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PubMed2006

Familial association and frequency of learning disabilities in ADHD sibling pair families.

In a sample of 235 families with at least two children with Attention-Deficit/ Hyperactivity Disorder (ADHD), the frequency and familial association of learning disabilities (LD) were assessed. Familiality was examined both between sibling pairs and between parents and their children. Two methods for defining LD, a discrepancy-based and a low-achievement model, were employed to examine the occurrence of LD in this sample. The specific types of LD examined included Reading Disability (RD), Math Disability (MD), and Writing Disability (WD). The prevalence rates were highest for RD, followed by WD then MD. The two definitions of LD yielded similar prevalence rates but identified different groups of children with vastly different IQ scores. Strong familial association was demonstrated for RD both between sibling pairs and between parents and children, with weaker association for WD. There was evidence of nonrandom mating for LD among parents, but not for ADHD or for ADHD + LD. Despite the high comorbidity of ADHD and LD among parents, the presence of ADHD in the parents did not predict child LD supporting independent familial factors underlying ADHD and LD.

Adolescent↗

PubMed2006

Self-handicapping prior to academic-oriented tasks in children with attention deficit/hyperactivity disorder (ADHD): medication effects and comparisons with controls.

Examined self-handicapping prior to academic-oriented tasks in children with and without ADHD and examined whether stimulant medication influenced self-handicapping. Participants were 61 children ages 6 to 13, including 22 children with ADHD tested after taking a placebo, 21 children with ADHD tested after taking stimulant medication, and 18 non-ADHD controls. Participants completed three measures of self handicapping and also completed self-evaluations of their performance. Results showed greater self handicapping and more positive self-evaluations in children with ADHD than in controls regardless of medication condition. Findings suggest children with ADHD may use self handicapping to ameliorate the effects of experiencing high rates of academic failure.

Adolescent↗

PubMed1994

Genetic factors in substance abuse based on studies of Tourette syndrome and ADHD probands and relatives. II. Alcohol abuse.

Prior studies have suggested childhood attention deficit hyperactivity disorder (ADHD) as a risk factor for alcohol abuse in adults. Gilles de la Tourette Syndrome, a hereditary tic and impulse disorder, is clinically and genetically similar to ADHD. To examine the hypothesis that individuals carrying the Gts gene are at increased risk to develop alcohol use problems, the same TS (Tourette Syndrome) and ADHD probands, relatives and controls used in the prior study of drug abuse were also studied using a structured questionnaire based on the Diagnostic Interview Schedule and the MAST test. The frequency of a positive response to any of 16 different questions concerning alcohol abuse showed a highly significant increase with increased genetic loading for Gts and ADHD genes. The percentage of more than one positive response in TS probands was markedly influenced by the presence of comorbid ADHD, discipline, obsessive-compulsive or drug abuse problems. Comorbid drug abuse problems were the best predictor of alcohol abuse problems. These results suggest that the genes responsible for TS and ADHD play an important role in alcohol abuse/dependence as well as drug abuse/dependence. One of the elements common to all of these disorders may be mutant genes affecting serotonin metabolism.

Adolescent↗

PubMed2005

Emotional dysregulation in adult ADHD and response to atomoxetine.

BACKGROUND: Before 1980, attention-deficit/hyperactivity disorder (ADHD) was called minimal brain dysfunction and included emotional symptoms now listed as "associated features" in DSM-IV. Data from two multicenter, placebo-controlled studies with 536 patients were reexamined to assess: 1) the pervasiveness of these symptoms in samples of adults with ADHD; 2) the response of these symptoms to atomoxetine; and 3) their association with depressive/anxiety symptoms. METHODS: The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) was used to assess temper, affective lability, and emotional overreactivity, thus identifying patients exhibiting "emotional dysregulation." Other DSM-IV Axis I diagnoses were exclusionary. Outcome measures were the Conners' Adult ADHD Rating Scale (CAARS) and the WRAADDS. RESULTS: Thirty-two percent of the sample met post hoc criteria for emotional dysregulation and had higher baseline scores on ADHD measures, a lower response to placebo, and greater response to atomoxetine (p = .048). Symptoms of emotional dysregulation had a treatment effect (p < .001) at least as large as the CAARS (p = .002) and the total WRAADDS (p = .001). Emotional dysregulation was present in the absence of anxiety or depressive diagnosis. CONCLUSIONS: Symptoms of emotional dysregulation were present in many patients with ADHD and showed a treatment response similar to other ADHD symptoms.

Adrenergic Uptake Inhibitors↗

PubMed2004

Dipole source localization of event-related brain activity indicative of an early visual selective attention deficit in ADHD children.

OBJECTIVE: This study was aimed at investigating whether attention-deficit hyperactivity disorder (ADHD) children suffer from specific early selective attention deficits in the visual modality with the aid of event-related brain potentials (ERPs). Furthermore, brain source localization was applied to identify brain areas underlying possible deficits in selective visual processing in ADHD children. METHODS: A two-channel visual color selection task was administered to 18 ADHD and 18 control subjects in the age range of 7-13 years and ERP activity was derived from 30 electrodes. RESULTS: ADHD children exhibited lower perceptual sensitivity scores resulting in poorer target selection. The ERP data suggested an early selective-attention deficit as manifested in smaller frontal positive activity (frontal selection positivity; FSP) in ADHD children around 200 ms whereas later occipital and fronto-central negative activity (OSN and N2b; 200-400 ms latency) appeared to be unaffected. Source localization explained the FSP by posterior-medial equivalent dipoles in control subjects, which may reflect the contribution of numerous surrounding areas. CONCLUSIONS: ADHD children have problems with selective visual processing that might be caused by a specific early filtering deficit (absent FSP) occurring around 200 ms. The neural sources underlying these problems have to be further identified. Source localization also suggested abnormalities in the 200-400 ms time range, pertaining to the distribution of attention-modulated activity in lateral frontal areas.

Attention↗

PubMedDate not supplied

The relations between DISC-IV DSM diagnoses of ADHD and multi-informant CBCL-AP syndrome scores.

BACKGROUND: Previous studies have examined the relation between attention problems (APs) obtained with the Child Behavior Checklist (CBCL) and attention deficit hyperactivity disorder (ADHD) assessed with the Diagnostic and Statistical Manual of Mental Disorders (DSM). We will examine this relation across sex using multi-informant data. METHODS: Parents of 12538 twins, aged 7, 10, and 12 years, and teachers of twins, aged 10 years, completed the questionnaires. The mothers of a sample of 283 boys and 291 girls who scored either low or high on longitudinal maternal CBCL-AP were interviewed. RESULTS: Children with a low AP score obtained a negative ADHD diagnosis in 96% of cases. Children with a high AP score obtained a positive diagnosis in 36% (girls) and 59% (boys) of cases. The association between paternal and maternal AP ratings and ADHD was the same, whereas the association between teacher AP ratings and ADHD was low. CONCLUSIONS: The association between AP and ADHD is higher in boys than girls, possibly because of a bias toward the male manifestation of ADHD.

Attention↗

PubMed2006

Is ADHD a valid disorder in children with intellectual delays?

To assess the validity of ADHD in children with mental retardation, we applied Robins and Guze's [Robins, E., and Guze, S.B. (1970). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 983-987.] criteria for determining the validity of a psychiatric disorder. We review the literature describing clinical correlates, family history, treatment response, laboratory studies, course, and outcome of children with ADHD and mental retardation. Although clearly an area in need of further research, there is preliminary evidence to suggest that ADHD is a valid psychiatric condition in children with mental retardation. Nevertheless, without knowing the base rates of ADHD symptoms in the mental retardation population, the positive predictive power and negative predictive power of ADHD symptoms in this population remain an open question. In addition to assessment of base rate symptoms, future research should consider what diagnostic algorithm may best be applied to the diagnosis of ADHD in mental retardation.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

DCD and ADHD: a genetic study of their shared aetiology.

Previous studies have found that rates of attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) are very similar, both being approximately 7% in sample populations [Kadesjö, B., & Gillberg, C. (1999). Developmental coordination disorder in Swedish 7-year-old children. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 820-828; Milberger, S., Faraone, S., Biederman, J., Testa, M., & Tsuang, M. (1996). New phenotype definition of attention deficit hyperactivity disorder in relatives for genetic analyses. American Journal of Medical Genetics, 67, 369-377]. The rate of comorbidity between the two has been found to be close to 50% [Barkley, R. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press]. Investigations into the comorbidity of the disorders points to a shared aetiology between them. The aim of the present investigation was to examine the extent to which the shared aetiology is due to common genetic factors to both disorders. We also investigated whether particular subtypes of each disorder were more linked than others. Mailed questionnaires were completed by parents (predominantly mothers) of 1285 twin pairs aged 5 and 16 years from the volunteer Australian Twin Registry (ATR). Included were a DSM-IV-based ADHD form, the alternative SWAN (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour scale) and the Developmental Coordination Disorder Questionnaire (DCDQ). Statistical analyses including structural equation modelling were carried out to explore the genetic factors of both disorders. The modelling showed a strong shared additive genetic component between most subtypes of ADHD and DCD to the subtypes of the other disorder. Analyses comparing the two ADHD measures showed an overlap of the symptoms captured by each measure but also significant differences. The DCD-fine motor and ADHD-Inattentive were most strongly linked using the DSM-IV based scale. On the SWAN scale the results were similar but the general coordination scale was also very strongly linked. Implications for the use of different assessment tools are discussed.

Adolescent↗

PubMed2006

An intervention program for ADHD in patients with substance use disorders: preliminary results of a field trial.

The comorbidity of attention deficit hyperactivity disorder (ADHD) is frequently not well recognized in substance abuse treatment institutions in The Netherlands. As a consequence, patients with substance use disorder (SUD) and ADHD often receive suboptimal treatment. To prevent every treatment center from having to invent its own diagnostic procedure and intervention for ADHD, a national working group was established. This group developed an intervention program for the screening, diagnosis, and treatment of ADHD in patients with SUD. This article describes the development and content of this intervention program. An important part of this development was testing the intervention program in two addiction treatment centers in The Netherlands. Systematic screening of ADHD was part of the test. A self-report questionnaire was used. Subjects with positive screening results were referred for the diagnostic procedure. Nine hundred twenty-eight screenings were performed: 207 screened positive, 115 came for further diagnostics, and 65 were ultimately diagnosed with ADHD.

Activities of Daily Living↗

PubMed2004

Molecular genetics of attention-deficit hyperactivity disorder (ADHD): an update.

Attention-deficit hyperactivity disorder (ADHD) is a heritable and behavioral condition of childhood, affecting 5-10% of school-age children worldwide. Affected patients exhibit various behavioral problems such as carelessness, restlessness, disobedience and failure to stay quiet in class. The etiology of ADHD is not known. However, family, twin and adoption studies have provided strong evidence for a genetic etiology of the disorder. A genome-wide scan has identified six chromosomal loci with LOD scores suggestive of linkage. Animal studies suggest the involvement of the brain dopamine pathway and its alteration in ADHD but there is no direct evidence to support this hypothesis. In addition, there are at least 20 candidate genes of small effect that have been studied but none of them appear to be the major gene causing ADHD. Medical intervention along with psychosocial therapy proved to be beneficial for controlling ADHD, although some undesirable side effects have been encountered during medical treatment. In the future, identification of environmental factors, study of additive gene effects and the interaction of genes and environmental factors may provide better insight into the pathophysiology of ADHD. This may lead to an effective new treatment strategy.

Adolescent↗

PubMed2006

No association between TPH2 gene polymorphisms and ADHD in a UK sample.

Tryptophan Hydroxylase 2 (TPH2) is the rate-limiting enzyme in the biosynthesis of serotonin which is exclusively expressed in the brain. Recent molecular studies reported significant association between markers mapped to TPH2 and psychiatric conditions including ADHD. We have examined four single nucleotide polymorphisms (SNPs) two of which (rs1843809, rs1386493) were reported to associate with ADHD in an Irish ADHD sample. Transmission disequilibrium analysis revealed no significant association between any of these markers and ADHD. Dividing by the sex of the transmitting parent has also failed to replicate the previously reported paternal over-transmission of the associated alleles to ADHD probands. A larger sample size will be required to clarify if TPH2 alleles are or are not associated with ADHD.

Adolescent↗

PubMed2005

Age and medication effects on rhythmic responses in ADHD: possible oscillatory mechanisms?

Voluntary motor responses in children with attention-deficit hyperactivity disorder (ADHD) may reflect underlying neuronal oscillatory mechanisms. The aims of this study were: (1) to corroborate the presence of rhythmic motor abnormalities on tapping test in children with attention-deficit hyperactivity disorder, shown in previous studies; (2) to delineate the characteristics of ADHD children demonstrating these rhythmic abnormalities; (3) to assess the impact of methylphenidate (Ritalin) on this abnormal motor phenomenon. The study was designed in a double blind manner. Sixty-four ADHD children aged 6-12 years and 60 matched controls underwent a finger tapping test (1-5 Hz). We measured the abnormal rhythmic tapping with and without methylphenidate treatment in a double blind design. Conventional statistical analysis was used to assess the correlation of the presence of motor abnormality with various clinical characteristics (such as degree of hyperactivity/impulsivity). Fifty-six percent of children with ADHD compared to 8% of controls demonstrated abnormal rhythmic responses at a mean frequency of 3.1+/-0.9 Hz. These erroneous voluntary movements were more common in children with a greater degree of hyperactivity, in younger children but not significantly altered by methylphenidate treatment. Surprisingly, abnormal rhythmic responses showed less variability than found for responses for which the tapping was adequately paced, suggesting different motor control processes for normal and abnormal paced tapping. We speculate that rhythmic tapping responses reflect abnormal oscillatory mechanisms involved in ADHD, exacerbated in younger children with ADHD and in those in whom the hyperactivity/impulsivity is more pronounced.

Age Factors↗

PubMed2002

Newborn thyroxine levels and childhood ADHD.

OBJECTIVES: Normal brain development is highly dependent on adequate levels of iodine and thyroid hormone. It has been suggested that Attention Deficit Hyperactivity Disorder (ADHD) is the consequence of prenatal thyroidal endocrine disruption. The hypothesis was examined using neonatal thyroxine levels as a bio-marker of prenatal thyroid status and comparing it to subsequent development of ADHD. DESIGN AND METHODS: In a matched case-control study, cases were defined as children diagnosed with ADHD, while children born in the same hospital and tested on the same day served as matched controls. Conditional logistic regression analysis with unequal numbers of controls was performed. RESULTS: The neonatal thyroxine levels were within normal limits for each of the children who were subsequently diagnosed as having ADHD, and their distribution was no different from that of their controls. CONCLUSIONS: Children diagnosed with ADHD do not demonstrate prenatal thyroidal dysfunction as reflected in the newborn thyroxine levels, therefore neonatal thyroxine levels are not a bio-marker for the subsequent development of ADHD.

Age Factors↗

PubMed1999

Contrasts in memory functions between adolescents with schizophrenia or ADHD.

Previous research on memory and schizophrenia has relied on a limited number of global memory measures instead of a comprehensive assessment of various memory components. In addition, little effort has been directed at examining memory functioning in patients with early-onset schizophrenia. Published research often lacks a relevant neuropsychiatric comparison group to control for attention difficulties. Patients with Attention Deficit Hyperactivity Disorder (ADHD) were included in the present study for this purpose. To our knowledge, a direct comparison of the two patient groups on memory functions has never been made. In the present study, both adolescents with schizophrenia and adolescents with ADHD were compared on a comprehensive memory test battery. Nineteen adolescents with schizophrenia were compared to 20 ADHD adolescents and 30 normally functioning adolescents on measures of working memory and long-term episodic memory, including tests of verbal and visual memory, free recall and recognition memory. The performance of the adolescents with schizophrenia was impaired as compared to the normal group on most of the memory measures. They performed significantly more poorly than the adolescents with ADHD on the visual memory tests. The ADHD group scored more impaired than the schizophrenia group on working memory tests with focus on distractibility. The findings suggest a general memory deficit among adolescents with schizophrenia related to both verbal and visual material. Impairment on the measures of visual memory is specific to schizophrenia and does not characterise the ADHD subjects.

Adolescent↗

PubMed1998

Clinical features of children with both ADHD and mania: does ascertainment source make a difference?

OBJECTIVE: We evaluated the structural diagnostic results of children ascertained through an ADHD diagnosis with comorbid mania to determine if they have the same phenotype as children ascertained through a mania diagnosis with comorbid ADHD. METHOD: We compared a sample of children participating in a family genetic study of ADHD to a sample of children ascertained through a study of childhood mania. RESULTS: Similar correlates of ADHD and mania were observed in children satisfying criteria for both disorders irrespective of ascertainment source. CONCLUSIONS: Findings suggest that children with mania and ADHD have two disorders, their features not varying with the primary diagnostic focus. LIMITATIONS: The results may have been limited by small sample size. CLINICAL RELEVANCE: Because the coexistence of ADHD and mania seriously complicates the course and treatment of children, understanding the compatibility of these disorders has important clinical implications in the management of this population.

Adolescent↗

PubMed2000

History of childhood attention deficit hyperactivity disorder (ADHD) features among adults with panic disorder.

BACKGROUND: The prevalence of ADHD features during childhood and its relationship to the course and presentation of panic in adults with panic disorder was examined. METHODS: The presence of DSM-III-R ADHD was retrospectively ascertained in a cohort of 85 adults with panic disorder by structured interview. RESULTS: Childhood ADHD features occurred in 23.5% of panic subjects; 9.4% satisfied full DSM-III-R criteria for ADHD, 14.1% had 'subthreshold' diagnoses. Two-thirds of panic patients with ADHD indicated persistence of symptoms into adulthood. Fewer had married or completed college than those with panic alone. There was no significant difference in clinical pattern and severity of panic, or comorbidity of adult Axis I and childhood anxiety disorders in both groups. CONCLUSION: Given its frequency and persistence, ADHD comorbidity is an important clinical consideration in all panic patients. Its co-occurrence does not influence the clinical pattern of panic, but may contribute to adverse social outcome.

Adolescent↗

PubMed2002

A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.

(1) The authors tested the prediction that relative deficiencies in highly unsaturated fatty acids (HUFAs) may underlie some of the behavioral and learning problems associated with attention-deficit/hyperactivity disorder (ADHD) by studying the effects of HUFA supplementation on ADHD-related symptoms in children with specific learning difficulties (mainly dyslexia) who also showed ADHD features. (2) Forty-one children aged 8-12 years with both specific learning difficulties and above-average ADHD ratings were randomly allocated to HUFA supplementation or placebo for 12 weeks. (3) At both baseline and follow-up, a range of behavioral and learning problems associated with ADHD was assessed using standardized parent rating scales. (4) At baseline, the groups did not differ, but after 12 weeks mean scores for cognitive problems and general behavior problems were significantly lower for the group treated with HUFA than for the placebo group; there were significant improvements from baseline on 7 out of 14 scales for active treatment, compared with none for placebo. Group differences in change scores all favored HUFA, reaching conventional significance levels for 3 out of 14 scales. (5) HUFA supplementation appears to reduce ADHD-related symptoms in children with specific learning difficulties. Given the safety and tolerability of this simple treatment, results from this pilot study strongly support the case for further investigations.

Attention Deficit Disorder with Hyperactivity↗

PubMed1999

Effect of methylphenidate on attention in children with attention deficit hyperactivity disorder (ADHD): ERP evidence.

Methylphenidate is the most common treatment for attention deficit hyperactivity disorder (ADHD) and has been shown to improve attention and behaviour. However, the precise nature of methylphenidate on specific aspects of attention at different dose levels remains unclear. We studied methylphenidate effects in ADHD from a neurophysiological perspective, recording event-related potentials (ERPs) during attention task performance in normal controls and children with ADHD under different dose conditions. Twenty children with ADHD and 20 age matched controls were assessed with a continuous performance task requiring subjects to identify repeating alphabetic characters. ERPs and behavioural measures were recorded and analyzed for trials where a correct response was made. The ADHD group was assessed off drug (baseline) and on placebo, low (0.28 mg/kg) and high (0.56 mg/kg) dose levels of methylphenidate. The results showed that the ADHD group at baseline was more impulsive and inattentive than controls and had shorter P2 and N2 latencies and longer P3 latencies. Low dose methylphenidate was associated with reduced impulsivity (fewer false alarms) and decreased P3 latencies, whereas the higher dose level was associated with reduced impulsivity and less inattention (more hits), as well as increased P2 and N2 latencies and decreased P3 latencies. Amplitudes were unaffected and there were no adverse effects of the higher dose for any of the children. These results suggest differential dosage effects and a dissociation between dose levels and aspects of processing.

Attention↗