Assessing the Magnitude of Risk for ADHD in Offspring of Parents with ADHD: A Systematic Literature Review and Meta-Analysis

The main aim of this study was to examine the body of knowledge on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in "high-risk" children whose parents are diagnosed with ADHD. This knowledge could aid early identification for children presenting with ADHD symptoms at a young age. We conducted a systematic search of the literature assessing high-risk children. Included were original articles published in English with the main aim to assess prevalence of ADHD in high risk children. In addition, a meta-analysis was conducted to examine this prevalence. Four articles met our inclusion and exclusion criteria all suggesting an increased prevalence of ADHD in children of parents with ADHD. The meta-analysis also confirmed the increased prevalence of ADHD in high-risk children. The literature indicates that children of ADHD parents have an increased risk of developing ADHD compared to control children.

A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study

AIMS

We piloted the effectiveness and acceptability of a novel text messaging-based (SMS) digital health intervention aimed at addressing the previously documented poor rate of patient engagement in stimulant treatment in the primary care setting.

METHODS

117 adults ages 18-55 from primary care and psychiatric practices who were prescribed a stimulant medication for ADHD treatment received the SMS intervention. Comparators were age-, race-, and sex-matched patients from the same health care organization's electronic medical record who had been prescribed stimulant medications over a similar time period. Using documented prescription records, we determined whether patients had timely prescription refills.

RESULTS

Ninety-six percent (N = 112) of participants completed our a priori metric of patient engagement consisting of 37 days of the SMS program. Eighty-one percent of participants refilled their index prescriptions in a timely manner compared to only 36% of patients receiving treatment as usual (OR=7.54, 95% CI: 4.46, 12.77; p<0.001). We found no significant interaction between prescribing source (non-psychiatry vs. psychiatry) and intervention group (SMS vs. treatment as usual).

CONCLUSIONS

These data suggest that an ADHD-centric, digital health intervention using text messaging significantly improves patient engagement in stimulant treatment in adults with ADHD.

Further evidence of low adherence to stimulant treatment in adult ADHD: an electronic medical record study examining timely renewal of a stimulant prescription

RATIONALE

ADHD is a prevalent and morbid neurobiological disorder affecting up to 5% of adults. While stimulants have been documented to be safe and effective in adults with ADHD, uncertainties remain about adherence to these treatments.

OBJECTIVES

The main aim of this article was to evaluate contemporaneous rates and correlates of adherence to stimulants in adults with ADHD using data from electronic medical records from a large healthcare organization focusing on timely renewal of an initial prescription.

METHODS

Subjects were patients 18 to 44 years of age who had been prescribed a stimulant between January 1, 2015, and December 31, 2016. Prescription and sociodemographic data were extracted from the Partners HealthCare Research Patient Data Registry (RPDR). Our outcome metric was renewal of the index stimulant prescription defined as the first prescription recorded in the electronic record for the period under investigation.

RESULTS

We identified 2689 patients with an index prescription for a stimulant medication. Results showed that only 42% of patients renewed their prescriptions in a timely enough fashion to be considered consistently medicated.

CONCLUSIONS

Results indicate that adults with ADHD have a low rate of renewal of their initial stimulant prescription indicating poor patient engagement in their treatment for ADHD.

Immunologic effects of gliotoxin in rats: mechanisms for prevention of autoimmune diabetes mellitus

Various fungal products, such as gliotoxin (GT), have immunomodulating activity, a fact exploited previously by our group for prevention of autoimmune diabetes mellitus in BB/Wor rats. To understand better the immunologic effects in GT-treated rats, splenocytes from 65-day-old prediabetic diabetes-prone rats were phenotypically characterized after chronic treatment with GT. A parallel study examined the direct effects of GT on splenocyte preparations incubated with the mycotoxin. In vitro treatment of splenocytes with GT revealed relative decreases in CD4+ and increases in CD8+ T-cell subsets, whereas in vivo treatment with GT did not result in detectable alterations in relative CD4+ and CD8+ cell subsets. We were unable to show significant effects on NK cells or MHC class II cells. However, in vitro and in vivo GT treatments significantly enhanced the detectable RT6 surface marker, a key regulatory element in autoimmune diabetes pathogenesis. This study showed that GT selectively affects certain lymphocyte subsets, possibly through the mechanism of apoptosis, which was increased in vivo as well as in vitro.

Effect of gliotoxin on development of diabetes mellitus in diabetes-prone BB/Wor rats

The object of this investigation was to determine if gliotoxin, an immunomodulating fungal secondary metabolite, is capable of preventing the development of autoimmune diabetes mellitus in diabetes-prone BB/Wor rats. Chronic treatment, consisting of 1 microg gliotoxin/g of body wt administered three times weekly from the age of 30 days through 120 days, reduced the incidence of diabetes from 90% diabetic by 120 days among vehicle-treated animals to 56% diabetic among gliotoxin-treated animals. This result was significant by life table analysis. Animals treated with gliotoxin maintained lower serum glucose levels even in the pre-diabetic state than control (vehicle-treated) rats. Gliotoxin at levels used in this study showed no appreciable effect on the viability of rat insulinoma (RIN 38) cells in culture and only slightly decreased their insulin secretion. Animals chronically treated with gliotoxin showed weight gains comparable to those seen in controls, and the effect of gliotoxin on peripheral blood leukocyte counts was not significant. The possibility that gliotoxin exerted its effect through immunomodulating effects was implied by the loss of white pulp in splenic follicles of gliotoxin-treated animals.