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PubMed2005

[The prevalence of attention deficit hyperactivity disorder].

INTRODUCTION: Hyperactivity is a common, genetically-based disorder in childhood in which a number of neurological and psychological factors that give rise to attentional disorders, impulsiveness and motor overactivity are involved. DEVELOPMENT: The prevalence rate of attention deficit hyperactivity disorder (ADHD) is a controversial matter. Although the DSM-IV gives an interval of between 3 and 5%, which is probably the value that is most widely accepted by the scientific community, there is in fact a very high degree of variability. According to different authors, an interval of 2-30% is obtained in the general population. In Anglo-Saxon countries the most commonly accepted prevalence of this entity is 5%, but few studies have been conducted in our country. In an epidemiological study with a community-based sample extracted by multistage, stratified sampling in school-age children on the island of Majorca, the estimated prevalence of ADHD was 4.7%. The authors consider aspects concerning the prevalence of ADHD and subtypes by ages, sex, in both the clinical and community environments. CONCLUSIONS: The analysis of these data will enable us to compare the different evaluation methods used and to draw conclusions about screening and early detection methods.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Deficient attention is hard to find: applying the perceptual load model of selective attention to attention deficit hyperactivity disorder subtypes.

BACKGROUND: Whether selective attention is a primary deficit in childhood Attention Deficit Hyperactivity Disorder (ADHD) remains in active debate. METHODS: We used the perceptual load paradigm to examine both early and late selective attention in children with the Primarily Inattentive (ADHD-I) and Combined subtypes (ADHD-C) of ADHD. RESULTS: No evidence emerged for selective attention deficits in either of the subtypes, but sluggish cognitive tempo was associated with abnormal early selection. CONCLUSIONS: At least some, and possibly most, children with DSM-IV ADHD have normal selective attention. Results support the move away from theories of attention dysfunction as primary in ADHD-C. In ADHD-I, this was one of the first formal tests of posterior attention network dysfunction, and results did not support that theory. However, ADHD children with sluggish cognitive tempo (SCT) warrant more study for possible early selective attention deficits.

Attention↗

PubMed2002

Behavioral characteristics of auditory processing disorder and attention-deficit hyperactivity disorder: predominantly inattentive type.

Auditory processing disorder (APD) and attention-deficit hyperactivity disorder (ADHD) present overlapping symptomatology. Previous research has demonstrated that professionals use different behavioral descriptors to characterize APD and ADHD combined and predominantly hyperactive-impulsive subtypes, which present with hyperactivity, impulsivity, and inattention. The present study extends this research by comparing audiologists' and pediatricians' rankings of 58 behavioral symptoms associated with APD and ADHD predominantly inattentive (PI) subtype, the ADHD subtype that presents without hyperactivity and impulsivity. Audiologists ranked the degree to which each symptom pertained to individuals with APD, and pediatricians ranked the same symptom as it relates to ADHD-PI. Item analysis revealed that respondents identified a reasonably exclusive set of behaviors characterizing APD and ADHD-PI. None of the four behaviors ranked 2 SD above the grand means (i.e., inattention, academic difficulties, asking for things to be repeated, and poor listening skills) was ranked in common.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Relationship between traumatic dental injuries and attention-deficit/hyperactivity disorder in children and adolescents: proposal of an explanatory model.

The objective of the present study was to determine the association between attention-deficit/hyperactivity disorder (ADHD) and traumatic dental injuries in a child psychiatric clinical population in Istanbul. A total of 475 consecutive children aged 8-17 years were enrolled in the study. Children and their parents were interviewed about the presence of traumatic dental injury and if a positive response was obtained further questions were inquired regarding the time and cause of the injury, and whether treatment had been sought. Child psychiatric diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Of the 475 children, 32 reported a traumatic dental injury (6.7%) with statistically significant association with ADHD (chi(2) = 26.90, d.f. = 1, P = 0.0001; odds ratio = 17.41, 95% CI: 4.11-73.55). On the Conners Teacher Report Questionnaire, children with dental trauma group differed significantly from the non-ADHD group but not from the ADHD group (F = 17.02, d.f. = 2, P = 0.0001). Among children with ADHD and dental fracture, the most common subtype was combined ADHD (90%). This is the first study describing a significant association between dental fractures and ADHD which contributes to an explanatory model on dental traumas among children. According to us, awareness of this association is essential at child psychiatry and pediatric dentistry settings and we recommend preventive efforts to be directed at the treatment of ADHD.

Adolescent↗

PubMed2006

Subtypes of attention-deficit/hyperactivity disorder (ADHD): distinct or related disorders across measurement levels?

The aim of this literature review is to assess the current state of knowledge regarding differences and similarities between the inattentive (IA) and combined (C) subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD) in order to detail challenges concerning further conceptualization, diagnostics, and treatment. The literature on ADHD-IA and ADHD-C was reviewed and contrasted across genetic, neuroanatomical, neurophysiological/ neurochemical, neuro(psycho)logical, and clinical psychiatric measurement levels. It was found that the more fundamental the measurement level, the less unambiguous evidence is found for subtype differences. Only on the clinical psychiatric diagnostic level, do more or less clear-cut differences in cognitive, social, academic, and behavioural functioning emerge. In conclusion, fundamental research that compares ADHD-IA and ADHD-C is relatively rare. At this point, only irrefutable phenomenological evidence of subtype differences seems to be available, even in attention problems which are presumed to be identical. The question as to whether both subtypes should be considered as two independent disorders was not adequately resolved.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Mutational analysis of the nicotinic acetylcholine receptor alpha 4 subunit gene in attention deficit/hyperactivity disorder: evidence for association of an intronic polymorphism with attention problems.

Recent studies suggest the presence of genetically distinct subtypes of attention deficit/hyperactivity disorder (ADHD) and that attention problems can be treated with receptor subtype selective nicotine agonists. In this study, individuals with two independent familial subtypes of ADHD defined by latent class analysis were systematically screened for sequence variations in the coding regions and intron/exon junctions of the nicotinic acetylcholine receptor alpha 4 subunit gene (CHRNA4). Common polymorphisms were used for transmission disequilibrium test (TDT) analyses. A significant association was found for a 5' intron 2 single nucleotide polymorphism and severe inattention problems (P = 0.007, effect size = 4, 95% CI 1.3-14.1). The location of the polymorphism is compatible with it affecting pre-mRNA stability or splicing.

Attention↗

PubMed2006

Efficacy and safety of mixed amphetamine salts extended release (Adderall XR) in the management of attention-deficit/hyperactivity disorder in adolescent patients: a 4-week, randomized, double-blind, placebo-controlled, parallel-group study.

BACKGROUND: The ability to recognize and diagnose attention-deficit/hyperactivity disorder (ADHD) has increased in recent years. The persistence of ADHD symptoms puts adolescents with ADHD at risk for long-term adverse psychosocial outcomes. OBJECTIVE: The primary goal of this study was to assess the efficacy and safety of mixed amphetamine salts extended release (MAS XR) in the management of adolescents with ADHD. METHODS: This was a 4-week, randomized, multicenter, double-blind, placebo-controlled, parallel-group, forced-dose-titration study. Adolescents aged 13 to 17 years with ADHD were randomized to 1 of 4 active treatments (MAS XR 10, 20, 30 or 40 mg/d) or to placebo. All doses were given in the morning. This study used a forced-dose-titration design in which patients randomized to the 10-mg/d group received 1 dose of 10 mg/d for 4 weeks. Patients randomized to the 20-mg/d group received 1 dose of 10 mg/d for the first week and 1 dose of 20 mg/d for the remaining weeks; patients randomized to the 30-mg/d group received 1 dose of 10 mg/d for the first week, 1 dose of 20 mg/d for the second week, and 1 dose of 30 mg/d for the remaining 2 weeks; and patients randomized to the 40-mg/d group received 1 dose of 10 mg/d for the first week, 1 dose of 20 mg/d for the second week, 1 dose of 30 mg/d for the third week, and 1 dose of 40 mg/d for the fourth week. The primary efficacy measure was change from baseline to end point in the ADHD Rating Scale-IV (ADHD-RS-IV) score. The secondary efficacy measure was the score on the Clinical Global Impressions-Improvement (CGI-I) scale for ADHD. ADHD-RS-IV total scores were analyzed post hoc in patients with low baseline ADHD-RS-IV severity (ie, patients with baseline ADHD-RS-IV total scores less than the median) and high baseline ADHD-RS-IV severity (ie, patients with baseline ADHD-RS-IV total scores greater than the median). Safety was assessed by recording adverse events, vital signs, and body weight at all study visits and 30 days after drug discontinuation. RESULTS: Of the 287 randomized adolescents, 258 completed the study. The intent-to-treat (ITT) population included 278 patients. The majority of patients were male (65.5%) and white (73.7%) The mean weight (57.8 kg [127.1 lb]) at baseline and the mean height (163.8 cm [64.5 in]) at screening were comparable across all MAS XR treatment groups. Patients in the placebo group had a mean weight of 59.8 kg (131.6 lb) and a mean height of 166.1 cm (65.4 in). Most (56.5%) of the patients had ADHD combined inattentive/hyperactive-impulsive subtype. Two hundred nineteen (78.8%) patients were treatment naive, and 59 (21.2%) had received treatment for ADHD within 30 days before screening. ITT analysis of the ADHD-RS-IV revealed statistically significant (P < 0.001) improvement in mean ADHD-RS-IV total scores in all 4 MAS XR treatment groups, compared with placebo, at all weeks throughout the 4-week study; the mean change from baseline to end point was -17.8 in the MAS XR 10- to 40-mg/d groups and -9.4 in the placebo group. Significant treatment effects were observed in both the ADHD-RS-IV inattentive (P < 0.001) and hyperactive-impulsive (P < 0.001) subscales from baseline. In patients with low baseline ADHD-RS-IV severity, statistically significantly (P < or = 0.01) greater improvements were observed in the MAS XR 20-, 30-, and 40-mg/d groups than in the placebo group; in patients with high baseline ADHD-RS-IV severity, statistically significantly (P < or = 0.02) greater improvements were observed in all active treatment groups compared with placebo. On the CGI-I scale at end point, a higher percentage of adolescents in all MAS XR treatment groups were considered improved (MAS XR 10 mg/d, 51.9% [P < 0.01]; 20 mg/d, 66.0% [P < 0.001]; 30 mg/d, 70.7% [P < 0.001]; 40 mg/d, 63.9% [P < 0.001]) compared with adolescents receiving placebo (26.9%). The most common adverse events in patients receiving MAS XR versus placebo were anorexia/decreased appetite (35.6% vs 1.9%), headache (16.3% vs 22.2%), insomnia (12.0% vs 3.7%), abdominal pain (10.7% vs 1.9%), and weight loss (9.4% vs 0%). Most adverse events were mild or moderate in intensity (97.5%); no serious adverse events were reported. CONCLUSIONS: The adolescents with ADHD treated with 10- to 40-mg/d MAS XR up to 4 weeks had significant improvements in ADHD symptoms compared with those who received placebo. Results of this study suggest that once-daily dosing with MAS XR up to 40 mg was effective and well tolerated for the management of ADHD in these adolescents.

Adolescent↗

PubMed2000

Comparison of attention-deficit/hyperactivity disorder symptom subtypes in Ukrainian schoolchildren.

OBJECTIVE: This study used a parent-completed, DSM-IV-referenced rating scale to examine prevalence rates of attention-deficit/hyperactivity disorder (ADHD) behaviors and differences between subtypes in 10- to 12-year-old Ukrainian children. METHOD: During 1997, a total of 600 parents and children residing in Kyiv, Ukraine, and their teachers participated in extensive clinical assessments using standard Western measures. RESULTS: The screening prevalence rate of ADHD behaviors was 19.8%: 7.2% for inattentive (I), 8.5% for hyperactive-impulsive (HI), and 4.2% for combined (C). Post hoc comparisons indicated a number of significant (p < .05) group differences. Mothers of children with ADHD symptoms reported higher rates of disruptive behavior, negative mother-child interactions, and physical punishment than the non-ADHD group. Teachers rated children with ADHD as more hyperactive and inattentive, but only the HI subtype was rated more oppositional than non-ADHD students. The I subtype was less academically proficient and socially adept (but less likely to have behavior problems). The C subtype was the most behaviorally disruptive (mother ratings), and their fathers were more likely to be aggressive and abuse alcohol. The HI subtype also had problems with disruptive behavior but were less socially impaired. CONCLUSIONS: Although symptom prevalence rates are higher in Ukraine than the United States, this study provides additional evidence supporting DSM-IV ADHD subtypes as distinct clinical entities.

Analysis of Variance↗

PubMed2002

Clock face drawing in children with attention-deficit/hyperactivity disorder.

The clock drawing test has been found to be sensitive to visual-spatial perception, graphomotor skills, verbal reasoning, and executive functioning in adult patient populations, as well as frontal lobe maturation in normal children. Our study is among the first to assess the use of clock drawing as a neuropsychological measure in the pediatric population. Participants included 41 children with attention-deficit/hyperactivity disorder (ADHD) and 41 normal controls, ages 6-12 years, matched for age, gender, and handedness. Conceptualization of time and construction of the clock face were assessed separately using a scoring system normed on school-age children in an earlier study. Children with Predominantly Inattentive Type were found to perform similarly to those with Combined Type of ADHD. However, children with ADHD, regardless of subtype, performed significantly poorer than controls. Qualitative analysis of performance revealed errors that were subsequent to poor planning during task execution, consistent with executive dysfunction commonly present in children with ADHD. Further, multiple regression analysis demonstrated that a neuropsychological measure of executive functioning was predictive of clock construction performance in children with ADHD. Constructional praxis and receptive vocabulary also were predictive of clock construction ability. Implications of these findings are discussed.

Journal Article↗

PubMed1998

Clinical evaluation of attention-deficit hyperactivity disorder by objective quantitative measures.

This study assessed the diagnostic potential of the actigraph, the Continuous Performance Test, and the Matching Familiar Figures Test in diagnosing attention-deficit hyperactivity disorder (ADHD). Twenty boys previously diagnosed with ADHD and 52 controls were examined. By these measures the boys with ADHD were differentiated from the controls with sensitivity and specificity above 75%. We were able to classify ADHD into eight subtypes by combining the scores of the actigraph and the CPT: "hyperactive-impulsive", "hyperactive-inattentive", "impulsive-inattentive", "hyperactive", "impulsive", "inattentive", "mixed", and "unspecified" type. These classifications may be useful in diagnosing ADHD.

Attention↗

PubMed2005

Performance of children diagnosed with ADHD on selected planning and reconstitution tests.

A sample of 177 children between the ages of 8 and 12 years, 93 participants diagnosed with attention deficit hyperactivity disorder (ADHD) and 85 control participants, were administered selected tasks from the WJ-III Tests of Cognitive Abilities, Wechsler Intelligence Scale for Children-III (WISC-III), and WISC-III PI that targeted various reconstitution skills such as aspects of planning and reasoning. Planning from the WJ-III Cog, Wechsler Mazes from the WISC-III, and Elithorn Mazes from the WISC-III PI were used to measure the concept of planning Concept Formation and Analysis Synthesis from the WJ-III Cog were chosen to represent reconstitution. Results indicated that age and gender were not contributory factors to differences on the selected measures. IQ was found to be contributory and was used as a covariate in all analyses. The overall results of the study indicated a need to further divide the broad category of ADHD into its subtypes when analyzing performance on measures of executive functions, particularly reconstitution. A large effect size was found for Concept Formation and results of this study suggested that the Predominately Inattentive Type and Combined Type of ADHD had the most difficulty on this task, as shown by the significantly lower scores on the measure when compared to the control group and the Predominately Hyperactive-Impulsive Type. The Predominately Inattentive-Hyperactive Impulsive Type did not have any significant difficulties with any of the measures used on this task as evidenced by the small effect sizes. Further areas to investigate such as metacognitive strategies, distinct problem solving strategies, incorporating feedback, and utilizing response inhibition are discussed.

Aging↗

PubMed2005

[Interrater reliability for diagnosis in adults of attention deficit hyperactivity disorder and oppositional defiant disorder using K-SADS-E].

The diagnosis of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in adults lacks adequate assessment instruments. The aim of this investigation is to evaluate the interrater reliability of the sections of K-SADS-E adapted for the diagnosis of these disorders among adults. The adaptations were limited to asking questions directly to the patient, investigation of a later onset of symptoms, and asking for adult specific symptoms. Six trained raters scored 16 recorded interviews. Kappa coefficients were 1.00 for ADHD diagnosis in the past, 0.91 for subtype in the past, 1.00 for ADHD diagnosis in the present, 0.95 for subtype in the present, 1.00 and 0.89 for ODD diagnosis in the past and present, respectively (all with p < 0.001). These results reveal excellent agreement for the ADHD and ODD diagnosis in adults using the adapted form of the Portuguese version of K-SADS-E.

Adult↗

PubMed2005

Performance and private speech of children with attention-deficit/hyperactivity disorder while taking the Tower of Hanoi test: effects of depth of search, diagnostic subtype, and methylphenidate.

We administered the Tower of Hanoi to demographically comparable samples of control participants (n = 34) and children with the Combined (n = 22) and Inattentive subtypes (n = 19) of Attention-Deficit/Hyperactivity Disorder (ADHD). Controls excelled over children with the Inattentive subtype, who outperformed patients with the Combined subtype. These results replicated findings of greater executive deficits in the Combined than in the Inattentive type of ADHD. Double-blind administration of methylphenidate improved task performance only for patients with the Inattentive subtype. In a drug-free Baseline session, children with both subtypes of ADHD made more private verbalizations than controls, particularly when failing puzzles. In later sessions, regardless of drug condition, the inattentive sample exhibited a smaller increase in self-regulatory utterances under failure. In contrast, the combined sample decreased self-regulatory verbalizations under failure only under methylphenidate. The results support some differences between the two subtypes of ADHD in executive functioning and in their response to stimulant therapy.

Attention Deficit Disorder with Hyperactivity↗

PubMed2007

Evaluation of potential gene-gene interactions for attention deficit hyperactivity disorder in the Han Chinese population.

Several lines of evidence suggest that attention-deficit/hyperactivity disorder (ADHD) is a polygenic disorder produced by the interaction of several genes with minor effects. To explore potential gene-gene interactions among candidate genes for ADHD, we studied the dopamine D2 receptor (DRD2), dopamine D4 receptor (DRD4), dopamine transporter (DAT1), and catechol-O-methyltransferase (COMT) genes in the Han Chinese population. A sample of 340 children with ADHD was diagnosed according to the DSM-IV criteria. We also recruited 226 unrelated controls. Identified polymorphisms included a 48-base-pair-repeat in Exon 3 of DRD4, a 40-base-pair-repeat in the 3' untranslated region of DAT1, a restriction-fragment-length polymorphism at codon 158 of COMT, and a -241A > G transition in the promoter of DRD2. Associations of polymorphisms with ADHD and its subtypes were examined by comparing allele frequencies between probands and controls. Binary logistic regression analysis was used to examine the potential gene-gene interactions. Binary logistic regression analysis with the sample of refined phenotypes showed that male gender and long-repeat genotypes of DRD4 and DAT1 were independent risk factors for ADHD. We found no evidence for gene-gene interactions among the candidate genes studied. The present study suggests that dopamine candidate genes are associated with increased vulnerability to ADHD in the Han Chinese population.

Adolescent↗

PubMed2004

[Association studies of G352A polymorphism of dopamine transporter gene in Han Chinese attention deficit hyperactivity disorder patients].

OBJECTIVE: To investigate association of the new polymorphism G352A in the dopamine transporter gene (DAT1) exon 15 with attention deficit hyperactivity disorder (ADHD) in Han Chinese children. METHODS: The new mutant polymorphism G352A in the dopamine transporter gene (DAT1) exon 15 was found by the fluorescently-labeled dye-terminators assay. The study samples were comprised of 337 ADHD children, 207 unrelated controls and 201 integrated ADHD trios (included proband and biological parents). Associations of polymorphisms with ADHD and its subtypes were examined by: (i) comparing cases and controls; and (ii) using family-based association study in transmission-disequilibrium test (TDT). RESULTS: The allele frequencies at the DAT1 G352A locus in the control samples were 79.5% for 352G and 20.5% for 352A respectively. Association studies revealed no association between G352A in exon 15 of DAT1 and ADHD. But after a stratification by gender, there was possible association between G352A and ADHD girls: the 352G allele had a tendency to be preferentially transmitted to ADHD girls. CONCLUSION: There is no association between G352A, the new polymorphism, in exon 15 of DAT1 and ADHD. The 352G allele has a tendency to be preferentially transmitted to ADHD girls, but the findings require replication before drawing a definitive conclusion.

Adolescent↗

PubMed2002

Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder.

People with attention-deficit/hyperactivity disorder (ADHD) are affected by the disorder throughout their lifetimes. Children with ADHD often have comorbid oppositional defiant disorder and conduct disorder in addition to having developmental and social problems. The persistence of ADHD into adolescence and young adulthood varies according to who is being interviewed and the criteria used to define the disorder. For those adolescents and adults in whom ADHD does persist, educational difficulties continue, and problems in the areas of employment, driving, and sexual relationships emerge. ADHD is also associated with increased health care costs even when controlled for psychiatric treatment. Because most ADHD research has been conducted with male children and adolescents with ADHD, combined type, most outcomes for ADHD should be thought of as male outcomes for this subtype. In the future, ADHD researchers should study outcomes for girls and women and for people with ADHD, predominately inattentive type.

Accidents, Traffic↗

PubMed2005

[A pilot study of prevalence of hyperactivity and attention deficit disorder in scholar children in Salvador, Bahia, Brazil].

This study aims to estimate the prevalence of attention deficit hyperactivity disorder (ADHD) in scholar children through a teacher's questionnaire. A pilot study was conducted based in the total number of students under high school, in public and private schools in Salvador, Bahia, Brazil. The instrument used was Teacher's version of ADHS scale. Eight kids (5.3%) were recognized as highly probability of attention deficit disorder, three (2%) with high probability of subtype hyperactive/impulsive, and one (0.6%) as combined subtype. Children with ADHD might have serious social problems, not only brought by the disorder, but also due to co morbidity with other disorders, leading to serious social withdrawn. Early diagnostic and treatment of ADHD might improve educational and psychosocial development of these kids.

Adolescent↗

PubMed2005

Similarities and differences between aggressive and delinquent children and adolescents in a national sample.

OBJECTIVE: To examine differences in the correlates, comorbidity and use of services between aggressive and delinquent children and adolescents. METHOD: An Australian representative sample (n = 4083) of parents of children and adolescents were administered a psychiatric diagnostic interview, the Child Behaviour Checklist, and other instruments to measure service use. The characteristics of children with high scores (top 5%) in the aggressive and delinquent syndromes or both were then examined. RESULTS: The proportion of aggressive children decreased with increasing age while that of delinquents increased. The aggressive group was specifically associated with the impulsive-hyperactive subtype of attention deficit hyperactivity disorder (ADHD) (OR = 12.63; 95% CI = 5.97-26.74). Comorbidity between ADHD, aggression and delinquency was less frequent among adolescents than in children, with the exception of the inattentive subtype in which comorbidity was higher. Both aggressive and delinquent groups had a considerable overlap with conduct disorder. Aggressive and delinquent youths used services more often, but parents perceived aggressive children as more in need of help than delinquent ones. Living in a sole parent family was specifically associated with the delinquent group (OR = 3.34; 95% CI = 2.25-4.96). CONCLUSIONS: The results suggest that these empirically derived syndromes while sharing many features also differ in important ways, highlighting the need for further convergence between categorical and dimensional classifications. Their differential association with the subtypes of ADHD requires further examination and may help to understand the relationship between ADHD and conduct problems. The importance of aggressive behaviour in children should not be underestimated since it is associated with significant psychopathology, parental distress and use of services.

Adolescent↗