Abstract Attention Deficit Hyperactivity Disorder Research Articles

Performance Improvement CME: Adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders and is now understood to be a lifelong condition for most individuals. Unfortunately, many adults with ADHD are not being diagnosed, possibly due to insufficient diagnostic criteria, the complex presentation of the disorder, and a reluctance by physicians to diagnose the disorder in adults. Additionally, many of those who have been diagnosed with ADHD do not receive adequate treatment despite the availability of established and effective agents. Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME activity focuses on improving the diagnosis and treatment of adult ADHD.

Preliminary evaluation after setting up a post-assessment attention deficit hyperactivity disorder clinic in a community setting

Attention deficit hyperactivity disorder (ADHD) is a common neuro-behavioural condition affecting school age children, older adolescents and young adults. It often leads to challenging educational, social and personal difficulties and co-morbidities which makes it an appropriate focus for the setting up of a dedicated clinic. This service innovation was planned to ensure that ADHD patients receive regular multi-disciplinary reviews and to improve the training standards of junior doctors. We hypothesised that multimodal treatment approach shall be more acceptable to parents and children with ADHD than medication alone. It was our belief that the setting up of a post-assessment ADHD clinic will lead to efficient use of existing resources thereby saving clinical time. Our local audit identified 51 young people with ADHD stabilised on medication. One year after setting up the post-assessment ADHD clinic, feedback was obtained using questionnaires from clinicians and parents. Seventy-five percent of parents and all the clinicians responded. Parents indicated that they were quite satisfied with the changes made. Clinicians were of the opinion that the dedicated ADHD clinic was more efficient in meeting the children's needs. This survey validated our hypothesis that multi-modal reviews were more acceptable to parents of children with ADHD. The setting up of the dedicated clinic proved to be an efficient way of using the existing resources without any additional costs.

Medication Treatment for Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) has become the most commonly diagnosed psychiatric disorder among school-age children. For more than half a century, physicians have prescribed medications to help manage behaviors such as hyperactivity, impulsivity, and inattention. Today, there is a growing consensus that ADHD is a biologically based disorder, and medication is now considered the first line treatment. This article discusses the therapeutic benefits and potential side effects of psychotropic medications commonly prescribed to youth with ADHD, academic and behavioral benefits associated with medication therapy, recommendations for monitoring medication efficacy, legal considerations, and the importance of establishing school medication policies.

Clinical use of a modified release methylphenidate in the treatment of childhood attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder in childhood, affecting over 5% of children worldwide. As well as the core symptoms of inattention, hyperactivity and impulsivity, patients often exhibit learning difficulties and impairment in social functioning. The frequency of referral is higher for boys than for girls (about 2:1), and girls are generally older at the time of referral.Pharmacological therapy is considered the first-line treatment for patients with severe ADHD and severe impairment. Stimulant medications are licensed in the UK for the management of ADHD in school-age children and young people, and are effective in controlling ADHD symptoms.While immediate-release preparations of methylphenidate (MPH) have proven effective in the treatment of ADHD, there are a number of problems associated with their use, most notably compliance, stigma and medication diversion. Modified release preparations are now available that overcome the need for multiple daily dosing, and which offer different MPH release profiles, thereby enabling the physician to match the medication to the patient's particular requirements.This review describes the diagnosis, referral and treatment pathways for patients with ADHD in the UK and the practical considerations when initiating pharmacological treatment. The clinical experience of treating ADHD with a modified-release MPH preparation (Equasym XL®) is illustrated with case studies.

Associative learning in ADHD: improved expression under methylphenidate

Attention Deficit/Hyperactivity Disorder (ADHD) is characterised by developmentally inappropriate levels of inattention, impulsivity and hyperactivity. As might be expected of a disorder in which inhibitory deficits form part of the diagnostic criteria, deficits in response inhibition in ADHD have been evidenced in a number of studies. To date, the tasks used in such studies have required participants to inhibit the learned stimulus-response associations that result in unwanted behavior. However, no research has examined the inhibition of stimulus-stimulus associations, formally ‘conditioned inhibition’. The present study used video game style conditioned inhibition procedures, developed for children and adolescents with a clinical diagnosis of ADHD and suitable for typically developing matched controls. Two computer-based tasks (‘Mission to Mars’ and ‘Weapon-X’) required participants to predict the occurrence of an outcome based on the stimuli presented. We selected 12 male participants with ADHD on medication (methylphenidate), but without comorbid Tourette Syndrome, pervasive developmental disorder, learning disability or psychosis. This group showed overall normal inhibition of stimulus-stimulus associations, measured repeatedly over trials and with two task variants. There was no correlation between inhibitory learning and symptom severity ratings. However, participants with ADHD on higher dosages of methylphenidate, or longer duration of treatment with methylphenidate, showed improved ability to anticipate outcomes following the different stimulus presentations on non-inhibited versus inhibited trials. This effect was most clearly demonstrated on the Weapon-X task. Thus, methylphenidate dose-relatedly improved the expression of associative learning. This action may contribute to its therapeutic effects in improving cognitive function in ADHD.

The Reality-Sampling Deficit and ADHD: Indication for an Active Technique

Attention-deficit hyperactivity disorder (ADHD) is a common condition and one that the current evidence base highlights as not being best served by the prescription of medication alone (Jensen et al., 2007). The demand facing clinicians is twofold. For the psychiatrist, there is a need to be open to and accommodating of an analytic perspective of ADHD, as one extending understanding of the condition beyond the neurological. For the analyst, I suggest there is a requirement to be open to altering the analytic frame. It is this latter demand that I shall aim to help answer in this article, by highlighting the existence of a reality-sampling deficit in patients with ADHD. Using clinical examples, I shall examine how the concept of a reality-sampling deficit may aid our understanding of the ADHD child's internal experience and their relationship to external reality. In turn, this will lead us toward some adaptations of analytic technique, with an emphasis more upon process than content and links to mentalization-based therapy. I will discuss some relevant aspects of psychoanalytic theory as well as the current evidence base (biological, psychological, and psychodynamic) to form a platform from which we might better help the child with ADHD.

Cardiovascular Side Effects of Atomoxetine and Its Interactions with Inhibitors of the Cytochrome P450 System

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood and adolescence. Classically, stimulants have been used in the treatment of this condition. Atomoxetine (Strattera; Eli Lilly and Company) is a selective norepinephrine reuptake inhibitor (SNRI), one of the first medications in the nonstimulant class of medications that has been approved by the FDA for the treatment of ADHD. Atomoxetine is a phenoxypropylamine derivative and is structurally related to the antidepressant fluoxetine. The common side effects reported with the use of atomoxetine include mainly GI disturbances. Cardiovascular side effects are less commonly reported. The increase in the noradrenergic tone may explain some of the side effects noted with the use of this medication. Here, we present a case of a patient who presented with syncope, orthostatic hypotension, and tachycardia and discuss the various clinical implications based on the pharmacokinetics and pharmacodynamics of the drug.

Atomoxetine in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Systematic Review of Review Papers 2009-2011. An Update for Clinicians

Attention deficit/hyperactivity disorder (ADHD) is a common disorder and a plethora of new data has been published from clinical trials and national epidemiological databases in the last three years. In the United Kingdom Atomoxetine is currently the only licensed non-stimulant medication. As part of a systematic review of atomoxetine data Jan 2009–June 2011 formal searches found 750 citations. From these 13 met criteria for either review or systematic review papers and contained clinical data synthesis on atomoxetine. No individual review paper alone would be sufficient for clinicians to be updated at that time on all clinical aspects of atomoxetine data. The crucial data relating to clinical parity of atomoxetine and methylphenidate in trials and meta-analysis where relevant confounding biases are removed are not often discussed. Systematic review of complex data is critical for ADHD clinicians and will need regular updating due to the large volume of new data.

Using Technology in the diagnosis of Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is among the most prevalent chronic health disorders affecting school-age children [1]. The disorder attracts a lot of controversies [2,3]. One of the main reasons for criticism is the diagnostic process, which in some aspects is subjective and can be relatively easily biased [4]. There is a discrepancy between the expanding scientific biological, genetic and imaging knowledge and the clinical based procedure of ADHD diagnosis [4]. In the absence of available biological markers that would support diagnosis on a routine clinical visit, professionals are asked to continue and use clinical interview, extensive history taking, parent-teacher rating scales, review of psycho-educational test data, and direct observation [4,5]. Shortcomings associated with standard clinical approaches suggest an increasing need to consider complementary strategies for determining diagnostic standing and assessing treatment outcome.

The Relationship Between Executive Function, AD/HD, Overeating, and Obesity

Attention-deficit/hyperactivity disorder (AD/HD) and obesity are complex, costly disorders affecting physical, emotional, and social well-being. Executive function (EF), the cognitive ability for self-understanding and regulation, is often impaired in AD/HD, yet rarely considered in treatment of obese individuals with AD/HD. The hypothesis for this study is that low EF is seen in individuals with 4 or more symptoms of adult AD/HD and is associated with overeating behaviors leading to obesity. A nonexperimental single group design was used. A volunteer convenience sample (n = 125) completed EF, AD/HD, eating, and BMI measures. Path analysis tested the hypothesized/ modified model. Chi square (χ(2) = 6.15, df = 6, p = .4) and RMSEA (0.014) indicated a very good fit for the data. Assessment of EF and AD/HD symptoms in obese individuals is supported. Further study is needed to more fully understand this relationship and to develop strategies to address overeating behaviors in obese individuals with AD/HD.

The root of ADHD: nature or nurture?

Attention deficit hyperactivity disorder (ADHD) has once again hit the headlines after a study suggested a genetic link to the disorder. Marios Adamou assesses the impact of these findings

Restless legs syndrome as a possible predictor for psychiatric disorders in parents of children with ADHD

Attention-deficit hyperactivity disorder (ADHD) is a common disorder with estimated prevalence of 5% in children and 3.4% in adults. Psychiatric disorders are a frequent concomitant feature. Restless legs syndrome (RLS) may mimic the symptoms of ADHD. The aim of the study is to evaluate whether the presence of RLS predicts occurrence of psychiatric disorders in parents of children with ADHD. Thirty-seven parents of 26 children with ADHD were examined for RLS and for lifetime prevalence rates of psychiatric disorders and personality disorders based on the Structured Clinical Interview for DSM-IV Diagnoses (SCID). Prevalence rates in parents were 29.7% for RLS, 67.6% for Axis I and 40.5% for Axis II disorders. Mothers revealed higher rates for depression, anxiety disorders and ADHD than fathers, whereas personality disorders occurred at higher rates in fathers. The presence of RLS predicted a diagnosis of ADHD (odds ratio (OR) 21.9), agoraphobia (OR=20.4) and any anxiety disorder (OR=8.5). Although limited by the small sample size, we found evidence for increased rates of cluster B personality disorders (OR=59.3) in parents with RLS. All parents of the latter group (100%) reported a positive family history of psychiatric disorders which was not the case in parents without RLS (69.2%) excluding the index children with ADHD. RLS seems to indicate increased vulnerability for psychiatric disorders, i.e., ADHD and anxiety disorders, in a subgroup of parents from ADHD children. Synaptic dysfunction affecting dopaminergic transmission among other transmitter systems may be a common final pathway related to the phenotypic spectrum of ADHD.

Repetitive Ritalin Treatment Modulates the Diurnal Activity Pattern of Young SD Male Rats

Attention Deficit Hyperactivity Disorder (ADHD) is a common behavioral disorder of children and is treated by psychostimulants. Psychostimulant exposure to children at the time of neuronal development can cause behavioral and physiological changes continuing during adulthood. Most of the studies on psychostimulants investigate the acute effects of the drug. The objective of this study was to investigate whether acute or chronic exposure to methylphenidate (MPD), the drug most often used to treat ADHD in children, will modulate the diurnal activity pattern of young rats. Maintaining the diurnal activity pattern is a physiological process that regulates the internal homeostasis. Dose response protocol was used to study the effect of acute and chronic MPD in four young post natal day 40 (P 40) rat groups, (each N=8), as follows: saline (control) group, and 0.6, 2.5, or 10.0 mg/kg i.p. MPD groups, respectively. The experiment was performed over 11 consecutive days of continuous locomotor activity recording using the open field assay. The data evaluation was divided into four phases as follows: acute, induction, washout and expression phases. There was a dose-dependent increase in the average locomotor activity in the first few hours post-injection. Analysis of the diurnal rhythmic pattern of locomotion in the three dose groups compared to control demonstrated that only the 10.0 mg/kg MPD elicited significant changes in diurnal pattern activity in the washout and the expression phase. In addition, this study indicated that chronic MPD treatment elicits dose dependent anticipation and/or withdrawal and behavioral sensitization.

An integrated theory for Attention-Deficit Hyperactivity Disorder [ADHD

Attention-deficit hyperactivity disorder (ADHD) is a commonly diagnosed condition of childhood, thought to affect 3 to 5% of all school-aged children (Buitelaar, 2002). In spite of the prevalence of ADHD, there is no consensus between child psychoanalysts and child psychiatrists about its aetiology and management. This is despite (or perhaps because of) the fact that the core symptoms of age-inappropriate hyperactivity, inattentiveness, and impulsivity (Kaplan, Sadock, & Grebb, 1994) can be conceptualized in the terms of both schools of thought. However, if we retreat to separate and distinct conceptualizations there is a risk that the lack of an integrated theory may have adverse consequences for those we attempt to treat. In order to avoid this, we need to re-examine the core psychoanalytic perspective in the context of current neuropsychiatric perspectives in order to clarify our understanding of this condition and better help the children in our care.

Evaluation of a School-Based Social Skills Program for Children With Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among school-aged children. An associated feature of the disorder is a deficit in social functioning, which can be detrimental in terms of long-term outcomes. Therefore, it is crucial to identify evidence-based interventions which can improve the social skills of children with ADHD. The current study was an evaluation of a school-based social skills training program, called Working Together: Building Children's Social Skills Through Folk Literature. The modified version of the program with generalization enhancers was delivered in three schools to 16 children over a 10-week period. Results indicated that this program was effective for improving social skills in children with ADHD, particularly for children with poor pragmatic language skills.

Structural and functional brain imaging in adult attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a childhood disorder that persists into adulthood. Nevertheless, there are far fewer imaging studies in adult compared with childhood ADHD. Here we review the imaging literature on brain structure, function and structural and functional connectivity in adult ADHD, as well as the effects of psychostimulants on brain dysfunctions. Importantly, we discuss similarities and differences between these deficit findings and those in childhood ADHD to address the key question of continuity of brain abnormalities into adulthood. Findings show strikingly similar but more inconsistent abnormalities in adult ADHD in key childhood ADHD deficit areas of frontostriatal, temporoparietal and cerebellar regions, presumably due to highly prevalent confounding factors in adult ADHD of elevated rates of comorbidity and medication history.

Etiological pathways for developmental coordination disorder and attention-deficit/hyperactivity disorder: shared or discrete?

Attention-deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) are two of the most common developmental disorders of childhood. Furthermore, children with a diagnosis...

Effects of Red Ginseng on Neonatal Hypoxia-induced Hyperacitivity Phenotype in Rats

Attention deficit hyperactivity disorder (ADHD) affects 4-12% of chool-age children worldwide and is characterized by three core symptoms: hyperactivity, inattention, and impulsivity. Although standard pharmacological treatments, such as methylphenidate and atomoxetine, are available, concerns about drug-induced psychological and cardiovascular problems, as well as growth retardation and sleep disturbances, highlight the continuing need for new therapeutic interventions. Using a neonatal hypoxia-induced hyperactivity model in rats, the potential positive role that oral administration of red ginseng extract may have in relation to the hyperactive phenotype was investigated. Hypoxia was induced in 2-day-old male Sprague-Dawley (SD) rat pups by placing them in a nitrogen chamber for 15 min. The neonatal hypoxia-induced rats showed a significant increase in hyperactivity phenotype, such as increased movement duration, movement distance, and rearing frequency, which was determined by monitoring their spontaneous locomotor activity using the Ethovision video tracking system. One week of oral treatment with red ginseng extract decreased the hyperactivity phenotype of the neonatal hypoxia-induced rats and increased the locomotor activity of the control rats. In the neonatal hypoxia-induced rats, expression of the norepinephrine transporter in the forebrain was increased, and red ginseng treatment partially prevented its up-regulation, while increasing its level in the control rats. Taken together, these results suggest that red ginseng extract decreased the neonatal hypoxia-induced hyperactivity phenotype, although it increased locomotor activity in normal animals.

ADHD and dysthymic disorder: Toward understanding this common comorbidity in children and adolescents

Attention-deficit/hyperactivity disorder (ADHD) and dysthymic disorder (DD) are common childhood psychiatric disorders that have a greater-than-chance association. To date, their relationship has not been systematically examined despite their frequent co-occurrence in children and adolescents referred to clinical health services. This article defines ADHD and DD, reviews their characteristics, and outlines the emerging evidence from phenomenological and cognitive neuroscience studies regarding their association. ADHD and, separately, DD are significant drivers for oppositional defiant disorder symptoms in children and adolescents. ADHD and DD both have elevated levels of neurological subtle signs, spatial working memory deficits, and right frontal-striatal-parietal underactivation compared with healthy control participants. ADHD and DD both also have elevated levels of parental psychopathology, with the comorbid group having significantly higher levels than those with ADHD or DD alone. We explore the clinical implications of these findings.

Oral megadose methylphenidate ingestion for suicide attempt

Attention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric syndrome with onset in childhood. Stimulants are the primary therapeutic agents in children with ADHD. Methylphenidate (MPH) comprises >90% of stimulant use for ADHD in the USA. There is evidence to suggest that stimulants in ADHD populations are being used more broadly, for longer periods and without interruptions. As therapeutic use increases, the risk of unintentional overdoses, therapeutic errors, and intentional overdoses due to abuse, misuse or suicide attempts increase. In the present report we describe a suicide attempt involving high-dose immediate-release MPH in an 8-year-old girl with ADHD.