Background
Sluggish cognitive tempo (SCT) is distinct from attention‐deficit/hyperactivity disorder inattention (ADHD‐IN) and concurrently associated with a range of impairment domains. However, few ...longitudinal studies have examined SCT as a longitudinal predictor of adjustment. Studies to date have all used a relatively short longitudinal time span (6 months to 2 years) and only rating scale measures of adjustment. Using a prospective, multi‐method design, this study examined whether SCT and ADHD‐IN were differentially associated with functioning over a 10‐year period between preschool and the end of ninth grade.
Methods
Latent state‐trait modeling determined the trait variance (i.e. consistency across occasions) of SCT and ADHD‐IN across four measurement points (preschool and the end of kindergarten, first grade, and second grade) in a large population‐based longitudinal sample (N = 976). Regression analyses were used to examine trait SCT and ADHD‐IN factors in early childhood as predictors of functioning at the end of ninth grade (i.e. parent ratings of psychopathology and social/academic functioning, reading and mathematics academic achievement scores, processing speed and working memory).
Results
Both SCT and ADHD‐IN contained more trait variance (Ms = 65% and 61%, respectively) than occasion‐specific variance (Ms = 35% and 39%) in early childhood, with trait variance increasing as children progressed from preschool through early elementary school. In regression analyses: (a) SCT significantly predicted greater withdrawal and anxiety/depression whereas ADHD‐IN did not uniquely predict these internalizing domains; (b) ADHD‐IN uniquely predicted more externalizing behaviors whereas SCT uniquely predicted fewer externalizing behaviors; (c) SCT uniquely predicted shyness whereas both SCT and ADHD‐IN uniquely predicted global social difficulties; and (d) ADHD‐IN uniquely predicted poorer math achievement and slower processing speed whereas SCT more consistently predicted poorer reading achievement.
Conclusions
Findings of this study – from the longest prospective sample to date – provide the clearest evidence yet that SCT and ADHD‐IN often differ when it comes to the functional outcomes they predict.
Background
Clinically significant attention‐deficit/hyperactivity disorder (ADHD) symptoms are common and impairing in children and youth with autism spectrum disorder(ASD). The aim of this ...systematic review and meta‐analysis was to (a) evaluate the efficacy and safety of pharmacotherapy for the treatment of ADHD symptoms in ASD and (b) distil findings for clinical translation.
Methods
We searched electronic databases and clinical trial registries (1992 onwards). We selected randomized controlled trials conducted in participants <25 years of age, diagnosed with ASD that evaluated ADHD outcomes (hyperactivity/impulsivity and inattention) following treatment with stimulants (methylphenidate or amphetamines), atomoxetine, alpha‐2 adrenergic receptor agonists, antipsychotics, tricyclic antidepressants, bupropion, modafinil, venlafaxine, or a combination, in comparison with placebo, any of the listed medications, or behavioral therapies. Data were pooled using a random‐effects model.
Results
Twenty‐five studies (4 methylphenidate, 4 atomoxetine, 1 guanfacine, 14 antipsychotic, 1 venlafaxine, and 1 tianeptine) were included. Methylphenidate reduced hyperactivity (parent‐rated: standardized mean difference SMD = −.63, 95%CI = −.95,−.30; teacher‐rated: SMD = −.81, 95%CI = −1.43,−.19) and inattention (parent‐rated: SMD = −.36, 95%CI = −.64,−.07; teacher‐rated: SMD = −.30, 95%CI = −.49,−.11). Atomoxetine reduced inattention (parent‐rated: SMD = −.54, 95%CI = −.98,−.09; teacher/investigator‐rated: SMD = −0.38, 95%CI = −0.75, −0.01) and parent‐rated hyperactivity (parent‐rated: SMD = −.49, 95%CI = −.76,−.23; teacher‐rated: SMD = −.43, 95%CI = −.92, .06). Indirect evidence for significant reductions in hyperactivity with second‐generation antipsychotics was also found. Quality of evidence for all interventions was low/very low. Methylphenidate was associated with a nonsignificant elevated risk of dropout due to adverse events.
Conclusions
Direct pooled evidence supports the efficacy and tolerability of methylphenidate or atomoxetine for treatment of ADHD symptoms in children and youth with ASD. The current review highlights the efficacy of standard ADHD pharmacotherapy for treatment of ADHD symptoms in children and youth with ASD. Consideration of the benefits weighed against the limitations of safety/efficacy data and lack of data evaluating long‐term continuation is undertaken to help guide clinical decision‐making regarding treatment of co‐occurring ADHD symptoms in children and youth with ASD.
Background
The most recent Global Burden of Disease Study (GBD 2010) is the first to include attention‐deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) for burden quantification. We ...present the epidemiological profiles of ADHD and CD across three time periods for 21 world regions.
Methods
A systematic review of global epidemiology was conducted for each disorder (based on a literature search of the Medline, PsycInfo and EMBASE databases). A Bayesian metaregression tool was used to derive prevalence estimates by age and sex in three time periods (1990, 2005 and 2010) for 21 world regions including those with little or no data. Prior expert knowledge and covariates were applied to each model to adjust suboptimal data. Final prevalence output for ADHD were adjusted to reflect an equivalent value if studies had measured point prevalence using multiple informants while final prevalence output for CD were adjusted to reflect a value equivalent to CD only.
Results
Prevalence was pooled for males and females aged 5–19 years with no difference found in global prevalence between the three time periods. Male prevalence of ADHD in 2010 was 2.2% (2.0–2.3) while female prevalence was 0.7% (0.6–0.7). Male prevalence of CD in 2010 was 3.6% (3.3–4.0) while female prevalence was 1.5% (1.4–1.7). ADHD and CD were estimated to be present worldwide with ADHD prevalence showing some regional variation while CD prevalence remained relatively consistent worldwide.
Conclusions
We present the first prevalence estimates of both ADHD and CD globally and for all world regions. Data were sparse with large parts of the world having no estimates of either disorder. Epidemiological studies are urgently needed in certain parts of the world. Our findings directly informed burden quantification for GBD 2010. As mental disorders gained increased recognition after the first GBD study in 1990, the inclusion of ADHD and CD in GBD 2010 ensures their importance will be recognized alongside other childhood disorders.
Background
Attention‐deficit/hyperactivity disorder (ADHD)‐like symptoms are common in fetal alcohol spectrum disorders (FASD). FASD and ADHD groups both display executive function impairments; ...however, there is ongoing debate whether the pattern and magnitude of executive function deficits differs between these two types of disorders.
Methods
An electronic literature search was conducted (PubMed, PsychInfo; 1972–2013) to identify studies comparing the executive functioning of children with FASD with ADHD or control groups. FASD groups included those with and without dysmorphy (i.e., FAS, pFAS, ARND, and other FASD diagnoses). Effect sizes (Hedges' g, standardized mean difference) were calculated. Random effects meta‐analytic models were performed using the metafor package for R.
Results
Fifty‐one studies met inclusion criteria (FASD N = 2,115; ADHD N = 453; controls N = 1,990). Children with FASD showed the strongest and most consistent deficits in planning, fluency, and set‐shifting compared to controls (Hedges' g = −0.94, −0.78) and children with ADHD (Hedges' g = −0.72, −0.32). FASD was associated with moderate to large impairments in working memory, compared to controls (Hedges' g = ‐.84, ‐.58) and small impairments relative to groups with ADHD (Hedges' g = ‐.26). Smaller and less consistent deficits were found on measures of inhibition and vigilance relative to controls (Hedges' g = −0.52, −0.31); FASD and ADHD were not differentiated on these measures. Moderator analyses indicated executive dysfunction was associated with older age, dysmorphy, and larger group differences in IQ. Sex and diagnostic system were not consistently related to effect size.
Conclusions
While FASD is associated with global executive impairments, executive function weaknesses are most consistent for measures of planning, fluency, and set‐shifting. Neuropsychological measures assessing these executive function domains may improve differential diagnosis and treatment of FASD.
Objective
Attention‐deficit/hyperactivity disorder (ADHD) in mood disorders is associated with unfavorable outcomes, including more frequent mood episodes, and increased risk of suicide. The reported ...prevalence of ADHD in individuals with mood disorders varies widely.
Methods
We searched PsycInfo and PubMed for articles published before September 21st, 2020, using search terms for ADHD and mood disorders. We included original data on the prevalence of ADHD in individuals with bipolar disorder (BD) or major depressive disorder (MDD). We estimated the prevalence of ADHD, by developmental period and disorder using random‐effects meta‐analyses. We also compared the rate of ADHD in people with MDD and BD, and with and without mood disorders.
Results
Based on 92 studies including 17089 individuals, prevalence of ADHD in BD is 73% (95% CI 66–79) in childhood, 43% (95% CI 35–50) in adolescence, and 17% (95% CI 14–20) in adulthood. Data from 52 studies with 16897 individuals indicated that prevalence of ADHD in MDD is 28% (95% CI 19–39) in childhood, 17% (95% CI 12–24) in adolescence, and 7% (95% CI 4–11) in adulthood. ADHD was three times more common in people with mood disorders compared to those without and 1.7 times more common in BD compared to MDD.
Conclusion
People with mood disorders are at a significant risk for ADHD. ADHD should be assessed and treated in individuals with BD and MDD. Comprehensive assessment strategies are needed to address challenges of diagnosing ADHD alongside mood disorders.
Background
Prior studies examining the sleep of adolescents with and without attention‐deficit/hyperactivity disorder (ADHD) have relied on mean values such as average sleep duration, which masks ...intraindividual variability (IIV). The objective was to investigate whether adolescents with ADHD have greater IIV of sleep/wake patterns than adolescents without ADHD using actigraphy and daily sleep diaries.
Method
Adolescents (ages 13.17 ± 0.40 years; 45% female) with (n = 162) and without (n = 140) ADHD were recruited from middle schools at two sites. Participants wore actigraphs and completed sleep diaries for an average of 2 weeks.
Results
Multilevel models were conducted with sex, sleep medication use, ADHD medication use, number of days with data, and social jetlag controlled for in analyses. For actigraphy, adolescents with ADHD had greater variability for time in bed, sleep onset and offset, and wake after sleep onset than adolescents without ADHD. For sleep diary data, adolescents with ADHD had greater variability in bedtime, wake time, sleep duration, sleep onset latency, sleep quality, and night wakings than adolescents without ADHD. Social jetlag was a significant predictor of variability in sleep measures based on both actigraph and daily diaries; however, ADHD status was not associated with social jetlag.
Conclusions
This is the first study to show that adolescents with ADHD have more variable sleep/wake patterns than their peers using both objective and subjective sleep measures. IIV of sleep/wake patterns may be important for clinicians to assess and monitor as part of treatment. Research is needed to understand the mechanisms underlying increased IIV of sleep/wake patterns in adolescents with ADHD and potential consequences for daytime functioning.
Background
Children with Attention‐Deficit Hyperactivity Disorder (ADHD) appear to have a higher risk of language problems compared with typically developing children, although the types of language ...problems experienced are less clear. This review aims to establish the types of language problems experienced by children with ADHD according to systematically reviewed literature and determine the empirical evidence for language problems in children with ADHD compared with non‐ADHD controls.
Methods
A standardized search protocol was used on databases: CINAHL, Medline, and PsychINFO. We identified studies with the following inclusion criteria: (a) confirmed ADHD status at the time of the study, (b) inclusion of a non‐ADHD control group, (c) use of a validated language measure, and (d) age ≤ 18. t‐Tests, Pearson's r, and Hedges g effect sizes (ES) were calculated using summary statistics. Random effects meta‐analyses were conducted for the language domain suitable for analysis. Publication bias was investigated using both the trim and fill and p‐curve techniques.
Results
Twenty‐one studies were included in the systematic review (ADHD = 1,209; Control = 1,101), within which 60 of 68 separate analyses found significant differences between the ADHD and control group on the language measures (p < .05). Follow‐up meta‐analyses found evidence for large deficits in the ADHD groups overall (10/11 studies met p < .05; weighted mean ES WMES: 1.04); expressive (10/10 met p < .05; WMES: 1.23); receptive (12/14 met p < .05; WMES: 0.97), and pragmatic language (4/4 studies met p < .05; WMES: 0.98) compared with controls.
Conclusions
This study demonstrates that children with ADHD have poorer performance on measures of overall, expressive, receptive, and pragmatic language compared with controls. A screening of language functioning may be a valuable addition to the assessment of ADHD.
Background
Epidemiologic evidence indicates a relevant association between atopic dermatitis (AD) and attention‐deficit/hyperactivity disorder (ADHD). Underlying mechanisms and ways to best identify ...subgroups of AD patients at risk for ADHD are poorly understood.
Aims of the study
To compare sociodemographic, clinical and psychosocial characteristics of children with AD, ADHD, comorbid AD/ADHD and age‐matched healthy controls and to investigate aspects of AD related to ADHD symptoms.
Methods
Applying a factorial design, we investigated 4 groups of children aged 6‐12 years: AD‐only (ie, without ADHD), ADHD‐only (ie, without AD), AD + ADHD and healthy controls (HC; ie, no AD/no ADHD). Using validated instruments, ADHD symptoms and other behavioural problems, quality of life, parenting stress and sleeping problems were compared between groups. In children with AD‐only, clinical signs (objective SCORAD), symptoms (POEM, VAS pruritus, VAS sleeping problems) and previous treatment of AD were assessed to investigate disease patterns related to ADHD symptoms.
Results
Compared to HC (n = 47), children with AD‐only (n = 42), ADHD‐only (n = 34) and comorbid AD + ADHD (n = 31) had significantly increased behavioural problems and decreased quality of life. Children with AD‐only had significantly higher levels of ADHD symptoms than HC. In children with AD‐only, previous use of antihistamines was significantly associated with increased ADHD symptoms (OR 1.88; 95% CI 1.04‐3.39). Current clinical signs and AD symptoms were unrelated to the level of ADHD symptoms.
Conclusions
Even if the clinical diagnosis of ADHD is excluded, children with AD show increased levels of ADHD symptoms. Further investigations need to determine whether early antihistamine exposure is a major risk factor for ADHD or a surrogate for previous AD severity and/or associated sleeping problems.
Accumulating evidence suggests a higher risk for cardiovascular diseases among individuals with mental disorders, but very little is known about the risk for overall and specific groups of ...cardiovascular diseases in people with attention‐deficit/hyperactivity disorder (ADHD). To fill this knowledge gap, we investigated the prospective associations between ADHD and a wide range of cardiovascular diseases in adults. In a nationwide population‐based cohort study, we identified 5,389,519 adults born between 1941 and 1983, without pre‐existing cardiovascular diseases, from Swedish registers. The study period was from January 1, 2001 to December 31, 2013. Incident cardiovascular disease events were identified according to ICD codes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards regression model, with ADHD as a time‐varying exposure. After an average 11.80 years of follow‐up, 38.05% of individuals with ADHD versus 23.57% of those without ADHD had at least one diagnosis of cardiovascular disease (p<0.0001). ADHD was significantly associated with increased risk of any cardiovascular disease (HR=2.05, 95% CI: 1.98‐2.13) after adjusting for sex and year of birth. Further adjustments for education level, birth country, type 2 diabetes mellitus, obesity, dyslipidemia, sleep problems and heavy smoking attenuated the association, which however remained significant (HR=1.84, 95% CI: 1.77‐1.91). Further adjustment for psychiatric comorbidities attenuated but could not fully explain the association (HR=1.65, 95% CI: 1.59‐1.71). The strongest associations were found for cardiac arrest (HR=2.28, 95% CI: 1.81‐2.87), hemorrhagic stroke (HR=2.16, 95% CI: 1.68‐2.77), and peripheral vascular disease/arteriosclerosis (HR=2.05, 95% CI: 1.76‐2.38). Stronger associations were observed in males and younger adults, while comparable associations were found among individuals with or without psychotropic medications and family history of cardiovascular diseases. These data suggest that ADHD is an independent risk factor for a wide range of cardiovascular diseases. They highlight the importance of carefully monitoring cardiovascular health and developing age‐appropriate and individualized strategies to reduce the cardiovascular risk in individuals with ADHD.
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