Therapy For ADHD Research Articles

Use of complementary and alternative medicine in children with ADHD: Results from the 2012 and 2017 National Health Interview Survey

ObjectiveTo examine the prevalence, patterns, and factors associated with CAM use among children with ADHD. MethodWe used data from the 2012 and 2017 National Health Interview Survey. Descriptive statistics, Wald F chi-square test, and multivariable logistic regression were performed. ResultsApproximately 8.4 % of U.S. children had ADHD in 2017. Children with ADHD had greater CAM use than those without (p < 0.05). Meditation (10.8 %), yoga (9.6 %), and deep breathing (7.3 %) were the most commonly used mind-body CAM modalities in ADHD children in 2017, with their use increased 468 %, 433 %, and 192 %, respectively, since 2012. Nearly all children experiencing ADHD (91.9 %) have comorbid psychiatric disorders, and they are more likely to use CAM than those without comorbidities (p < .0001). Less than one-third of the respondents disclosed children’s CAM use to their medical doctors. Among children with ADHD, CAM use is generally not correlated with conventional medical care use, except for a significant inverse relationship between CAM use and use of prescription medication for more than three months. ConclusionThe use of mind-body CAM modalities has substantially increased among children with ADHD, compared to those without ADHD, from 2012 to 2017. Parents' reasons for the use of CAM among their children with ADHD included their unique function in reducing ADHD symptoms and their lack of unwanted side-effects. It is imperative to improve effective communication between health care providers and ADHD patients and their parents, in order to understand patients’ values and preferences for using CAM therapies as a natural holistic therapy for ADHD.

Prevalence of ADHD in Accident Victims: Results of the PRADA Study.

Background: Recent research has shown an increased risk of accidents and injuries in ADHD patients, which could potentially be reduced by stimulant treatment. Therefore, the first aim of our study was to evaluate the prevalence of adult ADHD in a trauma surgery population. The second aim was to investigate accident mechanisms and circumstances which could be specific to ADHD patients, in comparison to the general population. Methods: We screened 905 accident victims for ADHD using the ASRS 18-item self-report questionnaire. The basic demographic data and circumstances of the accidents were also assessed. Results: Prevalence of adult ADHD was found to be 6.18% in our trauma surgery patient sample. ADHD accident victims reported significantly higher rates of distraction, stress and overconfidence in comparison to non-ADHD accident victims. Overconfidence and being in thoughts as causal mechanisms for the accidents remained significantly higher in ADHD patients after correction for multiple comparison. ADHD patients additionally reported a history of multiple accidents. Conclusion: The majority of ADHD patients in our sample had not previously been diagnosed and were therefore not receiving treatment. The results subsequently suggest that general ADHD screening in trauma surgery patients may be useful in preventing further accidents in ADHD patients. Furthermore, psychoeducation regarding specific causal accident mechanisms could be implemented in ADHD therapy to decrease accident incidence rate.

Integrated cognitive behavioral therapy for ADHD in adult substance use disorder patients: Results of a randomized clinical trial

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) frequently co-occurs with Substance Use Disorders (SUDs). Standard ADHD pharmacotherapies are not effective in patients with this comorbidity and cognitive behavioral therapy (CBT) has not been tested in this population. This RCT aimed to compare the efficacy of Integrated CBT (CBT/Integrated) directed at adult ADHD and SUD with CBT directed at SUD only (CBT/SUD) in patients with SUD and ADHD (SUD + ADHD). MethodsRandomized clinical trial among 119 SUD + ADHD patients in a SUD treatment center. CBT/Integrated consisted of 15 individual sessions of motivational therapy, coping skills training and relapse prevention for SUD, and training of planning skills, problem-solving skills and dealing with emotions for ADHD. CBT/SUD consisted of 10 individual SUD treatment sessions only. Primary outcome was ADHD symptom severity according to the ADHD rating scale (ARS) at post-treatment. Secondary outcomes included ADHD symptom severity after two-month follow-up, and treatment response (≥30% ADHD symptom reduction), substance use, depressive or anxiety symptoms, and quality of life at post-treatment and follow-up. ResultsCBT/Integrated was more effective than CBT/SUD in the reduction of ADHD symptoms post-treatment: ARS = 28.1 (SD 9.0) vs. 31.5 (SD 11.4) (F = 4.739, df = 1, 282, p = .030; d = 0.34). At follow-up, CBT/Integrated still resulted in lower ARS scores than CBT/SUD, but the difference was not significant at the 0.05 level. For other secondary outcomes, including substance use, no significant between-group differences were present. ConclusionsCompared to regular SUD cognitive behavioral therapy, integrated cognitive behavioral therapy resulted in a significant extra improvement in ADHD symptoms in SUD + ADHD patients.

Comparative Study of Treatments of Children with ADHD with Medication Alone Vs Medication with Cognitive Behavioral Therapy

This study is important due to the long terms negative effects of using stimulants for ADHD therapy as they manifest negative side effects. The amphetamine stimulants are neurotoxic with long-terms use and it’s imperative to use it in lower dosages while at the same time yielding the maximum affects to treat ADHD symptoms. This narrative review is conducted to explore the professional literature between 2000-2015. The trials conducted to explore the efficacy of adjunctive therapy with stimulants demonstrated various results. The supplementation of combined magnesium and vitamin B6 yielded positive results with significant improvement in ADHD, specifically in hyperactivity, aggression, and low attention span. Zinc supplementation, with 30 mg or more, with amphetamine aided in lowering the dosage of amphetamine use by at least 20% while yielding the same results compared to higher amphetamine use without zinc. Zinc+methylphenidate combination yielded positive results to lower ADHD symptoms; however the results are not conclusive due to more trials are needed in different dosages of zinc. Based on the clinical studies, dietary supplements are useful in treating ADHD symptoms. Clinical trials with zinc and magnesium+B6 have shown to yield positive results in lowering the ADHD symptoms. With current ADHD therapy, continued stimulant use leads to tolerance and increases with continued use; hence the stimulant dosage also needs to be increased to reach efficacy. Adding adjunctive dietary supplements have demonstrated that the stimulant dosages can be lowered. However, further study is needed to factor in bioavailability, efficacy of other dosages, diet, and any other factors that could hinder the function of the dietary supplements internally.

Cognitive-Behavioral Therapy for Adult ADHD: A Randomized Clinical Trial in China

Objective: Cognitive-behavioral therapy (CBT) is effective for adult ADHD, and booster sessions may improve long-term outcome. This study was designed to investigate the effects of group CBT and its booster sessions for Chinese adult patients with ADHD. Method: There were CBT only group (n = 43), CBT +booster group (n = 43), and control group with patients on the waiting list (n = 22). The primary outcome was the score of the ADHD–Rating Scale (ADHD-RS). Secondary outcomes included emotion, executive function (EF), impulsivity, self-esteem, and life quality at 12th and 24th week. Results: At 12th week, the score of ADHD-RS, EF, and impulsivity showed significant improvement in CBT +booster group comparing with control group. At 24th week, differences between CBT only group and CBT +booster group were not significant. Conclusion: CBT was effective for Chinese adult patients with ADHD. Booster sessions do not appear to provide additional benefits.

In children 6–10 years old on stimulant therapy for ADHD, how often should blood pressure be measured?

In children 6–10 years old on stimulant therapy for ADHD, how often should blood pressure be measured?

Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation.

Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.

Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices.

The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians. Children and adolescents initially diagnosed with ADHD and fractures between 2010 and 2015 were identified by 243 pediatricians. In this nested case-control study, each ADHD case with a fracture was matched (1:1) to an ADHD control without a fracture for age, gender, index year, and physician. In total, 2894 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of ADHD therapy. Multivariate logistic regression models were created to determine the effect of ADHD therapy on the risk of fracture in the entire population and in three age-specific subgroups. Patients receiving ADHD medications were at a lower risk of fracture than patients without ADHD medications (OR = 0.61). The impact of ADHD therapy on the risk of fracture was stronger in the age group of 6-9years (OR = 0.41) than in the age groups of 10-13years (OR = 0.68) and 14-17years (OR = 0.74). Finally, a significant correlation was found between therapy duration and fracture risk (OR = 0.71 per month). ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.

The Efficacy of Cognitive Behavioral Therapy for Adults With ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: To systematically review the literature on published randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) for adult ADHD and to establish the effectiveness of CBT in reducing ADHD symptoms. Method: A systematic review of nine RCTs and two subsequent meta-analyses of eight of the studies were conducted. Results: Just nine studies were identified, of generally good quality but with some limitations. Four trials (total N = 160) compared CBT with waiting list controls, and three trials (total N = 191) compared CBT with appropriate active control groups. Meta-analyses showed that CBT was superior to waiting list with a moderate to large effect size (standardized mean difference [SMD] = 0.76, 95% confidence interval [CI] [0.21, 1.31], p = .006) and superior to active control groups with a small to moderate effect size (SMD = 0.43, 95% CI [0.14, 0.71], p = .004). Conclusion: These results give support to the efficacy of CBT in reducing symptoms of ADHD post-intervention.

Potential Social and Neurocognitive Benefits of Aerobic Exercise as Adjunct Treatment for Patients With ADHD

Objective: The aim of the article is to review the evidence that aerobic exercise may be a useful adjunct treatment for ADHD. Method: Studies on physical, cognitive, and psychosocial aspects of aerobic exercise that are relevant to ADHD are reviewed and evaluated. Results: Stimulant medication, the main pharmacotherapy for ADHD, and aerobic exercise both act on catecholamine pathways. Aerobic exercise has been shown to be beneficial in preclinical studies on spontaneous hypertensive rats, an animal model of ADHD, and in clinical trials of children with ADHD, as an adjunct treatment to medication. Social and neurocognitive function in children and adults seem to be positively affected by exercise as well. Nevertheless, no controlled clinical trials in adults with ADHD have been conducted. Conclusion: Aerobic exercise may be a useful non-medication adjunct therapy for ADHD. The clinical effectiveness of aerobic exercise for ADHD in children and adults warrants further clinical studies.

18F]FMeNER-D2: A systematic in vitro analysis of radio-metabolism

IntroductionThe norepinephrine transporter (NET) presents an important target for therapy and diagnosis of ADHD and other neurodegenerative and psychiatric diseases. Thus, PET is the diagnostic method of choice, using radiolabeled NET-ligands derived from reboxetine. So far, [18F]FMeNER-D2 showed best pharmacokinetic and -dynamic properties. However, the disadvantage of reboxetine derived PET tracers is their high metabolic cleavage—resulting in impeding signals in the PET scans, which hamper a proper quantification of the NET in cortical areas. MethodsMetabolic stability testing was performed in vitro using a plethora of human and murine enzymes. ResultsNo metabolism was observed using monoamine oxidase A and B or catechol-O-methyl transferase. Incubation of [18F]FMeNER-D2 with CYP450-enzymes, predominantly located in the liver, led to a significant and fast metabolism of the tracer. Moreover, the arising three radiometabolites were found to be more polar than [18F]FMeNER-D2. Surprisingly, definitely no formation of free [18F]fluoride was observed. ConclusionAccording to our in vitro data, the interfering uptake in cortical regions might be attributed to these emerging radiometabolites but does not reflect bonding in bone due to defluorination. Further research on these radiometabolites is necessary to elucidate the in vivo situation. This might include an analysis of human blood samples after injection of [18F]FMeNER-D2, to enable a better correction of the PET-input function.

The Successful ADHD Therapy Result Based on Mother's Therapy Decision Making Process

The purpose of this study is to find some aspects that can influence successful ADHD therapy result based on mother's decision making process. Three mothers participated in this study. Each mother has been giving behavioral, medical, and combined therapy for her child with ADHD. One mother was taken from lecturer's client and the others were taken from Mental Hospital. Interview and observation were conducted in this qualitative study. Interview and observation about decision making process and some factors that have a role in decision making process were analyzed by researcher as the result of successful ADHD therapy. Parenting, family conflict related to the therapy, satisfaction toward therapy and mother's expectation out of therapy are some aspects that can influence the successful ADHD therapy result. The result of this research shows that collaborations between psychologist, psychiatrist, parents, and teacher at school do play big parts in the successful ADHD therapy result. According to the interview between researcher and mothers, a child with behavioral therapy has the highest level of success and satisfaction of the other children. The other mothers who have been giving ADHD drugs to their children stated that medical therapy was not effective enough to cure ADHD and the ADHD symptoms would reappear if they stopped that treatment. Furthermore, those mothers, who have been handled by psychiatrist only, wanted to see psychologist. Economy factor is their hindrance to give better therapy for their children. Verbal and non-verbal violence also have been found by the researcher when observing the child who was undertaking speech therapy at the hospital.

Cognitive behavioural therapy for ADHD in adults: systematic review and meta-analyses

Systematically review and analyse the efficacy of CBT versus treatment as usual in adults with ADHD. The literature was systematically searched ending the 28 March 2014. Standardised mean differences (SMD) and 95% confidence intervals were calculated. CBT was efficacious in reducing symptoms of ADHD (SDM -1.0, 95% CI -1.5 to -0.5) when evaluated by the patients, but not when evaluated by a clinician. Symptoms of depression and anxiety were significantly reduced when self-reported (SMD -1.0, 95% CI -1.6 to -0.5 and -1.0, 95% CI -1.3 to -0.3, respectively) and evaluated by a clinician (SMD -0.9, 95% CI -1.7 to -0.2 and -0.9, 95% CI -1.6 to -0.1). The clinical global impression scores improved more in the group randomised to CBT (-1.0; 95% CI -1.6 to -0.4). CBT seems efficacious in some domains affecting adult patients with ADHD, but needs further evaluation.

Dystonia with MPH/Risperidone Combined Therapy for ADHD.

Investigators from Child Neurology and Pediatrics, University of Texas Health Science Center, Houston, report extrapyramidal symptoms in a 13-year-old boy with a psychiatric history of schizophrenia, bipolar disorder, ADHD, and autism, responsive to combination risperidone, oxcarbazepine, and MPH.

Cognitive-Behavioral Therapy for ADHD in College: Recommendations “Hot Off the Press”

Cognitive-Behavioral Therapy for ADHD in College: Recommendations “Hot Off the Press”

Cognitive-Behavioral Therapy for ADHD in Adolescents: Clinical Considerations and a Case Series

Although ADHD in adolescents is an impairing and prevalent condition, with community prevalence estimates between 2% and 6%, psychosocial treatments for adolescents compared to younger children are relatively understudied. Our group has successfully developed an evidence base for cognitive-behavioral therapy (CBT) for ADHD in medication-treated adults with ADHD with clinically significant symptoms. In the current paper, we describe an adaptation of this treatment to adolescents, and provide case reports on 3 adolescents who participated in an open pilot trial. The results suggest that the treatment approach was well tolerated by the adolescents and that they experienced clinical benefit. This early report of the approach in adolescents is promising and requires further efficacy testing.

Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder: a case-control study

Background Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorder in childhood. ADHD children with overlapping symptoms and signs of motor problems have more serious prognosis than that of children with ADHD only. However, the motor and sensory processing problems in children with ADHD have not been studied well. Few people adopt the technique of computerized dynamic posturography (CDP) in the study of ADHD, which is applied widely in clinical and laboratory research to objectively evaluate human's balance performance. This study aimed to assess the characteristics of postural control and sensory information processing of boys with two subtypes of ADHD by using CDP, so as to provide the proof for non-drug therapy of ADHD. Method From June 2003 to September 2004, a total of 73 boys (7–15 years of age) with ADHD and 73 normal developing boys matched by age and intelligence quotient from Peking University Institute of Mental Health were recruited in the study. The Sensory Organization Test was adopted to test the static balance performance under six sensory input conditions by SMART EquiTest 8.0 (NeuroCom) instrument. The sensory information from three sensory systems were available under condition 1, the visual inputs were removed or distorted under condition 2 or 3, the somatosensory inputs were in conflict with or without the visual inputs removed under condition 4 or 5, and both the visual and somatosensory inputs were in conflict under condition 6. The indexes of equilibrium score, somatosensory, vestibular, and visual ratios, and strategy scores were analyzed to indicate the subjects’ postural control ability. Results ADHD boys had significantly lower composite equilibrium score (CES) than the normal group (P &lt;0.05). Under condition 1 and conditions 3–6, the equilibrium scores (ES) of the ADHD group were significantly lower (all P &lt;0.05) than those of the control. Significantly lower visual and vestibular ratios and strategy scores under conditions 4–6 were found in boys with ADHD compared with the control group (P &lt;0.05). Boys of ADHD-predominantly inattentive (ADHD-I) type had a significantly lower CES and ES under conditions 4–6 than the controls (all P &lt;0.05) while the ESs of ADHD-combined type (ADHD-C) boys under each condition were similar with that of boys with ADHD-I and no significant difference was found between boys with ADHD-C and the control group (all P &gt;0.05). Compared with the control group, the ADHD-I boys showed significantly lower visual and vestibular ratios and strategy scores under conditions 4–6 whereas the ADHD-C boys showed a trend of lower visual ratio (all P &lt;0.05). Conclusions ADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control. Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys. These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits. Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children.

Detection of auto-antibodies to DAT in the serum: interactions with DAT genotype and psycho-stimulant therapy for ADHD.

Interest is rising for auto-immune contribution in neuro-psychiatry. We evaluated the auto-antibodies against dopamine transporter (DAT aAbs) in 61 children (46 ADHD who met DSM-IV-TR criteria, 15 healthy controls). ADHD patients were assigned, according to severity, either to a non-pharmacological therapy (NPT, N=32) or to a pharmacological treatment (PT, N=14) with methylphenidate (MPH). In ADHD children, blood samples were withdrawn twice, at recruitment (T0 basal) and after 6 weeks (T1); following 16 excluded subjects, DAT genotype was characterized (9-repeat or 10-repeat alleles; N=15 each). After 18 months of NPT or PT, some patients (carrying at least one 9-repeat allele) were blood sampled again (T2), for comparison with healthy controls (final n=8) RESULTS: Compared to NPT, basal DAT aAbs titers were higher within most severe patients (then assigned to PT), specifically if carrying a DAT 10/10 genotype. DAT aAbs levels of NPT group resulted highly correlated with distinct subscales of Conners' Parent/Teacher Scales (Rs>0.34), especially within DAT 10/10 genotype (Rs>0.53). While T1 titers were elevated over T0 baseline for NPT children, such an increase was not observed in PT patients carrying at least one 9-repeat allele, who also showed behavioral response to subchronic MPH. After 12-24 months of MPH exposure, DAT aAbs titers in PT subjects were comparable to those of healthy controls, while titers remained significantly elevated in NPT patients. Data warrant further research on serum DAT aAbs, which could be used to confirm ADHD diagnosis and/or to monitor therapeutic efficacy of MPH.

ADHD therapy with methylphenidate in mothers – a danger for embryonic development?

ADHD therapy with methylphenidate in mothers – a danger for embryonic development?

Ω-3/6 Fatty Acids, Methylphenidate, and Combined ADHD Therapy

Ω-3/6 Fatty Acids, Methylphenidate, and Combined ADHD Therapy