AKT question relating to attention deficit hyperactivity disorder diagnosis

Lifelong greenspace exposure and ADHD in Polish children: Role of physical activity and perceived neighbourhood characteristics

Background Lower parental education is linked to higher incidence of attention-deficit hyperactivity disorder (ADHD) diagnosis in offspring, as is having ADHD in family, but these associations are rarely studied together. We examined whether parental education predicts offspring ADHD diagnosis differently for children and adolescents with or without ADHD family members. Methods We used Finnish total population register-based data on individuals born between 1994-2003 with non-migrant background. We followed 228,247 boys and 217,866 girls for first ADHD diagnosis, measured from health care or medication registers, in childhood (4-12) and adolescence (13-17), and identified ADHD for biological parents or full siblings. We used Poisson regression to examine differences in diagnoses separately by offspring sex and age group. Results Preliminary results show that boys are more often diagnosed for ADHD in childhood and girls in adolescence, but incidence is higher for boys in both age groups. Among boys and girls without ADHD family members, lower parental education is associated with higher incidence in both childhood and adolescence. Among those with ADHD family members, lower parental education predicts higher incidence in childhood, but in adolescence the differences by parental education even out for boys, and for girls, higher parental education predicts higher incidence. Conclusions While lower parental education predicts higher ADHD diagnosis incidence in general, for adolescents in ADHD families, higher parental education seems to increase the likelihood of getting diagnosed -particularly for girls. This suggests that adolescents in ADHD families with lower parental education may remain without ADHD diagnosis if they are not diagnosed as children. Support measures should be developed to ensure equal access to diagnosis and care irrespective of age, gender and family background. Key messages • Lower parental education predicts higher ADHD diagnosis incidence in general. Yet, adolescents in ADHD families with lower educated parents may remain underdiagnosed. • Support measures should be developed to guarantee equal access to ADHD diagnosis and care regardless of family background.

This study examined racial-ethnic differences in attention-deficit hyperactivity disorder (ADHD) diagnosis and treatment during adolescence and early adulthood. A national health care claims database was used to identify a cohort of 4,216,757 commercially insured youths with at least 1 year of coverage during 2014-2019. Racial-ethnic differences in the prevalence of visits with a recorded ADHD diagnosis (identified through ICD-9-CM and ICD-10-CM codes) and of ADHD treatment (identified through medical claims for psychosocial treatments and pharmacy claims for ADHD medications) were examined. Period prevalence rates were determined within five age categories, stratified by race-ethnicity. Poisson regression with a natural log link was used within each age category to estimate prevalence ratios (PRs) comparing prevalence in each racially and ethnically minoritized group with prevalence in the White group. The overall prevalence of ADHD diagnosis was 9.1% at ages 12-14 and 5.3% at ages 24-25. In each age category, Asian, Black, and Hispanic youths had lower prevalence of ADHD diagnosis than did White youths (PR=0.29-0.77). Among youths with an ADHD diagnosis, relative racial-ethnic differences in treatment were small (PR=0.92-1.03). Throughout adolescence and early adulthood, racially and ethnically minoritized youths were less likely than White youths to have health care visits with recorded ADHD diagnoses and, among those with diagnoses, were also slightly less likely to receive treatment. More research is needed to understand the processes underlying these differences and their potential health consequences among racially and ethnically minoritized youths.

Association of water fluoride and urinary fluoride concentrations with attention deficit hyperactivity disorder in Canadian youth

(1) Background: Attention deficit hyperactivity disorder (ADHD) constitutes one of the leading mental health and behavioral disorders in childhood and adolescence. The main objective of this study was to analyze the time trend in the incidence of ADHD diagnoses in Navarre (Spain) from 2003 to 2019 in children and adolescents from 5 to 19 years old. Additionally, the seasonal trends of ADHD incidence and ADHD prevalence were determined. (2) Methods: A population-based observational retrospective study, which included people born between 1991 and 2011 and who attended compulsory education between 2007 and 2017 in Navarre (Spain), was carried out with data from both the Education and Health Department databases. (3) Results: The incidence rate increased from 4.18 cases per 1000 person-years in 2003 to 7.43 cases per 1000 person-years in 2009, before decreasing progressively to 2.1 cases per 1000 person-years in 2019. A peak incidence rate at 7–8 years of age was observed, which is consistent across the study period and for both genders. Males were more than twice as likely to be diagnosed with ADHD than females, with similar time trends in both. A seasonal pattern in ADHD diagnosis was found, with peaks in February–March and the lowest rates in the summer months. Inattentive cases were much more frequent than hyperactive cases, whereas combined cases remained low across the study period. (4) Conclusions: In this age-period-cohort analysis, a clear period and age effect was observed. We found a decreasing trend in the ADHD incidence rate since 2015. Further research is needed to confirm whether a change of trend is occurring globally.

INTRODUCTION: Attention Deficit Hyperactivity Disorder (ADHD) and previous history of concussion (PHC) are being reported more frequently in college athletes; the presence of these co-morbidities and their effects on concussion assessment has been somewhat limited. PURPOSE: Determine if a relationship exists between ADHD and PHC and the effect of these co-morbidities on neuropsychological test scores. METHODS: This study was a retrospective cross-sectional between groups design. D-1 college athletes (N=1840, males N=1737, females N=103) with a mean age of 19.8+1.6 years completed a computerized neuropsychological test (ImPACT) to establish baseline assessment of concussion history during pre-participation physicals. Participants were divided into groups based upon self-reported diagnosis of ADHD and PHC. Self-report symptoms and ImPACT composite scores served as dependent variables. Comparisons of groups were calculated utilizing regression models and One-Way ANOVAs. All statistical analyses were conducted utilizing STATA 9.0. RESULTS: 102 (5.5%) participants self-reported a diagnosis of ADHD. 486 (26.5%) of the participants self-reported a history of concussion. There was a difference between ADHD and controls for self-reported symptoms (F (1, 1838) = 26.226, p > 0.001, Composite Verbal Memory (F (1, 1838) = 10.02, p = 0.002), Composite Motor (F (1, 1838) = 5.96, p = 0.015), Composite reaction time (F (1, 1838) = 3.94, p = 0.047). No statistical differences were found between the PHC group and normal counterparts. There was a difference for the interaction between ADHD and PHC on Composite Verbal Memory (F (5, 1834) = 2.44, p= 0.0325). CONCLUSIONS: The increase of media and clinician awareness of PHC and ADHD diagnoses has increased reporting during baseline assessment. Significant differences existed between groups with participants with ADHD and participants with ADHD and PHC performing below their "normal" counterparts. Previous literature supports the potential additive effect of learning disabilities and PHC; however this subgroup of ADHD did not replicate previous findings. The increase of ADHD and PHC diagnoses demands that health care practitioners understand the implications and effects of these disabilities on neuropsychological tests utilized in concussion assessment.

BackgroundThe association between exposure to perfluorinated compounds (PFCs) and attention deficit hyperactivity disorder (ADHD) diagnosis has been sparsely investigated in humans and the findings are inconsistent.ObjectivesA matched case-control study was conducted to investigate the association between fetal exposure to PFCs and ADHD diagnosis in childhood.MethodsThe study base comprised children born in Malmö, Sweden, between 1978 and 2000 that were followed up until 2005. Children with ADHD (n = 206) were identified at the Department of Child and Adolescent Psychiatry. Controls (n = 206) were selected from the study base and were matched for year of birth and maternal country of birth. PFC concentrations were measured in umbilical cord serum samples. The differences of the PFC concentrations between cases and controls were investigated using Wilcoxon's paired test. Possible threshold effects (above the upper quartile for perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) and above limit of detection [LOD] for perfluorononanoic acid (PFNA)) were evaluated by conditional logistic regression.ResultsThe median umbilical cord serum concentrations of PFOS were 6.92 ng/ml in the cases and 6.77 ng/ml in the controls. The corresponding concentrations of PFOA were 1.80 and 1.83 ng/ml. No associations between PFCs and ADHD were observed. Odds ratios adjusted for smoking status, parity, and gestational age were 0.81 (95% confidence interval [CI] 0.50 to 1.32) for PFOS, 1.07 (95% CI 0.67 to 1.7) for PFOA, and 1.1 (95% CI 0.75 to 1.7) for PFNA.ConclusionsThe current study revealed no support for an association between fetal exposure to PFOS, PFOA, or PFNA and ADHD.

Background/Objective: Literature has demonstrated a bidirectional relationship between attention-deficit hyperactivity disorder (ADHD) and sleep disordered breathing (SDB) in the pediatric population. SDB is a term used to describe a range of disorders that impact and interrupt ventilation patterns during sleep. ADHD and SDB have overlapping symptoms such as inattention, impulsivity, hyperactivity, cognitive impairments, and behavior problems. It is important to recognize SDB in children, as it has been associated with hypertension, cardiovascular disease, atrial fibrillation, growth failure, and negatively impacted school performance. Previous studies estimate a 25 to 57% incidence of SDB in children and adolescents diagnosed with ADHD. The primary goal of this study was to evaluate if the prevalence of SDB in children diagnosed with ADHD, as recorded in a national electronic medical record database, is consistent with previous studies. Methods: Data was obtained from the IU School of Medicine-Evansville RWEdataLab (CRC/Sidus Insights) Psychiatry dataset, which contains de-identified records across the United States from 4.89 million patients with psychiatric diagnoses. Selection criteria included patients currently less than 20 years of age with both an ADHD diagnosis and a SDB diagnosis. Primary retrospective analysis compared patients with an ADHD diagnosis to patients with ADHD+SDB diagnoses. Results: 68,259 patients < 20 years of age were diagnosed with ADHD. 1,959 patients also had a SDB diagnosis, indicating a prevalence of 2.87%. 72.79% of individuals with both diagnoses had ADHD as their first recorded diagnosis or had both ADHD and SDB diagnoses first recorded on the same date. Conclusion and Potential Impact: Prevalence of SDB in children with ADHD was found to be substantially lower than estimated literature prevalence of 25 to 57%. Future research is necessary to identify if current practitioners are regularly screening for SDB in children with ADHD.

Updated European Consensus Statement on diagnosis and treatment of adult ADHD

Previous studies have suggested that Attention Deficit Hyperactive Disorder (ADHD) affect individuals across their lifespan, especially in relation to employment. The purpose of this review was to synthesize the results from studies examining the prospective association of ADHD diagnosis in childhood and later education, earnings and employment, compared to children without an ADHD diagnosis. A review protocol was prospectively registered with PROSPERO (ID = CRD42019131634). The findings were reported according to the PRISMA guidelines. The systematic review is based on a structured and preplanned analysis of original prospective longitudinal studies. A total of 2505 potential records were identified, two through backward search. Six papers met the inclusion criteria. One paper was assessed as good, four as fair and one as poor quality. The studies indicated that ADHD diagnosis affected the nature of the individual’s attachment to the labour market across different labour market attachment outcomes. Adults with persisting symptoms, had significantly more problems at work. Even if ADHD symptoms desist in adulthood, the negative impact of earlier ADHD symptoms can still be seen on occupational outcomes. Significantly fewer probands had a Bachelor’s degree compared to controls. Based on one good quality study and four fair quality studies, it is indicated that patients with childhood diagnosed ADHD, generally experience employment of lower quality compared with peers, in relation to income, education and occupational attainment. The overall level of evidence is rated as poor.

Introduction Most research on the association between insomnia and attention deficit hyperactivity disorder (ADHD) has been conducted in children. It has been established that insomnia and ADHD are frequently comorbid, but less is known about whether the association extends to individual ADHD symptoms, or any possible moderators of the association. This study aims to understand whether sex plays a key role in the moderation between insomnia and ADHD in adult military servicemembers, as well as to investigate the relationship between insomnia diagnosis and ADHD symptomology. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21292; age 18-61, 88.24% male). Participants completed a survey that included items assessing insomnia and ADHD status based on DSM-5 criteria. Chi-squares and logistic regression, including interactions with sex, were used to examine the relationship between insomnia diagnosis and ADHD symptomology. Results There is a significant association between insomnia and ADHD diagnoses (r = 0.30; <.0001), consistent with prior literature. There was a small but statistically significant moderation by sex of the relationship between insomnia and ADHD diagnosis (Chi square = 9.43; p = .002). There was also a strong association between insomnia diagnosis and certain symptoms of ADHD: keeping attention on repetitive work (Chi square = 3687.75; <.0001), remembering appointments (Chi square = 3186.735; <.0001), and getting things in order (Chi square = 2756.28; <.0001). Conclusion Insomnia diagnosis was associated with both ADHD diagnosis and symptomology in a nationwide sample of army servicemembers, with the relationships being stronger in males compared to females. These findings highlight the importance of assessment and treatment of insomnia in patients with ADHD given their interrelationships. Support (If Any) This publication is based on data obtained from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1). KEM’s time was supported by the U.S. Department of Veterans Affairs, Clinical Science Research and Development Service - IK2 CX001874. EAK’s time was supported by the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2 RX001836.

There is an ongoing public debate on the diagnosis of attention deficit hyperactivity disorder (ADHD) in which critics have claimed that the disorder is over-diagnosed, while the potential under-diagnosis of children with ADHD has received little attention. In this study we estimate the number of children with parent-reported ADHD behaviour at age 7 and absence of recorded ADHD diagnosis through adolescence, and investigate whether socio-demographic characteristics of this group differed from the children diagnosed with ADHD during follow-up. Our study was based on data from the Danish National Birth Cohort, where parents of 51,527 children completed questionnaires, including the Strength and Difficulties Questionnaire (SDQ). ADHD diagnosis was identified through Danish registers and parent-reported ADHD behaviour by the specific SDQ subscale. Socio-demographic predictors of positive parent-reported SDQ ADHD behaviour and absence of recorded ADHD diagnosis in their children were examined using logistic regression analyses. Children with parent-reported ADHD behaviour and no diagnosis (1.3%) were more likely to be girls (OR 1.83; 95% CI 1.45; 2.29), more likely to have mothers with a low socioeconomic status (OR high vs. low 1.49; 95% CI 1.10; 2.02), and to live in certain regions of the country (OR: Capital vs. Southern: 2.04; 95% CI 1.51; 2.73) than children with an ADHD diagnosis. The children showed markedly impairments on all the SDQ subscales. The results demonstrate a considerable number of children with ADHD symptoms who potentially go undetected and underline the influence of socio-demographic factors in the pathway to a diagnosis of ADHD.

Attention deficit hyperactivity disorder (ADHD) is a multifactorial neurodevelopmental disorder, yet the interplay between ADHD polygenic risk scores (PRSs) and other risk factors remains relatively unexplored. The authors investigated associations, confounding, and interactions of ADHD PRS with birth-related, somatic, and psychosocial factors previously associated with ADHD. Participants included a random general population sample (N=21,578) and individuals diagnosed with ADHD (N=13,697) from the genotyped Danish iPSYCH2012 case cohort, born between 1981 and 2005. The authors derived ADHD PRSs and identified 24 factors previously associated with ADHD using national registers. Logistic regression was used to estimate associations of ADHD PRS with each risk factor in the general population. Cox models were used to evaluate confounding of risk factor associations with ADHD diagnosis by ADHD PRS and parental psychiatric history, and interactions between ADHD PRS and each risk factor. ADHD PRS was associated with 12 of 24 risk factors (odds ratio range, 1.03-1.30), namely, small gestational age, infections, traumatic brain injury, and most psychosocial risk factors. Nineteen risk factors were associated with ADHD diagnosis (odds ratio range, 1.20-3.68), and adjusting for ADHD PRS and parental psychiatric history led to only minor attenuations. Only the interaction between ADHD PRS and maternal autoimmune disease survived correction for multiple testing. Higher ADHD PRS in the general population is associated with small increases in risk for certain birth-related and somatic ADHD risk factors, and broadly to psychosocial adversity. Evidence of gene-environment interaction was limited, as was confounding by ADHD PRS and family psychiatric history on ADHD risk factor associations. This suggests that the majority of the investigated ADHD risk factors act largely independently of current ADHD PRS to increase risk of ADHD.

PurposeAn emerging body of work suggests a link between childhood maltreatment and attention-deficit hyperactivity disorder (ADHD). However, research examining the role of maltreatment in the early course of the disorder lacks robust evidence from longitudinal studies. Our aim was to examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences, and to estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence.MethodsData were obtained from the Boricua Youth Study, a longitudinal study of 2480 children and adolescents of Puerto Rican background. Neglect, physical, emotional and sexual abuse, and foster placement were regressed on ADHD diagnosis measured at each of three waves using the Diagnostic Interview Schedule for Children-IV. Multilevel regressions estimated the effects of exposure on ADHD, adjusted by age, sex, income, household education, parental psychopathology, comorbidity and ADHD medication status.ResultsEmotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis; for boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence.ConclusionsAssociations between early maltreatment and ADHD were robust. Different categories of maltreatment increase the likelihood of ADHD for girls and boys. Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.

Large-scale family studies on the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are lacking. Thus, we aimed to estimate the co-occurrence and familial co-aggregation of clinically ascertained ADHD and BPD diagnoses using the entire Swedish population. In a register-based cohort design we included individuals born in Sweden 1979–2001, and identified their diagnoses during 1997–2013; in total, 2,113,902 individuals were included in the analyses. We obtained clinical diagnoses of ADHD and BPD from inpatient and outpatient care. Individuals with an ADHD diagnosis had an adjusted (for birth year, sex, and birth order) odds ratio (aOR) of 19.4 (95% confidence interval [95% CI] = 18.6–20.4) of also having a BPD diagnosis, compared to individuals not diagnosed with ADHD. Having a sibling with ADHD also increased the risk for BPD (monozygotic twins, aOR = 11.2, 95% CI = 3.0–42.2; full siblings, aOR = 2.8, 95% CI = 2.6–3.1; maternal half-siblings, aOR = 1.4, 95% CI = 1.2–1.7; paternal half-siblings, aOR = 1.5, 95% CI = 1.3–1.7). Cousins also had an increased risk. The strength of the association between ADHD and BPD was similar in females and males, and full siblings showed similar increased risks regardless of sex. Among both males and females, ADHD and BPD co-occur within individuals and co-aggregate in relatives; the pattern suggests shared genetic factors and no robust evidence for etiologic sex differences was found. Clinicians should be aware of increased risks for BPD in individuals with ADHD and their relatives, and vice versa.