Attention-Deficit/Hyperactivity Disorder

An epidemiological study of Attention Deficit / Hyperactivity Disorder (ADHD) suggests that the prevalence may be two to three times higher than the figure of 3 ± 5% often cited. In addition, the data suggest that both underdiagnosis and overdiagnosis occur frequently. Rodent animal models of ADHD, like the Spontaneously Hypertensive Rat (SHR) and other rat models such as those with chemical and radiationinduced brain lesions and cerebellar stunting, and the Coloboma mouse model exhibit clear similarities with several aspects of the human disorder and should prove useful in studying specific traits. Operant behavioral tasks that model learning, short -term memory and simple discriminations are sensitive to ADHD and methylphenidate has been shown to normalize ADHD performance in a short -term memory task. Recent findings challenge not only the current postulate that response inhibition is a unique deficit in ADHD, but also the concepts of ADHD and its treatment, which presume intact perceptual abilities. Time perception deficits may account, in part, for the excessive variability in motor response times on speeded reaction time tasks, motor control problems and motor clumsiness associated with ADHD. The Multimodality Treatment Study of ADHD (MTA) provided data suggesting that pharmacological interventions that included systematic and frequent follow -up with parents and teachers, with or without psychosocial interventions, are superior to psychosocial interventions or standard community care alone. Additionally, the MTA was one of the first studies to demonstrate benefits of multimodal and pharmacological interventions lasting longer than 1 year. Imaging studies have demonstrated differences in brain areas in children with ADHD: anterior corpus callosum, right anterior white matter, and cerebellar volumes are all decreased in children with ADHD and there is less brain asymmetry in ADHD subjects. Additionally, functional imaging studies, coupled with pharmacological manipulations, suggest decreased blood flow and energy utilization in prefrontal cortex and striatum, and the dysregulation of catecholamine systems in persons with ADHD. D (M.G. Paule).

Executive functioning deficits characterize the neuropsychological profiles of the childhood neurodevelopmental disorders of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). This study sought to determine whether similar impairments exist in adults with ADHD (N = 53) and ASD (N = 45) in comparison with a healthy control group (N = 31), whether the two disorders can be distinguished on the basis of their executive functioning features, and whether these impairments are related to symptom severity. Both clinical groups were found to exhibit executive functioning deficits. The ADHD group had difficulty withholding a response, with relative preservation of initiation and planning abilities. In contrast, the ASD group exhibited significant impairments in initiation, planning and strategy formation. The specific executive functioning deficits were related to severity of response inhibition impairments in ADHD and stereotyped, repetitive behaviours in ASD. These findings suggest the autism

Objective. Very little research has focused on the efficacy of Adderall (Shire-Richwood Inc, Florence, KY) in the treatment of children with attentiondeficit/hyperactivity disorder (ADHD), and no studies have compared it with standardized doses of Ritalin (Novartis Pharmaceuticals, East Hanover, NJ). It is thought that Adderall has a longer half-life than Ritalin and might minimize the loss of efficacy that occurs 4 or 5 hours after Ritalin ingestion. We compared two doses of Ritalin and Adderall in the treatment of ADHD in children in an acute study and assessed the medications' time courses.

This study investigated the effect of methylphenidate (Ritalin) on the selective attention of hyperactive children designated as favorable or adverse responders to stimulant medication. Using a type II incidental learning paradigm, it was found that children in the drug condition recalled more central and less incidental stimuli than those children in the placebo condition. While no differential effects on recall were found for responder type, methylphenidate did affect the
spontaneous overt labeling of central stimuli by the favorable responder group. Results were interpreted in terms of the role of methylphenidate in narrowing the focus of attention. Implications for the classification of hyperactive children
as favorable and adverse responders were also discussed.

This study examined the relationship between sensory deficits and externalizing behavior problems in preschool children. Parents of 179 urban, Latino preschool children completed two parent-report measures, the Short Sensory Profile (SSP), as a checklist for sensory symptoms, and the Achenbach Checklist for Ages 1½–5 (CBCL/1½–5) to assess externalizing behavior problems. Measures were available in Spanish or English depending on the parent’s preference. Correlations were performed between the total sensory deficits scale of the SSP and the Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, and Externalizing Problems scales of the CBCL. Significant correlations were found between increasing levels of sensory deficits and increasing externalizing behavior problems. Correlations were also examined in subcategories of age, gender and socioeconomic status. Five-year-old children showed stronger correlations than 4-year-old children, while males showed stronger correlations than females, and the highest correlations were found in children of families reporting between $18,001 and $24,000 per year annual income. Findings suggest that Latino preschool children with externalizing behavior problems may suffer from delays in sensory development that impact their behavior. Clinical interventions should promote strategies that either reduce or increase environmental stimuli in accordance with the sensory abilities of the individual child.

To test the hypotheses that in children with attention-deficit/hyperactivity disorder (ADHD) (1) symptoms of ADHD, oppositional defiant disorder, and overall functioning are significantly improved by methylphenidate combined with intensive multimodal psychosocial treatment compared with methylphenidate alone and with methylphenidate plus attention control and (2) more children receiving combined treatment can be taken off methylphenidate. Method: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate were randomized for 2 years to (1) methylphenidate alone; (2) methylphenidate plus psychosocial treatment that included parent training and counseling, social skills training, psychotherapy, and academic assistance, or (3) methylphenidate plus attention psychosocial control treatment. Assessments included parent, teacher, and psychiatrist ratings, and observations in academic and gym classes. Results: Combination treatment did not lead to superior functioning and did not facilitate methylphenidate discontinuation. Significant improvement occurred across all treatments and continued over 2 years. Conclusions: In stimulant-responsive children with ADHD, there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms.

Socioeconomic status and health status are directly related across the world. Children with low-socioeconomic status not only experience greater health problems in childhood but also aspects of their socioeconomic status become biologically incorporated through both critical periods of development and cumulative effects, leading to poor health outcomes as adults. We explore 3 main influences related to child's socioeconomic status that impact long-term health: the material environment, the social environment, and the structural or community environment. These influences illustrate the importance of clinical innovations, health services research, and public policies that address the socioeconomic determinants of these distal health outcomes. (J Dev Behav Pediatr 31:154 -160, 2010) Index terms: socioeconomic status, poverty, life course.

The purpose of this study was to examine the clinical validities and efficiencies of the Child Behavior Checklist (CBCL) and the ADHD Rating Scale-IV (ARS) in identifying children with attention-deficit hyperactivity disorder (ADHD) in Korean community-based samples. A large sample of elementary school students (n = 1668) participated in this study. We used the CBCL and the ARS as the screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by DSM-IV-based structured interviews. Of the 46 subjects who underwent clinical psychiatric interviews, 33 were diagnosed as having ADHD. A T score of 60 with regard to the Attention Problems profile of the CBCL resulted in a reasonable level of sensitivity or positive predictive value in the diagnosis of ADHD. In both the parent and teacher reports of the ARS, 90th percentile cut-off points resulted in a high level of predictive value. The highest levels of specificity and positive predictive value were ...

Objective. 1) To compare standard twice-daily methylphenidate (MPH) dosing with a single morning dose of MPH and of Adderall during a typical school-day time period, and 2) to conduct a dose-response study of the effects of a late-afternoon (3:30 PM) dose of MPH and Adderall on evening behavior and side effects.

A 10-year-old boy was referred for ongoing behavioral problems. These problems were reported as having occurred at home since preschool years and had become increasingly problematic outside of the home in latter years, resulting in frequent suspensions from school. A range of diagnoses had been made in the years prior to referral, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder, and pervasive developmental disorder-not otherwise specified (PDD-NOS). The central intervention since age 6 had been pharmacotherapy, with intermittent support at school in the form of school counseling and teachers' aids. However, the situation appeared to only be worsening, and the need for a more integrated, multimodal approach was recognized. In addition to individual therapy for the client and his mother, the intervention also included engagement of the father, collaboration with other educational and professional service providers, and the development of an integrated plan with shared objectives and strategies. The case explores limitations inherent in taking a medical model diagnostic approach to child behavioral problems and highlights the need to utilize an idiographic approach taking a range of individual psychosocial circumstances into account, rather than taking a more nomothetic treatment approach based mainly on diagnostic assessment.

It has been proposed that developmental dyslexia may be associated with relative deficiencies in certain highly unsaturated fatty acids (HUFA).In children with attention-deficit/hyperactivity disorder, minor physical signs of fatty acid deficiency have been shown to correlate with blood biochemical measures of HUFA deficiency.These clinical signs of fatty acid deficiency were therefore examined in 97 dyslexic children in relation to reading and related skills, and possible sex differences were explored.

The use of complementary and alternative medicine (CAM) as a treatment for children diagnosed with attention deficit-hyperactivity disorder (ADHD) is widespread, but little is known on the effectiveness of many such therapies. This study investigated meditation as a family treatment method for children with ADHD, using the techniques of Sahaja Yoga Meditation (SYM). Parents and children participated in a 6-week programme of twice-weekly clinic sessions and regular meditation at home. Pre-and post-treatment assessments included parent ratings of children's ADHD symptoms, self-esteem and child-parent relationship quality. Perceptions of the programme were collected via parent questionnaires and child interviews. Results showed improvements in children's ADHD behaviour, selfesteem and relationship quality. Children described benefits at home (better sleep patterns, less anxiety) and at school (more able to concentrate, less conflict). Parents reported feeling happier, less stressed and more able to manage their child's behaviour. Indications from this preliminary investigation are that SYM may offer families an effective management tool for family-oriented treatment of childhood ADHD.

In project DyAdd, we compared the fatty acid (FA) profiles of serum phospholipids in adults with attention deficit hyperactivity disorder (ADHD) (n ¼ 26), dyslexia (n ¼ 36), their comorbid combination (n ¼ 9), and healthy controls (n ¼ 36). FA proportions were analyzed in a 2 Â 2 design with Bonferroni corrected post hoc comparisons. A questionnaire was used to assess dietary fat quality and use of supplements. Results showed that ADHD and dyslexia were not associated with total saturated FAs, monounsaturated FAs, or n-3 polyunsaturated FAs (PUFAs). However, those with ADHD had elevated proportions of total n-6 PUFAs (including g-linolenic and adrenic acids) as compared to those without ADHD. Dyslexia was related to a higher proportion of monounsaturated nervonic acid and a higher ratio of n-6/n-3 PUFAs. Among females none of the associations were significant. However in males, all the original associations observed in all subjects remained and ADHD was associated with elevated nervonic acid and n-6/n-3 PUFA ratio like dyslexia. Controlling for poorly diagnosed reading difficulties, education, dietary fat quality, or use of FA supplements did not generally remove the originally observed associations.

Here we describe the application of cognitive genetics to the study of attention deficit hyperactivity disorder (ADHD). Cognitive genetics owes much to the pioneering work of cognitive neuropsychologists such as John Marshall, whose careful observations of cognitive dissociations between brain-lesioned patients greatly advanced the theoretical understanding of normal cognitive function. These theories have in turn helped to constrain linkages between candidate genes and cognitive processes and thus help to drive the relatively new field of cognitive genetics in a hypothesis-driven fashion. We examined the relationship between sustained attention deficits in ADHD and genetic variation in a catecholamine-related gene, dopamine beta hydroxylase (DβH). DBH encodes the enzyme that converts dopamine to noradrenaline and is crucial to catecholamine regulation. A polymorphism with the DBH gene has been associated with ADHD. In fifty-two children with ADHD, we examined whether variation in the Taq I DBH gene polymorphism was related to sustained attention performance. Participants performed the Sustained Attention to Response Test (SART). Performance on the SART discriminates ADHD from control children, and in imaging work, is associated with right frontoparietal activation. A significant effect of DBH genotype was found on SART performance measures. Children possessing two copies of the ADHD-associated risk allele (A2) had significantly poorer sustained attention than those ADHD children who did not possess this allele or a non-genotyped control group. The DBH gene may contribute to the susceptibility for ADHD, in part because of its varying effects on the development of brain mechanisms mediating sustained attention.

Objectives: To establish the socio-demographic and clinical profile of children attending Early Intervention Program (EIP).Methods: Retrospective analysis of case records of 100 consecutive children examined from July 2002 to June 2004. Data regarding socio-demographic variables, clinical profile, locomotor, speech and audiology functions were recorded. Data is described in terms of frequency and mean (with SD).Results: Mean age of these children was 4.0±1.4 years. 70% were male and a similar percentage hailed from urban areas. 88% were mentally retarded with mean IQ of 50±24.3. Cerebral Palsy was seen in 50% of the children, learning disorder in 24%, Attention Deficit Hyperactivity Disorder (ADHD) in 12% and autism in 4%. 25% of children suffered from epilepsy and 66% were unable to communicate verbally. 21% of children had strong evidence of genetic disorders. An etiological diagnosis could not be made in 31% of children.Conclusions: Awareness of developmental delay as well as of possible interventions is low in India. Speech delay is the only delay which is considered important by parents. Active involvement and early referrals from pediatricians, obstetricians and other specialists is suggested.

Background.-The American Academy of Pediatrics (AAP) has published clinical practice guidelines for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). However, implementation of guidelines has been notoriously difficult to achieve in the wider context of changing individual physicians' clinical practice.

Conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are common childhood externalizing disorders that frequently co-occur. However, the causes of their comorbidity are not well understood. To address that question, we analyzed data from >600 Finnish twin pairs, who completed standardized interviews at age 14. Behavior genetic methods were used to examine how genetic/environmental factors contribute to each disorder's symptoms and to their covariation. We found significant genetic effects on each disorder with only modest evidence of shared environmental influences. Our data suggest the comorbidity among CD, ADHD, and ODD is primarily explained by shared genetic influences; however, each disorder was also under unique genetic influence, supporting the distinction of each disorder. KEY WORDS: attention deficit hyperactivity disorder; conduct disorder; oppositional defiant disorder; genetics; externalizing disorders.

ADHD is characterized by inattention, hyperactivity, and disinhibition, including the inability to screen out distracting stimuli. Prepulse inhibition (PPI) of startle indexes a related gating process and is enhanced during attended compared to ignored stimuli. We predicted that PPI during attended stimuli would be enhanced by the stimulant methylphenidate (MPH) and that this effect would be moderated by baseline PPI. Children with ADHD (n=36) completed a baseline day and a randomized, double-blind medication trial (placebo vs. sustained release MPH). Bilateral startle eyeblink EMG was measured during a tone discrimination task. MPH enhanced PPI during attended, but not during ignored stimuli. Extending findings that pretreatment functioning moderates stimulant effects on PPI, this effect tended to be inversely related to baseline PPI. These data fit with the clinical literature on ADHD and the hypothesis that MPH enhances interference control for important environmental stimuli.

This study tested the hypotheses that visual search impairments in schizophrenia are due to a delay in initiation of search or a slow rate of serial search. We determined the specificity of these impairments by comparing children with schizophrenia to children with attention-deficit hyperactivity disorder (ADHD) and age-matched normal children. The hypotheses were tested within the framework of feature integration

I analyze narratives of people diagnosed with ADHD (Attention Deficit Hyperactivity Disorder) and BPD (Borderline Personality Disorder) to search for new evidence to improved efficacy in treatments  environments. The evidence of suffering -particularly the social suffering- is revealed as a reality with great presence in these powerfull narratives, which must necessarily be considered to articulate new paths, or improve therapeutic procedures and conventionaltreatment
aimed towards healing of these people. From my research experience, I propose understand these stories of grief as evidence for the clinic. So these narratives of suffering subjectivities can become auditors healthcare quality documents, allowing evaluating and improving practices by incorporating a different and more social understanding from the disorders. This perspective is implemented is of a social approach, based in a particular way in the social theory of emotions and anthropology of emotions. Ethnographic and narrative materials analyzed relate mainly to the fieldwork of the author, and researchs conducted by the author over the past five years, both in Spain and Mexico.

Objective: Some longitudinal magnetic resonance imaging (MRI) studies have shown reduced volume or cortical thickness (CT) in the frontal cortices of individuals with attention-deficit/hyperactivity disorder (ADHD). These studies indicated that the aforementioned anatomical abnormalities disappear during adolescence. In contrast, cross-sectional studies on adults with ADHD have shown anatomical abnormalities in the frontal lobe region. It is not known whether the anatomical abnormalities in ADHD are a delay or a deviation in the encephalic maturation. The aim of this study was to compare CT in the frontal lobe of children, adolescents and adults of both genders presenting ADHD with that in corresponding healthy controls and to explore its relationship with the severity of the illness. Method: An MRI scan study was performed on never-medicated ADHD patients. Twenty-one children (6e10 year-olds), twenty adolescents (14e17 year-olds) and twenty adults (25e35 year-olds) were matched with healthy controls according to age and sex. CT measurements were performed using the Freesurfer image analysis suite. Results: The data showed regions in the right superior frontal gyrus where CT was reduced in children, adolescents and adults with ADHD in contrast to their respective healthy controls. The CT of these regions correlated with the severity of the illness. Conclusions: In subjects with ADHD, there is a thinning of the cortical surface in the right frontal lobe, which is present in the children, adolescents and in adults.

Currently behavior modification, stimulant medication, and combined treatments are supported as evidence-based interventions for attention deficit hyperactivity disorder in classroom settings. However, there has been little study of the relative effects of these two modalities and their combination in classrooms. Using a within-subject design, the present study investigated the single effects of behavior modification (no, low, and high intensity), methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg), and the combination of these treatments in an analogue classroom setting with 48 children (ages 6 -12) diagnosed with attention deficit hyperactivity disorder. Results indicated substantial effects of both unimodal treatments and their combination on measures of classroom behavior, productivity, and teacher ratings of functioning. The results are discussed in light of the current literature on single and combined treatments for attention deficit hyperactivity disorder.

To test the hypothesis that intensive multimodal psychosocial intervention (that includes academic assistance and psychotherapy) combined with methylphenidate significantly enhances the academic performance and emotional status of children with attention-deficit/hyperactivity disorder (ADHD) compared with methylphenidate alone and with methylphenidate combined with nonspecific psychosocial treatment (attention control). Method: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate were randomized for 2 years to receive one of three treatments: (1) methylphenidate alone, (2) methylphenidate plus psychosocial treatment that included academic remediation, organizational skills training, and psychotherapy as well as parent training and counseling and social skills training, or (3) methylphenidate plus attention control treatment. Children's function was assessed through academic testing, parent ratings of homework problems, and self-ratings of depression and self-esteem. Results: No advantage was found on any measure of academic performance or emotional status for the combination treatment over methylphenidate alone and over methylphenidate plus attention control.

Article abstract-Objective: To test for brain structure differences in reading disability (RD) by means of MRI-based morphometry. Background: Consensus is lacking on the brain structural correlates of RD. The current study reports on a wider set of structures in the largest sample yet studied, controlling for age, gender, IQ, and attention deficit hyperactivity disorder (ADHD). Methods: A case-control study was performed that was comprised of 75 individuals with RD (mean age, 17.43 Ϯ 4.29 years) and 22 control subjects without RD (mean age, 18.69 Ϯ 3.75 years), each a single member of a twin pair. The two groups were similar in age, gender, and handedness, but differed in full-scale IQ (FSIQ), with the RD group having a lower mean FSIQ (101.8 Ϯ 9.9 versus 118.3 Ϯ 10.3). Using three group-by-structure analyses of covariance, groups were compared in terms of volume (in cubic centimeters) of major neocortical subdivisions, subcortical structures, and midsagittal areas (in square millimeters) of three subdivisions of the corpus callosum. Results: Controlling for age, gender, and IQ, the authors found a significant group-by-structure interaction for the major neocortical subdivisions ( p ϭ 0.002), reflecting a different developmental pattern in the RD group, with the insula and anterior superior neocortex being smaller and the retrocallosal cortex being larger in the RD group. In contrast, they found no group main or interaction effects for the subcortical or callosal structures. The pattern of results was essentially the same in subjects without ADHD. Conclusions: Most brain structures do not differ in size in RD, but cortical development is altered subtly. This study replicates in a larger sample previous findings of insular differences in RD and demonstrates further that those differences are not attributable to comorbid ADHD.

Objective: The Preschool ADHD Treatment Study (PATS) was a NIMH-funded, six-center, randomized, controlled trial to determine the efficacy and safety of immediate-release methylphenidate (MPH-IR), given t.i.d. to children ages 3 to 5.5 years with attention-deficit/hyperactivity disorder (ADHD). Method: The 8-phase, 70-week PATS protocol included two double-blind, controlled phases, a crossover-titration trial followed by a placebo-controlled parallel trial. The crossovertitration phase`s primary efficacy measure was a combined score from the Swanson, Kotkin, Atkins, M-Flynn, and Pelham (SKAMP) plus the Conners, Loney, and Milich (CLAM) rating scales; the parallel phase`s primary outcome measure was excellent response, based on composite scores on the Swanson, Nolan, and Pelham (SNAP) rating scale. Results: Of 303 preschoolers enrolled, 165 were randomized into the titration trial. Compared with placebo, significant decreases in ADHD symptoms were found on MPH at 2.5 mg (p G .01), 5 mg (p G .001), and 7.5 mg (p G .001) t.i.d. doses, but not for 1.25 mg (p G .06). The mean optimal MPH total daily dose for the entire group was 14.2 T 8.1 mg/day (0.7 T 0.4 mg/kg/day).

Objective: This study examines the relationship between parental self-confidence, warmth, and involvement, and corporal punishment in families of children with attention deficit/hyperactivity disorder (ADHD). Method: The diagnosis of ADHD was established through clinical interviews with the parents, children, and teachers, according the criteria in DSM-IV-TR. This diagnosis was also established by having the parents complete the Conners' Parent Rating Scale, and the teachers complete the Conners' Teacher Rating Scale. Two groups of Iranian parents, one group with children who have ADHD (N = 130) and a control group (N = 120), completed questionnaires measuring parental self-confidence and parenting styles. Results: Parents of children with ADHD were found to have lower self-confidence and less warmth and involvement with their children, and used corporal punishment significantly more than the parents of control children.

Attention deficit hyperactivity disorder (ADHD) is a childhood disorder that may persist during adulthood. ADHD may effect patient's social relations, academic performance and professional life. ADHD effects 30 to 50 percent of adults who are diagnosed with ADHD during childhood. Many adults with ADHD may also have comorbid psychiatric disorders, including anxiety disorders, mood disorders, impulse control disorders, substance use disorders and personality disorders. The aim of the current review was to review the reflections of ADHD symptoms from childhood through adulthood and to discuss psychiatric comorbidity. In the first part of the review the definition and subtypes of the disorder was summarized. In the second section the relation between executive functions and moral development was discussed on the context of ADHD. We reviewed the childhood and adulthood symptoms of the disorder in the following section. In the fourth section we discussed the relation between ADHD and antisocial behaviors as it has been emphasized by most of previous studies. Eventually we searched and summarized available literature of ADHD from1980 to 2009 from Medline and Pubmed.