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Introduction: There has been no study in the literature evaluating serum tumor necrosis factor-like weak inducer of apoptosis (TWEAK) levels in attention-deficit/hyperactivity disorder (ADHD). Therefore, we performed the present study to specifically measure serum TWEAK levels to see whether or not its eventual alterations might have an etiopathogenetic significance in children with ADHD. Subjects and methods: A total of 49 treatment-naive children with ADHD and 39 healthy controls were included in the present study. The severities of ADHD and conduct disorder symptoms were assessed via parent- and teacher-rated questionnaires. Venous blood samples were collected, and serum TWEAK levels were measured. Results: Serum TWEAK levels of the ADHD group were significantly lower than the control group. Conclusions: This study shows that ADHD patients have decreased serum TWEAK levels, suggesting a possible involvement of TWEAK in the etiopathogenesis of ADHD.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with obesity, however, the potential causality between the traits remains unclear. We examined both genetic and prenatal evidence for causality using Mendelian Randomisation (MR) and polygenic risk scores (PRS). We conducted bi-directional MR on ADHD liability and six obesity-related traits using summary statistics from the largest available meta-analyses of genome-wide association studies. We also examined the shared genetic aetiology between ADHD symptoms (inattention and hyperactivity) and body mass index (BMI) by PRS association analysis using longitudinal data from Northern Finland Birth Cohort 1986 (NFBC1986, n = 2984). Lastly, we examined the impact of the prenatal environment by association analysis of maternal pre-pregnancy BMI and offspring ADHD symptoms, adjusted for PRS of both traits, in NFBC1986 dataset. Through MR analyses, we found evidence for bidirectional causality between ADHD liability and obesity-related traits. PRS association analyses showed evidence for genetic overlap between ADHD symptoms and BMI. We found no evidence for a difference between inattention and hyperactivity symptoms, suggesting that neither symptom subtype is driving the association. We found evidence for association between maternal pre-pregnancy BMI and offspring ADHD symptoms after adjusting for both BMI and ADHD PRS (association p-value = 0.027 for inattention, p = 0.008 for hyperactivity). These results are consistent with the hypothesis that the co-occurrence between ADHD and obesity has both genetic and prenatal environmental origins.

ObjectiveThis study investigated the effects of a school-based skill-training intervention in attention control and executive functions for pupils with hyperactivity-impulsivity (H-I) and cognitive control (CC) deficits. The main aim was to examine whether the intervention differently influenced H-I and CC, and whether cognitive abilities or conduct problems moderated response to the intervention.MethodElementary school pupils from 41 schools participated the study and were divided into an intervention group (n = 71) and a waitlist control group (n = 77). Intervention outcomes were assessed with an inventory assessing executive function difficulties (including H-I and CC) completed by classroom teachers.ResultsSignificant intervention effects and positive changes were detected in CC but not in H-I. Significant intervention effects were found mainly among pupils with low levels of conduct problems.ConclusionsThe results suggest that a skill-training intervention has specific positive effects on CC, but conduct problems may diminish response to intervention.

Analyses of the polygenic architecture of childhood, persistent and late-diagnosed attention-deficit hyperactivity disorder (ADHD) in a Danish population-based case-cohort sample identify differences among ADHD subgroups with respect to common and rare variants. Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset in childhood (childhood ADHD); two-thirds of affected individuals continue to have ADHD in adulthood (persistent ADHD), and sometimes ADHD is diagnosed in adulthood (late-diagnosed ADHD). We evaluated genetic differences among childhood (n = 14,878), persistent (n = 1,473) and late-diagnosed (n = 6,961) ADHD cases alongside 38,303 controls, and rare variant differences in 7,650 ADHD cases and 8,649 controls. We identified four genome-wide significant loci for childhood ADHD and one for late-diagnosed ADHD. We found increased polygenic scores for ADHD in persistent ADHD compared with the other two groups. Childhood ADHD had higher genetic overlap with hyperactivity and autism compared with late-diagnosed ADHD and the highest burden of rare protein-truncating variants in evolutionarily constrained genes. Late-diagnosed ADHD had a larger genetic overlap with depression than childhood ADHD and no increased burden in rare protein-truncating variants. Overall, these results suggest a genetic influence on age at first ADHD diagnosis, persistence of ADHD and the different comorbidity patterns among the groups.

Objective: To evaluate the executive functions and social reciprocity of children and adolescents diagnosed with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) and compared them with healthy controls. Material and Method: Patients aged 6-17 years diagnosed with ASD (n=33) and ADHD (n=37) and healthy controls in the same age range (n=33) were included in the study. Behavioral Rating Inventory of Executive Functions (BRIEF) sub-scales and Social Responsiveness Scale (SRS) were used for evaluating executive function areas and social responsiveness. Results: Our results revealed that children and adolescents with ASD and ADHD were significantly impaired for all BRIEF sub-scales except emotional control and that the significant increase in sub-scale scores expressing deterioration continued after adjustment for SES, verbal IQ scores, and gender. ASD patients received significantly higher SRS scores compared to ADHD and control groups and ADHD patients also had significantly higher values compared to the controls. Conclusion: Further studies with parent-report scales that allow easier and faster evaluation of executive functions and social reciprocity will contribute to better understanding of the personal needs of children with neurodevelopmental disorders and the finding of new treatments.

Contains fulltext : 287469.pdf (Publisher’s version ) (Open Access) Attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are highly heritable neurodevelopmental conditions, with considerable overlap in their genetic etiology. We dissected their shared and distinct genetic etiology by cross-disorder analyses of large datasets. We identified seven loci shared by the disorders and five loci differentiating them. All five differentiating loci showed opposite allelic directions in the two disorders and significant associations with other traits, including educational attainment, neuroticism and regional brain volume. Integration with brain transcriptome data enabled us to identify and prioritize several significantly associated genes. The shared genomic fraction contributing to both disorders was strongly correlated with other psychiatric phenotypes, whereas the differentiating portion was correlated most strongly with cognitive traits. Additional analyses revealed that individuals diagnosed with both ASD and ADHD were double-loaded with genetic predispositions for both disorders and showed distinctive patterns of genetic association with other traits compared with the ASD-only and ADHD-only subgroups. These results provide insights into the biological foundation of the development of one or both conditions and of the factors driving psychopathology discriminatively toward either ADHD or ASD.

Attention-deficit/hyperactivity disorder (ADHD) in adults is understudied, especially regarding neural mechanisms such as oscillatory control of attention sampling. We report an electroencephalography (EEG) study of such cortical mechanisms, in ADHD-diagnosed adults during administration of Test of Variables of Attention (TOVA), a gold-standard continuous performance test for ADHD that measures the ability to sustain attention and inhibit impulsivity. We recorded 53 adults (28 female, 25 male, aged 18-60), and 18 matched healthy controls, using 128-channel EEG. We analyzed sensor-space features established as neural correlates of attention: timing-sensitivity and phase-synchrony of response activations, and event-related (de)synchronization (ERS/D) of alpha and theta frequency band activity; in frontal and parietal scalp regions. TOVA test performance significantly distinguished ADHD adults from neurotypical controls, in commission errors, response time variability (RTV) and d' (response sensitivity). The ADHD group showed significantly weaker target-locked and responselocked amplitudes, that were strongly right-lateralized at the N2 wave, and weaker phase synchrony (longer reset poststimulus). They also manifested significantly less parietal prestimulus 8-Hz theta ERS, less frontal and parietal poststimulus 4-Hz theta ERS, and more frontal and parietal prestimulus alpha ERS during correct trials. These differences may reflect excessive modulation of endogenous activity by strong entrainment to stimulus (alpha), combined with deficient modulation by neural entrainment to task (theta), which in TOVA involves monitoring stimulus spatial location (not predicted occurrence onset which is regular and task-irrelevant). Building on the hypotheses of theta coding for relational structure and rhythmic attention sampling, our results suggest that ADHD adults have impaired attention sampling in relational categorization tasks.

Background Attention-deficit/hyperactivity disorder (ADHD) is associated with negative life outcomes and recent studies have linked it to increased mortality. These studies have examined nationwide registers or clinic-referred samples and mostly included participants up until the age of 30. No studies have investigated mortality associated with subthreshold levels of ADHD symptoms. Our aim was to analyze mortality in a perinatal risk cohort of 46-year-old adults with childhood ADHD (cADHD) and milder childhood attention problems (including hyperactivity and inattention; cAP) compared with a group with similar birth risks but no or low levels of childhood ADHD symptoms (Non-cAP). Causes of death obtained from a national register were examined. Methods Mortality was analyzed with Cox proportional hazard models for all-cause mortality, cause-specific mortality (natural and unnatural causes), and age-specific mortality (under and over age 30). All models were adjusted with gender. The total n in the study was 839 (cADHD n = 115; cAP n = 216; Non-cAP n = 508). Results By the age of 46, 11 (9.6%) deaths occurred in the cADHD group, 7 (3.2%) in the cAP group, and 20 (3.9%) in the Non-cAP group. The cADHD group had the highest mortality risk (adjusted hazard ratio = 2.15; 95% CI 1.02, 4.54). Mortality was not elevated in the cAP group (adjusted hazard ratio = 0.72; 95% CI .30, 1.72). Mortality in the cADHD group was mainly attributed to unnatural causes of death (adjusted hazard ratio = 2.82; 95% CI 1.12, 7.12). The mortality risk in the cADHD group was sixfold before age 30 (adjusted hazard ratio = 6.20; 95% CI 1.78, 21.57). Conclusions Childhood ADHD was associated with a twofold risk of premature death by the age of 46 in this prospective longitudinal cohort study. Our results corroborate previous findings and the morbidity of ADHD. Subthreshold levels of childhood ADHD symptoms were not linked to increased mortality. Our results suggest that mortality risk is higher in young than middle adulthood. Future studies should examine mortality associated with ADHD in different ages in adulthood to identify those in greatest risk of premature death.

This study was designed to provide more insight into the relationship between social support and externalizing behavior in forensic patients with ADHD. Because ADHD is highly associated with psychosocial impairment, we expected poor social support and attachment insecurity (i.e., preoccupied, fearful, and dismissive attachment) to be associated with higher levels of externalizing behaviors in forensic patients with ADHD. Self-reports of 32 forensic male outpatients with ADHD (M age = 35.34) were compared with self-reports of healthy (n = 32; M age = 33.84), and ‘at risk’ control males with (a history of) psychological problems (n = 30; M age = 36.47) from the general population. In addition, associations between social support, attachment and externalizing behaviors (i.e., aggression, antisociality, anger and hostility) were examined within the sample as a whole. Analyses of variance showed that forensic patients with ADHD had higher levels of externalizing behaviors and insecure attachment, and lower levels of secure attachment compared to both healthy and at risk controls. Multivariate regression analyses showed that social support was not associated with any of the externalizing behaviors, after accounting for attachment. In contrast, insecure attachment was associated with higher levels of all externalizing behaviors examined. Finally, insecure attachment best explained antisociality and hostility, suggesting that attachment is more important than other psychopathological risk factors that distinguish the different groups.

Attentional biomarkers in attention deficit hyperactivity disorder are difficult to detect using only behavioural testing. We explored whether attention measured by a low-cost EEG system might be helpful to detect a possible disorder at its earliest stages. The GokEvolution application was designed to train attention and to provide a measure to identify attentional problems in children early on. Attention changes registered with NeuroSky MindWave in combination with the CARAS-R psychological test were used to characterise the attentional profiles of 52 non-ADHD and 23 ADHD children aged 7 to 12 years old. The analyses revealed that the GokEvolution was valuable in measuring attention through its use of EEG–BCI technology. The ADHD group showed lower levels of attention and more variability in brain attentional responses when compared to the control group. The application was able to map the low attention profiles of the ADHD group when compared to the control group and could distinguish between participants who completed the task and those who did not. Therefore, this system could potentially be used in clinical settings as a screening tool for early detection of attentional traits in order to prevent their development. Ministerio de Ciencia e Innovación PID2019-110739GB-I00/ AEI/10.13039/501100011033 Ministerio de Ciencia, Innovación y Universidades PSI2015-65500-P

Background There is an ongoing debate as to whether attention-deficit hyperactivity disorder (ADHD) in highly intelligent individuals has a similar presentation as in average intelligent individuals. The aim of this study was to examine the cognitive correlates of ADHD in highly intelligent children and adolescents with ADHD. Method Two independent samples (N = 204 and N = 84) of (1) high intelligence quotient (IQ) (IQ ≥ 120) children and adolescents with ADHD were used, carefully matched on age, gender, ADHD severity, and IQ with (2) control participants with high intelligence, (3) participants with ADHD with an average intelligence (IQ 90–110), and (4) control participants with an average intelligence. These samples were selected from the Dutch node of the International Multicenter ADHD Genetics (NeuroIMAGE) and Tracking Adolescents’ Individual Lives Survey (TRAILS) cohorts, respectively, in which a large battery of cognitive tasks was administered. Linear mixed models were used to examine the main effects of ADHD and IQ and their interaction on cognitive performance. Results ADHD-control group differences were not moderated by IQ; mostly equally large ADHD-control differences in cognitive performance were found for high versus average intelligent groups. The small moderating effects found mostly indicated somewhat milder cognitive problems in highly intelligent individuals with ADHD. Overall, highly intelligent children and adolescents with ADHD performed at the level of the average intelligent control children. Conclusions Our findings indicate the cognitive profile of ADHD is similar in highly versus average intelligent individuals with ADHD, although ADHD-related cognitive deficits may be easily overlooked in the high intelligence population when compared to the typical (i.e., average intelligent) control group.

Background Attention-deficit/hyperactivity disorder (ADHD) is a psychosocially impairing and cost-intensive mental disorder, with first symptoms occurring in early childhood. It can usually be diagnosed reliably at preschool age. Early detection of children with ADHD symptoms and an early, age-appropriate treatment are needed in order to reduce symptoms, prevent secondary problems and enable a better school start. Despite existing ADHD treatment research and guideline recommendations for the treatment of ADHD in preschool children, there is still a need to optimise individualised treatment strategies in order to improve outcomes. Therefore, the ESCApreschool study (Evidence-Based, Stepped Care of ADHD in Preschool Children aged 3 years and 0 months to 6 years and 11 months of age (3;0 to 6;11 years) addresses the treatment of 3–6-year-old preschool children with elevated ADHD symptoms within a large multicentre trial. The study aims to investigate the efficacy of an individualised stepwise-intensifying treatment programme. Methods The target sample size of ESCApreschool is 200 children (boys and girls) aged 3;0 to 6;11 years with an ADHD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or a diagnosis of oppositional defiant disorder (ODD) plus additional substantial ADHD symptoms. The first step of the adaptive, stepped care design used in ESCApreschool consists of a telephone-assisted self-help (TASH) intervention for parents. Participants are randomised to either the TASH group or a waiting control group. The treatment in step 2 depends on the outcome of step 1: TASH responders without significant residual ADHD/ODD symptoms receive booster sessions of TASH. Partial or non-responders of step 1 are randomised again to either parent management and preschool teacher training or treatment as usual. Discussion The ESCApreschool trial aims to improve knowledge about individualised treatment strategies for preschool children with ADHD following an adaptive stepped care approach, and to provide a scientific basis for individualised medicine for preschool children with ADHD in routine clinical care. Trial registration The trial was registered at the German Clinical Trials Register (DRKS) as a Current Controlled Trial under DRKS00008971 on 1 October 2015. This manuscript is based on protocol version 3 (14 October 2016).

Known comorbidities for Attention-Deficit Hyperactivity Disorder (ADHD) include conduct problems, substance use disorder and gaming. Comorbidity with conduct problems may increase the risk for substance use disorder and gaming in individuals with ADHD. The aim of the study was to build a causal model of the relationships between ADHD and comorbid conduct problems, and alcohol, nicotine, and other substance use, and gaming habits, while accounting for age and sex. We used a state-of-the-art causal discovery algorithm to analyze a case-only sample of 362 ADHD-diagnosed individuals in the ages 12–24 years. We found that conduct problem severity mediates between ADHD severity and nicotine use, but not with more severe alcohol or substance use. More severe ADHD-inattentive symptoms lead to more severe gaming habits. Furthermore, our model suggests that ADHD severity has no influence on severity of alcohol or other drug use. Our findings suggest that ADHD severity is a risk factor for nicotine use, and that this effect is fully mediated by conduct problem severity. Finally, ADHD-inattentive severity was a risk factor for gaming, suggesting that gaming dependence has a different causal pathway than substance dependence and should be treated differently. By identifying these intervention points, our model can aid both researchers and clinicians.

Amaç: Bu çalışmanın amacı erişkin dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) hastalarında nörobilişsel işlevler ile zihin okuma performansı ve dürtüsellik arasındaki ilişkiyi saptamaktır. Yöntem: Çalışmaya erişkin DEHB tanısı konulmuş olan 18-65 yaş arasında 30 hasta ile 30 sağlıklı kontrol alındı. Tüm katılımcılara DSM-IV Eksen I Bozuklukları için Yapılandırılmış Klinik Görüşme (SCID-I), Erişkin DEHB Öz Bildirim Ölçeği (EDHÖ), Barratt Dürtüsellik Ölçeği (BDÖ), Gözlerden Zihin Okuma Testi (GZOT) ve nöropsikolojik testler (Sayı Dizisi Testi, İşitsel Sessiz Üç Harf Sıralaması Testi, Rey İşitsel Sözel Öğrenme ve Bellek Testi, Görsel Kopyalama Testi, Kontrollü Kelime Çağrışım Testi ve Stroop Testi) uygulandı. Bulgular: DEHB grubunda EDHÖ ve BDÖ puan ortalamaları kontrol grubuna göre yüksek saptandı. GZOT puan ortalaması karşılaştırıldığında iki grup arasında anlamlı farklılık bulunmadı. DEHB grubunda İşitsel Sessiz Üç Harf Sıralaması Testi puanı, Stroop kelime okuma hata sayısı alt testi puanı ve kontrollü kelime çağrışım testinin perseverasyon puanı kontrol grubuna göre yüksek saptandı. Korelasyon analizinde BDÖ dikkatsel dürtüsellik alt ölçek puanı ile ileri sayı dizisi test puanı arasında; BDÖ motor dürtüsellik alt ölçek puanı ile REY 1 ve REY 5 test puanı arasında; BDÖ plansızlık alt ölçek puanı ile REY 5 test puanı arasında; BDÖ toplam puanı ile ileri sayı dizisi, REY 1, REY 5, REY1-5 ve REY 7 test puanları arasında negatif yönde anlamlı ilişki saptandı. Sonuç: Erişkin DEHB hastalarında sözel bellek işlevleri dürtüsellik ile ilişkilidir. DEHB hastalarında dürtüsellik, yürütücü işlevler ve zihin kuramı birbirinden bağımsız işlevler olabilir., Objective: The aim of this study was to determine the relationship between neurocognitive functions, reading the mind in the eyes performance and impulsivity in adult attention deficit and hyperactivity disorder (ADHD) patients. Methods: Thirty subjects who had a diagnosis of ADHD and 30 control subjects aging between 18-65 years were included into the study. Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Axis I (SCID l), Adult ADHD Self-Report Scale (ASRS), Barratt Impulsivity Scale (BIS), Reading the Mind in the Eyes Test (RMET) and neuropsychological tests (Digit Span Test, Auditory Consonant Trigram-ACT, Rey Verbal Learning Test, Visual Reproduction Test, Controlled Oral Word Association Test-COWAT and Stroop Task) were performed to all participants. Results: ASRS and Barratt Impulsivity Scale scores were significantly higher in ADHD group than the control group. No difference was found in RMET scores between the adult ADHD and the control groups. ACT, Stroop word reading mistake subscale and COWAT perseveration scores were found to be ADHD group than the control group. Correlation analyses revealed that there was a significant and negative relationship between BIS inattention score and digit span forward test score; BIS motor impulsivity score and REY 1, REY 5 scores; BIS non-planning score and REY 5 score; BIS total score and digit span forward, REY 1, REY 5, REY 7 scores. Conclusion: Verbal memory functions are related with impulsivity in ADHD patients. Impulsivity, executive functions and theory of mind may be independent functions in patients with ADHD.

Modern environments are full of information, and place high demands on the attention control mechanisms that allow the selection of information from one (focused attention) or multiple (divided attention) sources, react to changes in a given situation (stimulus-driven attention), and allocate effort according to demands (task-positive and task-negative activity). We aimed to reveal how attention deficit hyperactivity disorder (ADHD) affects the brain functions associated with these attention control processes in constantly demanding tasks. Sixteen adults with ADHD and 17 controls performed adaptive visual and auditory discrimination tasks during functional magnetic resonance imaging (fMRI). Overlapping brain activity in frontoparietal saliency and default-mode networks, as well as in the somato-motor, cerebellar, and striatal areas were observed in all participants. In the ADHD participants, we observed exclusive activity enhancement in the brain areas typically considered to be primarily involved in other attention control functions: During auditory-focused attention, we observed higher activation in the sensory cortical areas of irrelevant modality and the default-mode network (DMN). DMN activity also increased during divided attention in the ADHD group, in turn decreasing during a simple button-press task. Adding irrelevant stimulation resulted in enhanced activity in the salience network. Finally, the irrelevant distractors that capture attention in a stimulus-driven manner activated dorsal attention networks and the cerebellum. Our findings suggest that attention control deficits involve the activation of irrelevant sensory modality, problems in regulating the level of attention on demand, and may encumber top-down processing in cases of irrelevant information. (C) 2018 Elsevier B.V. All rights reserved.

OBJECTIVE: Current data about Attention Deficit Hyperactivity Deficiency (ADHD) guideline use in the Netherlands are absent. This study analysed ADHD guideline use among different healthcare workers, and the use of key elements from these guidelines to diagnose ADHD.METHOD: A survey assessing ADHD guideline use was distributed throughout the Netherlands to various health care professionals. Only professionals involved during the diagnostic process were included.RESULTS: Response rate among GPs was low (111/1450), but high among other health care professionals (251/287). A total of 362 surveys were analysed, 186 responders (51%) were involved during the diagnostic process. Overall guideline use was 64.5%; the national multidisciplinary guideline or a guideline made by a professional's own institution were most used. Psychiatrists, psychologists and paediatricians reported compliance with key elements of the guidelines such as gathering information from a third party (> 90%) and carrying out a developmental history (> 88%). Use of a standardized interview (CONCLUSION: Despite low general use of guidelines, psychiatrists, psychologists and paediatricians use similar key elements of ADHD guidelines. This study provides opportunities to improve care through increasing familiarity with ADHD guidelines and the use of standardized interviews.

OBJECTIVES: In this study, we examined the consequences of ignoring violations of assumptions underlying the use of sum scores in assessing attention problems (AP) and if psychometrically more refined models improve predictions of relevant outcomes in adulthood.METHODS: Tracking Adolescents' Individual Lives data were used. AP symptom properties were examined using the AP scale of the Child Behavior Checklist at age 11. Consequences of model violations were evaluated in relation to psychopathology, educational attainment, financial status, and ability to form relationships in adulthood.RESULTS: Results showed that symptoms differed with respect to information and difficulty. Moreover, evidence of multidimensionality was found, with two groups of items measuring sluggish cognitive tempo and attention deficit hyperactivity disorder symptoms. Item response theory analyses indicated that a bifactor model fitted these data better than other competing models. In terms of accuracy of predicting functional outcomes, sum scores were robust against violations of assumptions in some situations. Nevertheless, AP scores derived from the bifactor model showed some superiority over sum scores.CONCLUSION: These findings show that more accurate predictions of later-life difficulties can be made if one uses a more suitable psychometric model to assess AP severity in children. This has important implications for research and clinical practice.

AmaçDikkat Eksikliği Hiperaktivite Bozukluğu‟nda (DEHB) önemli fonksiyonel kayıplaraneden olan öfke, irritabilite ve engellenme toleranssızlığı gibi duygu düzenleme güçlükleri(DDG) görülebilir. Bu araştırmada DEHB tanılı çocuk ve ergenler ile sağlıklı kontrolgrubunu duygu düzenleme özellikleri bakımından karşılaştırmak, duygu düzenleme güçlüğüile ilişkili olabilecek faktörleri incelemek amaçlanmıştır.Gereç ve YöntemAraştırma Namık Kemal Üniversitesi Tıp Fakültesi, Çocuk ve ErgenPsikiyatri polikliniğinde DSM-V tanı kriterlerine göre DEHB tanısı konulan 6-18 yaşaralığında 72 çocuk-ergen ve 30 sağlıklı kontrol ile yürütülmüştür. Okul Çağı Çocukları içinDuygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi – Şimdi ve Yaşam Boyu Şekli(ÇDŞG – ŞY) yarı yapılandırılmış görüşme formu kullanılarak komorbiditeler belirlenmiştir.Çocukluk Çağı Davranış Değerlendirme Ölçeği (ÇDDÖ) ile duygu düzenleme güçlüğü(DDG=dikkat+anksiyete/depresyon+agresyon alt ölçekleri) puanı elde edilmiştir.BulgularDEHB grubunda DDG puanı 1--89.45±19.33 iken, sağlıklı kontrol grubundaDDG puanı 164.13±9.94 olarak bulunmuştur. İki grup arasında DDG puanları bakımındananlamlı fark saptanmıştır (p˂0.001**). DEHB grubu klinik özellikler bakımındandeğerlendirildiğinde eş psikiyatrik bozuklukların DDG ile ilişkili olmadığı, DEHB bileşikgörünüm özelliklerinin ise DDG için önemli yordayıcı olduğu sonucu elde edilmiştir(p=0.011*).SonuçBu araştırmanın sonuçları DEHB tanılı bireylerde DDG‟nün sağlıklı kontrollere göreanlamlı düzeyde fazla olduğu ve DEHB bileşik görünümün DDG için yordayıcı olduğusonucunu ortaya koymuştur. DEHB‟ye eşlik eden duygu düzenleme güçlüğü, kişide dahafazla işlevsellik kaybına yol açtığı ve bozukluğun yetişkin yaşta devamı ileilişkilendirildiğinden, DEHB tanı ve tedavi sürecinde ayrıca ele alınması gereken önemliklinik özelliklerdendir., AimEmotion regulation difficulties(ERD) such as anger, irritability and frustration intolerance leading to severefunctional losses may be observed in attention deficit-hyperactivity disorder(ADHD). The purpose of this study was to compare children and adults diagnosedwith ADHD and a healthy control group in terms of emotion regulationcharacteristics and to examine factors potentially associated with ERD.MethodThe study was performed with 72children/adults aged 6-18 diagnosed with ADHD based on DSM-V diagnosticcriteria at the XXXXXX Child and Adolescent Psychiatry Polyclinic, Turkey, and30 healthy controls. The Schedule for Affective Disorders and Schizophrenia forSchool-Age Children – Present and Lifetime Version (K-SADS-PL), asemi-structured interview form, was used to determine comorbidities. ERD scores(ERD=attention+anxiety/depression+aggression subscales) were determined usingthe Childhood Behavior Checklist (CBCL).ResultsMean ERD scores were 189.45±19.33in the ADHD group and 164.13±9.94 in the healthy control group. A significantdifference was determined in ERD scores between the two groups (p˂0.001**).When the ADHD group was evaluated in terms of clinical characteristics,comorbid psychiatric disorders were not associated with ERD, but combined typeADHD characteristics emerged as significant predictors for ERD (r=0.43,r2=0.18, p=0.001**).ConclusionThe results of this research revealedsignificantly greater ERD in individuals diagnosed with ADHD compared tohealthy controls, and that combined type ADHD is a predictor for ERD. Since ERDaccompanying ADHD lead to greater function loss in the individual and areassociated with persistence of the disorder in adulthood, these are importantclinical characteristics also requiring evaluation during the diagnosis andtreatment of ADHD.

Aims Several studies indicate the similarity between the symptoms of fetal alcohol syndrome and attention-deficit hyperactivity disorder (ADHD). This study hypothesized that prenatal exposure to ethanol (EtOH) can be used as an animal model of ADHD in Wistar rats. Methods At the first stage of the study, alcohol was delivered to the pregnant dams (237-252 g) by intra-gastric route throughout Gestation Days 8-20 at a dose of 6 g/kg/day. Untreated control group with isocaloric sucrose intubation was also included. Of the 16 male pups (174-180 g), 8 were in the fetal alcohol effects (FAE) group and 8 were in the untreated control group. Subjects went through behavior shaping, discrimination learning and reversal learning. Number of sessions to learn the tasks, response frequency to inhibitory (S-) and excitatory (S+) stimulus features, response latency and inter-response time (IRT) were measured. Results Significant differences were obtained on only the reversal task. Rats with FAE needed greater number of sessions to learn the reversal task, and they had a higher frequency of incorrect responses in specifically the latter part of the sessions. Conclusion Our results suggest that reversal learning of FAE rats exhibits deficit in the inhibition of pre-learned responses. Responses behaviorally mimicked attention deficit and impulsivity symptoms of human ADHD. However, the experimental design of the study was not conducive to hyperactivity. Accordingly, rats with FEA can be an alternative to other models since it is not, for example, based on a symptom that is atypical (such as hypertension) to ADHD. Short summary Significant difference was obtained in a reversal task between male rats prenatally exposed to ethanol and matched controls. The greater number of sessions for learning and higher frequency of incorrect responses behaviorally mimicked symptoms of ADHD, suggesting that rats with fetal ethanol effects can serve as a useful animal model.

Introduction: Inattention is one of the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Most of patients with ADHD show motor impairment, consisting in the persistence of neurological soft signs (NSS). Our aim was to evaluate attentional and motor functioning in an ADHD sample and healthy children (HC) and possible link between attentional dysfunction and motor impairment in ADHD.Method: Twenty-seven drug-naive patients with ADHD and 23 HC were tested with a test battery, measuring different aspects of attention. Motor evaluation has provided three primary variables: overflow movements (OM), dysrhythmia and total speed of timed activities.Results: Compared to HC, patients were impaired in a considerable number of attentional processes and showed a greater number of NSS. Significant correlations between disturbances of attention and motor abnormalities were observed in ADHD group.Conclusion: Our findings suggest that attentional processes could be involved in the pathophysiology of the NSS and add scientific evidence to the predictive value of NSS as indicators of the severity of functional impairment in ADHD. Given the marked improvement or complete resolution of NSS following treatment with methylphenidate, we suggest that evaluation of NSS is useful to monitor the effectiveness of pharmacological treatment with MPH in ADHD.

This study aimed to evaluate the baseline sleep habits of children with ADHD and the effects of treatment with methylphenidate (MPH) and atomoxetine (ATX) on sleep parameters. Treatment naive children with clinically normal intelligence diagnosed with ADHD were enrolled in the study. Children were treated naturalistically with MPH and ATX. Treatments were started at 0.5 mg/ kg/ day and titrated weekly to a maximum of 1.2 mg/ kg/ day. The daily equivalent dose was calculated according to clinician toolkits of Utah Academy of Child and Adolescent Psychiatry. DSM-IV Based Screening and Assessment Scale for Disruptive Behavior Disorders- Parent form (DBSASDBD) and Clinical Global Impression Scale were used to assess ADHD symptoms and Children's Sleep Habits Questionnaire (CSHQ)- Short Form was used to assess the sleep habits and problems before and after the treatment. Both MPH and ATX reduced symptom severity of ADHD in all domains and also reduced total CSHQ scores with similar effect sizes. (0.7 for MPH vs. 0.8 for ATX). The rate of clinically significant sleep problems at baseline was 93.5 %. At the end-point, 83.9 % of the sample still displayed clinically significant sleep problems while none of the children were judged to have moderate-severe sleep problems. Our results suggest that both ATX and MPH may selectively improve different sleep domains in children with ADHD. Studies using standardized dosing schemes for longer durations and evaluating sleep with objective measurements may clarify the differential effects of treatments on sleep among children with ADHD. WOS:000573651300010 2-s2.0-85083851580 PubMed: 32361211

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention.

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention.

This study investigated the stability and state-related characteristics of electroencephalographic (EEG) deviances in attention-deficit/hyperactivity disorder (ADHD). Three minutes resting EEG with eyes closed and eyes open were compared between 21 children with ADHD and 29 typically developing children. Across resting conditions, children with ADHD exhibited divergent topographic distribution for theta, alpha and beta power compared to typically developing children. In addition, less alpha and theta suppression to eye opening was found in children with ADHD, but only in those without comorbid ODD/CD. Findings of the present study refer to a consistent divergence in topographic distribution in ADHD across resting state conditions, yet demonstrate that state-related factors and comorbidity may also contribute to resting EEG deviances in ADHD. The state-related findings are in accord with several theoretical accounts emphasizing the role of contextual and state factors defining deficits in ADHD.

OBJECTIVE: In adulthood, depressive mood is often comorbid with ADHD, but its role in ADHD-inattentiveness and especially relations with mind wandering remains to be elucidated. This study investigated the effects of laboratory-induced dysphoric mood on task-unrelated mind wandering and its consequences on cognitive task performance in college students with high (n = 46) or low (n = 44) ADHD-Inattention symptomatology and Hyperactivity/Impulsivity symptoms in the normal range.METHODS: These non-clinical high/low ADHD-Inattention symptom groups underwent negative or positive mood induction after which mind wandering frequency was measured in a sustained attention (SART), and a reading task. Effects of ruminative response style and working memory capacity on mind wandering frequency were also investigated.RESULTS: Significantly higher frequencies of self -reported mind wandering in daily life, in the SART and reading task were reported in the ADHD-Inattention symptom group, with detrimental effects on text comprehension in the reading task. Induced dysphoric mood did specifically enhance the frequency of mind wandering in the ADHD-Inattention symptom group only during the SART, and was related to their higher self-reported intrusive ruminative response styles. Working memory capacity did not differ between high/low attention groups and did not influence any of the reported effects.CONCLUSIONS: These combined results suggest that in a non-clinical sample with high ADHD-inattention symptoms, dysphoric mood and a ruminative response style seem to be more important determinants of dysfunctional mind wandering than a failure in working memory capacity/executive control, and perhaps need other ways of remediation, like cognitive behavioral therapy or mindfulness training.

Contains fulltext : 169834.pdf (Publisher’s version ) (Open Access) Contains fulltext : 169834pos.pdf (Author’s version postprint ) (Open Access) BACKGROUND: Neuroimaging studies have shown structural alterations in several brain regions in children and adults with attention deficit hyperactivity disorder (ADHD). Through the formation of the international ENIGMA ADHD Working Group, we aimed to address weaknesses of previous imaging studies and meta-analyses, namely inadequate sample size and methodological heterogeneity. We aimed to investigate whether there are structural differences in children and adults with ADHD compared with those without this diagnosis. METHODS: In this cross-sectional mega-analysis, we used the data from the international ENIGMA Working Group collaboration, which in the present analysis was frozen at Feb 8, 2015. Individual sites analysed structural T1-weighted MRI brain scans with harmonised protocols of individuals with ADHD compared with those who do not have this diagnosis. Our primary outcome was to assess case-control differences in subcortical structures and intracranial volume through pooling of all individual data from all cohorts in this collaboration. For this analysis, p values were significant at the false discovery rate corrected threshold of p=0.0156. FINDINGS: Our sample comprised 1713 participants with ADHD and 1529 controls from 23 sites with a median age of 14 years (range 4-63 years). The volumes of the accumbens (Cohen's d=-0.15), amygdala (d=-0.19), caudate (d=-0.11), hippocampus (d=-0.11), putamen (d=-0.14), and intracranial volume (d=-0.10) were smaller in individuals with ADHD compared with controls in the mega-analysis. There was no difference in volume size in the pallidum (p=0.95) and thalamus (p=0.39) between people with ADHD and controls. Exploratory lifespan modelling suggested a delay of maturation and a delay of degeneration, as effect sizes were highest in most subgroups of children (21 years): in the accumbens (Cohen's d=-0.19 vs -0.10), amygdala (d=-0.18 vs -0.14), caudate (d=-0.13 vs -0.07), hippocampus (d=-0.12 vs -0.06), putamen (d=-0.18 vs -0.08), and intracranial volume (d=-0.14 vs 0.01). There was no difference between children and adults for the pallidum (p=0.79) or thalamus (p=0.89). Case-control differences in adults were non-significant (all p>0.03). Psychostimulant medication use (all p>0.15) or symptom scores (all p>0.02) did not influence results, nor did the presence of comorbid psychiatric disorders (all p>0.5). INTERPRETATION: With the largest dataset to date, we add new knowledge about bilateral amygdala, accumbens, and hippocampus reductions in ADHD. We extend the brain maturation delay theory for ADHD to include subcortical structures and refute medication effects on brain volume suggested by earlier meta-analyses. Lifespan analyses suggest that, in the absence of well powered longitudinal studies, the ENIGMA cross-sectional sample across six decades of ages provides a means to generate hypotheses about lifespan trajectories in brain phenotypes. FUNDING: National Institutes of Health. 10 p.

Background Methylphenidate (MPH), the first choice medication for attention-deficit hyperactivity disorder (ADHD), is associated with serious adverse effects like arrhythmia. Evidence on the association of ADHD with immune and oxidant-antioxidant imbalances offers potential for antioxidant and/or immunomodulatory nutritional supplements as ADHD therapy. One small randomised trial in ADHD suggests, despite various limitations, therapeutic benefit from Pycnogenol®, a herbal, polyphenol-rich extract. Methods This phase III trial is a 10-week, randomised, double-blind, placebo and active treatment controlled multicentre trial with three parallel treatment arms to compare the effect of Pycnogenol® to MPH and placebo on the behaviour of 144 paediatric ADHD and attention-deficit disorder (ADD) patients. Evaluations of behaviour (measured by the ADHD-Rating Scale (primary endpoint) and the Social-emotional Questionnaire (SEQ)), immunity (plasma cytokine and antibody levels, white blood cell counts and faecal microbial composition), oxidative stress (erythrocyte glutathione, plasma lipid-soluble vitamins and malondialdehyde and urinary 8-OHdG levels, as well as antioxidant enzyme activity and gene expression), serum zinc and neuropeptide Y level, urinary catecholamines and physical complaints (Physical Complaints Questionnaire) will be performed in week 10 and compared to baseline. Acceptability evaluations will be based on adherence, dropouts and reports of adverse events. Dietary habits will be taken into account. Discussion This trial takes into account comorbid behavioural and physical symptoms, as well as a broad range of innovative immune and oxidative biomarkers, expected to provide fundamental knowledge on ADHD aetiology and therapy. Research on microbiota in ADHD is novel. Moreover, the active control arm is rather unseen in research on nutritional supplements, but of great importance, as patients and parents are often concerned with the side effects of MPH. Trial registration Clinicaltrials.gov number: NCT02700685. Registered on 18 January 2016. EudraCT 2016-000215-32. Registered on 4 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1879-6) contains supplementary material, which is available to authorized users.

Contains fulltext : 169889.pdf (Publisher’s version ) (Open Access) Attention Deficit Hyperactivity Disorder (ADHD) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex (dACC). In the current study, we investigated for the first time whether real-time fMRI neurofeedback (rt-fMRI) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning. An exploratory randomized controlled treatment study with blinding of the participants was conducted. Participants with ADHD (n = 7 in the neurofeedback group, and n = 6 in the control group) attended four weekly MRI training sessions (60-min training time/session), during which they performed a mental calculation task at varying levels of difficulty, in order to learn how to up-regulate dACC activation. Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC. Before and after the training, ADHD symptoms and relevant cognitive functioning was assessed. Results showed that both groups achieved a significant increase in dACC activation levels over sessions. While there was no significant difference between the neurofeedback and control group in clinical outcome, neurofeedback participants showed stronger improvement on cognitive functioning. The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients. Due to the study's small sample size, potential clinical benefits need to be further investigated in future studies. TRIAL REGISTRATION: ISRCTN12390961.

AimsTo determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse.DesignData were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study.SettingForty-seven centres of SUD treatment in 10 countries.ParticipantsA total of 1205 treatment-seeking SUD patients.MeasurementsStructured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II).FindingsThe prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR)=2.8, 95% confidence interval (CI)=1.8-4.2], BPD (OR=7.0, 95% CI=3.1-15.6 for alcohol; OR=3.4, 95% CI=1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR=4.1, 95% CI=2.1-7.8) and HME (OR=4.3, 95% CI=2.1-8.7) were all more prevalent in ADHD(+) compared with ADHD(-) patients (PConclusionsTreatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.

AimsTo determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. DesignData were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study. SettingForty-seven centres of SUD treatment in 10 countries. ParticipantsA total of 1205 treatment-seeking SUD patients. MeasurementsStructured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II). FindingsThe prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR)=2.8, 95% confidence interval (CI)=1.8-4.2], BPD (OR=7.0, 95% CI=3.1-15.6 for alcohol; OR=3.4, 95% CI=1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR=4.1, 95% CI=2.1-7.8) and HME (OR=4.3, 95% CI=2.1-8.7) were all more prevalent in ADHD(+) compared with ADHD(-) patients (P ConclusionsTreatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.

BackgroundThe results of twin and sibling studies suggest that executive functioning is a prime candidate endophenotype in attention deficit hyperactivity disorder (ADHD). However, studies have not assessed the co-segregation of executive function (EF) deficits from parents to offspring directly, and it is unclear whether executive functioning is an ADHD endophenotype in adolescents, given the substantial changes in prefrontal lobe functioning, EF and ADHD symptoms during adolescence.MethodWe recruited 259 ADHD and 98 control families with an offspring average age of 17.3 years. All participants were assessed for ADHD and EF [inhibition, verbal (VWM) and visuospatial working memory (VsWM)]. Data were analysed using generalized estimating equations (GEEs).ResultsParental ADHD was associated with offspring ADHD and parental EF was associated with offspring EF but there were no cross-associations (parental ADHD was not associated with offspring EF or vice versa). Similar results were found when siblings were compared. EF deficits were only found in affected adolescents and not in their unaffected siblings or (un)affected parents.ConclusionsThe core EFs proposed to be aetiologically related to ADHD, that is working memory and inhibition, seem to be aetiologically independent of ADHD in adolescence. EF deficits documented in childhood in unaffected siblings were no longer present in adolescence, suggesting that children ‘grow out’ of early EF deficits. This is the first study to document ADHD and EF in a large family sample with adolescent offspring. The results suggest that, after childhood, the majority of influences on ADHD are independent from those on EF. This has potential implications for current aetiological models of causality in ADHD.

Background Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that can negatively impact on an individual’s quality of life. It is pathophysiologically complex and heterogeneous with different neuropsychological processes being impaired in different individuals. Executive function deficits, including those affecting attention, working memory and inhibitory control, are common. Cognitive training has been promoted as a treatment option, based on the notion that by strengthening the neurocognitive networks underlying these executive processes, ADHD symptoms will also be reduced. However, if implemented in childhood or later, when the full disorder has become well-established, cognitive training has only limited value. INTERSTAARS is a trial designed to test a novel approach to intervention, in which cognitive training is implemented early in development, before the emergence of the disorder. The aim of INTERSTAARS is to train early executive skills, thereby increasing resilience and reducing later ADHD symptoms and associated impairment. Methods/design Fifty 10–14-month-old infants at familial risk of ADHD will participate in INTERSTAARS. Infants will be randomised to an intervention or a control group. The intervention aims to train early attention skills by using novel eye-tracking technology and gaze-contingent training paradigms. Infants view animated games on a screen and different events take place contingent on where on the screen the infant is looking. Infants allocated to the intervention will receive nine weekly home-based attention training sessions. Control group infants will also receive nine weekly home visits, but instead of viewing the training games during these visits they will view non-gaze-contingent age-appropriate videos. At baseline and post treatment, infant attention control will be assessed using a range of eye-tracking, observational, parent-report and neurophysiological measures. The primary outcome will be a composite of eye-tracking tasks used to assess infant attention skills. Follow-up data will be collected on emerging ADHD symptoms when the infants are 2 and 3 years old. Discussion This is the first randomised controlled trial to assess the potential efficacy of cognitive training as a prevention measure for infants at familial risk of ADHD. If successful, INTERSTAARS could offer a promising new approach for developing early interventions for ADHD. Trial registration International Standard Randomised Controlled Trial registry: ISRCTN37683928. Registered on 22 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1727-0) contains supplementary material, which is available to authorized users.

Contains fulltext : 125369.pdf (Publisher’s version ) (Open Access) For clinically referred children with Autism Spectrum Disorder (ASD) or Attention Deficit/Hyperactivity Disorder (ADHD) several early indicators have been described. However, knowledge is lacking on early markers of less severe variants of ASD and ADHD from the general population. The aim of the present study is to identify early indicators of high risk groups for ASD and ADHD problems based on routine data from community pediatric services between infancy and age four. Data are from 1,816 participants who take part in Tracking Adolescents' Individual Lives Survey (TRAILS), a longitudinal study. Information on early developmental factors was extracted from charts of routine Preventive Child Healthcare (PCH) visits. To assess ASD and ADHD problems, respectively, we used the Children's Social Behavior Questionnaire (CSBQ) and the Child Behavior Checklist (CBCL), filled out by parents three times between the ages of 11 and 17. Note that these are parent ratings and not diagnostic instruments performed by trained clinicians. Male gender, low birth weight, low level of education of the mother, social, behavioral, language, psychomotor and eating problems significantly predicted ASD problems (odds ratios (OR) between 1.34 and 2.41). ADHD problems were also predicted by male gender and low level of education of the mother and by maternal smoking during pregnancy, good gross motor skills in first year, early attention and hyperactivity problems, and absence of parent-reported positive behavior (ORs between 1.36 and 1.74). Routine data on early childhood from PCH services are predictive for ASD and ADHD problems in adolescents in the general population. The PCH services are a useful setting to identify high risk groups, and to monitor them subsequently.

Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and a variant of autism spectrum disorder (ASD). The FXS population is quite heterogeneous with respect to comorbidities, which implies the need for a personalized medicine approach, relying on biomarkers or endophenotypes to guide treatment. There is evidence that quantitative electroencephalography (EEG) endophenotype-guided treatments can support increased clinical benefit by considering the patient's neurophysiological profile. We describe a case series of 11 children diagnosed with FXS, aged one to 14 years, mean 4.6 years. Case data are based on longitudinal clinically-observed reports by attending physicians for comorbid symptoms including awake and asleep EEG profiles. We tabulate the comorbid EEG symptoms in this case series, and relate them to the literature on EEG endophenotypes and associated treatment options. The two most common endophenotypes in the data were diffuse slow oscillations and epileptiform EEG, which have been associated with attention and epilepsy respectively. This observation agrees with reported prevalence of comorbid behavioral symptoms for FXS. In this sample of FXS children, attention problems were found in 37% (4 of 11), and epileptic seizures in 45% (5 of 11). Attention problems were found to associate with the epilepsy endophenotype. From the synthesis of this case series and literature review, we argue that the evidence-based personalized treatment approach, exemplified by neurofeedback, could benefit FXS children by focusing on observable, specific characteristics of comorbid disease symptoms.

Context: Substance use disorders (SUD) are a major public health problem. Attention deficit hyperactivity disorder (ADHD) is a comorbid condition associated with both onset and prognosis of SUD. Prevalence estimates of ADHD in SUD vary significantly.Objective: To obtain a best estimate of the prevalence of ADHD in SUD populations.Data sources: A literature search was conducted using MEDLINE, PsycINFO and EMBASE. Search terms were ADHD, substance-related disorders, addiction, drug abuse, drug dependence, alcohol abuse, alcoholism, comorbidity, and prevalence. Results were limited to the English language.Study selection: After assessing the quality of the retrieved studies, 29 studies were selected. Studies in which nicotine was the primary drug of abuse were not included.Data extraction: All relevant data were extracted and analysed in a meta-analysis. A series of meta-regression analyses was performed to evaluate the effect of age, primary substance of abuse, setting and assessment procedure on the prevalence of ADHD in a variety of SUD populations.Data synthesis: Overall, 23.1% (Cl: 19.4-27.2%) of all SUD subjects met DSM-criteria for comorbid ADHD. Cocaine dependence was associated with lower ADHD prevalence than alcohol dependence, opioid dependence and other addictions. Studies using the DICA or the SADS-L for the diagnosis of ADHD showed significantly higher comorbidity rates than studies using the KSADS, DISC, DIS or other assessment instruments.Conclusions: ADHD is present in almost one out of every four patients with SUD. The prevalence estimate is dependent on substance of abuse and assessment instrument. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Background The effects of a restricted elimination diet in children with attention-deficit hyperactivity disorder (ADHD) have mainly been investigated in selected subgroups of patients. We aimed to investigate whether there is a connection between diet and behaviour in an unselected group of children. Methods The Impact of Nutrition on Children with ADHD (INCA) study was a randomised controlled trial that consisted of an open-label phase with masked measurements followed by a double-blind crossover phase. Patients in the Netherlands and Belgium were enrolled via announcements in medical health centres and through media announcements. Randomisation in both phases was individually done by random sampling. In the open-label phase (first phase), children aged 4-8 years who were diagnosed with ADHD were randomly assigned to 5 weeks of a restricted elimination diet (diet group) or to instructions for a healthy diet (control group). Thereafter, the clinical responders (those with an improvement of at least 40% on the ADHD rating scale [ARS]) from the diet group proceeded with a 4-week double-blind crossover food challenge phase (second phase), in which high-IgG or low-IgG foods (classified on the basis of every child's individual IgG blood test results) were added to the diet. During the first phase, only the assessing paediatrician was masked to group allocation. During the second phase (challenge phase), all persons involved were masked to challenge allocation Primary endpoints were the change in ARS score between baseline and the end of the first phase (masked paediatrician) and between the end of the first phase and the second phase (double-blind), and the abbreviated Conners' scale (ACS) score (unmasked) between the same timepoints. Secondary endpoints included food-specific IgG levels at baseline related to the behaviour of the diet group responders after IgG-based food challenges. The primary analyses were intention to treat for the first phase and per protocol for the second phase. INCA is registered as an International Standard Randomised Controlled Trial, number ISRCTN 76063113. Findings Between Nov 4,2008, and Sept 29,2009,100 children were enrolled and randomly assigned to the control group (n=50) or the diet group (n=50). Between baseline and the end of the first phase, the difference between the diet group and the control group in the mean ARS total score was 23.7 (95% CI 18.6-28.8; p Interpretation A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged.

Background The effects of a restricted elimination diet in children with attention-deficit hyperactivity disorder (ADHD) have mainly been investigated in selected subgroups of patients. We aimed to investigate whether there is a connection between diet and behaviour in an unselected group of children.Methods The Impact of Nutrition on Children with ADHD (INCA) study was a randomised controlled trial that consisted of an open-label phase with masked measurements followed by a double-blind crossover phase. Patients in the Netherlands and Belgium were enrolled via announcements in medical health centres and through media announcements. Randomisation in both phases was individually done by random sampling. In the open-label phase (first phase), children aged 4-8 years who were diagnosed with ADHD were randomly assigned to 5 weeks of a restricted elimination diet (diet group) or to instructions for a healthy diet (control group). Thereafter, the clinical responders (those with an improvement of at least 40% on the ADHD rating scale [ARS]) from the diet group proceeded with a 4-week double-blind crossover food challenge phase (second phase), in which high-IgG or low-IgG foods (classified on the basis of every child's individual IgG blood test results) were added to the diet. During the first phase, only the assessing paediatrician was masked to group allocation. During the second phase (challenge phase), all persons involved were masked to challenge allocation Primary endpoints were the change in ARS score between baseline and the end of the first phase (masked paediatrician) and between the end of the first phase and the second phase (double-blind), and the abbreviated Conners' scale (ACS) score (unmasked) between the same timepoints. Secondary endpoints included food-specific IgG levels at baseline related to the behaviour of the diet group responders after IgG-based food challenges. The primary analyses were intention to treat for the first phase and per protocol for the second phase. INCA is registered as an International Standard Randomised Controlled Trial, number ISRCTN 76063113.Findings Between Nov 4,2008, and Sept 29,2009,100 children were enrolled and randomly assigned to the control group (n=50) or the diet group (n=50). Between baseline and the end of the first phase, the difference between the diet group and the control group in the mean ARS total score was 23.7 (95% CI 18.6-28.8; pInterpretation A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged.

Objective: To provide more insight into subjective attention complaints in a healthy adult and elderly population and how these affect Quality of Life (QoL). Method: A group of 1,550 healthy Dutch participants complete a postal questionnaire including items from the Maastricht Attention and Memory Checklist (MAC). The impact of attention complaints on QoL is investigated in a subsample of 499 participants. Results: Factor analysis ( N = 1,550) reveals two factors: Attention and Memory. Attention complaints are related to depressed mood, anxiety, vitality, and sleep problems that can have serious consequences for daily life functioning and QoL ( n = 499). Memory complaints are related to other aspects of health, such as pain and changes in health. Conclusion: Attention complaints in the healthy population are common and related to depression, anxiety, and sleep and several aspects of QoL, such as problems with social functioning, emotional problems, and vitality.

ADHD is considered a disorder of self-regulation. Recent research has shown that awareness of bodily states, referred to as interoceptive awareness, crucially contributes to self-regulatory processes. Impaired self-regulation in ADHD has been explained in terms of arousal regulation deficits in ADHD (the state regulation deficit (SRD) account). There is now ample support for the SRD account, however the exact reason for arousal regulation difficulties is not yet known. The SRD account explicitly refers to the ability to monitor one's momentary bodily state as a prerequisite for effective state regulation. However, surprisingly, no study to date has tested the ability to become aware of bodily signals, i.e. interoceptive awareness, in ADHD. In the current study, we therefore compared interoceptive awareness between 24 adults with ADHD and 23 controls by means of both an objective (heartbeat perception task) and subjective measure (questionnaire) of interoceptive awareness. Results revealed a strikingly similar performance for both groups on both measures, suggesting preserved interoceptive awareness in adult ADHD.

Twenty male adults with ADHD, 16 dyslexic adults, 15 comorbid adults, and 16 normal controls were compared on performance and underlying brain responses, during a cued Continuous Performance Test (O-X CPT), with the aim of discovering features of information processing differentiating between the groups. The study evaluated both cue- and target-related processes by analysing performance measures (errors, reaction time, and variability of reaction time), and event-related potentials (ERPs). Cue-related ERP components included the Cue-N2, Cue-P3, contingent negative variation (CNV) consisting of the CNV1, related to cue orienting, and the CNV2, related to response preparation. For targets, a distinction was made between response-related (Go), and inhibitory (Nogo) processing. Target-related components included the Go-P3, Nogo-N2, and Nogo-P3.Performance deficits were found only for the ADHD group, who demonstrated a faster decline in response speed with time-on-task and greater overall within-subject variability. No group differences were found for cue-related ERP components. Yet, controlling for group differences in internalising problems, inhibitory control was reduced in all clinical groups compared to controls, as demonstrated by an absence of frontal amplification of P3 in the Nogo condition, relative to the Go condition. For the ADHD group, in contrast to the comorbid and the dyslexic group, this effect remained after controlling for externalising symptoms, indicating that only for the ADHD group deficiencies in inhibitory control were not explained by externalising behaviour. (C) 2010 Elsevier Ltd. All rights reserved.

BackgroundAttention deficit hyperactivity disorder (ADHD) shows a strong phenotypic and genetic association with reaction time (RT) variability, considered to reflect lapses in attention. Yet we know little about whether this aetiological pathway is shared with other affected cognitive processes in ADHD, such as lower IQs or the generally slower responses (mean RTs). We aimed to address the question of whether a shared set of genes exist that influence RT variability, mean RT, IQ and ADHD symptom scores, or whether there is evidence of separate aetiological pathways.MethodMultivariate structural equation modelling on cognitive tasks data (providing RT data), IQ and ADHD ratings by parents and teachers collected on general population sample of 1314 twins, at ages 7–10 years.ResultsMultivariate structural equation models indicated that the shared genetic influences underlying both ADHD symptom scores and RT variability are also shared with those underlying mean RT, with both types of RT data largely indexing the same underlying liability. By contrast, the shared genetic influences on ADHD symptom scores and RT variability (or mean RT) are largely independent of the genetic influences that ADHD symptom scores share with IQ.ConclusionsThe finding of unique aetiological pathways between IQ and RT data, but shared components between mean RT, RT variability and ADHD symptom scores, illustrates key influences in the genetic architecture of the cognitive and energetic processes that underlie the behavioural symptoms of ADHD. In addition, the multivariate genetic model fitting findings provide valuable information for future molecular genetic analyses.

Objective: We examined whether children (8-11 years) diagnosed with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) or Attention-Deficit/Hyperactivity Disorder (ADHD) showing primarily hyperactive behavior, differed in selective attention and working memory (WM) abilities.Methods: Healthy controls and children with ADHD, PDD-NOS or symptoms of both disorders (PDD/HD) (n = 15 in each group) carried out a visual selective memory search task while their EEG was recorded from which event-related potentials were derived.Results: Compared to the control group, all patient groups made more omissions while hyperactive children also exhibited more false alarms. Regarding the process of WM-controlled search, significant group differences in ERP data were found between the control group and each of the clinical groups.Conclusions: The results point to less efficient WM-functioning in all patient groups. Whereas the clinical groups differed from each other at the behavioral level as measured by questionnaires, no distinction between the clinical groups could be made with respect to performance or ERP measures of WM capacity and selective attention.Significance: The results suggest that a possible differentiation in selectivity and working memory capacities between PDD-NOS and ADHD is hard to find. This may agree with clinical practice, where differential diagnosis is a subject of discussion. (C) 2008 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd, All rights reserved.

BackgroundLittle is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD).AimsTo estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative.MethodAn ADHD screen was administered to respondents aged 18–44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability.ResultsEstimates of ADHD prevalence averaged 3.4% (range 1.2–7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders.ConclusionsAdult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

Contains fulltext : 35205.pdf (Publisher’s version ) (Closed access) Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, starting in early childhood and persisting into adulthood in the majority of cases. Family and twin studies have demonstrated the importance of genetic factors and candidate gene association studies have identified several loci that exert small but significant effects on ADHD. To provide further clarification of reported associations and identify novel associated genes, we examined 1,038 single-nucleotide polymorphisms (SNPs) spanning 51 candidate genes involved in the regulation of neurotransmitter pathways, particularly dopamine, norepinephrine and serotonin pathways, in addition to circadian rhythm genes. Analysis used within family tests of association in a sample of 776 DSM-IV ADHD combined type cases ascertained for the International Multi-centre ADHD Gene project. We found nominal significance with one or more SNPs in 18 genes, including the two most replicated findings in the literature: DRD4 and DAT1. Gene-wide tests, adjusted for the number of SNPs analysed in each gene, identified associations with TPH2, ARRB2, SYP, DAT1, ADRB2, HES1, MAOA and PNMT. Further studies will be needed to confirm or refute the observed associations and their generalisability to other samples.

Objective: We aimed to examine the heavy metal bar patrons in Istanbul by means of self-reported questionnaires for psychiatric disorder symptoms. Material and Methods: Seventy-one volunteers from 4 popular heavy metal bars were included to the study. The Beck Depression Inventory, the Liebowitz Social Anxiety Scale (LSAS), the Adult Attention Deficit Disorder/Attention Deficit and Hyperactivity Disorder (ADD/ADHD) Scale and the Michigan Alcoholism Screening Test (MAST) were administered to the participants. Results: One fourth of the participants (25.4%) were under high risk for a depressive episode (BDI>17), 22 (32.3%) reported significant social anxiety (LSAS>30), and 41 (57.7%) showed moderate ADHD symptoms (Adult ADD/ADHD scale: 20-59). According to BDI score participants who were under the risk for depression showed higher scores in Adult ADD/ADHD scale scores than that of participants who were not under a risk for depression (p=0.001 for attention deficit; p=0.003 for hyperactivity; p=0.002 for impulsivity; p=0.001 for total score). In the study group, ADD/ADHD scale attention deficit score was positively correlated with the total fear, total avoidence and the total scores of LSAS (r=.359 p

BackgroundThe importance of early intervention approaches for the treatment of attention-deficit hyperactivity disorder (ADHD) has been increasingly acknowledged. Parenting programmes (PPs) are recommended for use with preschool children with ADHD. However, low ‘take-up’ and high ‘drop-out’ rates compromise the effectiveness of such programmes within the community.MethodsThis qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD-type problems in the UK. Semi-structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement.Results and conclusionsMany of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD-specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self-confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented.

The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) and treated with medication is steadily increasing. The aim of this paper was to critically discuss five debatable assumptions on ADHD that may explain these trends to some extent. These are that ADHD (i) causes deviant behaviour, (ii) is a disease, (iii) is chronic and (iv) is best treated by medication and (v) that classification should precede treatment. Conclusion We argue that ADHD is not a disease, not the cause of deviant behaviour and in most cases not chronic. Treatment for attention and hyperactivity problems could start with psychosocial interventions and without a diagnostic label. A stepped diagnosis approach may reduce overdiagnosis without risking undertreatment.

Objectives: Noise often has detrimental effects on performance. However, because of the phenomenon of stochastic resonance (SR), auditory white noise (WN) can alter the "signal to noise'' ratio and improve performance. The Moderate Brain Arousal (MBA) model postulates different levels of internal "neural noise'' in individuals with different attentional capacities. This in turn determines the particular WN level most beneficial in each individual case-with one level of WN facilitating poor attenders but hindering super-attentive children. The objective of the present study is to find out if added WN affects cognitive performance differently in children that differ in attention ability. Methods: Participants were teacher-rated super-(N = 25); normal-(N = 29) and sub-attentive (N = 36) children (aged 8 to 10 years). Two non-executive function (EF) tasks (a verbal episodic recall task and a delayed verbal recognition task) and two EF tasks (a visuo-spatial working memory test and a Go-NoGo task) were performed under three WN levels. The non-WN condition was only used to control for potential differences in background noise in the group testing situations. Results: There were different effects of WN on performance in the three groups-adding moderate WN worsened the performance of super-attentive children for both task types and improved EF performance in sub-attentive children. The normal-attentive children's performance was unaffected by WN exposure. The shift from moderate to high levels of WN had little further effect on performance in any group. Significance: The predicted differential effect of WN on performance was confirmed. However, the failure to find evidence for an inverted U function challenges current theories. Alternative explanations are discussed. We propose that WN therapy should be further investigated as a possible non-pharmacological treatment for inattention.

Executive attention and its relationship with effortful control (EC) were investigated in children with ADHD (n=24), autism spectrum disorder (ASD; n=20), and controls (n=21). Executive attention measures included flanker-performance and event-related potentials (N2, P3, and ERN). EC was assessed using questionnaires. Only the ERN was found to be robustly related to EC across groups. N2 did not differ between groups and only children with ADHD+ODD showed diminished executive attention as expressed in RT and P3. In ADHD, monitoring of incorrect (ERN) and correct (CRN) responses was diminished. Overall, the link between EC and executive attention was less strong as expected and varied depending on group and measure considered. All groups were able to detect conflict (N2) and all but ADHD+ODD were able to allocate extra attention in order to respond correctly (P3). Findings indicate a general reduced response monitoring in ADHD.

Background: Attention deficit hyperactivity disorder is increased in children with intellectual disability. Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks. Method: One hundred and twenty two drug-free children aged 7-15 with hyperkinetic disorder and IQ 30-69 were recruited to a double-blind, placebo-controlled trial that randomized participants using minimization by probability, stratified by referral source and IQ level in a one to one ratio. Methylphenidate was compared with placebo. Dose titration comprised at least 1 week each of low (0.5 mg/kg/day), medium (1.0 mg/kg/day) and high dose (1.5 mg/kg/day). Parent and teacher Attention deficit hyperactivity disorder (ADHD) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures. Clinical response was determined with the Clinical Global Impressions scale (CGI-I). Adverse effects were evaluated by a parent-rated questionnaire, weight, pulse and blood pressure. Analyses were by intention to treat. Results: Methylphenidate was superior to placebo with effect sizes of 0.39 [95% confidence intervals (CIs) 0.09, 0.70] and 0.52 (95% CIs 0.23, 0.82) for the parent and teacher Conners ADHD index. Four (7%) children on placebo versus 24 (40%) of those on methylphenidate were judged improved or much improved on the CGI. IQ and autistic symptoms did not affect treatment efficacy. Active medication was associated with sleep difficulty, loss of appetite and weight loss but there were no significant differences in pulse or blood pressure. Conclusions: Optimal dosing of methylphenidate is practical and effective in some children with hyperkinetic disorder and intellectual disability. Adverse effects typical of methylphenidate were seen and medication use may require close monitoring in this vulnerable group.