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Bell LJ, John OP, Hinshaw SP. ADHD Symptoms in Childhood and Big Five Personality Traits in Adolescence: A Five-Year Longitudinal Study in Girls. Res Child Adolesc Psychopathol 2024; 52:1369-1382. [PMID: 38809446 DOI: 10.1007/s10802-024-01204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/30/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by developmentally extreme and impairing symptoms of inattention and/or hyperactivity/impulsivity. Great interest has emerged in the ways ADHD and its underlying symptom dimensions relate to the development of personality traits. Much extant research on this topic is cross-sectional, relying on self-report measures and male samples. Herein, we present data from a prospective, longitudinal study of a socioeconomically and racially diverse sample of girls, including those with ADHD and a matched neurotypical comparison sample. We examined how parent- and teacher-reported ADHD in middle childhood relate to self-reported Big Five personality traits in adolescence. As expected, childhood ADHD diagnosis prospectively predicted lower self-reported Conscientiousness, lower Agreeableness, and higher Neuroticism in adolescence. With ADHD diagnosis covaried, Inattention (IA) predicted only low Conscientiousness, Hyperactivity/Impulsivity (HI) predicted only low Agreeableness, and neither predicted adolescent Neuroticism. An exploratory moderator analysis showed that family income moderated the effects of IA and HI on the negativity of adolescent self-descriptions of their own personalities, with more pronounced negative effects for girls in families with higher (rather than lower) income. Familial pressures to achieve in higher-income families may be linked to more pronounced negative ramifications of ADHD on personality development.
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Affiliation(s)
- Laura J Bell
- Department of Psychology, University of California, Berkeley, USA.
| | - Oliver P John
- Department of Psychology, University of California, Berkeley, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
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Zheng Q, Shum KKM. Brief Report: A Randomized Controlled Trial of a Digital Working Memory Intervention for Preschoolers Displaying ADHD Symptoms. J Autism Dev Disord 2024:10.1007/s10803-023-06213-1. [PMID: 38197998 DOI: 10.1007/s10803-023-06213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE This study aimed to investigate the effects of a self-paced digital working memory (WM) intervention on preschoolers with ADHD symptoms and explore the relation between WM and time perception (TP) through a randomized controlled trial. METHOD Fifty preschoolers between four-to-six years of age (M = 4.93 years) were randomly assigned to three groups: a WM training group (WM; n = 14), a social-emotional (SE) training active control group (n = 15), and a waitlist control group (n = 21). Both the WM and SE groups received fifteen 10-min self-paced digital training sessions over five consecutive weeks. RESULTS The digital WM training was effective in improving children's digit span performance compared to the waitlist control group only. Within-group comparisons across two time points indicated a near-significant improvement in numeration and trends of reduced ADHD symptoms and improved TP tasks in the WM group at the post-test, but between-group differences were not observed. CONCLUSION The study showed limited effects of the WM training on preschoolers displaying ADHD symptoms. However, the results implied an association between working memory and time perception that awaits further investigation.
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Affiliation(s)
- Que Zheng
- Department of Psychology, The University of Hong Kong, Hong Kong, China
- Department of Social Work, The Guangdong University of Technology, Guangdong, China
| | - Kathy Kar-Man Shum
- Department of Psychology, The University of Hong Kong, Hong Kong, China.
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Abhayaratna HC, Ariyasinghe DI, Ginige P, Chandradasa M, Hansika KS, Fernando A, Wijetunge S, Dassanayake TL. Psychometric properties of the Sinhala version of the Swanson, Nolan, and Pelham rating scale (SNAP-IV) Parent Form in healthy children and children with ADHD. Asian J Psychiatr 2023; 83:103542. [PMID: 36963301 DOI: 10.1016/j.ajp.2023.103542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE The present study aimed to translate and adapt the Parent Form of the MTA Version of the Swanson, Nolan, and Pelham ADHD/ODD rating scale (SNAP-IV) into Sinhala and examine its psychometric properties. METHOD The MTA version of the SNAP-IV was translated into the Sinhala language by adhering to the WHO translation and adaptational process. The final Sinhala SNAP-IV (S-SNAP-IV) was administered to parents of 412 healthy children and adolescents (age: 6-18 years), and 272 children and adolescents with ADHD (age: 4-19 years). Internal consistency and factor structure of the S-SNAP-IV were determined in each sample. RESULTS Conforming to that of the original English version, the S-SNAP-IV showed a three-factor structure (inattention, hyperactivity/impulsivity, and oppositional defiant disorder) in each sample, except for three item deviations (10,11, and 13) in the healthy sample. The S-SNAP-IV showed excellent internal consistency in the total sample (Cronbach's alpha = 0.97), healthy sample (Cronbach's alpha = 0.90), and the clinical sample (Cronbach's alpha = 0.94). The S-SNAP-IV also showed good discriminative validity: Only 1.5% of the healthy sample exceeded the cut-off scores in any domain, whereas all newly diagnosed, unmedicated children were S-SNAP-IV positive in at least one domain. CONCLUSIONS The findings suggest that the three-factor model fits the S-SNAP-IV, and it clearly distinguishes children with ADHD from non-ADHD children. We conclude that the S-SNAP-IV possesses satisfactory psychometric properties-consistent with the MTA English version and its translations into other languages-making it a reliable and valid instrument for screening children with ADHD.
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Affiliation(s)
| | | | - Pabasari Ginige
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Miyuru Chandradasa
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka; Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | | | | | - Tharaka L Dassanayake
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Sri Lanka; School of Psychological Sciences, The University of Newcastle, Australia; Teaching Hospital Peradeniya, Sri Lanka.
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Zheng Q, Cheng YY, Sonuga-Barke E, Shum KKM. Do Executive Dysfunction, Delay Aversion, and Time Perception Deficit Predict ADHD Symptoms and Early Academic Performance in Preschoolers. Res Child Adolesc Psychopathol 2022; 50:1381-1397. [PMID: 35689730 PMCID: PMC9187895 DOI: 10.1007/s10802-022-00937-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) are commonly observed to have learning difficulties. This study examined how three neuropsychological constructs—executive dysfunction, delay aversion, and time perception—were associated with ADHD symptoms and early academic performance in preschoolers at risk of ADHD. One hundred and thirty-one preschoolers (70 boys, 53%) aged 4 to 6 (M = 5.31 years) were assessed on their ADHD-related behaviors, neuropsychological functioning, word reading, and math abilities at two time points one year apart. Factor analysis indicated that inhibitory and attentional control deficit, delay aversion, and time perception/working memory deficit were three dissociable factors. Among the three factors, inhibitory and attentional control measured at Time 1 was the strongest predictor of ADHD symptoms at both Time 1 and Time 2. Time perception was closely related to working memory, and they predicted word reading and numeration across time most strongly among other neuropsychological constructs. Our findings suggested that inhibitory and attentional control, delay aversion, and time perception are dissociable neuropsychological deficits underlying ADHD symptoms in preschoolers. Poor time perception may serve as a marker for the early identification of preschoolers with potential learning problems, and a possible target of intervention for ADHD.
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Affiliation(s)
- Que Zheng
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Yu Yan Cheng
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Edmund Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Nam SH, Lim MH, Park TW. Stimulant Induced Movement Disorders in Attention Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2022; 33:27-34. [PMID: 35418800 PMCID: PMC8984208 DOI: 10.5765/jkacap.210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/11/2022] Open
Abstract
Stimulants, such as amphetamine and methylphenidate, are one of the most effective treatment modalities for attention deficit hyperactivity disorder (ADHD) and may cause various movement disorders. This review discusses various movement disorders related to stimulant use in the treatment of ADHD. We reviewed the current knowledge on various movement disorders that may be related to the therapeutic use of stimulants in patients with ADHD. Recent findings suggest that the use of stimulants and the onset/aggravation of tics are more likely to be coincidental. In rare cases, stimulants may cause stereotypies, chorea, and dyskinesia, in addition to tics. Some epidemiological studies have suggested that stimulants used for the treatment of ADHD may cause Parkinson’s disease (PD) after adulthood. However, there is still a lack of evidence that the use of stimulants in patients with ADHD may cause PD, and related studies are only in the early stages. As stimulants are one of the most commonly used medications in children and adolescents, close observations and studies are necessary to assess the effects of stimulants on various movement disorders, including tic disorders and Parkinson’s disease.
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Affiliation(s)
- Seok-Hyun Nam
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Public Human Resources, Dankook University, Cheonan, Korea
| | - Tae Won Park
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Psychiatry, Jeonbuk National University College of Medicine, Jeonju, Korea
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Does Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD? CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Anxiety disorders are common comorbidities in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are also at a high risk of bullying behavior. However, little is known about the roles of anxiety symptomatology in the relationship between ADHD and bullying behavior.
Objective
This cross-sectional, clinic-based study aims to investigate the associations between anxiety symptomatology and bullying involvement in youth with ADHD.
Method
One hundred and eighty children and adolescents with ADHD aged 10–18 years participated in the study. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was self-rated, and the participants were interviewed with the Revised Olweus Bully/Victim Questionnaire to categorize bullying involvement. Data were analyzed through percentage, nonparametric statistics, chi-squared statistics, and logistic regression analysis.
Results
Sixty-nine percent of youth with ADHD reported involvement in bullying, of which 33.3%, 8.9%, and 27.2% were classified as victims, bullies, and bully-victims, respectively. The means and 95% confidence intervals of the total SCARED scores showed a significant difference among bullying behavior groups. The highest SCARED scores could be noticed in the victim and bully-victim groups, with the lowest scores observed in the bully group. Youth with ADHD who had comorbid anxiety were 3.51 times more likely to be bullied than those who did not have anxiety.
Conclusions
A differential effect of anxiety symptomatology on bullying behavior in youth with ADHD was evident. These results highlight the utility of including anxiety in the conceptualization of bullying problems in youth with ADHD to plan successful anti-bullying interventions.
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Swansburg R, Hai T, MacMaster FP, Lemay JF. Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada. Paediatr Child Health 2021; 26:e199-e207. [PMID: 34326910 PMCID: PMC8194688 DOI: 10.1093/pch/pxab030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives The COVID-19 pandemic created an environment of restricted access to health and recreation services. Lifestyle habits including sleep, eating, exercise, and screen use were modified, potentially exacerbating adverse mental health outcomes. This study investigates the impact of COVID-19 on lifestyle habits and mental health symptoms in paediatric attention-deficit/hyperactivity disorder (ADHD) in Canada. Methods An online survey was distributed across Canada to caregivers of children with ADHD (children aged 5 to 18 years) assessing depression (PHQ-9), anxiety (GAD-7), ADHD (SNAP-IV), and lifestyle behaviours. Data were analyzed by gender (male/female) and age category (5 to 8, 9 to 12, and 13 to 18 years). Spearman’s correlations between lifestyle habits and mental health outcomes were conducted. Results A total of 587 surveys were completed. Mean child age was 10.14 years (SD 3.06), including 166 females (28.3%). The PHQ-9 and GAD-7 indicated that 17.4% and 14.1% of children met criteria for moderately severe to severe depression and anxiety symptoms respectively. Children met SNAP-IV cut-off scores for inattention (73.7%), hyperactivity/impulsivity (66.8%), and oppositional defiant disorder (38.6%) behaviours. Caregivers reported changes in sleep (77.5%), eating (58.9%), exercise (83.7%), and screen use (92.9%) in their ADHD child, greatly impacting youth. Sleeping fewer hours/night, eating more processed foods, and watching TV/playing videogames >3.5 hours/day correlated with greater depression, anxiety and ADHD symptoms, and exercising <1 hour/day further correlated with depression symptoms (P<0.01). Conclusions The COVID-19 pandemic has resulted in less healthy lifestyle habits and increased mental health symptoms in Canadian children with ADHD. Longitudinal studies to better understand the relationship between these factors are recommended.
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Affiliation(s)
- Rose Swansburg
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tasmia Hai
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Frank P MacMaster
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jean-François Lemay
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Aiding diagnosis of childhood attention-deficit/hyperactivity disorder of the inattentive presentation: Discriminant function analysis of multi-domain measures including EEG. Biol Psychol 2021; 161:108080. [PMID: 33744372 DOI: 10.1016/j.biopsycho.2021.108080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We developed a neurocognitive assessment tool (NCAT) in consultation with mental health professionals working with children with AD/HD as a diagnostic aid and screening tool. This study examines the predictive utility of NCAT in the classification of children with AD/HD Inattentive presentation. METHOD Fifty three children with AD/HD Inattentive presentation and 161 typically-developing children completed an NCAT assessment. Discriminant function analyses examined group membership prediction for separate components of NCAT and for the components combined. RESULTS The combined model correctly classified 93.4 % of participants, with 91.4 % sensitivity and 93.9 % specificity. Contributions to classification were from SNAP-IV, psychological needs satisfaction, self-regulation, executive function performance, and EEG. The combined model resulted in a 9.3 % increase in specificity and 5.9 % increase in sensitivity compared to SNAP-IV alone. CONCLUSIONS NCAT provides good discrimination between children with and without AD/HD of the Inattentive presentation, and further investigation including other subtypes and comorbidities is warranted.
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Takeda T, Nissley-Tsiopinis J, Nanda S, Eiraldi R. Factors Associated With Discrepancy in Parent-Teacher Reporting of Symptoms of ADHD in a Large Clinic-Referred Sample of Children. J Atten Disord 2020; 24:1605-1615. [PMID: 27261499 DOI: 10.1177/1087054716652476] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To identify factors associated with discrepancy in parent-teacher reporting of symptoms of ADHD. Method: Parents and teachers rated 1,364 children using an ADHD rating scale. Data were analyzed using multiple regressions and ANOVA. Results: Demographic variables predicted greater parent-teacher discrepancy for ethnic minority families than for Caucasian families. Comorbidity variables predicted greater discrepancy for children who had a comorbid externalizing disorder. Academic performance variables predicted discrepancy for children who showed more homework problems. When all significant predictors were entered together, externalizing disorders and homework problems emerged as significant predictors. Participants whose parents reported higher levels of symptoms were of significantly higher socioeconomic status. Participants whose teachers reported higher levels of symptoms were significantly less likely to have a comorbid externalizing disorder and parent-reported homework problems. Conclusion: Parent-teacher discrepancies are likely to occur when the child has significant homework and externalizing behavior problems.
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Affiliation(s)
| | | | | | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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10
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Macoun SJ, Pyne S, MacSween J, Lewis J, Sheehan J. Feasibility and potential benefits of an attention and executive function intervention on metacognition in a mixed pediatric sample. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:240-252. [PMID: 32701379 DOI: 10.1080/21622965.2020.1794867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The term "metacognition" describes thinking about a cognitive phenomenon or, more simply put, thinking about thinking . Metacognition involves using knowledge about one's cognitive processes to change behavior, including monitoring and controlling cognition. Metacognition is vital for learning and is often more difficult for children with neurodevelopmental concerns (e.g. Attention Deficit Hyperactivity Disorder [ADHD], Fetal Alcohol Spectrum Disorder [FASD], Autism Spectrum Disorders [ASD]), possibly due to underlying deficits in attention and executive functioning (EF). The present study evaluated a 6- to 8-week cognitive intervention aimed at improving attention and EF and children's metacognitive abilities. Participants included a mixed sample of 50 children ages 6-12 years presenting with attention and/or EF deficits. Children within the active intervention group completed a game-based attention/EF intervention called Caribbean Quest (CQ), which combines process-specific and compensatory approaches to remediate attention and EF. Educational Assistants (EAs) supported children during gameplay by teaching explicit metacognitive strategies. Pre/post assessments included measures of attention and working memory (WM), metacognitive awareness (child, parent, and EA questionnaires), and metacognitive regulation (metacognitive monitoring and control). Results indicated post-intervention gains in WM, metacognitive awareness, and metacognitive regulation (self-monitoring and metacognitive control). These results provide preliminary support for CQ as potentially beneficial in improving aspects of EF and metacognition in children.
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Affiliation(s)
- Sarah J Macoun
- Psychology Department, University of Victoria, Victoria, British Columbia, Canada
| | - Sarah Pyne
- Psychology Department, University of Victoria, Victoria, British Columbia, Canada
| | - Jennifer MacSween
- Psychology Department, University of Victoria, Victoria, British Columbia, Canada
| | - Jessica Lewis
- Psychology Department, University of Victoria, Victoria, British Columbia, Canada
| | - John Sheehan
- Psychology Department, University of Victoria, Victoria, British Columbia, Canada
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Hall CL, Guo B, Valentine AZ, Groom MJ, Daley D, Sayal K, Hollis C. The Validity of the SNAP-IV in Children Displaying ADHD Symptoms. Assessment 2019; 27:1258-1271. [PMID: 30991820 DOI: 10.1177/1073191119842255] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) is a widely used scale that measures the core symptoms of attention deficit hyperactivity disorder (ADHD). However, there are contradictory findings regarding factor structure. Factor structure and measurement equivalence/invariance analysis on parent and teacher SNAP-IV for children referred for an ADHD assessment (N = 250; 6-17 years), revealed a two-factor structure provided the best fit. SNAP-IV scores were also compared with clinician diagnosis of ADHD and research diagnoses of ADHD and hyperkinetic disorder. Parent ratings of inattention and hyperactivity/impulsivity were good predictors of research but not clinician diagnosis. For teacher ratings, only hyperactivity/impulsivity scores were associated with research and clinician diagnosis. SNAP-IV scores showed high sensitivity but low specificity to clinician diagnosis. The SNAP-IV is a valid outcome measure for use in randomized controlled trials and clinical settings, and is best used as a screening rather than a diagnostic tool for ADHD.
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Affiliation(s)
- Charlotte L Hall
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Althea Z Valentine
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Madeline J Groom
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - David Daley
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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Dornelas LF, Duarte NMC, Morales NMO, Pinto RMC, Araújo RRH, Pereira SA, Magalhães LC. Functional Outcome of School Children With History of Global Developmental Delay. J Child Neurol 2016; 31:1041-51. [PMID: 26936059 DOI: 10.1177/0883073816636224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the functional and developmental outcomes in school age children diagnosed with global developmental delay before 2 years old and to verify the association between their final diagnosis and environmental and biological factors. Forty-five Brazilian children (26 boys), mean age 95.84 (7.72) months, who attended regular school and were diagnosed with global developmental delay before they were 2 years old had their functions evaluated. Children with global developmental delay were diagnosed with several conditions at school age. Students with greater chances of receiving a diagnosis were those whose mothers were younger at the time their children were born (OR = 1.47, CI = 1.04-2.09, P = .03), who had impaired motor performance, specially balance (OR = 1.33, CI = 1.01-1.75, P = .04), and who needed help during cognitive and behavioral tasks at school (OR = 1.08, CI = 1.00-1.17, P = .048). Interdisciplinary evaluation contributed to defining the specific diagnosis and to identifying the necessity of specialized support.
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Affiliation(s)
| | - Neuza M C Duarte
- Association of Assistance for Children with Disabilities, Minas Gerais, Brazil
| | - Nívea M O Morales
- Department of Pediatrics, Medical School, Universidade Federal de Uberlândia, Minas Gerais, Brazil
| | - Rogério M C Pinto
- Mathematics School, Universidade Federal de Uberlândia, Minas Gerais, Brazil
| | - Renata R H Araújo
- Association of Assistance for Children with Disabilities, Minas Gerais, Brazil
| | - Sílvia A Pereira
- Association of Assistance for Children with Disabilities, Minas Gerais, Brazil
| | - Lívia C Magalhães
- Occupational Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil
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Pastura G, Kubo TTA, Gasparetto EL, Figueiredo O, Mattos P, Prüfer Araújo A. Pilot study of brain morphometry in a sample of Brazilian children with attention deficit hyperactivity disorder: influence of clinical presentation. Clin Neuroradiol 2016; 27:503-509. [PMID: 27137781 DOI: 10.1007/s00062-016-0512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 03/15/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Currently, the diagnosis of attention deficit hyperactivity disorder (ADHD) rests on clinical criteria. Nonetheless, neuroimaging studies have demonstrated that children with ADHD have different cortical thickness and volume measures to typically developing children (TDC). In general, studies do not evaluate the influence of clinical presentation in the brain morphometry of ADHD children. Our objective was to perform a pilot study in order to evaluate cortical thickness and brain volume in a sample of Brazilian ADHD children and compare these to those of TDC, taking into account the influence of clinical presentation. METHODS We performed an analytic study comparing 17 drug-naïve ADHD children of both genders, aged between 7 and 10, and 16 TDC. ADHD subjects were first considered as one group and further separated based on clinical presentation. RESULTS The brain volume did not differ between patients and TDC. Smaller cortical thicknesses were identified on the left superior, medium and inferior temporal cortex, as well as in the left inferior parietal cortex. When compared to TDC, combined and inattentive ADHD presentations depicted smaller cortical thickness with high significance and power. The same magnitude of results was not observed when comparing inattentive ADHD and TDC. CONCLUSIONS In this pilot study, ADHD is associated with abnormalities involving the cortical thickness of the posterior attentional system. The cortical thickness in the left superior, medium and inferior temporal cortex, as well as in the left inferior parietal cortex may differ according to ADHD presentations.
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Affiliation(s)
- Giuseppe Pastura
- Departamento de Pediatria, Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil.
| | | | | | - Otavio Figueiredo
- COPPEAD Institute, The Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Mattos
- Department of Psychiatry, The Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Rêgo GG, Campanhã C, Kassab AP, Romero RL, Minati L, Boggio PS. Adult-like neuroelectrical response to inequity in children: Evidence from the ultimatum game. Soc Neurosci 2015; 11:193-206. [DOI: 10.1080/17470919.2015.1057295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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El Malhany N, Gulisano M, Rizzo R, Curatolo P. Tourette syndrome and comorbid ADHD: causes and consequences. Eur J Pediatr 2015; 174:279-88. [PMID: 25224657 DOI: 10.1007/s00431-014-2417-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/27/2014] [Accepted: 09/01/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Attention deficit hyperactivity disorder (ADHD) is the most common comorbid condition in patients with Tourette syndrome (TS). The co-occurrence of ADHD and TS is in most cases associated with a higher social and psychopathological impairment. Comorbidity between Tourette and ADHD appears to have a complex and partially known pathogenesis in which genetic, environmental, and neurobiological factors can be implicated. Genetic studies have revealed an involvement of dopaminergic, catecholaminergic, and GABAergic genes that modulated the activity of neurotransmitters. Furthermore, there are a lot of networks implicated in the development of ADHD and TS, involving cortical and striatal areas and basal ganglia. Although a large number of studies tried to find a common pathogenesis, the complex pathways responsible are not clear. The genes implicated in both disorders are currently unidentified, but it is probable that epigenetic factors associated with neural modifications can represent a substrate for the development of the diseases. CONCLUSION In this paper, recent advances in neurobiology of ADHD and TS are reviewed, providing a basis for understanding the complex common pathogenesis underlying the frequent co-occurrence of the two conditions and the therapeutic choices.
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Affiliation(s)
- N El Malhany
- Section of Child Neuropsychiatry, Department of Neurosciences, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy,
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Motor Skills in Brazilian Children with Developmental Coordination Disorder versus Children with Motor Typical Development. Occup Ther Int 2014; 21:176-85. [DOI: 10.1002/oti.1376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/13/2014] [Accepted: 08/06/2014] [Indexed: 11/07/2022] Open
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A School-Based Post-Katrina Therapeutic Intervention. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:363-72. [DOI: 10.1007/s10488-014-0576-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Agostini OS, Magalhães LDC, Campos AF. Assessment of motor coordination and dexterity of six years old children: A psychometric analysis. MOTRIZ: REVISTA DE EDUCACAO FISICA 2014. [DOI: 10.1590/s1980-65742014000200006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Motor coordination of six-year-old children was examined using the Assessment of Motor Coordination and Dexterity, AMCD (Avaliação da Coordenação e Destreza Motora - ACOORDEM), in order to verify test-retest reliability and investigate whether motor performance is influenced by gender, type of school and residence location. Eighty-five children were evaluated, and their parents and teachers completed questionnaires. For test-retest reliability, the AMCD was repeated with 10 children. Mann-Whitney and chi-square tests identified significant influence of sex, type of school and residence location in just a few of the test items. The test-retest reliability was moderate in the items performance, and good to excellent in the majority of the questionnaires' items. We conclude that some items should be revised and normative tables for the identification of motor delay could be created considering only the age variable. Future studies should continue the process of validating the AMCD instrument with the assessment of younger children.
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Moldavsky M, Pass S, Sayal K. Primary school teachers' attitudes about children with attention deficit/hyperactivity disorder and the role of pharmacological treatment. Clin Child Psychol Psychiatry 2014; 19:202-16. [PMID: 23625952 DOI: 10.1177/1359104513485083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical experience and research suggest that teachers' attitudes about attention deficit/hyperactivity disorder (ADHD) are an important factor influencing access to specialist assessment and treatment, including medication. METHODS We performed a thematic analysis of comments written by primary school teachers who participated in a case-vignette study investigating the ability of teachers to recognise ADHD. Teachers read one of four types of vignette describing the behaviour of a nine-year-old child who met diagnostic criteria for ADHD (either a boy or a girl with inattentive or combined subtype of ADHD). They answered questions (identical for all types of vignette) about their views regarding the problems and their management. Teachers were invited to add their own comments. RESULTS Altogether 496 teachers from 110 schools completed the questionnaire: 250 (50%) teachers from 94 schools wrote at least one comment, adding up to 341 comments. Regarding their views on the need to refer the child to specialist services, 32 teachers made comments that reflected caution. The most frequent comments were that it was too early to say whether a referral was necessary, the problems were not severe enough or the main support would come from school. Teachers also reported a lack of knowledge about specialist services or criticised them. When asked whether medication might be beneficial for the child, 125 teachers expressed hesitant or negative views: that it was premature to express an opinion about medication or too soon to give medication to the child; that medication was not necessary or should not be used at all; or that the problems were not severe enough or were emotional in nature. Only five teachers reported having a positive experience of the effect of medication. CONCLUSION Teachers' comments suggested a strong preference in using within-school strategies for the management of children with ADHD. Teachers were reluctant to endorse medication for DHD and expressed negative views about its use. Health services should support teachers' management of ADHD-related behaviours in school and provide information to increase teachers' ability to identify the need for a referral to specialist health services.
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Affiliation(s)
- Maria Moldavsky
- 1Nottinghamshire Healthcare National Health Service (NHS) Trust, UK
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Ramtvedt BE, Røinås E, Aabech HS, Sundet KS. Clinical gains from including both dextroamphetamine and methylphenidate in stimulant trials. J Child Adolesc Psychopharmacol 2013; 23:597-604. [PMID: 23659360 PMCID: PMC3842881 DOI: 10.1089/cap.2012.0085] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate clinical gains from including both dextroamphetamine and methylphenidate in stimulant trials. METHOD Thirty-six medication-naïve children ages 9-14 years diagnosed with attention-deficit/hyperactivity disorder (ADHD) were enrolled for 6 weeks in a crossover trial, with 2 weeks of methylphenidate, dextroamphetamine, and placebo, in a randomly assigned, counterbalanced sequence. Outcome measures constituted a computer-based continuous performance test combined with a motion tracking system (Qb Test) and an ADHD questionnaire rated by parents and teachers. RESULTS Group analyses found significant treatment effects of similar size for the two stimulants on both outcome measures. Single-subject analyses revealed that each stimulant produced a favourable response in 26 children; however, an individual child frequently responded qualitatively or quantitatively differently to the two stimulants. By including both stimulants in the trial, the number of favorable responders increased from 26 (72%) to 33 (92%). In children with favorable responses of unequal strength to the two stimulants, a shift from inferior drug to best drug was associated with a 64% mean increase in the overall response strength score, as measured by the ADHD questionnaire. CONCLUSIONS The likelihood of a favorable response and optimal response strength is increased by including both stimulants in the stimulant trial. The study was first registered in clinical trials 28 September 2010. Clinical Trials.gov Identifier: NCT01220440.
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Affiliation(s)
- Bjørn E Ramtvedt
- 1 Østfold Hospital Trust , Neuropsychiatric Unit, Fredrikstad, Norway
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Rizzo R, Gulisano M, Calì PV, Curatolo P. Tourette Syndrome and comorbid ADHD: current pharmacological treatment options. Eur J Paediatr Neurol 2013; 17:421-8. [PMID: 23473832 DOI: 10.1016/j.ejpn.2013.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/30/2012] [Accepted: 01/26/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is the most common co-morbid condition encountered in people with tics and Tourette Syndrome (TS). The co-occurrence of TS and ADHD is associated with a higher psychopathological, social and academic impairment and the management may represent a challenge for the clinicians. AIM To review recent advances in management of patients with tic, Tourette Syndrome and comorbid Attention Deficit Hyperactivity Disorder. METHODS We searched peer reviewed and original medical publications (PUBMED 1990-2012) and included randomized, double-blind, controlled trials related to pharmacological treatment for tic and TS used in children and adolescents with comorbid ADHD. "Tourette Syndrome" or "Tic" and "ADHD", were cross referenced with the words "pharmacological treatment", "α-agonist", "psychostimulants", "selective norepinephrine reuptake inhibitor", "antipsychotics". RESULTS Three classes of drugs are currently used in the treatment of TS and comorbid ADHD: α-agonists (clonidine and guanfacine), stimulants (amphetamine enantiomers, methylphenidate enantiomers or slow release preparation), and selective norepinephrine reuptake inhibitor (atomoxetine). It has been recently suggested that in a few selected cases partial dopamine agonists (aripiprazole) could be useful. CONCLUSION Level A of evidence supported the use of noradrenergic agents (clonidine). Reuptake inhibitors (atomoxetine) and stimulants (methylphenidate) could be, also used for the treatment of TS and comorbid ADHD. Taking into account the risk-benefit profile, clonidine could be used as the first line treatment. However only few studies meet rigorous quality criteria in terms of study design and methodology; most trials have low statistical power due to small sample size or short duration. Treatment should be "symptom targeted" and personalized for each patient.
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Affiliation(s)
- Renata Rizzo
- Section of Child Neuropsichiatry, Dipartimento di Scienze Mediche e Pediatriche, Catania University, Via Santa Sofia 78, 95123 Catania, Italy.
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Is Medication Information for Children with Autism Spectrum Disorder Monitored and Coordinated Across Professionals? Findings from a Teacher Survey. SCHOOL MENTAL HEALTH 2013; 5:48-57. [PMID: 23526921 DOI: 10.1007/s12310-012-9098-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prescription medications are commonly used for children with autism spectrum disorder (ASD), however, there is little research regarding how the effect of medication is monitored across settings once prescribed. The present study addressed this issue for children with ASD in school by administering a questionnaire to teachers of students with ASD who were and were not being given medication. Specifically, the questionnaire assessed the teachers' knowledge about whether the child was being given medication, and whether behavior changes or side effects were being communicated in any way to the child's family and prescribing physician. The results showed that for children who were being given medication, fewer than half of the teachers reported knowing the child was being given medication. For those children who were not being given medication, only 53% of the teachers reported correct information for their students. Of the teachers who knew their students were being given medication, all reported that they were not conferring with the child's prescribing physician regarding behavioral observations or side effects. Whether teachers are blind to the medication types and dosage the students are being given or not, some type of communication to physicians about the children's behavior at school is important. Given the importance of monitoring medication for children with ASD, implications for system change, for professionals and for funding agencies are discussed.
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Venkatesh C, Ravikumar T, Andal A, Virudhagirinathan BS. Attention-deficit/Hyperactivity Disorder in Children: Clinical Profile and Co-morbidity. Indian J Psychol Med 2012; 34:34-8. [PMID: 22661805 PMCID: PMC3361840 DOI: 10.4103/0253-7176.96155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To study the clinical profile and co-morbidity in Indian children with attention-deficit/hyperactivity disorder (ADHD). MATERIALS AND METHODS A prospective analytical study of 2 years duration at the Child Guidance Clinic of a pediatric tertiary care hospital in a south Indian city using Diagnostic and statistical manual of Mental Disorders-1V based questionnaires. RESULTS Of the 251 referrals, 51 (20.3%) children met the inclusion criteria for the diagnosis of ADHD. M:F ratio was 6.3:1. The mean age was 5.7 years. A majority of the children belonged to middle and lower socio-economic class and were first-born children. Most children were brought up in nuclear families. History of delayed speech and language development was commonly seen in these children. Combined type of ADHD was the most common type. At least one co-morbid diagnosis was seen in 86.3% of children, and learning disability was the most common co-morbid diagnosis. The mean IQ was 90 (SD±12). CONCLUSION Early markers of cognitive dysfunction like delayed speech, language and social and adaptive development may be a pointer towards the diagnosis of ADHD in children. Knowledge about their sociodemographic profile and other co-morbid conditions that are associated with ADHD is necessary to fully understand the magnitude of the problem and to plan effective therapy for them.
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Affiliation(s)
- C Venkatesh
- Department of Pediatrics, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamilnadu, India
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Ginsberg L, Katic A, Adeyi B, Dirks B, Babcock T, Lasser R, Scheckner B, Adler LA. Long-term treatment outcomes with lisdexamfetamine dimesylate for adults with attention-deficit/hyperactivity disorder stratified by baseline severity. Curr Med Res Opin 2011; 27:1097-107. [PMID: 21438796 DOI: 10.1185/03007995.2011.567256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the impact of baseline severity on lisdexamfetamine dimesylate (LDX) efficacy in a long-term study of adults with attention-deficit/hyperactivity disorder (ADHD). RESEARCH DESIGN AND METHODS Adults from a 4-week, placebo-controlled, forced dose-escalation study with LDX (30-70 mg/day) or placebo were enrolled in a long-term, open-label dose-optimization study for an additional 12 months. In post hoc analyses, participants were stratified by baseline severity (from the prior short-term study) with Clinical Global Impressions-Severity (CGI-S) scores of 4 (moderately), 5 (markedly), or ≥6 (severely/extremely ill). ADHD-Rating Scale IV (ADHD-RS-IV) with adult prompts (primary) and CGI-Improvement (CGI-I) were used to assess effectiveness. Clinical response was defined as a ≥30% decrease in ADHD-RS-IV from baseline and a CGI-I of 1 or 2; symptomatic remission was defined as ADHD-RS-IV ≤18. Treatment-emergent adverse events (TEAEs) were monitored. RESULTS Participants had baseline CGI-S scores of 4 (n = 114), 5 (n = 188), or ≥6 (n = 43). At endpoint, mean (SD) change from baseline in ADHD-RS-IV was greater (p < 0.0001) for participants with CGI-S = 5 (-26.4 [11.77]) and ≥6 (-32.3 [9.81]) than for participants with CGI-S = 4 (-19.5 [9.97]). At endpoint, 81.6%, 84.6%, and 88.4% of participants were very much/much improved (CGI-I of 1 or 2) in CGI-S categories of 4, 5, and ≥6, respectively. Clinical response criteria were met by 78.9%, 83.5%, and 88.4% and symptomatic remission criteria by 64.0%, 65.4%, and 72.1% of participants with CGI-S = 4, 5, and ≥6, respectively. The most frequently reported TEAEs with participant incidence ≥10% for any LDX dose were upper respiratory tract infection (21.8%), insomnia (19.5%), headache (17.2%), dry mouth (16.6%), decreased appetite (14.3%), and irritability (11.2%). CONCLUSIONS Some aspects of these analyses (e.g., open-label design without placebo control, inclusion and exclusion criteria of the demographic profile of participants, and the post hoc nature of the statistical analysis) limit interpretation. However, long-term LDX treatment demonstrated increased degree of symptom improvement with greater baseline symptom severity. Rates of clinical response and symptomatic remission tended to be greater for those with greater baseline severity. LDX demonstrated a safety profile consistent with long-acting stimulant use.
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Swanson JM, Wigal T, Lakes K. DSM-V and the future diagnosis of attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2009; 11:399-406. [PMID: 19785982 PMCID: PMC3632645 DOI: 10.1007/s11920-009-0060-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In general, recommendations for the DSM-V and future diagnoses of psychiatric disorders include a dimensional approach to complement the standard categorical approach. For the assessment of attention-deficit/hyperactivity disorder (ADHD), dimensional approaches to supplement the rigid categorical approach of the DSM-IV abound. Historically, dimensions based on severity of symptoms of ADHD and severity of general psychopathology have been used. General dimensional approaches described by a workgroup organized by the American Psychiatric Association are reviewed to provide background and context for a discussion of old and new dimensional approaches to complement future categorical diagnosis of ADHD in the DSM-V.
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Parenting practices and attention-deficit/hyperactivity disorder: new findings suggest partial specificity of effects. J Am Acad Child Adolesc Psychiatry 2009; 48:146-54. [PMID: 19065110 PMCID: PMC2827638 DOI: 10.1097/chi.0b013e31819176d0] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Examine the relations of attention-deficit/hyperactivity disorder (ADHD) diagnosis and symptom domains with parenting practices. METHOD One hundred eighty-one children (ages 6-12 years) were assessed for ADHD and non-ADHD status via parent semistructured clinical interview (Diagnostic Interview Schedule for Children-IV) and parent and teacher standardized ratings. They included controls (n = 52), ADHD Inattentive type (n = 24), and ADHD Combined type (n = 71) as well as "not otherwise specified" cases (included in regressions only). Parents completed the Alabama Parenting Questionnaire and a structured interview (the Diagnostic Interview Schedule-IV) about their own ADHD symptoms. Symptom counts were created for oppositional defiant disorder (ODD), conduct disorder (CD), inattention, and hyperactivity-impulsivity to complement categorical analyses. RESULTS In categorical analysis, maternal inconsistent discipline was associated with ADHD Combined type, even with child ODD and CD diagnosis and parent ADHD symptoms statistically controlled. Paternal low involvement was associated with ADHD regardless of subtype, even with ODD and CD covaried; however, the effect was marginal when paternal ADHD was covaried. In dimensional analysis of symptom counts, maternal inconsistent discipline was related to all behavior domains but none uniquely. Paternal low involvement and inconsistent discipline were related uniquely with child inattention and not other behavioral domains. CONCLUSIONS Specific aspects of parenting are related to ADHD apart from ODD or CD and are not fully attributable to parental ADHD.
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Cormier E. Attention deficit/hyperactivity disorder: a review and update. J Pediatr Nurs 2008; 23:345-57. [PMID: 18804015 DOI: 10.1016/j.pedn.2008.01.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 01/08/2008] [Accepted: 01/09/2008] [Indexed: 11/24/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and pervasive childhood disorder characterized by developmentally inappropriate activity level, impulsivity, and inability to sustain attention and concentration. Core symptoms of the disorder are associated with impairment in multiple domains of functioning and often coexist with other psychiatric disorders, the most prevalent being oppositional defiant disorder, conduct disorder, depression, and anxiety disorders. Concerns have been expressed about the overdiagnosis of ADHD, an upsurge in prescription of stimulant medication, and wide variations in practice patterns related to diagnosis and treatment of children with ADHD among primary care providers. Clinical research and expert consensus guidelines over the past decade have increasingly clarified the most effective approaches to diagnosis and treatment of the disorder. Hence, the purpose of this article was to provide primary care providers with the most current, evidence-based information on the assessment and treatment of children with ADHD.
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Affiliation(s)
- Eileen Cormier
- Florida State University College of Nursing, 421 Vivian M. Duxbury Hall, Tallahassee, FL 32306-4310, USA.
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Gau SS, Shang C, Liu S, Lin C, Swanson JM, Liu Y, Tu C. Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form. Int J Methods Psychiatr Res 2008; 17:35-44. [PMID: 18286459 PMCID: PMC6878250 DOI: 10.1002/mpr.237] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This study aimed to establish the psychometric properties of parent ratings on the Chinese version of the Swanson, Nolan, and Pelham IV scale (SNAP-IV) in a school-based sample of 3534 students in grades 1 to 8 from two cities and two suburbs in Taiwan and 189 children diagnosed with attention deficit/hyperactivity disorder (ADHD) (aged 6 to 15) consecutively recruited from a medical center in Taipei. Parents completed the Chinese versions of the SNAP-IV, Strengths and Difficulties Questionnaire, and Child Behavior Checklist. The Chinese SNAP-IV demonstrated similar three factor structure (Inattention, Hyperactivity/Impulsivity, and Oppositional) as its English version, and satisfactory test-retest reliability (intraclass correlation = 0.59 approximately 0.72), internal consistency (alpha = 0.88 approximately 0.90), concurrent validity (Pearson correlations = 0.56 approximately 0.72), and discriminant validity. Boys scored higher than girls across the eight school grade levels. The SNAP-IV clearly distinguished children with ADHD from school-based participants. Comorbidity with oppositional defiant disorder/conduct disorder predicted higher SNAP-IV scores among children with ADHD. Our findings suggest that the Chinese SNAP-IV is a reliable and valid instrument for rating ADHD-related symptoms in both clinical and community settings in Taiwan.
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Affiliation(s)
- Susan Shur‐Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Mental Health and Substance Abuse Research, National Health Research Institute, Taiwan
| | - Chi‐Yung Shang
- Department of Psychiatry, Yun Lin Branch, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih‐Kai Liu
- Department of Child and Adolescent Psychiatry, Taoyuan Mental Hospital, Department of Health, Executive Yuan, Tao‐Yuan, Taiwan
| | - Chien‐Ho Lin
- Department of Psychiatry, Chimei Medical Center, Tainan, Taiwan
| | - James M. Swanson
- University of California at Irvine, Child Development Center, Irvine, CA, USA
| | - Yu‐Chih Liu
- Department of Psychiatry, Buddhist Dalin Tzu Chi General Hospital, Chia‐Yi, Taiwan
| | - Chang‐Ling Tu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Swanson JM, Moyzis RK, McGough JJ, McCracken JT, Riddle MA, Kollins SH, Greenhill LL, Abikoff HB, Wigal T, Wigal SB, Posner K, Skrobala AM, Davies M, Ghuman JK, Cunningham C, Vitiello B, Stehli A, Smalley SL, Grady D. Effects of source of DNA on genotyping success rates and allele percentages in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS). J Child Adolesc Psychopharmacol 2007; 17:635-46. [PMID: 17979583 DOI: 10.1089/cap.2007.0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In children diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their parents, who were participants of the Preschool ADHD Treatment Study (PATS), we assessed the effect of source of DNA (from buccal or blood cells) on the genotyping success rate and allele percentages for the five polymorphisms in three candidate genes (DAT1, DRD4, and SNAP 25) investigated in the PATS pharmacogenetic study of response to stimulant medication. METHOD At baseline assessment, 241 individuals (113 probands and 128 parents) consented to participate; 144 individuals (52 probands and 92 parents) provided blood samples from venipuncture, and 97 individuals (61 probands and 36 parents) provided buccal samples from cheek swab as specimens for isolation of DNA. Three types of polymorphisms-variable number of tandem repeat (VNTR) polymorphism, tandem duplication polymorphism (TDP), and single nucleotide polymorphism (SNP)-were evaluated, including the DRD4 gene 48-bp VNTR in exon III, the DAT1 gene 40-bp VNTR in 3'-untranslated region, the DRD4 gene TDP 120-bp duplication in the promoter region, the SNAP-25 gene TC-1069 SNP, and the SNAP-25 gene TG-1065 SNP. Standard procedures were used to genotype individuals for each of these five polymorphisms. RESULTS Using the methods available in 2004, the genotyping success rate was on the average much greater for DNA from blood cells than buccal cells (e.g., 91% vs. 54% in probands). For some polymorphisms (DRD4-VNTR, DRD4-TDP, and SNAP25-TC SNP), allele proportion also varied by blood versus buccal source of DNA (e.g., 26.5% vs. 18.6% for the 7-repeat allele of the DRD4 gene). CONCLUSIONS The much lower success rate for genotyping based on DNA from buccal than blood cells is likely due to the quality of DNA derived from these two sources. The observed source differences in allele proportion may be due to self-selection related to choice of how specimens were collected (from cheek swab or venipuncture), or to a selective detection of some alleles based on differences in DNA quality.
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Affiliation(s)
- James M Swanson
- Child Development Center, University of California-Irvine, 19722 MacArthur Boulevard, Irvine, CA 92612, USA.
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Steinhausen HC, Blattmann B, Pfund F. Developmental outcome in children with intrauterine exposure to substances. Eur Addict Res 2007; 13:94-100. [PMID: 17356281 DOI: 10.1159/000097939] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The developmental outcome of children born to Swiss substance-dependent mothers in a residential treatment program was studied in a sample of 61 children ranging from infancy to preadolescence (mean age = 5.10, SD = 3.10 years) by use of age-appropriate tests of intelligence. A large list of biological and psychosocial risk factors was tested for associations with outcome in the children. The mean profile of test findings across all age ranges was significantly lower than population norms and there was an excess of children with subnormal intellectual functioning. Performance IQ was associated negatively only with intrauterine substance exposure, but with none of the other risk factors. Among the various substances, predominantly heroin or methadone were responsible for this association when controls for nicotine or cannabis consumption were made. The study provides further evidence that intrauterine exposure to heroin and methadone negatively affects the developmental outcome in the offspring of substance-dependent mothers.
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Affiliation(s)
- H-C Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zürich, Zürich, Switzerland.
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Martel MM, Nigg JT. Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. J Child Psychol Psychiatry 2006; 47:1175-83. [PMID: 17076757 DOI: 10.1111/j.1469-7610.2006.01629.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Models of attention-deficit/hyperactivity disorder (ADHD) suggest developmental influences may feed into components of the disorder separately from associated disruptive behavior problems. We investigated this in terms of key personality/temperament traits of Reactive and Effortful Control, Resiliency, and Emotionality. METHODS A sample of 179 children (age 6-12, 63% boys), of whom 92 had ADHD, 52 were Controls, and 35 were borderline or not otherwise specified cases of ADHD, were examined. Dispositional trait scores were derived from parent-completed California Q-sort and the Early Adolescent Temperament Questionnaire. Child ADHD symptoms were evaluated using maternal structured diagnostic interview and teacher-completed symptom ratings. RESULTS Traits were differentially associated with symptoms. Reactive Control was related to hyperactivity-impulsivity as rated by both parents and teachers. Negative Emotionality was related to oppositional-defiance. Resiliency was primarily related to inattention-disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data. A moderation effect emerged; the relationship between parent-rated Negative Emotionality and teacher-rated ADHD symptoms was stronger for children with high levels of both Reactive and Effortful Control. CONCLUSIONS Results are interpreted in relation to a two-pathway model of ADHD; regulation problems contribute to the emergence of symptoms of inattention-disorganization, reactive or motivational control problems to the emergence of hyperactivity-impulsivity, and these are distinct from negative affectivity. Children with regulation deficits and a reactive motivational style are especially at risk for the development of ADHD.
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Stawicki JA, Nigg JT, von Eye A. Family psychiatric history evidence on the nosological relations of DSM-IV ADHD combined and inattentive subtypes: new data and meta-analysis. J Child Psychol Psychiatry 2006; 47:935-45. [PMID: 16930388 DOI: 10.1111/j.1469-7610.2006.01628.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A key issue in the nosology of attention deficit hyperactivity disorder (ADHD) has concerned whether the DSM-IV combined (ADHD-C) and primarily inattentive (ADHD-PI) subtypes are in fact distinct disorders, or instead are fairly closely related, perhaps differing only in severity. Pertinent to this question, but in short supply, are data on family psychiatric history. METHOD We present new data followed by a meta-analysis. For the new data 210 children were well-characterized via structured interview and multi-informant ratings as ADHD-C or ADHD-PI. Three hundred and thirty-five parents completed structured diagnostic interviews to determine whether they had ADHD-C or ADHD-PI. Comorbid disorders were also assessed. For the meta-analysis, 6 existing family-history data sets using DSM-IV subtypes were pooled and analyzed (total N = 4120). RESULTS The new family study found support for subtype-specific transmission, but the effect was small. Girls with ADHD-C had more severe family psychiatric histories (non-ADHD disorders in parents) than girls with ADHD-I, but this subtype effect did not occur for boys. The meta-analysis of 6 data sets implemented a model-fitting methodology. Despite inconsistent results across individual studies, the pooled data consistently suggested that (1) some degree of subtype specific transmission is occurring, (2) the effect is small, (3) non-specific (gradient) transmission also occurs, specifically in families of children with ADHD-C. CONCLUSION The much-debated relation between these two most prevalent ADHD subtypes is best modeled via two processes transmitting in families. One process is distinct for the two syndromes, and the other is shared. We briefly suggest neuropsychological models that would account for this state of affairs and suggest future research to refine the nosology with these findings in mind.
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Pierrehumbert B, Bader M, Thévoz S, Kinal A, Halfon O. Hyperactivity and attention problems in a Swiss sample of school-aged children: effects of school achievement, child gender, and informants. J Atten Disord 2006; 10:65-76. [PMID: 16840594 DOI: 10.1177/1087054705286050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The sensitivity and tolerance regarding ADHD symptoms obviously differ from one culture to another and according to the informants (parents, teachers, or children). This stimulates the comparison of data across informants and countries. METHOD Parents and teachers of more than 1,000 school-aged Swiss children (5 to 17 years old) fill in Conners's questionnaires on ADHD. Children who are older than 10 years old also fill in a self-report questionnaire. Results are compared to data from a North American sample. RESULTS Swiss parents and teachers tend to report more ADHD symptoms than American parents and teachers as far as the oldest groups of children are concerned. Interactions are evidenced between school achievement, child gender, and informants. A relatively low rate of agreement between informants is found. CONCLUSION These results strengthen the importance to take into account all informants in the pediatric and the child psychiatry clinic, as well as in the epidemiological studies.
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Affiliation(s)
- Blaise Pierrehumbert
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Lausanne, Switzerland.
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Scahill L, Erenberg G, Berlin CM, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy T, Zinner S, Walkup J. Contemporary assessment and pharmacotherapy of Tourette syndrome. NeuroRx 2006; 3:192-206. [PMID: 16554257 PMCID: PMC3593444 DOI: 10.1016/j.nurx.2006.01.009] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.
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Affiliation(s)
- Lawrence Scahill
- Yale Child Study Center, 230 South Frontage Road, P.O. Box 207900, New Haven, CT 06520, USA.
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Abstract
BACKGROUND Children being evaluated for attention deficit hyperactivity disorder (ADHD) often have an eye exam as part of their evaluation. The symptoms of convergence insufficiency (CI) can make it difficult for a student to concentrate on extended reading and overlap with those of ADHD. METHODS A retrospective review of 266 patients with CI presenting to an academic pediatric ophthalmology practice was performed. All patients included were diagnosed with CI by one author (DBG) and evaluated for the diagnosis of ADHD. A computerized review was also performed looking at the converse incidence of CI in patients carrying the diagnosis of ADHD. RESULTS We reviewed 266 charts of patients with CI. Twenty-six patients (9.8%) were diagnosed with ADHD at some time in their clinical course. Of the patients with ADHD and CI, 20 (76.9%) were on medication for ADHD at the time of diagnosis for CI while 6 (23.1%) were either not on medication or the medication was discontinued several months before the diagnosis of CI. The review of computer records showed a 15.9% incidence of CI in the ADHD population. CONCLUSION We report an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8-3.3%). We also note a seeming three-fold greater incidence of CI in the ADHD population. This may simply represent an association and not be a causative relationship. Until further studies are performed, however, patients diagnosed with ADHD should be evaluated to identify the small subset that may have CI -- a condition that responds well to treatment at home.
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Affiliation(s)
- David B Granet
- Department of Ophthalmology, Ratner Children's Eye Center, University of California, San Diego, CA 92093, USA.
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36
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Nass RD. Evaluation and assessment issues in the diagnosis of attention deficit hyperactivity disorder. Semin Pediatr Neurol 2005; 12:200-16. [PMID: 16780291 DOI: 10.1016/j.spen.2005.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article discusses the availability and appropriateness of various assessment techniques for diagnosing ADHD. In terms of the interview/history, the necessity and viability of using formal structured, semi structured, computerized and informal interviews for making an ADHD diagnosis are critiqued. The pros and cons of the various questionnaires frequently used to diagnose ADHD are addressed. The conundrum raised by multiple informants who often disagree is discussed, as are the effects of age and gender. The contributions of the medical and neurological examinations to the diagnosis of ADHD are considered. The utility of a neuropsychological assessment and of continuous performance testing to diagnosis is critiqued. Finally the lack of need for laboratory tests and the lack of necessity of neurological workup, specifically EEG and imaging, are argued.
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Affiliation(s)
- Ruth D Nass
- Department of Neurology, New York University School of Medicine, New York, NY 10016, USA.
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Wolraich ML, Bickman L, Lambert EW, Simmons T, Doffing MA. Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD. J Atten Disord 2005; 9:354-68. [PMID: 16371681 DOI: 10.1177/1087054705278834] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatment and control conditions and followed for 39 months. The interventions consisted of group workshops and single one-on-one tutorials with parents, teachers, and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties. There are few significant effects on communication that are short lived. Results suggest that the interventions are insufficient to cause significant increase in communication. Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions.
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Counts CA, Nigg JT, Stawicki JA, Rappley MD, von Eye A. Family adversity in DSM-IV ADHD combined and inattentive subtypes and associated disruptive behavior problems. J Am Acad Child Adolesc Psychiatry 2005; 44:690-8. [PMID: 15968238 DOI: 10.1097/01.chi.0000162582.87710.66] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated the relationship between a family adversity index and DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes and associated behavior problems. The relationship of family adversity to symptoms and subtypes of ADHD was examined. METHOD Parents and 206 children aged 7-13 completed diagnostic interviews and rating scales about socioeconomic status, parental lifetime psychiatric disorders, marital conflict, and stressful life events. RESULTS Children with ADHD combined type experienced more risk factors than community controls (p = .002) or children with ADHD predominantly inattentive type (p = .02). The families of children with ADHD combined type described more risk factors associated with family adversity than the families of children with ADHD inattentive type and the control group. Parent-rated symptoms of child inattention/disorganization were related uniquely to the adversity index score independently of conduct disorder symptoms. Children's perceptions of marital conflict were independently related to inattention and hyperactivity behaviors as rated by parents and teachers after control of all other risk factors. Oppositional defiant symptoms were independently related to marital conflict and maternal psychopathology, whereas conduct disorder symptoms were uniquely related to low socioeconomic status and maternal psychopathology. CONCLUSIONS Family adversity is related to ADHD combined type in children and may be related specifically to ADHD symptoms in addition to conduct disorder symptoms.
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Affiliation(s)
- Carla A Counts
- Department of Psychology, Florida State University, Tallahassee, USA
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Park L, Nigg JT, Waldman ID, Nummy KA, Huang-Pollock C, Rappley M, Friderici KH. Association and linkage of alpha-2A adrenergic receptor gene polymorphisms with childhood ADHD. Mol Psychiatry 2005; 10:572-80. [PMID: 15520832 DOI: 10.1038/sj.mp.4001605] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a heritable disorder, prevalent from childhood through adulthood. Although the noradrenergic (NA) system is thought to mediate a portion of the pathophysiology of ADHD, genes in this pathway have not been investigated as frequently as those in the dopaminergic system. Previous association studies of one candidate gene in the NA system, ADRA2A, showed inconsistent results with regard to an MspI polymorphism. In the current study, two nearby single-nucleotide polymorphisms, which define HhaI and DraI restriction fragment length polymorphisms, were also genotyped and were in significant linkage disequilibrium with the MspI RFLP. Transmission disequilibrium tests (TDTs) in a sample of 177 nuclear families showed significant association and linkage of the DraI polymorphism with the ADHD combined subtype (P=0.03), and the quantitative TDT showed association of this polymorphism with the inattentive (P=0.003) and hyperactive-impulsive (P=0.015) symptom dimensions. The haplotype that contained the less common allele of the DraI polymorphism likewise showed a strong relationship with the inattentive (P=0.001) and hyperactive-impulsive (P=0.004) symptom dimensions. This study supports the hypothesis that an allele of the ADRA2A gene is associated and linked with the ADHD combined subtype and suggests that the DraI polymorphism of ADRA2A is linked to a causative polymorphism.
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Affiliation(s)
- L Park
- Genetics Program, Michigan State University, East Lansing, MI 48824, USA
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40
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Hemoencephalography–A New Therapy for Attention Deficit Hyperactivity Disorder (ADHD): Case Report. ACTA ACUST UNITED AC 2005. [DOI: 10.1300/j184v08n03_06] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wigal S, Swanson JM, Feifel D, Sangal RB, Elia J, Casat CD, Zeldis JB, Conners CK. A double-blind, placebo-controlled trial of dexmethylphenidate hydrochloride and d,l-threo-methylphenidate hydrochloride in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2004; 43:1406-14. [PMID: 15502600 DOI: 10.1097/01.chi.0000138351.98604.92] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of dexmethylphenidate hydrochloride (d-MPH, Focalin) for the treatment of attention-deficit/hyperactivity disorder (ADHD) and to test an a priori hypothesis that d-MPH would have a longer duration of action than d,l-threo-methylphenidate (d,l-MPH). METHOD This was a randomized, double-blind study conducted at 12 U.S. centers. One hundred thirty-two subjects received d-MPH (n=44), d,l-MPH (n=46), or placebo (n=42) twice daily for 4 weeks, with titration of the dose based on weekly clinic visits. The primary efficacy variable was change from baseline to last study visit on teacher-completed Swanson, Nolan, and Pelham Rating Scale (Teacher SNAP). Secondary efficacy measures included the change on parent-completed SNAP (Parent SNAP), Clinical Global Impressions Scale-Improvement (CGI-I) score, and Math Test performance. Assessments at home in late afternoon were included to test the hypothesis that d-MPH would have a longer duration of efficacy than d,l-MPH. Safety was assessed through monitoring occurrence and severity of adverse events and discontinuations related to them. RESULTS Treatment with either d-MPH (p=.0004) or d,l-MPH (p=.0042) significantly improved Teacher SNAP ratings compared with placebo. The d-MPH group showed significant improvements compared with placebo on the afternoon Parent SNAP ratings (p=.0003) and scores on the Math Test (p=.0236) obtained late in the afternoon at 6:00 p.m. Sixty-seven percent of patients showed improvement on d-MPH and 49% on d,l-MPH based on CGI-I scores. Both d-MPH and d,l-MPH were well tolerated, no patient in the d-MPH group and only two patients each in the d,l-MPH and placebo groups discontinued the study. CONCLUSIONS For the treatment of ADHD, an average titrated dose of 18.25 mg/day of d-MPH is as efficacious and safe as an average titrated dose of 32.14 mg/day of d,l-MPH. Both active treatments have large effect sizes. Thus, d-MPH and d,l-MPH appear to provide similar efficacy, and d-MPH may have longer duration of action after twice-daily dosing, but additional studies are needed to determine the statistical and clinical significance of this possibility.
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Affiliation(s)
- Sharon Wigal
- Irvine Child Development Center, University of California, Irvine, CA 92612, USA.
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42
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Leslie LK, Weckerly J, Plemmons D, Landsverk J, Eastman S. Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings. Pediatrics 2004; 114:129-40. [PMID: 15231919 PMCID: PMC1519417 DOI: 10.1542/peds.114.1.129] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of the San Diego Attention-Deficit/Hyperactivity Disorder Project (SANDAP) protocol, a pediatric community-initiated quality improvement effort to foster implementation of the American Academy of Pediatrics (AAP) attention-deficit/hyperactivity disorder (ADHD) diagnostic guidelines, and to identify any additional barriers to providing evidence-based ADHD evaluative care. METHODS Seven research-naïve primary care offices in the San Diego area were recruited to participate. Offices were trained in the SANDAP protocol, which included 1) physician education, 2) a standardized assessment packet for parents and teachers, 3) an ADHD coordinator to assist in collection and collation of the assessment packet components, 4) educational materials for clinicians, parents, and teachers, in the form of handouts and a website, and 5) flowcharts delineating local paths for referral to medical subspecialists, mental health practitioners, and school-based professionals. The assessment packet included the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating Scales. In this study, we chose a conservative interpretation of the AAP ADHD guidelines for diagnosing ADHD, requiring that a child met criteria for ADHD on both the parent and teacher rating scales. A mixed-method analytic strategy was used to address feasibility and barriers, including quantitative surveys with parents and teachers and qualitative debriefing sessions conducted an average of 3 times per year with pediatricians and office staff members. RESULTS Between December 2000 and April 2003, 159 children were consecutively enrolled for evaluation of school and/or behavioral problems. Clinically, only 44% of the children met criteria for ADHD on both the parent and teacher scales, and 73.5% of those children were categorized as having the combined subtype. More than 40% of the subjects demonstrated discrepant results on the Vanderbilt scales, with only the parent or teacher endorsing sufficient symptoms to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Other mental health and learning problems were common in the sample; 58.5% of subjects met screening criteria for oppositional defiant disorder/conduct disorder, 32.7% met screening criteria for anxiety/depression, and approximately one-third had an active individualized education program in place or had received an individualized education program in the past. On evaluation, the SANDAP protocol was acceptable and feasible for all stakeholders. However, additional barriers to implementing the AAP ADHD guidelines were identified, including 1) limited information in the guidelines regarding the use of specific ADHD rating scales, the evaluation and treatment of children with discrepant and/or negative results, and the indications for psychologic evaluation of learning problems, 2) families' need for education regarding ADHD and support, 3) characteristics of physical health and mental health plans that limited care for children with ADHD, and 4) limited knowledge and use of potential community resources. CONCLUSIONS Our results indicate that children presenting for evaluation of possible ADHD in primary care offices have complex clinical characteristics. Providers need mechanisms for implementing the ADHD diagnostic guidelines that address the physician education and delivery system design aspects of care that were developed in the SANDAP protocol. Additional barriers were also identified. Careful attention to these factors will be necessary to ensure the sustained provision of quality care for children with ADHD in primary care settings.
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Key Words
- pediatrics
- primary care
- attention-deficit/hyperactivity disorder
- guidelines
- dsm-iv, diagnostic and statistical manual of mental disorders, 4th ed.
- aap, american academy of pediatrics
- adhd, attention-deficit/hyperactivity disorder
- nichq, national initiative for children’s healthcare quality
- pcp, primary care provider
- sandap, san diego adhd project
- ac, adhd coordinator
- odd, oppositional defiant disorder
- cd, conduct disorder
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Affiliation(s)
- Laurel K Leslie
- Child and Adolescent Services Research Center, Children's Hospital, San Diego, California 92123-0282, USA.
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Beebe-Frankenberger M, Bocian KM, MacMillan DL, Gresham FM. Sorting second-grade students: Differentiating those retained from those promoted. JOURNAL OF EDUCATIONAL PSYCHOLOGY 2004. [DOI: 10.1037/0022-0663.96.2.204] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales. V: scales assessing attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2003; 42:1015-37. [PMID: 12960702 DOI: 10.1097/01.chi.0000070245.24125.b6] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This article summarizes information on scales assessing attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. METHOD The authors sampled articles on ADHD over the past decade. Several popular older ADHD measures have recently been revised, and new ADHD scales have been developed. The authors selected primarily ADHD scales based on the DSM-IV construct of ADHD that also have multiple literature citations. They then reviewed their psychometric properties. Those with adequate psychometric functioning plus considerable literature citations, known wide usage in clinical practice, or a current niche are presented here. RESULTS Several rating scales consistent with the DSM-IV conceptualization of ADHD are now available for use in both home and school settings. Many of the instruments demonstrate solid psychometric properties and a strong normative base. However, some popular scales have not been adequately investigated. Some measures are restricted to the comprehensive assessment of ADHD, whereas others also include symptoms of other disorders. The potential applications for these scales with youths diagnosed with ADHD are broad. CONCLUSIONS Rating scales can reliably, validly, and efficiently measure DSM-IV-based ADHD symptoms in youths. They have great utility in research and clinical work, assist treatment planning, and help to ensure accountability in practice.
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Affiliation(s)
- Brent R Collett
- University of Washington School of Medicine at Children's Hospital and Regional Medical Center, Seattle, USA
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46
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Nigg J, Blaskey L, Huang-Pollock C, John O. ADHD Symptoms and Personality Traits: Is ADHD an Extreme Personality Trait? ACTA ACUST UNITED AC 2002. [DOI: 10.1521/adhd.10.5.6.20559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nigg JT, John OP, Blaskey LG, Huang-Pollock CL, Willcutt EG, Hinshaw SP, Pennington B. Big five dimensions and ADHD symptoms: links between personality traits and clinical symptoms. J Pers Soc Psychol 2002; 83:451-469. [PMID: 12150240 DOI: 10.1037/0022-3514.83.2.451] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) in adulthood is conceptualized as originating in childhood. Despite considerable theoretical interest, little is known about how ADHD symptoms relate to normal personality traits in adults. In 6 studies, the Big Five personality dimensions were related to ADHD symptoms that adults both recalled from childhood and reported concurrently (total N = 1,620). Substantial effects emerged that were replicated across samples. First, the ADHD symptom cluster of inattention-disorganization was substantially related to low Conscientiousness and, to a lesser extent, Neuroticism. Second, ADHD symptom clusters of hyperactivity-impulsivity and oppositional childhood and adult behaviors were associated with low Agreeableness. Results were replicated with self-reports and observer reports of personality in community and clinical samples. Findings support theoretical connections between personality traits and ADHD symptoms.
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Nigg JT, Blaskey LG, Huang-Pollock CL, Rappley MD. Neuropsychological executive functions and DSM-IV ADHD subtypes. J Am Acad Child Adolesc Psychiatry 2002; 41:59-66. [PMID: 11800208 DOI: 10.1097/00004583-200201000-00012] [Citation(s) in RCA: 332] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate and compare a focused set of component neuropsychological executive functions in the DSM-IV attention-deficit/hyperactivity disorder combined (ADHD-C) and inattentive (ADHD-I) subtypes. METHOD The Stop task, Tower of London, Stroop task, Trailmaking Test, and output speed measures were completed by 105 boys and girls aged 7-12 classified as either DSM-IV ADHD-C (n = 46), ADHD-I (n = 18), or community control (n = 41). RESULTS Both subtypes had deficits on output speed. A group x gender interaction was observed on the Stop task: boys with ADHD-C were impaired versus boys with ADHD-I, whereas girls in the two subtypes did not differ. The ADHD-C type had a deficit in planning. Neither ADHD group had a deficit in interference control per se, although they were slower than controls on the Stroop tasks. CONCLUSIONS ADHD-I shares neuropsychological deficits with ADHD-C in the domain of output speed; on most domains the subtypes did not differ. Neuropsychological distinctions between these ADHD subtypes may be few, depending on which domain of executive functioning is assessed, and these distinctions differ by gender. In the case of boys, the two subtypes may be distinguished by the specificity of motor inhibition deficits to ADHD-C.
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Affiliation(s)
- Joel T Nigg
- Department of Psychology, Michigan State University, East Lansing 48824-1117, USA
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Podolski CL, Nigg JT. Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems. JOURNAL OF CLINICAL CHILD PSYCHOLOGY 2001; 30:503-13. [PMID: 11708238 DOI: 10.1207/s15374424jccp3004_07] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.
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Affiliation(s)
- C L Podolski
- Michigan State University, Department of Psychology, 135 Snyder Hall, East Lansing, MI 48824-1117, USA
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Abstract
These are controversial times for those who care for children with attention deficit hyperactivity disorder (ADHD). Class action law suits have been filed in federal courts in California and New Jersey accusing a manufacturer of methylphenidate and the American Psychiatric Association of conspiring to expand the use of this drug. These suits have recently been dismissed. This is just the latest chapter in the long-running debate over the existence, diagnosis, and treatment of ADHD. Controversies relating to ADHD continue to polarize physicians, educators, caregivers, and parents of these children. There are those who believe that ADHD does not exist as a true disorder. At the other end of the spectrum are those who are too quick to make the diagnosis without an adequate patient workup. Parents can unfortunately get caught in the middle of this debate when making treatment decisions for their children.
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