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PubMedDate not supplied

[The biopsychosocial characteristics of schoolchildren with attention deficit hyperactivity disorder indicators].

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood. According to the literature, ADHD is a syndrome produced by multiple causes that depend on genetic factors and environmental and social adversities. AIMS: Our aim was to describe the biopsychosocial characteristics of schoolchildren with ADHD indicators. PATIENTS AND METHODS: The sample used in our study consisted of 31 children (aged between 7 and 10 years) studying in the first and second course of primary education in state-run schools in Florianopolis (Santa Catarina, Brazil), who had ADHD indicators based on the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV) and the EDAH questionnaires, which were answered by teachers and parents. The mothers and another legal guardian of these children answered a biopsychosocial questionnaire that contained questions concerning their pre, peri and postnatal history, neuropsychomotor development, family environment and questions about ADHD. RESULTS: Findings showed a number of diverse risk factors that may be related with the disorder. Many of these biopsychosocial characteristics were highly prevalent in the children in this study. They cannot, however, be considered to be a cause of the disorder but they may be possible risk factors. CONCLUSIONS: Knowledge of the child's history is important to be able to reach an accurate diagnosis, as well as to try to prevent and treat this syndrome.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Effect of stimulant medication on lower extremity response time of boys with attention deficit hyperactivity disorder.

Children with attention deficit hyperactivity disorder (ADHD) have been labeled as "inefficient movers"; however, little research has examined the effect of stimulant medication on lower extremity movements. 16 boys, 11 to 13 years old, with ADHD performed a lower-limb choice-response time task, both on and off medication. When nonmedicated, children had significantly slower reaction times to all three targets and significantly slower movement times for the contralateral and midline movements. For both conditions, children had significantly faster movement time when using the right leg than the left leg. These findings suggest that movement characteristics of children with ADHD are different under medicated and nonmedicated situations.

Adolescent↗

PubMed2000

Family study of girls with attention deficit hyperactivity disorder.

OBJECTIVE: Because attention deficit hyperactivity disorder (ADHD) is relatively infrequent among girls, little is known about the causes of ADHD in girls. To help fill this gap in the literature, the authors assessed the familial transmission of ADHD in families ascertained through girls. METHOD: Interviewers who were blind to diagnosis administered structured psychiatric interviews to 140 girls with ADHD and their 417 first-degree relatives and to 122 girls without ADHD and their 369 first-degree relatives. RESULTS: The relatives of the ADHD girls had a significantly higher prevalence of ADHD, according to either the DSM-III-R or DSM-IV definition, than the relatives of the comparison girls. However, this did not differ from the prevalence the authors reported previously for families of boys with ADHD. Like the boys' families, the relatives of the girl probands also had significantly higher prevalences of antisocial, mood, anxiety, and substance use disorders, although the prevalence of familial antisocial disorders was lower than had been observed in the boys' families. There was no association between the DSM-IV subtypes of the probands and relatives. CONCLUSIONS: The familial transmission of ADHD and comorbid disorders generalizes to families of girls with ADHD. Neither proband gender nor subtype influences the familial transmission of ADHD.

Adolescent↗

PubMed2006

Activation in ventral prefrontal cortex is sensitive to genetic vulnerability for attention-deficit hyperactivity disorder.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a heritable neuropsychiatric disorder, associated with atypical patterns of brain activation in functional imaging studies. Neuroimaging measures may serve as an intermediate phenotype in genetic studies of ADHD, as they are putatively more closely linked to gene expression than a clinical diagnosis. METHODS: We used rapid, mixed-trial, event-related functional magnetic resonance imaging (fMRI) to investigate changes in brain activation during a go no-go task in boys with ADHD, their unaffected siblings, and matched control subjects. RESULTS: On the hardest inhibitory trials in our task, children and adolescents with ADHD had lower accuracy than control subjects, whereas their unaffected siblings did not. Control subjects activated a network of regions, including ventral prefrontal and inferior parietal cortex. Both children and adolescents with ADHD and their unaffected siblings showed decreased activation in these areas, as well as fewer correlations between performance and activation. CONCLUSIONS: These findings suggest that the magnitude of activation during successful inhibitions is sensitive to genetic vulnerability for ADHD in a number of regions, including ventral prefrontal cortex. If this can be replicated in future studies, this suggests that neuroimaging measures related to inhibitory control may be suitable as intermediate phenotypes in studies investigating gene effects in ADHD.

Adolescent↗

PubMed1990

Stimulant medication use by primary care physicians in the treatment of attention deficit hyperactivity disorder.

Treatment of attention deficit hyperactivity disorder (ADHD), one of the most common behavioral disorders in children in the United States, remains controversial because of concern about stimulant medication use. Extending a previous study of pediatricians, the present study surveyed a random national sample of family practitioners and then directly screened 457 patients of 10 pediatricians and family practitioners in two small midwestern cities. Responses to the national survey indicated that stimulant medication remains the main treatment prescribed by primary care physicians for children with ADHD. In the direct patient screening, the prevalence of ADHD diagnoses was 5.3% (pediatricians) and 4.2% (family practitioners) of all elementary-school-aged children screened. Eighty-eight percent of these children were treated with methylphenidate. Although medication was considered an effective treatment by the parents of 85% of the children given the medication, efficacy was unrelated to the accuracy of diagnosis. When explicit DSM-III-R criteria were used, only 72% of those assigned a diagnosis of ADHD by the physicians would have received that diagnosis based on a structured psychiatric interview with the parents and only 53% received that diagnosis based on teacher report of symptoms, even when the child was not receiving medication. Although the majority of physicians (in both the surveys and the direct screenings) reported using at least some behavioral treatments with their patients, parents reported infrequent use of nonpharmacologic forms of therapy, such as behavior modification. These data thus indicate a relatively modest rate of stimulant medication use for ADHD, but a serious underuse of systematic behavioral treatments in primary care.(ABSTRACT TRUNCATED AT 250 WORDS)

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Clinical assessment and treatment of attention deficit hyperactivity disorder in adults.

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood, with significant levels of inattentive, hyperactive and impulsive behavior. Impairments associated with adult ADHD include distress from the symptoms, impaired ability to function in work and academic settings, and problems sustaining stable relationships. The disorder is commonly associated with volatile moods, antisocial behavior, and drug and alcohol misuse. There is an increased risk of developing comorbid anxiety, depression, personality disorders, and drug and alcohol dependence. Despite the proven effectiveness of drugs such as methylphenidate, dexamphetamine and atomoxetine, few cases of ADHD are recognized and treated in the UK. The reasons for this are unclear, since most psychiatrists working with children and adolescents are aware that ADHD commonly persists into adult life and they also see the disorder affecting parents of children with ADHD. Issues of transition from the care of child to adult psychiatry and the need to refer adult relatives of children with ADHD to suitable psychiatric services are a major concern. Furthermore, many cases of adult ADHD go unrecognized or are seen by mental health teams that are not familiar with the subtleties of the adult presentation. As a result, misdiagnosis and treatment for conditions such as atypical depression, mixed affective disorder, cyclothymia, and borderline and unstable emotional personality disorders is not uncommon. There is therefore a requirement for further training in this area. This review will describe the common clinical presentation and provide guidelines for the diagnosis and treatment of ADHD in adults. Any psychiatrically trained physician using standard psychiatric assessment procedures can perform clinical evaluations for adult ADHD. As with other psychiatric disorders in adulthood, ADHD has its own characteristic onset, course and psychopathology. Symptoms of ADHD are trait-like, being stable characteristics from early childhood, and commonly co-occur with affective instability. Stimulants are the mainstay of treatment and are effective in around 70% of cases. Psychotherapeutic interventions also have an important role. These guidelines will assist psychiatrists and other adult mental health workers in identifying and treating individuals with adult ADHD.

Adult↗

PubMed1996

Behavioral and pharmacological studies on the validation of a new animal model for attention deficit hyperactivity disorder.

Childhood hyperactivity (attention deficit hyperactivity disorder, ADHD) is a common behavior disorder among grade-school children. The characteristic symptoms are attentional problems and hyperkinesia. A number of animal models for ADHD syndrome have been developed, but very few of these models are truly representative in that they rarely describe both hyperactivity and attentional problems. Frequently the disorder has been induced in animals by pharmacological manipulations or exogenous brain lesions which are distinct from the disturbances in normal developmental processes which ultimately lead to ADHD. The main purpose of the present research was to develop a new animal model of ADHD, such that it would include an attention deficit, hyperactivity and alleviation by treatment with a psychostimulant. We used rats trained for a 5-choice serial reaction time task which assessed sustained attention. In this behavioral paradigm, rats are required to discriminate spatially a short visual stimulus that will occur randomly in one of five locations and have to maintain an adequate activity level. The ability of a rat to maintain its attention on the task can be measured by counting choice accuracy (percent correct responses), whereas percentage of premature responses indicates the level of motoric activity. According to the present results, rats performing poorly in the task have poorer choice accuracy and they make more premature responses than well performing individuals, i.e., a clear correlation was observed between these parameters (r = -0.59, p < .001). Interestingly, choice accuracy of poorly performing rats was found to be better at the beginning of testing, but it became impaired toward the end of testing session. It was also found that the deficiency was not due to impaired visual discrimination, since a reduction in the intensity of the visual stimulus impaired to a similar extent the performance of normal and poorly performing subjects. Equally, no relationship was observed between choice accuracy and the latencies to collect earned food pellets after the correct responses, indicating that motivational factors do not underlie the attention deficit or excessive activity of poorly performers. Furthermore, methylphenidate hydrochloride at doses of 100 and 1000 micrograms/kg slightly improved the attentional performance of poorly performing animals. At the dose 100 micrograms/kg, methylphenidate slightly decreased the probability of premature responses (impulsivity) in these rats, but 1000 micrograms/kg methylphenidate increased the impulsivity of both normal and poorly performing rats. However, methylphenidate did not affect the choice accuracy of normal animals tested at the baseline conditions or with the reduced stimulus duration which impaired their performance. The present data indicate that rats showing poor performance when trained and tested in a 5-choice serial reaction time task may be a model for ADHD.

Animals↗

PubMed2002

Conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, and is more prevalent in boys. The adult outcome of girls with ADHD has never been studied. AIMS: To identify predictors for adult psychiatric outcome of children with ADHD, including gender and comorbidity. METHOD: Children aged 4-15 years, referred for hyperactivity/inattention and treated with stimulants were included (n=208). The Psychiatric Case Register provided follow-up data on psychiatric admissions in adulthood until a mean age of 31 years. RESULTS: A total of 47 cases (22.6%) had a psychiatric admission in adulthood. Conduct problems in childhood were predictive (hazard ratio HR=2.3; 95% CI 1.22-4.33). Girls had a higher risk compared with boys (HR=2.4; 95% CI 1.1-5.6). CONCLUSIONS: Girls with ADHD had a higher risk of adult psychiatric admission than boys. Conduct problems were also associated with a higher risk. Girls with ADHD with conduct problems had a very high risk of a psychiatric admission in adulthood.

Adolescent↗

PubMed2005

Dexmethylphenidate extended-release capsules for attention deficit hyperactivity disorder.

Medications for attention deficit hyperactivity disorder (ADHD) currently represent the ninth largest segment of the CNS market by sales, with 2.4 billion USD spent annually on this condition and 40% annual growth. Stimulant medications remain the most effective ADHD therapies and provide robust improvement in ADHD symptoms in both youth and adults. Current prescribing practices favor extended release preparations due to increased convenience, compliance and tolerability with once-daily dosing. Dexmethylphenidate extended release is a long-acting preparation of the ADHD medication Focalin (dexmethylphenidate immediate release) and was approved for marketing by the US Food and Drug administration in June 2005. Dexmethylphenidate consists of the single dextro-isomer form of d,l-methylphenidate commonly marketed as Ritalin. Dexmethylphenidate extended release utilizes spheroidal oral drug absorption system technology to achieve a 50% immediate medication delivery and 50% delayed release of dexmethylphenidate approximately 4 h after ingestion. Placebo-controlled, clinical trials in children and adults with ADHD have demonstrated efficacy for behavioral and academic ratings, with an analog classroom study showing medication effects up to 12 h after dosing. Dexmethylphenidate extended release was generally well tolerated with a side-effect profile similar to other stimulants. The most common reported side effects include diminished appetite and insomnia. Given its duration of effect, favorable tolerability and flexibility in dosing, dexmethylphenidate extended release is likely to gain considerable use as an ADHD treatment.

Animals↗

PubMed2002

Use of complementary and alternative medicine for symptoms of attention-deficit hyperactivity disorder.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is a common childhood psychiatric condition for which evidence-based treatments have been established. This study describes use of complementary and alternative medicine among children with ADHD or at risk of having ADHD and explores possible predictors of use of such treatments. METHODS: A sample of 1,615 parents of elementary school students in a public school district were interviewed in a telephone screening survey of ADHD symptoms and use of traditional and nontraditional ADHD treatment. A total of 822 parents had a child with a diagnosis of ADHD, had a child in whom ADHD was suspected, or had a child about whose emotions or behavior the parents or school staff had general concerns. RESULTS: Use of complementary and alternative medicine was significantly higher among children who had received a diagnosis of ADHD (12 percent) or in whom ADHD was suspected (7 percent) than among those about whom parents or school staff had general concerns (3 percent). Faith healing had been used for 4 percent of the 822 children. Nontraditional treatments were more likely to have been used among children with a diagnosis or a suspected diagnosis of ADHD and those whose parents used the Internet as a source of information than among other children. CONCLUSIONS: Providers should inquire about nontraditional interventions and educate families about evidence-based approaches when treating children with ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

Suggestions for improving intimacy in couples in which one partner has attention-deficit/ hyperactivity disorder.

Attention-deficit/hyperactivity disorder (AD/HD) is a neurobiological disorder that is both hereditary and lifelong. Three types of AD/ HD have been determined: hyperactive-impulsive, inattentive, and combined. The hyperactive-impulsive type is marked by a lack of self-control; people with this type have a constant need for activity and are very impatient. The inattentive type has difficulty paying attention, especially to details. The combined type has characteristics of both. The goals of this article are to discuss the impact that AD/HD has on couples when one partner has the disorder and to offer some suggestions for improving intimacy.

Adult↗

PubMed1994

Gender differences in a sample of adults with attention deficit hyperactivity disorder.

Although originally conceptualized as a childhood disorder, attention deficit hyperactivity disorder (ADHD) may also be an adult disorder. However, despite increasing media attention to adult ADHD, its validity has only recently been studied in a systematic fashion. The overrepresentation of females in adult samples in comparison to pediatric samples of ADHD raises additional questions about the validity of this disorder in adults. The goal of this article is to explore whether ADHD is a valid clinical entity in female subjects and whether it is expressed differently in male and female adults. To this end, we examined the clinical, cognitive, and functional characteristics of 128 referred adult ADHD cases of both sexes. Each subject had a clinical diagnosis of childhood-onset ADHD confirmed by structured interview. The male and female ADHD adults were similar to one another but more disturbed and impaired than non-ADHD adult control subjects. Compared with normal control females, ADHD women had higher rates of major depression, anxiety disorders, and conduct disorder; and more evidence of school failure and cognitive impairment. The consistency of these findings in both genders further supports the validity of the diagnosis of ADHD in adults. Our results stress the viability and importance of identification of female subjects with ADHD. The underidentification and undertreatment of females with ADHD may have substantial mental health and educational implications, suggesting that research is needed to develop a better understanding of clinical indicators of ADHD in females.

Adult↗

PubMed1996

Clinical recognition and management of adult attention deficit hyperactivity disorder.

Adults with attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are a new phenomenon to many health care providers. While increasing evidence indicates children with ADD/ADHD can have persistent problems into adulthood, the significance and management of these disorders for adults are poorly understood. Studies of adults are confounded by frequent comorbidity with other conditions and by retrospective diagnosis of childhood ADD/ADHD. Research studies of pharmacologic interventions do not indicate a clear pattern of efficacy and safety for any drug class. Pharmacologic treatment of adults with ADD/ADHD is often guided by clinical experience. Efficacy of treatment with medications may be related to specific subpopulations among adults with ADD/ADHD. No controlled studies of the clinical efficacy of nonpharmacologic treatment have been done, but clinical experience suggests that counseling to assist with organizational skills and interpersonal relationships may be helpful. Adults who present with problems that include impulsivity, distractibility, impaired interpersonal relationships and significant discrepancies between intellectual ability and work performance should have adult ADD/ADHD as part of their differential diagnosis. A cautious approach to pharmacological management and referral to counselors who have experience with adult ADD/ADHD is advised.

Adult↗

PubMed2006

Increased number of subcortical hyperintensities on MRI in children and adolescents with Tourette's syndrome, obsessive-compulsive disorder, and attention deficit hyperactivity disorder.

OBJECTIVE: To investigate whether cerebral hyperintensities on T2-weighted magnetic resonance images (MRI) are associated with childhood neuropsychiatric disorders. METHOD: The authors compared the frequency of cortical and subcortical cerebral hyperintensities in 100 children and adolescents with Tourette's syndrome, obsessive-compulsive disorder (OCD), or attention deficit hyperactivity disorder (ADHD) and 32 healthy comparison subjects. RESULTS: The frequency of cerebral hyperintensities was significantly higher in subjects with Tourette's syndrome, OCD, or ADHD than in healthy comparison subjects; each diagnostic group seemed to contribute to this effect. Among the patient groups, the likelihood of detecting cerebral hyperintensities in the subcortex (primarily the basal ganglia and thalamus) was significantly greater than in the cortex. CONCLUSIONS: A childhood diagnosis of Tourette's syndrome, OCD, or ADHD significantly increased the likelihood of detecting cerebral hyperintensities, particularly in the subcortex, supporting the notion that subcortical injury may play a role in the pathophysiology of these conditions.

Adolescent↗

PubMed2004

The comorbidity of Pervasive Developmental Disorder and Attention Deficit Hyperactivity Disorder: results of a retrospective chart review.

OBJECTIVE: To determine if a sample of children meeting diagnostic criteria for a Pervasive Developmental Disorder (PDD) display symptoms and impairment related to Attention Deficit Hyperactivity Disorder (ADHD) sufficient to warrant a comorbid diagnosis of ADHD. Further, do children with PDD displaying such symptoms demonstrate more impairment in daily life activities than those children only having PDD? METHOD: A retrospective chart review was conducted on children (N = 57) diagnosed with the PDD's of Autism or PDD-Not Otherwise Specified (PDD-NOS), or ADHD. Comparative analysis of questionnaire and neuropsychological test data was completed to determine the severity of ADHD-like symptoms presenting among children with PDD. RESULTS: From the pool of subjects having PDD with sufficient data (N = 27), 7 or 26% met DSM-IV criteria for the combined type of ADHD. Nine or 33% met diagnostic criteria for the Inattentive Type of ADHD and 11 or 41% did not demonstrate a significant number of ADHD symptoms to warrant a comorbid diagnosis of ADHD. Results indicate that a subgroup of children with PDD displaying significant ADHD-like symptoms may in fact have ADHD thus warranting a comorbid diagnosis of ADHD. Current data did not suggest children with PDD and the combined type of ADHD demonstrated significantly more impairment in daily life functioning than those children only having PDD. However, this appeared likely the result of small sample size. The data, however, does indicate such children experience more difficulties in daily situations as rated by parents and teachers. CONCLUSION: These findings reinforce clinical observations indicating that some children with PDD may also experience an independent comorbid condition of ADHD, suggesting that a comorbid diagnosis of ADHD with PDD be considered in such cases. If further findings are replicated, the current exclusionary DSM-IV-TR criteria of making such a comorbid diagnosis should be re-considered.

Attention Deficit Disorder with Hyperactivity↗

PubMed1997

Frontocortical activity in children with comorbidity of tic disorder and attention-deficit hyperactivity disorder.

Comorbidity of tic disorder (TD) and attention-deficit hyperactivity disorder (ADHD) in children is common but not fully understood. Thus we investigated the effect of TD and ADHD on the amplitude of the postimperative negative variation (PINV) in children with combined tic + hyperactivity symptoms (TD + HA). PINV was chosen as an indicator of frontal lobe functioning that is closely related to self-regulation of behavior. PINVs of four groups of children (healthy controls, pure TD, pure ADHD, and combined TD + HA; total number 43) were elicited in an auditory warned reaction task in three conditions (control = CC, loss-of-control = LoCC, and lack-of-control = LaCC) at midfrontal (Fz) and midcentral (Cz) leads of the scalp. Effects of TD and ADHD were revealed only in the noncontrol conditions, being independent in the LaCC, but interactive in the LoCC. Thus, the additive model of psychopathological classification concerning the comorbidity of TD and ADHD was only partially supported by the observed pattern of psychophysiological results.

Attention↗

PubMed1996

Backward-masking deficit in adolescents with schizophrenic disorders or attention deficit hyperactivity disorder.

OBJECTIVE: Backward masking is a cognitive task that involves the earliest phases of visual information processing. Disrupted task performance caused by a visual mask has been found repeatedly in schizophrenic patients; however, the specificity to schizophrenia of deficits in backward masking has received only limited study. METHOD: In this study 20 patients with early-onset schizophrenic disorders were compared to 20 adolescents with attention deficit hyperactivity disorder (ADHD) and 30 normal adolescents on a two-digit identification task in three backward-masking conditions: no mask, a short stimulus interval (33.0 msec), and a long stimulus interval (49.5 msec). RESULTS: The performance of the two groups of patients was similar, and both groups showed a statistically significant masking deficit after the long stimulus interval and a nearly significant deficit after the short stimulus interval in comparison with the normal subjects. CONCLUSIONS: Increased vulnerability to the masking stimulus was confirmed in schizophrenic subjects, but it is not specific to schizophrenia and is not accounted for by psychotic symptoms alone, since the subjects with ADHD performed similarly.

Adolescent↗

PubMedDate not supplied

[Cognitive evoked potentials in the hyperactivity attention deficit disorder].

INTRODUCTION: The Attention Deficit Hyperactivity Disorder, ADHD, is characterized by deficient attention, impulsiveness and excessive motor activity. The incidence is estimated between 5 and 9% of children of school age. The P300 wave is one of the cognitive components of the event related potential ( ERP) that is more used to investigate the attention and the cognitive processes. OBJECTIVE: The aim of this study was to investigate the information processing in children with ADHD predominantly inattentive type by means of the visual and auditory P300 component. PATIENTS AND METHODS: P300 wave using an auditory and visual oddball paradigm were recorded in 18 children with ADHD and in 18 normal children ( control group ). RESULTS: We found differences in reaction time and in the percentage of errors between children with ADHD and between controls. In the ADHD the latency of the auditory and visual P300 were significantly longer than in the control group, and the amplitude of both components were significantly smaller in the ADHD group than in controls. We didn t found differences in the cortical distribution of the P300 between the two groups. CONCLUSIONS: These data suggests that there is an abnormal processing of cognitive information in children with ADHD predominantly inattentives and a dysfunction in attentional mechanisms.

Attention Deficit Disorder with Hyperactivity↗