Attention Deficit Hyperactivity Disorder Attention Deficit Research Articles

B - 61 Psilocybin as a First-Line Treatment of ADHD in Adult Populations

Abstract Objectives The first line for symptom management of attention deficit hyperactivity disorder (ADHD) is a class of medications that act on dopamine and noradrenaline receptors, which leads to symptom reduction at the cost of significant side effects. These side effects have led to community searching for alternative methods that manage ADHD symptoms in adults that lead to less side effects. Microdosing Psilocybin has emerged as a course of treatment that could provide benefits for those who may experience serious side effects to stimulant medication. Method This literature review was conducted using search terms such as, ADHD attention deficit hyperactivity disorder, psychedelic treatment, stimulant treatment of ADHD, naturalistic treatment of ADHD, 5-HT, neural plasticity. Journals that reported about the benefits and concerns of Psilocybin use for ADHD are Neurochemistry International, American College of Neuropharmacology, European Psychology, Movement and Nutrition in Health and Disease, Journal of Psychopharmacology, and Psychiatry Research. Results Research shows that not only does microdosing Psilocybin have less adverse effects than stimulant medications when being used to treat ADHD, but it also leads to an alternative method that focuses on serotonin receptors when other avenues are unsuccessful. Conclusions This poster illustrates the alternative use of Psilocybin for treatment in ADHD and highlights neurological underpinnings that may lead to explaining success. Limitations of stimulant medications are also reviewed.

Alpha modulation via transcranial alternating current stimulation in adults with attention-deficit hyperactivity disorder.

One potential therapy treating attention-deficit/hyperactivity disorder (ADHD) is to modulate dysfunctional brain activations using brain stimulation techniques. While the number of studies investigating the effect of transcranial direct current stimulation on ADHD symptoms continues to increase, transcranial alternating current stimulation (tACS) is poorly examined. Previous studies reported impaired alpha brain oscillation (8-12 Hz) that may be associated with increased attention deficits in ADHD. Our aim was to enhance alpha power in adult ADHD patients via tACS, using different methods to explore potential therapeutic effects. Undergoing a crossover design, adults with ADHD received active and sham stimulation on distinct days. Before and after each intervention, mean alpha power, attention performance, subjective symptom ratings, as well as head and gaze movement were examined. Frequency analyses revealed a significant power increase in the alpha band after both interventions. Despite a trend toward an interaction effect, this alpha power increase was, however, not significantly higher after active stimulation compared to sham stimulation. For the other measures, some additional pre-post effects were found, which were not intervention-related. Our study cannot provide clear evidence for a tACS-induced increase in alpha power in adult ADHD patients, and thus no stimulation related improvement of attention parameters. We provide further recommendations for the future investigation of tACS as a potential ADHD treatment.

ASD and ADHD Comorbidity: What Are We Talking About?

According to the scientific literature, 50 to 70% of individuals with autism spectrum disorder (ASD) also present with comorbid attention deficit hyperactivity disorder (ADHD). From a clinical perspective, this high rate of comorbidity is intriguing. What is the real significance of this dual diagnosis? Is ADHD in fact always present in such cases? Might the attentional impairment reported among our ASD patients actually be a distinct trait of their ASD—namely, impaired joint attention—rather than an ADHD attention deficit? Could their agitation be the consequence of this joint attention impairment or related to a physical restlessness etiologically very different from the agitation typical of ADHD? The neurobiological reality of ASD-ADHD comorbidity is a subject of debate, and amphetamine-based treatment can have paradoxical or undesirable effects in the ASD population. Consequently, does a dual diagnosis, notwithstanding its currency in the literature, prevent us from shedding sufficient light on major physiopathologic questions raised by the clinical picture of ASD?

Effect of trait anxiety on cognitive test performance in adolescents with and without attention-deficit/hyperactivity disorder

ABSTRACTIntroduction: Attention-deficit/hyperactivity disorder (ADHD) and anxiety are frequently comorbid disorders associated with different types of abnormal performance on neuropsychological tests. Although some studies have shown that comorbid anxiety alters ADHD test performance, results inconsistently show both improvements and worsening of different abilities, with failures to replicate across different anxiety disorders. Alternatively, trait anxiety may reflect a more stable influence on ADHD test performance than various diagnosable anxiety disorders. Method: To better understand the possible enhancing or deleterious effects of anxiety on ADHD cognitive impairments, this study examined the effect of individual differences in trait anxiety measured by the Multidimensional Anxiety Scale for Children (MASC) on a battery of computerized, rapid-performance tests measuring attention and impulsivity-related performance in 98 Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM–IV) Combined-Subtype ADHD adolescents and 123 healthy controls. It was hypothesized that trait anxiety would attenuate response inhibition and attention deficits in ADHD. Results: ADHD-diagnosed adolescents with higher trait anxiety performed better on indices of sustained attention, reaction time, and motor variability, and had altered overall test-performance strategy, while response inhibition was affected in both ADHD and non-ADHD. Conclusions: This study provides the first evidence that pathological levels of anxiety are not needed to see differences in ADHD neuropsychological test performance. Instead, mildly elevated trait anxiety confers a protective influence by reducing the degree of impairment seen in ADHD. These findings suggest that better performing ADHD adolescents might have optimized levels of cortical arousal, and raise new questions about how best to identify the neurobiological substrates responsible for the beneficial effects.

The sleep structure of children with attention deficit hyperactivity disorder

Objective To investigate the sleep structure of children with attention deficit hyperactivity disorder(ADHD) and the differences among subtypes of ADHD. Methods Ninety children with ADHD were diagnosed in Department of Neurology, the Children's Hospital Affiliated to Capital Institute of Pediatrics between June 2012 and June 2013, including 75 boys and 15 girls, 6-14 years old[(9.5±2.4) years old], and among them there were 55 cases of ADHD-combined type, 25 cases of ADHD-inattentive type, and 10 cases of ADHD-hyperactive impulsive type.Thirty healthy children whose age and sex matched with ADHD group, came from Beijing and the surrounding area, were selected as the healthy control group, including 23 boys and 7 girls, 6-14 years old [(9.2 ± 2.9) years old]. Two groups underwent full overnight sleep assessment. Results The latency of rapid eye movement(REM) in children with ADHD was (146.58±47.28) minutes, and the sleep latency was 19.00 minutes[(8.25-37.50)minutes]; while the latency of REM in healthy control group was(87.55±13.59) minutes, and the sleep latency was 9.00 minutes[(3.50-13.63)minutes]. Compared with healthy control group, children with ADHD demonstrated the increased latency REM and sleep latency, and decreased sleep efficiency, the increasing times of awakening and total duration, and these differences were all statistically significant(all P<0.05). The percentage of non-rapid eye movement(NREM) phase Ⅱ in ADHD hybrid was lower than the ADHD attention-deficit(t=2.012, P<0.05). Sleep latency in ADHD attention-deficit was longer than the ADHD hybrid(t=2.964, P<0.05). No statistical differences were found among the various types in other indicators.The prevalence of periodic limb movements in sleep(PLMS) was 27.78%(25/90 cases) in ADHD group and the prevalence of PLMS was 3.30% (1/30 cases) in the healthy control group.The diffe-rences in prevalence between 2 groups were statistically significant(χ2=8.053, P<0.05). Conclusions Children with ADHD significantly display more problems with sleep.Sleep latency and NREMⅡ are different between ADHD attention-deficit and ADHD hybrid. Key words: Attention deficit hyperactivity disorder; Sleep structure; Child

To Andreas Warnke, Professor of Child and Adolescent Psychiatry, Head of the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy at the University of Wuerzburg, Germany, to celebrate his professional life and work at the occasion of his 65th anniversary

This special issue is dedicated to a prodigious child and adolescent psychiatrist who has always truly cared for the well-being of his young patients regarding their situation from a holistic point of view. After his education in Montenegro, Brazil, and Frankfurt, Germany, Andreas Warnke not only studied human medicine but also psychology at the Universities of Giesen and Marburg and obtained his doctorate of human medicine in 1977. Primarily, he practised as a psychologist starting his child and adolescent psychiatry career at the Max-Planck-Institute at Munich in 1979, which he successfully continued at the University Clinic of Marburg (1983), where he became a Professor in 1989. Since 1991, he has been the head of the Department of Child and Adolescent Psychiatry at the University of Wuerzburg. Over the following decade, he was able to win over local social institutions and politicians and has extended and expanded his clinic by setting up a huge multi-professional out-patients’ department, a beautiful day-clinic and an ultra-modern intense care unit. A highly specialized centre for mentally handicapped children and adolescents with psychiatric disorders will be opened during the next year. Despite his leading position and his numerous management tasks, he has never lost the kindness and warmth towards his patients and their families. Moreover, it has always been one of his most important issues to politically cement the relevance and esteem of child and adolescent psychiatry, psychosomatics and psychotherapy in professional and everyday life. Thus, he has been recognized and admired personally within managing boards of several leading committees such as the ‘‘Deutsche Gesellschaft fur Kinderund Jugendpsychiatrie’’ (DGKJP), the Committee of the German guidelines for Child and Adolescent Psychiatry, the European Association of Child and Adolescent Psychiatry (ESCAP) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) to name only a few. Since 2008, Andreas Warnke has been the president of the association ‘‘World Federation of Attention Deficit/ Hyperactivity Disorder (ADHD)’’ founded in Zurich, Switzerland. Andreas Warnke has also been active on numerous journal editorial boards such as the ‘‘Zeitschrift fur Kinderund Jugendpsychiatrie und Psychotherapie’’, which is the most important child and adolescent psychiatric journal in Germany and for which he was the editorin-chief, the ‘‘Journal of Neural Transmission’’ and the recently founded journal ‘‘ADHD Attention Deficit and Hyperactivity Disorders’’. Finally, he has organized many successful congresses and initiated innovative congress categories such as in 1993 the ‘‘Arbeitskreis Biologische Kinderund Jugendpsychiatrie’’, which was the first annual meeting for researchers of biological child and adolescent psychiatry in Germany, in 1996 the ‘‘Arzt-Lehrer-Tagung’’, an interdisciplinary meeting of school teachers and child and adolescent psychiatrists and in 1998 the ‘‘Wurzburger Fachtagung Kinderund Jugendpsychiatrie C. Mehler-Wex (&) University of Ulm, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany e-mail: claudia.mehler-wex@uniklinik-ulm.de

Cognitive remediation in ADHD: Effects of periodic non-contingent alerts on sustained attention to response

Few studies have attempted direct cognitive remediation of attention deficits in attention-deficit hyperactivity disorder (ADHD). The present study investigated the efficacy of periodic non-informative alerting cues for improving sustaining attention in ADHD. This technique is known to improve sustained attention in right frontal injury patients and may be effective in ADHD, given that this disorder has also been linked with right frontal dysfunction. Fifteen children with ADHD and 15 matched controls completed four blocks of a modified version of the Sustained Attention to Response Task (SART). Eight random non-contingent alerts were introduced on two of these blocks as a cue for participants to adopt a more supervisory stance to their performance. While the alerting cues did not alter the total number of commission errors committed by ADHD children over a task block, they did produce a significant short-term reduction in commission errors in the period immediately following an alerting cue. Our data demonstrate that sustained attention performance can be enhanced in children with ADHD using a simple cognitive training strategy. Methods from the field of cognitive rehabilitation may be viably applied to the remediation of attention deficits in ADHD.

The Cognitive Genetics of Attention Deficit Hyperactivity Disorder (ADHD): Sustained attention as a Candidate Phenotype

Here we describe the application of cognitive genetics to the study of attention deficit hyperactivity disorder (ADHD). Cognitive genetics owes much to the pioneering work of cognitive neuropsychologists such as John Marshall, whose careful observations of cognitive dissociations between brain-lesioned patients greatly advanced the theoretical understanding of normal cognitive function. These theories have in turn helped to constrain linkages between candidate genes and cognitive processes and thus help to drive the relatively new field of cognitive genetics in a hypothesis-driven fashion. We examined the relationship between sustained attention deficits in ADHD and genetic variation in a catecholamine-related gene, dopamine beta hydroxylase (D[.beta]H). DBH encodes the enzyme that converts dopamine to noradrenaline and is crucial to catecholamine regulation. A polymorphism with the DBH gene has been associated with ADHD. In fifty-two children with ADHD, we examined whether variation in the Taq I DBH gene polymorphism was related to sustained attention performance. Participants performed the Sustained Attention to Response Test (SART). Performance on the SART discriminates ADHD from control children, and in imaging work, is associated with right frontoparietal activation. A significant effect of DBH genotype was found on SART performance measures. Children possessing two copies of the ADHD-associated risk allele (A2) had significantly poorer sustained attention than those ADHD children who did not possess this allele or a non-genotyped control group. The DBH gene may contribute to the susceptibility for ADHD, in part because of its varying effects on the development of brain mechanisms mediating sustained attention.

The Diversity of Attention Deficits in ADHD

The performance of participants with attention-deficit/hyperactivity disorder (ADHD) relative to control participants was measured on four tasks uniquely assessing the functions of selective attention, executive attention, sustained attention, and orienting of attention. The results showed that deficits in sustained attention were the most pronounced, characterizing most participants with ADHD and deficits in each of the other three functions characterized more than half of these participants. Different participants with ADHD revealed different clusters of attentional deficits. These results call for a revision of leading theories of ADHD that identify the core of the pathology as a sole deficit in executive functions.