Attention Deficit Hyperactivity Disorder Boys Research Articles

Identifying ADHD boys by very-low frequency prefrontal fNIRS fluctuations during a rhythmic mental arithmetic task

Objective. Computer-aided diagnosis of attention-deficit/hyperactivity disorder (ADHD) aims to provide useful adjunctive indicators to support more accurate and cost-effective clinical decisions. Deep- and machine-learning (ML) techniques are increasingly used to identify neuroimaging-based features for objective assessment of ADHD. Despite promising results in diagnostic prediction, substantial barriers still hamper the translation of the research into daily clinic. Few studies have focused on functional near-infrared spectroscopy (fNIRS) data to discriminate ADHD condition at the individual level. This work aims to develop an fNIRS-based methodological approach for effective identification of ADHD boys via technically feasible and explainable methods. Approach. fNIRS signals recorded from superficial and deep tissue layers of the forehead were collected from 15 clinically referred ADHD boys (average age 11.9 years) and 15 non-ADHD controls during the execution of a rhythmic mental arithmetic task. Synchronization measures in the time-frequency plane were computed to find frequency-specific oscillatory patterns maximally representative of the ADHD or control group. Time series distance-based features were fed into four popular ML linear models (support vector machine, logistic regression (LR), discriminant analysis and naïve Bayes) for binary classification. A ‘sequential forward floating selection’ wrapper algorithm was adapted to pick out the most discriminative features. Classifiers performance was evaluated through five-fold and leave-one-out cross-validation (CV) and statistical significance by non-parametric resampling procedures. Main results. LR and linear discriminant analysis achieved accuracy, sensitivity and specificity scores of near 100% (p <.001) for both CV schemes when trained with only three key wrapper-selected features, arising from surface and deep oscillatory components of very low frequency. Significance. We provide preliminary evidence that very-low frequency fNIRS fluctuations induced/modulated by a rhythmic mental task accurately differentiate ADHD boys from non-ADHD controls, outperforming other similar studies. The proposed approach holds promise for finding functional biomarkers reliable and interpretable enough to inform clinical practice.

Gender Differences in Auditory and Visual Attentional Performance in Children with and without ADHD.

Despite the relatively high prevalence of attention deficit hyperactivity disorder (ADHD), the impairment of ADHD in women is underestimated due to the different ways the phenomenon manifests compared to traditional male symptoms. In order to close the gender gap in diagnosis and treatment, this study aims to explore the impact of gender on auditory and visual attention in children with and without ADHD. A total of 220 children with and without ADHD participated in this study. Their auditory and visual attention performances were analyzed by comparative computerized auditory and visual subtests. Auditory and visual attention performance in children with and without ADHD did affect by gender, including typically developing (TD) boys are better than TD girls at distinguishing visual targets from non-target stimuli. When performing attention tasks, TD girls generally maintained a cautious response, which was different from TD boys, who generally adopted positive response methods. ADHD girls suffered from more serious auditory inattention problems than ADHD boys; however, ADHD boys suffered from more auditory and visual impulsive problems than ADHD girls. The internal attention problems of female ADHD children were broader than that of their male ADHD peers and were also more severe, especially in problems of auditory omission and auditory response acuity. ADHD children had a significant gap in auditory and visual attention performance compared to TD children. The research results support the impact of gender on the performance of auditory and visual attention in children with and without ADHD.

Investigation of white matter functional networks underlying different behavioral profiles in attention-deficit/hyperactivity disorder.

Cortical functional network alterations have been widely accepted as the neural basis of attention-deficit/hyperactivity disorder (ADHD). Recently, white matter has also been recognized as a novel neuroimaging marker of psychopathology and has been used as a complement to cortical functional networks to investigate brain-behavior relationships. However, disorder-specific features of white matter functional networks (WMFNs) are less well understood than those of gray matter functional networks. In the current study, we constructed WMFNs using a new strategy to characterize behavior-related network features in ADHD. We recruited 46 drug-naïve boys with ADHD and 46 typically developing (TD) boys, and used clustering analysis on resting-state functional magnetic resonance imaging data to generate WMFNs in each group. Intrinsic activity within each network was extracted, and the associations between network activity and behavior measures were assessed using correlation analysis. Nine WMFNs were identified for both ADHD and TD participants. However, boys with ADHD showed a splitting of the inferior corticospinal-cerebellar network and lacked a cognitive control network. In addition, boys with ADHD showed increased activity in the dorsal attention network and somatomotor network, which correlated positively with attention problems and hyperactivity symptom scores, respectively, while they presented decreased activity in the frontoparietal network and frontostriatal network in association with poorer performance in response inhibition, working memory, and verbal fluency. We discovered a dual pattern of white matter network activity in drug-naïve ADHD boys, with hyperactive symptom-related networks and hypoactive cognitive networks. These findings characterize two distinct types of WMFN in ADHD psychopathology.

Nutritional complexity in children with ADHD related morbidities in China: A cross-sectional study.

To assess the general and nutritional health of children with attention deficit/ hyperactivity disorder (ADHD). The National Multicenter Sleep Research Database for 23791 school-age children in grades 1-6 from 9 cities in China was accessed. Children with a specialist diagnosis of ADHD or not (non-ADHD) in 2005 were studied. National anthropometric growth standards for children aged 2-18 years classified children as underweight, wasted, stunted (short stature presumed nutritional), or overweight/obesity. Independent variables were preterm birth, sleep quality and prior disease and ADHD was the dependent variable. Binary logistic regression models were developed along with interaction analyses for associated disorder or disease on overweight/obesity, and stunted. Some 18731 records were analyzed for 808 children with ADHD. The comparative prevalences for ADHD with non-ADHD children were stunted 9.8% vs 5.9% (p<0.001) and overweight/ obesity (32.6% vs 29.6%, p=0.002) respectively. ADHD boys were more often underweight (7.5% vs 5.3%, p=0.027), but not in girls. ADHD likelihood Odds Ratios, ORs (with 95%CI) were for premature birth 1.838, (1.393-2.423), allergic diseases 1.915 (1.526-2.399), otitis media 1.54 (1.118- 2.146), tonsillar or adenoid hypertrophy1.662 (1.348-2.050), gastroesophageal reflux 3.008(1.792-1.792-5.049), and sleep disorder 2.201(1.847-2.623) were ADHD risk factors. Only poor sleep quality and ADHD exhibited an interaction for stunted with OR=0.409 (0.233-0.719). Compromised and complex nutritional health in ADHD children challenges clinical nutrition with a range of health problems, albeit coherent with the needed nutritional emphasis in the 'first 1000 days'.

Boys with attention-deficit/hyperactivity disorder perform wider and fewer finger tapping than typically developing boys – Peer comparisons and the effects of methylphenidate from an exploratory perspective

AimThis study aimed to investigate the differences in fine motor and coordination skills between boys with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) boys and the effect of methylphenidate (MPH) in boys with ADHD. MethodsFourteen boys aged 7–12 years who were diagnosed with ADHD and previously treated with MPH were instructed to tap their thumbs and index fingers together repetitively for 10 s after attaching magnetic sensors. The participants executed “in-phase” and “anti-phase” tapping. A two-way analysis of variance for comparing boys with ADHD and TD boys and the paired t-test to investigate the effect of MPH between sessions with and without MPH were performed. ResultsBoys with ADHD showed a significantly lower “number of taps” and a significantly higher “average of local maximum distance” than TD boys. “Energy balance” was significantly lower in ADHD boys than in TD boys. MPH caused a significant difference in the “standard deviation (SD) of phase difference” in “anti-phase tapping.” ConclusionOur studies indicated that finger-tapping movements in boys with ADHD tended to be significantly wider and fewer than those in TD boys, and MPH may improve the phase difference of bimanual fine motor coordination skills in boys with ADHD who are above 1.0 SD. The results should be interpreted with caution because we conducted statistical tests for many outcomes and groups without considering the multiplicity factor from an exploratory perspective.

ADHD overdiagnosis and the role of patient gender among Iranian psychiatrists

BackgroundRegarding the controversy about the overdiagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents there are two main directions addressed as issue of age bias and issue of gender bias. In this relation, replication of findings demonstrating significant overdiagnosis is of importance which make the systematic evaluation of such occurrence necessary.ObjectiveThe seminal study by Bruchmüller, Margraf & Schneider, 2012 is replicated here, although in a different cultural context, in this case Iran, as ADHS might be perceived differently there. We assessed both gender bias and the impact of potential overdiagnosis on treatment recommendations.MethodsA total of 344 licensed Iranian psychiatrists (mean age = 45.17, SD = 9.50) participated in this study. Each psychiatrist received a cover letter that introduced the study as well as a case vignette. Overall, there are eight different cases, one child with ADHD and three non-ADHD children, for both a boy (Ali) and a girl (Sara). Participants also received a questionnaire requesting their particular diagnosis, treatment recommendation and the therapist’s sociodemographic information. Chi square tests and multiple logistic regression were applied for data analyses.ResultsOverdiagnosis occurred in both girl and boy children, although overdiagnosis was 2.45 more likely in boys than in girls (p < 0.01). With respect to the psychiatrist’s gender, we detected no difference between males or females, as both overdiagnosed ADHD in boys (pfemale < 0.01 and pmale < 0.01). Furthermore, ADHD overdiagnosis had a direct impact on medication prescription (p < 0.01).ConclusionThis study suggests that diagnosticians should strictly adhere to diagnostic criteria to minimize diagnostic error.

Maternal polycystic ovary syndrome and attention deficit hyperactivity disorder in offspring at 3years of age: Odense Child Cohort.

Previous data suggested a link between maternal polycystic ovary syndrome (PCOS) and offspring attention deficit hyperactivity disorder (ADHD), which could be mediated by higher prenatal androgen exposure. The study was part of the prospective Odense Child Cohort and included 1776 pregnant women, 165 (9%) with PCOS and 1607 (91%) controls. ADHD symptoms at 3years of age were defined using the parent-reported questionnaire Child Behavior Checklist/1.5-5 (scores >90th centile of Danish national standard). Maternal blood samples were collected in the third trimester measuring total testosterone by mass spectrometry, sex hormone-binding globulin, and calculated free testosterone. Offspring anogenital distance was measured at 3months of age. Regression models were performed with presence of ADHD symptoms as the dependent variable and adjusted for maternal age, body mass index, parity, smoking status, educational level, and parental psychiatric diagnoses. ADHD symptoms were present in 105/937 (11%) boys and 72/839 (9%) girls. In boys, maternal PCOS was positively associated with ADHD symptoms (unadjusted odds ratio [OR] 1.91, 95% CI 1.07-3.43, p=0.03, adjusted OR 2.20, 95% CI 1.20-4.02, p=0.01), whereas maternal PCOS was not associated with ADHD symptoms in girls. Maternal total testosterone, free testosterone, and offspring anogenital distance were not associated with higher risk of ADHD symptoms in the offspring. Higher risk of ADHD in boys born of mothers with PCOS were not associated with maternal third-trimester testosterone levels or offspring anogenital distance.

Parental income and mental disorders in children and adolescents: prospective register-based study.

BackgroundChildren with low-income parents have a higher risk of mental disorders, although it is unclear whether other parental characteristics or genetic confounding explain these associations and whether it is true for all mental disorders.MethodsIn this registry-based study of all children in Norway (n = 1 354 393) aged 5–17 years from 2008 to 2016, we examined whether parental income was associated with childhood diagnoses of mental disorders identified through national registries from primary healthcare, hospitalizations and specialist outpatient services.ResultsThere were substantial differences in mental disorders by parental income, except for eating disorders in girls. In the bottom 1% of parental income, 16.9% [95% confidence interval (CI): 15.6, 18.3] of boys had a mental disorder compared with 4.1% (95% CI: 3.3, 4.8) in the top 1%. Among girls, there were 14.2% (95% CI: 12.9, 15.5) in the lowest, compared with 3.2% (95% CI: 2.5, 3.9) in the highest parental-income percentile. Differences were mainly attributable to attention-deficit hyperactivity disorder in boys and anxiety and depression in girls. There were more mental disorders in children whose parents had mental disorders or low education, or lived in separate households. Still, parental income remained associated with children’s mental disorders after accounting for parents’ mental disorders and other factors, and associations were also present among adopted children.ConclusionsMental disorders were 3- to 4-fold more prevalent in children with parents in the lowest compared with the highest income percentiles. Parents’ own mental disorders, other socio-demographic factors and genetic confounding did not fully explain these associations.

Developmental trajectory of subtle motor signs in attention-deficit/hyperactivity disorder: A longitudinal study from childhood to adolescence

ABSTRACT This study examined the developmental trajectory of neurodevelopmental motor signs among boys and girls with attention-deficit/hyperactivity disorder (ADHD) and typically-developing (TD) children. Seventy children with ADHD and 48 TD children, aged 8–17 years, were evaluated on at least two time-points using the Physical and Neurological Assessment of Subtle Signs (PANESS). Age-related changes in subtle motor signs (overflow, dysrhythmia, speed) were modeled using linear mixed-effects models to compare the developmental trajectories among four subgroups (ADHD girls and boys and TD girls and boys). Across visits, both boys and girls with ADHD showed greater overflow, dysrhythmia, and slower speed on repetitive motor tasks compared to TD peers; whereas, only girls with ADHD were slower on sequential motor tasks than TD girls. Developmental trajectory analyses revealed a greater reduction in overflow with age among boys with ADHD than TD boys; whereas, trajectories did not differ among girls with and without ADHD, or among boys and girls with ADHD. For dysrhythmia and speed, there were no trajectory differences between the subgroups, with all groups showing similar reductions with age. Children with ADHD show developmental trajectories of subtle motor signs that are consistent with those of TD children, with one clear exception: Boys with ADHD show more significant reductions in overflow from childhood to adolescence than do their TD peers. Our findings affirm the presence of subtle motor signs in children with ADHD and suggest that some of these signs, particularly motor overflow in boys, resolve through adolescence while dysrhythmia and slow speed, may persist.

Increased Temporal Lobe Beta Activity in Boys With Attention-Deficit Hyperactivity Disorder by LORETA Analysis.

Aim: Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder that affects 6.1 million US children. The mechanism of ADHD is currently unclear. Differences in ADHD presentations between boys and girls are well-established. In the present study, we used quantitative electroencephalography (EEG) to investigate the brain area and EEG bands of boys with ADHD.Methods: This study enrolled 40 boys with ADHD and 40 age-matched controls without ADHD. Low-resolution electromagnetic tomography (LORETA) and instantaneous frequency were used to analyze EEG data to reveal the mechanisms underlying ADHD in boys.Results: We found that the instantaneous frequencies in the T3 and T4 EEG channels in boys with ADHD were significantly higher than those in the controls. The beta band showed significant difference in current density between the ADHD and control groups. In the entire brain area, the bilateral inferior and middle temporal gyrus exhibited the most significant difference between the ADHD and control groups in the EEG beta band. Connectivity analysis revealed an increase in connectivity between the left middle frontal gyrus and fusiform gyrus of the temporal lobe in boys with ADHD.Conclusions: LORETA is a promising tool for analyzing EEG signals and can be used to investigate the mechanism of ADHD. Our results reveal that the inferior temporal gyrus, middle temporal gyrus, and fusiform gyrus of the temporal lobe are potentially involved in the pathogenesis of ADHD in boys. In comparison with other imaging methods, such as magnetic resonance imaging, EEG is easy to perform, fast, and low cost. Our study presents a new approach for investigating the pathogenesis of ADHD in boys.

Bindungsrepräsentationen, belastende Lebensereignisse und ADHS bei Jungen im Alter von 6 bis 10 Jahren

Attachment Representations, Critical Life Events and ADHD in Boys at 6 to 10 Years of Age The importance of the attachment theory was repeatedly pointed out in the literature for understanding children with attention deficit hyperactivity disorder (ADHD) with regard to their emotional state. Symptoms of ADHD, like attention deficits, motor agitation and impulsivity are seen as risk factors for insecure attachment in the parent-child relationship. The acquisition of attachment representations in children with ADHD might help to describe - and individual classify - the syndromes of this behavioural disorder better. The aims of the present study are, therefore, the investigation of attachment representations and critical life events in boys with ADHD. We focused on boys only, since they are particularly prone to develop ADHD. Using the story-completion technique, we investigated whether boys with ADHD showed insecure attachment more frequently compared to boys without ADHD. 31 boys with ADHD at six to ten years of age were recruited in two different clinics. Of these, 29 % showed a secure and 71 % showed an insecure attachment representation. Within insecure attachment, the ambivalent attachment representation occurred most frequently (41 %). On average, we found 2.3 critical life events. The enhanced frequency of the ambivalent attachment representation indicates that ADHD might be linked to externalizing behaviour. The results support the hypothesis that ADHD is increasingly associated with insecure attachment. The binding theory is able to contribute to a better understanding of the emotional state in boys with ADHD.

Comparison of the K-WISC-IV profiles of boys with autism spectrum disorder and attention-deficit/hyperactivity disorder

AimsThis study aimed to compare the intelligence profiles of children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) using the Korean Wechsler Intelligence Scale for Children–Fourth Edition (K-WISC-IV) scores to differentiate between their cognitive characteristics. MethodsSubjects were boys with ASD (n = 49) and ADHD (n = 44). The index and subtest scores of the ASD and ADHD groups were compared using MANOVA. Repeated-measures ANOVA was performed to investigate the cognitive strengths and weaknesses within the ASD and ADHD groups. ResultsVerbal comprehension was significantly lower in the ASD group compared to the ADHD group. The ASD group also scored lower than the ADHD group on Vocabulary, Comprehension, Picture Concepts, Picture Completion, and Symbol Search. The ADHD group scored lower than the ASD group on Digit Span. The ASD group displayed slower processing speed and social judgment, while the ADHD group exhibited poor working memory and graphomotor processing. ConclusionThe WISC-IV profiles might help distinguishing between the cognitive characteristics of ASD and ADHD boys.

Peripheral Brain-Derived Neurotrophic Factor and Contactin-1 Levels in Patients with Attention-Deficit/Hyperactivity Disorder.

Brain-derived neurotrophic factor (BDNF) facilitates neuronal growth and plasticity, and is crucial for learning and memory. Contactin-1 (CNTN1) is a member of the subfamily of neural immunoglobulin and is involved in the formation of axon connections in the developing nervous system. This cross-sectional study investigates whether BDNF and CNTN1 affect susceptibility to attention deficit/hyperactivity disorder (ADHD). A total of 136 drug-naïve patients with ADHD (108 boys and 28 girls) and 71 healthy controls (45 boys and 26 girls) were recruited. Blood samples were obtained to measure the plasma levels of BDNF and CNTN1 in each child. We found that BDNF levels in the ADHD boys exceeded those in the control boys, but BDNF levels in the ADHD girls were lower than those in the control girls. Boys who had higher BDNF levels performed worse on the Wechsler Intelligence Scale for Children—Fourth Edition, but girls who had higher BDNF levels made fewer omission errors in the Conners’ Continuous Performance Test. However, CNTN1 level did not differ significantly between patients and controls, and were not correlated to ADHD characteristics, regardless of gender. The findings suggest BDNF may influence sex-specific susceptibility to ADHD, but CNTN1 was not associated with ADHD pathophysiology.

Screening with an ADHD-specific rating scale in preschoolers: A cross-cultural comparison of the Early Childhood Inventory-4.

The Early Childhood Inventory-4 (ECI-4) Hyperactivity-Impulsivity (HI) and Inattention (IA) subscales are screeners for attention-deficit/hyperactivity disorder (ADHD). There have been few studies of the screening properties of these subscales, particularly outside the United States. We investigated the classification accuracy of the parent and teacher versions of the HI and IA subscales and the cross-cultural validity of the cutoff values based on norms from a United States sample. The present study was part of the Norwegian Mother and Child Cohort Study. Parents and teachers rated boys (n = 332) and girls (n = 319) with the ECI-4 (mean Age 3.5 years). Interviewers who were blind to the ratings used the Preschool Age Psychiatric Assessment Interview to assign ADHD diagnoses. The ECI-4 HI and IA subscales showed acceptable accuracy in identifying ADHD in boys and girls (areas under the curve ranged from .67 to .85). In a multivariate regression analysis, the parent and teacher HI subscale scores significantly contributed to ADHD identification, but not the IA subscale scores. To achieve the necessary sensitivity to detect children with ADHD, lower cutoff levels than those specified by the United States ECI-4 norms were needed. For screening purposes, the parent and teacher ECI-4 showed acceptable accuracy in identifying preschoolers at risk for ADHD, and it may be sufficient to use the HI subscale scores. The suggested cutoff values provided by the United States ECI-4 norms had limited cross-cultural validity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Methylphenidate and atomoxetine normalise fronto-parietal underactivation during sustained attention in ADHD adolescents

Problems with sustained attention are a key clinical feature of Attention Deficit/Hyperactivity Disorder (ADHD) which also manifests in poor performance and abnormal fronto-striato-parietal activation during sustained attention. Methylphenidate and atomoxetine improve attention functions and upregulate abnormal fronto-cortical activation during executive function tasks in ADHD patients. Despite this, no functional Magnetic Resonance Imaging (fMRI) study has compared the effects of methylphenidate and atomoxetine on the neurofunctional substrates of sustained attention in ADHD. This randomised, double-blind, placebo-controlled, cross-over study investigated the comparative normalisation effects of methylphenidate and atomoxetine on fMRI correlates and performance in 14 ADHD adolescents relative to 27 age-matched healthy controls during a parametric sustained attention/vigilance task with progressively increasing load of sustained attention. ADHD patients were scanned three times under a single clinical dose of either methylphenidate, atomoxetine, or placebo in pseudo-randomised order. Healthy controls were scanned once and compared to patients under each drug condition to test for potential drug-normalisation effects. Relative to controls, ADHD boys under placebo were impaired in performance and had underactivation in predominantly right-hemispheric fronto-parietal, and striato-thalamic regions. Both drugs normalised all underactivations, while only methylphenidate improved performance deficits. Within patients, methylphenidate had a drug-specific effect of upregulating left ventrolateral prefrontal/superior temporal activation relative to placebo and atomoxetine, while both drugs increased activation of right middle/superior temporal cortex, posterior cingulate, and precuneus relative to placebo. The study shows shared normalisation effects of methylphenidate and atomoxetine on fronto-striato-thalamo-parietal dysfunction in ADHD during sustained attention but a drug-specific upregulation effects of methylphenidate on ventral fronto-temporal regions.

Mullerian inhibiting substance, sex hormone binding globulin and sex hormone levels in stimulant-naïve, first-diagnosed prepubertal boys with attention-deficit/hyperactivity disorder: comparison with matched healthy controls as well as before and after oros-methylpenidate treatment

Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder with strong male predominance. Since Müllerian Inhibiting Substance (MIS) produces sex-linked bias in animal studies, we aimed to investigate the role of MIS, Sex Hormone Binding Globulin (SHBG) and sex hormone levels in boys with ADHD.Methods: We compared prepubertal, psychostimulant-naïve boys with ADHD with age-matched healthy control boys (HCs). Patients were re-evaluated after 30 days of methylphenidate treatment assessing ADHD severity, and serum MIS, testosterone, estradiol, and albumin concentrations.Results: Compared to 30 HCs, with ADHD (n = 49, age = 6.9 ± 0.2 years) had lower SHBG (p = .014), and higher free testosterone (p = 0.006) and bioavailable testosterone (p = .002) percentages. Methylphenidate improved ADHD measures (all p < .0001) and abnormal baseline hormonal levels, increasing SHBG levels (p = .024), and lowering free (p = .001) and bioavailable testosterone (p = .016) percentages so that only free testosterone percentages remained higher versus HCs post-treatment (p = .02).Conclusions: Compared to age- and sex-matched HCs, prepubertal, stimulant-naïve boys with ADHD had significantly lower SHBG and higher free and bioavailable testosterone percentages, suggesting a possible contribution of sex hormones to ADHD. Osmotic-release oral system methylphenidate treatment for 30 days significantly improved ADHD symptoms and abnormal sex hormone levels, normalizing SHBG and bioavailable testosterone percentages that were similar to HCs while free testosterone remained elevated versus HCs.Key pointsCompare to healthy matched controls prepubertal stimulant-naïve boys with ADHD had significantly lower SHBG and higher free and bioavailable testosterone percentages, suggesting a possible effect on sex hormones to ADHD.After 30-day methylphenidate treatment, ADHD symptoms significantly improved, and SHBG and bioavailable testosterone percentages normalized which were similar to HCs, while free testosterone remained elevated versus HCs.We found a negative relationship between MIS levels and hyperactivity scores in ADHD boys. This finding suggests that MIS may contribute to hyperactivity symptoms, either directly by affecting behavior or indirectly by affecting sex hormone levels.

Attention-Deficit/Hyperactivity Disorder Symptoms and Community Violence Exposure in Russian Adolescents.

A large body of research has shown that exposure to community violence is common for many children across the world. However, less is known about exposure in particular subgroups such as those children with developmental disorders. To address this research gap, the aim of this study was to examine community violence exposure (CVE) in adolescents with attention-deficit/hyperactivity disorder (ADHD) symptoms and the role of gender in this association. Data were analyzed from 2,782 adolescents aged 13 to 17 years from Arkhangelsk, Russia that were collected during the Social and Health Assessment (SAHA). ADHD status was assessed with the hyperactivity/inattention scale of the Strengths and Difficulties Questionnaire (SDQ). Information was obtained on past-year witnessing and violence victimization in the community. Results showed that CVE was more prevalent in children with ADHD symptoms. Specifically, 75.1% of children with ADHD symptoms had been exposed to any violence versus 62.3% in the non-ADHD group (χ2 = 18.65, p < .001). Multivariate analyses of covariance (MANCOVAs) revealed that CVE was significantly higher for adolescents with ADHD symptoms for both witnessing and victimization, while exposure was significantly higher for ADHD boys compared with girls. The findings of this study suggest that CVE may be elevated in adolescents with higher ADHD symptoms. Given that CVE has been associated with a variety of negative social and psychological outcomes in typically developing children, an important task for future research is to determine what factors are associated with CVE in adolescents with ADHD symptoms including those relating to such phenomena as comorbid psychopathology, the family, and peer relations, so that interventions can be designed and implemented to reduce CVE and its detrimental effects in this population.

Does a social self-perceptual bias mask internalizing symptoms in children with attention-deficit/hyperactivity disorder?

Children with attention-deficit/hyperactivity disorder (ADHD) often present with additional psychiatric conditions. Comorbidity is associated with poorer long-term outcomes, highlighting the need for effective assessment and intervention. However, self-perceptual biases may mask the presence of symptoms for a subgroup of children with ADHD. This study examined the role of social self-perceptual biases in children with ADHD versus control children on self-reports of loneliness, and depressive and anxious symptoms. The research question was examined in two samples. Sample 1 consisted of 7.7-12.8-year-old boys with ADHD (n=199) and control boys (n=74); Sample 2 consisted of 7.7-11.4-year-old boys and girls with ADHD (n=178) and control children (n=86). Across samples, children reported social competence and symptoms of anxiety and depression. Child-reported loneliness was examined in Sample 1. A social competence discrepancy score (difference between self-report and teacher-report) was used as an indicator of social self-perceptual bias. Hierarchical multiple regression analyses tested social self-perceptual bias as a suppressor variable. The magnitude of the associations between ADHD and self-reported feelings of depression, anxiety and loneliness was greater when social self-perceptual bias was included in models as compared to models that did not include social self-perceptual bias (ΔR2 s range=0.04-0.19). Findings across both samples suggest that social self-perceptual biases may mask internalizing symptom severity on self-reports for individuals who overestimate their social competence. More research is needed to determine the best approach to assessing internalizing problems among children with ADHD.

Dehydroepiandrosterone sulfate, free testosterone, and sex hormone-binding globulin on susceptibility to attention-deficit/hyperactivity disorder

The neuroendocrine system may affect the pathophysiology of gender differences in attention deficit/hyperactivity disorder (ADHD). This study examines whether the relationships among dehydroepiandrosterone sulfate (DHEA-S), free testosterone, or sex hormone-binding globulin (SHBG) and ADHD presentations exhibit gender differences. A total of 113 boys and 35 girls with ADHD (all drug naïve) and 46 and 26 healthy control boys and girls, respectively, were recruited. Blood samples were obtained to measure the serum levels of DHEA-S, free testosterone, and SHBG in each child. The Swanson, Nolan, and Pelham Scale for ADHD Version IV (SNAP-IV) was used to evaluate behavioral symptoms and the Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV) and the Conners’ Continuous Performance Test (CPT) were utilized to assess neurocognitive functions. Patients with ADHD had lower DHEA-S levels than male and female healthy control subjects, and no significant differences were observed in free testosterone and SHBG levels between the patients and the controls. DHEA-S levels were negatively correlated with children’s impulsivity performance in the CPT. SHBG levels were negatively correlated with ADHD behavior symptoms among boys. Free testosterone levels were not significantly correlated with either ADHD clinical symptoms or neuropsychological functions. We propose that DHEA-S serves as a potential biomarker of ADHD and is consistently involved in the pathogenesis of ADHD in both boys and girls. SHBG may be involved in behaviors associated with ADHD in boys. Additional studies with basic scientific measures are warranted to elucidate the relationship between androgen hormones and clinical presentations of ADHD.

Having a Sibling With ADHD or ASD Increases Risk for Both Disorders

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessHaving a Sibling With ADHD or ASD Increases Risk for Both DisordersNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:18 Jan 2019https://doi.org/10.1176/appi.pn.2019.1a4AbstractOverall, about 15 percent of later-born siblings in the ADHD and ASD risk groups were diagnosed with ADHD or ASD, compared with about 2 percent of children whose older siblings had neither disorder.Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are distinct childhood conditions, but they share many traits. Children with both disorders often display impulsivity, difficulties with social skills, and repetitive behaviors. A study published December 10, 2018, in JAMA Pediatrics identified a hereditary overlap as well. Children who have an older sibling who has been diagnosed with ASD are not only at an increased risk of ASD themselves, but also at an increased risk of developing ADHD. Similarly, children who have an older sibling diagnosed with ADHD are at an increased risk of being diagnosed with ADHD or ASD.iStock/romrodinka“[L]ater-born siblings of children with ASD and ADHD appear to be at elevated risk within and across diagnostic categories and thus should be monitored for both disorders,” wrote lead author Meghan Miller, Ph.D., an assistant professor of psychiatry and behavioral sciences at the University of California, Davis, and colleagues. “Practitioners may wish to share such information with families given the potential relevance of monitoring social communication, attention, and behavior regulation skills in later-born siblings of children with ASD or ADHD.”Miller and colleagues analyzed medical records from two large U.S. health care systems: Wisconsin’s Marshfield Clinic and Kaiser Pacific Northwest, which covers Oregon and Washington. They looked for families who had at least one more child after having a child diagnosed with ADHD or ASD. The authors did this to overcome the effect of “reproductive stoppage,” in which parents decide to stop having children after one is diagnosed with a developmental disorder. Family analyses that look only at the total number of siblings with or without a disorder likely underestimate the true inheritance risks, the authors wrote.The final dataset included 15,175 non-firstborn children; of these, 730 had an older sibling diagnosed with ADHD (the ADHD risk group) and 158 had an older sibling diagnosed with ASD (the ASD risk group).Compared with children whose older siblings had neither disorder, children in the ASD risk group were about 30 times more likely to also be diagnosed with ASD and 3.7 times more likely to be diagnosed with ADHD. Children in the ADHD risk group were about 13 times more likely to be diagnosed with ADHD and 4.4 times more likely to be diagnosed with ASD than children whose older siblings had neither disorder.Overall, about 15 percent of later-born siblings in the ADHD and ASD risk groups were diagnosed with ADHD or ASD, compared with about 2 percent of children whose older siblings had neither disorder. Miller told Psychiatric News that the analysis could not rule out that some of the increased prevalence of ADHD and/or ASD among the siblings in the ASD and ADHD risk groups was due to shared environmental factors. However, she said there is a lot of evidence that shows these two disorders are highly heritable.As expected, the odds of ASD or ADHD in later-born siblings increased even more if the child was a boy. In the ADHD risk group, the odds of an ADHD diagnosis in a later born sibling also increased if the older diagnosed sibling was a girl.“Some studies have suggested that there may be a ‘female protective effect’ for male-predominant disorders like ASD and ADHD,” Miller told Psychiatric News. That means females need to inherit a greater amount of genetic risk factors before they manifest a disorder. Therefore, if a daughter develops ADHD, it suggests the parents are carrying a greater genetic burden, which would make ADHD in boys more likely. The authors did not observe this same trend with older female siblings in the ASD risk group, which they suggested may have been due to the smaller number of diagnoses in the dataset.This study was supported by grants from the National Institute of Mental Health. ■ An abstract of “Sibling Recurrence Risk and Cross-Aggregation of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder” can be accessed here. “Later Sibling Recurrence of Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder: Clinical and Mechanistic Insights,” here. ISSUES NewArchived