severity among Adolescents with ADHD

Objective

This study aimed to examine the sub-dimensions of the theory of mind (ToM) and to investigate the relationship between ToM skills and disorder severity by comparing adolescents with attention-deficit hyperactive disorder (ADHD) with healthy individuals.

Methods

The study included 42 adolescents with ADHD and education- and age-matched 41 healthy volunteers. The Smarties test, ice cream truck test, faux pas recognition test, and eyes test were applied to all participants. Turgay Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV)-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was applied to the group with ADHD to measure the disorder severity.

Results

The group with ADHD was seen to have ToM skills impairment. There was a statistically significant difference between the groups in terms of the ice cream truck test, faux pas recognition test, and eyes test. A significant correlation was observed between the T-DSM-IV-S results and the eyes test results of the patients.

Conclusion

This study has shown that advanced ToM skills can be impaired in adolescents with ADHD and that impairment in skills is associated with disorder severity.

Transforming pediatric neuropsychology through video-based teleneuropsychology: an innovative private practice model pre-COVID-19

Objective

In pediatric neuropsychology multiple barriers such as long wait times until an appointment, insurance coverage, and limited providers who are bilingual/bicultural or who sub-specialize in pediatric neuropsychology, often slow families from receiving diagnoses and interventions in a timely and affordable manner. This paper focuses on increasing accessibility through the development of a video-based, pediatric teleneuropsychology (TeleNP) practice model that was developed in a private practice 2 years before the COVID-19 pandemic.

Method

‘Design thinking’ methodology to problem-solving was utilized to innovate the traditional neuropsychology practice model in under-served areas who may have limited financial and healthcare resources. The practice model approach to include a virtual diagnostic clinic with increased patient and provider efficiency was created to enhance accessibility for patients and sustainability for providers.

Results

Video-based TeleNP screenings were conducted for 67 children with developmental (i.e., attention deficit hyperactivity disorder, autism spectrum disorder) and language disorders, as well as concussion and psychiatric diagnoses. Additional comorbidities were identified in 65.6% of children. Follow-up data approximately 2 months later revealed 98.5% of children were receiving new interventions as a result of the video-based TeleNP assessment.

Conclusion

Video-based TeleNP benefits the consumer as it can reduce wait times, decrease family financial burden (i.e., travel and parent time off work), expedite referrals for interventions, and provide geographically under-served populations access to providers who are linguistically and culturally responsive. For providers, this model revealed improvements with direct implications for cost-saving, thereby facilitating long-term economic sustainability within a private practice healthcare marketplace.

A Measure of Emotional Regulation and Irritability in Children and Adolescents: The Clinical Evaluation of Emotional Regulation-9

Objective: To develop a scale for emotional regulation using item response theory. Method: Eighteen Swanson Nolan and Pelham (SNAP-IV) items that loaded on an emotional dysregulation factor were submitted to Rasch analysis. After eliminating the items that violated Rasch criteria, the remaining items were examined for reliability and validated against the Conners' emotional lability index. Results: A nine-item scale for emotional regulation was developed that satisfies the Rasch model and reliably distinguishes emotionally dysregulated/irritable children and adolescents. A score of 4 or higher in this scale has optimal accuracy for identifying children and adolescents with current significant dysfunction in emotional regulation. Among youth with ADHD inattentive, hyperactive-impulsive, and combined types, 42%, 56%, and 71% met the Clinical Evaluation of Emotional Regulation-9 (CEER-9) threshold for emotional lability, respectively. Conclusion: A nine-item scale whose sum total is a measure of emotional regulation is proposed as a tool for clinical and research purposes.

Blood oxytocin levels are not associated with ADHD tendencies and emotionality in healthy adults

Oxytocin (OT) regulates social and emotional behaviour. Core symptoms of attention-deficit/hyperactivity disorder (ADHD) include social and emotional dysfunctions potentially associated with lower endogenous OT levels. A dimensional approach was employed to examine relationships between plasma OT levels, ADHD tendencies, and emotionality in a healthy adult sample. Moreover, we aimed at replication of results regarding ADHD tendencies and emotionality from our previous work. Subjects were N = 110 healthy Chinese males (M_age: 22.01 ± 2.02 years). Variables of interest were plasma OT levels, individual variations in ADHD tendencies assessed via the Adult ADHD Self-Report Scale Symptom Checklist (ASRS), and positive and negative emotionality assessed via primary emotional traits of the Affective Neuroscience Personality Scales (ANPS). Hypotheses were tested by means of (partial) Spearman and Pearson correlations. Plasma OT levels were neither related to ADHD tendencies, nor to primary emotional traits. ADHD tendencies were significantly related to higher negative emotionality (correlation coefficients: r= .35 to r = .47) and lower positive emotionality (correlation coefficients: r= -.42 to r = -.36). The absence of associations between plasma OT levels and ADHD tendencies, primary emotional traits, and emotionality might be explained by the lack of robust associations between peripheral and central OT levels. Results regarding ADHD tendencies and emotionality replicate previous findings, emphasizing that (sub-clinically) elevated ADHD tendencies associate with dysregulated emotionality. Future studies examining the role of endogenous OT in ADHD should explore the generalizability of the present findings to women and patients with ADHD.

Skin Picking Successfully Treated With Atomoxetine in Comorbid Skin Picking and Attention-Deficit/Hyperactivity Disorder: A Case Report

"Skin picking disorder" (SPD: also known as neurotic excoriation, psychogenic excoriation, or dermatillomania) is classified in the "obsessive-compulsive and related disorders" category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and characterized by unintentional, repetitive skin picking behaviors. Atomoxetine is a selective noradrenaline reuptake inhibitor used in the treatment of attention-deficit/hyperactivity disorder (ADHD). In this case report, we present a 9-year-old girl with the comorbid diagnosis of ADHD and SPD treated successfully with atomoxetine. To our knowledge, this is the first report of skin picking treated with atomoxetine in a patient with ADHD. We discussed possible explanations of mechanisms. Further studies are required on the effectiveness of atomoxetine for the treatment of SPD in the presence and absence of comorbid ADHD.

Sex and Emotion Regulation Difficulties Contribute to Depression in Young Adults With Attention-Deficit/Hyperactivity Disorder

Many young adults with attention-deficit/hyperactivity disorder (ADHD) are at risk for depression. Yet, questions remain about factors associated with the development of depression in young adults with ADHD. This study examined the effects of sex and emotion regulation difficulties on depression in a sample of young adults with (n = 172) and without (n = 730) ADHD. Two aspects of emotion regulation difficulties were examined-impairments in emotional insight (i.e., lack of emotional awareness, nonacceptance of emotion, and lack of emotional clarity) and impairments in behavioral response to emotion (i.e., impulse control difficulties, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies). Significant correlations between ADHD and all indices of emotion regulation difficulty emerged. Sex moderated the association between ADHD and lack of emotional awareness, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies. Specifically, ADHD was significantly associated with limited emotion regulation awareness for women but not men, while ADHD was associated with greater difficulties engaging in goal-directed behavior and limited access to emotion regulation strategies for women compared to men. These three areas of emotion regulation dysfunction simultaneously mediated the association between ADHD and depression. The findings indicate the importance of considering emotion regulation and sex in understanding depression in young adults with ADHD.

Machine learning classification of ADHD and HC by multimodal serotonergic data

Serotonin neurotransmission may impact the etiology and pathology of attention-deficit and hyperactivity disorder (ADHD), partly mediated through single nucleotide polymorphisms (SNPs). We propose a multivariate, genetic and positron emission tomography (PET) imaging classification model for ADHD and healthy controls (HC). Sixteen patients with ADHD and 22 HC were scanned by PET to measure serotonin transporter (SERT') binding potential with [11C]DASB. All subjects were genotyped for thirty SNPs within the HTR1A, HTR1B, HTR2A and TPH2 genes. Cortical and subcortical regions of interest (ROI) were defined and random forest (RF) machine learning was used for feature selection and classification in a five-fold cross-validation model with ten repeats. Variable selection highlighted the ROI posterior cingulate gyrus, cuneus, precuneus, pre-, para- and postcentral gyri as well as the SNPs HTR2A rs1328684 and rs6311 and HTR1B rs130058 as most discriminative between ADHD and HC status. The mean accuracy for the validation sets across repeats was 0.82 (±0.09) with balanced sensitivity and specificity of 0.75 and 0.86, respectively. With a prediction accuracy above 0.8, the findings underlying the proposed model advocate the relevance of the SERT as well as the HTR1B and HTR2A genes in ADHD and hint towards disease-specific effects. Regarding the high rates of comorbidities and difficult differential diagnosis especially for ADHD, a reliable computer-aided diagnostic tool for disorders anchored in the serotonergic system will support clinical decisions.

A systematic review of coping strategies in parents of children with attention deficit hyperactivity disorder (ADHD)

BACKGROUND

Parents of children with attention deficit hyperactivity disorder (ADHD) use several coping strategies to deal with ADHD symptoms impacting family life.

AIM

The aim of this systematic review was to summarize the coping strategies used by parents of children with ADHD, identify which tools are most frequently used to measure coping strategies, and examine factors influencing parental coping.

METHOD

According to PRISMA guidelines, we searched for articles indexed in PubMed, EBSCOhost, Scopus, and Web of Science using a combination of expressions including "coping" AND "ADHD" OR "attention-deficit/hyperactivity disorder" AND "parent" OR "parenting" OR "caregiver".

RESULTS

Fourteen empirical studies were identified as relevant to our research. Many different types of tools are used to assess coping strategies. We found that parents of ADHD children used more avoidant-focused coping strategies than parents of typical children. Mothers of ADHD children sought significantly more support and used more indirect means than mothers of typically developing (TD) children.

CONCLUSIONS

This review underlines the importance of further exploring coping mechanisms of parents of children with ADHD in order to promote positive coping strategies for parents of children with ADHD, and to help such parents to identify people who can support them.

A new semi-nonverbal task glance, moderate role of cognitive flexibility in ADHD children's theory of mind

Introduction: Studies have documented both executive functions (EF) impairment in children with Attention Deficit / Hyperactivity Disorders (ADHD) and Theory of Mind (ToM), yielding mixed results, possibly because of a variety of tasks used, all requiring different levels of language skills.Aim: To investigate the relationship between ToM and EF with non-language-based tasks.Methods: Thirty ADHD (7-9 years old) were compared to thirty controls (age and IQ matched). Participants' ToM was assessed using the Animated Triangles task and two EF tasks, namely spatial control test, the Stockings Of Cambridge (SOC) and rule and acquisition test, the Intra-Extra Dimensional set shift (IED)-from the neuropsychological battery of the Cambridge Neuropsychological Test Automated Battery (CANTAB).Results: ADHD group had a significant ToM and EF impairment relative to the control group. ToM was not significantly correlated with EF; however, the performance on IED tasks affected the performance on ToM tasks.Discussion: The study provides evidence for a link between the abilities to attribute correct mental states to others, planning and shifting attention in ADHD children, suggesting the ability to rely on cognitive flexibility in the face of a changing environment plays a role in explaining the association between ToM and EF.

A Controlled Trial of Extended-Release Guanfacine and Psychostimulants on Executive Function and ADHD

Objective: To evaluate the effectiveness of guanfacine extended-release (GXR) versus placebo as adjunct therapy to usual care stimulant therapy in improving executive function in children aged 6 to 12 years diagnosed with ADHD. Method: In this single center, double-blind placebo-controlled crossover trial, subjects continued to take their psychostimulant and were randomly assigned at baseline to receive active treatment or placebo first. Efficacy measures included Behavioural Rating Inventory of Executive Function (BRIEF-P), ADHD Rating Scale IV (ADHD-RS IV), and Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) scales. Safety measures included adverse events and vital signs. Results: Significant benefits of GXR plus psychostimulant were observed on BRIEF-P (p value = .0392), ADHD-RS-IV (p < .0001), CGI-S (p = .0007), and CGI-I (p = .003). There were no serious adverse events and no new safety signals. Conclusion: Use of GXR as adjunctive therapy to stimulant therapy significantly improves executive function in children with ADHD.

Mineral-Vitamin Treatment Associated with Remission in Attention-Deficit/Hyperactivity Disorder Symptoms and Related Problems: 1-Year Naturalistic Outcomes of a 10-Week Randomized Placebo-Controlled Trial

Objective: This article presents 1-year follow-up of a randomized placebo-controlled trial with open-label extension evaluating the efficacy of a broad-spectrum micronutrient (vitamins and minerals) intervention. The object was to determine if dominant treatment at follow-up was associated with differential psychological outcomes. Methods: Ninety percent of the original sample of 93 children with attention-deficit/hyperactivity disorder (ADHD) were followed 52 weeks postbaseline. Assessments included measures of ADHD, mood, anxiety, and general function based on parent/clinician report. Outcome was considered based on dominant therapy at 52 weeks (trial micronutrients [n = 19], medications [n = 21], and no treatment [n = 35]). Nine children were not categorized due to inconsistent therapies. Results: Based on dominant treatment, more of those who stayed on trial micronutrients (84%) were identified as "Much" or "Very Much" improved overall relative to baseline functioning, compared to 50% of those who switched to psychiatric medications and only 21% of those who discontinued treatment [χ²(2) = 19.476, p < 0.001]. Fifteen (79%) of those still taking micronutrients, 8 (42%) of those using medications, and 7 (23%) of those who discontinued treatment were considered remitters based on parent-reported ADHD [χ²(2) = 15.3, p < 0.001]. Those who stayed on micronutrients were more likely to have failed medication treatment in the past. The micronutrient group also displayed better outcomes on measures of parent-rated hyperactivity and anxiety, and clinician-rated general function and mood, with moderate to large between-group effect sizes (micronutrients vs. medication: ES = 0.73-1.01; micronutrients vs. no treatment: ES = 0.54-1.01). Most common reasons for stopping trial micronutrients were cost and number of pills to swallow. No continued side effects were associated with micronutrients. Conclusions: Children who benefitted from micronutrients in the short term maintained changes at follow-up, without side effects. While both those who continued micronutrients and those who switched to medication showed improved ADHD symptoms, psychiatric medication use was associated with deterioration in mood and anxiety. Inherent selection bias limits generalizability.

Prenatal pet keeping and caregiver-reported attention deficit hyperactivity disorder through preadolescence in a United States birth cohort

BACKGROUND

While the keeping of pets has been shown to protect against childhood allergic disease and obesity, less is known regarding potential associations of prenatal pet keeping and attention deficit hyperactivity disorder (ADHD). We sought to examine the associations between prenatal dog or cat keeping with caregiver-reported ADHD in preadolescents in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) birth cohort (N = 1258).

METHODS

At an interview with the caregiver at child age 10-12 years, caregivers reported if the WHEALS child had ever been diagnosed with ADHD. Similarly, during an interview with the mother prenatally, pet keeping (defined as dog or cat kept inside ≥1 h/day) was ascertained. Logistic regression models were fit to examine the association of prenatal pet keeping (dog keeping and cat keeping, separately) with ADHD.

RESULTS

A subset of 627 children were included in the analyses: 93 who had ADHD and 534 with neurotypical development. After accounting for confounders and loss to follow-up, maternal prenatal dog exposure was associated with 2.23 times (95% CI: 1.15, 4.31; p = 0.017) greater odds of ADHD among boys. Prenatal dog keeping was not statistically significantly associated with ADHD in girls (odds ratio = 0.27, 95% CI: 0.06, 1.12; p = 0.070). Prenatal cat keeping was not associated with ADHD.

CONCLUSIONS

In boys, but not girls, maternal prenatal dog keeping was positively associated with ADHD. Further study to confirm these findings and to identify potential mechanisms of this association (e.g., modification of the gut microbiome, exposure to environmental toxicants or pet-related medications) is needed.

Interactive Avatar Boosts the Performances of Children with Attention Deficit Hyperactivity Disorder in Dynamic Measures of Intelligence

This study examined both children with attention deficit hyperactivity disorder (ADHD) and typically developing students in dynamic measures of intelligence through the use of a virtual avatar. Three conditions were compared: in the first condition, the avatar simply gave the instructions; in the second condition, the avatar presented the instructions and gave feedback on the attention of the learner; in the third condition, the avatar was not presented. Results indicated that ADHD subtypes do not differ in problem solving and the interactive avatar improved the performance of groups with ADHD in the dynamic intelligence test. Overall, these results support the hypothesis that the function of regulation and feedback of the avatar improve the attention process and, consequently, boosts performance.

Risk of Dementia in Adults With ADHD: A Nationwide, Population-Based Cohort Study in Taiwan

OBJECTIVE

This study aimed to investigate the association between adults with ADHD and the risk of developing dementia.

METHOD

Utilizing National Health Insurance Research Database of Taiwan, ADHD patients were identified and compared with age- and gender-matched controls (1:3).

RESULTS

Of the study participants, 37 (5.48%) developed dementia compared with 81 (4.0%) in the control group. Cox proportional hazards regression analysis revealed that the study participants were more likely to develop dementia. The crude hazard ratio (HR) is 3.418 (95% confidence interval [CI] = [2.289, 5.106], p < .001), and adjusted HR is 4.008 (95% CI = [2.526, 6.361], p < .001) in risk of developing dementia after adjusted for age, gender, comorbidities, geographical area of residence, urbanization level of residence, and monthly income.

CONCLUSION

Adults with ADHD have a 3.4-fold risk of developing dementia, and other large or national data sets should be explored to support the current findings.

Pupillary Light Reflex in Children with ADHD

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequently seen mental disorders in children with an increasing risk for other mental disorders. ADHD represents a primary biological dysfunction of the central nervous system, such as dysregulation of frontal-subcortical-cerebellar catecholaminergic circuits and imbalances in the dopaminergic system. However, autonomic nervous system, comprised of two primary branches - sympathetic and parasympathetic nervous systems that are normally in dynamic balance, plays an essential role in the regulation of body functions. Although it is generally assumed that the autonomic regulation is impaired during ADHD the information related to this dysregulation is limited. One of the options to observe changes of autonomic balance in ADHD is pupillary light reflex (PLR). Pupillometric evaluation can be used for the assessment of functioning of both autonomic nervous system branches and certain parameters of pupil responsivity can be helpful as a tool for medical diagnostic and treatment. In conclusion, these findings suggest the pupillometry as a non-invasive method that can indicate abnormalities in the complex central autonomic network regulating PLR.

Interrater agreement on behavioral executive function measures in adolescents with Attention Deficit Hyperactivity Disorder

Though most children with Attention Deficit Hyperactivity Disorder (ADHD) show difficulties in behavioral measures of executive functions (EF), few studies have examined interrater agreement in these measures.

OBJECTIVE

To analyze the agreement between parents, teachers and self-reports of behavioral EF in adolescents with ADHD and controls.

METHOD

A sample of 118 adolescents (75 with ADHD and 43 controls) was rated by parents, teachers and the adolescents themselves using the Comprehensive Executive Function Inventory. The intraclass correlation coefficient (ICC) and Bland and Altman methods were used to evaluate agreement.

RESULTS

The ICC between parents, teachers and self-report was poor or moderate in the group with ADHD; in the control group the agreement was fair to good. The Bland and Altman graphs show that, in the control group, most of the scores are below to the clinical cut-off point, while in the group with ADHD they are above.

CONCLUSIONS

Agreement between all raters was low. Parents, teachers and adolescents agreed on the absence of deficits in behavioral EF in the control group, and on the presence of deficits in the group with ADHD, although they did not agree on the frequency of these deficits.

Perceptual timing in children with attention-deficit/hyperactivity disorder (ADHD) as measured by computer-based experiments versus real-life tasks: protocol for a cross-sectional experimental study in an ambulatory setting

INTRODUCTION

The goal of this study is to get a better understanding of the fundamentals of perceptual timing deficits, that is, difficulties with estimating durations of explicitly attended temporal intervals, in children with attention-deficit/hyperactivity disorder (ADHD). Whereas these deficits were repeatedly demonstrated in laboratory studies using computer-based timing tasks, we will additionally implement a more practical task reflecting real-life activity. In doing so, the research questions of the planned study follow a hierarchically structured path 'from lab to life': Are the timing abilities of children with ADHD really disturbed both in the range of milliseconds and in the range of seconds? What causes these deficits? Do children with ADHD rather display a global perceptual timing deficit, or do different 'timing types' exist? Are timing deficits present during real-life activities as well, and are they based on the same mechanisms as in computerised tasks?

METHODS AND ANALYSES

A quasi-experimental study with two groups of male children aged 8-12 years (ADHD; controls) and with a cross-sectional design will be used to address our research questions. Statistical analyses of the dependent variables will comprise (repeated) measures analyses of variance, stepwise multiple regression analyses and latent class models. With an estimated dropout rate of 25%, power analysis indicated a sample size of 140 subjects (70 ADHD, 70 controls) to detect medium effect sizes.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the ethics committee of the Faculty of Medicine, University of Rostock. Results will be disseminated to researcher, clinician and patient communities in peer-reviewed journals and at scientific conferences, at a meeting of the local ADHD competence network and on our web page which will summarise the study results in an easily comprehensible manner.

TRIAL REGISTRATION NUMBER

DRKS00015760.