Background
Preschool ADHD symptoms have predictive utility for later presence of ADHD diagnoses (Harvey, Youngwirth, Thakar, & Errazuriz, 2009, Journal of Consulting and Clinical Psychology, 77, 349; ...Lahey et al., 2004, American Journal of Psychiatry, 161(11), 2014), yet some level of inattention, hyperactivity, and impulsivity are present even in typically developing preschoolers. Physical activity (PA) is known to have a broad spectrum of positive effects on the brain in school‐age typically developing children (Centers for Disease Control and Prevention, 2010, The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services), including functions impaired by ADHD (Halperin, Berwid, & O'Neill, 2014, Child and Adolescent Psychiatric Clinics of North America, 23, 899), yet links between PA and ADHD levels and impairments have rarely been studied in either typically developing or at‐risk preschool children. Importantly, impaired processing speed (PS), though not a symptom of ADHD, is a robust neuropsychological correlate (Willcutt & Bidwell, 2011, Treating attention deficit hyperactivity disorder: Assessment and intervention in developmental context. Kingston, NJ: Civic Research Institute) that may indicate additional risk for ADHD. Hence, we examined whether baseline PS moderates the association between preschoolers' PA, specifically moderate‐to‐vigorous PA (MVPA), and changes in ADHD levels and related behaviors.
Method
Eighty‐five preschoolers (49.4% female; Mage = 4.14, SDage = .64) were drawn from a larger study of the effects of the Kiddie Children and Teachers (CATs) on the Move PA program on school readiness. The sample was largely Head Start eligible (68.2%) and ethnically diverse. Hierarchical regressions were utilized to examine links between MVPA, averaged over a school year, and changes in inattention (IA), hyperactivity/impulsivity (HI), oppositional behaviors, moodiness, and peer functioning, and whether these associations varied based on baseline PS.
Results
Results indicated that for IA, HI, and peer functioning, higher amounts of MVPA were associated with greater adaptive change for those with lower (but not higher) levels of PS.
Conclusions
Preschool MVPA may be a viable method of reducing ADHD levels and impairments for those with lower PS.
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The relationship between pain and psychiatric conditions in children and adolescents has been understudied. This study aimed to investigate the influence of gender on the association between pain and ...psychiatric diagnoses, as well as the specific relationship between pain and attention deficit/hyperactivity disorder (ADHD), in a sample of adolescents from the general population. Additionally, the study explored whether pain frequency or intensity in individuals with ADHD was influenced by coexisting psychiatric disorders and ADHD medications.
This cross-sectional study included 1608 conveniently sampled Swedish upper secondary school students aged 15–19 years. Data were collected at the end of 2020 using the electronic "Mental and Somatic Health without borders" survey.
A significant positive association (p < 0.001) was observed between pain frequency, intensity, and the presence of any psychiatric diagnosis. Female adolescents reported more frequent and intensive pain in the groups with or without any psychiatric diagnosis and in those with ADHD, however the presence of a psychiatric diagnosis had a comparatively lesser impact on pain frequency in females when compared to males. In adolescents with ADHD, pain frequency, but not intensity, showed a significant further increase. Moreover, the presence of coexisting depression and/or anxiety further heightened the association between pain frequency and ADHD. Notably, common ADHD medications did not have a significant impact on pain experiences. Headache emerged as the most prevalent type of pain across all groups of adolescents. Back pain specifically appeared as the next most common type of pain among adolescents with ADHD.
The findings suggest a positive association between pain and the presence of psychiatric diagnoses, including ADHD, in adolescents. Gender modified this association. Back pain arised specifically coupled to ADHD. Common ADHD medications did not show a significant impact on pain experiences in this study. These results highlight the importance of a holistic approach to child and adolescent care.
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Objective
The General Life Functioning Scale (GLF) was developed to provide a complementary alternative to existing measures of impairment. We examined the psychometric properties of the GLF‐Parent ...version (GLF‐P), given the known value of informant ratings.
Methods
The GLF‐P was administered to parents of adults with attention‐deficit/hyperactivity disorder (ADHD) diagnosed in childhood and a nonADHD comparison group in the Pittsburgh ADHD Longitudinal Study. GLF‐P ratings described 334 participants (ADHD = 186; comparison = 148) rated at age 25 (Mage = 24.80 years, SDage = 0.46, range = 24–26) and 401 participants (ADHD = 237; comparison = 164) rated at age 30 (Mage = 29.30, SDage = 0.64, range = 28–33). Exploratory (EFA) and confirmatory (CFA) factor analyses were used.
Results
EFAs suggested and CFAs confirmed a five‐factor solution. We found measurement invariance across diagnostic and age groups, satisfactory internal consistency, construct validity, and known‐group validity.
Conclusion
Psychometric results suggest the GLF‐P as a helpful adjunctive measure of functioning. Further research is needed to determine the utility of the GLF across diverse settings.
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Background
Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. This syndrome results from various medications that engender ...serotonergic overactivity. Atomoxetine is a norepinephrine reuptake inhibitor used for the treatment of attention‐deficit hyperactivity disorder (ADHD). Two case reports have described serotonin syndrome induced by the combination of atomoxetine with venlafaxine or methylphenidate, but no report describes this syndrome induced by atomoxetine alone. This report describes serotonin syndrome induced solely by an overdose of atomoxetine in a patient with ADHD.
Case Presentation
The patient in this case was a 21‐year‐old man who had been treated with atomoxetine for ADHD. He was transported to our hospital 1 h after intentional ingestion of 1200 mg of atomoxetine in a suicide attempt. On admission, he showed profuse diaphoresis, marked agitation, somnolence, slight fever, tachycardia, prolonged QT interval, myoclonus, tremor, and hyperreflexia. He was diagnosed as having serotonin syndrome and was treated with administration of activated charcoal and massive infusion. Three days later, his serotonin syndrome symptoms had disappeared completely.
Conclusion
Findings in this case suggest that atomoxetine alone can cause serotonin syndrome presumably via its effects of serotonin reuptake inhibition. Clinicians should consider this syndrome induced by atomoxetine overdose.
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Background
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay ...attention, they are hyperactive and impulsive.
Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms.
Objectives
To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD.
Search methods
In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data.
Selection criteria
We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non‐serious adverse events, general behaviour and quality of life.
Data collection and analysis
Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel‐group trials and first period data from cross‐over trials formed the basis of our primary analyses; separate analyses were undertaken using post‐cross‐over data from cross‐over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias.
Main results
The studies. We included 38 parallel‐group trials (5111 participants randomised) and 147 cross‐over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys‐to‐girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high‐income countries.
The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials).
Risk of Bias. All 185 trials were assessed to be at high risk of bias.
Primary outcomes. Methylphenidate may improve teacher‐rated ADHD symptoms (standardised mean difference (SMD) ‐0.77, 95% confidence interval (CI) ‐0.90 to ‐0.64; 19 trials, 1698 participants; very low‐quality evidence). This corresponds to a mean difference (MD) of ‐9.6 points (95% CI ‐13.75 to ‐6.38) on the ADHD Rating Scale (ADHD‐RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD‐RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low‐quality evidence). The Trial Sequential Analysis‐adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2).
Secondary outcomes. Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non‐serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non‐serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low‐quality evidence). The Trial Sequential Analysis‐adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non‐serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.
Teacher‐rated general behaviour seemed to improve with methylphenidate (SMD ‐0.87, 95% CI ‐1.04 to ‐0.71; 5 trials, 668 participants; very low‐quality evidence).
A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta‐analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent‐reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low‐quality evidence).
Authors' conclusions
The results of meta‐analyses suggest that methylphenidate may improve teacher‐reported ADHD symptoms, teacher‐reported general behaviour, and parent‐reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow‐up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non‐serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.
Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non‐serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo‐like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.
Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non‐pharmacological treatments.
Introduction The National Institute for Health and Care Excellence (NICE) recommends Cognitive-Behavioural therapy (CBT) as the psychotherapeutic treatment of choice for adults with Attention Deficit ...Hyperactivity Disorder (ADHD) in the UK. However, the literature often refers to adapted CBT programs tailored for ADHD and provides limited insight into how adults with ADHD experience and perceive this form of treatment in routine clinical practice. Methods This mixed-methods study aims to explore ADHD individuals’ experience and perception of CBT delivered in routine clinical practice, to gain a better understanding of this treatment’s helpfulness and perceived effectiveness. Results A survey (n=46) and semi-structured in-depth interviews (n=10) were conducted to explore the experience of CBT and its perceived effectiveness in managing ADHD. The interviews were analysed using thematic analysis and the survey was synthesised using descriptive narratives. The thematic analysis highlighted three key themes: difficulties with the CBT framework, difficulties with CBT therapists, and consequences of CBT. The survey highlighted similar findings. Participants described the CBT framework as, generic, rigid, and too short, and described the CBT therapist as unspecialised, unempathetic, and not sufficiently adapting CBT to ADHD-related difficulties. Discussions Overall, participants found non-adapted, generic CBT in the UK to be unhelpful, overwhelming, and at times harmful to their mental well-being. Therefore, it is necessary for clinical bodies in the UK, while following the indicated NICE guidelines, to be mindful of adapting CBT delivery of CBT, to be most effective for people with ADHD and to mitigate potential harm.
•The proposed CAD system can diagnose ADHD using EEG data with high accuracy.•The new deep learning-based method discriminated two subsets of ADHD (ADHD-I and ADHD-C) in children.•The proposed method ...was capable of extracting relevant spatio-temporal features from raw EEG data.•High Frequency bands (β1, β2, and γ) and posterior side electrodes had the most contribution in classification process.
Attention deficit hyperactivity disorder (ADHD) is a ubiquitous neurodevelopmental disorder affecting many children. Therefore, automated diagnosis of ADHD can be of tremendous value. Unfortunately, unlike many other applications, the use of deep learning algorithms for automatic detection of ADHD is still limited.
In this paper, we proposed a novel computer aided diagnosis system based on deep learning approach to classify the EEG signal of Healthy children (Control) from ADHD children with two subtypes of Combined ADHD (ADHD-C) and Inattentive ADHD (ADHD-I). Inspired by the classical approaches, we proposed a deep convolutional neural network that is capable of extracting both spatial and frequency band features from the raw electroencephalograph (EEG) signal and then performing the classification.
We achieved the highest classification accuracy with the combination of β1, β2, and γ bands. Accuracy Recall, Precision, and Kappa values were %99.46, %99.45, %99.48, and 0.99, respectively. After investigating the spatial channels, we observed that electrodes in the Posterior side had the most contribution.
To the best of our knowledge, all previous multiclass studies were based on fMRI and MRI imaging. Therefore, the presented research is novel in terms of using a deep neural network architecture and EEG signal for multiclass classification of ADHD and healthy children with high accuracy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
The number of placebo‐controlled randomized studies relating to EEG‐neurofeedback and its effect on neurocognition in attention‐deficient/hyperactivity disorder (ADHD) is limited. For this ...reason, a double blind, randomized, placebo‐controlled study was designed to assess the effects of EEG‐neurofeedback on neurocognitive functioning in children with ADHD, and a systematic review on this topic was performed.
Methods
Forty‐one children (8–15 years) with a DSM‐IV‐TR diagnosis of ADHD were randomly allocated to EEG‐neurofeedback or placebo‐neurofeedback treatment for 30 sessions, twice a week. Children were stratified by age, electrophysiological state of arousal, and medication use. Neurocognitive tests of attention, executive functioning, working memory, and time processing were administered before and after treatment. Researchers, teachers, children and their parents, with the exception of the neurofeedback‐therapist, were all blind to treatment assignment. Outcome measures were the changes in neurocognitive performance before and after treatment.
Clinical trial registration: www.clinicaltrials.gov: NCT00723684.
Results
No significant treatment effect on any of the neurocognitive variables was found. A systematic review of the current literature also did not find any systematic beneficial effect of EEG‐neurofeedback on neurocognitive functioning.
Conclusion
Overall, the existing literature and this study fail to support any benefit of neurofeedback on neurocognitive functioning in ADHD, possibly due to small sample sizes and other study limitations.
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Adults with attention-deficit/hyperactivity disorder (ADHD) experience impairing levels of inattention and/or hyperactivity-impulsivity, while individuals without ADHD experience these symptoms to a ...lesser extent. Yet, ADHD self-report scales so far hardly captured continuous distributions across the general population. In addition, they focused on weaknesses and ignored strengths. To address these shortcomings, we present here the
. The normal distribution of the data collected and the scale's internal consistency, and factorial and convergent validity were assessed using data from a general population sample. Its clinical utility was evaluated by comparing scores from a clinical sample and a sample of individuals without ADHD and by calculating optimal cut-off values for specificity and sensitivity. The SWAN-DE-SB demonstrated normal distribution of the data collected, high internal consistency, and factorial and convergent validity. It reliably discriminated individuals with and without ADHD, with high specificity and sensitivity. It should therefore be considered a psychometrically convincing measure to assess strengths and weaknesses of ADHD symptoms and normal behavior in clinical and general population samples.
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