Attention-deficit/hyperactivity Disorder In School-age Children Research Articles

Investigating the Association Between Heavy Metals and Attention Deficit Hyperactivity Disorder in Children: An Exploratory Study.

Exposure to heavy metals has been associated with affecting children's neurodevelopment, particularly increasing the risk of developing attention-deficit hyperactivity disorder (ADHD). The current exploratory study aims to investigate potential associations between presence of 15 different heavy metals in urine and ADHD. A total of 190 urine samples of participants from clinical and non-clinical population (non-ADHD = 66; ADHD = 124) aged between 6 and 15 years from Barcelona and Tarragona (Spain) were analysed. Logistic regressions adjusted by sex, age, SES, BMI and diet quality were performed. Highest quartiles (3rd and 4th) of Pb (lead) (aOR 5.33; CI [1.89, 14.98]), Cd (cadmium) (aOR 3.69, CI [1.38, 9.83]), Cu (copper) (aOR 16.46, CI [4.66, 58.14]) and Sb (antimony) (aOR 3.04, CI [1.12, 8.23]) were significantly associated with increased odds of ADHD DSM-5 diagnosis. Additionally, Cu and Cd were associated with higher scores of inattention symptoms. Whereas, Cu and Sb were associated with hyperactivity-impulsivity severity. This exploratory study provides preliminary valuable evidence, suggesting potential associations between environmental factors, such as metal exposure, with ADHD in school-aged children. These findings highlight the importance of further research to support these associations and, if confirmed, explore strategies to mitigate the potential impacts of these toxicants on children's health.

Word-Finding Difficulties as a Prominent Early Finding in a Later Diagnosis of Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychological disorder primarily diagnosed in childhood. Early intervention was found to significantly improve developmental outcomes, implicating on the role of early identification of ADHD markers. In the current study, we explored the developmental history of children referred to neurological assessment to identify early ADHD predictors. A total of 92 children and adolescents (41 females) recruited at a pediatric neurology clinic, with suspected ADHD (n = 39) or other neurological difficulties (n = 53) such as headaches, seizures, tic disorders, orthostatic hypotension, postischemic stroke, intermittent pain, and vasovagal syncope. Developmental history information was obtained from caregivers, and evaluation for possible ADHD was performed. Developmental details were compared between children with and without current ADHD diagnosis. Word-finding difficulties (WFDs) in preschool age was reported in 30.4% of the sample. Among children diagnosed with ADHD, 43% had WFDs history, compared with only 5% in children without ADHD. Among children with WFDs history, 93% were later diagnosed with ADHD compared with 42% in children without WFDs history. The relationship between WFDs and ADHD was significant (chi-square test [1, N = 92] = 20.478, p < 0.0001), and a logistic regression model demonstrated that asides from a family history of ADHD, the strongest predictor for ADHD in school age children was a history of WFDs. Preliminary evidence supports a predictive link between preschool WFDs and later ADHD diagnosis, highlighting the importance of early WFDs clinical attention.

Effect of 25 hydroxyvitamin D on attention deficit and hyperactivity in school-age children with ADHD.

To observe the serum levels of 25 hydroxyvitamin D [25 (OH) D] in healthy school-age children and children with attention deficit hyperactivity disorder (ADHD) and to analyze the effects of serum 25 (OH) D on the symptoms of attention deficit and hyperactivity in school-age children with ADHD. According to the Diagnostic and Statistical Manual of Mental Disorders DSM-IV diagnostic criteria for ADHD in children, 80 healthy children aged 6 years or less than 10 years old and children diagnosed with ADHD in the Department of Rehabilitation Medicine, Department of Pediatrics and Department of Physical Examination of our hospital were randomly selected as research subjects. The serum 25 (OH) D level, attention deficit hyperactivity (Swanson, Nolan, and Pelham, version IV [SNAP-IV] parental version) score and Conners child behavior (PSQ) index were observed and compared between the 2 groups. In addition, the children with ADHD whose serum 25 (OH) D was lower than normal were treated with supplemental VitD3, and the changes in serum 25 (OH) D, SNAP-IV parental score and PSQ index of ADHD children were observed and compared. Serum 25(OH)D was insufficient or deficient in 26 healthy children, but the SNAP-IV score and PSQ index were normal. Serum 25(OH)D was lower than normal in 69 patients in the ADHD group, which was negatively correlated with SNAP-IV score (r = -0.3479, P = .0034) and negatively correlated with PSQ index (r = -0.3566, P = .0026). After vitamin D3 (VitD3) supplementation in 69 children with serum 25(OH)D levels lower than the normal ADHD group, it was found that the SNAP-IV score (r = -0.4654, P = .0037) and PSQ index (r = -0.5680, P = .0002) of 34 children with ADHD were negatively correlated with the increase in serum 25(OH)D. The SNAP-IV score and PSQ index of the other 35 children with ADHD showed no correlation with the increase in serum 25 (OH) D (P > .05). Serum 25(OH)D levels lower than normal are more common in school-age children, and levels lower than normal are not the key pathogenic factor of ADHD in school-age children, but serum 25(OH)D levels lower than normal may be the upregulation factor of attention deficit and hyperactivity disorder expression in some school-age children with ADHD. The lower level of serum 25(OH)D may be closely related to the severity of ADHD symptoms in some children.

Identifying Symptoms of ADHD and Disruptive Behavior Disorders Most Strongly Associated with Functional Impairment in Children: A Symptom-Level Approach

To enhance the understanding of how symptoms of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders such as oppositional defiant disorder (ODD), conduct disorder (CD), including callous-unemotional (CU) traits, differentially relate to functional impairment (FI). Participants were 474 German school-age children (age: M = 8.90, SD = 1.49, 81% male) registered for participation in the ESCAschool trial (ESCAschool: Evidence-based, Stepped Care of ADHD in school-aged children). Clinicians assessed the severity of individual symptoms and five FI domains specifically associated with ADHD symptoms or ODD/CD/CU symptoms using a semi-structured clinical interview. We conducted two multiple linear regression analyses, combined with relative importance analyses, to determine the impact of individual symptoms on global FI associated with ADHD and ODD/CD/CU symptoms. Next, we estimated two networks and identified the strongest associations of ADHD symptoms or ODD/CD/CU symptoms with the five FI domains. Symptoms varied substantially in their associations with global FI. The ADHD symptom Easily Distracted (15%) and ODD symptom Argues with Adults (10%) contributed most strongly to the total explained variance. FI related to academic performance, home life and family members, and psychological strain were most strongly associated with ADHD inattention symptoms, whereas FI related to relationships with adults and relationships with children and recreational activities were most strongly associated with hyperactivity-impulsivity symptoms. By comparison, the ODD/CD/CU symptoms most closely linked to FI domains originated from the ODD and CD dimensions. Our findings contribute to a growing body of literature on the importance of analyzing individual symptoms and highlight that symptom-based approaches can be clinically useful.

Once-Daily SPN-812 200 and 400 mg in the treatment of ADHD in School-aged Children: A Phase III Randomized, Controlled Trial

PurposeSPN-812 (viloxazine extended-release) is under investigation for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. This Phase III study evaluated the efficacy and tolerability of SPN-812 200 and 400 mg once daily in children 6–11 years of age with ADHD. MethodsPatients were randomly assigned to receive SPN-812 200 mg, SPN-812 400 mg, or placebo, once daily for 8 weeks (including ≤3 weeks titration period). The primary efficacy endpoint was the change from baseline (CFB) in ADHD Rating Scale (RS)-5 Total score at end of study (EOS). Key secondary endpoints included Clinical Global Impression–Improvement (CGI-I) score at EOS, CFB in Conners 3–Parent Short Form (PS) composite T-score at EOS, and CFB in Weiss Functional Impairment Rating Scale–Parent (WFIRS-P) Total average score at EOS. FindingsA total of 313 patients were enrolled, with 301 in the intent-to-treat population (194 boys, 107 girls; mean age [SD], 8.4 [1.7] years). At EOS, the CFBs in ADHD-RS-5 Total score and CGI-I score were significantly improved with both 200- and 400-mg/d SPN-812 versus placebo (ADHD-RS-5, P = 0.0038 and 0.0063, respectively; CGI-I, P = 0.0028 and 0.0099). At EOS, the CFB in Conners 3-PS composite T-score was significantly improved with 200- (P = 0.0064), but not 400-mg/d (P = 0.0917), SPN-812 compared to placebo. No significant difference between the groups was found in WFIRS-P Total average score. The rate of discontinuations due to adverse events in both SPN-812 treatment groups combined was <5%. ImplicationsSPN-812 200 and 400 mg once daily was associated with improvements in ADHD symptoms in school-aged children and was generally well tolerated. ClinicalTrials.gov identifier: NCT03247543.

Comparing the prevalence of attention deficit hyperactivity disorder in hearing-impaired children with normal-hearing peers

ObjectivesThe most important aspect of hearing loss is its effect on the communication abilities of individuals. The aim of this study was to compare the prevalence of attention deficit hyperactivity disorder (ADHD) in hearing-impaired (HI) children with normal-hearing (NH) peers. MethodsA total of 130 children (65 children with severe-to-profound hearing loss and 65 NH peers) participated in this cross-sectional study from November 2013 to May 2014. ADHD Rating Scale IV questionnaires were given to children's parents to collect data. Descriptive and analytical analyses were used in order to achieve the objectives of the study. ResultsThe mean age of the HI children and NH peers was 14.1 and 13.3 years, respectively. In the case group, 52 children suffered from congenital hearing loss and 10 children had acquired hearing loss. In total, 19 cases (29.2%) and eight controls (12.3%) were diagnosed with ADHD. This difference was statistically significant (P=0.017). The prevalence of ADHD in children with hereditary or acquired hearing loss was 30.7% and 20.0%, respectively. However, this difference was not significant (P=0.71). ConclusionThe prevalence of ADHD in school-aged children with hearing loss is higher than that in the general population of the same age. We could not find significant differences between the different subgroups due to the small sample size. Therefore, we recommend a further larger study to determine the interaction between hearing loss and ADHD.

Associations between road traffic noise exposure at home and school and ADHD in school-aged children: the TRAILS study

Environmental noise may play a role in the manifestation and severity of attention deficit/hyperactivity disorder (ADHD) symptoms, but evidence is limited. We investigated the cross-sectional associations between residential and school road traffic noise exposure and ADHD symptoms and diagnosis. The sample included n = 1710, 10–12-year-old children from the TRAILS study in The Netherlands. ADHD symptoms were measured using a DSM-IV based subscale from the Child Behavior Checklist. Children with diagnosed ADHD originated from the clinic-referred cohort. Road traffic noise (Lden) was estimated at the residence and school level, by model calculation. Risk ratios for ADHD symptoms and ADHD diagnoses, and regression coefficients for symptom severity were estimated separately and simultaneously for residential and school road traffic noise. Adjusted multinomial models with residential road traffic noise showed that residential noise was not associated with ADHD symptoms, but was associated with lower risks for ADHD diagnosis (RR = 0.93; 95% CI 0.89, 0.97). Similar associations were observed for models including school road traffic noise and models including both exposures. No clear exposure response relationship was observed for associations between residential or school noise and ADHD symptom severity. We found no evidence for a harmful association between road traffic noise and ADHD. Associations between noise and lower risks for ADHD were observed only in referred cases with a confirmed ADHD diagnosis and may be due to residual confounding or selection bias. Future studies should focus on residential and school noise exposure, and study associations with ADHD symptoms and diagnosis over time.

Diagnosis and Treatment Options for Preschoolers with Attention-Deficit/Hyperactivity Disorder.

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

&lt;p&gt;A virtual reality application for assessment for attention deficit hyperactivity disorder in school-aged children&lt;/p&gt;

Background and objective: The development of objective assessment tools for attention deficit hyperactivity disorder (ADHD) has become a hot research topic in recent years. This study was conducted to explore the feasibility and availability of virtual reality (VR) for evaluating symptoms of ADHD.Methods: School-aged children were recruited. The children with ADHD or without ADHD were assigned into the ADHD group or Control group, respectively. They were all evaluated using the Conners’ Parent Rating Scale (CPRS), Child Behavior Checklist (CBCL), Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), and a VR test.Results: The correct items, incorrect items, and the accuracy rate of the VR test of the children with ADHD were significantly different with those of the children in the Control group. The correct items, incorrect items, total time, and accuracy of the VR test were significantly correlated with the scores of IVA-CPT (auditory attention and visual attention), CPRS (impulsion/hyperactivity and ADHD index), and CBCL (attention problems and social problems), respectively.Discussion: The results supported the discriminant validity of the VR test for evaluating ADHD in school-age children suffering from learning problems. The VR test results are associated with the commonly used clinical measurements results. A VR test is interesting for children and therefore it attracts them to complete the test; whilst at the same time, it can also effectively evaluate ADHD symptoms.

Early food allergy and respiratory allergy symptoms and attention-deficit/hyperactivity disorder in Chinese children: A cross-sectional study.

The relationship between food allergy and respiratory allergy and attention-deficit/hyperactivity disorder (ADHD) in children is rarely investigated. The objective of this study was to determine whether early food allergy and respiratory allergy symptoms are associated with the prevalence of ADHD in Chinese school-age children. This cross-sectional study was conducted in school-age children using cluster-stratified methods from 9 cities across China between November and December 2005. A family and social environmental questionnaire including the diagnosis history of ADHD and allergic diseases (food allergy, allergic rhinitis, and bronchial asthma), as well as general information, was completed by parents. The prevalence of both allergic rhinitis (20.4%) and asthma (11.6%) in the food allergy group was significantly higher than in the non-food allergy group (9.0% and 2.8%, respectively; both P<.001). The multivariable analysis showed that single food allergy (OR=1.53, 95% CI: 1.13-2.05, P=.005), food allergy complicated with allergic rhinitis or asthma (OR=3.36, 95% CI: 2.19-5.14, P<.001), and food allergy complicated with allergic rhinitis and asthma simultaneously (OR=4.08, 95% CI: 2.05-8.11, P<.001) were independently associated with the increased risk of ADHD. Early food allergy is associated with ADHD in school-age children. Early food allergy and respiratory allergy symptoms independently and synergistically contributed to higher risk of ADHD. Monitoring food allergy in early life could help in the early prediction and intervention for the consequent allergy march and ADHD in children.

Impact of allergic airway diseases on risk of attention deficit hyperactivity disorder in school-age children

Objective: To investigate the impact of allergic airway diseases on the risk of attention deficit hyperactivity disorder (ADHD) in school-age children. Method: Used stratified cluster sampling method, school-age children in first to sixth grade in primary schools in 9 randomly selected cities including Shanghai, Guangzhou, Xi'an, and Wuhan were enrolled in the study. Interview of parents with questionnaires, which included school-age individual and family social environment questionnaire (including history of diagnosed ADHD, allergic rhinitis, and bronchial asthma) and Children's Sleep Habits Questionnaire (CSHQ), were finished and collected during November to December in 2005.Diagnosed allergic rhinitis and asthma by specialist were independent variables and divided into following three categories as no allergic diseases (neither allergic rhinitis nor asthma), single allergic disease (allergic rhinitis or asthma), and combined allergic diseases (allergic rhinitis and asthma). Diagnosed ADHD as dependent variable, binary logistic regress model was used to analyze the risks of ADHD in school-age children. Result: Totally 23 791 questionnaires were handed out, while 22 018 were collected. The children had an average age of (8.8±1.8) years, within which 10 869 were male, and 11 021 were female. The risk ratios of ADHD were 2.197 (95%CI: 1.823-2.648) and 3.150 (95%CI: 2.082-4.760) in children with single allergic disease and combined allergic diseases separately. There was no significant difference after adjusting for the factor of sleep habits, as the risk ratios were 2.055 (95%CI: 1.683-2.508) and 3.140 (95%CI: 2.061-4.784) in children with single and combined allergic airway disease separately. Conclusion: Allergic rhinitis and bronchial asthma increased the risk of ADHD, not depending on sleep habits. Hence, allergic airway diseases could be independent risk factors of ADHD.

Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children

ABSTRACTThe present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent–child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study’s limitations, and future directions for research are further discussed.

Prevalence of attention deficit hyperactivity disorder among urban school children

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

697 – Prevalence of adhd in a french community sample of 892 children: results from the chip-ard study

Introduction In many European countries including France, awareness for Attention Deficit-Hyperactivity Disorder (ADHD) is increasing. Unfortunately, estimates of prevalence based on validated instruments and reasonably large and representative samples are still lacking in many of these countries. Aims This study aims to estimate the prevalence rates of ADHD in school-aged children based on teacher ratings of the ADHD rating scale (ADHD-RS-IV) and of the Strengths and Weaknesses of ADHD-Symptoms scale of the Normal-Behavior (SWAN). These scales differ in item wording and scoring, and have both been extensively validated. Methods 892 youths aged from 5 to 18 are included in the present study. Maximum-likelihood prevalence rates were estimated (based on recommended scoring criteria) in the entire sample and in gender (boys vs. girls) and age (below and above 12 years-old) subgroups. Results Using the ADHD-RS, 10.65% of youths might have ADHD (4.37% Predominantly Inattentive subtype, 3.36% Combined subtype and 2.91% Predominantly Hyperactive-Impulsive subtype). Boys were more affected than girls (sex ratio 1.4:1), children were more affected than adolescents, and ADHD girls were more likely to be of the Inattentive subtype. Using the SWAN, 2.25% of youths might have ADHD (1.13% Combined subtype, .90% Predominantly Hyperactive-Impulsive subtype, .34% Predominantly Inattentive subtype). No overall differences between genders were observed, children were more affected than adolescents, and ADHD boys were more likely to be of hyperactive-impulsive subtype. Conclusion There are true differences according to the rating scales. Teacher ratings provide useful information that also has to be combined with parental and clinical ratings.

Phthalates Exposure and Attention Deficit Hyperactivity Disorder in School-Aged Children

ISEE-0182 Background: Very few studies have examined the association between attention deficit hyperactivity disorder (ADHD) and phthalate exposure in humans. The aim of this study was to investigate the impact of phthalates on symptoms of ADHD in school-aged children. Methods: A cross-sectional examination of urine phthalate concentrations was performed, and scores on measures of ADHD symptoms and neuropsychological dysfunction with regard to attention and impulsivity were obtained from 261 Korean children, aged 8–11 years. Results: Mono-2-ethylheyl phthalate (MEHP) and mono-2-ethyl-5-oxohexylphthalate (MEOP) for metabolites of di-2-ethylhexylphthalate (DEHP), and mono-n-butyl phthalate (MNBP) for metabolites of dibutyl phthalate (DBP) were measured in urine samples. The mean concentrations of MEHP, MEOP, and MNBP were 34.0 μg/dL (SD = 36.3; range: 2.1–386.7), 23.4 μg/dL (SD = 23.0; range: 0.75–244.8), and 46.7 μg/L (SD = 21.4; range: 13.2–159.3), respectively. After adjustment for covariates, teacher-rated ADHD scores were significantly associated with DEHP metabolites but not with DBP metabolites. We also found significant relationships between the urine concentrations of metabolites for DEHP and DBP and the number of omission errors in continuous performance tests. The commission errors were significantly associated with DBP metabolites but not with DEHP metabolites. Conclusion: The present study showed a strong positive association between phthalate metabolites in urine and symptoms of ADHD among school-aged children.

Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention-Deficit/Hyperactivity Disorder—United States, 2003

Attention-deficit/hyperactivity disorder (ADHD), previously known as attention deficit disorder, is a neurobehavioral disorder characterized by pervasive inattention and hyperactivity-impulsivity that often results in substantial functional impairment. Prevalence estimates of ADHD in school-aged children have ranged from 2% to 18% in community samples. Although stimulant medications are an effective first-line treatment for ADHD , concern persists regarding the possible side effects and long-term health outcomes associated with stimulant consumption. Estimating the number of children who have had ADHD diagnosed and are currently taking medication for the disorder is an important step toward understanding the overall burden of ADHD in the United States. Previously, population-based estimates of medication treatment for ADHD were not available or were limited by their lack of generalizability. To estimate rates of parent-reported ADHD diagnosis and medication treatment for ADHD, CDC analyzed data from the 2003 National Survey of Children's Health (NSCH). This report describes the results of that analysis, which indicated that, in 2003, approximately 4.4 million children aged 4-17 years were reported to have a history of ADHD diagnosis; of these, 2.5 million (56%) were reported to be taking medication for the disorder. Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.

Attention-Deficit/Hyperactivity Disorder in School-Aged Children: Association With Maternal Mental Health and Use of Health Care Resources

To investigate the association between the mental health status of mothers and attention-deficit/hyperactivity disorder (ADHD) in their school-aged children and to characterize the health care access and utilization of families affected by ADHD. Survey logistic regression procedures were used to investigate the association between activity-limiting mental health conditions in mothers and ADHD in their school-aged children using 1998 National Health Interview Survey data. A total of 9529 mother-child dyads were included in the final analysis. The prevalence of ADHD among children aged 4 to 17 years was 6.3%. Survey logistic regression statistics revealed an association between an activity-limiting depression, anxiety, or emotional problem in mothers and ADHD in their children. This association persisted after controlling for the gender, age, and race of the child; household income (as a function of the 1997 poverty level); and type of family structure as reported by the mother (adjusted odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.2-8.1). Mothers of a child with ADHD were 13 times more likely to have consulted with a mental health professional about their child's health within the past year despite reporting an inability to afford prescription medications (OR: 3.3; 95% CI: 2.2-4.9) and mental health care (OR: 7.4; 95% CI: 4.6, 11.8) for the child. Maternal mental health is significantly associated with the presence of ADHD in school-aged children. This finding further supports a link between maternal mental health and behavioral outcomes in children. Health care utilization and access findings support a family-oriented system of care.