The recent article in this journal regarding attention deficit hyperactivity disorder (ADHD) treatment1 provides an interesting snapshot of clinical practice. I write to extend discussion of their findings. The authors drew two potentially contradictory conclusions. The first was that practice falls in line with the recent draft NHMRC guidelines. Secondly, they identified considerable variation in prescription and treatment practice by profession, sector, duration of time in practice, practice size and focus, and location. If these conclusions are concurrently valid, the guidelines must encompass a significant degree of practice diversity. Is this ideal? Variability in practice can reflect local opportunities and limitations2 and accordingly may have adaptive advantages. Variation in practice may also be acceptable if clinical outcomes are relatively independent of practice activities and pathways. In other chronic medical conditions, however, where medical intervention is part of a comprehensive longitudinal strategy, I believe such variability would be considered undesirable and potentially detrimental to child health. With conditions such as diabetes and cystic fibrosis we have a variety of markers by which to monitor the cumulative impact of the disorder. By evaluating practice against these measures, particularly over long periods of time, consensus has emerged regarding which practices optimise not only short-term but particularly long-term health and well-being. As a result, variability in practice is reduced. For ADHD this is a complex challenge. The main clinical measure of disorder and related intervention for ADHD is behavioural symptom profile as determined by observational rating scales. This provides only limited information regarding current and cumulative impact of the disorder. The challenge further includes the scope of impact of ADHD in the lives of developing children. Variability around what clinicians consider to be their scope of care and related outcomes is clearly reflected in this study. The impairment attributable to ADHD relates not only to the symptoms but also to the demands of the context in which they manifest. Long-term well-being relates to a diverse set of secondary consequences across child development, mental health and social function3 rather than just the primary pathology. This situation may never change while we continue to manage children with diagnoses taken from the Diagnosis and Statistical Manual of Mental Disorders IV alone and measures of symptom expression. What are the short- and long-term measures of outcome against which we more effectively consider best practice?
36Diagnosis of Attention Deficit Hyperactivity Disorder by Using MR Imaging and Radiomics: A Potential Tool for Clinicians.
Diagnosis of Attention Deficit Hyperactivity Disorder by Using MR Imaging and Radiomics: A Potential Tool for Clinicians.
Read more2Living with symptoms of Attention Deficit-Hyperactivity Disorder (ADHD) in adulthood: a systematic review protocol of qualitative evidence
Living with symptoms of Attention Deficit-Hyperactivity Disorder (ADHD) in adulthood: a systematic review protocol of qualitative evidence
Read more41Auditory Event-related Potentials in Children With Attention Deficit Hyperactivity Disorder
Auditory Event-related Potentials in Children With Attention Deficit Hyperactivity Disorder
7Anxiety Disorders Comorbidity in Children and Adolescents with Attention Deficit Hyperactivity Disorder.
Our aim is to investigate the prevalence of comorbidity of anxiety disorders (AD) among patients newly diagnosed with attention deficit hyperactivity disorder (ADHD) and to compare symptom severity of ADHD and sociodemographic parameters between patients with and without AD. Among 1683 children and adolescents admitted to Kocaeli University Medical Faculty, Child and Adolescent Mental Health Outpatient Clinic, 447 children and adolescents, who were preliminarily diagnosed as ADHD by clinical interview based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), were invited to participate in the second phase of the study. Kiddie Schedule for Affective Disorder and Schizophrenia, Present and Lifetime-Turkish Version were applied to children and adolescents with ADHD and one of their parents to support the diagnoses of both ADHD and AD. Mothers, fathers, and teachers of the children were asked to complete DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale. Our study group comprised 170 children and adolescents diagnosed with ADHD of whom 19.4% were girls and 80.6% were boys; 27.6% of patients diagnosed with ADHD showed AD comorbidity. Age of the parents at birth of the patients with AD was significantly lower than that of patients without AD. In line with the previous studies, the comorbidity rate of AD was found to be higher among patients with ADHD than general population and clinical sample without ADHD. The possibility of comorbidity of AD in patients with ADHD should be considered because higher rates of AD are observed in ADHD and comorbidities of AD.
Read more270How common is attention-deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester, Minn.
The frequency of occurrence of attention-deficit/hyperactivity disorder (AD/HD) is in dispute. This uncertainty has contributed to the concern that too many children in the United States are being treated with stimulant medication. To determine the cumulative incidence of AD/HD in a population-based birth cohort and to estimate the prevalence of pharmacologic treatment for children who fulfill research criteria for AD/HD. Population-based birth cohort study. All children born between 1976 and 1982 in Rochester, Minn, who remained in the community after age 5 years (N = 5718). Medical and school records were reviewed for clinical diagnoses of AD/HD and supporting documentation (symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and positive results for AD/HD-related questionnaires). Research-identified cases were defined as: (1) "definite" AD/HD (clinical diagnosis and at least one type of supporting documentation); (2) "probable" AD/HD (clinical diagnosis but no supporting documentation or no clinical diagnosis but both types of supporting documentation); (3) "questionable" AD/HD (no clinical diagnosis, but at least one type of supporting documentation); and (4) "not AD/HD" (all other subjects). Information about pharmacologic treatment for AD/HD was abstracted for all subjects. The highest estimate of the cumulative incidence at age 19 years (with 95% confidence interval) of AD/HD (definite plus probable plus questionable AD/HD) was 16.0% (14.7-17.3). The lowest estimate (definite AD/HD only) was 7.4% (6.5-8.4). Prevalence of treatment with stimulant medication was 86.5% for definite AD/HD, 40.0% for probable AD/HD, 6.6% for questionable AD/HD, and 0.2% for not AD/HD. These results provide insight into the apparent discrepancies in estimates of the occurrence of AD/HD, with less stringent criteria resulting in higher cumulative incidence. Children who met the most stringent criteria for AD/HD were most likely to receive pharmacologic treatment.
Read more2A program to improve the assessment of a child for attention deficit hyperactivity disorder.
Due to the number of children diagnosed with attention deficit hyperactivity disorder (ADHD), increased risk of these children having comorbidities and/or an adverse childhood experienceand insufficient documentation of theDiagnostic and Statistical manual of Mental Disorders, fifth edition (DSM-5) criteria for an ADHD diagnosis, an ADHD evaluation program was developed for a child presenting for an initial ADHD evaluation. A quantitative design method evaluated provider's documentation by the percentage of DSM-5 criteria met before and after the implementation of the ADHD program. Descriptive statistics evaluated the system change by the percentage of providers who utilized the ADHD template and the use of the unspecified ADHD International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10) code, F90.9 by the percentage of code use before and after implementation of the ADHDprogram. The two-tailed Mann-Whitney U test was significantly based on p < 0.001. Providers met 100% of the DSM-5 criteria after implementation of the ADHD program in the electronic health record, compared to 50% before implementation. The ADHD program increased the provider's documentation and consistency to the DSM-5 criteria, decreasing the use of the unspecified ADHD ICD-10 code, allowing the provider to develop a more successful plan of care for children between the ages of 5 and 18.
Read more25Association between BDNF gene polymorphisms and attention deficit hyperactivity disorder in school-aged children in Wuhan, China
Association between BDNF gene polymorphisms and attention deficit hyperactivity disorder in school-aged children in Wuhan, China
Read moreThe sleep structure of children with attention deficit hyperactivity disorder
Objective To investigate the sleep structure of children with attention deficit hyperactivity disorder(ADHD) and the differences among subtypes of ADHD. Methods Ninety children with ADHD were diagnosed in Department of Neurology, the Children's Hospital Affiliated to Capital Institute of Pediatrics between June 2012 and June 2013, including 75 boys and 15 girls, 6-14 years old[(9.5±2.4) years old], and among them there were 55 cases of ADHD-combined type, 25 cases of ADHD-inattentive type, and 10 cases of ADHD-hyperactive impulsive type.Thirty healthy children whose age and sex matched with ADHD group, came from Beijing and the surrounding area, were selected as the healthy control group, including 23 boys and 7 girls, 6-14 years old [(9.2 ± 2.9) years old]. Two groups underwent full overnight sleep assessment. Results The latency of rapid eye movement(REM) in children with ADHD was (146.58±47.28) minutes, and the sleep latency was 19.00 minutes[(8.25-37.50)minutes]; while the latency of REM in healthy control group was(87.55±13.59) minutes, and the sleep latency was 9.00 minutes[(3.50-13.63)minutes]. Compared with healthy control group, children with ADHD demonstrated the increased latency REM and sleep latency, and decreased sleep efficiency, the increasing times of awakening and total duration, and these differences were all statistically significant(all P<0.05). The percentage of non-rapid eye movement(NREM) phase Ⅱ in ADHD hybrid was lower than the ADHD attention-deficit(t=2.012, P<0.05). Sleep latency in ADHD attention-deficit was longer than the ADHD hybrid(t=2.964, P<0.05). No statistical differences were found among the various types in other indicators.The prevalence of periodic limb movements in sleep(PLMS) was 27.78%(25/90 cases) in ADHD group and the prevalence of PLMS was 3.30% (1/30 cases) in the healthy control group.The diffe-rences in prevalence between 2 groups were statistically significant(χ2=8.053, P<0.05). Conclusions Children with ADHD significantly display more problems with sleep.Sleep latency and NREMⅡ are different between ADHD attention-deficit and ADHD hybrid. Key words: Attention deficit hyperactivity disorder; Sleep structure; Child
Read more91Perinatal complications in children with attention-deficit hyperactivity disorder and their unaffected siblings
Objectives: Genetic and nonshared environmental factors (experienced by 1 family member to the exclusion of the others) have been strongly implicated in the causes of attention-deficit hyperactivity disorder (ADHD). Pregnancy, labour/delivery and neonatal complications (PLDNC) have often been associated with ADHD; however, no investigations aimed at delineating the shared or nonshared nature of these factors have been reported. We aimed to identify those elements of the PLDNC that are more likely to be of a nonshared nature. Methods: We used an intrafamily study design, comparing the history of PLDNC between children diagnosed with ADHD, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and their unaffected siblings. Children with ADHD were recruited from the outpatient, day-treatment program of the Child Psychiatry Department, Douglas Hospital, Montréal. The unaffected sibling closest in age to the child with ADHD was used as a control. The history of PLDNC was assessed using the Kinney Medical and Gynecological Questionnaire and the McNeil–Sjöstrom Scale for both children with ADHD and their siblings. Seventy children with ADHD along with 50 of their unaffected siblings agreed to participate in the study. Child Behavior Checklist (CBCL), Continuous Performance Test (CPT) and Restricted Academic Situation Scale (RASS) scores were also used as measures of ADHD symptoms in children with ADHD. Results: The children with ADHD had significantly higher rates of neonatal complications compared with their unaffected siblings (F4,196 = 3.67, p < 0.006). Furthermore, neonatal complications in the children with ADHD were associated with worse CBCL total and externalizing scores and with poorer performance on the CPT. Conclusions: These results suggest that neonatal complications are probably a nonshared environmental risk factor that may be pathogenic in children with ADHD.
Read more4Sleep and Attention Deficit Hyperactivity Disorder
A growing number of studies have addressed the prevalence of sleep problems among children with attention deficit hyperactivity disorder (ADHD). As the major symptoms of ADHD (i.e., inattention, impulsiveness, and restlessness) are also characteristic of sleep deprivation, the role of sleep in ADHD is the focus of many investigations. Parental reports of sleep disturbances are common in children with ADHD (1–8), and as such they were so widely presumed to be an intrinsic part of the clinical phenotype of ADHD that sleep problems were included as one of the previous Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) diagnostic criteria for ADHD (9). However, none of the more recent diagnostic manuals (10,11) have included sleep disturbance as a symptomatic criterion for ADHD. Therefore, because parental perception of sleep disturbance helped to define ADHD previously, it is not surprising that studies using earlier diagnostic criteria found a significant association between ADHD and sleep problems.KeywordsObstructive Sleep ApneaSleep DisturbanceSleep DisorderSleep ProblemStimulant MedicationThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Read moreAn Exploratory Study of Strengthening Non-Dominant Side of Exercises on ADHD Children in Primary Schools
Empirical studies indicate that children with attention deficit hyperactivity disorder (ADHD) benefited significantly from exercise interventions. Further investigation shows that strength training of non-dominant limbs improves children's athletic ability and cognitive development. This study tested the effectiveness of a strength training intervention on non-dominant limbs for primary school children with ADHD, evaluating its impacts on children’s motor skills. In this experiment, 15 children with ADHD aged 6-10 years were recruited, including 12 boys and 3 girls. All meet the diagnostic criteria of the American Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for ADHD. Randomly divided into age-matched experimental and control groups, children in the experimental group received intensive training intervention on non-dominant side limbs, and the control group had ADHD Children are not involved in the intervention. Before the experiment, the children and their parents were interviewed on the basic situation of ADHD children. Before and after the experiment, these children of both groups were tested on the TGMD basic motor skills development test and the SNAP-IV scale test, and the parents and children signed the informed consent. The results showed that (1) After the experiment, the experimental group had significantly better overall level of manipulative motor skills and fundamental movement skills than the control group; (2) For the results of SNAP-IV scale, the experimental group (the non-dominant side limb intensive training group) made significantly better progress than the control group (Again, you need to insert t statistics, degree of freedom along with p value here). At the same time, the attention deficit factor of the experimental group and the control group was significantly different before and after the experiment (p < 0.05). More details are needed on the pre- and post-change for both conditions. The results suggest that intensified training on non-dominant limbs can not only improve the motor skills of ADHD children, especially the control ability, but also improve the attention level compared with conventional exercise intervention. It is recommended that strengthening training of non-dominant limbs can be used as more effective exercise intervention for children with ADHD.
Read more6Comparing the Drawings of Children with Attention Deficit Hyperactivity Disorder with Normal Children
Attention deficit hyperactivity disorder (ADHD) is the most common behavioral problem during childhood and in school-aged children. Various projection drawings have been designed for assessing children's personality and psychological disorders including the tests of draw a person (DAP) and draw a family (DAF). We aimed to compare the differences between typically developing children and children with ADHD using these tests. In this case-control study, all the 9-10 year-old boy students studying at the third and fourth grades were enrolled from schools in the 2nd educational district of Shiraz, south of Iran. Eighty students were then selected and enrolled into the ADHD group and the control group. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition- text Revised (DSM-IV-TR), and the Child Symptoms Inventory were used to diagnose the children with ADHD. We evaluated and analyzed impulsiveness, non-impulsiveness, emotional problems and incompatibility indices in the DAP and DAF tests in each group. A significant difference was found in the indices of incompatibility and emotional problems, impulsiveness, non-impulsiveness and DAF between typically developing children and those with ADHD. The mean (±SD) total scores of the above mentioned indices in the ADHD group were 19.79(±2.94), 12.31(±1.84), 5.26(±2.29) and 5.89(±2.13), respectively (P<0.001). The corresponding figures for these indices in the normal group were 12.11(±4.74), 5.63(±2), 10.36± (2.33) and 2.88(±2.13), respectively (P<0.001). Significant differences were obtained between the control group and children with ADHD using these two drawing tests. The rate of impulsivity and emotional problems indices in drawings of children with ADHD was markedly more common than those of the typically developing children. This suggests the need for further assessment to screen ADHD.
Read moreComparing the Efficacy of In-person Versus Videoconference Parent Management Training for ADHD: A Randomized Clinical Trial
Background: Parent management training (PMT) is a recognized intervention for managing attention deficit hyperactivity disorder (ADHD) in children. Objectives: The present study aims to bridge this gap by investigating the comparative effectiveness of in-person versus videoconference PMT. Methods: Ninety parents with diagnosed ADHD children participated in this parallel-design, randomized clinical trial. Parents were recruited from a community outpatient clinic and randomly assigned (block randomization) to either a videoconference or in-person PMT group. The ADHD children between the ages of 3 and 12 who met the diagnostic and statistical manual of mental disorders (DSM-5) standards for ADHD diagnosis were included, as long as the child did not have oppositional defiant disorder (ODD) or conduct problem. The primary outcome measure was parent-reported ADHD symptoms, assessed using the Conners’ Parent Rating Scale (CPRS-48) at baseline, post-treatment, and 2-month follow-up. The Swanson, Nolan, and Pelham (SNAP-IV) Questionnaire was also used as a secondary outcome measure. Statistical analyses included Independent samples t-test and mixed ANOVA, with effect sizes reported as Cohen’s d. Results: Both in-person and videoconference PMT significantly improved core ADHD symptoms (attention deficit, hyperactivity, and overall ADHD) (all P < 0.001 except videoconference PMT at follow-up for ADHD, P = 0.01) and conduct problems (P < 0.001). However, in-person PMT showed additional benefits for social and psychosomatic problems, with medium to large effect sizes. Specifically, the effect size for in-person PMT in improving conduct problems was 0.48, while the effect size for the superiority of in-person PMT over videoconference PMT in improving social problems was 0.55. These findings suggest that while both delivery methods are effective for core ADHD symptoms, in-person PMT may offer more comprehensive benefits, particularly in addressing social and psychosomatic issues. Conclusions: Videoconference PMT can be a viable alternative for improving core ADHD symptoms, particularly when in-person delivery is impractical. However, in-person PMT might be the preferred approach for addressing social and psychosomatic difficulties. These findings have implications for clinical practice and future research in expanding access to PMT.
Read more2Comparison of the Level and Prevalence of ADHD Symptoms in Macao (China) and U.S. University Students
Compared to other areas of the world and other Chinese societies such as Hong Kong and Taiwan, little is known about psychiatric conditions in Macao, a Special Administrative Region of China. There is growing evidence of the cross-national and cross-cultural validity of attention deficit hyperactivity disorder (ADHD), but there are no studies of ADHD symptoms in Macao. This study compared Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) ADHD symptoms of Macao postsecondary students (N = 459) to U.S. peers (N = 261). Based on symptom counts, Macao students reported higher rates of ADHD. With regard to recent problems, 7.01% of Macao students and 2.69% of U.S. students reported enough symptoms to meet the cutoff for 1 of the 3 subtypes. Requiring that enough symptoms be recalled to meet childhood criteria, recent rates dropped to 3.74% (Macao) and 1.15% (United States), which are within expectations based on worldwide estimates. Comparisons using other methods of calculating rates are also provided. This research adds to the limited knowledge of ADHD symptoms in postsecondary students across countries, and provides the first account of such symptoms in Macao. Assessment of ADHD symptoms in Macao is complicated by the high level of overall distress reported by students.
Read more289Psychological and Academic Functioning in College Students With Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) has been increasingly recognized as a valid adult diagnosis. Yet the impairments related to ADHD in college students have received little scholarly attention. Psychological and academic impairments in college students not previously diagnosed with ADHD were assessed in a retrospective chart review, using specifically defined diagnostic criteria, and compared with a control group. Students with ADHD had a significantly lower mean grade point average, were more likely to be on academic probation, and reported significantly more academic problems. Measures of psychological impairment in the ADHD group were not significantly different from those in the control group. College students diagnosed with ADHD had a specific pattern of academic impairment. The problems of these students, compared with other groups of children and adults with ADHD, appeared to be more related to a type of learning disorder than to the conceptualization of ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV).
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