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Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and the pathophysiology remains obscure. Some studies show that lipid imbalances are associated with ADHD etiology. We studied the association of serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG) levels in ADHD. We examined 88 children aged 8-12 years who were diagnosed with ADHD and 88 healthy children. The exclusion criteria were as follows: obesity, any psychotropic use in the last 3 months, presence of a chronic disease and/or malignancy, history of medically treated lipid metabolism disease in family members, intelligence quotient (IQ) 70, and comorbidities, with the exception of oppositional defiant disorder. The sample was evaluated using a semi-structured clinical assessment interview and Conners' rating scales. Despite controlling for age, sex, and body mass index (BMI) variables, the total cholesterol and LDL levels were significantly higher in the ADHD group than the levels of healthy controls, whereas the TG and HDL cholesterol levels were similar among groups. Conners' rating scales, reflecting symptom severity, and total cholesterol, TG, HDL, and LDL levels of the ADHD group were not correlated. The study results support the difference in serum lipid and lipoprotein profiles of children with ADHD compared with healthy controls. This difference is thought to be related with changes in oxidant/antioxidant balance states in ADHD.

DiGeorge Syndrome (DGS) is the most seen microdeletion syndrome and its prevalance varies from 1/4000 to 1/6000. Over embriogenesis, a deletion of an approximately 3 Mb frame from 22q11.2 results in this syndrome and its clinical features varies from congenital heart and gross vessels anomalies, hypocalcemia, respiratory problems, leucomotor or urogenitale system anomalies, hearing loss, to developmental delay. Alongside different clinical features and phenotypes, these patients should be followed up on psychiatric symptoms and disorders such as speech delay, specific learning difficulties (SLD), mental retardation, attention deficit hyperactivity disorder (ADHD), autism, anxiety, depression and even schizophrenia and other pcychotic disorders. This case, diagnosed with partial DGS and followed by immunology, cardiology, endocrinology and neurology departments, admitted to our clinic on account of his difficulties in learning and inattention. The patient was diagnosed with ADHD and SLD, then pharmacotherapy and individual educational programme were planned. The insufficient expression of the catecolamine-O-methyltransferase (COMT) gene located in the 22q11.2 gene could very well play a role in both the etiology of ADHD and SLD. There is still no clear causative relation between these, so there is a need to clarify this with further studies. As seen in our case, the patients with DGS and having some inattention or learning difficulties are needed to be examined by the child psychiatrists. Treatment protocols related to these patients' symptoms would be evaluated with a multidisciplinary attitude.

Mucopolysaccharidosis type III (MPS-III, Sanflippo syndrome) is one of the lysosomal storage diseases characterized by four different enzymes playing a role in catabolism of heparan sulfate substance. Type IIIB (Sanflippo B), one of them, is characterized by alpha-N-acetylglucosaminidase (NAGLU) enzyme deficiency and results in accumulation and storage of heparan sulfate in central nervous system, and then emerges itself with developmental deficiency, coarse facial features, delay in speech, mental retardation, hyperactivity, impulsivity, aggressive and disruptive behaviors, difficulty in establishing social relations, aimless hand movements, inadequate eye contact, and sleep disturbances. There are a few studies related to the treatment of neuropsychiatric symptoms of these patients. In this case, atomoxetine treatment added was shown to be effective, safe and tolerable, because risperidone treatment that the patient took was not effective in hyperactivity symptoms. A 12-year-old girl, diagnosed with MPS type IIIB (NAGLU deficiency; OMIM# 252920) when she was 5 years old, was admitted to our clinic with symptoms of hyperactivity, short span of attention, aggressive behavior, and quasi-autistic symptoms such as aimless hand movement, with risperidone use at 1.5 mg/day for approximately 1 year. After clinical and psychometric examinations, she was diagnosed with “mild mental retardation” and “attention deficit hyperactivity disorder”. Atomoxetine was added at a dose of 0.5 mg/kg/day to her risperidone treatment and its dosage was gradually increased up until to 1.4 mg/kg/day. Over the follow-up period, her attention deficit and hyperactivity disorder (ADHD) symptoms were ameliorated, reported by both her teachers and her parents via rating scales of ADHD. Her hyperactivity and irritability levels were noticed as decreased and improved over evaluation process throughout clinical interviews. Through atomoxetine treatment process, there was not any adverse effect. Int J Clin Pediatr. 2016;5(1):15-18 doi: http://dx.doi.org/10.14740/ijcp237w