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PubMed1999

Linkage study of catechol-O-methyltransferase and attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder is the most common child psychiatric disorder with a prevalence rate in an Ontario study of 9% in boys and 3% in girls [Szatmari et al., 1989]. This disorder is characterized by problems in the areas of attention, overactivity, impulse control, and distractibility. Strong evidence for a genetic component has been provided from twin, family, and adoption studies [for review see Levy et al., 1998] and molecular genetic studies are in progress by several groups worldwide. The Catechol-O-Methyltransferase (COMT) gene is an interesting candidate for ADHD as it is involved in the breakdown of dopamine and norepinephrine, neurotransmitters strongly implicated in the etiology of ADHD. In addition, children with velo-cardio-facial syndrome, a deletion syndrome of the chromosomal region 22q11 where the COMT gene has been localized, often have symptoms of ADHD suggesting this gene may have an etiological role in ADHD. In this study, we have tested for linkage in ADHD families using the functional polymorphism at codon 158 that determines COMT activity [Lachman et al., 1996] and analyzed the data with the transmission disequilibrium test (TDT). A total of 77 nuclear families collected from Toronto were genotyped. We find no evidence for linkage of this polymorphism and ADHD in our sample. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:710-713, 1999.

Adolescent↗

PubMed2001

No association between CHRNA7 microsatellite markers and attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is a highly heritable, common psychiatric disorder of childhood that probably involves several genes. There are several lines of evidence suggesting that the nicotinic system may be functionally significant in ADHD. First, nicotine promotes the release of dopamine and has been shown to improve attention in adults with ADHD, smokers, and nonsmokers. Second, ADHD is a significant risk factor for early initiation of cigarette smoking in children and maternal cigarette smoking appears to be a risk factor for ADHD. Finally, animal studies in rats and monkeys also suggest that nicotine may be involved in attentional systems and locomotor activity. The nicotinic system has previously been studied in schizophrenia where the neuronal nicotinic acetylcholine receptor alpha 7 subunit gene (CHRNA7) has been implicated in decreased P50 inhibition and attentional disturbances in patients with schizophrenia and in many of their nonschizophrenic relatives. Three known microsatellite markers (D15S165, D15S1043, and D15S1360) near the nicotinic acetylcholine alpha 7 receptor gene, CHRNA7, were studied in 206 ADHD parent-proband trios of children aged 5-16 with ADHD according to DSM-IV criteria. Children with known major medical or psychiatric conditions or mental retardation (IQ < 70) were excluded from the study. Markers D15S165 and D15S1360 were in linkage disequilibrium. The extended Transmission Disequilibrium Test analyses demonstrated no evidence that variation at the microsatellite markers D15S1360, D15S1043, and D15S165 influences susceptibility to ADHD. However, it remains possible that the CHRNA7 gene and other nicotinic system genes may be involved in conferring susceptibility to ADHD.

Adolescent↗

PubMed1992

Nursing interventions for children with attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder frequently coexists with a variety of psychiatric and developmental disorders of child psychiatric inpatients. The author highlights characteristics of these patients and examines nursing contributions to treatment. She emphasizes issues of medication administration and monitoring, as well as the development and implementation of interventions to decrease disruptive behavior, enhance self-control, and develop social skills. Effective management techniques are supported by research evidence and illustrated by case examples.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Biased paternal transmission of SNAP-25 risk alleles in attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder, affecting 5-10% of school-age children. Although the biological basis of this disorder is unknown, twin and family studies provide strong evidence that ADHD has a genetic basis involving multiple genes. A previous study found an association between ADHD and two polymorphisms in the 3' untranslated region (UTR) of SNAP-25, a gene encoding a synaptic vesicle docking protein known to play a role in the hyperactivity observed in the Coloboma mouse strain. In this paper, we test biased transmission of the 3' UTR SNAP-25 haplotype using a larger ADHD sample of 113 families with 207 affected children. Using the transmission disequilibrium test (TDT), we found a trend consistent with biased transmission of the TC haplotype of SNAP-25 in all transmissions and detected a significant distortion (P=0.027) when paternal transmissions were evaluated.

Adolescent↗

PubMed2006

Attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is a challenging condition to diagnose and treat. For diagnosis, the clinician needs to establish the presence of ADHD on Diagnostic and Statistical Manual of Mental Disorders criteria requiring information from parents and teachers and considering both alternative diagnoses and co-occurring conditions. In the treatment of ADHD as a chronic illness, the clinician needs to educate the family about the condition and partner with them about treatment decisions. The 2 treatments with demonstrated efficacy for ADHD are medications (stimulant medications and a selective norepinephrine reuptake inhibiter) and behavior-modification programs.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) affects between 1.4% and 6% of children. The importance of the role of primary care in the recognition and joint management of this disorder is being increasingly highlighted. Despite a wealth of research, the diagnosis and management of ADHD have attracted a good deal of controversy. In this discussion paper, we focus on the empirical basis for some of the more controversial aspects of ADHD, such as diagnosis (discussing both under- and overdiagnosis), aetiology, outcomes, and the role of psychosocial factors in this disorder. We conclude that, provided the diagnosis of ADHD is made accurately and systematically, there are no good scientific grounds for dismissing the concept of ADHD or for failing to intervene.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

[Electroencephalographic alterations in children with attention deficit hyperactivity disorder].

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a syndrome that affects between 3 5% of the population of school aged children, and may be accompanied by learning, language, behavioural or motor disorders. Although various electroencephalographic alterations have been described in these patients, their pathological significance has not been determined. There have also been reports of children with neuropsychological and language disorders having epileptiform anomalies in the EEG recording. PATIENTS AND METHODS: We conducted a study of 15 children, with no history of seizures, who had been referred to Child Neurology for treatment and who satisfied the criteria for ADHD according to the DSM IV and the ADHRS (attention deficit/hyperactivity rating scale). RESULTS: The EEG recording in the waking state showed significant anomalies in two of our patients (acute spike and wave paroxysmal activity in the left temporoparietal region and spike wave discharges during hyperventilation). The polysomnographic study revealed specific alterations in four children. There was a continuous spike wave trace during slow sleep (CSWS) in one case, paroxysmal activity (slow acute waves, spikes) in the temporoparietal region with secondary generalization or transmission (two cases), and frequent generalized paroxysmal discharges of slow acute waves in all phases of sleep (one case). CONCLUSIONS: The neurophysiological disorders observed in some of our patients could make it necessary to consider performing a night time polysomnographic study in certain cases of ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

The pathophysiology, medical management, and dental implications of children and young adults having attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder is considered to be the most common neurobehavioral disorder among school-aged children. Children who have ADHD exhibit symptoms of inattention, hyperactivity, and impulsivity that are extreme for their age. These symptoms adversely affect academic performance, vocational success, and social-emotional development. The disorder is usually treated with stimulant medications, but on occasion antidepressants and certain antihypertensive agents are used. Dentists caring for individuals with ADHD must be familiar with the manifestations of the disease and its associated features so they can garner the maximum level of cooperation from the patient. They must also be familiar with the drugs used to treat the disorder because many of these pharmaceuticals cause adverse orofacial and systemic reactions and may interact with dental therapeutic agents.

Adolescent↗

PubMed1995

Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is the term used to describe children who are inattentive, impulsive, and hyperactive. The cause is unknown and is thought to be multifactorial. Based on the work of others, we hypothesized that some children with ADHD have altered fatty acid metabolism. The present study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids (20:4n-6, 20:5n-3, and 22:6n-3) and in red blood cell total lipids (20:4n-6 and 22:4n-6) than did the 43 control subjects. Also, a subgroup of 21 subjects with ADHD exhibiting many symptoms of essential fatty acid (EFA) deficiency had significantly lower plasma concentrations of 20:4n-6 and 22:6n-3 than did 32 subjects with ADHD with few EFA-deficiency symptoms. The data are discussed with respect to cause, but the precise reason for lower fatty acid concentrations in some children with ADHD is not clear.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

[Neurocognitive symptoms of childhood attention deficit hyperactivity disorder].

OBJECTIVES: Attention Deficit Hyperactivity Disorder is the most common childhood-onset disorder that has been characterized with the dysfunction of executive functions. These functions are related to the frontal lobe, especially to different frontostriatal networks. The purpose of this study was to examine executive functions of 5-7 years old (non-literate) children with and without ADHD. METHOD: We used well-known neuropsychological tests (and some other tests developed by us) which measure the organisation and execution of behavior and thinking. 31 children with ADHD and 26 healthy children without ADHD -- comparable to the other sample with respect to age and sex -- participated in this examination. We compared the two groups in terms of various aspects of executive functions, such as inhibition, attention, motor implementation and visual memory. The test battery used included the Colour Raven Test, a version of the Tower of Hanoi for children, the Bender A and B Test, the Block Design Subtest of the Wechsler Intelligence Scale, the children version of Rey Complex Figure Test, the Picture Attention Test and the Fruit Stroop Test. In order to explore the characteristics of the variables, the factor-analytic method was used by which the various aspects of executive functions could be separated. RESULTS: Statistical comparison of the two groups revealed that several aspects of executive dysfunctions (strategy-constitution, inhibition, attention and motor implementation) can be seen in ADHD.

Analysis of Variance↗

PubMed2006

Role of electroencephalography in attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is characterized by symptoms of inattention, hyperactivity and impulsivity, and affects 3-5% of school-aged children. Recommendations regarding the relative importance of electroencephalography (EEG) in ADHD are ambiguous. Most guidelines for ADHD diagnostics only recommend an EEG in cases with clinical suggestion of seizure disorders or degenerative conditions and not for routine use. Although in most cases of ADHD, an EEG is indeed unnecessary, without a routine EEG, some children with absences or rolandic spikes will not be identified and, therefore, will not be treated correctly. The EEGs of children with ADHD demonstrated increased theta activity and fewer alpha waves compared with controls. Research on event-related potentials is helpful in identifying underlying attentional deficits in ADHD. Future studies that combine EEG analysis with functional magnetic resonance imaging data, positron emission tomography studies or genetic research will help to improve our knowledge about the pathophysiology of ADHD and perhaps lead to a better, more individual treatment in well defined subgroups.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

[Biochemical bases and research in attention-deficit hyperactivity disorder].

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder, which is very common among the school aged population. Its core symptoms are inattention, hyperactivity, and impulsivity. Currently, three principal subtypes of ADHD are recognized: ADHD predominantly inattentive type, ADHD predominantly hyperactive/impulsive type or ADHD combined type. Affected individuals have increased comorbidity risks, often followed by cognitive, emotional and/or social impairments as adults. Stimulants drugs such methylphenidate (Ritalin) or D amphetamine (Dexedrine) represent the first line drugs for the treatment of ADHD. DEVELOPMENT: The clinical features of ADHD were first described by Dr. George Frederick Still for Lancet in 1902, and in spite of the investigations carried out since then, the precise cause is still not clear. The purpose of this review is to describe recent advances of the neurobiological basis of ADHD. CONCLUSIONS: Recent neuroimaging studies in humans indicate a dysfunctions of the frontal striatal circuits in patients with ADHD, which can be improved by pharmacological treatment. Both pre and clinical studies implicate a dysregulation of the dopaminergic and noradrenergic systems, which are known to regulate the functions of these circuits. More recent evidence indicate that some features of ADHD could be linked to alterations in the posterior inferior vermis. These studies also stress the importance of taking into consideration factors such as age, gender and duration of pharmacological treatment when interpreting the results.

Adult↗

PubMed2000

The neurobiology of attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder is a childhood psychiatric disorder characterized by inattention, impulsivity, and overactivity. Considerable research has focused on the neurobiological substrates of this disorder. Although the specific nature of the brain dysfunction remains elusive, progress has been made and several models of the underlying pathophysiology have been suggested. Research in the fields of neuropsychology, neuroimaging, neurochemistry, and molecular genetics, which points to a multifactorial etiology for the disorder, is reviewed. While several inconsistencies exist across studies, evidence supports dysfunction of fronto-striatal dopaminergic and noradrenergic circuits with resultant executive deficits in cognitive functioning.

Attention Deficit Disorder with Hyperactivity↗

PubMed2000

A follow-up pilot study of objective measures in children with attention deficit hyperactivity disorder.

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a common childhood problem requiring stimulant medications in a significant proportion of cases. The aim of this pilot study was to assess the effects of prolonged stimulant medication therapy on a continuous performance test, the Test of Variables of Attention (TOVA), which measures objectively features of ADHD. METHODS: Eighteen children aged 8 to 16 years who were diagnosed with ADHD, based on the Diagnostic and Statistical Manual of Mental Disorders 4th edn criteria, were included in the study. Assessment on a continuous performance test (TOVA) was performed initially and the children were administered stimulant medications for at least 12 months. The medications were stopped for 1 week, followed by a repeat TOVA assessment which was compared to the initial TOVA assessment. RESULTS: Follow up TOVA scores showed a significant improvement in mean commission errors (impulsivity) after the stimulant medication therapy. No significant improvement was found in omission errors (inattention), response time and variability. There was a significant positive correlation between commission and omission scores (P value 0.0001). CONCLUSIONS: The results of this pilot study indicate that there is objective improvement in impulsivity in children with ADHD after a prolonged period of stimulant medication therapy. The study suggests that it would be useful to perform formal studies to investigate this further and also to assess the role of continuous performance test (TOVA) as a method for monitoring the need for ongoing therapy.

Adolescent↗

PubMed2006

Variations in prevalence of attention deficit hyperactivity disorder worldwide.

Attention deficit hyperactivity disorder (ADHD) is among the most common, intensely investigated, and yet diagnostically controversial neurobehavioral conditions of childhood. The prevalence of ADHD has been reported with great variations among different studies, ranging from 2.2% to 17.8%. The aim of this review was to investigate the variables that influence the prevalence of ADHD and to derive a best estimate for the prevalence of the disorder. We reviewed all the 39 studies on ADHD prevalence appearing in the Pubmed and published since 1992. These studies indicate that ADHD is more common in boys than girls, in younger than older children and adolescents, in one-setting rather than two-setting screening studies, in studies based on DSM-IV rather than DSM-III-R criteria. Additional factors that may well influence prevalence rates include source of information and assessment of clinical impairment. In conclusion, our findings suggest that population characteristics, methodology features, ethnic and cultural differences and diagnostic criteria involved in studies affect the prevalence of ADHD. Standardized designs may lead to firm conclusions on the true prevalence of ADHD, the estimation of which seems impossible to be achieved by reviewing the already existing literature.

Attention Deficit Disorder with Hyperactivity↗

PubMed1998

Neurobiology of attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is an early-onset, clinically heterogeneous disorder of inattention, hyperactivity, and impulsivity. Family, twin, adoption, segregation analysis, and molecular genetic studies show that is has a substantial genetic component. Although their results are still tentative, molecular genetic studies suggest that three genes may increase the susceptibility to ADHD: the D4 dopamine receptor gene, the dopamine transporter gene, and the D2 dopamine receptor gene. Studies of environmental adversity have implicated pregnancy and delivery complications, marital distress, family dysfunction, and low social class. The pattern of neuropsychological deficits found in ADHD children implicate executive functions and working memory; this pattern is similar to what has been found among adults with frontal lobe damage, which suggests that the frontal cortex or regions projecting to the frontal cortex are dysfunctional in at least some ADHD children. Moreover, neuroimaging studies implicate frontosubcortical pathways in ADHD. Notably, these pathways are rich in catecholamines, which have been implicated in ADHD by the mechanism of action of stimulants--the class of drugs that effectively treats many ADHD children. Yet human studies of the catecholamine hypothesis of ADHD have produced conflicting results, perhaps due to the insensitivity of peripheral measures.

Adult↗

PubMed2004

[Neuropsychological findings in adults with attention deficit hyperactivity disorder].

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder with childhood onset and persistence into adulthood. Role of neuropsychological testing is becoming an important clinical measure in the assessment and diagnosis of adults with ADHD. The aim of this study was to assess neuropsychological functions of adults with ADHD compared to healthy controls. METHOD: Neuropsychological functions of 16 adults with DSM-IV diagnosis of ADHD and 16 healthy controls were assessed. Control grup was matched in age, gender and years of education. Benton Visual Retention Test, Wisconsin Card Sorting Test (WCST), Wechsler Memory Scale and Stroop Color and Word Test were used for neuropsychological assessment. RESULTS: 13 of the ADHD patients were male and 3 were female. Mean age was 29.5+/-8.1, and mean education year was 13.4+/-2.2. In Stroop Color and Word Test, adults with ADHD completed word and color word subtests in a longer time than normal controls, made more mistakes in color reading subtest, made more corrections in word subtest, and had higher interferance scores compared to healthy controls (p.05). Adults with ADHD also showed poorer performance in Wechsler Memory Scale's logical memory subtest (p<.05). Patients' and healthy controls' performances were similar in Wisconsin Card Sorting Test and Benton Visual Retention Test. CONCLUSION: Although ADHD adults' perfomance in traditional measures of executive functioning (WCST) were similar to normal controls, they showed poor performance in tests measuring selective attention, distractibility and response inhibition (Stroop Test) indicating that attention problems do not remit with age and persist in adulthood.

Adult↗

PubMed2001

Treatment of attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is a common disorder among children and adolescents with reported prevalence rates of between 3 and 10%. Recent reports suggest that a multimodal treatment approach is preferable to address many symptoms of ADHD and its associated problems for the children, the family, and the school. Stimulant medications remain the mainstay of treatment and are highly effective in more than 75% of patients. Improvement in the core symptoms of inattention, impulsivity, and hyperactivity are most noticeable. Recently approved extended release preparation of methylphenidate will allow once a day dosing. Reports of effectiveness of some non-stimulant medications such as bupropion, especially for adolescents, appear promising. A number of behavioral and psychosocial interventions can be used effectively as part of multimodal approach to address many ADHD-related problems. This article provides an update on practical information on the treatment of children and adolescents with ADHD who do not have other associated psychiatric disorders.

Antidepressive Agents↗