The prevalence of attention deficit hyperactivity disorder in preschool-age children in Mashhad, north-East of Iran.

Can Guidelines Help Reduce the Medicalization of Early Childhood?

Family, twin, and adoption studies show attention deficit hyperactivity disorder (ADHD) to have a substantial genetic component, and some studies have reported an association between ADHD and the dopamine D4 (DRD4) gene. The authors recruited 27 triads that comprised an ADHD adult, his or her spouse, and their ADHD child. These triads were assessed for ADHD, and their DNA was genotyped for DRD4 alleles. A multiallelic transmission disequilibrium test suggested an association between ADHD and the DRD4 7-repeat allele. Among family members, the number of 7-repeat alleles predicted the diagnosis of ADHD. Prior reports of an association between ADHD and DRD4 generalize to families recruited through clinically referred ADHD adults. However, because there are some conflicting studies, further work is needed to clarify the role of DRD4 in the etiology of the disorder.

Attention deficit/hyperactivity disorder (ADHD) used to be studied at age of diagnosis–the typical time that professional help is sought and children get an ADHD diagnosis was also the time that they typically enrolled in scientific studies. As a consequence, most of our knowledge is about referred children with ADHD in middle childhood in the age range of 6–12 years. One implication of this is that for a long time ADHD research was not bothered so much by studying causes of ADHD after its onset—in other words, within the total of studies aimed at understanding the causes of ADHD, prospective studies in ADHD research have been rare. The first paper that I will highlight in this editorial is by Miller et al. (2023) who discuss the development of ADHD in the period from conception to age of onset. They stress that for understanding the causes of ADHD prospective research prior to its onset is needed and explain that any differences observed in children with ADHD (i.e., after its onset) compared to children without ADHD may be secondary to personal and environmental alterations that are evoked by the ADHD symptoms themselves. At the same time, they point out that an onset of ADHD is gradual and the distinction between pre-onset and post-onset not clear-cut: precursor behaviors of ADHD may already evoke personal and environmental alterations. Thus, for a causal understanding of ADHD, we need to know these as well. Prospective research from conception to full clinical onset allows us to chart such alterations and their temporal sequence up to a full onset of ADHD. The value of establishing the temporal sequence of personal and environmental alterations leading to a clinical onset of a disease cannot be underestimated. It is one element (albeit by no means a sufficient element) in establishing the causality of a risk factor (the risk factor should occur prior to the onset of the disease), and a very important one in observational research. The accumulation of knowledge as to whether a risk factor is (likely) causal is necessary if we want to target the risk factor for interventions: that is, only causal risk factors can actually influence the outcome. Prospective research charting the sequences of personal and environmental alterations in risk during the gradual unfolding of ADHD over time provides opportunities to identify mediators that are useful as intervention targets in particular developmental periods. Also, prospective research may identify protective factors, by comparing children who have the same risk profile (e.g., at conception, at birth) but one group progressing to a full clinical onset of ADHD yet another not. That is, if we only study those who already have an onset of ADHD like we used to do we can never know if onset of ADHD (particularly the impairments experienced by the children) can be prevented, postponed or reduced in severity and thus if and how a developmental trajectory heading toward onset of ADHD can be shifted toward a more favorable outcome. The paper by Miller et al. in this issue of JCPP Advances describes a research agenda for prospective research pre-onset to ADHD. The authors have formed the Early ADHD Consortium to improve future prospective research on the causes of ADHD. An important factor herein in my view is sample size. Clearly, we need the statistical power coming from large samples to get robust insights into the causes of ADHD: ADHD is a multifactorial condition resulting from the collective influence of multiple personal and environmental risk factors, each contributing a minor part but working in unison to heighten ADHD susceptibility. With none of the risk factors being necessary or sufficient, pathways toward onset of ADHD diverge among children and the to-be-expected small effects of any risk factor manifest as even smaller effects when averaged across all children in the study sample. This reasoning on why large samples are needed holds all the more if we are to identify the interplay (interactions) among risk factors. Furthermore, Miller et al. point out that neurodevelopmental alterations likely emerge prior to overt behavioral changes and that we need to understand causal factors at additional levels of understanding (e.g., metabolic or neural levels) next to the overt behavioral level, emphasizing once more the need for large samples. Team science in consortia to enlarge the sample turned out to be the game changer in the field of genetics, and this should also work out to improve our understanding of the broader (potentially interacting) causes of ADHD. JCPP Advances is therefore proud to publish the “Delineating early developmental pathways to ADHD: Setting an international research agenda” from the Early ADHD Consortium. The second paper that I will highlight by Li et al. is also published in JCPP Advances (2023) and focuses on a different phase in the life course of individuals with ADHD. Li et al. are a group of authors who come from another recently formed ADHD consortium “TIMESPAN,” which zooms in on cardiometabolic diseases which in most cases have an onset (long) after the onset of ADHD. The meta-analysis by Li et al. is on cardiovascular diseases (CVD) and shows that adults with ADHD are nearly twice as likely to develop CVD than adults without ADHD. An important asset of the paper is that the authors embedded this finding in the broader available knowledge on the link between neuropsychiatric disorders and CVD, showing that the two-fold risk in relation to CVD is similar to estimates for schizophrenia and substance use disorder but larger than estimates for mood, anxiety and stress related disorders. This group from TIMESPAN has just published a similar meta-analysis on ADHD and type 2 diabetes (Garcia-Argibay et al., 2023), and a strong empirical study on ADHD and CVD (Li et al., 2022), and together with the evidence from the longer-standing research tradition on comorbidity of ADHD with obesity (Cortese et al., 2016; Nigg et al., 2016), we can conclude that the link between ADHD and cardiometabolic diseases has now been well-established. Together, these papers including the one by Li et al. in JCPP Advances discuss steps that need to be taken for a mechanistic understanding of the causes of an onset of comorbid cardiometabolic diseases in adults with ADHD as well as the consequences (particularly the consequences are studied in the TIMESPAN consortium). Like causes of ADHD need to be established pre-onset to ADHD, prospective research on the sequence of personal and environmental alterations leading up to a comorbid condition need to be established pre-onset of a comorbid condition. This, with the same complication as in ADHD that onset of a comorbid condition is gradual and does not only include overt alterations in personal risk factors but also, for example, metabolic or neural alterations. One important reason to form the TIMESPAN consortium was, like it likely was for the Early ADHD Consortium, the need for a large sample size to do prospective research on multifactorial conditions (in this case both ADHD and the different cardiometabolic diseases are multifactorial). As argued, the ideas put forward by Miller et al. are not only relevant pre-onset to ADHD but throughout the lifespan. To illustrate this further, I want to highlight two aspects specifically. First, as pointed out already, Miller et al. emphasize that environmental risk factors of ADHD in early development may change over time. As an example of altering risk factors over development, maternal immune activation, during pregnancy, may contribute to the risk of a later onset of ADHD (He et al., 2022), while parental difficulties to regulate their emotions, subsequently during toddlerhood, may at that point in time contribute to the risk of a later onset of ADHD (Claussen et al., 2022). Note that these findings, apart from that they need further study, have never been studied prospectively in the same children to establish potential accumulation of risk. We may extend the idea that risk factors change across the lifespan from the causes of ADHD to the course of ADHD. For example, with regard to the development of comorbid obesity, impulsive reward driven eating of high caloric, low nutrient, foods leading to overweight may be particularly prevalent in adolescents with ADHD, while lack of physical activity associated with difficulties with motivation and organization in ADHD may contribute to weight gain particularly in adults (note that this is a fictitious example, changes in risk factors contributing to weight gain in individuals with ADHD relative to individuals without ADHD in different developmental periods have not yet been studied). These examples on changing risk factors across the lifespan illustrate how much prospective work, both pre-onset to or post-onset of ADHD, is still to be done. A second example of how ideas put forward by Miller et al. on causes of ADHD can be extended across the lifespan relates to the specificity or non-specificity of personal and environmental risk factors of ADHD (non-specificity meaning that they also play role in the onset of other conditions and not just in the onset of ADHD). Miller et al. explain that how an exclusive focus on onset of ADHD and the presumption of specificity of risk for this outcome may obscure transdiagnostic patterns and lead to inaccurate causal models. That non-specificity is ubiquitous and also relevant in the course of ADHD is undisputed. I already cited the example reported by Li et al. on the association of ADHD with CVD amidst similar associations of schizophrenia, substance use disorder, mood, anxiety and stress related disorders with CVD. Similarly, the most recent Genomewide Association Study on ADHD showed high sharing of genetic (concordant and discordant) genetic variants of ADHD with other disorders showing even more than before their strong intertwinement of the genetic architecture (Demontis et al., 2023). Specifically with regard to the onset of comorbid conditions during the course of ADHD, we may first of all draw from known personal and environmental risks of these conditions. The pertinent question with regard to specificity in this context is if these known risk factors have a similar effect whether ADHD is present or not (i.e., an interaction effect). For example, the effect may be stronger in individuals with ADHD compared to individuals without ADHD as in the previous example on how weight gain may be specifically linked to ADHD characteristics in different developmental periods (impulsivity and reward drivenness; motivational and organizational difficulties). In addition, prospective research may potentially show that timing may be different: known risk factors and precursors of onset of comorbidity may exert their influence earlier in individuals with than without ADHD. For example, there is some evidence that the onset of a condition is earlier in persons with than without ADHD (e.g., substance abuse: Dunne et al., 2014; CVD, Li et al., 2022). In addition, there may be risk factors that are specific to individuals with ADHD that lead up to the comorbid condition and which we currently do not know. Close monitoring in prospective research, as advocated by Miller et al., but now applied to the unfolding of the course of ADHD, specifically onset of comorbid conditions, will help establish this knowledge. This second example on the specificity of personal and environmental risk factors shows that broad knowledge beyond just ADHD is required. For example, in the example of Timespan, both specialists on ADHD and on cardiometabolic diseases take part. Again, if extended to other levels of understanding (metabolomic, neural, etc.), in addition to the overt personal risk factors, this holds even more. Thus, not only large sample sizes but also broad knowledge to do the best possible research can be accomplished by multidisciplinary team science. In this editorial, I argued that making the distinctions between the causes of ADHD and the course of ADHD and between the causes of onset of comorbidity and the course thereafter are essential. At the same time, the gradual onset of ADHD and any comorbid condition makes clear that there is no hard cut between causes and consequences. Yet through close monitoring over time, we will be able to establish the cascades of personal and environmental alterations leading to the onset of ADHD and to the onset of comorbid conditions. In my ideal world, we would do prospective mechanistic research on ADHD (or any other condition) from pregnancy to death, but this is obviously not going to happen. Yet, papers from multidisciplinary research teams working together on different parts of the lifespan, like Miller et al. in the Early ADHD Consortium, and Li et al. in the Timespan consortium, show that we are making good progress in understanding the ADHD lifespan. Catharina A. Hartman: Conceptualization; writing–original draft; writing–review and editing. Catharina A. Hartman is part of the TIMESPAN consortium, but not a co-author on the cited papers. She is also Deputy Editor-in-Chief for JCPP Advances.

Treatment Controversies in Adult ADHD.

ObjectivesTo systematically estimate the overall prevalence of attention-deficit hyperactivity disorder (ADHD) in children, adolescents and adults across the Middle East and North Africa (MENA) region.DesignSystematic review and meta-analysis conducted according...

The Prevalence of Attention Deficit-Hyperactivity Disorder in Children With Nonmonosymptomatic Nocturnal Enuresis: A 4-Year Followup Study

The diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) comorbid with epilepsy have been insufficiently addressed in China. We conducted a study in China to investigate the current status, diagnosis, and treatment of ADHD in children to further our understanding of ADHD comorbid with epilepsy, strengthen its management, and improve patients' quality of life. We carried out a multicenter cross-sectional survey of children with epilepsy across China between March2022 and August2022. We screened all patients for ADHD and compared various demographic and clinical factors between children with and without ADHD, including gender, age, age at epilepsy onset, duration of epilepsy, seizure types, seizure frequency, presence of epileptiform discharges, and treatment status. Our objective was to explore any possible associations between these characteristics and the prevalence of ADHD. Overall, 395 epilepsy patients aged 6-18years were enrolled. The age at seizure onset and duration of epilepsy ranged from 0.1-18 to 0.5-15years, respectively. Focal onset seizures were observed in 212 (53.6%) patients, while 293 (76.3%) patients had epileptiform interictal electroencephalogram (EEG) abnormalities. Among the 370 patients treated with anti-seizure medications, 200 (54.1%) had monotherapy. Although 189 (47.8%) patients had ADHD, only 31 received treatment for it, with the inattentive subtype being the most common. ADHD was more common in children undergoing polytherapy compared to those on monotherapy. Additionally, poor seizure control and the presence of epileptiform interictal EEG abnormalities may be associated with a higher prevalence of ADHD. While the prevalence of ADHD was higher in children with epilepsy than in normal children, the treatment rate was notably low. This highlights the need to give more importance to the diagnosis and treatment of ADHD in children with epilepsy.

Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.

BackgroundAttention-Deficit / Hyperactivity Disorder is a developmental neurological disorder that has three basic characteristics: Attention Deficit, Hyperactivity, and impulsivity. This study aimed to investigate the prevalence of ADHD in children and adolescents.MethodsThis investigation was carried out using the meta-analysis method under PRISMA guidelines. Until October 2020, the articles were gathered by scanning PubMed, Scopus, WOS, and Science Direct databases. The second version of Comprehensive Meta-Analysis software was used to run analyses after extracting data from chosen papers. At a significance level of 0.05, the I2 test was used to analyze study heterogeneity, and the Egger test was used to assess publication bias.ResultsThis analysis includes 61 cross-sectional research, with 53 research used to determine the prevalence of ADHD in children, 7.6% of 96,907 children aged 3 to 12 years had ADHD (95% confidence interval: 6.1–9.4%), and 5.6% of teenagers aged 12 to 18 years have ADHD (95% confidence interval: 4.8-7%). The prevalence of ADHD in children and adolescents according to the DSM-V criterion is also higher than previous diagnostic criteria, according to studies.ConclusionThe findings of this study based on meta-analysis show the high prevalence of attention deficit hyperactivity disorder (ADHD). The findings of this study demonstrate the importance of management and policy in the treatment and control of ADHD in children and adolescents.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorders in childhood and adolescence, affecting 2.2 to 17.8% of all school-aged children and adolescents. ADHD in children has been associated with a wide range of developmental deficits including limitations of learning or control of executive functions as well as global impairments of social skills. However, no review has been conducted to report the consolidated magnitude of ADHD in children and adolescents in Africa. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of ADHD in Africa.MethodsFollowing the PRISMA guideline, we systematically reviewed and meta-analyzed studies that investigated the prevalence of ADHD in Africa from three electronic databases (PubMed, Embase, and Scopus). We also looked at the reference lists of included studies to include other relevant studies. Subgroup and sensitivity analysis was carried out based on the study setting, tools used to measure ADHD, sex of participants, and the subtype of ADHD. Heterogeneity across the studies was evaluated using Cochran's Q- and the I2-test. We assessed potential publication bias using Egger's test and visual inspection of the symmetry in funnel plots.ResultsIn the present meta-analysis, 7452 articles were initially identified and evaluated. Of these, 12 studies that met the inclusion criteria were included in the final analysis. The pooled prevalence of ADHD in children and adolescents in Africa was 7.47% (95% CI 60–9.26). The prevalence of ADHD was apparently greater in boys (10.60%) than in girls (5.28%) with a male:female ratio of 2.01:1. In our subgroup analysis, the predominantly inattentive type (ADHD-I) was found to be the most common subtype of ADHD, followed by hyperactive–impulsive type (ADHD-HI) and the combined type (ADHD-C) with the prevalence of 2.95%, 2.77%, and 2.44% respectively. The predominantly inattentive type (ADHD-I) was the most common type of ADHD in both boys (4.05%) and girls (2.21%). The funnel plot and Egger's regression tests provided no evidence of substantial publication bias in the prevalence of ADHD.ConclusionOur systematic review suggested a higher prevalence of ADHD (7.47%) in children and adolescents in Africa, indicating that ADHD is a serious public health problem in children and adolescents in Africa. The prevalence of ADHD was considerably greater in males than in females. The predominantly inattentive type (ADHD-I) was the most common type of ADHD in both males and females. Greater attention needs to be paid to the prevention and treatment of ADHD.

Objective: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), classifies attention-deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder, with symptoms becoming apparent as early as the preschool years. Early recognition can lead to interventions such as parent/teacher-administered behavior therapy, the recommended first-line treatment for preschool patients. There are few data, however, to inform the use of second-line, pharmacotherapy options in this population. In this review, we identified recent literature on the diagnosis and treatment of ADHD in preschool children. Methods: A PubMed and clinicaltrials.gov search was conducted for trials assessing efficacy or safety of ADHD medications in children aged <6 years. Diagnostic methods and criteria focusing on recognition of ADHD in preschool children were also surveyed. Results: The DSM-5 describes different manifestations of ADHD in preschool versus school-aged children, but does not list separate criteria by age group. Importantly, behaviors indicative of ADHD in older children may be developmentally appropriate in preschool children. Several behavioral rating scales have been validated in children younger than 6 years of age for assessing ADHD. The Preschool ADHD Treatment Study (PATS) has provided the most extensive efficacy and safety data on methylphenidate (MPH) for ADHD in preschoolers to date, with significant improvement in ADHD symptoms observed with MPH compared with placebo, although adverse event-related discontinuation was higher in PATS compared with studies of MPH for ADHD in school-aged children. Since PATS was conducted, few studies designed to assess ADHD medication effectiveness in preschool children have been published. One article reported significant improvement in ADHD symptoms with MPH (immediate release) versus placebo, two studies showed no difference between MPH and risperidone or MPH plus risperidone in relief of ADHD symptoms, and one study demonstrated the efficacy of atomoxetine versus placebo for ADHD symptoms in preschoolers. Conclusions: Further research is needed on pharmacotherapy for preschool children with ADHD.

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood onset psychiatric disorders. Prevalence among school children varies from 1% to 20%.Western literature on this disorder has grown but in India only few studies have been done. Evaluation of prevalence of ADHD in school age children can help clinicians to consider the diagnosis of ADHD. Early intervention minimizes negative impact of this disorder. The main objective is to study the prevalence of ADHD among urban school going children. Methods: Nine hundred and ninety seven (540 males and 457 females) school children (aged between 6 to 12 years) from 3 government aided English medium schools of Bengaluru were selected for the study. Teachers and parents of these children were asked to complete a ten item Conner‘s index questionnaire for each of these children. Those with the scores of >15 were considered positive. Parents of children whose scores were positive for ADHD were interviewed by a psychiatrist and ADHD was diagnosed based on DSM-IV diagnostic criteria. Results: 23 (2.3%) children were diagnosed to have ADHD. Of 23 children, 18 (78.26%) were boys and 5 (21.74%) were girls. The mean age of boys with ADHD was 10.2 years and the mean age of girls with ADHD was 7.6years. The male to female ratio was 3.6:1. Conclusions: ADHD is one of the prevalent psychiatric disorders in school children. ADHD symptoms are frequently reported by teachers and parents by means of DSM-IV based questionnaire. This study recommends diagnosis and treatment of school children with ADHD.

The aim of this study was to examine clinical outcomes, psychiatric comorbidity and neuropsychological characteristics in Turkish adolescents with an attention deficit hyperactivity disorder (ADHD) diagnosis in childhood. A total of 45 children with ADHD diagnosis and 28 children with a psychiatric diagnosis other than ADHD in a 1-year cohort of 7-10-year-olds were reevaluated 6 years later using Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Wechsler Intelligence Scale for Children-Revised and Stroop Test TBAG version. This study shows that the clinical outcomes and the comorbidity patterns for ADHD from childhood to adolescence in Turkey are similar to reported rates in the Western countries. In the ADHD group, 75.6 % still has impairing ADHD symptoms and 46.6 % has comorbid psychiatric disorders. The main difference is anxiety disorders being the most common comorbid disorders (37.8 %) in Turkish ADHD youth. These findings stress the high comorbidity associated with ADHD and support the importance of assessment and treatment for ADHD and comorbidities during adolescence.

Aims1.Literature survey on ADHD in Down’s syndrome2.To evaluate the prevalence of Attention Deficit hyperactivity Disorder (ADHD ) and Autism in Down’s Syndrome using Light House Child development center Down’s Syndrome...

The main aim of this study was to examine the body of knowledge on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in “high-risk” children whose parents are diagnosed with ADHD. This knowledge could aid early identification for children presenting with ADHD symptoms at a young age. We conducted a systematic search of the literature assessing high-risk children. Included were original articles published in English with the main aim to assess prevalence of ADHD in high risk children. In addition, a meta-analysis was conducted to examine this prevalence. Four articles met our inclusion and exclusion criteria all suggesting an increased prevalence of ADHD in children of parents with ADHD. The meta-analysis also confirmed the increased prevalence of ADHD in high-risk children. The literature indicates that children of ADHD parents have an increased risk of developing ADHD compared to control children.