Time of onset and/or diagnosis of ADHD in European children: a systematic review

Methylphenidate and P300 in attention deficit hyperactivity disorder: A systematic review and meta-analysis

BACKGROUND

Methylphenidate (MPH) is a stimulant medicine often used to treat attention deficit hyperactivity disorder (ADHD), as it may positively affect behaviour and brain activity. This work aims to systematise the current literature about the effects of MPH on the amplitude of P300 in individuals with ADHD.

METHODS

A systematic review and meta-analysis of empirical studies measuring P300 amplitude and comparing MPH administration to either a pre-MPH condition or healthy controls was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Our results revealed no overall (n = 13) significant differences between individuals diagnosed with ADHD and medicated with MPH and controls. Although, a moderation analysis by region found differences between both groups on frontal sites. When comparing the pre- and post-effects of MPH on the same individuals (n = 17), it appears that P300 amplitude tends to increase post-administration in central and posterior regions. In this second meta-analysis, a moderation by task revealed a larger effect size for go/no-go.

DISCUSSION

In general, MPH was found to increase P300 amplitude in ADHD, somewhat normalising this aspect of their brain activity. The main limitations of the included studies are the insufficiently explained dosages and the skewness for male participants. Future research directions are discussed.

Exposure to different types of residential greenness during pregnancy and early childhood and attention-deficit/hyperactivity disorder diagnosis: A nested case-control study

BACKGROUND

Epidemiological studies suggest that exposure to greenness may protect children attention-deficit/hyperactivity disorder (ADHD) diagnosis. However, evidence to date is limited while no previous research has independently investigated exposure to prenatal greenness.

OBJECTIVE

We conducted a nested case-control study with data from Born in Bradford (BiB) and INfancia y Medio Ambiente (INMA) birth cohorts to investigate the association between exposure to various types of residential greenness and ADHD diagnosis, considering both pregnancy and early childhood exposure periods independently. PM2.5 was tested as a potential mediator of the association.

METHODS

Children with ADHD were identified based on a confirmed medical diagnosis. Pregnancy and early childhood exposure to residential greenness were estimated through Normalized Difference Vegetation Index (NDVI) within 300-m, urban green space and natural green space percentages within 300-m, and the linear distance to the closest green space in meters. We performed a conditional logistic regression to analyze the association between the included greenness metrics and ADHD.

RESULTS

We found no statistically significant associations between any of the pregnancy and early childhood greenness metrics and ADHD diagnosis in the BiB cohort. Further analysis on the INMA cohort found that higher urban green space percentage slightly increased the risk of ADHD diagnosis during both pregnancy (total effects: OR 1.04, 95 % CI 1.01 to 1.07, p = 0.012; direct effects: OR 1.06, 95 % CI 1.03 to 1.10, p < 0.001) and early childhood (total effects: OR 1.03, 95 % CI 1.00 to 1.07, p = 0.042; direct effects: OR 1.04, 95 % CI 1.00 to 1.07, p = 0.033). However, these associations were not supported by the sensitivity analyses.

CONCLUSIONS

This study found both null and inconsistent associations between the included greenness metrics and ADHD. Further research is warranted to elucidate the potential role of exposure to different types of greenness in ADHD diagnosis.

Genetic and Regulatory Mechanisms of Comorbidity of Anxiety, Depression and ADHD: A GWAS Meta-Meta-Analysis Through the Lens of a System Biological and Pharmacogenomic Perspective in 18.5 M Subjects

Background: In the United States, approximately 1 in 5 children experience comorbidities with mental illness, including depression and anxiety, which lead to poor general health outcomes. Adolescents with substance use disorders exhibit high rates of co-occurring mental illness, with over 60% meeting diagnostic criteria for another psychiatric condition in community-based treatment programs. Comorbidities are influenced by both genetic (DNA antecedents) and environmental (epigenetic) factors. Given the significant impact of psychiatric comorbidities on individuals' lives, this study aims to uncover common mechanisms through a Genome-Wide Association Study (GWAS) meta-meta-analysis. Methods: GWAS datasets were obtained for each comorbid phenotype, followed by a GWAS meta-meta-analysis using a significance threshold of p < 5E-8 to validate the rationale behind combining all GWAS phenotypes. The combined and refined dataset was subjected to bioinformatic analyses, including Protein-Protein Interactions and Systems Biology. Pharmacogenomics (PGx) annotations for all potential genes with at least one PGx were tested, and the genes identified were combined with the Genetic Addiction Risk Severity (GARS) test, which included 10 genes and eleven Single Nucleotide Polymorphisms (SNPs). The STRING-MODEL was employed to discover novel networks and Protein-Drug interactions. Results: Autism Spectrum Disorder (ASD) was identified as the top manifestation derived from the known comorbid interaction of anxiety, depression, and attention deficit hyperactivity disorder (ADHD). The STRING-MODEL and Protein-Drug interaction analysis revealed a novel network associated with these psychiatric comorbidities. The findings suggest that these interactions are linked to the need to induce "dopamine homeostasis" as a therapeutic outcome. Conclusions: This study provides a reliable genetic and epigenetic map that could assist healthcare professionals in the therapeutic care of patients presenting with multiple psychiatric manifestations, including anxiety, depression, and ADHD. The results highlight the importance of targeting dopamine homeostasis in managing ASD linked to these comorbidities. These insights may guide future pharmacogenomic interventions to improve clinical outcomes in affected individuals.

Comorbidity of attention deficit hyperactivity disorder in young adults who had major depressive disorder

BACKGROUND

The comorbidity of Major Depressive Disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) in adults is well recognized. The role of ADHD in the etiology of MDD, as well as the overlap of genetic and environmental factors between these two disorders, is an area of research. ADHD symptoms are considered risk factors for MDD.

OBJECTIVES

The study aimed to examine the relationship between MDD in young adults with history of ADHD.

DESIGN

Retrospective and observational study.

SETTINGS

Outpatient clinic of a tertiary hospital.

PATIENTS AND METHODS

Data of young adults diagnosed with MDD, aged 18-25 years and seen between January 2017 and May 2023, were included. Individuals with comorbidities other than ADHD in adulthood were excluded from the study. The sociodemographic and clinical data of a total of 489 cases, as well as data on childhood psychiatric referrals, diagnoses, and treatment histories, were retrospectively examined.

MAIN OUTCOME MEASURES

ADHD diagnosis history and clinical impact in adults diagnosed with MDD.

SAMPLE SIZE

489.

RESULTS

A total of 489 cases (68.9% female) with a mean age of 21.14 years were included in the study. It was determined that 8% of the cases had ADHD in adulthood, 13.3% in childhood, and 31.9% had at least one mental health diagnosis during childhood. The rate of ADHD diagnosis was significantly higher in males than females in both adulthood and childhood. Additionally, the age of diagnosis of MDD was lower in individuals with ADHD diagnosis and/or those who have discontinued ADHD treatment.

CONCLUSIONS

In young adults diagnosed with MDD, the comorbidity of ADHD should also be considered. It is important to acknowledge that ADHD is not just a childhood disorder but a lifelong disorder due to its negative consequences, and to develop appropriate strategies in this regard.

LIMITATİONS

Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.

Anxiety Symptoms Predict Subsequent Depressive Symptoms in Neurodivergent Youth: A 10-Year Longitudinal Study

Neurodivergent youth often experience anxiety and depressive symptoms that may hamper adaptive functioning and well-being. There is little knowledge of how anxiety and depression are related in neurodivergent youth. Therefore, we aimed to examine whether the relationship between anxiety and depressive symptoms is uni- or bidirectional in neurodiverse youth. We assessed self-reported anxiety and depressive symptoms over time in 173 youth (Mbaseline age = 11.7 years, SD = 2.1, 64% males, 36% females). The sample comprised 38 autistic youth, 85 youth diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 50 comparison youth assessed at baseline (T1), 2-year follow-up (T2, 97% retention), and 10-year follow-up (T3, 73% retention). We used cross-lagged models to analyze the data. In neurodivergent youth, more anxiety symptoms at T1 and T2 predicted more depressive symptoms at T2 and T3. Preceding anxiety symptoms were linked with later depressive symptoms, even after accounting for autoregressive effects of depressive symptoms. The results are consistent with a prodromal model in which anxiety symptoms can independently foreshadow the emergence of depressive symptoms over the course of development among neurodivergent youth. Potentially, addressing anxiety symptoms among youth with autism or ADHD could play a role in preventing the onset of youth depression.

Long-term effects of attention deficit hyperactivity disorder (ADHD) on social functioning and health care outcomes

INTRODUCTION

Research on the long-term effects of treatment for attention deficit hyperactivity disorder (ADHD) on educational and social outcomes is limited. This study aims to evaluate long-term social functioning outcomes in patients with ADHD and the potential effects of pharmacological treatment for ADHD.

METHODS

We used National Patient Registry data from 1995 to 2016 to identify patients diagnosed with ADHD and those collecting ADHD medication. Eligible patients were under 30 years old or had reached 30 between 2005 and 2016, ensuring a minimum 10-year observation period. A case-control design was applied, matching ADHD patients in a ratio of 1:4 with the general population based on age, sex, and residential municipality at the index year.

RESULTS

Patients with ADHD experienced substantial socioeconomic difficulties, indicated by increased direct health care costs, higher rates of psychiatric comorbidities, and greater co-medication use compared with controls. No association was found between adherence to ADHD medication and completion of education at age 30 years. Adherence to ADHD medication appeared to negatively impact employment status at age 30, confounded by the severity of psychiatric comorbidity.

CONCLUSIONS

Despite available treatments, patients with ADHD lag in achieving social functioning outcomes. Further research is needed to better understand how to support patients with ADHD in order to close the gaps in health and socioeconomic status.

Impact of online health education on attention-deficit/hyperactivity disorder screening results and parenting stress among school-aged children

Aims

To investigate the effects of an online health education lecture on the positive screening rate of attention-deficit/hyperactivity disorder (ADHD) and parenting stress among parents of children diagnosed with or screened positive for ADHD.

Methods

Using stratified proportional random cluster sampling, 14 primary schools in Chongqing were selected to conduct an online lecture about ADHD for parents and teachers. A total of 2,611 questionnaires were collected (1,508 intervention group, 1,103 control group).

Results

The lecture did not significantly affect the positive screening rate of ADHD (parents: β=-0.37, p=0.208; teachers: β=0.53, p=0.338); however, the positive screening rate increased post-intervention. Inattention scores were higher in the intervention group (β=0.42, p=0.040). Parents as primary caregivers were associated with lower ADHD symptom scores (β=-0.61, p=0.022). Lower parental education levels were associated with higher ADHD screening rates (β=0.49, p=0.039) and symptom scores (β=0.60, p=0.022). Teachers with 10-19 years of experience had higher positive screening rates (β=1.26, p=0.005) and symptom scores (β=2.60, p<0.001). The intervention did not affect parenting stress (Z=-1.413, p=0.158).

Conclusions

The lecture's effects were relatively weak, using questionnaires may have facilitated health communication. Individual characteristics of parents and teachers should be considered in assessments (ClinicalTrial.gov ID: NCT05231902).

EEG-Based ADHD Classification Using Autoencoder Feature Extraction and ResNet with Double Augmented Attention Mechanism

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) represents a widely prevalent and heterogeneous neurodevelopmental condition in pediatric populations, often exhibiting a substantial propensity to persist into adulthood. ADHD is a multifaceted disorder that resists straightforward diagnostic tests. Clinicians must invest substantial time and effort to secure an accurate diagnosis and implement effective treatment. ADHD diagnosis is primarily based on psychiatric tests, as there is currently no clinically utilized objective diagnostic tool. Nonetheless, several studies in have documented endeavors to create objective instruments designed to assist in the diagnostic process of ADHD, aiming to enhance diagnostic accuracy and reduce subjectivity.

METHOD

This research endeavor sought to establish an objective diagnostic modality for ADHD through the utilization of electroencephalography (EEG) signal analysis. With the use of innovative deep learning techniques, this research seeks to improve the diagnosis of ADHD using EEG data. To capture complex patterns in EEG data, this study proposes a double-augmented attention mechanism ResNet-based model. Using an autoencoder for feature extraction, the Reptile Search Algorithm for feature selection, and a modified ResNet architecture for model training comprise the technique.

RESULTS

AUC, F1-score, accuracy, precision, recall, and other standard classifiers like Random Forest and AdaBoost were utilized to compare the model's performance. By a wide margin, the proposed ResNet model outperforms the traditional models with a 99.42% accuracy, 99.03% precision, 99.82% recall, and 99.42% F1-score.

CONCLUSIONS

ROC AUC score of 0.99 for the model underscores its remarkable capability to differentiate between children with and without ADHD, thereby minimizing misclassification errors and improving diagnostic precision.

Impact of exposure to opioids in pregnancy on offspring developmental outcomes in the preschool years: an umbrella review

BACKGROUND

Early child development sets the course for optimal outcomes across life. Increasing numbers of children worldwide are exposed to opioids in pregnancy and frequently live in environments associated with adverse developmental outcomes. Although multiple systematic reviews have been published in this area, they use different exposures and different types of outcomes. This umbrella review aims to bring together these systematic reviews to provide a comprehensive overview of the evidence around the association between prenatal opioid exposure and preschool developmental outcomes.

METHODS

PubMed, MedLine, PsycInfo and Google Scholar were searched up to July 2024. Eligible studies were systematic reviews, meta-analyses or scoping reviews exploring prenatal opioid exposure (illicit opioids and prescribed treatments for opioid dependence) and developmental outcomes up to age 5. Reviews were screened by two authors. Quality assessment was undertaken using the Joanna Briggs Institute checklist for umbrella reviews. Degree of overlap was examined. Due to heterogeneity within the sample, no meta-analyses were undertaken and results were synthesised narratively.

RESULTS

11 reviews were included containing 478 individual papers. The overlap was slight (corrected cover area=5%). Developmental outcomes associated with prenatal opioid exposure included visual function, motor skills, externalising problems and language difficulties. No conclusive evidence was available for cognitive development or internalising symptoms. In cognitive, and motor, skills, findings differed by age, with later preschool findings being weaker. Authors frequently highlighted issues with poor quality research in the original studies, including small sample sizes and lack of controlling for confounding.

CONCLUSIONS

Multiple areas of child development were associated with prenatal opioid exposure; however, evidence was weak. Robust research, with larger sample sizes and adequate accounting for confounding, is needed to provide accurate information for women of childbearing age and practitioners to guide policy and ensure that appropriate funding, support and follow-up are in place.

PROSPERO REGISTRATION NUMBER

CRD42022307992.

Using Bifactor Twin Modeling to Assess the Genetic and Environmental Dimensionality of Adult ADHD Symptoms

Attention Deficit Hyperactivity Disorder (ADHD) is a common and heritable neurodevelopmental condition that has been the subject of a wealth of genetics research. Because ADHD has an early age of onset, most of this work has focused on children, meaning that less is known about the genetics of ADHD in adults. Additionally, while much research has assessed the heritability of ADHD as a general dimension, less has assessed the heritability of individual subtypes (inattention, hyperactivity) or symptoms of ADHD. It therefore remains unclear whether the genetic factors underlying ADHD symptoms conform to a unidimensional or multidimensional structure. The aim of this study was to assess the genetic and environmental dimensionality of adult ADHD symptoms. We analyzed data from 10,454 twins of the Twins Early Development Study, who provided self-reports of ADHD symptoms using the Conners scale at age 21 years. The data conformed well to a psychometric bifactor model, providing support for a general dimension of ADHD in addition to secondary dimensions for inattention and hyperactivity. However, a bifactor independent pathway twin model provided support for a general dimension only at the level of non-shared environmental effects and not additive genetic or shared environmental effects. This suggests that symptoms of ADHD cluster together under a general dimension of non-shared environmental effects, although the two subtypes of ADHD (inattention and hyperactivity) are meaningfully genetically distinct. We found the overall heritability of ADHD to be 40%, comparable with previous estimates for adult ADHD symptoms. Our results provide useful insights into the genetic and environmental architecture of specific ADHD symptoms.

Individual child factors affecting the diagnosis of attention deficit hyperactivity disorder (ADHD) in children and adolescents: a systematic review

Attention deficit hyperactivity disorder (ADHD) is a prevalent condition characterised by patterns of inattention, hyperactivity, and impulsivity. This systematic literature review aims to identify the child clinical and sociodemographic factors related to the detection and diagnosis of ADHD in children and adolescents, given concerns about delays or failures in identifying ADHD as well as over-diagnosis, hindering appropriate and timely support for children and families. Through electronic and manual searches of peer-reviewed and grey literature, 5852 articles were identified and subjected to two stages of screening by independent reviewers. Due to the heterogeneity in study methods, a narrative approach was used to summarise study findings. Forty-one studies meeting eligibility criteria revealed sixteen child-related factors influencing the ADHD diagnostic process. These factors include ADHD subtype, ADHD symptom severity, comorbid mental disorders, behavior problems, internalizing symptoms, functional impairment, social and cognitive functioning, physical health, gender, age, relative age, race/ethnicity, socio-economic status, insurance coverage, residence urbanicity, and family structure. While the impact of many of these factors on ADHD diagnosis was inconsistent due to the substantial diversity in study designs and context, certain patterns emerged. Meeting the criteria for the inattentive subtype, lower functional impairment, female gender, Black or Latinx ethnicity, and being relatively young for their grade were consistently found to be associated with a delayed or absent ADHD diagnosis. Further research is needed to explore the intricate relationships between these child-level variables and their implications for ADHD recognition, referral, and evaluation, especially outside the USA.

Exploring correlations between Conners' Continuous Performance Test and subjective measures of attention deficit hyperactivity disorder symptoms in a paediatric clinical sample

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterised by inattention and/or hyperactivity-impulsivity. The ADHD symptoms are often evaluated and quantified using various assessment tools, such as the Conners' Continuous Performance Test II (CCPT-II), ADHD Rating Scale (ADHD-RS), Child Behaviour Checklist (CBCL), Clinical Global Assessment Scale (CGAS) and Clinical Global Impression Scale (CGIS). This study sought to compare CCPT-II with parent- and clinician-rated rating scales (ADHD-RS, CBCL, CGAS and CGIS) in measuring the core ADHD symptoms within the paediatric ADHD population.

METHODS

The data, gathered from a large-scale randomised controlled trial involving 172 children aged 6-12 years with ADHD, was pooled, and a Pearson correlation analysis was conducted.

RESULTS

No significant correlations were observed between CCPT-II and ADHD-RS, as well as the various subscales of CBCL, CGAS and CGIS.

CONCLUSION

While CCPT-II may offer insights into ADHD symptomatology, its relationship with parent- and clinician-rated rating scales such as ADHD-RS, CBCL, CGAS and CGIS appears limited. Further research is warranted to elucidate the nuances of these assessment tools and their roles in evaluating ADHD.

Changes in Autism and Co-Occurring Conditions from Preschool to Adolescence: Considerations for Precision Monitoring and Treatment Planning

PURPOSE

To describe retention of an autism spectrum disorder (ASD) diagnosis from preschool to adolescence and the most common co-occurring diagnoses among children with ASD in preschool and adolescence. A second objective was to identify co-occurring diagnoses more likely to emerge between preschool and adolescence among children with ASD vs. another developmental or mental health diagnosis in preschool.

METHODS

Children completed a case-control study when they were between 2 and 5 years of age. Caregivers reported their child's diagnoses of ASD and attention deficit hyperactivity disorder (ADHD), any developmental delay (DD), epilepsy/seizure disorder, obsessive-compulsive disorder, sensory integration disorder, and speech/language disorder when the child was preschool age and, separately, during adolescence. Any anxiety and depression/mood disorder, intellectual disability (ID), and learning disability (LD) were considered only in adolescence.

RESULTS

85.5% of preschool children retained their ASD diagnosis in adolescence. DD, sensory integration disorder, and speech-language disorder co-occurred in over 20% of preschool age children with ASD. These same conditions, along with anxiety disorders, ADHD, ID, and LD, co-occurred in over 20% of adolescents with ASD. Significantly more children with ASD vs. another developmental or mental health diagnosis in preschool gained diagnoses of ADHD, DD, sensory integration disorder, and speech-language disorder by adolescence.

CONCLUSION

ASD is a highly stable diagnosis and co-occurring conditions are common. The prevalence of co-occurring diagnoses may depend on age, with some persisting from preschool to adolescence and others emerging over time. Health and education providers can use these findings to inform precision monitoring and treatment planning.

Protocols for transitioning to adult mental health services for adolescents with ADHD

BACKGROUND

For Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are essential. While some guidelines are available, they do not always consider the effective workload and scarce resources. In Italy, very few guidelines are currently available, and they do not adhere to common standards, possibly leading to non-uniform use.

METHODS

The present study analyzes 6 protocols collected from the 21 Italian services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. The protocols' content is described, and a comparison with the National Institute for Clinical Health and Excellence (NICE) guidelines is carried out to determine whether the eight NICE fundamental dimensions were present.

RESULTS

In line with the NICE guidelines, the dimensions addresses in the 6 analyzed documents are: early transition planning (although with variability in age criteria) (6/6), individualized planning (5/6), and the evaluation of transfer needs (5/6). All protocols also foresee joint meetings between child and adult services. The need to include the families is considered by 4 out of 6 protocols, while monitoring (2/6), and training programs (1/6) are less encompassed. In general, a highly heterogeneous picture emerges in terms of quality and quantity of regulations provided.

CONCLUSIONS

While some solid points and core elements are in common with international guidelines, the content's variability highlights the need to standardize practices. Finally, future protocols should adhere more to the patients' needs and the resources available to clinicians.

Applications of OPM-MEG for translational neuroscience: a perspective

Magnetoencephalography (MEG) allows the non-invasive measurement of brain activity at millisecond precision combined with localization of the underlying generators. So far, MEG-systems consisted of superconducting quantum interference devices (SQUIDS), which suffer from several limitations. Recent technological advances, however, have enabled the development of novel MEG-systems based on optically pumped magnetometers (OPMs), offering several advantages over conventional SQUID-MEG systems. Considering potential improvements in the measurement of neuronal signals as well as reduced operating costs, the application of OPM-MEG systems for clinical neuroscience and diagnostic settings is highly promising. Here we provide an overview of the current state-of-the art of OPM-MEG and its unique potential for translational neuroscience. First, we discuss the technological features of OPMs and benchmark OPM-MEG against SQUID-MEG and electroencephalography (EEG), followed by a summary of pioneering studies of OPMs in healthy populations. Key applications of OPM-MEG for the investigation of psychiatric and neurological conditions are then reviewed. Specifically, we suggest novel applications of OPM-MEG for the identification of biomarkers and circuit deficits in schizophrenia, dementias, movement disorders, epilepsy, and neurodevelopmental syndromes (autism spectrum disorder and attention deficit hyperactivity disorder). Finally, we give an outlook of OPM-MEG for translational neuroscience with a focus on remaining methodological and technical challenges.

Identifying Language Development in Children with ADHD: Differential Challenges, Interventions, and Collaborative Strategies

Attention Deficit Hyperactivity Disorder (ADHD) significantly influences children's language acquisition and usage. This theoretical study explores the multifaceted impact of ADHD on language development, specifically focusing on reading and writing challenges. Existing research reveals that approximately 30% of children with ADHD show significant delays in reading proficiency. Additionally, about 40% of these children struggle with phonological processing, which directly impacts their reading and writing skills. Interventions targeting executive function training combined with phonics-based instruction have been shown to significantly improve language outcomes. This study introduces a comprehensive framework connecting these challenges to specific interventions and collaborative strategies, emphasizing the importance of a multi-disciplinary approach. This work provides perspectives on the specific connections between ADHD symptoms and language difficulties, offering detailed potential solutions based on empirical data. Moreover, it features the necessity of adopting integrated intervention strategies to advance academic outcomes and communicative competencies for children with ADHD, providing new understandings into effective educational practices.

Evaluation of Problematic Video Game Use in Adolescents with ADHD and without ADHD: New Evidence and Recommendations

Video game addiction among adolescents, particularly those with ADHD, is a significant concern. To gather more insights into video game usage patterns in this population, we investigated levels of potentially problematic use, passion, motivations, and emotional/behavioral symptoms in adolescents with and without ADHD. Our cross-sectional, multicenter study involved 2513 subjects (Age M = 15.07; SD = 2.82) from 24 schools in Galicia (Spain), including 158 (6.3%) diagnosed with ADHD. We employed an ad hoc questionnaire covering sociodemographic data and ADHD diagnosis, the Questionnaire of Experiences Associated with Video Games (CERV), the scale of passion for video games, reasons for playing video games Questionaire (VMQ), and emotional/behavioral problems assessment (SDQ). Results indicated heightened vulnerability in adolescents with ADHD, manifesting in longer usage durations and higher problematic use scores. Interestingly, ADHD medication did not affect internet gaming disorder development. Motivations for gaming differed between groups, with the ADHD cohort showing distinctions in cognitive development, coping, and violent reward. Additionally, the ADHD group exhibited greater emotional/behavioral symptoms, hyperactivity, and reduced prosocial behavior.

Genetic and phenotypic heterogeneity in early neurodevelopmental traits in the Norwegian Mother, Father and Child Cohort Study

BACKGROUND

Autism and different neurodevelopmental conditions frequently co-occur, as do their symptoms at sub-diagnostic threshold levels. Overlapping traits and shared genetic liability are potential explanations.

METHODS

In the population-based Norwegian Mother, Father, and Child Cohort study (MoBa), we leverage item-level data to explore the phenotypic factor structure and genetic architecture underlying neurodevelopmental traits at age 3 years (N = 41,708-58,630) using maternal reports on 76 items assessing children's motor and language development, social functioning, communication, attention, activity regulation, and flexibility of behaviors and interests.

RESULTS

We identified 11 latent factors at the phenotypic level. These factors showed associations with diagnoses of autism and other neurodevelopmental conditions. Most shared genetic liabilities with autism, ADHD, and/or schizophrenia. Item-level GWAS revealed trait-specific genetic correlations with autism (items rg range = - 0.27-0.78), ADHD (items rg range = - 0.40-1), and schizophrenia (items rg range = - 0.24-0.34). We find little evidence of common genetic liability across all neurodevelopmental traits but more so for several genetic factors across more specific areas of neurodevelopment, particularly social and communication traits. Some of these factors, such as one capturing prosocial behavior, overlap with factors found in the phenotypic analyses. Other areas, such as motor development, seemed to have more heterogenous etiology, with specific traits showing a less consistent pattern of genetic correlations with each other.

CONCLUSIONS

These exploratory findings emphasize the etiological complexity of neurodevelopmental traits at this early age. In particular, diverse associations with neurodevelopmental conditions and genetic heterogeneity could inform follow-up work to identify shared and differentiating factors in the early manifestations of neurodevelopmental traits and their relation to autism and other neurodevelopmental conditions. This in turn could have implications for clinical screening tools and programs.

Time after time: failure to identify and support females with ADHD - a Swedish population register study

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is associated with risk taking and negative health-related outcomes across the lifespan. Due to delay in referral and diagnostics, young females with ADHD may not be identified, nor appropriately supported by adequate interventions.

METHODS

A total of 85,330 individuals with ADHD, all of whom were residents in Stockholm County between January 01, 2011, and December 31, 2021, were included as participants in this population-based, cross-sectional cohort study. Population controls (n = 426,626) were matched by age, sex, and socioeconomic status (SES). Data was obtained from Regional Healthcare Data Warehouse of Region Stockholm (VAL) in Stockholm County. Exposure was ADHD-index, defined as the first record of either ICD-10 F90 diagnosis and/or ATC-code for stimulant or non-stimulant ADHD-medication during the study period. Primary outcome was age at ADHD-index. Secondary outcome measures were psychiatric comorbidity, pharmacological treatment, and health care utilization, prior to and after ADHD-index.

RESULTS

Females were older at ADHD-index (23.5 years, SD 13.8) compared to males (19.6 years, SD 13.9, 95% CI of difference 3.74-4.11). Overall, females with ADHD showed higher rates of psychiatric comorbidity, pharmacological treatment, and health care utilization, compared to males with ADHD and female controls.

CONCLUSIONS

Females with ADHD receive diagnosis and treatment for ADHD approximately 4 years later than males. They have a higher burden of comorbid psychiatric conditions and health care utilization, compared to males with ADHD and female controls, both prior to and after ADHD-index. To prevent long-term adverse consequences for females with ADHD, methods, and tools for early diagnosis and treatments that mitigate personal suffering and societal burden are warranted.

Access to early diagnosis for attention-deficit/hyperactivity disorder among children and adolescents in Mexico City at specialized mental health services

BACKGROUND

In Mexico, this pioneering research was undertaken to assess the accessibility of timely diagnosis of Dyads [Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and their primary caregivers] at specialized mental health services. The study was conducted in two phases. The first phase involved designing an "Access Pathway" aimed to identify barriers and facilitators for ADHD diagnosis; several barriers, with only the teacher being identified as a facilitator. In the second phase, the study aimed to determine the time taken for dyads, to obtain a timely diagnosis at each stage of the Access Pathway. As well as identify any disparities based on gender and socioeconomic factors that might affect the age at which children can access a timely diagnosis.

METHOD

In a retrospective cohort study, 177 dyads participated. To collect data, the Acceda Survey was used, based on the robust Conceptual Model Levesque, 2013. The survey consisted of 48 questions that were both dichotomous and polytomous allowing the creation of an Access Pathway that included five stages: the age of perception, the age of search, the age of first contact with a mental health professional, the age of arrival at the host hospital, and the age of diagnosis. The data was meticulously analyzed using a comprehensive descriptive approach and a nonparametric multivariate approach by sex, followed by post-hoc Mann-Whitney's U tests. Demographic factors were evaluated using univariable and multivariable Cox regression analyses.

RESULTS

71% of dyads experienced a late, significantly late, or highly late diagnosis of ADHD. Girls were detected one year later than boys. Both boys and girls took a year to seek specialized mental health care and an additional year to receive a formal specialized diagnosis. Children with more siblings had longer delays in diagnosis, while caregivers with formal employment were found to help obtain timely diagnoses.

CONCLUSIONS

Our findings suggest starting the Access Pathway where signs and symptoms of ADHD are detected, particularly at school, to prevent children from suffering consequences. Mental health school-based service models have been successfully tested in other latitudes, making them a viable option to shorten the time to obtain a timely diagnosis.

Identifying non-adult attention-deficit/hyperactivity disorder individuals using a stacked machine learning algorithm using administrative data population registers in a universal healthcare system

Background

This research project aims to build a Machine Learning algorithm (ML) to predict first-time ADHD diagnosis, given that it is the most frequent mental disorder for the non-adult population.

Methods

We used a stacked model combining 4 ML approaches to predict the presence of ADHD. The dataset contains data from population health care administrative registers in Catalonia comprising 1,225,406 non-adult individuals for 2013-2017, linked to socioeconomic characteristics and dispensed drug consumption. We defined a measure of proper ADHD diagnoses based on medical factors.

Results

We obtained an AUC of 79.6% with the stacked model. Significant variables that explain the ADHD presence are the dispersion across patients' visits to healthcare providers; the number of visits, diagnoses related to other mental disorders and drug consumption; age, and sex.

Conclusions

ML techniques can help predict ADHD early diagnosis using administrative registers. We must continuously investigate the potential use of ADHD early detection strategies and intervention in the health system.

Hearing Impairment and Severe Attention Deficit/Hyperactivity Disorder: A Nationwide Study

BACKGROUND

The association between hearing impairment and attention-deficit/hyperactivity disorder (ADHD) is unclear. Therefore, we aimed to assess this association in Israel's national sample of over 1.1 million adolescents.

METHODS

We conducted a nationwide, population-based, cross-sectional study of all Israeli adolescents (n = 1,175,534, 58% males; mean age, 17 yrs) who were examined before mandatory military service during 2004 to 2020. Board-certified specialists confirmed diagnoses of hearing impairment and severe ADHD.

MAIN OUTCOMES AND MEASURES

We compared the prevalence of severe ADHD in adolescents with and without hearing impairment. Associations were analyzed using logistic regression models and sensitivity analyses accounting for hearing impairment type (sensorineural vs. conductive) and severity.

RESULTS

Of the 8,769 adolescents with hearing impairment, 57 were diagnosed with severe ADHD (prevalence = 0.65%). Of the 1,166,765 adolescents without hearing impairment, 3,936 were diagnosed with severe ADHD (prevalence = 0.29%). We found a significant association between hearing impairment and severe ADHD (odds ratio = 1.93 [95% confidence interval, 1.47-2.49]), which persisted in a multivariable model adjusted to age, sex, socioeconomic status, educational status, cognitive performance, and immigration status (odds ratio = 1.70 [95% confidence interval, 1.29-2.20]). The association also persisted when stratified by hearing impairment type (sensorineural vs. conductive) and severity.

CONCLUSIONS

Adolescents with hearing impairment had 70% increased odds of severe ADHD. Study findings suggest that active screening of patients with hearing impairment for ADHD should be considered.

Word-Finding Difficulties as a Prominent Early Finding in a Later Diagnosis of Attention Deficit Hyperactivity Disorder

OBJECTIVE

 Attention deficit hyperactivity disorder (ADHD) is a common neuropsychological disorder primarily diagnosed in childhood. Early intervention was found to significantly improve developmental outcomes, implicating on the role of early identification of ADHD markers. In the current study, we explored the developmental history of children referred to neurological assessment to identify early ADHD predictors.

METHODS

 A total of 92 children and adolescents (41 females) recruited at a pediatric neurology clinic, with suspected ADHD (n = 39) or other neurological difficulties (n = 53) such as headaches, seizures, tic disorders, orthostatic hypotension, postischemic stroke, intermittent pain, and vasovagal syncope. Developmental history information was obtained from caregivers, and evaluation for possible ADHD was performed. Developmental details were compared between children with and without current ADHD diagnosis.

RESULTS

 Word-finding difficulties (WFDs) in preschool age was reported in 30.4% of the sample. Among children diagnosed with ADHD, 43% had WFDs history, compared with only 5% in children without ADHD. Among children with WFDs history, 93% were later diagnosed with ADHD compared with 42% in children without WFDs history. The relationship between WFDs and ADHD was significant (chi-square test [1, N = 92] = 20.478, p < 0.0001), and a logistic regression model demonstrated that asides from a family history of ADHD, the strongest predictor for ADHD in school age children was a history of WFDs.

CONCLUSION

 Preliminary evidence supports a predictive link between preschool WFDs and later ADHD diagnosis, highlighting the importance of early WFDs clinical attention.

Hyperactivity in preschool age is associated with higher fat-free mass and healthy lifestyle behaviours five years later: A longitudinal study of Swedish children

BACKGROUND

There is evidence for a link between hyperactivity and obesity, especially among older children. Both conditions seem to be multifactorial in origin and hypotheses of common underlying issues, such as emotional dysregulation, have been suggested. However, studies of the co-occurrence of the two conditions in younger age groups have been inconclusive.

OBJECTIVES

We aimed to study the longitudinal associations of psychological strengths and difficulties at 4 years of age with health behaviours, body composition, physical fitness, and cardiovascular disease (CVD) risk factors 5 years later.

METHODS

Parents of 226 4-year-old children filled out the Strengths and Difficulties Questionnaire (SDQ). At 9 years of age, we assessed health behaviours, physical fitness, body composition, and CVD risk factors. Associations were examined with linear regression models that were adjusted for sex, age of the child at 9, and maternal education.

RESULTS

In the adjusted models, hyperactivity at 4 was associated with higher fat-free mass (β = 0.18, p = 0.007) and lower levels of sedentary behaviour (β -0.14, p = 0.043) at 9 years. Furthermore, greater emotional problems at 4 were associated with lower intake of fruit and vegetables (β -0.14, p = 0.038) at 9 years. However, there were no statistically significant associations between psychological difficulties and fat-mass index.

CONCLUSIONS

Our novel data provide no evidence of an association between hyperactivity in preschool age and obesity or obesity-related behaviours in school age. Future studies examining how psychological factors relate to obesity development should consider a developmental perspective.

Psychometric Properties of the Arabic Vanderbilt Children's ADHD Diagnostic Rating Scale (VADRS-A) in a Saudi Population Sample

Objective

This study aimed to utilize Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) to investigate the constructive validity of the Arabic translation of the Vanderbilt Attention Deficit/Hyperactive Disorder (ADHD) Diagnostic Scale (VADRS-A) using its two versions, the Arabic Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS-A) and the Arabic Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS-A).

Method

A descriptive research design was employed. Children were assessed by their parents and teachers, and a cluster sample of 1812 participants was chosen from many schools in Saudi Arabia, divided into two groups: parents (504) and teachers (1308) of children whose ages ranged between 5 to 12 years old. The VADPRS-A and VADTRS-A were administered to parents and teachers under the supervision of the Saudi ADHD Society.

Results

The results of the PCA of VADPRS-A found that the six factors saturate one general factor that explained (59%) of the total variance of the factor matrix with eigenvalues (3.540). Similarly, the PCA of VADTRS-A demonstrated that the five factors were saturated on a general factor that explained (69.20%) of the total variance of the factor matrix with eigenvalues (3.460). Also, the results indicate the high internal consistency of VADPRS-A and VADTRS-A, all factors correlated together and the total scores positively and significantly statistically (p>.001) correlation coefficients ranged between (0.296 to 0.843) for VADPRS-A, and ranges between (0.432 to 0.939) for VADTRS-A. Also, the Cronbach's α coefficient values for the six factors and total score of VADPRS-A were (.906, .925, .900, .896, .853, .872, .959) respectively, and these values are close to the values of the McDonald's ω for the factors and the total score were (.908, .923, .901, .871, .850, .877, .925) respectively. In the same way, Cronbach's α coefficients were (.967, .921, .914, .858, .948, .971) for all factors and the total score of VADTRS-A respectively, and these values are close to the values of the McDonald's ω (.968, .921, .919, .856, .943, .965) for all factors and the total score of VADTRS-A. In addition CFA for VADPRS-A and VADTRS-A models showed acceptable factor loading and good values of goodness-of-fit indices; CFI, TLI, RMSEA, IFI, and GFI (0.956, 0.942, 0.049, 0.956, 0.952) respectively for VADPRS-A model, and were (0.958, 0.932, 0.051, 0.963, 0.964) for VADTRS-A model, all of these were at an acceptable range. These results suggest a fit with the previous theoretical literature about VADPRS and VADTRS and DSM-5 and ICD-11 criteria of ADHD.

Conclusion

These findings highlighted the good psychometric properties of VADRS-A in both its versions VADPRS-A and VADTRS-A in the Saudi environment. Due to these findings, we suggest utilizing VADPRS-A and VADTRS-A during ADHD diagnosis in children 5-12 years old in Saudi Arabia, to facilitate early diagnosis and intervention, and to help mitigate the risks of ADHD during subsequent developmental phases in children's lives.

The risk of attention-deficit hyperactivity disorder among children with congenital heart disease: A systematic review and meta-analysis

BACKGROUND

Although current treatments are effective in dealing with congenital heart disease (CHD), non-cardiac comorbidities such as attention-deficit hyperactivity disorder (ADHD) have received widespread attention. The purpose of this systematic review and meta-analysis is to assess the risk of ADHD associated with CHD.

METHODS

The literature search was carried out systematically through eight different databases by the end of September 2022. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. The heterogeneity of the studies was assessed by the Cochran Q test and the I2 statistic. Subgroup and sensitivity analyses were used to explore the potential sources of heterogeneity.

RESULTS

Eleven studies were included in this study, which involved a total of 296 741 participants. Our study showed that the children with CHD were at a significantly increased risk of ADHD compared with the reference group (OR = 2.98, 95% CI: 2.18-4.08). The results were moderately heterogeneous. These factors including study design, geographic region and study quality were identified as the first three of the most relevant heterogeneity moderators by subgroup analyses. Sensitivity analysis yielded consistent results. There was no evidence of publication bias.

CONCLUSIONS

The present study suggests that CHD children have a significantly higher risk of ADHD when compared with those without CHD. Early identification and intervention of ADHD is important to reduce its symptoms and adverse effects; therefore, clinicians should increase screening for ADHD in children with CHD and intervene promptly to reduce its effects whenever possible.

The association between early childhood onset epilepsy and attention-deficit hyperactivity disorder (ADHD) in 3237 children and adolescents with Autism Spectrum Disorder (ASD): a historical longitudinal cohort data linkage study

Children and young people with Autism Spectrum Disorder (ASD) have an increased risk of comorbidities, such as epilepsy and Attention-Deficit/Hyperactivity Disorder (ADHD). However, little is known about the relationship between early childhood epilepsy (below age 7) and later ADHD diagnosis (at age 7 or above) in ASD. In this historical cohort study, we examined this relationship using an innovative data source, which included linked data from routinely collected acute hospital paediatric records and childhood community and inpatient psychiatric records. In a large sample of children and young people with ASD (N = 3237), we conducted a longitudinal analysis to examine early childhood epilepsy as a risk factor for ADHD diagnosis while adjusting for potential confounders, including socio-demographic characteristics, intellectual disability, family history of epilepsy and associated physical conditions. We found that ASD children and young people diagnosed with early childhood epilepsy had nearly a twofold increase in risk of developing ADHD later in life, an association which persisted after adjusting for potential confounders (adjusted OR = 1.72, CI95% = 1.13-2.62). This study suggests that sensitive monitoring of ADHD symptoms in children with ASD who have a history of childhood epilepsy may be important to promote early detection and treatment. It also highlights how linked electronic health records can be used to examine potential risk factors over time for multimorbidity in neurodevelopmental conditions.

The Prevalence of Risk Factors Among Children Diagnosed With Attention-Deficit/Hyperactivity Disorder, Aged 4-17 Years: A Cross-Sectional Study

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly observed in children. Although the etiology of ADHD is still unclear, many risk factors have been shown to increase the prevalence of ADHD, such as genetics, environmental factors, socioeconomic status, maternal smoking, and low birth weight.

AIM

The current cross-sectional study aimed to assess the prevalence of several risk factors associated with ADHD-diagnosed children aged 4-17 years using parent-reported data.

METHODS

An observational cross-section study was conducted between December 2022 and February 2023 using a self-constructed questionnaire that we sent to parents whose children were diagnosed with ADHD. The questionnaire included socioeconomic information (income, gender, parent education, number of children), child information (age, ADHD type, academic achievement), pregnancy and neonatal period (smoking status, gestation age, mode of delivery, child weight), and if there is a history of ADHD in the family.

RESULTS

A total of 306 parents responded to the questionnaire. The majority of our study population was males (77.8%). The combined type, which includes symptoms of both hyperactivity and inattention, represented 70% of the population in our study, which is higher than the inattention type (23%) and the hyperactivity type (6%). The prevalence of several risk factors known to be associated with ADHD, such as family income, parental education, complications during pregnancy, and the low birth weight of the child, were also reported.

CONCLUSION

To the best of our knowledge, this is the first study that examines the frequency of risk factors among children diagnosed with ADHD in Saudi Arabia. The study revealed that males are more likely to be diagnosed with ADHD than females. We also found that the combined type is the most diagnosed ADHD among children. Furthermore, there are no significant differences in the prevalence of the risk factors during the gestational or neonatal period among ADHD-diagnosed children. Therefore, a large-scale prospective study is needed to aid in evaluating the frequency and significance of various risk factors among diagnosed children.

Psychoactive substance use in patients diagnosed with attention-deficit/hyperactivity disorder: an exploratory study

Introduction

Attention-deficit/hyperactivity disorder (ADHD) was originally treated as a neurodevelopmental disorder that occurs mainly in children and tends to diminish or disappear with age, but we now know that symptoms persist into adulthood in over 50% of ADHD patients. Undiagnosed individuals often turn to psychoactive substance to minimize the negative aspects of functioning and improve quality of life.

Methods

The study was conducted online using random sampling through a Facebook group administered by physicians and targeted to patients diagnosed with ADHD. The study was naturalistic and exploratory, therefore no hypothesis was made. 438 correctly completed questionnaires were received. Analysis of the results showed that people with ADHD turn to psychoactive substances relatively frequently.

Results

The most commonly used stimulants include alcohol, marijuana, 3,4-methylenedioxymethamphetamine (MDMA), amphetamine/methamphetamine, and psilocybin. In the study population, methylphenidate is the most commonly used drug among patients. After treatment with psychostimulants, the majority of respondents note a decrease in symptoms of hyperactivity disorder, especially in male patients.

Conclusion

It is necessary to perform proper diagnostics and actively look for ADHD symptoms in patients who tend to use psychoactive substances.

Prenatal exposure to pregabalin, birth outcomes and neurodevelopment - a population-based cohort study in four Nordic countries

INTRODUCTION

Pregabalin is an antiepileptic drug frequently prescribed to pregnant women. Risks of adverse birth and postnatal neurodevelopmental outcomes following prenatal exposure to pregabalin are uncertain.

OBJECTIVE

To investigate the association between prenatal exposure to pregabalin and the risks of adverse birth and postnatal neurodevelopmental outcomes.

METHODS

This study was conducted using population-based registries in Denmark, Finland, Norway, and Sweden (2005-2016). We compared pregabalin exposure against no exposure to antiepileptics and against active comparators lamotrigine and duloxetine. We obtained pooled propensity score-adjusted estimates of association using fixed-effect and Mantel-Haenszel (MH) meta-analyses.

RESULTS

The total number of pregabalin-exposed births was 325/666,139 (0.05%) in Denmark, 965/643,088 (0.15%) in Finland, 307/657,451 (0.05%) in Norway, and 1275/1,152,002 (0.11%) in Sweden. The adjusted prevalence ratios (aPRs) with 95% confidence interval (CI) following pregabalin exposure versus no exposure were 1.14 (0.98-1.34) for major congenital malformations and 1.72 (1.02-2.91) for stillbirth, which attenuated to 1.25 (0.74-2.11) in MH meta-analysis. For the remaining birth outcomes, the aPRs were close to or attenuated toward unity in analyses using active comparators. Adjusted hazard ratios (95% CI) contrasting prenatal pregabalin exposure versus no exposure were 1.29 (1.03-1.63) for ADHD and attenuated when using active comparators, 0.98 (0.67-1.42) for autism spectrum disorders, and 1.00 (0.78-1.29) for intellectual disability.

CONCLUSIONS

Prenatal exposure to pregabalin was not associated with low birth weight, preterm birth, small for gestational age, low Apgar score, microcephaly, autism spectrum disorders, or intellectual disability. On the basis of the upper value of the 95% confidence interval, increased risks greater than 1.8 were unlikely for any major congenital malformation and ADHD. For stillbirth and most groups of specific major congenital malformations, the estimates attenuated in MH meta-analysis.

Psychostimulants for Children: Are We Over or Under Dosing?

An estimated 3% to 10% of school children meet the DSM-V criteria for ADHD (Attention-Deficit/Hyperactivity Disorder), however, to be over-diagnosed, the rate of children inappropriately diagnosed with ADHD (false positives) would have to be larger than the number of children with ADHD who are under-identified and not diagnosed (false negatives). Accordingly, a number of investigators take the position that under-treatment with psychostimulants, especially in children and adolescence, will result in continued ADHD symptomatology including future Substance Use Disorder (SUD). However, other researchers and clinicians believe otherwise and espouse laudable arguments for caution and prolonged methamphetamine treatment. While there is ongoing controversy of the role of genetics and epigenetics linked to ADHD, it seems clear that a number of dopaminergic genes and their risk polymorphisms act as DNA antecedents impacted by epigenetic induced methylation. Our hypothesis and literature review suggest that one possible solution is to embrace non addictive interventions to induce global dopamine homeostasis.

Increased fracture risk among children diagnosed with attention- deficit/hyperactivity disorder: a large matched cohort study

To analyse the risk of fractures among children with attention-deficit/hyperactivity disorder (ADHD) compared with matched children without ADHD; and to evaluate the impact of pharmacological treatment. This registry-based cohort study included 31,330 children diagnosed with ADHD and a comparison group of 62,660 children matched by age, sex, population sector and socioeconomic status. Demographic and clinical information was extracted from the electronic database of Meuhedet, a health maintenance organization. Fracture events between 2-18 years of age were identified by coded diagnoses. The overall fracture incidence rate was 334 per 10,000 patient-years (PY) in the ADHD group and 284 per 10,000 PY in the comparison group (p < 0.001). Among boys, the fracture incidence rates were 388 per 10,000 PY and 327 per 10,000 PY (p < 0.001), for the respective groups. Among girls, the rates were lower in both groups compared to boys, but higher in the ADHD compared to the matched group (246 vs 203 per 10,000 PY, p < 0.001). Among the children with ADHD, the hazard ratios (HR) to have a fracture were similar in boys (1.18, 95%CI 1.15-1.22, p < 0.001) and girls (1.22, 95%CI 1.16-1.28, p < 0.001). Children with ADHD were also at increased risk for two and three fractures; the hazard ratios (HRs) were 1.32 (95%CI 1.26-1.38, p < 0.001) and 1.35 (95%CI 1.24-1.46, p < 0.001), respectively. In a multivariable model of the children with ADHD, pharmacological treatment was associated with reduced fracture risk (HR 0.90, 95%CI 0.82-0.98, p < 0.001) after adjustment for sex, resident socioeconomic status and population sector.   Conclusion: Children with ADHD had greater fracture risk than a matched group without ADHD. Pharmacological treatment for ADHD may decrease this risk. What is Known: • Children with attention-deficit/hyperactivity disorder (ADHD) may be more prone to injuries and fractures than children without ADHD. What is New: • Children with ADHD were 1.2 times more likely to have a fracture than children with similar characteristics, without ADHD. The increased risk for fractures was even greater for two and three fractures (hazard ratios 1.32 and 1.35, respectively). • Our study suggests a positive effect of pharmacological treatment for ADHD in reducing fracture risk.

Prevalence and Risk Factors of Attention Deficit-Hyperactivity Disorder in the Saudi Population: A Systematic Review and Meta-analysis

Objectives

To determine the prevalence and risk factors of attention deficit hyperactivity disorder (ADHD) in Saudi Arabia.

Methods

Observational studies (case-control, cohort, and cross-sectional) that reported the prevalence and risk factors of ADHD among Saudis and were published in English were included. In March 2022, a computerized search was conducted on Medline (via PubMed), Web of Science, and Scopus using keywords associated with ADHD and Saudi Arabia. Two-stage screening and data extraction were performed. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional studies was used for the quality assessment. A random-effects model was used to estimate the prevalence. The Comprehensive Meta-analysis program was used for the analysis.

Results

Fourteen studies (N = 455,334 patients) were included. The pooled prevalence of ADHD in the Saudi population was 12.4% (95% CI: 5.4%-26%). For ADHD-Inattentive and ADHD-Hyperactive presentations, the prevalence was 2.9% (95% CI: 0.3%-23.3%) and 2.5% (95% CI: 0.2%-20.5%), respectively. Regarding the combined AD and HD, the prevalence was 2.5% (95% CI: 0.2%-20.5%). Children of women with psychological disorders during pregnancy (P = 0.043), insufficient vitamin B during pregnancy (P = 0.006), allergic reactions (P = 0.032), and disabling symptoms of muscle pain during pregnancy (P = 0.045) were associated with an increased risk of ADHD.

Conclusions

The prevalence of ADHD in the Saudi population is comparable with that in other countries from the Middle East and North Africa region. Careful monitoring of pregnant women, attention to nutritional sufficiency, psychological and emotional support, and avoidance of stressful events may lead to reducing the incidence of ADHD in the offspring.

Funding

None.

Registration

PROSPERO (Ref no.: CRD42023390040).

High rate of attention deficit hyperactivity disorder among children 6 to 17 years old in Southwest Ethiopia findings from a community-based study

BACKGROUND

Attention-deficit/hyperactivity disorder is among the common neuropsychiatric disorders affecting children and adolescents. The disorder affects the life of children, their parents, and the community when left untreated. Although evidence indicated a high prevalence of attention-deficit/hyperactivity disorder in the developed world, there is limited evidence in developing countries, particularly, Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of attention deficit hyperactivity disorder among Ethiopian children aged 6 to 17 years.

METHODS

A community-based cross-sectional study was conducted from August to September 2021 among children aged 6 to 17 years in Jimma town. A multistage sampling technique was applied to select 520 study participants. Data were collected by using the Vanderbilt Attention Deficit Hyperactivity Disorder- Parent Rating scale as a modified, semi-structured, and face-to-face interview. The association between independent variables and the outcome variable was investigated using bi-variable and multivariable logistic regression. The final model level of significance was set at a p-value of < 0.05.

RESULT

A total of 504 participants were involved in the study with a response rate of 96.9%. The overall prevalence of attention deficit hyperactivity disorder in this study was (9.9%, n = 50). Maternal complication during pregnancy (Adjusted odds ratio (AOR) = 3.56, 95% CI = 1.44-8.79, mothers illiteracy (AOR = 3.10, 95% CI = 1.24-7.79), attending primary school (AOR = 2.97, 95% CI = 1.32-6.73), history of head trauma (AOR = 3.20, 95% CI = 1.25-8.16), maternal alcohol use during pregnancy (AOR = 3.54, 95% CI = 1.26-10), bottle feeding during first six months (AOR = 2.87, 95% CI = 1.20-6.93) and child's age 6-11 years (AOR = 3.86, 95% CI = 1.77-8.43) were significantly associated with attention deficit hyperactivity disorder.

CONCLUSION

In this study, one in ten children and adolescents in Jimma town had attention deficit hyperactivity disorder. Therefore, the prevalence of attention deficit hyperactivity disorder was high. For this reason, there is a need to pay increased attention to control associated factors of attention deficit hyperactivity disorder and reduce its prevalence.

Deep Learning-Based ADHD and ADHD-RISK Classification Technology through the Recognition of Children's Abnormal Behaviors during the Robot-Led ADHD Screening Game

Although attention deficit hyperactivity disorder (ADHD) in children is rising worldwide, fewer studies have focused on screening than on the treatment of ADHD. Most previous similar ADHD classification studies classified only ADHD and normal classes. However, medical professionals believe that better distinguishing the ADHD-RISK class will assist them socially and medically. We created a projection-based game in which we can see stimuli and responses to better understand children's abnormal behavior. The developed screening game is divided into 11 stages. Children play five games. Each game is divided into waiting and game stages; thus, 10 stages are created, and the additional waiting stage includes an explanation stage where the robot waits while explaining the first game. Herein, we classified normal, ADHD-RISK, and ADHD using skeleton data obtained through games for ADHD screening of children and a bidirectional long short-term memory-based deep learning model. We verified the importance of each stage by passing the feature for each stage through the channel attention layer. Consequently, the final classification accuracy of the three classes was 98.15% using bi-directional LSTM with channel attention model. Additionally, the attention scores obtained through the channel attention layer indicated that the data in the latter part of the game are heavily involved in learning the ADHD-RISK case. These results imply that for ADHD-RISK, the game is repeated, and children's attention decreases as they progress to the second half.

Deep-Learning-Based ADHD Classification Using Children's Skeleton Data Acquired through the ADHD Screening Game

The identification of attention deficit hyperactivity disorder (ADHD) in children, which is increasing every year worldwide, is very important for early diagnosis and treatment. However, since ADHD is not a simple disease that can be diagnosed with a simple test, doctors require a large period of time and substantial effort for accurate diagnosis and treatment. Currently, ADHD classification studies using various datasets and machine learning or deep learning algorithms are actively being conducted for the screening diagnosis of ADHD. However, there has been no study of ADHD classification using only skeleton data. It was hypothesized that the main symptoms of ADHD, such as distraction, hyperactivity, and impulsivity, could be differentiated through skeleton data. Thus, we devised a game system for the screening and diagnosis of children's ADHD and acquired children's skeleton data using five Azure Kinect units equipped with depth sensors, while the game was being played. The game for screening diagnosis involves a robot first travelling on a specific path, after which the child must remember the path the robot took and then follow it. The skeleton data used in this study were divided into two categories: standby data, obtained when a child waits while the robot demonstrates the path; and game data, obtained when a child plays the game. The acquired data were classified using the RNN series of GRU, RNN, and LSTM algorithms; a bidirectional layer; and a weighted cross-entropy loss function. Among these, an LSTM algorithm using a bidirectional layer and a weighted cross-entropy loss function obtained a classification accuracy of 97.82%.

Screening of ADHD symptoms in primary school students and investigation of parental awareness of ADHD and its influencing factors: A cross-sectional study

Objective

The present study aimed to compare the differences in positive screening rates of attention deficit hyperactivity disorder (ADHD) symptoms between parents and teachers in the same sample of primary school students. Concurrently, parental awareness and information sources of ADHD were investigated, and possible relevant factors affecting parental awareness and their influence on positive screening rate of ADHD were analyzed.

Methods

A cross-sectional study was conducted in Changchun, China, between September 2020 and January 2021. Parents of 1,118 primary school students and 24 head teachers were recruited in the survey. Data were collected through a structured self-administered questionnaire. It consisted of socio-demographic characteristics, ADHD symptom screening questionnaire, parental awareness, and information sources of ADHD.

Results

Among the 1,118 primary school students, 30 (2.7%) and 60 (5.4%) students were positive for Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) screening in the parent version and teacher version, respectively. Parents had lower positive screening rates for ADHD symptoms than teachers. Relationship with children (mother, OR = 1.552, 95% CI = 1.104-2.180), bachelor degree or above of parents (OR = 1.526, 95% CI = 1.054-2.210), children's sex (girl, OR = 1.442, 95% CI = 1.093-1.904), and age (OR = 1.344, 95% CI = 1.030-1.754), children's grade (grade 2, OR = 0.522, 95% CI = 0.310-0.878; grade 3, OR = 0.388, 95% CI = 0.185-0.782), information sources of ADHD (medical staff, OR = 1.494, 95% CI = 1.108-2.015; family/relative/friend, OR = 1.547, 95% CI = 1.148-2.083; TV/Internet, OR = 3.200, 95% CI = 2.270-4.510) were the factors related to the parental awareness of ADHD.

Conclusion

Parents and teachers of primary school students recognize ADHD symptoms differently. The positive screening rate of ADHD among teachers was significantly higher than that of parents. Relationship with children, educational level of parents, children's sex, age, and grade, and information sources of ADHD are the relevant factors affecting parental awareness of ADHD. More efforts should be made to disseminate ADHD knowledge through mass media, and medical staff. Fathers, parents with low educational level, and parents of grade 2 and 3 pupils should be encouraged to acquire more knowledge on ADHD to improve the early recognition rate of ADHD symptoms.

Clinical trial registration

[http://www.chictr.org.cn/showproj.aspx?proj=54 072], identifier [ChiCTR2000033388].

Attention-deficit hyperkinetic disorder among children and adolescents with type 1 diabetes: a cross-sectional study

Background

Type 1 diabetes is a common childhood disease that is affected by and affects every aspect in the life of the child or adolescent with diabetes. Data on attention-deficit hyperkinetic disorder (ADHD) among children and adolescents with type 1 diabetes is limited. The aim of this study was to assess the prevalence of ADHD among a cross-sectional sample of 70 children and adolescents with type 1 diabetes as compared to 70 matched controls and to assess the glycemic control of included patients. For a comprehensive evaluation, assessment was done using Pediatric Symptom Checklist (PSC, the 35 item), Diagnostic and Statistical Manual of Mental Disorders—the fifth edition (DSM-5) criteria, and Conners comprehensive behavior rating scale—revised for parents/caregivers. Glycemic control of all included patients was also evaluated by HbA1c %.

Results

A screening PSC score was significantly higher for children and adolescents with type 1 diabetes than controls (p < 0.001). Significantly larger number of cases with type 1 diabetes fulfilled DSM-5 criteria for inattentive or hyperactive or mixed type ADHD (14.3%, 17.1% and 18.6%, respectively) as compared to controls (4.3%, 5.7%, and 7.1% respectively, p < 0.05). Also, a significantly larger number (more than half, 57.14%) had a Conners score above 70, and the mean scores on Conners parent rating scale were also significantly higher for children with type 1 diabetes than controls (p < 0.001). Most of the included patients did not achieve adequate glycemic control (47.14% of patients were in poor control and only about one fifth achieved a HbA1c < 7.5%).

Conclusion

ADHD is more common among children and adolescents with type 1 diabetes than in healthy controls. It is important to perform psychiatric evaluation of children and adolescents with type 1 diabetes especially those in poor metabolic control to assess for associated neuro-behavioral disorders such as ADHD. This is crucial to be able to properly design insulin therapy for such a group of patients who may suffer hypo- or hyper-glycemia due to inattention, forgetfulness, or hyperactivity and to properly select educational material that take the easy distractibility of ADHD patients into account as well as to be able to properly manage such cases given the extra stresses entailed in having a diagnosis of diabetes.

Association of Prenatal Exposure to Benzodiazepines and Z-Hypnotics With Risk of Attention-Deficit/Hyperactivity Disorder in Childhood

IMPORTANCE

Evidence is limited regarding the safety of prenatal benzodiazepine and z-hypnotic exposure and its association with long-term neurodevelopment in childhood.

OBJECTIVE

To quantify the associations of the timing and number of intervals of prenatal exposure to benzodiazepines and/or z-hypnotics with the risk of attention-deficit/hyperactivity disorder (ADHD) in childhood.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the 1999 to 2008 population-based Norwegian Mother, Father and Child Cohort Study, which are linked to the Medical Birth Registry of Norway, Norwegian Patient Registry, and Norwegian Prescription Database. Two populations of participants were created: a full sample and a mental health sample. The full sample included mothers and their live-born singletons, whereas the mental health sample was restricted to offspring of mothers who reported anxiety, depression, or sleeping problems during pregnancy or 6 months before pregnancy. Data were analyzed from September 2021 to February 2022.

EXPOSURES

Maternal self-report of benzodiazepine and/or z-hypnotic use during pregnancy was grouped into early pregnancy exposure and middle and/or late pregnancy exposure for analysis of the association with timing of exposure, and number of 4-week intervals of exposure was classified (single [1] vs multiple [≥2]) for analysis of the association with number of exposed intervals.

MAIN OUTCOME AND MEASURES

The outcome was ADHD, defined as time to ADHD diagnosis or filled prescription for ADHD medication. To control for confounding, inverse probability of treatment-weighted Cox proportional hazards regression models were used. Hazard ratios and 95% CIs were estimated. The weights were derived from propensity score modeling of the probability of benzodiazepine and/or z-hypnotic exposure as a function of potential confounders between the exposure and the outcome, including maternal symptoms of depression and anxiety.

RESULTS

The full sample comprised 82 201 pregnancies, and the mental health sample included 19 585 pregnancies. In total, 681 offspring (0.8%) in the full sample and 468 offspring (2.4%) in the mental health sample were prenatally exposed to benzodiazepines and/or z-hypnotics. After weighting, exposure in early (hazard ratio, 0.74; 95% CI, 0.39-1.94) and middle and/or late (hazard ratio, 0.76; 95% CI, 0.35-1.61) pregnancy was not associated with increased risk of childhood ADHD. There was no evidence of substantial association between the number of exposed intervals during pregnancy and childhood ADHD.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that there may be no increased risk of childhood ADHD associated with prenatal exposure to benzodiazepines and/or z-hypnotics, regardless of timing of exposure and number of exposed intervals. However, these findings should be interpreted with caution due to low study power.

Effect of short-term methylphenidate on social impairment in children with attention deficit/hyperactivity disorder: systematic review

Attention Deficit/Hyperactivity disorder (ADHD) is one of the most common disorders in school-age children. In addition to learning difficulties associated with the disorder's core symptoms of inattention and hyperactivity, children with ADHD display substantial social impairments. Methylphenidate (MPH) in formulations such as Ritalin or Concerta mitigates inattention and hyperactivity, but the effects of the therapy on social behavior in children with ADHD are not clear. This review aims to determine the effectiveness of short term (up to 6 months) MPH treatment on three domains of social skills in children aged 6-14 with ADHD: (i) Recognition of nonverbal emotional expressions, which are a marker of inherent (unlearned) social understanding, (ii) theory of mind (ToM) components that relate to learned cognition and social communication, and (iii) social competence in everyday environments. 15 relevant studies were identified based on inclusion/exclusion criteria. The results show mixed effects: the overall social performance as evaluated by parents, teachers or peers, and some components of ToM, were found to improve following a weeks-long course of MPH treatment. However, the effects of the medication are less clear when evaluating momentary/nonverbal social responses such as reactions to emotional facial expressions. While the findings of this review indicate that an MPH medication regime of order weeks to months could improve, to a degree, social impairment in children with ADHD, more studies are required to identify the medications' mechanism and confirm such a conclusion.