Attention-deficit/hyperactivity Disorder Symptom Severity Research Articles

Stimulant medication use and apparent cortical thickness development in attention-deficit/hyperactivity disorder: a prospective longitudinal study

BackgroundStimulant medication is commonly prescribed as treatment for attention-deficit/hyperactivity disorder (ADHD). While we previously found that short-term stimulant-treatment influences apparent cortical thickness development in an age-dependent manner, it remains unknown whether these effects persist throughout development into adulthood.PurposeInvestigate the long-term age-dependent effects of stimulant medication use on apparent cortical thickness development in adolescents and adults previously diagnosed with ADHD.MethodsThis prospective study included the baseline and 4-year follow-up assessment of the “effects of Psychotropic drugs On the Developing brain-MPH” (“ePOD-MPH”) project, conducted between June-1-2011 and December-28-2019. The analyses were pre-registered (https://doi.org/10.17605/OSF.IO/32BHF). T1-weighted MR scans were obtained from male adolescents and adults, and cortical thickness was estimated for predefined regions of interest (ROIs) using Freesurfer. We determined medication use and assessed symptoms of ADHD, anxiety, and depression at both time points. Linear mixed models were constructed to assess main effects and interactions of stimulant medication use, time, and age group on regional apparent cortical thickness.ResultsA total of 32 male adolescents (aged mean ± SD, 11.2 ± 0.9 years at baseline) and 24 men (aged mean ± SD, 29.9 ± 5.0 years at baseline) were included that previously participated in the ePOD-MPH project. We found no evidence for long-term effects of stimulant medication use on ROI apparent cortical thickness. As expected, we did find age-by-time interaction effects in all ROIs (left prefrontal ROI: P=.002, right medial and posterior ROIs: P<.001), reflecting reductions in apparent cortical thickness in adolescents. Additionally, ADHD symptom severity (adolescents: P<.001, adults: P=.001) and anxiety symptoms (adolescents: P=0.03) were reduced, and more improvement of ADHD symptoms was associated with higher medication use in adults (P=0.001).ConclusionWe found no evidence for long-term effects of stimulant-treatment for ADHD on apparent cortical thickness development in adolescents and adults. The identified age-dependent differences in apparent cortical thickness development are consistent with existing literature on typical cortical development.

Birth Order and Number of Siblings in Attention Deficit Hyperactivity Disorder: A Case Control Study

Aim: Studies addressing the etiology of Attention Deficit Hyperactivity Disorder (ADHD) in recent years have focused on family and birth-related factors.This study aimed to examine the relationship between Attention Deficit Hyperactivity Disorder (ADHD) and birth order and number of siblings. Method: A total of 239 participants, 135 children diagnosed with ADHD and 104 healthy children, were included in the study. All participants were evaluated through DSM-5-based psychiatric examinations, and their sociodemographic data forms were obtained. Conners’ Parent Rating Scale-Revised Short form (CPRS-RS) was also applied to the case group in order to determine the severity of ADHD symptoms. The findings were then compared using statistical methods. Results: No significant difference was observed between the individuals with ADHD and the healthy controls in terms of birth order or number of siblings (p= 0.252 and p= 0.222, respectively). A significant positive correlation was determined in the ADHD group between birth order and hyperactivity and oppositional subscales (r= 0.212, p= 0.022 and r= 0.231, p= 0.012, respectively). A significant positive correlation was also determined in the ADHD group between number of siblings and the oppositional subscale (r= 0.237, p= 0.009). Conclusions:In our study, no significant difference was observed between the ADHD and control groups in terms of birth order or number of siblings.It was observed that hyperactivity and defiance symptoms increased as birth order increased in children diagnosed with ADHD. Oppositional findings also increased in line with the number of siblings.We think that these findings should be taken into consideration in future research on ADHD.

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.

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.

Children's emotional reactivity and negative affect predict future ADHD symptom severity beyond initial ADHD symptom severity.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant emotion dysregulation. However, there is limited longitudinal data on associations between multiple aspects of emotion dysregulation and ADHD symptoms. Additionally, given substantial evidence that increased levels and variability of negative affect (NA) are identified in children with ADHD, it is important to examine the role of NA in this relationship. The present study used momentary and longitudinal data to examine the relation between two aspects of emotion dysregulation (emotional lability and emotional reactivity), the two ADHD symptom clusters separately (inattentive and hyperactive/impulsive), total ADHD symptom severity, and NA variability over a period of six months. Participants (N = 68) were parents of children aged 7-12years old (M = 9.80, SD = 1.34) who completed baseline and 6-month follow-up reports of children's ADHD symptoms and emotion dysregulation as well as ecological momentary assessments (EMA) of their children's NA for one week. Results were threefold: (1) children's emotional reactivity predicted inattentive, hyperactive/impulsive, and total ADHD symptom severity above and beyond initial ADHD symptom severity, but emotional lability did not significantly predict severity of any ADHD symptom cluster; (2) NA variability predicted hyperactive/impulsive and total ADHD symptom severity, but not inattentive severity; and (3) initial ADHD symptom severity did not predict emotion dysregulation at follow-up. The current study provides novel insight regarding the longitudinal influence of specific aspects of emotion dysregulation and NA on ADHD symptom severity in children and suggests that targeting emotional reactivity could minimize ADHD symptom severity.

Guanfacine for the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents with Down Syndrome: A Retrospective Chart Review.

Study Design: Retrospective case series. Objectives: The objective of this study was to provide naturalistic data on the use of guanfacine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in a clinically referred sample of youth with Down syndrome (DS). Methods: The medical records of children and adolescents with DS who received guanfacine for the treatment of ADHD from a multidisciplinary neurodevelopmental disorder clinic between September 1, 2011, and September 10, 2021, were reviewed. Demographic and clinical characteristics, guanfacine dose and treatment duration, and adverse effects were recorded. Clinical Global Impression Scale (CGI) scores for ADHD symptom severity (S) and improvement (I) were retrospectively assigned by a child and adolescent psychiatrist based on review of the clinic notes. Response to guanfacine was defined as completion of at least 12 weeks of treatment and a Clinical Global Impression Improvement subscale rating ≤2 (1 = "very much improved" or 2 = "much improved"). Results: Twenty-one patients were eligible for inclusion, of whom 17 (81%) completed at least 12 weeks of guanfacine. Ten of the 21 patients (48%; 95% confidence interval [CI]: 28%-68%) responded to treatment. The median time on guanfacine treatment covered by the clinic notes was 50.4 weeks, with a range of 0.3 weeks to 7.5 years. Thirteen patients (62%) remained on guanfacine at the time of their most recent clinic note. Nine patients had adverse events documented in their clinic notes (43%; 95% CI: 24%-63%), most commonly sleepiness (n = 7) and constipation (n = 2). Conclusion: About half of patients with DS responded to guanfacine for the treatment of ADHD and many tolerated long-term use. Study limitations primarily relate to the retrospective nature of the study and small sample size.

Relationship between Traumatic Experiences, Circadian Preference and ADHD Symptoms in Adolescents with ADHD Residing in Institutional Care: A Controlled Study

ABSTRACT Circadian preference, describes biological and behavioural characteristics that influence the ability to plan daily activities according to optimal waking times. It is divided into three main categories: morning, evening and intermediate. In particular, the evening chronotype is associated with conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Post Traumatic Stress Disorder (PTSD). This study was conducted in three groups aged 14–18 years: The first group consisted of 34 adolescents diagnosed with ADHD who had been in institutional care for at least two years and had not used medication in the last six months. The second group included 29 adolescents with ADHD living with their families who had not used medication in the last six months. The third control group consisted of 32 healthy adolescents. The study utilized sociodemographic data forms, the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) to measure ADHD symptoms, the Childhood Chronotype Questionnaire (CCQ), and the Childhood Trauma Questionnaire (CTQ). In institutionalized adolescents with diagnosed ADHD, ADHD and disruptive behavior symptoms were more severe. Increased trauma scores were associated with higher ADHD and disruptive behaviour symptom severity and evening chronotype. In the conducted mediation analysis, evening chronotype was identified as a full mediator in the relationship between trauma symptoms and ADHD symptoms, while it was determined as a partial mediator in the relationship between trauma symptoms and PTSD symptoms. In conclusion, traumatic experiences in institutionalized adolescents with diagnosed ADHD may exacerbate ADHD and disruptive behavior symptoms. Evening chronotype is associated with ADHD and disruptive behavior symptoms, and therefore, the chronotypes of these adolescents should be assessed. Chronotherapeutic interventions may assist in reducing inattention, hyperactivity, and behavioral problems.

Iranian Traditional Medicine for Treatment of Attention Deficit Disorder with Hyperactivity in Children: A Systematic Review of Randomized Controlled Trials

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a complex etiology. Stimulants as a first-line treatment are not effective in some cases. In this study, we conducted a systematic review to evaluate the efficacy of traditional Persian Iranian medicine (TIM) for children and adolescents with ADHD.
 Methods: Data were collected mainly from PubMed, Google Scholar, Web of Science, ProQuest, and Scopus databases until Dec 2022. The keywords related to ADHD, traditional Persian medicine (TPM), and (TIM) were searched. Two reviewers independently screened 714 abstracts and eventually, eight trials were included in the systematic reviews. Changes in the severity of ADHD symptoms were considered based on the validated cutoff on recognized rating scales as the result of the effect of TIM on ADHD.
 Results: Interventions included herbal extracts of Passiflora incarnate, whey protein, Ginkgo biloba, Crocus sativus L, sweet almond syrup, and horse milk. In all studies, except G. biloba, there was evidence of a reduction in the severity of ADHD. Low evidence could be found for G. biloba.
 Conclusion: Herbal and traditional remedies are an efficient and safe solution to alleviate the symptoms of ADHD. In future studies, TIM as a complementary therapy may be useful to alleviate ADHD symptoms, especially in children who are resistant to stimulant medications.

Iron Supplementation in Management of Neurodevelopmental Disorders: Systematic Review, Meta-Analysis, and Qualitative Synthesis.

The authors sought to explore the role of iron supplementation in the management of neurodevelopmental disorders among children and youths. A systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. A subset of results was suitable for meta-analysis. The quality of the evidence and strength of the clinical recommendations were assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation method, and critical appraisal was conducted with the Joanna Briggs Institute critical appraisal tools. Nine articles met inclusion criteria. These articles included studies of attention-deficit hyperactivity disorder (ADHD) (N=7), autism spectrum disorder (N=1), and Tourette's syndrome (N=1). Three randomized controlled trials evaluating iron supplementation for ADHD hyperactivity symptom severity (124 participants: placebo, N=56; supplement, N=68) met inclusion criteria for a meta-analysis. Effect sizes for the placebo and supplement groups were moderate (Cohen's d=0.76) and large (Cohen's d=1.70), respectively, although these differences were not significant. The impact of iron supplementation on inattentive ADHD symptom severity was examined in two trials (75 participants: placebo, N=31; supplement, N=44). Large, nonsignificant effect sizes were demonstrated for the placebo (Cohen's d=1.66) and supplementation (Cohen's d=3.19) groups. The quality of the evidence and strength of the clinical recommendations were considered very low. Further research is needed to examine the role of iron supplementation in the management of ADHD and neurodevelopmental disorders more generally. Additionally, iron supplementation comes with risks, including death in the case of overdose.

The impact of emotional dysregulation and comorbid depressive symptoms on clinical features, brain arousal, and treatment response in adults with ADHD.

The role of emotional dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) has become an important issue. This study, in which we analyzed data from a predictive pharmaco-EEG-trial, aimed to examine whether symptoms of ED in adult ADHD affect ADHD symptom severity, brain arousal regulation as measured by resting EEG, and the response to stimulant medication. ED is defined as having a sex- and age-corrected T-score of >70 on the emotional lability subscale of the German version of Conners' Adult ADHD Rating Scale. A total of 115 participants were included in the study, 56 of whom had ED. Participants with ED were more impaired in terms of the severity of core ADHD symptoms, especially inattentive symptoms, comorbid depressive symptoms, interpersonal relationships, and quality of life. In addition, participants with ED were more likely to report a total score above 13 on the Beck Depression Inventory-II, which was considered to be the cutoff for mild depression. No differences were found between the ED and non-ED groups in response to stimulant medication or in brain arousal regulation. In addition, there was no significant effect of ED with comorbid depressive symptoms on treatment response. There was a trend for subgroups that showed a change in brain arousal regulation associated with symptom improvement. Our findings may support the assumption that ED may be an important feature of ADHD. The use of EEG-based brain arousal regulation as a diagnostic and predictive tool in ADHD in the presence of ED and comorbid depressive symptoms should be further investigated.

Effects of psychedelic microdosing versus conventional ADHD medication use on emotion regulation, empathy, and ADHD symptoms in adults with severe ADHD symptoms: A naturalistic prospective comparison study.

Adults with attention-deficit hyperactivity disorder (ADHD) often struggle with emotion regulation (ER), impacting their empathic skills and relationships. ADHD medication might not be as effective for ER issues as for ADHD symptoms. Microdosing (MD) psychedelics has shown promise for ADHD treatment and previous studies reported social-emotional benefits. Two online prospective studies investigated MD effects on ER and empathy in adults with severe ADHD symptoms across three assessments: baseline, two-, and four-week post-initiation. Study 1 examined adults initiating MD on their own (n = 233, n = 64, and n = 44) and found positive effects on ER (cognitive reappraisal and expressive suppression) and aspects of empathy (perspective-taking and personal distress). Study 2, including a control group and an ADHD symptom scale, compared individuals only MD (n = 180, n = 50, and n = 38) to individuals using conventional ADHD medication (n = 37, n = 27, and n = 28). After 4 weeks, ADHD symptoms were lower in the MD group. Only improvements in expressive suppression persisted after adding the control group. This study indicates the positive effects of MD psychedelics on ADHD symptoms and ER in adults with severe ADHD symptoms while lacking evidence for effects on empathy.

Psychometric Properties of the Parental Stress Scale in Swedish Parents of Children with and without Neurodevelopmental Conditions.

Parents of children with neurodevelopmental conditions (NDC) are at risk of experiencing elevated levels of parental stress. Access to robust instruments to assess parental stress is important in both clinical and research contexts. Objective: We aimed to evaluate the psychometric properties of a Swedish version of the Parental Stress Scale (PSS), completed by parents of 3- to 17-year-old children, with and without NDCs. Main analyses were conducted on data from three independent samples: a community sample (n=1018), a treatment-seeking sample of parents of children with various disabilities (n=653), and a sample of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) who themselves reported varying ADHD symptom severities (n=562). Additional analyses were enabled by the use of data from a complementary test-retest sample (n=337). The internal consistency of the PSS was good (Cronbach's alpha, α=.87) and its test-retest reliability moderate (ICC=.66). The scale correlated in the expected direction with related constructs (r=.50-.56 in the community sample). An exploratory factor analysis found its internal structure to reflect two aspects of parental stress: Lack of Parental Rewards and Role Satisfaction (factor 1, α=.90) and Parental Stressors and Distress (factor 2, α=.85). The treatment-seeking parents of children with disabilities reported higher parental stress than community reference parents (p<.001; Cohen's d=1.17). Moreover, we found that parents with high ADHD symptom severity reported higher parental stress than parents with low ADHD symptom severity (p<.001; d=0.39). In summary, we found evidence in support of the reliability and validity of the PSS, which overall was judged to be useful as a measure of parental stress in a Swedish context. In addition, our results underline the importance of considering parental stress and related needs in assessments and intervention planning involving families of children with NDCs.

The role of executive functions in mediating the relationship between adult ADHD symptoms and hyperfocus in university students

BackgroundHyperfocus, a state of intense, narrow and prolonged attentional focus, has been associated with symptoms of attention-deficit/hyperactivity disorder (ADHD) in both clinical and non-clinical populations. Hyperfocus may be explained by difficulties in executive control, typically observed in ADHD. AimsTo investigate (1) whether ADHD and executive functions (EF) are associated with hyperfocus and (2) whether EF mediate the relationship between ADHD symptoms and hyperfocus. Methods and proceduresA non-clinical sample of 380 university students (264 females) completed self-reports of ADHD, EF, hyperfocus and hyperfocus during rewarding activities. Outcomes and resultsIncreased difficulties in EF and severity of ADHD symptoms were significantly and positively correlated with a higher frequency of hyperfocus. Moreover, EF difficulties partially mediated the relationship between ADHD and hyperfocus (after controlling for sex and substance use), but not the relationship between ADHD and hyperfocus during rewarding activities. Conclusions and implicationsDifficulties in EF partially explained the higher frequency of hyperfocus, but not of hyperfocus during rewarding activities, among university students reporting more severe ADHD symptoms. Future research should investigate whether and how specific EF and other ADHD-related neurocognitive difficulties (e.g., reward sensitivity) contribute to various types of hyperfocus experiences in ADHD. What this paper adds?This paper is a first attempt to explain the relationship between adult ADHD symptoms and hyperfocus experiences. Our findings suggest that, although highly correlated, existing self-reports of hyperfocus measure different aspects of this experience: hyperfocus and reward-related hyperfocus. We replicate previous findings that indicated a greater frequency of both types of hyperfocus in ADHD. Additionally, we demonstrate a connection between EF difficulties and different aspects of hyperfocus. Finally, we extend previous findings by proposing that EF difficulties partially explain the relationship between ADHD and hyperfocus, but not the relationship between ADHD and reward-related hyperfocus. We hypothesize that other neurocognitive difficulties (e.g., reward sensitivity) may contribute to explain the relationship between ADHD and different aspects of hyperfocus.

The Effect of Methylphenidate on Cognition in Patients with Comorbid Attention Deficit/Hyperactivity Disorder and Amphetamine Use Disorder: An Exploratory Single-Blinded within-Subject Study

Introduction: Attention deficit/hyperactivity disorder (ADHD) with co-occurring substance use disorder (SUD) is associated with poor treatment outcomes. Two randomized controlled trials, utilizing robust doses of stimulants, demonstrated a significant effect on treatment outcomes in patients with ADHD/SUD. This study aimed to investigate differences in executive functioning and explore the dose-dependent effect of OROS-methylphenidate (MPH) in patients with comorbid ADHD and amphetamine use disorder (ADHD+AMPH) and patients with ADHD only. Methods: Three groups (ADHD+AMPH, ADHD only, and healthy controls) were assessed repeatedly with a neuropsychological test battery. An exploratory within-subject single-blinded design was employed where the ADHD only group received a maximum dose of 72 mg OROS-MPH, the ADHD+AMPH group a maximum dose of 180 mg, whereas the healthy subjects did not receive any study medication. Both ADHD groups received the same dose titration up to 72 mg OROS-MPH. Results: The ADHD+AMPH group demonstrated a significantly poorer motor inhibition and spatial working memory and reported more severe ADHD symptoms compared to the ADHD only group. 180 mg OROS-MPH was associated with a significant improvement in executive functioning in the dual diagnosis group. However, the exploratory study design and recruitment issues do not allow for any conclusion to be drawn regarding the effect of 180 mg OROS-MPH. Conclusion: Patients with ADHD+AMPH present with more severe neurocognitive deficits compared to ADHD only. The effect of 180 mg OROS-MPH on cognition in patients with ADHD+AMPH was inconclusive. Future studies should consider recruitment issues and high drop-out rates in this study population.

Are congenital heart defects connected to more severe attention-deficit/hyperactivity disorder?: A systematic review and meta-analysis.

Congenital heart defects (CHDs) are the most common cause of birth defect-related infant morbidity and mortality, affecting 1% of 40,000 births per year in the United States. On the other side, the etiology of attention-deficit/hyperactivity disorder (ADHD) is multifactorial. Multiple studies have found that cardiac surgery patients have higher morbidity of having this disorder. Many studies have investigated the prevalence of ADHD in different subtypes of CHD, but few have focused on the severity of ADHD symptoms. Thus, we conducted this systematic review and meta-analysis to investigate the severity of ADHD symptoms in CHD patients. We searched PubMed, Embase, Scopus, and Web of Science were searched from inception to March 6, 2023 without any restrictions. We included observational studies published in English language that evaluated burden of symptom of ADHD in CHD patients. Moreover, the standardized mean difference (SMD) for continuous outcomes with 95% confidence interval (CI) was pooled. P-values <.05 are considered as significant, and we performed all statistical analyses using RevMan software Version 5.4.1. Eight studies were included in our review with a total number of 120,158 patients. CHD was associated with a statistically significant increase in both ADHD index T score and ADHD Hyperactivity-Impulsivity Subscale (informant) with (SMD = 0.65, 95% CI [0.40, 0.90], P < .00001, I2 = 81%) and (SMD = 0.16, 95% CI [0.04, 0.28], P = .008, I2 = 0%). Regarding ADHD Inattention Subscale (informant), the pooled data showed that a significant increase of this score in the CHD group (SMD = 0.25, 95% CI [0.13, 0.37], P < .001, I2 = 0%), and ADHD Combined Score (informant) showed a significant increase of this score in the CHD group (SMD = 0.23, 95% CI [0.11, 0.35], P = .0002, I2 = 0%). Our study revealed a strong association between CHD and not only ADHD, but also the severity of ADHD, making early diagnosis of ADHD in children with CHD a mandatory step in the clinical evaluation practice to improve these children on both clinical and psychological aspects.

The Limbic System in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: A Longitudinal Structural Magnetic Resonance Imaging Analysis

BackgroundDuring childhood and adolescence, attention-deficit/hyperactivity disorder (ADHD) is associated with changes in symptoms and brain structures, but the link between brain structure and function remains unclear. The limbic system, often termed the “emotional network,” plays an important role in a number of neurodevelopmental disorders, yet this brain network remains largely unexplored in ADHD. Investigating the developmental trajectories of key limbic system structures during childhood and adolescence will provide novel insights into the neurobiological underpinnings of ADHD. MethodsStructural magnetic resonance imaging data (380 scans), emotional regulation (Affective Reactivity Index), and ADHD symptom severity (Conners 3 ADHD Index) were measured at up to 3 time points between 9 and 14 years of age in a sample of children and adolescents with ADHD (n = 57) and control children (n = 109). ResultsCompared with the control group, the ADHD group had lower volume of the amygdala (left: β standardized [β_std] = −0.38; right: β_std = −0.34), hippocampus (left: β_std = −0.44; right: β_std = −0.34), cingulate gyrus (left: β_std = −0.42; right: β_std = −0.32), and orbitofrontal cortex (right: β_std = −0.33) across development (9–14 years). There were no significant group-by-age interactions in any of the limbic system structures. Exploratory analysis found a significant Conners 3 ADHD Index-by-age interaction effect on the volume of the left mammillary body (β_std = 0.17) in the ADHD group across the 3 study time points. ConclusionsChildren and adolescents with ADHD displayed lower volume and atypical development in limbic system structures. Furthermore, atypical limbic system development was associated with increased symptom severity, highlighting a potential neurobiological correlate of ADHD severity.

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.

Trait mindfulness and personality characteristics in a microdosing ADHD sample: a naturalistic prospective survey study.

Microdosing (MD), repeatedly taking psychedelics in small, non-hallucinogenic amounts, has been practiced by individuals to relieve attention deficit hyperactivity disorder (ADHD) symptoms. Generally, adults diagnosed with ADHD have lower levels of mindfulness and differ in personality structure from non-ADHD adults. How MD affects mindfulness and personality in adults with ADHD remains unexplored. This study aimed to investigate the effects of 4 weeks of MD on mindfulness and personality traits in adults diagnosed with ADHD and those experiencing severe ADHD symptoms. It was expected that mindfulness and the personality traits conscientiousness, extraversion, agreeableness, and openness would increase and neuroticism would decrease after 4 weeks of MD compared to baseline. It was explored if using conventional ADHD medication alongside MD and/or having comorbidities influenced MD-induced effects. An online prospective naturalistic design was used to measure participants before MD initiation and 2 and 4 weeks later. Validated self-report measures were used assessing mindfulness (15-item Five Facet Mindfulness Questionnaire) and personality traits (10-item version of the Big Five Inventory) at three time points. The sample included n = 233, n = 66, and n = 44 participants at the three time points, respectively. Trait mindfulness, specifically description and non-judging of inner experience, was increased, and neuroticism was decreased after 4 weeks of MD compared to baseline. The remaining personality traits remained unchanged. Using conventional medication and/or having comorbid diagnoses did not change the MD-induced effects on mindfulness and personality traits after 4 weeks. MD induced changes in otherwise stable traits. Future placebo-controlled studies are warranted to confirm whether these changes occur in a controlled setting.

Claudin-5, occludin, zonulin and tricellulin levels of children with attention-deficit/hyperactivity disorder

Background and objectivesAccumulating studies have pointed out that gut-blood and blood-brain barrier dysfunctions due to the alterations in permeability may play a role in the pathophysiology of neurodevelopmental disorders. Tight junctions are crucial components of these barriers and some peptides including claudin-5, occludin, zonulin and tricellulin are important components of these structures. This study aimed to investigate the relationship between these molecules and attention deficit hyperactivity disorder (ADHD) in children and adolescents. MethodsA total of 57 children with ADHD and 60 controls aged between 6 and 12 years were included in the study. The severity of ADHD symptoms was assessed through a parent-rated questionnaire, and Conner's Continuous Performance Test was administered to the study group. Serum levels of biochemical variables were measured using enzyme-linked immunosorbent assay kits. Biochemical parameter levels and scale scores were compared using Mann-Whitney U or Student's t tests. In addition, a multivariate analysis of covariance (MANCOVA) and a one-way analysis of covariance (ANCOVA) was performed on the outcome variables. Finally, a hierarchical regression model was conducted on the study group. ResultsSerum claudin-5 and tricellulin levels were significantly lower in the ADHD group compared to the control group. The difference between the groups in terms of serum claudin-5 and tricellulin levels remained significant after controlling for confounding factors such as age, gender and autistic characteristics. There was no significant difference between the groups in terms of serum zonulin and occludin levels. ConclusionThese results reveal that claudin-5 and tricellulin levels vary in patients with ADHD. Alterations in these peptides may affect the brain by leading to a dysregulation in intestinal or blood-brain barrier permeability. The causal relationship between these peptides and ADHD requires further investigation.

Risk factors of suicidal spectrum behaviors in adults and adolescents with attention-deficit / hyperactivity disorder – a systematic review

IntroductionAdolescents and adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of suicidal spectrum behaviors (SSBs). However, there is limited knowledge about risk factors triggering SSBs in this group of people.ObjectiveTo explore published literature concerning factors that may increase the risk of SSBs in adults and adolescents with ADHD.MethodsA systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on 22nd of February 2022 using the Ovid MEDLINE and Web of Science databases. Three categories of search terms were used: (1) self-harm, self-injury, self-mutilation, suicide, self-poisoning; (2) adults, adolescents; and (3) attention-deficit hyperactivity disorder/ADHD. Studies with data concerning mediating factors of SSBs in relation to a clinical diagnosis of ADHD in participants above 16 years of age were included.ResultsThe literature search identified 604 articles, of which 40 were included in the final study selection. Factors found to increase the likelihood of SSBs included ADHD symptom severity and persistence, female gender, family history of ADHD, childhood and parental influences, and social functioning. Even when adjusting for psychiatric comorbidities, most studies showed that adults and adolescents with ADHD have an elevated risk of SSBs.ConclusionThis systematic review has documented that several demographic and clinical features are associated with an increased risk of SSBs in adolescents and adults with ADHD. Notably, ADHD emerges as an independent risk factor for SSBs. This information ought to have clinical implications in terms of screening and suicide prevention strategies. Further longitudinal studies are needed to investigate the outcome of preventive strategies in individuals along the full spectrum of ADHD symptom severity.