Attention-deficit/hyperactivity Disorder Severity Research Articles

Electrophysiological indices of reward anticipation as ADHD risk and prognostic biomarkers

AbstractThe attention-deficit/hyperactivity disorder (ADHD) clinical phenotype has limitations for deciphering ADHD etiology and predicting prognosis. Although relative to the clinical phenotype, intermediate phenotypes may have better explanatory and prognostic power, the extent to which ADHD intermediate phenotypes are associated with ADHD risk and prognosis is unknown. The aim of this study was to evaluate evidence for event-related potential (ERP) measures of reward anticipation as ADHD risk and prognostic biomarkers. We examined, whether (1) in a sample of adolescents (N = 304; Mage = 15.78 years, SD = 1.08; 39.5% female), accounting for the effects of age, sex, ADHD severity and depression, ERPs are associated with ADHD polygenic risk scores (PRSs) (ADHD risk) and (2) in a sample of adolescents at-risk for ADHD (n = 99; Mage = 15.78 years, SD = 1.08; 39.5% female), accounting for the effects of age, sex, ADHD severity, depression, and baseline outcome values, ERPs are associated, prospectively, with alcohol misuse (ADHD prognosis). In adolescents, greater ADHD PRSs were associated with lower electrophysiological anticipatory attention to motivationally relevant feedback (b = −0.115, p = .046 95%CI [−0.228; −0.002]). The predictors accounted for 5% of the variance in the outcome. In adolescents at-risk for ADHD, at 18-month follow-up, lower electrophysiological anticipatory attention to motivationally relevant feedback was associated with greater alcohol consumption (b = −7.454, p = .007, 95%CI [−12.873; −2.034]). The predictors accounted for 31% of the variance in this outcome. These findings were replicated in sensitivity analyses with behavioral performance variables added as covariates. The current findings support the hypothesis that ERP amplitudes of reward anticipation may be ADHD risk and prognostic biomarkers and suggest that intermediate phenotypes may confer advantages over the ADHD clinical phenotype in delineating etiology and predicting prognosis.

A New Objective Diagnostic Tool for Attention-Deficit Hyper-Activity Disorder (ADHD): Development of the Distractor-Embedded Auditory Continuous Performance Test

Background/Objectives: Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Traditional diagnostic methods, which depend on subjective assessments, often lack precision. This study evaluates the validity and reliability of a newly developed diagnostic tool, the Distractor-Embedded Auditory Continuous Performance Test (da-CPT), which integrates auditory stimuli with distractors to enhance the clinical utility of ADHD diagnosis. Methods: The study included 160 children aged 6–12 years, comprising 80 with a confirmed ADHD diagnosis and 80 controls. All participants completed the da-CPT, a web-based tool designed to assess inattention, hyperactivity, impulsivity, and timing via an auditory-based task. To validate the da-CPT, participants also completed the Conners’ Parent Rating Scale—Revised Short Form (CPRS-R) and either the MOXO or IVA-2 tests. Data were analyzed using ROC curves and statistical correlations to assess sensitivity, specificity, and overall diagnostic accuracy. Results: The da-CPT demonstrated high diagnostic accuracy, with a sensitivity of 91.25% and specificity of 83.75%. ROC analysis indicated that the inattention index had the highest discriminatory power (AUC = 0.881), followed by timing, impulsivity, and hyperactivity (all p < 0.01). Furthermore, the da-CPT scores were strongly correlated with ADHD severity (p < 0.01). Conclusions: This study confirms that the da-CPT is a valid and reliable tool for diagnosing ADHD in children aged 6–12. By incorporating auditory stimuli and distractors, the tool offers a more ecologically valid assessment of ADHD symptoms in clinical settings, improving diagnostic precision and utility.

A novel approach to ADHD classification based on severity and emotional impairment: Findings from artificial intelligence analysis

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder characterized by symptoms of inattention and executive dysfunction, although there is not always agreement on the onset, course and long-term stability of the diagnosis. This study aims to detect differences in the cognitive profile according to the subtype of ADHD following a professional diagnosis and to propose an alternative classification. The scores obtained for each cognitive construct were compared using the Student’s t-test. In order to explore different diagnostic categories based on groupings made by Artificial Intelligence (AI) subjects were grouped based on their performance through the K-means clustering technique. The results obtained by Artificial Intelligence (AI) identified groups based on the severity of the cognitive profile and the presence of emotional impairment. Difficulties in perceived planning within family and school environments were highlighted as major risk factors in the severity of ADHD in children. Emotional disturbances perceived by both parents, such as depressive symptoms, anxiety, and somatization, were observed subsequently. In accordance with the results, an alternative way to classify ADHD is possible, involving categorization according to the presence or absence of emotional impairment, along with the severity of impairment in attentional and executive functions.

Influence of temperament and emotional dysregulation on depressive symptoms in adults with attention-deficit/hyperactivity disorder: A structural equation modelling analysis

ObjectiveDepressive symptoms in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are common. Clinical evidence suggests that affective temperaments and emotional dysregulation are reasonable putative explanatory factors of this association. In this study, we thus investigated the role of these features in influencing concomitant depressive symptoms in adults with ADHD. MethodsOutpatients with ADHD were consecutively enrolled. Depressive symptoms were measured by the Symptom Checklist-90 Revised (SCL-90-R), while the Temperament Evaluation Memphis for Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) was used to assess the affective temperament dimensions. We tested emotional dysregulation using the Difficulties in Emotion Regulation Scale (DERS). Structural equation modeling was performed to test the interplay between temperament, emotional dysregulation, and depressive symptoms, accounting for other clinical variables that showed an association with depressive symptoms at univariate level. ResultsA total of 164 individuals with ADHD (mean age of 29.8 ± 10.7 years), of which 61 (37.2%) women, were recruited. Data showed that, accounting for the possible influence of psychopharmacological treatment and ADHD severity, both emotional dysregulation (p < 0.001) and dysthymic temperament (p = 0.003), though not other affective temperament dimensions, might influence depressive symptoms in people with ADHD. ConclusionsDespite some limitations, our study emphasizes the role of dysthymic temperament and emotional dysregulation in contributing to levels of depressive symptoms among individuals with ADHD. A comprehensive temperament assessment in adults with ADHD can offer valuable insights for developing tailored treatment strategies and enhancing overall patient care.

Association Between Positive Childhood Experiences and Caregiver-Reported ADHD Diagnosis and Severity.

Little is known about the prevalence of positive childhood experiences (PCEs), a counter to adverse childhood experiences, in children with an attention-deficit hyperactivity disorder (ADHD) diagnosis. The purpose of this study was to examine the relationship between PCEs and ADHD diagnosis and severity, adjusting for child, family, and household characteristics, using a nationally representative data set. Using the 2020 to 2021 National Survey of Children's Health, our sample included children 6 years of age or older, as this is the age at which PCE questions are asked (n = 56,224). Multivariable logistic regression was used to examine the association between PCE type and ADHD diagnosis and severity, controlling for child and household characteristics. In multivariable regression analyses, children who had volunteered in their community had lower odds of a reported ADHD diagnosis than children who had not volunteered in their community (adjusted odds ratio [aOR] 0.83; 95% confidence interval [CI], 0.73-0.95). Children with a connected caregiver had a lower likelihood of ADHD diagnosis than children without a connected caregiver (aOR 0.66; 95% CI, 0.58-0.74). Children reporting moderate to severe ADHD were less likely to report exposure to any of the 7 PCEs examined, when compared with children reporting mild ADHD. The findings from this study can be important for clinicians and families to mitigate the negative social and academic outcomes that children with ADHD may face.

Abnormal brain entropy dynamics in ADHD

BackgroundBrain entropy (BEN) is a novel measure for irregularity and complexity of brain activities, which has been used to characterize abnormal brain activities in many brain disorders including attention-deficit/hyperactivity disorder (ADHD). While most research assumes BEN is stationary during scan sessions, the brain in resting state is also a highly dynamic system. The BEN dynamics in ADHD has not been explored. MethodsWe used a sliding window approach to derive the dynamical brain entropy (dBEN) from resting-state functional magnetic resonance imaging (rfMRI) dataset that includes 98 ADHD patients and 111 healthy controls (HCs). We identified 3 reoccurring BEN states. We tested whether the BEN dynamics differ between ADHD and HC, and whether they are associated with ADHD symptom severity. ResultsOne BEN states, characterized by low overall BEN and low within-state BEN located in SMN (sensorimotor network) and VN (visual network), its FW (fractional window) and MDT (mean dwell time) were increased in ADHD and positively correlated with ADHD severity; another state characterized by high overall BEN and low within-state BEN located in DMN (default mode network) and ECN (executive control network), its FW and MDT were decreased in ADHD and negatively correlated with ADHD severity. LimitationsThe window length of dBEN analysis can be further optimized to suit more datasets. The co-variation between dBEN and other dynamical brain metrics was not explored. ConclusionOur findings revealed abnormal BEN dynamics in ADHD, providing new insights into clinical diagnosis and neuropathology of ADHD.

Application and expansion of an algorithm predicting attention-deficit/hyperactivity disorder and impairment in a predominantly White sample.

Current assessment protocols for attention-deficit/hyperactivity disorder (ADHD) focus heavily on a set of highly overlapping symptoms, with well-validated factors like cognitive disengagement syndrome (CDS), executive function (EF), age, sex, and race and ethnicity generally being ignored. Using machine learning techniques, the current study aimed to validate recent findings proposing a subset of ADHD symptoms that, together, predict ADHD diagnosis, severity, and impairment level better than the full symptom list, while also testing whether the inclusion of the factors listed above could further increase accuracy. Parents of 1,922 children (50.1% male) aged 6-17 years completed rating scales of ADHD, CDS, EF, and impairment. Results suggested nine symptoms as most important in predicting outcomes: (a) has difficulty sustaining attention in tasks or play activities; (b) does not follow through on instructions and fails to finish work; (c) avoids tasks (e.g., schoolwork, homework) that require sustained mental effort; (d) is often easily distracted; (e) has difficulty organizing tasks and activities; (f) is often forgetful in daily activities; (g) fidgets with hands or feet or squirms in seat; (h) interrupts/intrudes on others; and (i) shifts around excessively or feels restless or hemmed in. The abbreviated algorithm achieved accuracy rates that did not significantly differ compared to an algorithm comprising all 18 symptoms in predicting impairment, while also demonstrating excellent discriminative ability in predicting ADHD diagnosis. Adding CDS and EF to the abbreviated algorithm further improved the prediction of global impairment. Continued refinement of screening tools will be key to ensuring access to clinical services for youth at risk for ADHD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attention Deficit Hyperactivity Disorder among Children with Speech Difficulties

Abstract: Speech sound disorders and attention deficit / hyperactivity disorder are developmental disorders that can significantly impact academic success. The comorbidity of these disorders may substantially add to the difficulties experienced by the child and require a combined treatment approach. Objectives: (1) to assess sociodemographic characteristics of children’s with speech difficulties (2) to assess attention deficit hyperactivity disorder and speech difficulties (3) to identify the relationship between attention deficit hyperactivity disorder and speech difficulties. Methodology: A descriptive cross-sectional study design was carried out in Baghdad Teaching Hospital. A non- probability (purposive) study sample of (300) child, who attended Hearing and Speech Center for the period from 12/April/2023 to 25/January/2024. The Questionnaire which is composed of: Socio-demographic characteristics, scales of behavioral problem, attention deficit hyperactivity disorder. Results: The study results reveal that the children experiencing severe attention deficit hyperactivity disorder and that significant relationship have been reported among speech sound disorder with attention deficit hyperactivity disorder at p-values= 0.046, also indicates that there was significant relationship among childhood apraxia and attention deficit hyperactivity disorder at p-values= 0.007. Conclusion: The children experience severe of attention deficit hyperactivity disorder, the significant relationship has been reported among speech sound disorder with attention deficit hyperactivity disorder, also indicates that there was significant relationship among childhood apraxia and attention deficit hyperactivity disorder.Recommendations: An intervention program to be planned accordingly and areas of deficit will be targeted in therapy. Liaison with parents and school teachers is indicated in order to achieve the child’s maximum potential.

Efficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions

Anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) affect up to 20% of children and adolescents. Despite demonstrated efficacy, evidence-based treatments for these conditions are often inaccessible; innovative solutions are essential to meet the demand for pediatric mental health care. To examine the efficacy and moderators of gamified DMHIs for anxiety, depression, and ADHD in randomized clinical trials (RCTs) for children and adolescents. A systematic search of PubMed, PsycInfo, and Web of Science was conducted for RCTs published before March 20, 2024. RCTs that evaluated the efficacy of gamified DMHIs for treating pediatric ADHD, depression, or anxiety were included. Studies were excluded if they did not use a gamified DMHI, provide sufficient data for effect sizes, or were unavailable in English. Efficacy data were extracted from rating scales for ADHD, depression, and anxiety. Extracted moderator variables included participant characteristics (eg, age and sex), intervention characteristics (eg, delivery modality and time limit), and trial design characteristics (eg, outcome measure and risk of bias). The primary outcome was change in ADHD, depression, or anxiety severity in the treatment group compared to the control group. Hedges g quantified treatment effects. The search strategy identified 27 RCTs that included 2911 participants across ADHD, depression, and anxiety disorders. There were modest significant effects of gamified DMHIs on ADHD (g, 0.28; 95% CI, 0.09 to 0.48) and depression (g, 0.28; 95% CI, 0.08 to 0.47) but small, nonsignificant effects for anxiety disorders (g, 0.07; 95% CI, -0.02 to 0.17). Moderator analyses revealed that DMHIs for ADHD delivered on a computer and those RCTs that had a greater preponderance of male participants produced larger treatment effects. DMHIs for depressive disorders that used preset time limits for gamified DMHIs also exhibited larger treatment effects. The findings suggest a benefit of gamified DMHIs for youth with ADHD or depressive disorder. Pediatricians and other health care professionals have new information about novel, accessible, and efficacious options for pediatric mental health care.

A - 36 Cognitive Impairments Linked to ADHD Severity and Insurance Gaps among U.S. Children

Abstract Objective To evaluate the presence and severity of attention-deficit/hyperactivity disorder (ADHD) in children in the United States, and to explore the relationship between ADHD, functional cognitive impairments, access to evidence-based treatments, and adequate health insurance. Method This study included children aged six to 17 (n = 34,109) from the 2022 National Survey of Children’s Health (NSCH) representing diverse races, ethnicities, and socioeconomic statuses. Data was collected on ADHD diagnosis, severity, insurance coverage, medication/behavioral treatment, and cognitive impacts. Results Of the participants, 10.5% reported ADHD, with 4.4% reporting mild symptoms and 6% reporting moderate to severe symptoms. The more severe ADHD symptoms were, the greater impact on cognitive performance was noted χ2(2,N = 4772) = 705 p &amp;lt; 0.001; with mild ADHD rarely impacting cognition resid.(1,2) = −421. Only 13.9% of children with ADHD is currently covered by health insurance, and only 6.6% of children with ADHD have health insurance to cover their mental and/or behavioral health services. Of those insured, children with severe ADHD were more likely to have insufficient coverage χ2(8,N = 4642) = 362 p &amp;lt; 0.001; resid.(3.3) = −23.5. Conclusions The study revealed a considerable 10.5% of U.S. children currently have ADHD, with greater cognitive impacts revealed for children with greater severity of symptoms. Results also revealed critical disparities in ADHD management, and in turn their cognitive functioning. While 59.7% reported insurance always covered mental health needs, and 13.9% indicated inconsistent coverage, contributing to treatment gaps. This lack of coverage particularly affects children with moderate to severe ADHD, exacerbating cognitive impacts. These findings underscore the need for comprehensive ADHD care and improved, consistent mental health coverage.

Validation and assessment of the self-injurious behavior scale for tic disorders (SIBS-T)

Self-injurious behavior (SIB) is a well-known phenomenon in patients with chronic tic disorders (CTD). To investigate prospectively symptomatology of SIB in adults with CTD, we developed and validated the self-injurious behavior scale for tic disorders (SIBS-T). Patients completed the SIBS-T and a variety of assessments for tics and comorbidities. We investigated SIB frequency, internal consistency of the SIBS-T, and carried out an exploratory factor analysis (EFA). We enrolled n = 123 adult patients with CTD. SIB was reported by n = 103 patients (83.7%). The most frequently reported SIB were beating/pushing/throwing and were found in 79.6% of cases. Patients with SIB had significantly higher tic severity measured with the Adult Tic Questionnaire (ATQ) (p = 0.002) as well as higher severity of psychiatric comorbidities such as obsessive–compulsive symptoms (OCS) (p < 0.001,), attention deficit/hyperactivity disorder (ADHD) (p < 0.001,), and anxiety (p = 0.001). In addition, patients with SIB had significantly lower quality of life (p = 0.002). Pearson correlations demonstrated significant associations between SIB and severity of tics (p < 0.001), depression (p = 0.005), ADHD (p = 0.008), and borderline personality traits (p = 0.014). Consequently, higher SIBS-T also correlated with greater impairment of quality of life (p < 0.001). The internal consistency of the SIBS-T was good (α = 0.88). The EFA confirmed a single factor underlying the SIBS-T.

Prevalence and clinical phenotypes of adult patients with attention deficit hyperactivity disorder and comorbid behavioral addictions.

Although the correlation between substance use disorder and attention deficit hyperactivity disorder (ADHD) has been largely studied, less is known about the correlation between behavioral addictions and ADHD. Thus, the aim of the present study was to investigate the prevalence of behavioral addictions in a large sample of adult patients with a primary diagnosis of ADHD and to compare the clinical profile of ADHD patients with and without behavioral addictions comorbidity. 248 consecutive adults newly diagnosed as ADHD patients were assessed through a series of validated scales for gambling disorder, internet, sex, shopping and food addictions. ADHD patients with at least one comorbid behavioral addiction were compared to non-comorbid patients on ADHD symptoms, impulsivity, mood and anxiety symptoms and functional impairment. 58.9% of patients had at least one behavioral addiction comorbidity. Of the whole sample, 31.9% of the patients had a comorbidity with one behavioral addiction while the 27% showed a comorbidity with two or more behavioral addictions. Internet addiction was the most common comorbidity (33.9%) followed by food addiction (28.6%), shopping addiction (19%), sex addiction (12.9%) and gambling disorder (3.6%). ADHD patients with comorbid behavioral addictions showed higher ADHD current and childhood symptoms, higher cognitive and motor impulsivity, higher mood and anxiety symptoms and higher functional impairment. Behavioral addictions are highly frequent in adult ADHD patients. Comorbid patients seem to have a more complex phenotype characterized by more severe ADHD, mood and anxiety symptoms, higher impulsivity levels and greater functional impairment.

Multidimensional ADHD Symptom Profiles: Associations with Adverse Childhood Experiences.

Adverse childhood experiences (ACEs) are associated with a range of negative health outcomes, including attention-deficit/hyperactivity disorder (ADHD) and neurocognitive deficits. This study identified symptom profiles in adult patients undergoing neuropsychological evaluations for ADHD and examined the association between these profiles and ACEs. Utilizing unsupervised machine learning models, the study analyzed data from 208 adult patients. The Gaussian Mixture Model revealed two distinct symptom profiles: "Severely Impaired" and "Moderately Impaired". The "Severely Impaired" profile, 23.6% of the sample, was characterized by more severe ADHD symptomatology in childhood and worse neurocognitive performance. The "Moderately Impaired" profile, 76.4% of the sample, had scores in the average range for self-reported internalizing and externalizing psychopathology and better neurocognitive performance. There was a greater number of ACEs reported by patients in the Severely Impaired profile than the Moderately Impaired profile (p =.022). Specifically, using an ACEs cutoff of ≥4, 53.1% of patients in the Severely Impaired profile reported four or more ACEs, compared with 34.6% in the Moderately Impaired profile (p = .020). Profiles were not related to clinician-ascribed diagnosis. Findings underscore the association between ACEs and worse symptom profiles marked by impaired neurocognitive function, increased internalizing and externalizing psychopathology, and heightened perceived stress in adults with ADHD. Future research may explore the effect of ACEs on symptom profiles in diverse populations and potential moderators or mediators of these associations. Findings offers valuable insights for clinicians in their assessment and treatment planning.

Sleep insufficiency and bedtime irregularity in children with ADHD: A population-based analysis

BackgroundSleep is impaired in children with attention-deficit/hyperactivity disorder (ADHD). However, population-based examination of indicators of sleep insufficiency and bedtime irregularity is limited. This investigation examined associations between ADHD, weeknight sleep insufficiency, and bedtime irregularity in a nationally-representative child sample, and indicators of these sleep outcomes in ADHD. MethodsParents of children aged 3–17 years with ADHD (n = 7671) were surveyed through the 2020–2021 National Survey of Children's Health. Inverse probability of treatment weighting generated a weighted matched control sample (n = 51,572). Weighted generalized linear models were performed without and with age-stratification to examine associations between ADHD and sleep, adjusting for sociodemographics in the full sample, and between nineteen sociodemographic and clinical variables and sleep in ADHD. ResultsHaving ADHD was associated with increased odds of sleep insufficiency and bedtime irregularity relative to controls, even after adjusting for sociodemographic variables. In ADHD, older age was associated with lower sleep insufficiency and greater bedtime irregularity. Black race, increased poverty, higher ADHD severity, depression, and increased screen time were associated with greater sleep insufficiency and bedtime irregularity. Adverse childhood experiences (ACEs) were associated with greater sleep insufficiency. Behavioral/conduct problems, female sex, and absence of both ADHD medication use and ASD diagnosis were associated with poorer bedtime irregularity. Age-stratified results are reported in text. ConclusionsChildren with ADHD face heightened risk for insufficient sleep and irregular bedtimes. Findings suggest intervention targets (e.g., Black race, poverty, depression, screen time) to improve both sleep insufficiency and bedtime irregularity. Results highlight ACEs and behavioral/conduct problems as targets to improve sleep insufficiency and bedtime regularity, respectively. Age-stratified findings are discussed.

"Your Child Should Not Return": Preschool Expulsion Among Children With Attention-Deficit/Hyperactivity Disorder as an Early Indicator of Later Risks.

Young children with attention-deficit/hyperactivity disorder (ADHD) can have challenging behaviors putting them at risk for preschool expulsion and for adverse outcomes across child development, health, and education. We examined the association of preschool expulsion with ADHD symptoms, diagnosis, treatment, and functioning among children with ADHD. Using the cross-sectional National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome on 2947 children aged 5 to 17 years ever diagnosed with ADHD, parents reported on preschool expulsion, ADHD symptoms, diagnosis, treatment, and functioning. Weighted analyses included calculations of estimated means, prevalence, and prevalence ratios. Preschool expulsion was experienced by 4.4% of children ever diagnosed with ADHD (girls: 1.5%; boys: 5.7%). Children with preschool expulsion had lower mean ages at first concern about ADHD symptoms, ADHD diagnosis, and initiation of ADHD medication and had higher prevalence of severe ADHD symptoms and other mental, behavioral, or developmental disorders. A history of preschool expulsion was associated with difficulties with overall school performance, organized activities, writing, handwriting, and the parent-child relationship, but not with math, reading, or peer or sibling relationships. Children with preschool expulsion more often received school supports, behavioral classroom management, peer intervention, and social skills training. Among children ever diagnosed with ADHD, history of preschool expulsion was associated with more severe ADHD symptoms, other disorders, earlier diagnosis and medication initiation, and academic and social impairment. Health care providers can use preschool expulsion as an indicator of risk for children with ADHD and connect families to effective treatments.

BDNF, proBDNF and proBDNF/BDNF ratio with electroencephalographic abnormalities in children with attention deficit hyperactivity disorder: Possible relations to cognition and severity.

Attention deficit hyperactivity disorder (ADHD) with and without subclinical epileptogenic discharges (SED) have been suggested to negatively affect cognitive abilities of children with ADHD. The role of brain-derived neurotrophic factor (BDNF) and its precursor proBDNF in ADHD is in need of being investigated. The aims were to evaluate the levels of serum BDNF, proBDNF and the proBDNF/BDNF ratio in addition to the potential impacts of SED on the children's cognitive abilities and the severity of ADHD. The included participants with ADHD were 30 children with normal electroencephalogram (EEG) (G1) and 30 children with SED (G2), together with 30 healthy children (G3). The cognitive abilities and severity of the disorder were evaluated. The biochemical measures were determined by ELISA. The presence of coexisting SED and nocturnal enuresis has led to a deleterious effect on cognitive processes but not on the severity. The focal epileptogenic discharge was the most common among children in G2. The levels of BDNF in Groups 1 and 2 were less than those in G3. The higher proBDNF/BDNF ratio could be related to the low BDNF levels rather than high proBDNF levels. The findings of this study highlight the importance of investigating the presence of SED and nocturnal enuresis in children with ADHD. Targeting strengthening of cognitive abilities in children with coexisting ADHD and SED is advised. The role of proBDNF in the pathophysiology of ADHD needs further investigation.

Attention-Deficit/Hyperactivity Disorder and Unhealthy Lifestyle in Adolescence: Unforeseen Role of Allostatic Overload and Psychological Well-Being.

Unhealthy lifestyle behaviors (ULBs) are common in early adolescence and could be worsened by Attention-Deficit/Hyperactivity Disorder (ADHD), as well as by specific psychosocial factors, such as stress and unbalanced (i.e., too high or low scores of) psychological well-being (PWB) dimensions. This multi-center study aimed to evaluate how interactions between ADHD symptoms and psychosocial factors associated with ULBs (i.e., Allostatic Overload and multidimensional Psychological Well-Being), considered as moderators, could affect the adoption of ULBs during adolescence. A total of 440 fourteen-year-old adolescents were recruited from six upper secondary schools in Bologna and Rome (Italy) and completed self-report questionnaires on ULBs, ADHD, and psychosocial factors. Relations between ADHD symptomatology and specific ULBs (i.e., impaired sleep, problematic Internet use) were moderated by variables deemed as "negative" (i.e., Allostatic Overload) or "positive" (i.e., PWB dimensions of Self-Acceptance, Personal Growth, Positive Relations, Purpose in Life, Environmental Mastery): when the "negative" moderator is absent and the levels of the "positive" moderators are higher, ULBs decrease among students with lower ADHD symptomatology but increase among students with more severe ADHD. Based on ADHD severity, interventions should aim at promoting a state of euthymia, which consists in balanced PWB dimensions and reflects the optimal level of well-being to fulfill one's own potential and self-realization.

A comparison of visual attention to pictures in the Autism Diagnostic Observation Schedule in children and adolescents with ADHD and/or autism.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are neurodevelopmental conditions which frequently co-occur. The Autism Diagnostic Observation Schedule (ADOS) is commonly used to aid with diagnostic assessment of ASD but was not originally designed for use in those with comorbid ADHD. Visual attention to social stimuli has been often studied in ASD using eye-tracking, to obtain quantitative indices of how attention is deployed to different parts of a social image/scene. As the ADOS includes tasks that rely on attending to and processing images of social scenes, these measures of visual attention could provide useful additional objective measurement alongside ADOS scores to enhance the characterisation of autistic symptoms in those with ADHD. Children with ASD, comorbid ASD and ADHD, ADHD and Neurotypical (NT) controls were recruited (n=84). Visual attention was measured using eye-tracking during free viewing of social scenes selected from the ADOS. The full ADOS was then administered. Stimulant medication was temporarily withdrawn during this assessment. Research diagnoses were based on the Development and Wellbeing Assessment (DAWBA), ADOS, Social Communication Questionnaire (SCQ, a measure of ASD severity) and Conners' Rating Scales (CRS-3, a measure of ADHD severity) following clinical consensus. Using factorial ANOVAs to model ADHD, Autism and their interaction, we found that fixation duration to faces was reduced in those with ASD (ASD and ASD+ADHD) compared to those without ASD (ADHD and NT). Reduced visual attention to faces in the whole sample was associated with Autism symptom severity (SCQ subscale scores) but not ADHD symptom severity (CRS-3 scores). Our findings provide preliminary evidence in support of implementing visual attention measurement during assessment of ASD in the context of comorbidity with ADHD. For example, if a child with ADHD was found to reduce attention to faces in ADOS pictures this may suggest additive difficulties on the autism spectrum. Replication across a larger sample would be informative. This work has future potential in the clinic to help with complex cases, including those with co-occurring ADHD and ASD.

ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment

ABSTRACT Objective To provide updated national prevalence estimates of diagnosed attention-deficit/hyperactivity disorder (ADHD), ADHD severity, co-occurring disorders, and receipt of ADHD medication and behavioral treatment among U.S. children and adolescents by demographic and clinical subgroups using data from the 2022 National Survey of Children’s Health (NSCH). Method This study used 2022 NSCH data to estimate the prevalence of ever diagnosed and current ADHD among U.S. children aged 3–17 years. Among children with current ADHD, ADHD severity, presence of current co-occurring disorders, and receipt of medication and behavioral treatment were estimated. Weighted estimates were calculated overall and for demographic and clinical subgroups (n = 45,169). Results Approximately 1 in 9 U.S. children have ever received an ADHD diagnosis (11.4%, 7.1 million children) and 10.5% (6.5 million) had current ADHD. Among children with current ADHD, 58.1% had moderate or severe ADHD, 77.9% had at least one co-occurring disorder, approximately half of children with current ADHD (53.6%) received ADHD medication, and 44.4% had received behavioral treatment for ADHD in the past year; nearly one third (30.1%) did not receive any ADHD-specific treatment. Conclusions Pediatric ADHD remains an ongoing and expanding public health concern, as approximately 1 million more children had ever received an ADHD diagnosis in 2022 than in 2016. Estimates from the 2022 NSCH provide information on pediatric ADHD during the last full year of the COVID-19 pandemic and can be used by policymakers, government agencies, health care systems, public health practitioners, and other partners to plan for needs of children with ADHD.

Attention-Deficit Hyperactivity Disorder (ADHD) Medication Use Trajectories Among Women in the Perinatal Period.

An increasing number of women of reproductive age are treated with attention-deficit hyperactivity disorder (ADHD) medication; however, patterns of ADHD medication use for women in the perinatal period have not been well described. This study aimed to describe ADHD medication use patterns from 1year before pregnancy to 1year after delivery, and to describe sociodemographic characteristics and clinical features by medication trajectories. The population-based cohort study included pregnancies in Denmark between 1997 and 2020, from the Medical Birth Register, by women who filled at least one prescription for ADHD medication from 12 months before pregnancy until 12 months after delivery. We applied group-based trajectory modeling to classify women into subgroups based on the identification of heterogeneous ADHD medication treatment patterns, and described the characteristics associated with these groups. Overall, we included 4717 pregnancies leading to liveborn singletons by 4052 mothers with a mean (standard deviation) age of 27.5 (5.6) years. We identified four treatment trajectories across pregnancy and the postpartum period: continuers (23.3%), discontinuers (41.8%), interrupters who ceased filling prescriptions during pregnancy but resumed postpartum (17.2%), and postpartum initiators (17.7%). Continuers were older at the time of conception, gave birth in more recent years, were more likely to smoke during pregnancy, and used other psychotropic medications during pregnancy. A large proportion of continuers used methylphenidate (89.1%) compared with the other groups (75.9-84.1%) and had switched ADHD medication type during the whole period (16.4% vs. 7.4-14.8%). We found that approximately 60% of women discontinued or interrupted their ADHD medication around pregnancy, and those who continued differed in sociodemographic and clinical factors that may reflect more severe ADHD.