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Song M, Stoyles SA, Mancini M, Winters-Stone K, Horak FB, Tipsord J, Maron L, Nousen E, Nigg JT. Examining for Associations between Motor Disturbances and ADHD Status in Young Adults. J Atten Disord 2025; 29:745-756. [PMID: 40243107 DOI: 10.1177/10870547251332029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2025]
Abstract
OBJECTIVE Some studies show an association between ADHD and impaired balance/gait in children. However, it remains largely unexplored whether such an association exists in adults. We explore that association in this study. METHOD This cross-sectional study included 45 adults aged 17 to 21 (25 with, and 20 without ADHD), most obtained from a longitudinal cohort study beginning in childhood. We measured balance/gait using objective measures from inertial sensors during the Instrumented Stand and Walk Test. Demographics and severity of ADHD symptoms were measured via questionnaires. RESULTS Young adults with ADHD showed a tendency toward worse balance and impaired gait in a dual-task activity than adults without ADHD. CONCLUSION These findings suggest balance and gait impairments are associated with ADHD in young adults. Balance/gait measures may hold promise as markers for persistent neurodevelopmental disorders, and the novel task used here may hold promise for measuring these impairments in adults with ADHD.
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Affiliation(s)
- MinKyoung Song
- Oregon Health & Science University (OHSU), Portland, USA
| | | | | | | | - Fay B Horak
- Oregon Health & Science University (OHSU), Portland, USA
| | | | - Leeza Maron
- Oregon Health & Science University (OHSU), Portland, USA
| | | | - Joel T Nigg
- Oregon Health & Science University (OHSU), Portland, USA
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2
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Hu Y, Zeng Y, Fu T, Hong D, Yang H, Zhu Z, Cheng D, Dang C, Song Y, Yang C, Yin W, Zhou Y. Functional connectivity anomalies in medication-naive children with ADHD: Diagnostic potential, symptoms interpretation, and a mediation model. Clin Neurophysiol 2025; 174:212-219. [PMID: 40305882 DOI: 10.1016/j.clinph.2025.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 03/24/2025] [Accepted: 04/08/2025] [Indexed: 05/02/2025]
Abstract
OBJECTIVE To identify reliable electroencephalography (EEG) biomarkers for attention deficit/hyperactivity disorder (ADHD) by investigating anomalous functional connectivity patterns and their clinical relevance. METHODS Resting-state EEG data were collected from 74 children aged 6-12 (33 unmedicated ADHD; 41 typically developing). Functional connectivity was quantified using the imaginary part of coherency (ICOH). Machine learning (ML)-based support vector machine (SVM) modeling, regression, and mediation analyses linked connectivity features to symptom severity and diagnostic classification. RESULTS Children with ADHD exhibited beta (β) band hypo-connectivity in frontal regions (Fp2-F4, Fp1-Cz, F7-Cz) and theta (θ) band hyper-connectivity in left parietal-central networks (C3-P7, P3-P7, etc.). An SVM classifier achieved an average area under the curve of 0.89 using three connectivity features. Left parietal θ band hyper-connectivity (C3-P7) correlated with both inattention and hyperactivity/impulsivity and mediated their interrelationship. CONCLUSIONS ADHD is characterized by disrupted frontoparietal connectivity, with θ band hyper-connectivity in sensory-integration networks potentially compensating for impaired frontal regulation. SIGNIFICANCE These findings highlight C3-P7 θ band connectivity as both a diagnostic and mechanistic biomarker, providing novel target for neurofeedback therapies and enhancing the differential diagnosis in neurodevelopmental disorders.
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Affiliation(s)
- Yingzi Hu
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Yexian Zeng
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Tong Fu
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Danping Hong
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Han Yang
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Zhihang Zhu
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Daomeng Cheng
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Caiping Dang
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; School of Health Management, Guangzhou Medical University, Guangzhou 511436, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Yan Song
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.
| | - Chanjuan Yang
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Weizhen Yin
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Yanling Zhou
- The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psychiatry and Psychology, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
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Garas P, Takacs ZK, Balázs J. Longitudinal Suicide Risk in Children and Adolescents With Attention Deficit and Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Brain Behav 2025; 15:e70618. [PMID: 40534226 PMCID: PMC12177204 DOI: 10.1002/brb3.70618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 04/23/2025] [Accepted: 05/23/2025] [Indexed: 06/22/2025] Open
Abstract
BACKGROUND/AIMS Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders among young people and significantly affects their quality of life. Previous research suggests an increased risk of suicidal behavior among individuals with ADHD; however, this has not yet been investigated in a meta-analysis of long-term studies. The primary aim of this study was to conduct an updated systematic review of longitudinal studies on ADHD and suicidality supplemented by meta-analytic calculations. METHODS A systematic search was conducted across the following databases: OVID Medline, OVID PsychInfo, PubMed, Scopus, and Web of Science. Only longitudinal studies were included, in which most participants were under 18 years of age at baseline, had a clinical ADHD diagnosis, and provided sufficient data about suicidal behavior. RESULTS In total, nine studies were included in both the meta-analysis and narrative review. The average odds ratios were significant and small to moderate in size for the following aspects: overall suicidality (OR = 3.336, 95% CI: 2.201; 5.057, p < 0.001), suicidal ideation (OR = 3.956, 95% CI: 1.996; 7.841, p < 0.001), suicide attempt (OR = 3.344, 95% CI: 1.682; 6.650, p = 0.001), and death (OR = 3.891, 95% CI: 2.103; 7.198, p < 0.001). The number of participants with ADHD ranged from 104 to 86,670, with a mean age between 5.2 and 14.94 years old, and the majority were male. Suicide behavior was more common in the ADHD combined subtype and the hyperactive/impulsive subtype. There are conflicting results regarding sex differences and the role of comorbidities. CONCLUSIONS The current systematic review and meta-analysis confirms previous findings that individuals with ADHD are at an elevated risk for suicidal behavior. However, this relationship is heterogeneous and complex, with significant differences across ADHD subtypes, age groups, sexes, comorbidities, and social issues, all of which play important roles in the development of suicidal behavior.
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Affiliation(s)
- Peter Garas
- Mental Health Sciences SchoolSemmelweis UniversityBudapestHungary
| | - Zsofia K. Takacs
- School of Health in Social Sciencethe University of EdinburghEdinburghUK
| | - Judit Balázs
- Institute of PsychologyEötvös Loránd UniversityBudapestHungary
- Oslo New University CollegeOsloNorway
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Camerota M, Castellanos FX, Carter BS, Check J, Helderman J, Hofheimer JA, McGowan EC, Neal CR, Pastyrnak SL, Smith LM, O'Shea TM, Marsit CJ, Lester BM. Trajectories of attention problems in preschoolers born very preterm. J Child Psychol Psychiatry 2025; 66:667-676. [PMID: 39523488 PMCID: PMC12018157 DOI: 10.1111/jcpp.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Children born preterm are at heightened risk for neurodevelopmental impairment, including specific deficits in attention. Few studies have investigated change over time in attention problems prior to school entry. The current study aims to describe trajectories of attention problems from age 2 through 5 years in a cohort of children born <30 weeks of gestational age (GA), identify sociodemographic, medical, and neurobehavioral characteristics associated with attention trajectories, and test whether attention problem trajectories predict the risk of a reported attention-deficit/hyperactivity disorder (ADHD) diagnosis. METHODS We studied 608 infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study, a prospective, multisite study of infants born <30 weeks of GA. Parents reported on child attention problems at ages 2, 3, 4, and 5 years using the Child Behavior Checklist and the Behavior Assessment System for Children. Sociodemographic and medical characteristics were assessed via maternal interview and medical record review. Neurobehavioral characteristics were determined using neonatal and 2-year assessments. Parent report of child ADHD diagnosis was obtained. We used latent growth curve (LGC) modeling to test our study aims. RESULTS A linear LGC model provided the best fit to the data. The average trajectory of attention problems evidenced low initial levels of symptoms and little change over time, yet there was significant heterogeneity in both initial levels and change over time. Individual differences in trajectory parameters were associated with sociodemographic, medical, environmental, and neurobehavioral characteristics. Children with higher initial levels of attention problems as well as steeper increases in attention problems over time were more likely to have a reported ADHD diagnosis. CONCLUSIONS There is significant heterogeneity in trajectories of attention problems from age 2 to 5 in children born <30 weeks of GA and these differences have clinical relevance. These data could inform follow-up guidelines for preterm infants.
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Affiliation(s)
- Marie Camerota
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
- Brown Center for the Study of Children at RiskWarren Alpert Medical School of Brown University and Women and Infants HospitalProvidenceRIUSA
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent PsychiatryNYU Grossman School of MedicineNew YorkNYUSA
- Nathan Kline Institute for Psychiatric ResearchOrangeburgNYUSA
| | - Brian S. Carter
- Department of Pediatrics‐NeonatologyChildren's Mercy HospitalKansas CityMOUSA
| | - Jennifer Check
- Department of PediatricsWake Forest School of MedicineWinston‐SalemNCUSA
| | - Jennifer Helderman
- Department of PediatricsWake Forest School of MedicineWinston‐SalemNCUSA
| | - Julie A. Hofheimer
- Department of PediatricsUniversity of North Carolina at Chapel Hill School of MedicineChapel HillNCUSA
| | - Elisabeth C. McGowan
- Department of PediatricsWarren Alpert Medical School of Brown University and Women and Infants HospitalProvidenceRIUSA
| | - Charles R. Neal
- Department of PediatricsUniversity of Hawaii John A. Burns School of MedicineHonoluluHIUSA
| | - Steven L. Pastyrnak
- Department of PediatricsSpectrum Health‐Helen DeVos HospitalGrand RapidsMIUSA
| | - Lynne M. Smith
- Department of PediatricsHarbor‐UCLA Medical CenterTorranceCAUSA
| | - Thomas Michael O'Shea
- Department of PediatricsUniversity of North Carolina at Chapel Hill School of MedicineChapel HillNCUSA
| | - Carmen J. Marsit
- Gangarosa Department of Environmental HealthEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Barry M. Lester
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
- Brown Center for the Study of Children at RiskWarren Alpert Medical School of Brown University and Women and Infants HospitalProvidenceRIUSA
- Department of PediatricsWarren Alpert Medical School of Brown University and Women and Infants HospitalProvidenceRIUSA
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Ontiveros N, Wiklund CA, Ohlis A, Ekblom Ö. The role of physical activity in the association between ADHD and emotional dysregulation. J Affect Disord 2025; 376:68-75. [PMID: 39889934 DOI: 10.1016/j.jad.2025.01.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 01/14/2025] [Accepted: 01/26/2025] [Indexed: 02/03/2025]
Abstract
BACKGROUND Emotional dysregulation (ED) represents a burden for individuals with ADHD. Physical activity (PA) is associated with improvements in emotion regulation, but knowledge is limited regarding its role in ED in the context of ADHD. This study aimed to increase understanding of the association between ADHD and ED and to explore the role of PA. Identifying modifiable risk factors could aid the design of future interventions. METHODS Children from the Swedish Twin Registry were included. ADHD symptoms and PA intensity and frequency were measured using parent-reported questionnaires at age 9/age 12. ED was assessed through questionnaires at age 15. The association between ADHD and ED was assessed through linear GEE regression models. Interaction terms and stratified analyses by level of PA were used to explore the role of PA. Analyses were done separately for boys and girls. RESULTS 12,094 children (52 % girls) were included. A positive association between ADHD symptoms and ED remained significant after adjusting for mental comorbidities and unmeasured family-shared confounders (β = 0.07, 95% CI 0.02-0.12 in boys; β = 0.09, 95% CI 0.02-0.16 in girls). The association was driven by inattention in boys but combined symptoms in girls. The association remained in all strata of PA. A significant interaction between PA frequency and ADHD symptoms was observed among boys (p = 0.02). LIMITATIONS Results were based on parent-reported PA; findings might differ with sensor-based measurements. CONCLUSION Higher ADHD symptoms in childhood were associated with greater ED in adolescence in all PA levels. Low PA frequency intensified the association among boys.
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Affiliation(s)
- Narda Ontiveros
- The Swedish School of Sports and Health Sciences (GIH), Department of Physical Activity and Health, Sweden.
| | - Camilla A Wiklund
- The Swedish School of Sports and Health Sciences (GIH), Department of Physical Activity and Health, Sweden
| | - Anna Ohlis
- Karolinska Institutet, Department of Global Public Health, Sweden
| | - Örjan Ekblom
- The Swedish School of Sports and Health Sciences (GIH), Department of Physical Activity and Health, Sweden; Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Health Promotion Among Children and Youth, Sweden
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Biabani M, Walsh K, Zhou SH, Wagner J, Johnstone A, Paterson J, Johnson BP, Matthews N, Loughnane GM, O'Connell RG, Bellgrove MA. Neurophysiology of Perceptual Decision-Making and Its Alterations in Attention-Deficit Hyperactivity Disorder. J Neurosci 2025; 45:e0469242025. [PMID: 39947920 PMCID: PMC11968538 DOI: 10.1523/jneurosci.0469-24.2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 01/12/2025] [Accepted: 01/22/2025] [Indexed: 04/04/2025] Open
Abstract
Despite the prevalence of attention-deficit hyperactivity disorder (ADHD), efforts to develop a detailed understanding of the neuropsychology of this neurodevelopmental condition are complicated by the diversity of interindividual presentations and the inability of current clinical tests to distinguish between its sensory, attentional, arousal, or motoric contributions. Identifying objective methods that can explain the diverse performance profiles across individuals diagnosed with ADHD has been a long-held goal. Achieving this could significantly advance our understanding of etiological processes and potentially inform the development of personalized treatment approaches. Here, we examine key neuropsychological components of ADHD within an electrophysiological (EEG) perceptual decision-making paradigm that is capable of isolating distinct neural signals of several key information processing stages necessary for sensory-guided actions from attentional selection to motor responses. Using a perceptual decision-making task (random dot motion), we evaluated the performance of 79 children (aged 8-17 years) and found slower and less accurate responses, along with a reduced rate of evidence accumulation (drift rate parameter of drift diffusion model), in children with ADHD (n = 37; 13 female) compared with typically developing peers (n = 42; 18 female). This was driven by the atypical dynamics of discrete electrophysiological signatures of attentional selection, the accumulation of sensory evidence, and strategic adjustments reflecting urgency of response. These findings offer an integrated account of decision-making in ADHD and establish discrete neural signals that might be used to understand the wide range of neuropsychological performance variations in individuals with ADHD.
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Affiliation(s)
- Mana Biabani
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Kevin Walsh
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Shou-Han Zhou
- School of Engineering, Cardiff University, Cardiff, Cardiff CF24 3AA, Wales, United Kingdom
| | - Joseph Wagner
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland 4067, Australia
| | - Alexandra Johnstone
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Julia Paterson
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Beth P Johnson
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Natasha Matthews
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland 4067, Australia
| | | | - Redmond G O'Connell
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin D02 PX31, Ireland
| | - Mark A Bellgrove
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin D02 PX31, Ireland
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Bayranj Z, Fotros D, Sohouli MH, Rohani P, Eslahi M, Ferdosi S, Khodadadi N, Hosseinzadeh M. The relation between MIND diet with odds of attention-deficit/hyperactivity disorder in Iranian children: a case-control study. Child Neuropsychol 2025; 31:331-345. [PMID: 38975687 DOI: 10.1080/09297049.2024.2375493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
This study aims to investigate the association between the MIND index (Mediterranean- Dietary approaches to Stop Hypertension diet Intervention for Neurodegenerative Delay) and attention-deficit hyperactivity disorder (ADHD) in the Iranian children. It builds upon existing research that highlights the role of dietary antioxidants in alleviating psychological disorders, cognitive impairments, and memory deficits. Additionally, previous studies have separately explored the beneficial effects of the Mediterranean and DASH diets on these issues. A case-control study was undertaken in Iran, involving a sample of 360 children and adolescents aged 7-13 years. Participants were divided into two groups, namely the case group (n = 120) and the control group (n = 240), with age and sex being matched between the groups. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) was employed for the diagnosis of ADHD. The MIND diet score was computed using the food intake data acquired from the Food Frequency Questionnaire (FFQ) completed by the subjects. The mean ± SD for the age and BMI of the study population was 8.76 ± 1.64 years and 16.90 ± 3.58 kg/m2, respectively. The mean score of MIND in this study was 27.93. After adjustment for potential confounder in the final model, subjects in highest compared to the lowest quartile of MIND diet score had significantly lower odds of ADHD (OR = 0.59, 95% CI 0.37-0.83; P-trend = 0.019). This study provides valuable evidence suggesting that adherence to the MIND diet is associated with decreased odds of ADHD.
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Affiliation(s)
- Zahra Bayranj
- Department of Clinical Nutrition and Dietetics, Kashan University of Medical Sciences, Kashan, Iran
| | - Danial Fotros
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Eslahi
- Department of Clinical Nutrition and Dietetics, Kashan University of Medical Sciences, Kashan, Iran
| | - Samira Ferdosi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navideh Khodadadi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Hosseinzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Dekkers TJ, Flisar A, Karami Motaghi A, Karl A, Frick MA, Boyer BE. Does Mind-Wandering Explain ADHD-Related Impairment in Adolescents? Child Psychiatry Hum Dev 2025; 56:346-357. [PMID: 37382726 PMCID: PMC11928403 DOI: 10.1007/s10578-023-01557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
Currently, diagnostic criteria for ADHD mainly reflect behavioral symptoms, neglecting internal phenomena like mind-wandering. Recent studies found that mind-wandering explains impairment beyond ADHD symptoms in adults. To better capture ADHD-related impairment in adolescents, we aimed to elucidate whether mind-wandering is associated with impairments that are prevalent in adolescents (i.e., risk-taking behavior, homework problems, emotional dysregulation, and general impairment) beyond ADHD symptoms. Furthermore, we sought to validate the Dutch translation of the Mind Excessively Wandering Scale (MEWS). We assessed a community sample of 626 adolescents on ADHD symptoms, mind-wandering, and the impairment domains. The Dutch MEWS had good psychometric properties. Mind-wandering was linked to general impairment and emotional dysregulation beyond ADHD symptoms, but was not linked to risk-taking behavior and homework problems beyond ADHD symptoms. Internal psychological phenomena such as mind-wandering may add to the behavioral symptoms of ADHD in explaining part of the impairment that adolescents with ADHD characteristics experience.
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Affiliation(s)
- Tycho J Dekkers
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Accare Child Study Center, Groningen, the Netherlands.
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands.
| | - Ajda Flisar
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Alexandra Karl
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Matilda A Frick
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bianca E Boyer
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Psychologenpraktijk Kuin, Haarlem, the Netherlands
- Department of Developmental and Educational Psychology, Leiden University, Leiden, the Netherlands
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9
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Mishra S, Choudhury O, Chaudhary V, Saraswathy KN, Shekhawat LS, Devi NK. Attention Deficit Hyperactivity Disorder in Obesity and Hypertension: A Study Among Young Adults in Delhi NCR, India. Am J Hum Biol 2025; 37:e70022. [PMID: 40062601 DOI: 10.1002/ajhb.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/15/2025] [Accepted: 02/15/2025] [Indexed: 05/13/2025] Open
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder increasingly recognized as an adult health concern. It is linked to behavioral disinhibitions that are studied to be associated with mental and physical health adversities, including obesity and hypertension, due to potential common genetic and environmental underpinnings. These connections remain underexplored, particularly in the Indian context. Hence, this study aims to explore the association of ADHD with obesity and hypertension among young adults in Delhi NCR, India. METHODS This cross-sectional study involved 1537 participants aged 18-25 years residing in Delhi NCR, India. Sociodemographic data was collected via pretested and modified interview schedules. ADHD was screened using the ASRS v1.1 tool. Obesity was assessed in terms of general and central obesity using standard anthropometric measurements. Blood pressure was recorded using a digital sphygmomanometer. RESULTS Combined-type ADHD correlated with a higher risk of central obesity, with 2.4-fold and 1.9-fold increased odds of high waist circumference (WC) and waist-height ratio (WHtR), respectively. The effect of ADHD on obesity intensified with age. No significant association was found with blood pressure, but trends suggested hypertension may escalate with age among ADHD individuals. CONCLUSIONS The study emphasizes the importance of incorporating ADHD diagnosis into obesity management programs and highlights the critical role of early, targeted interventions in effectively managing ADHD symptoms. Such an approach may help achieve better health outcomes and reduce the risk of future cardiovascular complications.
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Affiliation(s)
- Sumit Mishra
- Department of Anthropology, University of Delhi, Delhi, India
| | - Oishi Choudhury
- Department of Anthropology, University of Delhi, Delhi, India
| | | | | | - Lokesh Singh Shekhawat
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi, India
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Kunkle AE, Tennyson RL, Wander K, Shell-Duncan B, Eisenberg DTA. The Attention-Deficit/Hyperactivity Disorder-Associated DRD4 7R Allele Predicts Household Economic Status but Not Nutritional Status in Northern Kenyan Rendille Children. Am J Hum Biol 2025; 37:e70027. [PMID: 40062537 PMCID: PMC11925494 DOI: 10.1002/ajhb.70027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 01/29/2025] [Accepted: 02/24/2025] [Indexed: 03/22/2025] Open
Abstract
OBJECTIVES Around 11% of U.S. children are diagnosed with attention-deficit/hyperactivity disorder (ADHD). One hypothesis for ADHD's relatively high prevalence is that behaviors associated with ADHD were advantageous in past environments where they were positively selected for. A previous study showed that an allele associated with ADHD-the 7R allele of the gene encoding the D(4) dopamine receptor (DRD4)-had a positive effect on the nutritional status of nomadic adult Ariaal men and a negative effect on settled adult men. We attempted to replicate this finding by analyzing the impact of DRD4 7R on children's nutrition and other household metrics in the Rendille, a population closely related to the Ariaal. METHODS We genotyped 259 Rendille children aged 5-10 years for DRD4 7R and analyzed this against previously collected anthropometric and household data from two Rendille towns. Analyses were pre-registered (https://osf.io/p8yv2/) before the addition of the 7R genotype to the dataset. RESULTS DRD4 7R was not associated with iron nutrition, indicated by transferrin receptor (TfR) concentration, height-for-age (HAZ) or weight-for-height Z-scores (WHZ), or with maternal education status. However, DRD4 7R was positively associated with household economic status (p = 0.047). CONCLUSIONS The failure to replicate an association between DRD4 7R and nutritional status might be due to this sample being of children who are not yet substantially provisioning themselves. Given that children's genotypes are correlated with parents' genotypes, it is likely that the effects of the parents' genotypes, rather than the participating children's, explain the association between children's DRD4 7R genotype and household economic success.
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Affiliation(s)
- Amanda E Kunkle
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Robert L Tennyson
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Katherine Wander
- Department of Anthropology, Binghamton University (SUNY), Binghamton, New York, USA
| | - Bettina Shell-Duncan
- Department of Anthropology, University of Washington, Seattle, Washington, USA
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
| | - Dan T A Eisenberg
- Department of Anthropology, University of Washington, Seattle, Washington, USA
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
- Department of Biology, University of Washington, Seattle, Washington, USA
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11
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Zhu W. Magnetic resonance imaging evaluation and nuclear receptor binding SET domain protein 1 mutation in the Sotos syndrome with attention-deficit/hyperactivity disorder. World J Clin Cases 2025; 13:98319. [PMID: 39823103 PMCID: PMC11577501 DOI: 10.12998/wjcc.v13.i2.98319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/25/2024] [Accepted: 10/16/2024] [Indexed: 11/08/2024] Open
Abstract
Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene. Attention-deficit/hyperactivity disorder (ADHD) is considered a neurodevelopment and psychiatric disorder in childhood. Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD. Magnetic resonance imaging (MRI) has been used to assess medical images in Sotos syndrome and ADHD. The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial. In the future, genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.
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Affiliation(s)
- Wei Zhu
- Shanghai XiRong Information Science and Technology Co., Ltd, National Science and Technology Park, School of Life Sciences and Technology, Tongji University, Shanghai 200092, China
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12
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Ballard R. The Case for Managing Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care. Pediatr Ann 2025; 54:e4-e5. [PMID: 39760342 DOI: 10.3928/19382359-20241007-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
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13
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Leshno D, Lev Shalem L, Perlov Gavze R, Leshno M. Diabetes Glycemic Control in Adults With Type 2 Diabetes Mellitus and ADHD. J Atten Disord 2025; 29:101-106. [PMID: 39390799 PMCID: PMC11585963 DOI: 10.1177/10870547241288720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
INTRODUCTION Persistence in treatment is important in balancing diabetes and preventing complications. ADHD impairs quality of life and functioning in many areas of life. The aim of this study is to evaluate the possible association of ADHD and diabetes glycemic control among adults with type 2 diabetes mellitus (T2DM). METHODS All data were obtained from Maccabi Healthcare Services (MHS) automated databases. This retrospective cross-sectional study uses electronic medical records from the Maccabi Healthcare Services database during the years 2010 to 2020. Using a propensity score with the variables of age, gender, and duration of diabetes, we compared a group of 1,582 patients with T2DM and ADHD to 1,582 patients with T2DM and without ADHD. We used a t-test to compare continuous variables and a Mann-Whitney U test for non-parametric testing. In addition, we used multivariate logistic regression with a cutoff of several HbA1c values in T2DM patients with and without ADHD during 2019 to 2020. The proportion of patients with HbA1c values above 10%, 9%, and 8% in the group of patients with ADHD was 4.7 to 5.9 times higher than in patients without ADHD. In addition, the OR in the multivariate logistic regression was 4.2 (95% CI [2.5, 6.8]), 4.3 (95% CI [3.1, 6.1]), and 2.7 (95% CI [2.2, 3.4]) for cutoff of HbA1c of 10%, 9%, and 8%, respectively. CONCLUSION Patients with co-morbid ADHD and T2DM have a higher incidence of poor glycemic control. The findings extend the knowledge on the relationship between ADHD and diabetes and highlight the need for further research to improve treatment.
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Affiliation(s)
- Dahlia Leshno
- Maccabi Healthcare Services, Tel Aviv, Israel
- Tel Aviv University, Israel
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14
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Pan DN, Xie H, Zeng Y, Zhou Y, Lin C, Ma X, Ren J, Jiao Y, Wu Y, Wei W, Xue G. The development and validation of a tablet-based assessment battery of general cognitive ability. BMC Psychol 2024; 12:778. [PMID: 39719650 DOI: 10.1186/s40359-024-02283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/10/2024] [Indexed: 12/26/2024] Open
Abstract
BACKGROUND Traditional cognitive assessments, often reliant on paper-and-pencil tests and professional evaluators, suffer from subjectivity and limited result discrimination. This study introduces the Baguan Online Cognitive Assessment System (BOCAS), a tablet-based system that evaluates both general cognitive ability (GCA) and domain-specific functions across six domains: sensory-motor skills, processing speed, sustained attention, working memory, cognitive flexibility, and spatial ability. METHODS BOCAS was validated with 151 healthy Chinese adults aged 18-40. Reliability was assessed through internal consistency and test-retest reliability. Factor analysis and confirmatory factor analysis (CFA) were used to validate the model. The GCA score was correlated with the Raven IQ test and self-reported cognitive flexibility, and its relationship with negative emotions (depression and anxiety) was examined. RESULTS BOCAS showed satisfactory reliability, with internal consistency ranging from 0.712 to 0.846 and test-retest reliability from 0.56 to 0.71. Factor analysis revealed a common factor explaining 40% of the variance, and CFA indicated a good model fit (χ²/df = 1.81; CFI = 0.932). The GCA score strongly correlated with the Raven IQ test (r = 0.58) and was related to self-reported cognitive flexibility and negative emotions. CONCLUSION BOCAS offers a digital solution for cognitive assessment, providing automated, remote, and precise evaluations. It demonstrates reliability, validity, and potential for use in clinical and research settings.
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Affiliation(s)
- Dong-Ni Pan
- School of Psychology, Beijing Language and Culture University, Beijing, 100083, China
| | - Hailun Xie
- Beijing Infinite Brain Technology Co., Ltd, Beijing, 100022, PR China
| | - Yanjia Zeng
- School of Psychology, Beijing Language and Culture University, Beijing, 100083, China
| | - Yixiang Zhou
- School of Psychology, Beijing Language and Culture University, Beijing, 100083, China
| | - Cuizhu Lin
- School of Psychology, Beijing Language and Culture University, Beijing, 100083, China
| | - Xin Ma
- School of Psychology, Beijing Language and Culture University, Beijing, 100083, China
| | - Juejing Ren
- Beijing Infinite Brain Technology Co., Ltd, Beijing, 100022, PR China
| | - Yuanyun Jiao
- Beijing Infinite Brain Technology Co., Ltd, Beijing, 100022, PR China
| | - Yingying Wu
- Beijing Infinite Brain Technology Co., Ltd, Beijing, 100022, PR China
| | - Wei Wei
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, PR China
| | - Gui Xue
- Beijing Infinite Brain Technology Co., Ltd, Beijing, 100022, PR China.
- State Key Laboratory Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China.
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15
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Namimi-Halevi C, Dor C, Dichtiar R, Bromberg M, Sinai T. Attention-deficit hyperactivity disorder is associated with risky and unhealthy behaviours among adolescents. Public Health 2024; 237:51-56. [PMID: 39326298 DOI: 10.1016/j.puhe.2024.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/18/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES Attention-deficit hyperactivity disorder (ADHD) is highly prevalent among adolescents globally, particularly in Israel. This study aimed to evaluate associations between ADHD and engagement in risky/unhealthy behaviours among adolescents. STUDY DESIGN Cross-sectional study. METHODS Students participating in the 2015-2016 National Health Survey completed self-administered questionnaires, providing demographic, medical and behavioural information (n = 4616, 11-18 years old, 50.2% male). Multivariable logistic regression analyses assessed the associations between ADHD and risky/unhealthy behaviours, including current tobacco/hookah smoking, alcohol consumption (≥1 serving/month), excessive screen time (≥4 h/d), non-compliance with physical activity and sleep recommendations (<1 h/d, and <8 or <9 h/d depending on age, respectively) and unhealthy lifestyle (engagement in ≥3 of these behaviours). RESULTS A total of 752 participants reported ever being diagnosed with ADHD (287 of whom were treated with stimulants) and 3864 individuals were included in a non-ADHD comparison group. ADHD was significantly associated with higher prevalence of smoking (odds ratio [OR] 2.15; 95% confidence interval [CI]: 1.65, 2.80), alcohol consumption (OR 1.38; 95% CI: 1.10, 1.73) and excessive screen time [OR 1.41; 95% CI: 1.18, 1.70), each adjusted for sociodemographic characteristics and the other risky/unhealthy behaviours. Unhealthy lifestyle was twice as common in the ADHD group (OR 2.03; 95% CI: 1.64, 2.51). Stimulant-treated and non-treated adolescents with ADHD did not differ in demographic or behavioural characteristics. CONCLUSIONS ADHD was significantly associated with an unhealthy lifestyle among adolescents. These behaviours should be detected early and prevention measures put in place to limit their harmful consequences in this adolescent population. Additional large-scale prospective research is needed to deepen the understanding of this association.
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Affiliation(s)
- C Namimi-Halevi
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
| | - C Dor
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
| | - R Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
| | - M Bromberg
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - T Sinai
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel; School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
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16
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Trinczer IL, Shalev L. Computerised Attention Functions Training Versus Computerised Executive Functions Training for Children with Attention Deficit/Hyperactivity Disorder: A Randomised Controlled Trial. J Clin Med 2024; 13:7239. [PMID: 39685698 DOI: 10.3390/jcm13237239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 11/20/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by deficits in attention, hyperactivity, and impulsivity. Current treatments, such as stimulant medication and behavioural therapy, ameliorate symptoms but do not address the core cognitive dysfunctions. This study aimed to investigate the effects of two computerised neurocognitive training programs, attention functions training and executive functions training, in children with ADHD. Methods: Eighty children with ADHD (ages 8-13) were randomly assigned to one of three groups: Attention functions training (AFT), targeting sustained, selective-spatial, orienting, and executive attention; executive functions training (EFT), focusing on working memory, cognitive flexibility, and problem solving; or a passive control group. Training sessions were administered in small groups twice a week for nine weeks. Participants underwent comprehensive assessments of attention (Continuous Performance Test, Conjunctive Visual Search Task), executive functions (Corsi Block-Tapping Tasks), nonverbal reasoning (Raven's Colored Progressive Matrices), parent-rated behavioural symptoms, and arithmetic performance at baseline, post-intervention, and follow-up. Results: The AFT group demonstrated significant improvements in sustained and selective-spatial attention, nonverbal reasoning, inattentive symptoms, and arithmetic performance, and most improvements persisted at follow-up. The EFT group showed gains in nonverbal reasoning and inattentive symptoms, although no improvements were documented in working memory or in parent ratings of executive functions. Conclusions: The AFT program that addressed core attentional functions in children with ADHD produced robust cognitive and behavioural benefits, whereas the EFT program yielded behavioural benefits and a limited improvement in executive functions. Future research should explore different training protocols for broader gains in executive functions. These findings support the potential of theory-driven, structured neurocognitive training targeting basic cognitive functions as an effective small-group intervention for ADHD.
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Affiliation(s)
- Inbar Lucia Trinczer
- Attention Lab, School of Education, Tel-Aviv University, Tel Aviv 67017, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv 67017, Israel
| | - Lilach Shalev
- Attention Lab, School of Education, Tel-Aviv University, Tel Aviv 67017, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv 67017, Israel
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17
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Zolli N, Loubeau JK, Sikov J, Baul TD, Hasan S, Rosen K, Buonocore O, Rabin M, Duncan A, Fortuna L, Borba CPC, Silverstein M, Spencer AE. "If he doesn't buy in, it's a waste of time": Perspectives from diverse parents and adolescents on engaging children in ADHD treatment. Child Psychiatry Hum Dev 2024; 55:1190-1200. [PMID: 36534302 PMCID: PMC11161869 DOI: 10.1007/s10578-022-01473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
Engaging children and adolescents in ADHD care is critical for future independent disease management. However, there is a lack of evidence guiding health professionals and parents on how best to engage their children and adolescents in ADHD care. We recruited 41 diverse parents of children and adolescents with ADHD and 11 adolescents with ADHD from an urban, safety-net hospital to participate in in-depth, semi-structured qualitative interviews and then analyzed this data using thematic analysis. Children's level of illness insight about ADHD and self-esteem emerged as two major contributors to engagement of children and adolescents in ADHD care, and their intersection created four styles of engagement: proactive (high insight, high self-esteem), anxious (high insight, low self-esteem), apathetic (low insight, high self-esteem), and resistant (low insight, low self-esteem). This framework can help health professionals engage children and adolescents in care for ADHD and guide development of interventions to improve engagement in care.
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Affiliation(s)
- Nicole Zolli
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
- University of Illinois at Chicago, Chicago, IL, United States
| | - J Krystel Loubeau
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Jennifer Sikov
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Tithi D Baul
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Syeda Hasan
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Katherine Rosen
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Olivia Buonocore
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Megan Rabin
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Lisa Fortuna
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Michael Silverstein
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States
| | - Andrea E Spencer
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States.
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, Chicago, USA.
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Fernández-Arce L, Martínez-Pérez JM, García-Villarino M, Fernández-Álvarez MDM, Martín-Payo R, Lana A. Symptoms of Attention Deficit Hyperactivity Disorder and Oral Health Problems among Children in Spain. Caries Res 2024; 59:35-45. [PMID: 39265566 DOI: 10.1159/000541013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/12/2024] [Indexed: 09/14/2024] Open
Abstract
INTRODUCTION The aim of this study was to explore the association between symptoms of attention deficit hyperactivity disorder (ADHD) and oral health in a representative sample of the Spanish population aged 6-14 years. We also examined the contribution of several sociodemographic and behavioral determinants of children/adolescents and their family environment. METHODS A cross-sectional study involving 3,402 subjects aged between 6 and 14 years from the Spanish National Health Survey. The presence of ADHD symptoms was determined using the self-reported hyperactivity/inattention subscale of the Strength and Difficulties Questionnaire. Oral health was assessed using five indicators: caries, extraction, restorations, gingival bleeding, and the presence of teeth in poor condition (e.g., broken or misaligned). Logistic regressions were used to examine the association between the presence of ADHD symptoms and oral health indicators. These models were adjusted for sociodemographic factors, lifestyle variables, and oral hygiene behaviors relating to both the children and their parents. RESULTS Compared to children without ADHD symptoms, children with ADHD symptoms had a higher risk of caries (fully adjusted odds ratio: 2.16; 95% confidence interval: 1.66-2.82), extraction (1.42; 1.09-1.85), restoration (1.47; 1.19-1.82) and gingival bleeding (1.64; 1.11-2.41). The increased risk of caries was maintained when the analyses were restricted to middle/high social class families and children with low sugar intake, good oral hygiene behaviors and regular dental visits. CONCLUSIONS Children with ADHD symptoms in Spain had worse oral health indicators than those without ADHD symptoms. Our results suggest that the association of ADHD symptoms with caries was independent of socioeconomic level, cariogenic diet, frequency of toothbrushing, and dental visits.
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Affiliation(s)
- Lucía Fernández-Arce
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain,
- Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo, Spain,
| | | | - Miguel García-Villarino
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Del Mar Fernández-Álvarez
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rubén Martín-Payo
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo, Spain
| | - Alberto Lana
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo, Spain
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Ward J, McBride A, Gudka R, Becker K, Newlove-Delgado T, Price A. Wider health needs in attention deficit hyperactivity disorder from lived and professional experience: a qualitative framework analysis. BMJ Open 2024; 14:e083539. [PMID: 39153774 PMCID: PMC11331868 DOI: 10.1136/bmjopen-2023-083539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/26/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVES This study aimed to explore the perspectives of people with attention deficit hyperactivity disorder (ADHD), their supporters and primary care professionals (PCPs), on the wider physical and mental health needs of people with ADHD and the support currently available. DESIGN Qualitative semi-structured interviews, analysed using reflexive thematic analysis. SETTING Five general practice surgeries across England. PARTICIPANTS Participants with lived experience (people with ADHD and their supporters (n=11)) and PCPs (n=9) (eg, general practitioners and practice managers), recruited via clinical academic networks and previous work packages of this study. RESULTS We generated three major themes in relation to ADHD, using reflexive thematic analysis: understanding health, barriers to health and addressing health. Within these, participants reflected on mental and physical health challenges, as well as wider social difficulties and variability in support offered/accessed. CONCLUSIONS This study highlights that health problems in ADHD are complex and rooted both in individual factors (eg, mental health) and social factors (eg, support). This study also highlights the differences in expectations and fulfilment of healthcare.
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Affiliation(s)
- John Ward
- University of Exeter Medical School, Exeter, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | | | - Anna Price
- University of Exeter Medical School, Exeter, UK
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20
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Libutzki B, Neukirch B, Reif A, Hartman CA. Somatic burden of attention-deficit/hyperactivity disorder across the lifecourse. Acta Psychiatr Scand 2024; 150:105-117. [PMID: 38804256 DOI: 10.1111/acps.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/07/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE A thorough and comprehensive knowledge base on the extent of comorbidity of attention-deficit/hyperactivity disorder (ADHD) and somatic conditions is needed. METHOD We compared the prevalence of a wide range of somatic conditions in individuals with and without ADHD and described sex and lifecourse differences. Individuals with an ADHD diagnosis (N = 87,394) and age and sex-matched individuals without an ADHD diagnosis were identified from a large health claims dataset representative of the general German population, including both primary and specialized care (N = 4.874,754). Results were provided for the full sample as well as stratified for sex and age (<12 years, 13-17 years, 18-29 years, 30-59 years, ≥60 years). RESULTS The results showed that ADHD is associated with a wide variety of somatic conditions across the entire lifecourse. Specifically neurological disorders such as Parkison's disease (odds ratio [OR]: 5.21) and dementia (OR: 2.23), sleep-related disorders (OR: 2.38) and autoimmune disorders affecting the musculoskeletal, digestive, and endocrine system (fibromyalgia OR: 3.33; lupus OR: 2.17) are strongly and significantly associated with ADHD. Additionally, ADHD is associated with higher occurrence of common acute diseases typically treated by the general practitioner, hinting at an overall general lower health status. Sex differences in somatic comorbidity were not prominent. Age differences, in contrast, stood out: in particular endocrine, cardiovascular, and neurological disorders had an early onset in individuals with compared to individuals without ADHD. CONCLUSION This research underlines the high burden of disease due to somatic conditions among individuals with ADHD. The findings indicate the need for preventive measures to reduce comorbidity.
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Affiliation(s)
- Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benno Neukirch
- Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Grover J, Chakraborty S, Rushi, Puar S. Computerized cognitive retraining (ReadON.ai) among children diagnosed with attention deficit hyperactivity disorder. Ind Psychiatry J 2024; 33:346-353. [PMID: 39898095 PMCID: PMC11784689 DOI: 10.4103/ipj.ipj_259_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/11/2024] [Accepted: 07/30/2024] [Indexed: 02/04/2025] Open
Abstract
Background ADHD affects 8% of children and adolescents globally, marked by significant deficits in cognitive abilities, which leads to various emotional, behavioral, and adjustment issues. Traditional methods like medication and behavior therapy fall short in managing ADHD's cognitive domains, urging the adoption of innovative approaches like cognitive training programs specifically adopting the emerging technology such as ReadON.ai. However, the precise influence of computerized cognitive retraining on ADHD remains understudied. Aim To study the feasibility of computerized cognitive retraining (ReadON.ai) in enhancing cognitive abilities in children diagnosed with attention deficit hyperactivity disorder. Materials and Methods The study employs a pre- and post-intervention design including six participants (7-11 years), diagnosed with ADHD according to DSM-5 criteria. Each participant underwent 30 hours of computerized cognitive retraining (ReadON.ai) over ten weeks, targeting attention and concentration, working memory, memory and learning, perceptual abilities, and reasoning skills. Assessments before and after intervention included tools like Conners' 4TM Parent version and ReadON.ai CSA. Statistical analysis was conducted using IBM SPSS version 28. Results Paired t-test results revealed a significant difference in pre-test and post-test means of attention and concentration (t = -6.873, P < 0.001), working memory (t = -5.771, P < 0.001), learning and memory (t = -12.491, P < 0.001), perception (t = 14.398, P < 0.004), reasoning (t = -3.464, P < 0.018), hyperactivity (t = 11.073, P < 0.001), impulsivity (t = 11.948, P < 0.001), emotional dysregulation (t = 8.242, P < 0.001), anxious thoughts (t = 2.67 P = 0.219), depressed mood (t = 2.924, P = 0.020), school work (t = 7.387, P = 0.001) and peer interaction (t = 4.632, P = 0.006) with medium to large effect size. Conclusion Computerized cognitive retraining through ReadON.ai is feasible in enhancing cognitive abilities like attention and concentration, working memory, memory and learning, perception, and reasoning among children with ADHD.
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Affiliation(s)
- Jagriti Grover
- Institute of Behavioural (Health) and Allied Sciences, AUUP, Noida, Uttar Pradesh, India
| | | | - Rushi
- Department of Clinical Psychology, AIISH, Mysuru, Karnataka, India
| | - Sonia Puar
- AIBHAS, Amity University, Noida, Uttar Pradesh, India
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22
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Soldati L, Deiber MP, Schockaert P, Köhl J, Bolmont M, Hasler R, Perroud N. Sexually Transmitted Diseases and Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review. J Psychiatr Pract 2024; 30:259-265. [PMID: 39058524 PMCID: PMC11280443 DOI: 10.1097/pra.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Patients with attention-deficit/hyperactivity disorder (ADHD) suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that the specific difficulties associated with ADHD are bound to affect sexual behaviors, and favor risky sexual behaviors, thereby increasing the frequency of sexually transmitted diseases (STDs). This review provides an up-to-date synthesis of the literature concerning STDs in patients with ADHD. A systematic review of the literature was performed using the PubMed, PsychInfo, and Embase databases, with STDs as the main outcome measure. Patients with ADHD report more STDs than the general population. Results are limited by the small number of existing studies, as well as the heterogeneity of the outcome measures. Findings from this first systematic review of data on STDs in individuals with ADHD suggest that ADHD affects sexual health and sexual behaviors. Clinicians treating patients with ADHD should explore risky sexual behaviors in their patients and raise awareness about the risk of contracting STDs. Further studies are warranted to better evaluate the risk of contracting an STD in patients with ADHD.
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Affiliation(s)
- Lorenzo Soldati
- Department of Psychiatry, Division of Psychiatric Specialties, Sexual Medicine and Sexology Unit, University Hospital of Geneva, Geneva
| | - Marie-Pierre Deiber
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Schockaert
- Department of Psychiatry, Division of Psychiatric Specialties, Sexual Medicine and Sexology Unit, University Hospital of Geneva, Geneva
| | - John Köhl
- Department of Psychiatry, Division of Psychiatric Specialties, Sexual Medicine and Sexology Unit, University Hospital of Geneva, Geneva
| | - Mylène Bolmont
- Department of Psychiatry, Division of Psychiatric Specialties, Sexual Medicine and Sexology Unit, University Hospital of Geneva, Geneva
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
- Department of Psychiatry, Division of Psychiatric Specialties, TRE Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
- Department of Psychiatry, Division of Psychiatric Specialties, TRE Unit, University Hospital of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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23
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Ward JH, Becker K, Smith J, Price A, Newlove-Delgado T. Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study. BMC Health Serv Res 2024; 24:751. [PMID: 38898441 PMCID: PMC11188530 DOI: 10.1186/s12913-024-11188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders. METHODS This study forms part of the 'Managing young people with ADHD in Primary care (MAP) study'. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September-October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one. RESULTS 782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively). CONCLUSIONS Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD.
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Affiliation(s)
- John H Ward
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Royal Devon University Hospital NHS Foundation Trust, Devon, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Kieran Becker
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Jane Smith
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Anna Price
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Tamsin Newlove-Delgado
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
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24
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Dickinson K, Parmar P, Reyes AB, Hale EW. Bariatric Surgery Is Highly Effective and Underutilized in Patients with ADHD: A 5-Year Retrospective Cohort Study. Obes Surg 2024; 34:2066-2072. [PMID: 38619772 DOI: 10.1007/s11695-024-07211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Obesity and ADHD have become increasingly common diagnoses. In the last decade, research has found that there is a high prevalence of obesity in patients with ADHD. The mainstays of management in the general population include lifestyle modifications, pharmacotherapies, and/or bariatric surgery. However, there is a lack of understanding of appropriate management of patients with both ADHD and obesity. METHODS We identified those with obesity for at least five consecutive years (BMI > 30) in the TriNetX database before separating into two groups based on the presence or absence of ADHD. We assessed both the distribution of treatment modalities and the change in average BMI over time in each of our four groups across 5 years. RESULTS Average BMI decreased over time in all groups, with the smallest change seen in the ADHD Pharmacology cohort (- 0.366 kg/m2) and the largest in the ADHD Surgery group (- 8.532 kg/m2). Average BMIs at the 5-year mark were significantly different. CONCLUSION Our research found that pharmacological management of individuals with ADHD was only half as effective for individuals with ADHD than our control. Though surgical management of patients with ADHD is roughly 20 times more effective in managing obesity, it was not used as frequently in comparison to medication for management of weight.
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Affiliation(s)
- Kaitlyn Dickinson
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Pritika Parmar
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy Beth Reyes
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elijah W Hale
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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25
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French B, Nalbant G, Wright H, Sayal K, Daley D, Groom MJ, Cassidy S, Hall CL. The impacts associated with having ADHD: an umbrella review. Front Psychiatry 2024; 15:1343314. [PMID: 38840946 PMCID: PMC11151783 DOI: 10.3389/fpsyt.2024.1343314] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD. Methods An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications. Results Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality. Discussion This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning. Registration International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).
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Affiliation(s)
- Blandine French
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Gamze Nalbant
- Lifespan and Population Health Unit, University of Nottingham, Nottingham, United Kingdom
| | - Hannah Wright
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kapil Sayal
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Daley
- Nottingham Trent University (NTU) Psychology, School of Social Science, Nottingham Trent University, Nottingham, United Kingdom
| | - Madeleine J. Groom
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte L. Hall
- NIHR MindTech MedTech Cooperative, Nottingham National Institute of Health Research Biomedical Research Center (NIHR BRC), Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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26
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Lee YS, Sprong ME, Shrestha J, Smeltzer MP, Hollender H. Trajectory Analysis for Identifying Classes of Attention Deficit Hyperactivity Disorder (ADHD) in Children of the United States. Clin Pract Epidemiol Ment Health 2024; 20:e17450179298863. [PMID: 39130191 PMCID: PMC11311732 DOI: 10.2174/0117450179298863240516070510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder that affects attention and behavior. People with ADHD frequently encounter challenges in social interactions, facing issues, like social rejection and difficulties in interpersonal relationships, due to their inattention, impulsivity, and hyperactivity. METHODS A National Longitudinal Survey of Youth (NLSY) database was employed to identify patterns of ADHD symptoms. The children who were born to women in the NLSY study between 1986 and 2014 were included. A total of 1,847 children in the NLSY 1979 cohort whose hyperactivity/inattention score was calculated when they were four years old were eligible for this study. A trajectory modeling method was used to evaluate the trajectory classes. Sex, baseline antisocial score, baseline anxiety score, and baseline depression score were adjusted to build the trajectory model. We used stepwise multivariate logistic regression models to select the risk factors for the identified trajectories. RESULTS The trajectory analysis identified six classes for ADHD, including (1) no sign class, (2) few signs since preschool being persistent class, (3) few signs in preschool but no signs later class, (4) few signs in preschool that magnified in elementary school class, (5) few signs in preschool that diminished later class, and (6) many signs since preschool being persistent class. The sensitivity analysis resulted in a similar trajectory pattern, except for the few signs since preschool that magnified later class. Children's race, breastfeeding status, headstrong score, immature dependent score, peer conflict score, educational level of the mother, baseline antisocial score, baseline anxious/depressed score, and smoking status 12 months prior to the birth of the child were found to be risk factors in the ADHD trajectory classes. CONCLUSION The trajectory classes findings obtained in the current study can (a) assist a researcher in evaluating an intervention (or combination of interventions) that best decreases the long-term impact of ADHD symptoms and (b) allow clinicians to better assess as to which class a child with ADHD belongs so that appropriate intervention can be employed.
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Affiliation(s)
- Yu-Sheng Lee
- School of Integrated Sciences, Sustainability, and Public Health, College of Health, Science, and Technology, University of Illinois at Springfield, Illinois, United States
| | - Matthew Evan Sprong
- School of Public Management and Policy, College of Public Affairs and Education, University of Illinois at Springfield, llinois, United States
| | - Junu Shrestha
- School of Integrated Sciences, Sustainability, and Public Health, College of Health, Science, and Technology, University of Illinois at Springfield, Illinois, United States
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Tennessee, United States
| | - Heaven Hollender
- School of Health and Human Sciences, Indiana University Indianapolis, Indiana, United States
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27
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Roberts DK, Sarver DE, Cash AR, Walker BH, Lim CS. Understanding health behaviors that modify the risk for obesity in ADHD. J Pediatr Psychol 2024; 49:372-381. [PMID: 38516857 DOI: 10.1093/jpepsy/jsae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/31/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Research provides support for the associated risk of inadequate sleep duration, limited physical activity, and excessive media use in attention-deficit/hyperactivity disorder (ADHD) and obesity. The present study aims to (1) examine the association between ADHD and overweight or obese status (OW/OB); (2) comprehensively examine sleep duration, physical activity, and media use as potential moderators of OW/OB; and (3) examine the moderating effects of these health behaviors cross-sectionally by comparing medicated youth with ADHD, unmedicated youth with ADHD, and youth without ADHD. METHODS Data were acquired from the 2018 and 2019 National Survey of Children's Health, a nationally representative survey of caregivers conducted across the United States. The current study used data for youth 11-17 years old with a final sample size of 26,644. Hours of sleep, physical activity, and media use per day were dichotomized based on national recommendation guidelines for each health behavior (i.e., either meeting or not meeting guidelines). RESULTS The OW/OB prevalence rate was 7% greater among unmedicated youth with ADHD than among medicated youth with ADHD. Medicated youth with ADHD and peers without ADHD had similar OW/OB rates. Among medicated youth with ADHD, physical activity, sleep duration, and media use did not contribute to OW/OB risk after controlling for family poverty level. However, among unmedicated youth with ADHD, meeting sleep duration guidelines was linked to a lower OW/OB risk. CONCLUSION Overall, findings suggest that clinical providers and parents may wish to prioritize improved sleep duration in the management of OW/OB risk in youth with ADHD.
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Affiliation(s)
- Delanie K Roberts
- Department of Psychology, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Dustin E Sarver
- Department of Psychiatry and Human Behavior, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, United States
| | - Annah R Cash
- Department of Psychology, Child Study Center, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Benjamin H Walker
- Department of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Crystal S Lim
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
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28
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Rattay K, Robinson LR. Identifying Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD): a Public Health Concern and Opportunity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:195-202. [PMID: 38598041 PMCID: PMC11315233 DOI: 10.1007/s11121-024-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with significant individual and societal negative impacts of the disorder continuing into adulthood (Danielson et al. in Journal of Clinical Child and Adolescent Psychology, in press; Landes and London in Journal of Attention Disorders 25:3-13, 2021). Genetic and environmental risk (e.g., modifiable exposures such as prenatal tobacco exposure and child maltreatment) for ADHD is likely multifactorial (Faraone et al. in Neuroscience & Biobehavioral Reviews 128:789-818, 2021). However, the evidence for potentially modifiable contextual risks is spread across studies with different methodologies and ADHD criteria limiting understanding of the relationship between early risk factors and later childhood ADHD. Using common methodology across six meta-analyses (Bitsko et al. in Prevention Science, 2022; Claussen et al. in Prevention Science 1-23, 2022; Dimitrov et al. in Prevention Science, 2023; Maher et al. in Prevention Science, 2023; Robinson, Bitsko et al. in Prevention Science, 2022; So et al. in Prevention Science, 2022) examining 59 risk factors for childhood ADHD, the papers in this special issue use a public health approach to address prior gaps in the literature. This introductory paper provides examples of comprehensive public health approaches focusing on policy, systems, and environmental changes across socio-ecological contexts to improve health and wellbeing through prevention, early intervention, and support across development using findings from these meta-analyses. Together, the findings from these studies and a commentary by an author independent from the risk studies have the potential to minimize risk conditions, prioritize prevention efforts, and improve the long-term health and wellbeing of children and adults with ADHD.
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Affiliation(s)
- Karyl Rattay
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA
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29
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Danielson ML, Claussen AH, Bitsko RH, Katz SM, Newsome K, Blumberg SJ, Kogan MD, Ghandour R. ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:343-360. [PMID: 38778436 PMCID: PMC11334226 DOI: 10.1080/15374416.2024.2335625] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To provide updated national prevalence estimates of diagnosed attention-deficit/hyperactivity disorder (ADHD), ADHD severity, co-occurring disorders, and receipt of ADHD medication and behavioral treatment among U.S. children and adolescents by demographic and clinical subgroups using data from the 2022 National Survey of Children's Health (NSCH). METHOD This study used 2022 NSCH data to estimate the prevalence of ever diagnosed and current ADHD among U.S. children aged 3-17 years. Among children with current ADHD, ADHD severity, presence of current co-occurring disorders, and receipt of medication and behavioral treatment were estimated. Weighted estimates were calculated overall and for demographic and clinical subgroups (n = 45,169). RESULTS Approximately 1 in 9 U.S. children have ever received an ADHD diagnosis (11.4%, 7.1 million children) and 10.5% (6.5 million) had current ADHD. Among children with current ADHD, 58.1% had moderate or severe ADHD, 77.9% had at least one co-occurring disorder, approximately half of children with current ADHD (53.6%) received ADHD medication, and 44.4% had received behavioral treatment for ADHD in the past year; nearly one third (30.1%) did not receive any ADHD-specific treatment. CONCLUSIONS Pediatric ADHD remains an ongoing and expanding public health concern, as approximately 1 million more children had ever received an ADHD diagnosis in 2022 than in 2016. Estimates from the 2022 NSCH provide information on pediatric ADHD during the last full year of the COVID-19 pandemic and can be used by policymakers, government agencies, health care systems, public health practitioners, and other partners to plan for needs of children with ADHD.
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Affiliation(s)
- Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Angelika H Claussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Samuel M Katz
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
- Oak Ridge Institute for Science and Education
| | - Kimberly Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention
| | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration
| | - Reem Ghandour
- Maternal and Child Health Bureau, Health Resources and Services Administration
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30
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Keulers EHH, Resch C, Jonkman LM, Hurks PPM. Further validation of a new ADHD screening questionnaire measuring parents' explanations (time processing, cognition, and motivation) of inattention symptoms in their school-aged children. Child Neuropsychol 2024; 30:539-550. [PMID: 37345982 DOI: 10.1080/09297049.2023.2226351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
The triple pathway model suggests that different neuropsychological factors underlie symptoms of inattention (i.e., time, cognition and/or motivation problems). However, screening instruments asking individuals to judge the link between these neuropsychological factors and inattention are lacking. The recently developed screening questionnaire, PASSC, aims to examine these factors possibly causing inattention by asking parents to indicate to what extent their child experiences inattention symptoms and to what extent different neuropsychological factors explain this inattention. The present study extends prior validation research of the PASSC by examining associations between PASSC inattention explained by time, cognition, and/or motivation and children's performance on tests measuring these same three constructs. Results indicated positive correlations between PASSC inattention explained by time and less accurate performance on a time discrimination test, and between PASSC inattention explained by cognition and more working memory errors as well as higher attention switching costs. Furthermore, children whose parents indicated that their inattention was best explained by cognition showed higher switching costs than children whose inattention was best explained by motivation. This support for construct validity of the PASSC is limited to two PASSC explanations (i.e., time, cognition) and a subset of tests (i.e., time discrimination, attention switching, memory span). Future research should focus on integrating PASSC and performance test results to differentiate between children with attention problems but different underlying neuropsychological problems. Concluding, the PASSC can be a promising screening tool to identify inattention in children and the underlying explanation indicated by parents.
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Affiliation(s)
- Esther H H Keulers
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Christine Resch
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
- Department of Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
| | - Lisa M Jonkman
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Petra P M Hurks
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
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31
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Callahan BL, Becker S, Ramirez J, Taylor R, Shammi P, Gao F, Black SE. Vascular Burden Moderates the Relationship Between ADHD and Cognition in Older Adults. Am J Geriatr Psychiatry 2024; 32:427-442. [PMID: 37989710 DOI: 10.1016/j.jagp.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/01/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Recent evidence suggests attention-deficit/hyperactivity disorder (ADHD) is a risk factor for cognitive impairment in later life. Here, we investigated cerebrovascular burden, quantified using white matter hyperintensity (WMH) volumes, as a potential mediator of this relationship. DESIGN This was a cross-sectional observational study. SETTING Participants were recruited from a cognitive neurology clinic where they had been referred for cognitive assessment, or from the community. PARTICIPANTS Thirty-nine older adults with clinical ADHD and 50 age- and gender-matched older adults without ADHD. MEASUREMENTS A semiautomated structural MRI pipeline was used to quantify periventricular (pWMH) and deep WMH (dWMH) volumes. Cognition was measured using standardized tests of memory, processing speed, visuo-construction, language, and executive functioning. Mediation models, adjusted for sex, were built to test the hypothesis that ADHD status exerts a deleterious impact on cognitive performance via WMH burden. RESULTS Results did not support a mediated effect of ADHD on cognition. Post hoc inspection of the data rather suggested a moderated effect, which was investigated as an a posteriori hypothesis. These results revealed a significant moderating effect of WMH on the relationship between ADHD memory, speed, and executive functioning, wherein ADHD was negatively associated with cognition at high and medium levels of WMH, but not when WMH volumes were low. CONCLUSIONS ADHD increases older adults' susceptibility to the deleterious cognitive effects of WMH in the brain. Older adults with ADHD may be at risk for cognitive impairment if they have deep WMH volumes above 61 mm3 and periventricular WMH above 260 mm3.
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Affiliation(s)
- Brandy L Callahan
- Department of Psychology (BLC, SB), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute (BLC, SB), Calgary, Alberta, Canada.
| | - Sara Becker
- Department of Psychology (BLC, SB), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute (BLC, SB), Calgary, Alberta, Canada
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience & Recovery (JR, RT, FG, SEB), LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program (JR, RT, PS, FG, SEB), Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Rebecca Taylor
- Dr. Sandra Black Centre for Brain Resilience & Recovery (JR, RT, FG, SEB), LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program (JR, RT, PS, FG, SEB), Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Prathiba Shammi
- Hurvitz Brain Sciences Program (JR, RT, PS, FG, SEB), Sunnybrook Research Institute, Toronto, Ontario, Canada; Neuropsychology & Cognitive Health Program (PS), Baycrest Health Sciences Centre, Toronto, Ontario, Canada
| | - Fuqiang Gao
- Dr. Sandra Black Centre for Brain Resilience & Recovery (JR, RT, FG, SEB), LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program (JR, RT, PS, FG, SEB), Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sandra E Black
- Dr. Sandra Black Centre for Brain Resilience & Recovery (JR, RT, FG, SEB), LC Campbell Cognitive Neurology Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program (JR, RT, PS, FG, SEB), Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medicine (Neurology) (SEB), University of Toronto, Toronto, Ontario, Canada
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Curzon MM, Dick AS, Coccia C, Graziano PA. Exploring Differences in Physical Health in Young Children With and Without ADHD. J Pediatr Psychol 2024; 49:120-130. [PMID: 38078865 PMCID: PMC10874215 DOI: 10.1093/jpepsy/jsad090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To assess differences in child physical health outcomes and metrices associated with obesity in a sample of predominantly Hispanic/Latinx young children with and without attention-deficit/hyperactivity disorder (ADHD). METHODS Participants included 127 children diagnosed with ADHD and 96 typically developing (TD) children between 4 and 7 years of age. Objective measures of children's body composition, fitness, and physical activity were conducted. Parents of children completed food recalls to assess their child's dietary intake, diet quality was calculated based on the Healthy Eating Index-2015, and parents completed a survey about their family's health habits. RESULTS Logistic regression revealed that those with ADHD were more likely to be classified as having an overweight or obese (Ov/O) body mass index (BMI). Linear regression analyses indicated that children with ADHD performed worse on a fitness test and consumed more calories relative to TD children. Moderation analyses indicated that sex differences in steps were prominent in our TD sample, but not among those with ADHD. CONCLUSIONS Young children with ADHD are at greater risk for having an Ov/O BMI, being less fit, and eating a greater intake of calories compared to TD children.
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Affiliation(s)
- Madeline M Curzon
- Department of Psychology, Center for Children and Families, Florida International University, USA
| | - Anthony S Dick
- Department of Psychology, Center for Children and Families, Florida International University, USA
| | - Catherine Coccia
- Department of Psychology, Center for Children and Families, Florida International University, USA
| | - Paulo A Graziano
- Department of Psychology, Center for Children and Families, Florida International University, USA
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Yu RA, Goulter N, Godwin JW, McMahon RJ. Child and Adolescent Psychopathology and Subsequent Harmful Behaviors Associated with Premature Mortality: A Selective Review and Future Directions. Clin Child Fam Psychol Rev 2023; 26:1008-1024. [PMID: 37819404 DOI: 10.1007/s10567-023-00459-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
In the United States (U.S.), premature mortality in adulthood from suicide, alcohol-related disease, and substance overdoses has increased steadily over the past two decades. To better understand these trends, it is necessary to first examine the harmful behaviors that often precede these preventable deaths (i.e., suicidal ideation and attempts, and harmful alcohol and substance use). Representing critical developmental periods in which psychopathology is most likely to emerge, childhood and adolescence provide an informative lens through which to investigate susceptibility to harmful behaviors. This article synthesizes current evidence describing these rising U.S. mortality rates and the prevalence rates of harmful behaviors linked to these types of mortality. A brief selective review of longitudinal research on harmful behaviors in relation to the most relevant categories of child and adolescent psychopathology is then provided. Finally, recommendations for future research and implications for prevention are discussed.
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Affiliation(s)
- Rachelle A Yu
- Simon Fraser University and B.C. Children's Hospital, Burnaby, Canada.
| | | | | | - Robert J McMahon
- Simon Fraser University and B.C. Children's Hospital, Burnaby, Canada
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Dobrosavljevic M, Kuja-Halkola R, Li L, Chang Z, Larsson H, Du Rietz E. Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study. BMC Med 2023; 21:452. [PMID: 37993878 PMCID: PMC10664476 DOI: 10.1186/s12916-023-03174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Emerging research suggests that attention-deficit/hyperactivity disorder (ADHD) increases the risk for cardiovascular (CVDs) and metabolic disorders (i.e., cardiometabolic disorders) in adulthood. Yet, available studies are scarce and have mainly been focused on individuals receiving clinical ADHD diagnoses. We aimed to investigate the prospective associations of ADHD symptoms in young and mid-adulthood with subsequent cardiometabolic disorders and the underlying mechanisms. METHODS We studied 10,394 twins from the Swedish Twin Registry (STR), born between 1958 and 1985 without previous medical history of cardiometabolic disorders. They provided self-assessment of ADHD symptoms (score range 0-36) via a validated, DSM-IV-based scale in a web-based questionnaire/telephone interview within the Study of Twin Adults: Genes and Environment (STAGE), in 2005-2006 (aged 19-47 years), and were followed until the end of 2018 (33-59 years) to identify incident clinical diagnoses/medication prescriptions for cardiometabolic disorders acquired from Swedish national registers. We used Cox regression models to investigate the associations between ADHD symptoms score and cardiometabolic outcomes, with and without adjustment for relevant covariates, and a co-twin control design to study familial confounding. RESULTS A one-unit increase in the level of ADHD symptoms was associated with a 2% increase in the rate of CVDs (hazard ratio [HR] = 1.02, 95% confidence interval 1.01-1.04) and a 3% increase in the rate of metabolic disorders (HR = 1.03, 1.02-1.05), after adjusting for birth year and sex. The associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. The associations remained significant after adjusting for familial factors shared by dizygotic twin pairs but became nonsignificant after adjusting for factors shared by monozygotic twin pairs. However, the strength of the associations attenuated significantly in monozygotic twins compared to dizygotic twins for CVDs only, suggesting genetic confounding. CONCLUSIONS ADHD symptom score is associated with a higher risk for cardiometabolic disorders, which may be explained by lower educational attainment, adverse lifestyle factors, and psychiatric comorbidities. Moreover, the associations appear to be partly confounded by shared genetic factors, especially for CVDs. Further research is needed to investigate the identified associations at the level of individual cardiometabolic disorders and to follow-up participants until a more advanced older age.
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Affiliation(s)
- Maja Dobrosavljevic
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Tsirmpas C, Nikolakopoulou M, Kaplow S, Andrikopoulos D, Fatouros P, Kontoangelos K, Papageorgiou C. A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study. JMIR Form Res 2023; 7:e48362. [PMID: 37819688 PMCID: PMC10600652 DOI: 10.2196/48362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms. OBJECTIVE This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants' engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels. METHODS This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Barkley Adult ADHD Rating Scale-IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability. RESULTS The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5. CONCLUSIONS The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy.
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Affiliation(s)
| | | | - Sharon Kaplow
- Feel Therapeutics Inc., San Francisco, CA, United States
| | | | | | - Konstantinos Kontoangelos
- First Department of Psychiatry, Eginition Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
- Neurosciences and Precision Medicine Research Institute "Costas Stefanis", University Mental Health, Athens, Greece
| | - Charalabos Papageorgiou
- Neurosciences and Precision Medicine Research Institute "Costas Stefanis", University Mental Health, Athens, Greece
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Levine SZ, Rotstein A, Kodesh A, Sandin S, Lee BK, Weinstein G, Schnaider Beeri M, Reichenberg A. Adult Attention-Deficit/Hyperactivity Disorder and the Risk of Dementia. JAMA Netw Open 2023; 6:e2338088. [PMID: 37847497 PMCID: PMC10582792 DOI: 10.1001/jamanetworkopen.2023.38088] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/02/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Evidence that adult attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk of dementia is scarce and inconsistent, and potential sources of bias are untested. Objective To examine the association between adult ADHD and the risk of dementia. Design, Setting, and Participants This prospective national cohort study consisted of 109 218 members of a nonprofit Israeli health maintenance organization born between 1933 and 1952 who entered the cohort on January 1, 2003, without an ADHD or dementia diagnosis and were followed up to February 28, 2020. Participants were aged 51 to 70 years in 2003. Statistical analysis was conducted from December 2022 to August 2023. Exposure Adult ADHD was a time-varying covariate, classified as present from the age of the first diagnosis (using the International Classification of Diseases, Ninth Revision, and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision); otherwise, absent. Main Outcome and Measures Cox regression models were fitted to quantify the association between adult ADHD and the risk of incident dementia with hazard ratios (HRs) and their 95% CIs unadjusted and in the primary analysis, using inverse probability weights, adjusted for 18 sources of potential confounding. In 14 complementary analyses, subgroup and sensitivity analyses were implemented. Results At the beginning of the follow-up, the sample of 109 218 participants had a mean (SD) age of 57.7 (5.5) years, 56 474 participants (51.7%) were female, and 52 744 (48.3%) were male. During follow-up, 730 participants (0.7%) received a diagnosis of adult ADHD, and 7726 (7.1%) received a diagnosis of dementia. Dementia occurred among 96 of 730 participants (13.2%) with adult ADHD and 7630 of 108 488 participants (7.0%) without adult ADHD. In the primary analysis, compared with the absence of adult ADHD, the presence of adult ADHD was statistically significantly (P < .001) associated with an increased dementia risk (unadjusted HR, 3.62 [95% CI, 2.92-4.49; P < .001]; adjusted HR, 2.77 [95% CI, 2.11-3.63; P < .001]). Twelve of the 14 complementary analyses did not attenuate the conclusions based on the results of the primary analysis. There was, however, no clear increase in the risk of dementia associated with adult ADHD among those who received psychostimulant medication, and evidence of reverse causation was mild. Conclusions and Relevance In this cohort study of individuals born between 1933 and 1952 and followed up in old age, adult ADHD was associated with an increased risk of dementia. Policy makers, caregivers, patients, and clinicians may wish to monitor reliably for ADHD in old age.
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Affiliation(s)
| | - Anat Rotstein
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Arad Kodesh
- Mental Health, Meuhedet Health Services, Tel Aviv, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian K. Lee
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Michal Schnaider Beeri
- The Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center, Brain Health Institute, Rutgers University, Piscataway, New Jersey
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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Musella KE, Weyandt LL. Attention-deficit hyperactivity disorder and youth's emotion dysregulation: A systematic review of fMRI studies. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:353-366. [PMID: 36065486 DOI: 10.1080/21622965.2022.2119142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.
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Affiliation(s)
- Katharine E Musella
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lisa L Weyandt
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Motomura Y, Hayashi S, Kurose R, Yoshida H, Okada T, Higuchi S. Effects of others' gaze and facial expression on an observer's microsaccades and their association with ADHD tendencies. J Physiol Anthropol 2023; 42:19. [PMID: 37679805 PMCID: PMC10486107 DOI: 10.1186/s40101-023-00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the effect of others' gaze on an observer's microsaccades. We also aimed to conduct preliminary investigations on the relationship between the microsaccadic response to a gaze and a gazer's facial expression and attention-deficit/hyperactivity disorder (ADHD) tendencies. METHODS Twenty healthy undergraduate and graduate students performed a peripheral target detection task by using unpredictable gaze cues. During the task, the participants' eye movements, along with changes in pupil size and response times for target detection, were recorded. ADHD tendencies were determined using an ADHD questionnaire. RESULTS We found that consciously perceiving the gaze of another person induced the observer's attention; moreover, microsaccades were biased in the direction opposite to the gaze. Furthermore, these microsaccade biases were differentially modulated, based on the cognitive processing of the facial expressions of the gaze. Exploratory correlation analysis indicated that microsaccade biases toward gazes with fearful expressions may specifically be correlated with participant characteristics, including inattention. CONCLUSIONS Our findings support that microsaccades reflect spatial attention processing and social cognitive processing. Moreover, the exploratory correlation analysis results suggested the potential benefit of using microsaccade bias toward spatial attention to assess pathophysiological responses associated with ADHD tendencies.
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Affiliation(s)
- Yuki Motomura
- Department of Human Life Design, Faculty of Design, Kyushu University, 4-9-1 Shiobaru, Minamiku, Fukuoka, 815-8540, Japan.
| | - Sayuri Hayashi
- Department of Kansei Science, Graduate School of Integrated Frontier Science, Kyushu University, 4-9-1 Shiobaru, Minamiku, Fukuoka, 815-8540, Japan
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-0031, Japan
| | - Ryousei Kurose
- Department of Kansei Science, Graduate School of Integrated Frontier Science, Kyushu University, 4-9-1 Shiobaru, Minamiku, Fukuoka, 815-8540, Japan
| | - Hiroki Yoshida
- Department of Kansei Science, Graduate School of Integrated Frontier Science, Kyushu University, 4-9-1 Shiobaru, Minamiku, Fukuoka, 815-8540, Japan
| | - Takashi Okada
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-0031, Japan
| | - Shigekazu Higuchi
- Department of Human Life Design, Faculty of Design, Kyushu University, 4-9-1 Shiobaru, Minamiku, Fukuoka, 815-8540, Japan
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Wiggs KK, Thornton K, Fredrick JW, Cusick CN, Langberg JM, Becker SP. Physical and Extracurricular Activity in Adolescents With and Without ADHD: Examining Group Differences and the Role of Cognitive Disengagement Syndrome Symptoms. J Atten Disord 2023; 27:1207-1222. [PMID: 36799448 DOI: 10.1177/10870547231154905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This study examined extracurricular and physical activity related to ADHD (diagnosis and symptoms) and cognitive disengagement syndrome (CDS) symptoms. METHODS Participants were 302 adolescents (ages 12-14) with and without ADHD and primary caregivers. ADHD diagnosis was determined with parent interview. Questionnaires provided information on parent-reported demographic characteristics, ADHD symptoms, and extracurricular activity involvement; and adolescent-reported ADHD and CDS symptoms and indices of physical activity. RESULTS Although ADHD diagnosis and symptom dimensions were correlated with less extracurricular and physical activity involvement, CDS symptoms were most often independently associated with these outcomes. Females and adolescents from lower income homes also often had less involvement in extracurricular and physical activity. CONCLUSIONS Findings point to the need for more research in this area, careful assessment of risk factors (i.e., CDS symptoms, economic burden), and interventions that address inactivity in adolescents with ADHD, including those that address inequity related to income and sex.
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Affiliation(s)
| | | | - Joseph W Fredrick
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | | | | | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
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Abed M, Mansureh HH, Masoud GAL, Elaheh H, Mohammad-Hossein NHK, Yamin BD, Abdol-Hossein V. Construction of Meta-Thinking Educational Program Based on Mental-Brain Simulation ( MTMBS) and Evaluating its Effectiveness on Executive Functions, Emotion Regulation, and Impulsivity in Children With ADHD: A Resting-State Functional MRI Study. J Atten Disord 2023; 27:1223-1251. [PMID: 36843348 DOI: 10.1177/10870547231155436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE The aim of present research was to make a Meta-Thinking educational program based on mental-brain simulation and to evaluate its effectiveness on executive functions, emotion regulation and impulsivity in children with ADHD. METHODS The research method was Embedded Design: Embedded Experimental Model. The research sample included 32 children with ADHD who were randomly assigned to two experimental and control groups. The intervention was implemented for eight sessions of 1.5 hr for the experimental group, and fMRI images were taken from them, while the control group didn't receive any treatment. Finally, using semi-structured interviews, coherent information was collected from the parents of the experimental group about the changes made. Data were analyzed with SPSS-24, MAXQDA, fMRIprep, and FSL software. RESULTS The Meta-Thinking Educational Program had effect on performance of ADHD children and suppressed brain regions related to DMN. CONCLUSION The Implementation of this educational program plays a vital role in improving psychological problems of children with ADHD.
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Kollin SR, Lim CS, Lee AA. The longitudinal influence of ADHD status and stimulant medication on body mass index and blood pressure among youth with obesity. Pediatr Obes 2023; 18:e13058. [PMID: 37263740 DOI: 10.1111/ijpo.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/30/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Youth with attention-deficit hyperactivity disorder (ADHD) are more vulnerable to developing obesity. Stimulant medication use, an evidence-based treatment for ADHD, is associated with lower body mass index (BMI) and higher blood pressure among non-overweight youth. OBJECTIVES The purpose of this study was to examine the longitudinal influence of ADHD and stimulant medication use on BMI and blood pressure among a sample of 456 youth with overweight and obesity treated in a paediatric weight management clinic. METHODS Mixed linear modelling examined the main and interactive effects of time by ADHD status and stimulant medication use on BMI and blood pressure. RESULTS Youth without ADHD experienced a significantly faster decrease in BMI compared to youth with ADHD (p < 0.001). Youth with ADHD who were taking stimulant medication had a significantly faster decrease in BMI compared to youth with ADHD who were not taking stimulant medication (p = 0.009). There was no significant effect of ADHD status or stimulant medication use on diastolic or systolic blood pressure trajectories over time (ps >0.05). CONCLUSIONS Results from this study suggest that youth with ADHD who are not taking stimulant medication may not benefit from clinical weight management to the same extent as either youth without ADHD or youth with ADHD who are taking a stimulant medication.
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Affiliation(s)
- Sophie R Kollin
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
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Becker S, Chowdhury M, Tavilsup P, Seitz D, Callahan BL. Risk of neurodegenerative disease or dementia in adults with attention-deficit/hyperactivity disorder: a systematic review. Front Psychiatry 2023; 14:1158546. [PMID: 37663597 PMCID: PMC10469775 DOI: 10.3389/fpsyt.2023.1158546] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose of review Several psychiatric disorders have been associated with an increased risk of developing a neurodegenerative disease and/or dementia. Attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder, has been understudied in relation to dementia risk. We summarized existing literature investigating the risk of incident neurodegenerative disease or dementia associated with ADHD. Recent findings We searched five databases for cohort, case-control, and clinical trial studies investigating associations between ADHD and neurodegenerative diseases/dementia in May 2023. Study characteristics were extracted by two independent raters, and risk of bias was assessed using the Newcastle Ottawa Scale. Search terms yielded 2,137 articles, and seven studies (five cohort and two case-control studies) ultimately met inclusion criteria. Studies examined the following types of neurodegeneration: all-cause dementia, Alzheimer's disease, Parkinson's and Lewy body diseases, vascular dementia, and mild cognitive impairment. Heterogeneity in study methodology, particularly covariates used in analyses and types of ratios for risk reported, prevented a meta-analysis and data were therefore summarized as a narrative synthesis. The majority of studies (4/7) demonstrated an overall low risk of bias. Summary The current literature on risk of developing a neurodegenerative disease in ADHD is limited. Although the studies identified present evidence for a link between ADHD and subsequent development of dementia, the magnitude of the direct effect of ADHD on neurodegeneration is yet to be determined and better empirically designed studies are first needed. Furthermore, the mechanism of how or why ADHD is associated with an increased risk of developing a neurocognitive disorder is still unclear and should be explored in future studies. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022348976, the PROSPERO number is CRD42022348976.
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Affiliation(s)
- Sara Becker
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mohammad Chowdhury
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pattara Tavilsup
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dallas Seitz
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brandy L. Callahan
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Xu M, Yu X, Fan B, Li G, Ji X. Influence of Mode of Delivery on Children's Attention Deficit Hyperactivity Disorder and Childhood Intelligence. Psychiatry Investig 2023; 20:714-720. [PMID: 37559451 PMCID: PMC10460982 DOI: 10.30773/pi.2022.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/03/2023] [Accepted: 05/12/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To investigate whether differences exist in attention deficit hyperactivity disorder (ADHD) and intelligence between children born by cesarean delivery and those born by vaginal delivery. METHODS This retrospective study included singleton children that were born between January 2013 and December 2014. The Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48) was required on the probability of psychological and behavioral problems. The China-Wechsler Intelligence Scale for Children (C-WIRS) was used for evaluation of crystallized intelligence and Raven's Standard Progressive Matrices for evaluation of fluid intelligence. RESULTS A total of 10,568 valid questionnaires were obtained. CPRS-48 ADHD index and detection rate were higher in cesarean delivery group than those in vaginal delivery group. Cesarean delivery groups had a lower performance intelligence quotient score according to C-WISC. CONCLUSION Children born by cesarean delivery were more likely to have a risk of ADHD and a lower performance intelligence quotient compared with those born by vaginal delivery.
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Affiliation(s)
- Min Xu
- Department of Obstetrics, Qingdao Chengyang People’s Hospital, Qingdao, China
| | - Xuemei Yu
- Department of Obstetrics, Qingdao Chengyang People’s Hospital, Qingdao, China
| | - Benjie Fan
- Department of Obstetrics, Qingdao Chengyang People’s Hospital, Qingdao, China
| | - Guimei Li
- Department of Obstetrics, Qingdao Chengyang People’s Hospital, Qingdao, China
| | - Xinxin Ji
- Department of Obstetrics, Qingdao Chengyang People’s Hospital, Qingdao, China
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Zdorovtsova N, Jones J, Akarca D, Benhamou E, The Calm Team, Astle DE. Exploring neural heterogeneity in inattention and hyperactivity. Cortex 2023; 164:90-111. [PMID: 37207412 DOI: 10.1016/j.cortex.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/21/2023] [Accepted: 04/04/2023] [Indexed: 05/21/2023]
Abstract
Inattention and hyperactivity are cardinal symptoms of Attention Deficit Hyperactivity Disorder (ADHD). These characteristics have also been observed across a range of other neurodevelopmental conditions, such as autism and dyspraxia, suggesting that they might best be studied across diagnostic categories. Here, we evaluated the associations between inattention and hyperactivity behaviours and features of the structural brain network (connectome) in a large transdiagnostic sample of children (Centre for Attention, Learning, and Memory; n = 383). In our sample, we found that a single latent factor explains 77.6% of variance in scores across multiple questionnaires measuring inattention and hyperactivity. Partial Least-Squares (PLS) regression revealed that variability in this latent factor could not be explained by a linear component representing nodewise properties of connectomes. We then investigated the type and extent of neural heterogeneity in a subset of our sample with clinically-elevated levels of inattention and hyperactivity. Multidimensional scaling combined with k-means clustering revealed two neural subtypes in children with elevated levels of inattention and hyperactivity (n = 232), differentiated primarily by nodal communicability-a measure which demarcates the extent to which neural signals propagate through specific brain regions. These different clusters had similar behavioural profiles, which included high levels of inattention and hyperactivity. However, one of the clusters scored higher on multiple cognitive assessment measures of executive function. We conclude that inattention and hyperactivity are so common in children with neurodevelopmental difficulties because they emerge through multiple different trajectories of brain development. In our own data, we can identify two of these possible trajectories, which are reflected by measures of structural brain network topology and cognition.
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Affiliation(s)
- Natalia Zdorovtsova
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Jonathan Jones
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Danyal Akarca
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Elia Benhamou
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - The Calm Team
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Duncan E Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK
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Dobrosavljevic M, Larsson H, Cortese S. The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults. Expert Rev Neurother 2023; 23:883-893. [PMID: 37725058 DOI: 10.1080/14737175.2023.2250913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION There is a striking knowledge gap on ADHD in older adults, and the diagnosis as well as treatment for ADHD in this age group. AREAS COVERED The authors first review the literature on the prevalence, functional impairment, and health comorbidities of ADHD across the lifespan. Next, they address the diagnostic criteria for ADHD in adults according to the DSM/ICD, available screening/diagnostic tools, differential diagnosis, and the validity of diagnostic criteria for ADHD in older adults. Finally, the authors focus on empirical evidence on the prevalence rates, medication response, and safety of pharmacological treatment of ADHD in older adults, and national and international clinical guidelines on the treatment of ADHD in this age group. EXPERT OPINION It is expected that future editions of the DSM and ICD will provide specifiers to the standard ADHD criteria, to better inform the diagnosis of ADHD in older adults. It is also expected that the increasing number of epidemiological studies will provide rigorous estimates on the prevalence, incidence, and burden of ADHD in older adults. One may expect an increasing number of RCTs assessing the efficacy/effectiveness and tolerability/safety of pharmacological as well as non-pharmacological interventions which will inform future guidelines on ADHD in older adults.
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Affiliation(s)
- Maja Dobrosavljevic
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Life and Environmental Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York, NY, USA
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Larsson H. How can we improve the management of individuals with attention deficit hyperactivity disorders and co-occurring cardiometabolic disease? Expert Rev Cardiovasc Ther 2023; 21:725-728. [PMID: 37925740 DOI: 10.1080/14779072.2023.2279608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
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47
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Liu G, Lu W, Qiu J, Shi L. Identifying individuals with attention‐deficit/hyperactivity disorder based on multisite resting‐state functional magnetic resonance imaging: A radiomics analysis. Hum Brain Mapp 2023; 44:3433-3445. [PMID: 36971664 PMCID: PMC10171499 DOI: 10.1002/hbm.26290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by symptoms of age-inappropriate inattention, hyperactivity, and impulsivity. Apart from behavioral symptoms investigated by psychiatric methods, there is no standard biological test to diagnose ADHD. This study aimed to explore whether the radiomics features based on resting-state functional magnetic resonance (rs-fMRI) have more discriminative power for the diagnosis of ADHD. The rs-fMRI of 187 subjects with ADHD and 187 healthy controls were collected from 5 sites of ADHD-200 Consortium. A total of four preprocessed rs-fMRI images including regional homogeneity (ReHo), amplitude of low-frequency fluctuation (ALFF), voxel-mirrored homotopic connectivity (VMHC) and network degree centrality (DC) were used in this study. From each of the four images, we extracted 93 radiomics features within each of 116 automated anatomical labeling brain areas, resulting in a total of 43,152 features for each subject. After dimension reduction and feature selection, 19 radiomics features were retained (5 from ALFF, 9 from ReHo, 3 from VMHC and 2 from DC). By training and optimizing a support vector machine model using the retained features of training dataset, we achieved the accuracy of 76.3% and 77.0% (areas under curve = 0.811 and 0.797) in the training and testing datasets, respectively. Our findings demonstrate that radiomics can be a novel strategy for fully utilizing rs-fMRI information to distinguish ADHD from healthy controls. The rs-fMRI-based radiomics features have the potential to be neuroimaging biomarkers for ADHD.
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Serrano JW, Abu-Ramadan TM, Vasko JM, Leopold DR, Canu WH, Willcutt EG, Hartung CM. ADHD and Psychological Need Fulfillment in College Students. J Atten Disord 2023; 27:912-924. [PMID: 36924424 DOI: 10.1177/10870547231161530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Self-determination theory suggests that the satisfaction and frustration of basic psychological needs-autonomy, competence, relatedness-are uniquely associated with overall well-being. Undergraduates with attention-deficit/hyperactivity disorder (ADHD) experience more academic-related impairment and are less likely to graduate. Thus, well-being is important to understand and aim to improve in these students. METHOD Students at four universities (N = 2,197) completed a survey and reported previous diagnoses, ADHD symptoms, and psychological need satisfaction and frustration. Group differences were explored via t-tests; associations were explored via structural equation modeling. RESULTS The ADHD group reported lower satisfaction and higher frustration across all psychological needs. Inattention and hyperactivity/impulsivity were uniquely associated with aspects of need fulfillment beyond the impact of comorbid symptoms. Sex differences emerged such that women with ADHD had the lowest overall need satisfaction. CONCLUSIONS Addressing need fulfillment, both satisfaction and frustration, in interventions with undergraduates with clinical/subclinical levels of ADHD may optimize treatment effectiveness.
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Affiliation(s)
| | | | | | | | - Will H Canu
- Appalachian State University, Boone, NC, USA
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Zwemer CH, Mohseni S, Forssten MP, Malyavko A, Zebley JA, Qaddumi WN, Cornejo M, Sarani B, Kartiko S. The relationship of ADHD and trauma mortality: An NTDB analysis. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231163660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Objective Nearly 7% of the adult US population has symptomatic Attention Deficit Hyperactivity Disorder (ADHD), which is associated with an increased risk for traumatic injury. There is limited data on the outcome of hospitalized trauma patients with ADHD. This study aimed to use a large nationwide database to investigate the relationship between a diagnosis of ADHD and clinical outcomes in hospitalized patients after major trauma. Methods All patients 18 years or older in the National Trauma Database were retrospectively reviewed. Propensity score analysis was used to match patients with and without the diagnosis of ADHD at a 1:1 ratio based on age, sex, race, highest AIS in each region, comorbidities, and the presence of advanced directives limiting care. Outcomes of patients with ADHD admitted to the trauma service between the years 2015 and 2017 were compared to those without ADHD. The primary outcome of interest was in-hospital mortality, while the secondary outcomes included complications and hospital length of stay. Results There were 9399 patients included in the study with a diagnosis of ADHD. These patients were overall more likely to be younger, male, and Caucasian, compared to their matched counterparts without ADHD. ADHD was associated with a significantly lower in-hospital mortality than patients without ADHD. There was no difference in the ICU admission rate, ICU LOS, ventilator use, or complication rates between patients with and without ADHD. Conclusion A diagnosis of ADHD has a complex association with clinical outcomes after trauma. The current large national analysis found that patients with a diagnosis of ADHD had significantly lower overall in-hospital mortality.
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Affiliation(s)
- Catherine H Zwemer
- Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Alisa Malyavko
- Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC, USA
| | - James A Zebley
- Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC, USA
| | - Waleed N Qaddumi
- Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC, USA
| | - Miglia Cornejo
- Department of Psychiatry, Division of Child/Adolescent and Family Psychiatry, The George Washington University, Washington DC, USA
| | - Babak Sarani
- Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC, USA
| | - Susan Kartiko
- Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC, USA
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Trivedi C, Nandakumar AL, Yousefzadehfard Y, Goriparthi TSK, Chaudhari G, Vora D, Mansuri Z, Jain S. Suicide Risk Among Adolescents With ADHD: An Overview From the National Inpatient Sample Data Set. J Nerv Ment Dis 2023; 211:216-220. [PMID: 36108281 DOI: 10.1097/nmd.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Studies have shown an association between attention deficit hyperactivity disorder (ADHD) and suicide; however, it has not been studied from inpatient hospitalization data among adolescents. For this study, data from the National Inpatient Sample data set were used. Based on the diagnosis of ADHD, the patient sample was stratified into two groups. Study group was composed of patients with ADHD, and control group was selected by propensity score matching (1:1), which composed of patients without ADHD. The primary outcome was suicidal ideation/attempt between the groups. Prevalence of SI was 25.1% in patients with ADHD versus 10.3% among patients without ADHD. Prevalence of SA was also very high (8.0% vs 3.9%) among patient with ADHD compared with non-ADHD group. After controlling for covariates, ADHD was a strong predictor of suicidal ideation/attempt with an odds ratio of 2.18. It is important to screen for suicidality in patient with ADHD given the high prevalence of suicidality.
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Affiliation(s)
- Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | | | - Yashar Yousefzadehfard
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | | | - Gaurav Chaudhari
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | - Darshini Vora
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Shailesh Jain
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
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