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PubMed2006

The association between parenting stress, depressed mood and informant agreement in ADHD and ODD.

OBJECTIVE: In Attention Deficit Hyperactivity Disorder (ADHD) agreement between parents and teachers is often low. Parental depressed mood and parenting stress are considered to decrease informant agreement. This study examined informant agreement in children with ADHD and the association between parental depressed mood, parenting stress and agreement in the ratings of ADHD, ODD and CD symptoms. METHOD: 65 parents completed questionnaires on ADHD behavior of their child, parenting stress and depressed mood, teachers reported on ADHD behavior. RESULTS: Low agreement was found for hyperactive and moderate agreement for inattentive, ODD and CD symptoms. Stepwise regression analyses showed that parenting stress, and not parental depressed mood accounted for 12% of the variance in inattention symptoms disagreement, 14% of the variance in hyperactive symptoms disagreement and 9% in oppositional behavior disagreement. No significant predictors were found for CD disagreement. The found effect was independent of stimulant medication use. CONCLUSION: Parenting stress, but not parental depressed mood, was associated with the disagreement between parents and teachers on both ADHD and ODD symptoms. These results emphasize the importance of considering parenting stress in diagnosing ADHD and comorbid ODD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Teacher reports of ADHD symptoms in Italian children at the end of first grade.

OBJECTIVE: To determine the prevalence of teacher-rated ADHD symptoms in Italian first-graders. METHOD: 1891 first-graders aged 6.6-7.4 years were evaluated using a 34-item DSM-IV-referenced ADHD teacher rating questionnaire which included all the 18 DSM-IV ADHD diagnostic criteria, some Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), depression and anxiety symptoms, and questions about the child's social and scholastic impairment. RESULTS: Criteria for ADHD were met in 7.1% (n=135) of the subjects (10.4% males and 3.8% females), 3.5% with the Inattentive subtype, 2.3% with the Hyperactive/Impulsive subtype and 1.3% with a Combined subtype. Internalizing (depression and/or anxiety) symptoms were reported in 25.9% of the subjects with ADHD symptoms, 17% showed externalizing symptoms (ODD or CD), and 12.6% showed both. Comorbid symptoms were 10 times more frequent than in subjects without ADHD symptoms. Inattentive subtype and scholastic impairment were more frequent in females, Hyperactive/Impulsive subtype and social impairment were more frequent in males. CONCLUSIONS: Even though the real prevalence of ADHD in first graders is presumably lower than that found in the present study, this screening procedure might allow detecting those children who could benefit from referral for more comprehensive assessments.

Anxiety↗

PubMed2005

Global and regional gray matter reductions in ADHD: a voxel-based morphometric study.

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder characterized by inattentiveness, motor hyperactivity and impulsivity. According to neuroimaging data, the neural substrate underlying ADHD seems to involve fronto-striatal circuits and the cerebellum. However, there are important discrepancies between various studies, probably due to the use of different techniques. The aim of this study is to examine cerebral gray (GM) and white (WM) matter abnormalities in a group of ADHD children using a voxel-based morphometry protocol. The sample consisted of 25 children/adolescents with DSM-IV TR diagnosis of ADHD (medicated, aged 6-16 years) who were compared with 25 healthy volunteer children/adolescents. ADHD brains on an average showed a global volume decrease of 5.4% as compared to controls. Additionally, there were regionally specific effects in the left fronto-parietal areas (left motor, premotor and somatosensory cortex), left cingulate cortex (anterior/middle/posterior cingulate), parietal lobe (precuneus bilaterally), temporal cortices (right middle temporal gyrus, left parahippocampal gyrus), and the cerebellum (bilateral posterior). There were no differences in WM volume between ADHD children and control subjects. The results are consistent with previous studies that used different techniques, and may represent a possible neural basis for some of the motor and attentional deficits commonly found in ADHD.

Adolescent↗

PubMed2005

Telling good from bad news: ADHD differentially affects processing of positive and negative feedback during guessing.

Neuroimaging studies on ADHD suggest abnormalities in brain regions associated with decision-making and reward processing such as the anterior cingulate cortex (ACC) and orbitofrontal cortex. Recently, event-related potential (ERP) studies demonstrated that the ACC is involved in processing feedback signals during guessing and gambling. The resulting negative deflection, the 'feedback-related negativity' (FRN) has been interpreted as reflecting an error in reward prediction. In the present study, ERPs elicited by positive and negative feedback were recorded in children with ADHD and normal controls during guessing. 'Correct' and 'incorrect' guesses resulted in respectively monetary gains and losses. The FRN amplitude to losses was more pronounced in the ADHD group than in normal controls. Positive and negative feedback differentially affected long latency components in the ERP waveforms of normal controls, but not ADHD children. These later deflections might be related to further emotional or strategic processing. The present findings suggest an enhanced sensitivity to unfavourable outcomes in children with ADHD, probably due to abnormalities in mesolimbic reward circuits. In addition, further processing, such as affective evaluation and the assessment of future consequences of the feedback signal seems to be altered in ADHD. These results may further help understanding the neural basis of decision-making deficits in ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2007

Somatosensory function in boys with ADHD and tactile defensiveness.

In this study, we tested for deficits in somatosensory function in boys with Attention Deficit Hyperactivity Disorder (ADHD) and tactile defensiveness (TD). The subjects were 67 boys with ADHD, sub-typed as TD (ADHD+TD+) or non TD (ADHD+TD-), matched with 60 "typical" children in the control group. Sixty nine percent of the boys with ADHD were categorized as TD. The groups were compared on three measures: (a) performance scores on subtests of the Sensory Integration and Praxis Test, (b) measurements of the Somatosensory Evoked Potential (SEP) and (c) ratings of the children's affective responses during tactile stimulation. Both ADHD groups differed from the control group on most study measures. No significant differences were found between the two ADHD subgroups on threshold and perceptual tests scores, except for Finger Identification. However, the TD+ group demonstrated significantly higher central SEP amplitudes than did the TD- group. Together, the results support claims that TD is related to central processing of somatosensory information, but not to anomalous tactile perception, with the exception of Finger Identification.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

ADHD and stuttering: a tutorial.

UNLABELLED: The purpose of this tutorial is twofold. The first is to provide a brief description of some of the key diagnostic features of attention deficit hyperactivity disorder (ADHD) for speech-language pathologists who might not be knowledgeable about this disorder. The second purpose is to provide information and suggestions about treating children who stutter and who have been diagnosed with ADHD. Specific information is provided regarding medication used to treat ADHD symptoms as well as the minimal documented evidence of its impact on stuttering. Suggestions for educational, behavioral, and cognitive management of children who stutter and have ADHD also are discussed. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) identify diagnostic criteria for children with ADHD; (2) differentiate pharmacological, environmental, and behavioral interventions for children with ADHD; and (3) examine effective instructional techniques for children who stutter and have ADHD.

Adolescent↗

PubMed2002

Polymorphism of the serotonin-2A receptor gene (HTR2A) associated with childhood attention deficit hyperactivity disorder (ADHD) in adult women with seasonal affective disorder.

INTRODUCTION: Several lines of research point to a possible overlap between seasonal affective disorder (SAD) and attention deficit hyperactivity disorder (ADHD), particularly in females. There is also emerging evidence that variation of the 5-HT2A receptor gene (HTR2A) contributes to both SAD and ADHD. The current study investigated whether variation in HTR2A was associated with symptoms of childhood ADHD in adult women with SAD. METHOD: Sixty-six women with SAD were administered the Wender-Utah Rating Scale (WURS), which retrospectively assesses childhood ADHD, as part of an ongoing genetic study of SAD. WURS scores were compared across the three genotypic groups defined by the T102C polymorphism of HT2RA. RESULTS: Analysis of variance indicated a significant difference in mean 25-item WURS scores across the three genotypic groups (p = 0.035). Post-hoc tests revealed that the C/C genotypic group had a significantly higher mean score than both the T/T group and T/C group. Based on previously established WURS criteria, 38% of subjects with the C/C genotype, and none with the T/T genotype, had scores consistent with childhood ADHD. LIMITATIONS: The current sample size is small, and childhood ADHD diagnoses were based on retrospective recall. CONCLUSION: These preliminary results suggest a possible association between variation in HTR2A, childhood ADHD, and the later development of SAD in women.

Adult↗

PubMed1998

Depression in attention deficit hyperactivity disorder (ADHD) children: "true" depression or demoralization?

BACKGROUND: The purpose of this study was to further evaluate the nature of the association between major depression (MD) and attention deficit hyperactivity disorder (ADHD) by examining predictors of persistence of MD attending to issues of familiality, adversity and comorbidity. METHODS: Four years of follow-up of 76 depressed ADHD children were analyzed using multivariate regression to determine predictors of persistent MD. RESULTS: Bipolar disorder and higher indices of interpersonal problems predicted MD persistence. In contrast, school difficulty and ADHD-associated measures of severity were not associated with persistent MD. Remission from ADHD was also not statistically significantly associated with remission from MD. CONCLUSIONS: ADHD and MD had independent and distinct courses, indicating that ADHD-associated MD reflects a depressive disorder and not merely demoralization. LIMITATIONS: This study may have reduced power due to stratification of our group of ADHD boys with persistent and remitting MD.

Adolescent↗

PubMed1998

Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling.

BACKGROUND: In contrast to differential diagnosis (ddx) of older adolescent and adult bipolarity (BP), which includes schizophrenia and substance use disorders, the main ddx of prepubertal and early adolescent BP is attention-deficit disorder with hyperactivity (ADHD). To address this ddx issue, and to provide prepubertal mania manifestations, interim baseline data are presented from the National Institute of Mental Health (NIMH)-funded study 'Phenomenology and Course of Pediatric Bipolarity'. METHODS: Data are from the first 60 BP and the first 60 ADHD cases from 270 consecutively ascertained subjects (90 BP, 90 ADHD and 90 community controls). Comprehensive assessments included the Washington University at St. Louis Kiddie and Young Adult-Schedule for Affective Disorders and Schizophrenia--Lifetime and Present Episode Version-DSM-IV (WASH-U-KSADS) blindly administered by nurses to mothers about their offspring and to children/adolescents about themselves. Caseness was established by consensus conferences that included diagnostic and impairment data, teacher and school reports, agency records, videotapes and medical charts. RESULTS: Mean baseline age of BP cases was 11.0+/-2.7 years and the mean age at onset of BP was 8.1+/-3.5 years. Elated mood, grandiosity, hypersexuality, decreased need for sleep, racing thoughts and all other mania items except hyperenergetic and distractibility were significantly and substantially more frequent among BP than ADHD cases (e.g., elation: 86.7% BP vs. 5.0% ADHD; grandiosity: 85.0% BP vs. 6.7% ADHD). In the BP group, 55.0% had grandiose delusions, 26.7% had suicidality with plan/intent and 83.3% were rapid, ultra-rapid or ultradian cyclers. LIMITATIONS: Sites for consecutive case ascertainment from the lowest socioeconomic status classes were unavailable due to current health care policies. CLINICAL RELEVANCE: Prepubertal and early adolescent BP cases differentiate from ADHD by mania-specific criteria and commonly present with ultra-rapid or ultradian cycling.

Activity Cycles↗

PubMed1998

Is instrumental variability abnormally high in children exhibiting ADHD and aggressive behavior?

To test whether instrumental behavior of some children with attention deficit hyperactivity disorder (ADHD) is more variable than control subjects, the sequences of responses by three groups of children were compared: (i) those diagnosed with ADHD who lived in a residential treatment facility for children demonstrating aggressive behavior; (ii) age-matched children from the same facility who did not have an ADHD diagnosis but who had also demonstrated abnormal levels of aggression; and (iii) normal children from a local school. The experiment consisted of rewarding children for responding in a computer 'game' on two keys of a keyboard during each of three phases. In phase 1, rewards were provided independently of sequence variability (IND). In phase 2, rewards depended upon highly variable sequences of left and right responses. Phase 3 was a return to the IND contingencies. The results showed that sequence variability was higher in the sequence variability (VARY) phase than in the preceding IND phase, but remained high when the contingencies returned to IND, thus replicating previous findings. In none of the phases did the ADHD children respond more variably than the controls. However, ADHD subjects made more off-task responses than did controls. Thus, although the present research showed differences between ADHD and control subjects, there was no evidence to support higher behavioral variability in the ADHD subjects.

Aggression↗

PubMed2002

Dopaminergic system genes in ADHD: toward a biological hypothesis.

Converging evidence has implicated abnormalities of dopamine neurotransmission to the pathology of attention deficit hyperactivity disorder (ADHD). Several genetic association studies have been published, but so far, no DNA variants have been unequivocally demonstrated as contributing to ADHD susceptibility. Four dopamine related gene loci have been implicated, however: DAT 1, DRD 4, DBH, and DRD 5. Each of these may influence the liability of ADHD to a small degree. Notably, all are involved in signal transduction at the neuronal synapse. In this article, we investigate as candidate genes for ADHD, DNA polymorphisms at dopamine receptors, the dopamine transporter, and genes known to be involved in dopamine synthesis and metabolism. In a recent article, we confirmed the previously reported association of DAT 1 (480 bp allele) with ADHD and identified polymorphisms at two additional loci showing preferential transmission to ADHD children of alleles at DRD 5 (148 bp allele) and at DBH (allele 2, Taq I polymorphism). Increased transmission of the 4 bp deletion in the untranslated exon 1 of the DOPA decarboxylase gene was also observed but was of marginal significance. Nonsignificant trends of association were found for TH (allele 2) and DRD2 (Ser-311). No preferential transmission of alleles to ADHD children was observed for polymorphisms at DRD 1, DRD 2 (Taq I), DRD 3, DRD 4, and COMT. Analyzing the data by sex of transmitting parent showed significant preferential paternal transmission of alleles at TH (allele 2) and a nonsignificant trend for paternal transmission for DRD 2 (Ser-311). We attempt to put these findings together with what is known of the function of the particular proteins, and suggest working hypotheses.

Adolescent↗

PubMed2002

A quantitative trait locus analysis of the dopamine transporter gene in adults with ADHD.

Numerous lines of evidence have shown that attention deficit hyperactivity disorder (ADHD) is a highly heritable disorder, whether it is considered as a category or a dimension. We tested for an association between the dopamine transporter gene (DAT1) and ADHD considering the disorder as categorical as well as a continuous trait. Genotypes for the DAT1 variable number of tandem repeat (VNTR) alleles, along with Brown Attention Deficit Disorder Scale (BADDS) and Wender Utah Rating Scale (WURS) scores were available for 152 adult ADHD patients. In 72 of these patients DNAs from at least one parent were accessible to perform a family-based analysis (FBAT). The mean quantitative trait values of the whole sample of singleton patients were compared among the specific genotype groups using ANOVA. The family-based analysis did not reveal any association between DAT1 alleles and ADHD either when it was considered as a dichotomous trait (Z = 0.16, p =.86) or as a continuous trait (Wender Scale Z = -1.67, p =.09; Brown ADD Scale Z = 0.28, p =.77). No significant differences were detected in the mean symptom scores among the specific genotype groups. The results from our study do not support a major role for the DAT1 VNTR alleles in our sample of adult ADHD. In view of several positive reports in child ADHD, more work is required to elucidate the potential role of the DAT1 VNTR as a risk factor in ADHD.

Adult↗

PubMed2003

Disturbed transcallosally mediated motor inhibition in children with attention deficit hyperactivity disorder (ADHD).

OBJECTIVE: The aim of this study was to investigate mechanisms of motor-cortical excitability and inhibition which may contribute to motor hyperactivity in children with attention deficit hyperactivity disorder (ADHD). METHODS: Using transcranial magnetic stimulation (TMS), involvement of the motor cortex and the corpus callosum was analysed in 13 children with ADHD and 13 sex- and age-matched controls. Contralateral silent period (cSP) and transcallosally mediated ipsilateral silent period (iSP) were investigated. RESULTS: Resting motor threshold (RMT), amplitudes of motor evoked potentials (MEP) and cSP were similar in both groups whereas iSP-latencies were significantly longer (p<0.05) and their duration shorter (p<0.01) in the ADHD group. For the ADHD group iSP duration tended to increase and iSP latency to decrease with age (n.s.). Conners-Scores did neither correlate with iSP-latencies and -duration nor with children's age. CONCLUSIONS: The shortened duration of iSP in ADHD children could be explained by an imbalance of inhibitory and excitatory drive on the neuronal network between cortex layer III-the projection site of transcallosal motor-cortical fibers-and layer V, the origin of the pyramidal tract. The longer iSP-latencies might be the result of defective myelination of fast conducting transcallosal fibers in ADHD. iSP may be a useful supplementary diagnostic tool to discriminate between ADHD and normal children.

Adolescent↗

PubMed2000

Visual behaviour of ADHD children during an attention test: an almost forgotten variable. Attention-Deficit Hyperactivity Disorder.

The goal of this study was to examine whether looking away behaviour of ADHD children interferes with their test performance. ADHD and normal children carried out two continuous performance tests (CPTs): one with a regular interstimulus interval (ISI), and the other with an irregular ISI. Children were instructed to push a response button when a target stimulus was presented on the monitor. The children's visual behaviour was recorded and scored offline. A micro-analysis of the visual behaviour indicated that ADHD children timed their looking away behaviour in the regular CPT: i.e. they looked away from the monitor and back in the interval between two succeeding stimuli. As a result they did not miss stimuli. Timing of looking away was less possible in the CPT with the irregular ISI. In this condition, looking away interfered with the ADHD children's task accuracy. In sum, looking away behaviour had a negative effect on the accuracy of test performance of ADHD children when stimuli were unpredictable. Looking away behaviour was not associated with the slower reaction times of the ADHD children. Hence, the often reported slowness of ADHD children is not to be explained by their visual behaviour.

Attention↗

PubMed2005

Stopping and changing in adults with ADHD.

BACKGROUND: A lack of inhibitory control has been suggested to be the core deficit in children with attention deficit hyperactivity disorder (ADHD). This means that a primary deficit in behavioral inhibition mediates a cascade of secondary deficits in other executive functions, such as arousal regulation. Clinical observations have revealed that with increasing age symptoms of hyperactivity and impulsivity decline at a higher rate than those of inattention. This might imply that a deficit in attention rather than a lack of inhibitory control is the major feature in adult ADHD. METHOD: To study whether an attentional or inhibitory deficit predominates, the stop-signal task and the stop-change task were presented to 24 adults with ADHD combined subtype and 24 controls. RESULTS: Relative to controls, the stop-signal reaction time (SSRT) was significantly more prolonged than the go-stimulus reaction time (RT) in patients with ADHD. This disproportionate elongation of the SSRT was comparable across tasks, even though the stop-change task exerted more complex (or at least different) demands on the inhibitory system than the stop-signal task. ADHD patients had a higher proportion of choice errors, possibly reflecting more premature responses. Specifically in the stop-change task, patients had more variable choice responses and made more inappropriate change responses, which may also reflect enhanced impulsivity. CONCLUSIONS: The results support a core deficit in behavioral inhibition in adults with ADHD. We further suggest that there is more evidence for a critical role of deficient inhibitory control in adults than in children with ADHD.

Adolescent↗

PubMed2005

An investigation of visuospatial memory impairment in children with attention deficit hyperactivity disorder (ADHD), combined type.

BACKGROUND: Memory impairment is not considered a core cognitive feature of attention deficit hyperactivity disorder, combined type (ADHD-CT), although it is associated with impairments in attentional and executive functions. This study investigates visuospatial memory impairment, in particular encoding and retrieval aspects, in children with ADHD-CT who are stimulant-medication naive and medicated with stimulant medication. METHOD: A cross-sectional study of visuospatial memory in 6- to 12-year-old children with stimulant-medication-naive ADHD-CT (n = 62) and medicated ADHD-CT (n = 58) compared to an age- and gender-matched healthy control group (n = 39) was completed. RESULTS: Both medication-naive and medicated ADHD-CT groups demonstrated subtle yet significant impairment in visuospatial memory. The memory impairment was delay-independent, which, along with other factors, suggest dysfunction of the encoding rather than retrieval phase of visuospatial memory. CONCLUSIONS: Careful study of large ADHD-CT samples does detect deficits in a visuospatial memory task, but these reflect attentional deficits rather than being specifically due to dysfunction of the medial temporal lobe explicit memory system. Children with ADHD-CT may benefit from cognitive and behavioural strategies focused on improving encoding of relevant information rather than retrieval strategies.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Long-term safety and effectiveness of mixed amphetamine salts extended release in adults with ADHD.

OBJECTIVE: Assess the long-term safety and effectiveness of mixed amphetamine salts extended release (MAS XR) in adults with attention-deficit/hyperactivity disorder (ADHD) combined subtype. METHODS: A 24-month, open-label extension of a 4-week, multicenter, double-blind, placebo-controlled, parallel-group, forced-dose-escalation study of MAS XR in adults (>or=18 years of age) with ADHD. The 223 enrolled subjects started treatment at 20 mg/day for 1 week, with subsequent titration up to 60 mg/day for optimal therapeutic effects. At monthly visits, efficacy was assessed based on the ADHD Rating Scale IV (ADHD-RS-IV). Safety assessments included spontaneously reported adverse events, laboratory assessments, and monitoring of vital signs. FINDINGS: ADHD symptoms significantly improved for all subjects as measured by change from baseline in mean ADHD-RS-IV total scores (-7.2+/-13.04 unit points; P<.001); this was sustained for up to 24 months. The most common treatment-related adverse events were dry mouth (43% of subjects reporting at least one occurrence), infection (33%), insomnia (32%), anorexia/decreased appetite (32%), headache (30%), and nervousness (26%). Most adverse events were mild to moderate in intensity. CONCLUSION: Treatment with MAS XR 20-60 mg/day for adult ADHD was generally well tolerated and was associated with sustained symptomatic improvement for up to 24 months.

Administration, Oral↗

PubMed2000

The EEG consistency index as a measure of ADHD and responsiveness to medication.

The primary diagnostic procedure for Attention-Deficit/Hyperactivity Disorder (ADHD) is the clinical interview, because psychological, neuropsychological, and neurological tests to date have not had sufficient specificity. Currently, there is no objective means to measure severity of ADHD, or the extent to which it is benefited by various dosages of medication. We recently reported that a certain EEG profile, the Consistency Index, occurring during the transition between two easy cognitive tasks clearly differentiated ADHD from non-ADHD boys between the ages of 8 and 12. The current study replicated this with older males (19-25) using different tasks, and a double blind, placebo versus Ritalin controlled crossover design. Seven ADHD subjects were found to have a significantly lower Consistency Index than 6 non-ADHD males while transitioning from 2 Simple tasks during placebo condition, while only the ADHD subjects demonstrated a significant improvement in their Consistency Index while on Ritalin. Similar but nonsignificant trends were observed while transitioning across Hard tasks.

Adolescent↗