Co-occurring symptoms of attention deficit hyperactivity disorder (ADHD) in a population-based sample of adolescents screened for depression

Deliberate self-harm in adolescents screening positive for attention-deficit / hyperactivity disorder: a population-based study

BACKGROUND

Adolescents with attention-deficit / hyperactivity disorder (ADHD) have an increased risk of self-harm. The risk of self-harm among adolescents who display an elevated level of ADHD symptoms, but without a formal diagnosis, is not well-studied and understood.

OBJECTIVE

To investigate the relationship between self-reported symptoms of ADHD and self-harm in a population-based sample of adolescents.

METHODS

Adolescents in the population-based youth@hordaland study were invited to complete the Adult ADHD Self-Report Scale (ASRS) and the Short Mood and Feelings Questionnaire (SMFQ). They were asked whether they ever deliberately have taken an overdose or tried to harm themselves on purpose, once or multiple times, defined according to the code used in the Child and Adolescent Self-harm in Europe (CASE) Study. Adolescents reporting severe problems on ≥ four of six selected items on the ASRS-v 1.1 screener were defined as ADHD-screen positive (ADHD-SC+), and the remaining sample as ADHD-screen negative (ADHD-SC-). SMFQ score ≥ 12 was used to define a high level of depressive symptoms.

RESULTS

A total of 9692 adolescents (mean age 17.4 years, 53.1% females) participated in the study, of which 2390 (24.7%) screened positive on the ASRS. ADHD-SC+ adolescents engaged in self-harm more often than the ADHD-SC- group (14.6% vs. 5.4%, OR = 3.02, 95%CI [2.57-3.24]). This remained significant after adjustment for demographic variables, SMFQ score ≥ 12, symptoms of conduct disorder and familial history of self-harm and suicide attempts (OR = 1.58, 95%CI [1.31-1.89]). They were also more likely to report an overdose as their method of self-harm (OR = 1.52, 95%CI [1.05-2.23]). Within the ADHD-SC+ group female sex, high levels of inattention and hyperactivity/impulsivity symptoms, SMFQ score ≥ 12, symptoms indicating conduct disorder and familial history of self-harm and suicide attempts increased the likelihood of engaging in deliberate self-harm.

CONCLUSION

Adolescents who screened positive for ADHD had increased risk of engaging in self-harm. Clinicians should consider the increased risk of such engagement in adolescents who present with high level of ADHD symptoms, even in the absence of a clinical ADHD diagnosis.

Dysregulations of amino acid metabolism and lipid metabolism in urine of children and adolescents with major depressive disorder: a case-control study

RATIONALE

The mechanisms underlying major depressive disorder (MDD) in children and adolescents are unclear. Metabolomics has been utilized to capture metabolic signatures of various psychiatric disorders; however, urinary metabolic profile of MDD in children and adolescents has not been studied.

OBJECTIVES

We analyzed urinary metabolites in children and adolescents with MDD to identify potential biomarkers and metabolic signatures.

METHODS

Here, liquid chromatography-mass spectrometry was used to profile metabolites in urine samples from 192 subjects, comprising 80 individuals with antidepressant-naïve MDD (AN-MDD), 37 with antidepressant-treated MDD (AT-MDD) and 75 healthy controls (HC). We performed orthogonal partial least squares discriminant analysis to identify differential metabolites and employed logistic regression and receiver operating characteristic analysis to establish a diagnostic panel.

RESULTS

In total, 143 and 71 differential metabolites were identified in AN-MDD and AT-MDD, respectively. These were primarily linked to lipid metabolism, molecular transport, and small molecule biochemistry. AN-MDD additionally exhibited dysregulated amino acid metabolism. Compared to HC, a diagnostic panel of seven metabolites displayed area under the receiver operating characteristic curves of 0.792 for AN-MDD, 0.828 for AT-MDD, and 0.799 for all MDD. Furthermore, the urinary metabolic profiles of children and adolescents with MDD significantly differed from those of adult MDD.

CONCLUSIONS

Our research suggests dysregulated amino acid metabolism and lipid metabolism in the urine of children and adolescents with MDD, similar to results in plasma metabolomics studies. This contributes to the comprehension of mechanisms underlying children and adolescents with MDD.

The pooled prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Attention-deficit/hyperactivity disorder is one of the most common childhood neurobehavioral disorders, which has a serious negative effect on educational achievement, peer relationships, social functioning, behavior, and self-esteem of children. However, the pooled prevalence of attention-deficit/hyperactivity disorder is not well known in Ethiopia. Therefore, the main objective of this systematic review and meta-analysis is to estimate the pooled prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Ethiopia.

METHODS

PubMed, HINARI, Science Direct, Psych INFO, Google Scholar, African Journals Online, and cross-referenced were searched to identify relevant articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection. Further, trim and fill analysis was done to correct publication bias.Forest plots and tables were used to present results. The random effect model was used to compute the pooled prevalence of attention-deficit/hyperactivity disorder among children and adolescents.

RESULTS

The overall pooled prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Ethiopia was 14.2% (95% CI: 8.48, 22.83). Being male (OR: 2.19, 95% CI: 1.54; 3.12), being aged 6-11 years (OR: 3.67, 95% CI: 1.98; 6.83), low family socioeconomic status (OR: 3.45 95% CI: 2.17; 5.47), maternal complication during pregnancy (OR: 3.29, 95% CI: 1.97; 5.51) and family history of mental illness (OR: 3.83, 95% CI:2.17; 6.77) were factors associated with a higher odds of attention-deficit/hyperactivity disorder among children and adolescents.

CONCLUSIONS

The overall pooled prevalence of attention-deficit/hyperactivity disorder among children and adolescents is high in Ethiopia as compared to previous literature. To reduce the prevalence of attention-deficit/hyperactivity disorder among children and adolescents, emphasis has to be given to prevention, early detection, and management of pregnancy-related complications. Moreover, parents with mental illness should be supported and properly treated to reduce the impact of hostile parenting on their child's health.

TRIAL REGISTRATION

Registered in PROSPERO with ID: CRD42024536334.

Mixed-Methods Examination of Adolescent-Reported Barriers to Accessing Mental Health Services

PURPOSE

Many adolescents struggle to access the mental healthcare they need. To increase access to mental health services, we must have a clear understanding of the barriers adolescents face from their own perspectives. This online mixed-methods study aimed to enhance understanding of access barriers by centering the perspectives of diverse adolescents who had recently tried and failed to access mental health support.

METHODS

In this convergent parallel mixed-methods study, adolescents responded to a preintervention, open-ended question about barriers they have faced to accessing mental health services when they needed them and shared information about their background and depressive symptoms. Barriers were assessed using inductive, conventional content analysis. Quantitative analyses examined barrier differences across sociodemographic groups.

RESULTS

All adolescents (aged 11-17 years, 50% racially minoritized youth, 15% gender diverse youth, 64% LGBTQ + youth; 78% with clinically elevated depressive symptoms) reported at least one barrier to accessing mental health support, and 20% reported multiple barriers. Content analysis revealed 13 barrier categories, with parent-related barriers (three different categories) accounting for 32% of all barriers. The most common barrier categories related to personal and financial constraints. Asian adolescents, adolescents who were aged 17 years or more, and adolescents who reported uncertainty of their gender identity endorsed the numerically highest mean number of barriers to accessing mental health support.

DISCUSSION

High-symptom adolescents reported myriad barriers to accessing mental health support, with 32% of all barriers related to parents.

Low Persistence of Inattention Symptoms From Childhood to Adolescence: A Population-Based Study

OBJECTIVE

To investigate the persistence of dimensional measures of inattention in a population-based, gender-balanced sample of adolescents with parent reports of inattention from childhood and self-reports of inattention in adolescence.

METHOD

Adolescents, 16-19 years old, completed the Adult ADHD Self Report Scale. Their parents completed the Swanson, Nolan, and Pelham Rating Scale-4th Edition when they were 7-9 and 11-13 years old.

RESULTS

More severe inattention in boys than girls in childhood shifted to a female predominance in adolescence. The correlation between reports of inattention in childhood and adolescence was weak, with parent reports explaining only ~5% of the variance in the inattention score reported in adolescence.

CONCLUSION

The weak association between inattention in childhood and adolescence is consistent with the emerging challenges associated with being an adolescent, but the impact of shifts in informants, gender and age on symtpom presentations should be investigated in future studies.

Referring Adolescent Primary Care Patients to Single-Session Interventions for Anxiety and Depression: Protocol for a Feasibility Study

BACKGROUND

Despite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions (SSIs) for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap.

OBJECTIVE

We aimed to implement a clinical workflow for primary care and behavioral health providers to refer patients aged 13 to 17 years with mild to moderate depression and anxiety symptoms to Project YES (Youth Empowerment and Support), an open-access SSI platform, in a large group medical practice with an integrated behavioral health department.

METHODS

Pediatric primary care and integrated behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the electronic health record system, Epic, to refer patients during well-child visits and pediatric behavioral health visits. Patients with mild to moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time.

RESULTS

The rollout will take place between November 2022 and May 2023, when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023.

CONCLUSIONS

SSIs such as those available through Project YES have the potential to provide low-cost, evidence-based mental health treatment to adolescents with mild to moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45666.

A Digital Single-Session Intervention Platform for Youth Mental Health: Cultural Adaptation, Evaluation, and Dissemination

BACKGROUND

Despite the proliferation of evidence-based digital mental health programs for young people, their low uptake and inconsistent implementation preclude them from benefiting youths at scale. Identifying effective implementation strategies for evidence-based supports is especially critical in regions where treatment access is lowest owing to mental health provider shortages.

OBJECTIVE

The goal of this academic-community partnership, funded by the City of San Antonio Metropolitan Health District, was to culturally adapt, disseminate, and gauge the acceptability and utility of an evidence-based digital mental health platform-Project Youth Empowerment and Support (YES)-among English- and Spanish-speaking youths living in south Texas.

METHODS

Project YES is an open-access, anonymous platform containing 3 evidence-based, self-guided interventions for youth mental health. Project YES was culturally adapted via focus groups and co-design sessions with San Antonio youths with lived experience of depression and anxiety; translated into Spanish; and disseminated throughout San Antonio, Texas, via community and school partnerships.

RESULTS

During the project period (April 2021 to December 2021), 1801 San Antonio youths began and 894 (49.64%) of them completed a 30-minute, single-session intervention within Project YES (aged 11-17 years; n=718, 39.87% male; n=961, 53.36% female; and n=3, 0.17% intersex; n=1477, 82.01% Hispanic; n=77, 4.28% non-Hispanic White; n=113, 6.27% Black; n=28, 1.55% Asian; and n=93, 5.16% other). This completion rate (49.64%) surpassed those previously observed for Project YES (eg, 34% when disseminated via social media). San Antonio youths rated Project YES as highly acceptable across all metrics, both in English and Spanish. In addition, the youths who completed Project YES-ENGLISH reported significant improvements in hopelessness (Cohen d=0.33; P<001), self-hate (Cohen d=0.27; P<001), and perceived agency (Cohen d=0.25; P<001) from before to after the intervention, and the youths who completed Project YES-SPANISH reported significant improvements in self-hate (Cohen d=0.37; P=.049) from before to after the intervention.

CONCLUSIONS

The results indicate that Project YES-an open-access, free, and anonymous web-based single-session intervention platform-is an acceptable, accessible, and applicable mental health support for English- and Spanish-speaking San Antonio youths.

Psychopathological symptoms as precursors of depressive symptoms in adolescence: a prospective analysis of the GINIplus and LISA birth cohort studies

INTRODUCTION

Depressive symptoms are highly prevalent in adolescence, highlighting the need for early identification of precursors. Research into psychopathological symptoms predicting depressive psychopathology in adolescents is therefore of great relevance. Moreover, given that the prevalence of depressive symptomatology in adolescence shows marked differences between girls and boys, insight into potential sex-specific differences in precursors is important.

METHODS

This study examined the relationships between emotional problems, conduct problems, hyperactivity/inattention, peer problems, and difficulties in prosocial behaviour at age 10 (Strengths and Difficulties Questionnaire), and the presence of depressive symptoms at age 15 (Depression Screener for Teenagers). Using data from 2824 participants of the GINIplus and LISA birth cohorts, the association of each SDQ subscale at age 10 years with the presence of depressive symptoms at age 15 years was analyzed using sex-specific logistic regression, adjusting for potential confounders.

RESULTS

Emotional problems [odds ratio (OR) 1.99, p = 0.002 for boys and OR 1.77, p < 0.001 for girls] and peer problems (OR 2.62, p < 0.001 for boys, OR 1.91, p = 0.001 for girls) at age 10 showed an increased risk for the presence of depressive symptoms at age 15. Additionally, boys with conduct problems at age 10 were at greater risk of showing depressive symptoms in adolescence (OR 2.50, p < 0.001).

DISCUSSION

Based on the identified prospective relationships in our study, it might be of particular importance to tailor prevention approaches during childhood to peer and emotional problems to reduce the risk of depressive psychopathology in adolescence. Moreover, particularly in boys, it seems important to also target conduct problems in childhood as a precursor of depressive symptoms in the adolescent period.

Bullying Involvement in Adolescence: Implications for Sleep, Mental Health, and Academic Outcomes

Adolescents' involvement in bullying is associated with both sleep and mental health problems, but the nature of this association remains unclear; further, its association with academic outcomes has received little attention. Thus, the aims of the current study were to (a) determine whether involvement in bullying as a victim, bully, or bully-victim was associated with greater sleep and mental health problems and (b) explore the potential mediating effect of sleep and mental health problems on the association between bullying and academic outcomes. A large 2012 population-based study in Hordaland County, Norway, surveyed 10,220 adolescents (16-19 years; 54% girls) about bullying involvement using the revised version of the Olweus Bully/Victim Questionnaire, detailed sleep assessment, and mental health questionnaires. Academic outcomes were obtained from official administrative registries. 1.7% of the adolescents (n = 156) reported being victims of bullying, 1.0% (n = 92) reported being a bully, and 0.5% (n = 50) reported being a bully-victim. All categories of bullying involvement had higher rates of mental health problems compared with adolescents not involved in bullying. Victims reported more symptoms of anxiety and depression, whereas bullies reported higher rates of conduct problems. Adolescents in all bullying categories also reported significantly shorter sleep duration and higher prevalence of insomnia as well as lower grade point average (GPA) compared with adolescents not involved; however, school absence was not associated with bullying involvement. Bullying involvement and GPA showed complete mediation for bullies and bully-victims and partial mediation for victims through sleep duration, conduct problems, and symptoms of depression and attention deficit hyperactivity disorder (ADHD). Bullying is strongly associated with mental health and sleep problems, in addition to lower academic performance. Findings support the importance of addressing bullying involvement during this important developmental period.

Test-Retest Reliability of the 25-item version of Wender Utah Rating Scale. Impact of Current ADHD Severity on Retrospectively Assessed Childhood Symptoms

Objective: To investigate test-retest reliability of the 25-item version of Wender Utah Rating Scale (WURS-25) and factors influencing retrospective reports of childhood behavior in adults with ADHD. Method: Eighty-five adults with ADHD and 189 controls completed the WURS-25 and the adult ADHD Self-Rating Scale (ASRS) at two time points (mean interval = 7 years) and provided information about dyslexia, somatic, and psychiatric disorders. Results: The correlation between WURS-25 scores at the two time points was strong, and reports from 60% of the adults with ADHD showed no change in severity level. Reports on the WURS-25 were positively associated with current ADHD symptoms at both time points and the presence of dyslexia and mood disorders, with the strongest association found among adults reporting the most severe WURS-25 score. Conclusion: Although our study showed an acceptable test-retest reliability of WURS-25, the substantial contribution from current ADHD symptoms to the WURS scores emphasizes the importance of collateral information from family members and others who knew the adult in childhood.

Attention-Deficit/Hyperactivity Disorder Symptom Dimensions Differentially Predict Adolescent Peer Problems: Findings From Two Longitudinal Studies

Introduction: Previous findings that inattention (IA) and hyperactive/impulsive (HI) symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships.

Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder (ADHD; M age = 9.5) was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children (53% girls; M age = 8.3) was assessed and followed approximately 4 years later. Both investigations used parent and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample.

Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants (parent vs. teacher). Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex.

Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples.

Current and Retrospective Childhood Ratings of Emotional Fluctuations in Adults With ADHD

Introduction: Emotional fluctuations and mood swings are common among adults with Attention Deficit/Hyperactivity Disorder (ADHD). Here we investigated if these problems could be retrospectively traced back to childhood behavior.

Methods: Adults with an ADHD diagnosis (n = 502, 48% female) and a population-based control sample (n = 818, 59% female) completed the Adult ADHD Self-report Scale (ASRS), the Wender Utah Rating Scale (WURS) and the Mood Disorder Questionnaire (MDQ). All participants also provided self-reported information about co-existent psychiatric and somatic diseases, and demographic data. Reports on the MDQ were used to define subgroups with [MDQ(+)] and without [MDQ(–)] life-time periods of emotional fluctuations and the WURS scale was used to retrospectively assess childhood ADHD related behaviors and symptoms.

Results: 50.2% of the ADHD group and 5% of the controls were defined with emotional fluctuations [MDQ(+)]. Childhood behavior ratings of “impulsivity,” “loosing of control,” and “trouble with authorities” independently predicted emotional fluctuations reported in adulthood via logistic regression analyses. Inclusion of these three items in a classification analysis gave an accuracy score around 70% in identifying each of the two MDQ categories in the ADHD group.

Discussion: The strong association between self-reported features of emotional problems in childhood and in adulthood suggests a trajectory that should be detected and remediated at an early age. Future longitudinal studies should prioritize the examination of developmental mechanisms explaining the persistence of emotional problems from childhood into adulthood.

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health

BACKGROUND

Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood.

OBJECTIVE

We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment & Support), an open-access platform offering three online SSIs for youth internalizing distress.

METHODS

After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES.

RESULTS

From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers).

CONCLUSIONS

Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress.

TRIAL REGISTRATION

Open Science Framework; osf.io/e52p3.

Insomnia, Alcohol Consumption and ADHD Symptoms in Adults

Introduction

Substance use disorders and insomnia are common in the general population, and particularly among adults with attention-deficit/hyperactivity disorder (ADHD). Here we investigated the relationship between insomnia, alcohol consumption and ADHD symptoms.

Methods

Adults with an ADHD diagnosis (n = 235, 41.3% males) and controls (n = 184, 38% males) completed a questionnaire assessing insomnia (Bergen Insomnia Scale), alcohol consumption (Alcohol Use Disorders Identification Test), and current ADHD symptoms (Adult ADHD Self-report Scale). The majority of the sample (95%) gave additional information about childhood ADHD symptoms (Wender Utah Rating Scale), and information about lifetime occurrence of an internalizing disorder was included as part of background information.

Results

Compared to controls, the ADHD group reported a higher frequency of insomnia, a higher quantity of consumed alcohol and a higher frequency of internalizing disorders. Current and childhood ADHD symptoms were more severe in those with than without insomnia. Scores on ADHD symptom scales were explained by the presence of insomnia and internalizing disorders, while the contribution from alcohol consumption was restricted to the control group.

Discussion

The high functional impact of insomnia, alcohol misuse and internalizing disorders is well known. The present study contributed by focusing on their relations to ADHD symptoms, and by showing that strong relations were not restricted to adults with a clinical ADHD diagnosis. By this, the results put a critical light on a categorical delineation between adults with an ADHD diagnosis and population selected controls, and call for further studies including dimensional metrics of ADHD symptoms and co-occurring problems.

Childhood methylphenidate adherence as a predictor of antidepressants use during adolescence

Methylphenidate (MPH) is a common and effective treatment for attention deficit hyperactivity disorder (ADHD), but little is known about the relationship between early childhood intake of MPH and onset of antidepressant treatment during adolescence. The study aimed to examine whether adherence to MPH during early childhood predicts the initiation of antidepressants during adolescence. This is a 12-year historical prospective nationwide cohort study of children enrolled in an integrated care system who were first prescribed MPH between the ages of 6 and 8 years (N = 6830). We tested for an association between their adherence to MPH during early childhood (as indicated by medication possession ratio from MPH onset through the age of twelve) and the likelihood of being prescribed any antidepressant during adolescence (age 13-18). As all country citizens are covered by mandatory health insurance, and full services are provided by one of the four integrated care systems, data regarding patients' diagnoses, prescriptions, and medical purchases are well documented. Logistic regression analysis indicated that those with higher adherence to MPH had a 50% higher risk (95% CI 1.16-1.93) of receiving antidepressants during adolescence when controlling for other comorbid psychiatric conditions and parental use of antidepressants. In this large-scale longitudinal study, MPH adherence during early childhood emerged as a predictor for antidepressant treatment during adolescence, which may reflect increased emotional and behavioral dysregulation in this group. The highly adherent patients are at higher risk and should be clinically monitored more closely, particularly into adolescence.

Polyunsaturated fatty acids metabolism, purine metabolism and inosine as potential independent diagnostic biomarkers for major depressive disorder in children and adolescents

Major depressive disorder (MDD) in children and adolescents is a recurrent and disabling condition globally but its pathophysiology remains poorly elucidated and there are limited effective treatments available. We performed metabolic profiling of plasma samples based on ultra-high-performance liquid chromatography equipped with quadrupole time-offlight mass spectrometry to explore the potential biomarkers of depression in children and adolescents with MDD. We identified several perturbed pathways, including fatty acid metabolism-particularly the polyunsaturated fatty acids metabolism, and purine metabolism-that were associated with MDD in these young patients. In addition, inosine was shown as a potential independent diagnostic biomarker for MDD, achieving an area under the ROC curve of 0.999 in discriminating drug-naive MDD patients and 0.866 in discriminating drug-treated MDD from healthy controls. Moreover, we found evidence for differences in the pathophysiology of MDD in children and adolescents to that of adult MDD, specifically with tryptophan metabolism. Through metabolomic analysis, we have identified links between a framework of metabolic perturbations and the pathophysiology and diagnostic biomarker of child and adolescent MDD.

Distribution of ADHD symptoms, and associated comorbidity, exposure to risk factors and disability: Results from a general population study

The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms were associated with an increased burden of disease. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 5303). NEMESIS-2 is a nationally representative face-to-face survey on mental health of the Dutch general population. ADHD symptoms, mental comorbidity, and disability were assessed using the Adult ADHD Self-Report Scale Screener, the Composite International Diagnostic Interview version 3.0, and the Medical Outcomes Study Short Form Health Survey, respectively. Dose-response relationships were found between the number of ADHD symptoms and Axis I and II mental disorders; exposure to risk factors; and mental and physical disability. Our study supports the notion that ADHD is a dimensional trait in the adult general population. Even low numbers of symptoms were associated with an increased burden of disease, and therefore these should be identified and treated.

[Research advances in pathogenesis of attention deficit hyperactivity disorder]

Both of genetic and environmental factors play important roles in the pathogenesis of attention deficit hyperactivity disorder (ADHD), and genetic factors can increase the susceptibility of individuals to environmental risk factors. There are extensive and various structural and functional abnormalities of the brain in patients with ADHD. Given the close functional relationship between brain areas, exploration has also been expanded to the dysfunction of brain network in recent years. As for the biochemical mechanism underlying ADHD, monoamine neurotransmitters are still most valued, and abnormalities of brain-derived neurotrophic factors and glutamic acid/γ-aminobutyric acid imbalance may also be present. Due to the abnormal neuroendocrine function and connectivity between brain areas caused by the synergistic effect of genetic and environmental factors, the prefrontal cortex loses control of the lower brain areas, so that the basal ganglia and amygdala affect normal behavioral and emotional reactions. Dysfunction of the endocrine axes may further aggravate neuroendocrine disorder. The above process may eventually lead to changes in brain structure and function, which may be associated with the development of ADHD. However, considering the heterogeneity of ADHD, its pathological process may not be the same, and the exact mechanism needs to be further clarified.

Adolescent psychopathology in Times of Change: The need for integrating a developmental psychopathology perspective

In addition to the major physical, sexual and cognitive changes, as well as changes in relationships with parents and peers, in recent years adolescents also have to cope with many technological changes and increasing societal instabilities. Most of the existing research has examined the extent to which increasing uncertainties might impact expression of psychopathology and its magnitude. Emerging from a developmental psychopathology perspective, we are looking first for a better understanding of the meaning that adolescents give to these changes, which in turn is likely to affect their behavior. We are also looking for better understanding the importance of the role parents, and other societal systems/institutions (such as peers) play in ameliorating or enhancing the likelihood of maladaptive adolescent behavior under these circumstances.

Longitudinal association between mental disorders in childhood and subsequent depression - A nationwide prospective cohort study

BACKGROUND

Depression ranges among the most impairing mental disorders worldwide, and early detection is a global health priority. Little is known about the association between non-affective mental disorders in childhood/adolescence and later depression.

METHODS

Nationwide register-based prospective cohort study, estimating cumulative incidences and incidence rate ratios (IRR) for later depression in individuals with and without non-affective mental disorders in early life.

RESULTS

475,213 females and 484,813 males born 1990-2007 were followed for a mean of 9.14 years (contributing a total of 8778,331 person-years of observation). In the cohort, 7963 (5451 females) were diagnosed with depression. Depression was more common in individuals with prior non-affective mental disorders in adolescence (15.98% in females and 7.02% in males) and in childhood (4.98% in females and 1.6% in males), than in the background population (3.94% and 1.3% in females; 1.37% and 0.47% in males). Eating and anxiety disorders in childhood/adolescence carried the highest absolute risk of depression. The relative risk of depression was particularly high the first year after the first non-affective disorder (IRR = 15.5; 14.07-17.10), but remained highly elevated more than five years after the first non-affective diagnosis (IRR = 2.05; 1.84-2.28), when compared to young people without such disorders.

LIMITATIONS

This study only included diagnoses given at hospital departments, representing the more severe mental disorders.

CONCLUSIONS

Children and adolescents with non-affective mental disorders were at substantially increased absolute and relative risk of developing depression in young adulthood, especially females diagnosed with anxiety- or eating disorders in adolescence. These findings may help identify groups of children and adolescents at very high risk of developing depression.

Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

Parent Rated Symptoms of Inattention in Childhood Predict High School Academic Achievement Across Two Culturally and Diagnostically Diverse Samples

Objective: To investigate parent reports of childhood symptoms of inattention as a predictor of adolescent academic achievement, taking into account the impact of the child’s intellectual functioning, in two diagnostically and culturally diverse samples.

Method: Samples: (a) an all-female sample in the U.S. predominated by youth with ADHD (Berkeley Girls with ADHD Longitudinal Study [BGALS], N = 202), and (b) a mixed-sex sample recruited from a Norwegian population-based sample (the Bergen Child Study [BCS], N = 93). Inattention and intellectual function were assessed via the same measures in the two samples; academic achievement scores during and beyond high school and demographic covariates were country-specific.

Results: Childhood inattention predicted subsequent academic achievement in both samples, with a somewhat stronger effect in the BGALS sample, which included a large subgroup of children with ADHD. Intellectual function was another strong predictor, but the effect of early inattention remained statistically significant in both samples when intellectual function was covaried.

Conclusion: The effect of early indicators of inattention on future academic success was robust across the two samples. These results support the use of remediation procedures broadly applied. Future longitudinal multicenter studies with pre-planned common inclusion criteria should be performed to increase our understanding of the importance of inattention in primary school children for concurrent and prospective functioning.