Attention-deficit/hyperactivity Disorder Severity Research Articles

Brain Correlates of the Interaction Between 5-HTTLPR and Psychosocial Stress Mediating Attention Deficit Hyperactivity Disorder Severity.

The serotonin transporter 5-HTTLPR genotype has been found to moderate the effect of stress on severity of attention deficit hyperactivity disorder (ADHD), with stronger effects of stress in carriers of the short allele than in individuals homozygous for the long allele. The underlying neurobiological mechanism of this gene-environment interaction in ADHD is unknown. The authors aimed to determine whether 5-HTTLPR moderates the effect of stress on brain gray matter volume and, if so, which brain regions mediate the effect of this gene-environment interaction on ADHD severity. Structural MRI, 5-HTTLPR genotype, and stress exposure questionnaire data were available for 701 adolescents and young adults participating in the multicenter ADHD cohort NeuroIMAGE study (from 385 families; 291 with ADHD, 78 with subthreshold ADHD, 332 healthy comparison subjects; 55.8% male; average age: 17.0 years). ADHD symptom count was determined through multi-informant questionnaires. For the analysis, a whole-brain voxel-based morphometry approach was combined with mediation analysis. Stress exposure was associated with significantly less gray matter volume in the precentral gyrus, middle and superior frontal gyri, frontal pole, and cingulate gyrus in S-allele carriers compared with participants homozygous for the l-allele. The association of this gene-environment interaction with ADHD symptom count was mediated by gray matter volume in the frontal pole and anterior cingulate gyrus. 5-HTTLPR genotype moderates the effect of stress on brain regions involved in social cognitive processing and cognitive control. Specifically, regions important for cognitive control link this gene-environment interaction to ADHD severity.

Treatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs

To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines. Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described. Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%). These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group.

Comorbid symptomatology moderates response to risperidone, stimulant, and parent training in children with severe aggression, disruptive behavior disorder, and attention-deficit/hyperactivity disorder.

In this study, we evaluated parent and child characteristics as predictors and moderators of response in the four-site Treatment of Severe Childhood Aggression (TOSCA) study. A total of 168 children with severe aggression, disruptive behavior disorder, and attention-deficit/hyperactivity disorder (ADHD) were enrolled in a 9-week trial of basic treatment (n=84, stimulant+parent training+placebo) versus augmented treatment (n=84, stimulant+parent training+risperidone). In the initial report, augmented treatment surpassed basic treatment in reducing the primary outcome of disruptive behavior (D-Total) scores. In the current study, we evaluated parent (income, education, family functioning, employment) and child variables (intelligence quotient [IQ], aggression type, comorbid symptomatology) as predictors or moderators, using linear mixed models and the MacArthur guidelines. Higher scores on ADHD symptom severity and callous/unemotional traits predicted better outcome on D-Total regardless of treatment assignment. Two moderators of D-Total were found: Higher anger/irritability symptoms and lower mania scores were associated with faster response, although not better overall effect at endpoint, in the augmented but not the basic group. Several variables moderated response on secondary outcomes (ADHD severity and prosocial behavior), and were characterized by faster response, although not better outcome, in the augmented but not in the basic group. Maternal education moderated outcome on the measure of positive social behavior; children of mothers with less education benefited more from augmented treatment relative to basic than those with more education. Although these findings require validation, they tentatively suggest that augmented treatment works equally well across the entire sample. Nevertheless, certain child characteristics may be useful indicators for the speed of response to augmented treatment.

Stimulating interest: A brief introduction to drugs for ADHD

About 1-in-20 children and adolescents have attention deficit hyperactivity disorder (ADHD). Parental training and education, and psychological treatment for patients, are the usual first-line treatments for moderate ADHD. NICE recommends drugs for severe ADHD, as well as for children with moderate ADHD who refused non-drug treatment, or whose symptoms and impairment did not respond adequately to training, education and psychological treatment. The drug choice needs to be individualised, form part of a comprehensive treatment plan and carers (including school staff) need to remain alert for adverse events. This article briefly introduces the place of, and some issues surrounding, stimulants for ADHD.

The Role of Parental Temperament Traits in Disruptive Behavioral Disorders of Children with ADHD

Introduction No study up to now investigated the role of parental temperament traits in disruptive behavioral disorders (DBD) of children with attention-deficit/hyperactivity disorder (ADHD). Objectives To determine the relationships between parent temperament characteristics and child DBD symptoms in children with ADHD. Methods The sample consisted of 542 treatment naive children with ADHD aged 6-17 years. All children had to be living with both biological mothers and fathers. The severity of ADHD and comorbid DBD were assessed via parent and teacher rated Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale. Temperamental dimensions of mothers and fathers were measured by TEMPS-A. The association between parental ADHD and DBD was evaluated with two separate structural equation models. Results Relationships of parent ADHD and DBD symptoms were presented in Figures 1 and 2. Discussion This study showed a significant relationship between maternal depressive and paternal cyclothymic affective temperament and conduct disorder, and between maternal anxious and irritable, and paternal cyclothymic affective temperament and oppositional defiant disorder in children with ADHD. This study highlights that children with more severe behavioural symptoms are more likely to have a parent with certain temperament traits. Download : Download full-size image Download : Download full-size image

Impact of Parental ADHD Dimensions On Disruptive Behavioral Disorders Symptomatology in Children with ADHD

Introduction Little is known about the effect of parental attention-deficit/hyperactivity disorder (ADHD) dimensions on the development of disruptive behavioral disorders (DBD) in children with ADHD. Objectives To study the association of parental ADHD on the DBD symptoms in children with ADHD. Methods The sample consisted of 542 treatment naive children with ADHD aged 6-17 years. All children had to be living with both biological mothers and fathers. The severity of ADHD and comorbid DBD were assessed via parent and teacher rated Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale. Current ADHD severity of mothers and fathers were evaluated by a self-report inventory. The association between parental ADHD and DBD was evaluated with two separate structural equation models. Results Relationships of parent ADHD and DBD symptoms were presented in Figures 1 and 2. Discussion These results suggest maternal hyperactivity may be a vulnerability factor for the development of conduct disorder and oppositional defiant disorder in children with ADHD. Download full-size image Download full-size image

Association of Anxiety, Anxiety Sensitivity and Depressive Symptoms with Aggression and Disruptive Behavioral Disorders in Children with ADHD

Numerous factors including anxiety, anxiety sensitivity (AS), and depression were reported to be relevant to the aggression both for disruptive behavioral disorders (DBD) in children and for attention-deficit/hyperactivity disorder (ADHD), but the pathways through which they act are insufficiently understood. To investigate the role of anxiety, AS, and depression in the relationship between aggression and DBD symptoms in ADHD children. The sample consisted of 342 treatment naïve children with ADHD aged 9-17 years. ADHD severity and comorbid<a name="_GoBack"></a> DBD were assessed via parent and teacher rated Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale. Severity of anxiety, AS, depression, and reactive and proactive agression of children were evaluated by self-report inventories. The association between DBD and other psychiatric variables was evaluated with two separate structural equation models. Relationships of psychiatric variables and DBD symptoms were presented in Figures 1 and 2. Discussion: These results may suggest the presence of a vicious circle between anxiety, reactive aggression and DBD in ADHD children. However, global AS seems to have a protective effect on the development of DBD, probably due to its role in aversive conditioning. Figure Structural model for the perdictores of parent-rated disruptice behavioural disorders symptoms in children with ADHD

Maternal psychiatric history is associated with the symptom severity of ADHD in offspring

Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.

Elevated background noise in adult attention deficit hyperactivity disorder is associated with inattention.

BackgroundInattention and distractibility are core symptoms of attention deficit hyperactivity disorder (ADHD). Still the neuronal organization is largely unknown. Previously we studied the electrophysiological activity of a distinct neuronal network—the retina—and found no change in stimulus-driven neural activity in patients with ADHD. However there is growing evidence for an elevated non stimulus-driven neural activity, or neuronal background noise, as underlying pathophysiological correlate. To further examine the biological bases that might underlie ADHD and problems with inattention, we performed a new analysis to test the hypothesis of an elevated background noise as underlying neuronal correlate for ADHD and problems with inattention in humans. A direct measure of background noise in patients with ADHD has not been described yet.MethodsThe retinal background noise was assessed based on pattern electroretinogram (PERG) data in 20 unmedicated ADHD patients and 20 healthy controls. The PERG is an electrophysiological measure for retinal ganglion cell function. ADHD severity was assessed by interview and questionnaire.ResultsNoise amplitude was significantly higher (138%) in patients with ADHD compared to the control group (p = 0.0047). Noise amplitude correlated significantly with psychometric measures for ADHD (CAARS) especially inattention (r = 0.44, p = 0.004).ConclusionsThe data provide evidence that an elevated background noise is associated with symptoms of inattention in ADHD and support the use of therapeutic interventions that reduce noise and distraction in patients with ADHD.

Intellectual functioning in relation to autism and ADHD symptomatology in children and adolescents with 22q11.2 deletion syndrome.

The 22q11.2 deletion syndrome (22q11DS; velo-cardio-facial syndrome) is associated with an increased risk of various disorders, including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). With this study, we aimed to investigate the relation between intellectual functioning and severity of ASD and ADHD symptomatology in 22q11DS. A sample of 102 individuals (62 females) with 22q11DS aged 9 to 18.5 years were assessed using age appropriate Wechsler scales of intelligence as well as psychological and psychiatric assessment to evaluate the presence of ASD and ADHD symptomatology. Intelligence profiles were characterised by lower scores on the factor perceptual organisation and higher scores on the factor processing speed, with on subtest level higher scores on digit span and lower scores on arithmetic and vocabulary as compared with the mean factor or subtest score respectively. No differences in intelligence profiles were found between subgroups with and without ASD and/or ADHD. Low scores on coding were associated with higher severity of ASD symptomatology, while lower scores on block design were associated with more severe ADHD symptomatology. On several sub-domains of intelligence, poorer performance was associated with higher severity of ASD and ADHD symptomatology. The impact of developmental disorders in 22q11DS can be traced in specific domains of intellectual functioning as well as in severity of symptomatology.

No lower cognitive functioning in older adults with attention-deficit/hyperactivity disorder.

Research illustrates cognitive deficits in children and younger adults with attention-deficit/hyperactivity disorder (ADHD). Few studies have focused on the cognitive functioning in older adults. This study investigates the association between ADHD and cognitive functioning in older adults. Data were collected in a cross-sectional side study of the Longitudinal Aging Study Amsterdam (LASA). A diagnostic interview to diagnose ADHD was administered among a subsample (N = 231, age 60-94). ADHD symptoms and diagnosis were assessed with the Diagnostic Interview for ADHD in Adults (DIVA) 2.0. Cognitive functioning was assessed with tests in the domains of executive functioning, information processing speed, memory, and attention/working memory. Regression analyses indicate that ADHD diagnosis and ADHD severity were only negatively associated with cognitive functioning in the attention/working memory domain. When adjusting for depression, these associations were no longer significant. The study shows that ADHD in older adults is associated with lower cognitive functioning in the attention/working memory domain. However, this was partly explained by depressive symptoms.

Toward personalized smoking-cessation treatment: Using a predictive modeling approach to guide decisions regarding stimulant medication treatment of attention-deficit/hyperactivity disorder (ADHD) in smokers.

Osmotic-release oral system methylphenidate (OROS-MPH) did not show overall benefit as an adjunct smoking cessation treatment for adult smokers with ADHD in a randomized, placebo-controlled, multicenter clinical trial. A secondary analysis revealed a significant interaction between ADHD symptom severity and treatment-response to OROS-MPH, but did not account for other baseline covariates or estimate the magnitude of improvement in outcome if treatment were optimized. This present study addressed the gaps in how this relationship should inform clinical practice. Using data from the Adult Smokers with ADHD Trial (N = 255, six sites in five US States), we build predictive models to calculate the probability of achieving prolonged abstinence, verified by self-report, and expired carbon monoxide measurement. We evaluate the potential improvement in achieving prolonged abstinence with and without stratification on baseline ADHD severity. Predictive modeling demonstrates that the interaction between baseline ADHD severity and treatment group is not affected by adjusting for other baseline covariates. A clinical trial simulation shows that giving OROS-MPH to patients with baseline Adult ADHD Symptom Rating Scale (ADHD-RS) >35 and placebo to those with ADHD-RS ≤35 would significantly improve the prolonged abstinence rate (52 ± 8% vs. 42 ± 5%, p < .001). In smokers with ADHD, utilization of a simple decision rule that stratifies patients based on baseline ADHD severity can enhance overall achievement of prolonged smoking abstinence. Similar analysis methods should be considered for future clinical trials for other substance use disorders.

Addition of methylphenidate to intensive dialectical behaviour therapy for patients suffering from comorbid borderline personality disorder and ADHD: a naturalistic study.

Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with borderline personality disorder (BPD). However, few studies have examined how comorbid BPD-ADHD patients, treated or not with methylphenidate (MPH), respond to psychotherapy compared to non-comorbid BPD patients. In this perspective, we used a naturalistic study to compare, during a month-long intensive dialectical behaviour therapy (DBT), the clinical course of BPD patients and comorbid BPD-ADHD patients who were treated or untreated with MPH. Out of the 158 BPD patients recruited, 59 had adult ADHD as a comorbidity; among these, 29 underwent a treatment with MPH or des-methylphenidate, while the 30 others did not. MPH treatment was given non-randomly and only when ADHD was considered to be hampering the capacity of the subjects to follow the therapy. Patients completed the following forms upon admission and after 1month of treatment: the adult ADHD Self-Report Scale (ASRS v.1.1), the Barratt Impulsiveness Scale (BIS-10), the State-Trait Anger Expression (STAXI), the Beck Depression Inventory II (BDI-II), and the Beck Hopelessness Scale. At baseline, comorbid BPD-ADHD patients showed significantly higher impulsiveness than BPD patients. In the entire sample, there was a significant decrease in all dimensions ranging from small to large effect sizes during the 4-week intensive DBT. BPD-ADHD patients who were undergoing MPH treatment showed a significantly improved response to DBT treatment for Trait-State Anger scores, motor impulsiveness, depression severity, and ADHD severity, when compared to those without stimulant medication. This study outlines the importance of systematically screening BPD patients for ADHD, since a MPH-based treatment will improve the symptoms of patients who are comorbid for BPD and ADHD. Due to the non-random allocation of subjects, more severely affected patients were more readily placed on MPH; this suggests that the more severe the ADHD symptoms, the greater the chance for the patient of being treated.

Shared Genetic Influences Between Attention-Deficit/Hyperactivity Disorder (ADHD) Traits in Children and Clinical ADHD

ObjectiveTwin studies and genome-wide complex trait analysis (GCTA) are not in agreement regarding heritability estimates for behavioral traits in children from the general population. This has sparked a debate on the possible difference in genetic architecture between behavioral traits and psychiatric disorders. In this study, we test whether polygenic risk scores associated with variation in attention-deficit/hyperactivity disorder (ADHD) trait levels in children from the general population predict ADHD diagnostic status and severity in an independent clinical sample.MethodSingle nucleotide polymorphisms (SNPs) with p < .5 from a genome-wide association study of ADHD traits in 4,546 children (mean age, 7 years 7 months) from the Avon Longitudinal Study of Parents and Children (ALSPAC; general population sample) were selected to calculate polygenic risk scores in 508 children with an ADHD diagnosis (independent clinical sample) and 5,081 control participants. Polygenic scores were tested for association with case-control status and severity of disorder in the clinical sample.ResultsIncreased polygenic score for ADHD traits predicted ADHD case-control status (odds ratio = 1.17 [95% CI = 1.08–1.28], p = .0003), higher ADHD symptom severity (β = 0.29 [95% CI = 0.04–0.54], p = 0.02), and symptom domain severity in the clinical sample.ConclusionThis study highlights the relevance of additive genetic variance in ADHD, and provides evidence that shared genetic factors contribute to both behavioral traits in the general population and psychiatric disorders at least in the case of ADHD.

Distinguishing Adolescents With ADHD From Their Unaffected Siblings and Healthy Comparison Subjects by Neural Activation Patterns During Response Inhibition.

Dysfunctional response inhibition is a key executive function impairment in attention deficit hyperactivity disorder (ADHD). Still, behavioral response inhibition measures do not consistently differentiate affected from unaffected individuals. The authors therefore investigated neural correlates of response inhibition and the familial nature of these neural correlates. Functional MRI measurements of neural activation during the stop-signal task and behavioral measures of response inhibition were obtained in adolescents and young adults with ADHD (N=185), their unaffected siblings (N=111), and healthy comparison subjects (N=124). Stop-signal task reaction times were longer and error rates were higher in participants with ADHD, but not in their unaffected siblings, while reaction time variability was higher in both groups than in comparison subjects. Relative to comparison subjects, participants with ADHD and unaffected siblings had neural hypoactivation in frontal-striatal and frontal-parietal networks, whereby activation in inferior frontal and temporal/parietal nodes in unaffected siblings was intermediate between levels of participants with ADHD and comparison subjects. Furthermore, neural activation in inferior frontal nodes correlated with stop-signal reaction times, and activation in both inferior frontal and temporal/parietal nodes correlated with ADHD severity. Neural activation alterations in ADHD are more robust than behavioral response inhibition deficits and explain variance in response inhibition and ADHD severity. Although only affected participants with ADHD have deficient response inhibition, hypoactivation in inferior frontal and temporal-parietal nodes in unaffected siblings supports the familial nature of the underlying neural process. Activation deficits in these nodes may be useful as endophenotypes that extend beyond the affected individuals in the family.

Attention Deficit Hyperactivity Disorder symptoms and smoking trajectories: Race and gender differences

PurposeThis study examined the influence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms severity and directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) on trajectories of the probability of current (past month) smoking and the number of cigarettes smoked from age 13 to 32. Racial and gender differences in the relationship of ADHD symptoms and smoking trajectories were also assessed. MethodsA subsample of 9719 youth (54.5% female) was drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Cohort sequential design and zero-inflated Poisson (ZIP) latent growth modeling were used to estimate the relationship between ADHD directionality and severity on smoking development. ResultsADHD severity's effect on the likelihood of ever smoking cigarettes at the intercept (age 13) had a greater impact on White males than other groups. ADHD severity also had a stronger influence on the initial number of cigarettes smoked at age 13 among Hispanic participants. The relationships between ADHD directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) and a higher number of cigarettes smoked at the intercept were stronger among Hispanic males than others. Gender differences manifested only among Whites. ConclusionADHD severity and directionality had unique effects on smoking trajectories. Our results also highlight that the risk of ADHD symptoms may differ by race and gender.

ADHD severity is associated with white matter microstructure in the subgenual cingulum.

AimsThis analysis examined hypothesised associations between microstructural attributes in specific white matter (WM) tracts selected a priori and measures of clinical variability in adolescents with a diagnosis of attention deficit hyperactivity disorder (ADHD). Firstly, associations were explored between WM microstructure and ADHD severity in the subgenual cingulum. Secondly, to ensure that tract-specific approaches afforded enhanced rather than differential sensitivity, associations were measured between WM microstructure and autistic traits in the right corticospinal tract based on results of a previously-published voxelwise analysis.Methods40 right-handed males aged 14–18 years (19 with DSM-IV combined type ADHD and 21 healthy controls) underwent a 60 direction diffusion MRI scan. Clinical ADHD and autism variation were assessed by validated questionnaires. Deterministic tractography based on spherical deconvolution methods was used to map the subgenual cingulum and corticospinal tract.ResultsFractional anisotropy was positively correlated and radial diffusivity was negatively correlated with a) ADHD severity in the left subgenual cingulum and b) autistic traits in the inferior segment of the right corticospinal tract. No case–control differences were found.ConclusionsResults shed light on possible anatomical correlates of ADHD severity and autistic symptoms in pathways which may be involved in the ADHD phenotype. They provide further evidence that tract-specific approaches may a) reveal associations between microstructural metrics and indices of phenotypic variability which would not be detected using voxelwise approaches, and b) provide improved rather than differential sensitivity compared to voxelwise approaches.

Altered neural connectivity during response inhibition in adolescents with attention-deficit/hyperactivity disorder and their unaffected siblings.

IntroductionResponse inhibition is one of the executive functions impaired in attention-deficit/hyperactivity disorder (ADHD). Increasing evidence indicates that altered functional and structural neural connectivity are part of the neurobiological basis of ADHD. Here, we investigated if adolescents with ADHD show altered functional connectivity during response inhibition compared to their unaffected siblings and healthy controls.MethodsResponse inhibition was assessed using the stop signal paradigm. Functional connectivity was assessed using psycho-physiological interaction analyses applied to BOLD time courses from seed regions within inferior- and superior frontal nodes of the response inhibition network. Resulting networks were compared between adolescents with ADHD (N = 185), their unaffected siblings (N = 111), and controls (N = 125).ResultsControl subjects showed stronger functional connectivity than the other two groups within the response inhibition network, while subjects with ADHD showed relatively stronger connectivity between default mode network (DMN) nodes. Stronger connectivity within the response inhibition network was correlated with lower ADHD severity, while stronger connectivity with the DMN was correlated with increased ADHD severity. Siblings showed connectivity patterns similar to controls during successful inhibition and to ADHD subjects during failed inhibition. Additionally, siblings showed decreased connectivity with the primary motor areas as compared to both participants with ADHD and controls.DiscussionSubjects with ADHD fail to integrate activation within the response inhibition network and to inhibit connectivity with task-irrelevant regions. Unaffected siblings show similar alterations only during failed stop trials, as well as unique suppression of motor areas, suggesting compensatory strategies. These findings support the role of altered functional connectivity in understanding the neurobiology and familial transmission of ADHD.

Association of hair manganese level with symptoms in attention-deficit/hyperactivity disorder.

ObjectiveThe study examined the association between hair manganese level and symptoms of attention-deficit/hyperactivity disorder (ADHD) in Korean children.MethodsForty clinic-referred children with ADHD and 43 normal control children participated in this study. The participants were 6-15 years old and were mainly from the urban area of Seoul, Korea. ADHD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. The severity and symptoms of ADHD was evaluated according to the ADHD Diagnostic System, and parent's Korean ADHD Rating Scale (K-ARS). All participants completed intelligence test and hair mineral analysis. We divided the data of hair Mn into two groups to determine whether a deficit or excess of Mn are associated with ADHD. Multiple logistic regression analyses were performed to identify hair manganese levels associated with ADHD, controlling for age, sex, and full scale intelligence quotient (IQ).ResultsThe proportion of abnormal range Mn group was significantly high in ADHD compared to controls. However, after statistical control for covariates including age and sex, abnormal range Mn group was significantly associated with ADHD (OR=6.40, 95% CI=1.39-29.41, p=0.017).ConclusionThe result of this study suggests that excess exposure or deficiency of Mn were associated with ADHD among children in Korea. Further investigation is needed to evaluate the effects of hair manganese levels on symptoms in ADHD.

The role of adverse life events on depression in older adults with ADHD

BackgroundComorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression is high, also in older adults. Thus far it is not well understood why ADHD and depression are so strongly interrelated. One factor that may play a role in older adults with ADHD is an increased risk of experiencing adverse life events. MethodsSix year follow-up data were used from the Longitudinal Aging Study Amsterdam (LASA). To diagnose ADHD, the DIVA 2.0, a diagnostic interview was administered among a subsample (N=230, age 60–94). In addition to the ADHD diagnosis, the associations between the number of ADHD symptoms, depressive symptoms and adverse life events were examined. Data were analyzed by means of logistic and linear regression analyses. ResultsCompared to older adults without ADHD, those with ADHD reported more serious conflicts. The risk of depression in older adults with ADHD was partly explained by serious conflicts. Furthermore, the association between ADHD severity and depression was stronger in those who experienced serious conflicts and those who experienced more adverse life events. LimitationsThe ADHD diagnosis was based on the DSM-IV criteria, which were developed for children, and have not yet been validated in (older) adults. ConclusionsHaving conflicts with others and accumulation of adverse life events over time partly explained the association between ADHD and depression. Better and earlier treatment of ADHD may prevent the development of depression in the presence of life events associated with ADHD.