Actigraph-Measured Movement Correlates of Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Young People with Tuberous Sclerosis Complex (TSC) with and without Intellectual Disability and Autism Spectrum Disorder (ASD)

Risk Factors for Psychiatric Disorders in Pediatric Patients with Tuberous Sclerosis Complex

To identify and evaluate risk factors for psychiatric disorders in pediatric patients with tuberous sclerosis complex (TSC).We recruited 121 children with TSC from the Hangzhou Children's Hospital between April 2021 and December 2023. Four clinical psychiatric scales were used to screen and diagnose the psychiatric comorbidities of TSC: the autism behavior checklist, the SNAP-IV scale, and the self-rating anxiety and depression scales. Risk factors related to each psychiatric disorder were analyzed using univariate and multivariate regression analyses.Comorbid psychiatric disorders were found in 70 (57.85%) children: 51 (42.15%) cases had autism spectrum disorder (ASD), 49 (40.50%) cases had attention-deficit hyperactivity disorder (ADHD), 17 (14.05%) cases had anxiety, and 14 (11.57%) cases had depression. Uni- and multivariate logistic regression analysis revealed that seizure frequency (>1/month; OR = 6.206, P = 0.021), use of anti-seizure medications (≥ 2 types; OR = 118.869, P = 0.003), infantile spasms (OR = 25.748, P = 0.000), ADHD (OR = 11.170, P = 0.001), and intellectual disability (OR = 32.131, P = 0.001) were risk factors for TSC children with ASD; ASD was the only risk factor for occurrence of ADHD (OR = 7.302, P = 0.022). Seizure duration (≥ 2 years; OR = 56.200, P = 0.036) and seizure frequency (>1/month; OR = 25.855, P = 0.027) were closely related to occurrence of anxiety and/or depression disorders in pediatric patients with TSC.The study results showed that psychiatric comorbidities of children with TSC had a high incidence and risk factors. The study provides new insights into the diagnosis and treatment of comorbid psychiatric disorders in pediatric patients with TSC.

Exploring an objective measure of overactivity in children with rare genetic syndromes

BACKGROUND

Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates.

METHODS

A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes.

RESULTS

M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex.

DISCUSSION

These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.

Epilepsy severity mediates association between mutation type and ADHD symptoms in tuberous sclerosis complex

The association between attention-deficit/hyperactivity disorder (ADHD) and tuberous sclerosis complex (TSC) is widely reported, with support for the role of epilepsy, yet the mechanisms underlying the association across development are unclear. The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of TSC. In Phase 1 of the study, baseline measures of epilepsy, cortical tuber load, and mutation were obtained with 125 children ages 0-16 years. In Phase 2, at an average of 8 years later, ADHD symptoms were measured for 81 of the participants. Structural equation modeling revealed an indirect pathway from genetic mutation, to cortical tuber load, to epileptic spasm severity in infancy, to ADHD symptoms in middle childhood and adolescence, in addition to a pathway linking current seizure severity to ADHD symptoms. Findings were retained when intelligence quotient (IQ) was entered as a correlated factor. The findings support a cascading developmental pathway to ADHD symptoms mediated by early-onset and severe epilepsy in the first 2 years of life. This warrants detailed investigation of seizure characteristics and cognitive and behavioral sequelae associated with ADHD from early in life, to further the understanding of the association between ADHD and early-onset epilepsy across syndromic and non-syndromic populations.

The autism spectrum disorder phenotype in children with tuberous sclerosis complex: A systematic review and meta-analysis

AIM

To investigate the phenotype in autistic children with tuberous sclerosis complex (TSC), specifically autism spectrum disorder (ASD) severity and characteristics, intellectual ability, adaptive and executive function, language skills, attention-deficit/hyperactivity disorder features, and internalizing and externalizing behaviours.

METHOD

MEDLINE, Embase, and the Cochrane Library were searched up to March 2021. Studies that investigated predefined phenotypic factors in children with TSC-ASD were included according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. Two authors independently reviewed titles, abstracts, full texts, and extracted the data. Risk of bias and GRADE assessments were completed.

RESULTS

Thirty-four studies with 3160 children with TSC, 30% with ASD, were included. Meta-analysis found that 90% (95% confidence interval 86%-94%) of children with TSC-ASD have an intellectual disability. There was some evidence to suggest that young children with TSC-ASD and idiopathic ASD have a similar pattern of severity and behaviour. Overall, data about phenotypic characteristics were limited.

INTERPRETATION

A greater proportion of children with TSC-ASD are reported to have an intellectual disability than children with idiopathic ASD. Early intervention should consider the needs of children with a high likelihood of intellectual disability. Research is needed to better understand the impacts of intellectual disability and other co-occurring difficulties on adaptive function, participation, and quality of life in TSC-ASD.

WHAT THIS PAPER ADDS

Most children with tuberous sclerosis complex (TSC) and autism spectrum disorder (ASD) have an intellectual disability. TSC-ASD early intervention planning should consider the high likelihood of intellectual disability. Quality of life and the functional impact of intellectual disability in TSC-ASD are not understood. Little is known about co-occurring difficulties in TSC-ASD.

A Robust Movement Quantification Algorithm of Hyperactivity Detection for ADHD Children Based on 3D Depth Images

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood mental disorders. Hyperactivity is a typical symptom of ADHD in children. Clinicians diagnose this symptom by evaluating the children's activities based on subjective rating scales and clinical experience. In this work, an objective system is proposed to quantify the movements of children with ADHD automatically. This system presents a new movement detection and quantification method based on depth images. A novel salient object extraction method is proposed to segment body regions. In movement detection, we explore a new local search algorithm to detect any potential motions of children based on three newly designed evaluation metrics. In the movement quantification, two parameters are investigated to quantify the participation degree and the displacements of each body part in the movements. This system is tested by a depth dataset of children with ADHD. The movement detection results of this dataset mainly range from 91.0% to 95.0%. The movement quantification results of children are consistent with the clinical observations. The public MSR Action 3D dataset is tested to validate the performance of this system.