Attention-deficit/hyperactivity Disorder Symptom Severity Research Articles

The Relationship Between Alexithymia and Impulsiveness in Adult Attention Deficit and Hyperactivity Disorder.

It has been emphasised recently that emotion regulation problems may be the core symptoms of attention deficit hyperactivity disorder (ADHD). In this study, we aimed to determine the incidence of alexithymia, the relationship between alexithymia and impulsiveness, the severity of ADHD, depression and anxiety semptoms in adult ADHD. All participants were assessed with the Structured Clinical Interview For DSM IV Axis I Disorders (SCID-I); and completed the Toronto Alexithymia Scale (TAS), the Impulsive Behavior Scale (UPPS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), Adult Attention Deficit and Hyperactivity Disorder Self Reporting Scale (ASRS) and the Wender Utah Rating Scale (WURS). The ADHD patients were also assessed with the Diagnostic Interview for ADHD (DIVA) for DSM-5 criteria. The study included 101 ADHD patients with a mean age of 23.06 ± 4.24 years with 47.5% females, and 100 healthy control individuals with a mean age of 22.76 ± 5.68 years with 50% female participants. Alexithymia incidence was 41.5% in the ADHD group. The increase in the levels of impulsiveness, depression and anxiety correlated with the severity of ADHD symptoms; and impulsiveness predicted alexithymia in the ADHD group. Alexithymia incidence was higher in the ADHD group. When ADHD and control participants were combined, alexithymic individuals was more associated with impulsivity with frequent display of anxiety symptoms.

Serum Levels of Interleukin-6 and Tumor Necrosis Factor Alpha in Children With Attention-Deficit Hyperactivity Disorder.

ABSTRACTBackground:Attention-deficit hyperactivity disorder (ADHD) is a common disorder in children, but its etiology and pathogenesis are still unclear.Aims:The aims of this study were to measure the level of serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) as markers of immune system involvement in children with ADHD, and to study their correlation with symptoms severity of ADHD.Materials and Methods:The study was conducted on 80 children diagnosed as ADHD based on the criteria adapted from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Eighty healthy children of matched age and sex served as a control group. All children enrolled in the study were subjected to history taking, clinical examination, and psychometric tests. Assay for serum IL-6 and TNF-α for all patients and controls was performed using enzyme-linked immunosorbent assay.Results:The mean serum level of IL-6 was 26.11 ± 11.14 and 6.23 ± 2.52 in children with ADHD and controls, respectively. Children with ADHD showed significantly higher serum IL-6 levels than the control group (P = 0.001). Serum IL-6 showed no significant correlation with the intelligence quotient (IQ) or the Abbreviated Conners’ Rating Scale scores for parents. However, TNF-α showed no significant differences between the two groups and no significant correlation with the IQ or the Abbreviated Conners’ Rating Scale scores for parents.Conclusion:Serum IL-6 levels were significantly higher in children with ADHD compared to controls; however, the IL-6 levels did not correlate with ADHD symptoms severity. Increased IL-6 levels may contribute to the etiology of ADHD.

The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder

Adults with attention deficit hyperactivity disorder (ADHD) frequently suffer from sleep problems and report high levels of daytime sleepiness compared to neurotypical controls, which has detrimental effect on quality of life. We evaluated daytime sleepiness in adults with ADHD compared to neurotypical controls using an observer-rated sleepiness protocol during the Sustained Attention Response Task as well as electroencephalogram (EEG) slowing, a quantitative electroencephalographic measure collected during a short period of wakeful rest. We found that adults with ADHD were significantly sleepier than neurotypical controls during the cognitive task and that this on-task sleepiness contributed to cognitive performance deficits usually attributed to symptoms of ADHD. EEG slowing predicted severity of ADHD symptoms and diagnostic status, and was also related to daytime sleepiness. Frontal EEG slowing as well as increased frontal delta were especially prominent in adults with ADHD. We have validated and adapted an objective observer-rated measure for assessing on-task sleepiness that will contribute to future sleep research in psychology and psychiatry. These findings indicate that the cognitive performance deficits routinely attributed to ADHD and often conceptualized as cognitive endophenotypes of ADHD are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity. Daytime sleepiness plays a major role in cognitive functioning of adults with ADHD.

Is Functional Improvement Always Correlated with Symptomatic Improvement in Children With Attention-Deficit/Hyperactivity Disorder Managed with Oros Methylphenidate? A Prospective Open-Label Naturalistic Follow-Up Study

OBJECTIVE: To investigate the relationship between symptomatic improvement and functional improvement in children with attention deficit hyperactivity disorder (ADHD) who were being treated with OROS methylphenidate. METHODS: Parents evaluated the severity of ADHD symptoms on the Turgay-DSM-IV ADHD/Disruptive Behavior Disorders Scale (T-DSM-IV). They assessed functioning on the Weiss Functional Impairment Rating Scale- Parent Form (WFIRS-P), and the Pediatric Quality of Life Inventory (PedsQL) was used to assess quality of life. Clinicians rated global outcome on the Clinical Global Impressions Scale (CGI). Response was measured in terms of the following criteria: a 20% change in symptoms, a CGI-I score that was much improved (2) or very much improved (1), or an improvement of 0.25 (the minimally important difference) on the WFIRS. Improvement in quality of life was defined as ≥ 20% change in PedsQL score. RESULTS: Sixty-three children completed the study. After 12 weeks, 77.7% of patients met the a priori criteria for treatment response rate. Among patients who exhibited improvement in symptoms, 42.9% also showed improved functioning. Among those who showed improved functioning, 95.5% showed improvement in symptoms. Of patients who showed improvement in symptoms, 34.6% percent also showed improvement in quality of life. Of those who showed improvement in quality of life, 94.4% also showed improvement in symptoms. CONCLUSIONS: Evaluation of changes in functional improvement, quality of life improvement, and symptom improvement during ADHD treatment enables clinicians to identify individuals whose functional impairment/quality of life persists despite symptom improvement. On that basis, additional treatment interventions can be organized for those individuals.

Effect of Parenting Style on Severity of Attention-Deficit/Hyperactivity Disorder among Children Attending Al-Azhar University Hospital, New Damietta

Background: Having an attention deficit hyperactivity disorder (ADHD) child has a disruptive effect on parenting style. As it demands more efforts to be managed and control their behaviors. Insufficient parenting style in childhood can affect the progress of the disorder, worse its signs and symptoms, and increases the risk of development of other behavioral problems, as an oppositional defiant disorder. Aim of the work: We were aiming in this study to assess the relationship between the severity of ADHD and parenting style. Patients and methods: This cross-sectional study was conducted on 100 children who had been attending the psychiatry outpatient clinic from January to June 2019. ADHD was diagnosed with an interview. The ADHD severity and parenting style were assessed by Conner’s Parent Rating Scale (CPRS-R-L) and parenting style scale, respectively. Results: The mean age of the enrolled children was 7.91 ± 2.39 years, and 72% were males. The severity of ADHD was 9% mild, 36% moderate, 32% severe, and 23% very severe. There was a statistically significant relation between “negative” or authoritarian parenting style and severity of ADHD (p <0.001). Conclusion: The results of this study demonstrated that ADHD was more common among males with statistically significant relation with parenting style, and a “positive” parenting style may help in decrease the severity of ADHD symptoms.

Fronto-parietal engagement in response inhibition is inversely scaled with attention-deficit/hyperactivity disorder symptom severity.

Impaired response inhibition is one of the most consistent findings in attention deficit hyperactivity disorder (ADHD). However, the underlying brain mechanisms are not clear. This study aimed to underpin atypical inhibition-related brain activation and connectivity patterns in ADHD using a novel Go/No-go task design, and to determine its association with clinical symptoms of the disorder. Forty-eight adults with ADHD performed a Go/No-go task in which target frequency was manipulated during functional MRI. Specific inhibition-related brain activation was correlated with ADHD symptom severity, to assess the relationship of individual differences in engagement of inhibition-related brain circuits with the magnitude of every-day functioning impairments. Finally, generalized psychophysical interaction analyses were carried out to examine whether not only engagement but also functional connectivity between regions implicated in response inhibition is related to symptom severity. We found no evidence for the expected parietal modulation by increased demand for inhibition at the group-level results. However, this lack of modulation was mediated by individual differences in ADHD symptom severity - increased engagement of the intraparietal sulcus (IPS) in inhibition-demanding events was evident in individuals with less severe symptoms but dissipated with increase in symptomatology. Similarly, functional connectivity between the IPS and the right inferior frontal gyrus (rIFG) was elevated under high inhibitory demand conditions, but this effect diminished with increased symptom severity. The results highlight the importance of IPS engagement in response inhibition and suggest that IPS modulation may be driven by top-down control from the IFG. Moreover, the current findings force the point of treating ADHD as a continuum whereby brain correlates are scaled with severity of the disorder, and point to the potential use of individual differences in the modulation of IPS activation and connectivity as a neuromarker of ADHD.

Prediction of drop-out and outcome in integrated cognitive behavioral therapy for ADHD and SUD: Results from a randomized clinical trial

BackgroundPatients with substance use disorder (SUD) or Attention Deficit Hyperactivity Disorder (ADHD) have a high risk of drop out from treatment. Few studies have investigated predictors of therapy drop out and outcome in SUD patients with comorbid ADHD. Recently, integrated cognitive behavioral therapy (CBT/Integrated) was shown to be more effective than standard CBT (CBT/SUD) in the treatment of SUD + ADHD. ObjectiveTo investigate the association of demographic, clinical and neurocognitive variables with drop-out and treatment outcome, and to examine which of these variables are suitable for patient-treatment matching. MethodsWe performed an RCT in which 119 patients were allocated to CBT/Integrated (n = 60) or CBT/SUD (n = 59). In addition, 55 patients had dropped out before randomization. Demographic variables, clinical characteristics and measures of cognitive functioning (Stroop, Tower of London (ToL) and Balloon Analogue Risk Task (BART)) were included as predictors. Outcome measures were: early treatment drop-out, ADHD symptom severity, and substance use severity at end of treatment and follow up. ResultsPrimary substance of abuse (drugs as opposed to alcohol only) and lower accuracy scores on the ToL were significant predictors of early treatment drop-out. Having more depression and anxiety symptoms and using ADHD medication at baseline significantly predicted more ADHD symptoms at end of treatment, and higher accuracy scores on the ToL significantly predicted higher substance use at end of treatment. No significant predictor-by-treatment interactions were found. ConclusionThe results add to the existing realization that also relatively mild cognitive deficits are a risk factor for treatment drop-out in these patients.

Sluggish cognitive tempo and processing speed in adolescents with ADHD: do findings vary based on informant and task?

Few studies have examined whether behavioral sluggish cognitive tempo (SCT) symptoms are related to speeded task performance. Mixed findings in existing research could be due to previous studies using a broad conceptualization of processing speed, not including self-report of SCT symptoms, and relying on non-optimal measures of SCT. Using a multi-informant design with both parent- and adolescent-reported SCT symptoms, the present study provides a preliminary test of the hypothesis that SCT symptoms would be associated with slower performance on tasks having greater graphomotor and fine motor demands. Participants were 80 adolescents (ages 13-17years; 71% male) with attention-deficit/hyperactivity disorder (ADHD). Adolescents and parents completed ratings of SCT. Adolescents were administered the Wechsler Symbol Search and Coding subtests and the Grooved Pegboard Test. When adjusting for age, sex, and ADHD symptom severity, parent-reported SCT symptoms were not significantly associated with Symbol Search or Coding scores but were significantly associated with slower Grooved Pegboard time. Adolescent-reported SCT symptoms were not significantly associated with Symbol Search but were significantly associated with lower Coding scores and slower Grooved Pegboard time. Findings provide preliminary support for the hypothesis that SCT may be more clearly associated with processing speed task performance as motor demands increase and provide a potential explanation for the mixed literature on SCT in relation to processing speed by demonstrating that the presence and magnitude of associations vary by informant and task.

Atypical gamma functional connectivity pattern during light sleep in children with attention deficit hyperactivity disorder

IntroductionWe examined functional connectivity analyses in electroencephalograms (EEGs) of patients with attention deficit hyperactivitydisorder (ADHD) and in those of typically developing children (TDC) to uncover neurobiological abnormalities. MethodologyWe enrolled 31 children with ADHD (mean age 11.1 years; 23 boys) and 17 sex-, age-, and intelligence-matched TDC to undergo 19-channel EEGs during light sleep. We estimated functional connectivity using the phase lag index (PLI) and coherence measurements that capture the synchronization of EEG signals and graphed metrics with GRETNA. We also performed continuous performance tests (CPTs) on the children and obtained answered questionnaires on ADHD and autism spectrum disorder. ResultsThe central-to-posterior gamma PLI was lower in children with ADHD than that in TDC. The other PLI frequency bands and all coherence frequency bands were not statistically different between both groups. Individuals with high hyperactivity scores on questionnaires and low reaction times (SDs) on CPT had low motor and occipital pairs of gamma PLIs. Graph metrics showed no differences between the groups. ConclusionsThe difference in averaged gamma PLI (especially with motor and occipital pairs) between groups was more suitable for diagnosis than the averaged coherence. Lower averaged gamma PLIs reflected more severe ADHD symptoms. A prospective study with more controlled conditions is warranted to determine if gamma-band PLI can be used as an auxiliary tool for ADHD diagnosis.

The Relationship Between Maternal Stress and Boys' ADHD Symptoms and Quality of Life: An Australian Prospective Cohort Study

PurposeThis study prospectively examined the role of maternal stress in boys' attention deficit hyperactivity disorder (ADHD) symptoms and quality of life (QoL). MethodsChildren with ADHD (5–13 years) were recruited from 21 pediatric practices and followed up 12 months later (n = 166). Maternal stress was examined at baseline, and boys' ADHD symptoms and QoL were examined at baseline and 12 months later. Linear regressions examined whether baseline maternal stress predicted child ADHD symptoms and QoL 12 months later in a series of adjusted models that accounted for child age, ADHD medication use, neighborhood disadvantage, comorbidities and baseline ADHD symptoms or QoL (full model). ResultsIn the unadjusted model, maternal stress at baseline was significantly associated with more severe parent-reported ADHD symptoms at 12 months, accounting for 5.7% of the variance in ADHD symptoms, but this association was attenuated after adjustments in the full model. Baseline maternal stress was associated with poorer QoL at 12 months in boys in the unadjusted model, accounting for 12.4% of the variance, which remained significant in the full adjusted model. ConclusionsMaternal stress is associated with lowered QoL in boys, and may pose a risk for boys' later QoL. Practice implicationsStress management interventions with mothers of children with ADHD experiencing heightened stress are warranted, and are likely to have a positive impact on mothers as well as children.

Relations between caregiver-report of sleep and executive function problems in children with autism spectrum disorder and attention-deficit/hyperactivity disorder

BackgroundMany children with autism spectrum disorder (ASD) experience comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD). Additionally, children with ASD and ADHD often have sleep disturbances and deficits in executive functioning (EF). In typical development, sleep disturbances are causally linked to EF deficits and exacerbate ADHD-like symptoms. AimThe aim of this study was to determine whether caregiver-report sleep and EF difficulties predict ADHD symptoms in children with ASD. MethodsCaregiver-report of child sleep, EF, and ADHD symptom severity was collected for 101 children with ASD, 7–11 years of age. Hierarchical linear regressions tested the independent and interactive effects of sleep and EF in predicting ADHD symptoms. ResultsChildren with ASD were more likely to have symptoms of ADHD if they experienced both sleep and EF difficulties. Children with difficulties in working memory were particularly at risk for clinically significant symptoms of ADHD. Notably, however, sleep did not mediate or moderate the relation between working memory and ADHD symptoms in this sample, suggesting that these variables act through independent mechanisms to increase vulnerability for comorbidity. ConclusionsThese results have clinical significance as sleep and EF deficits may identify an ASD subgroup that is at increased risk for a comorbid ADHD diagnosis.

Objective assessment of attention-deficit/hyperactivity disorder in older adults compared with controls using the QbTest.

Attention-deficit/hyperactivity disorder (ADHD) persists into old age, with prevalence rates of 2.8% to 3.3% in adults over 60 years of age. Most diagnostic assessment tools are not validated for older adults. The Quantified behavioral Test (QbTest) is an objective assessment for the core symptoms of ADHD and is validated for children and younger adults. We investigated whether the QbTest can be used to differentiate between older adults with ADHD and healthy controls. Older adults aged 55 to 79 years with (n = 97) or without (n = 112) ADHD were assessed with the QbTest. They also rated their ADHD symptom severity. QbTest raw scores were compared between groups. Factor scores were computed using factor loadings from a confirmatory factor analysis (CFA). Multilevel regressions were used to determine effects of background characteristics and comorbidity. Logistic regressions were performed to determine whether the QbTest differentiated between patients with ADHD and healthy controls. The factor structure of the CFA was comparable with that of younger age groups. Older age was associated with higher Inattention score. Parameters comprising the factors Hyperactivity and Inattention, but not Impulsivity, were shown to contribute significantly in differentiating between the groups. The QbTest had a correct classification rate of 70%, which was increased to 91% when combining QbTest scores and self-reports of ADHD symptom severity. The QbTest is feasible for older adults, and the factors Hyperactivity and Inattention are valid parameters for the diagnostic assessment of ADHD in older adults, when used in addition to self-reports.

The relationship between alpha asymmetry and ADHD depends on negative affect level and parenting practices

Atypical frontal alpha asymmetry is associated with the approach/withdrawal and affective processes implicated in many psychiatric disorders. Rightward alpha asymmetry, associated with high approach, is a putative endophenotype for attention deficit/hyperactivity disorder (ADHD). However, findings are inconsistent, likely because of a failure to consider emotional heterogeneity within the ADHD population. In addition, how this putative risk marker interacts with environmental factors known to increase symptom severity, such as parenting practices, has not been examined. The current study examined patterns of alpha asymmetry in a large sample of adolescents with and without ADHD, including the moderating role of negative affect and inconsistent discipline. Resting-state EEG was recorded from 169 well-characterized adolescents (nADHD = 79). Semi-structured clinical interviews and well-validated rating scales were used to create composites for negative affect and inconsistent discipline. The relationship between alpha asymmetry and ADHD diagnosis was moderated by negative affect. Right asymmetry was present only for those with ADHD and low levels of negative affect. In addition, greater right alpha asymmetry predicted severity of ADHD symptoms for those with the disorder, but only in the context of inconsistent parenting practices. Results confirm right alpha asymmetry is a possible endophenotype in ADHD but highlight the need to consider emotional heterogeneity and how biological risk interacts with child environment in order to fully characterize its relationship to disorder liability and severity.

Digital Attention-Related Augmented-Reality Game: Significant Correlation between Student Game Performance and Validated Clinical Measures of Attention-Deficit/Hyperactivity Disorder (ADHD).

As many as half of school children with autism spectrum disorder (ASD) exhibit symptoms of attention-deficit/hyperactivity disorder (ADHD), resulting in marked negative academic, social, and behavioral outcomes. The focus of the US Food and Drug Administration (FDA) on real-world data from novel digital sources, and the emergence of Current Procedural Terminology (CPT) codes to reimburse for digital monitoring and neurobehavioral testing suggest an increasing acceptance of the role of technology in augmenting clinical care and research. Empowered Brain is an augmented reality and artificial intelligence-based social-emotional communication aid for students with ASD. In this study, student performance on Empowered Brain is correlated to validated clinical measures of ADHD. Seven high school students with a diagnosis of ASD were recruited from a public high school. All students were assessed for severity of ADHD-related symptoms via three clinical gold-standard assessments, namely the Aberrant Behavioral Checklist (ABC), Social Responsiveness Scale 2 (SRS-2), and Teacher Report Form (TRF). Students used Empowered Brain over a one-week period. We measured the correlation of student in-game performance (as measured by point- and star-based rewards) relative to the hyperactivity subscale of the ABC (ABC-H), and the ADHD-subscale of the TRF. All seven students completed the study and managed to successfully use Empowered Brain. Students received a culminative total of 32 sessions, an average of 4.6 sessions per student (range 2–8). Student in-game performance demonstrated highly significant correlation relative to ABC-H (points: p = 0.0013; stars: p = 0.0013), and significant correlation to TRF ADHD scores (points: p = 0.012; stars: p = 0.012). No adverse effects were noted among students who used Empowered Brain. New technologies may herald novel ways of identifying and characterizing symptoms of ADHD in student populations. This study provides evidence that Empowered Brain in-game performance correlates with ADHD symptom severity in students with ASD. Larger samples are required to validate these findings, with more diverse participants that can also widen the generalizability of these findings to a broader range of brain conditions that manifest with inattention, impulsivity, and hyperactivity. Through further research, we may find that such technologies can help us to identify and longitudinally monitor such symptoms, and potentially aid in severity stratification and digital phenotyping.

Association between inflammatory cytokines and ADHD symptoms in children and adolescents with obesity: A pilot study

Whilst the association between Attention-Deficit/Hyperactivity Disorder (ADHD) and obesity is supported by meta-analytic evidence, the mechanisms underpinning this link need to be further elucidated. Inflammatory processes may increase the risk of ADHD symptoms in individuals with obesity. This pilot study set out to start testing this hypothesis by assessing the correlation between serum levels of inflammatory cytokines and ADHD symptoms severity in a sample of children and adolescents with obesity. We measured ADHD symptoms severity in 52 children/adolescents with obesity (BMI > 95th centile) with the Conners questionnaire, revised, short version, parent (CPRS-R:S) and teacher (CTRS-R:S) versions. Additionally, a categorical diagnosis of ADHD was established using the Kiddie-SADS-PL. Serum levels of IL-6, Il-10, and TNF-alpha were also obtained. The prevalence of ADHD was 9.6%. We found a significant correlation between IL-6, as well as TNF-alpha, and hyperactivity/impulsivity subscores of the CPRS-R:S and CTRS-R:S, that held even after controlling for BMI and oppositional symptoms. This study provides a rationale for larger, longitudinal studies to gain insight into inflammatory processes underpinning the link between obesity and ADHD. This line of research has the potential to lead to novel, pathophysiologically-based management strategies for individuals with obesity and ADHD.

From Toddlerhood to Adolescence: Which Characteristics Among Toddlers with Autism Spectrum Disorder Predict Adolescent Attention Deficit/Hyperactivity Symptom Severity? A Long-Term Follow-Up Study.

High rates of attention deficit/hyperactivity disorder (ADHD) comorbidity have been described in autism spectrum disorder (ASD). This study searched for predictors at toddlerhood of the severity of ADHD symptoms at adolescence. The study included 65 participants, (mean age = 13:8year), diagnosed with ASD at toddlerhood. Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at toddlerhood and adolescence. More severe restricted and repetitive behaviors (RRB) in toddlerhood predicted the severity of Inattention symptoms. In addition, more severe RRB and lower adaptive skills in the toddler years significantly predicted the severity of Hyperactivity/Impulsivity symptoms. Adolescents with elevated ADHD symptoms diagnosed at toddlerhood with ASD showed lower cognitive and adaptive skills and more severe autism symptoms.

Infant Social Avoidance Predicts Autism but Not Anxiety in Fragile X Syndrome.

Objective: Autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and anxiety are three of the most common childhood psychiatric disorders. Early trajectories of social avoidance have been linked with these psychiatric disorders in previous studies, but it remains unclear how social avoidance differentially predicts comorbid disorders in a high-risk genetic subgroup. Here, we delineate the association between trajectories of social avoidance from infancy and subsequent ASD, ADHD, and anxiety outcomes at preschool in children with fragile X syndrome (FXS), a well-characterized single-gene disorder highly associated with social avoidance as well as elevated rates of ASD, ADHD, and anxiety.Method: Males with FXS (n = 78) aged 4–62 months participated in a longitudinal study resulting in 201 assessments. The Social Avoidance Scale (SAS) documented socially avoidant behaviors from infancy in three domains—physical movement, facial expression, and eye contact during both the first minute and the last hour of an interaction. ASD, ADHD, and anxiety symptom outcomes at preschool were measured via parent-report questionnaires.Results: Increased social avoidance across infancy and preschool predicted elevated ASD symptom severity but reduced ADHD and anxiety symptom severity in males with FXS.Conclusion: ASD, ADHD, and anxiety symptoms relate inconsistently to social avoidance behaviors, providing new insight toward the debate of independence or overlap among these disorders in FXS and other disorders (i.e., ASD). The results suggest that the nuanced profile of the developmental and temporal aspects of social avoidance may inform more the accuracy of differential diagnoses of comorbid psychiatric disorders in FXS.

Parental age and developmental milestones: pilot study indicated a role in understanding ADHD severity in Indian probands

BackgroundIn different ethnic groups, birth related factors have shown significant influence in the etiology of Attention deficit hyperactivity disorder (ADHD). Based on these interesting findings, we aimed to investigate association between different pre- and post natal variables and ADHD associated traits in Indian subjects.MethodsADHD Probands recruited based on the DSM-IV, were assessed by the Conner’s Parent Rating Scale for behavioral problem (BPr), inattention (IA), hyperactivity (HA) and ADHD index (AI). Impulsivity (Imp) was assessed by the Tsukuyama scale.ResultsHigher paternal (Std β = 0.23) and lower maternal (Std β = 0.21) age showed significant association with Imp of the probands. Higher paternal age also revealed association with BPr (Std β = 0.18). Age of onset was distinctly associated with AI (Std β < 0.16) while developmental delay was negatively correlated with BPr, Imp, IA and birth weight (r < − 0.13); also confirmed by Posthoc-ANOVA (P < 0.05).ConclusionWe infer that parental age, developmental delay and birth related variables may have a cumulative effect on ADHD symptom severity.

Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort

As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is. We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association-that is, whether dietary patterns predict ADHD symptoms or vice versa. We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling. Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = -0.08; 95% CI: -0.11, -0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls. Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk.

Temperament and Character Profiles Associated with Internalizing and Externalizing Problems in Children with Attention Deficit Hyperactivity Disorder.

ObjectiveThis study aimed to identify temperament and character profiles associated with internalizing and externalizing problems in children with attention deficit hyperactivity disorder (ADHD). MethodsChildren with ADHD (n=114, 8.51±1.87 years) were selected from the Department of Child and Adolescent Psychiatry at Jeju National University Hospital. They were diagnosed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version and evaluated using the Advanced Test of Attention and Korean Wechsler Intelligence Scale for Children-Fourth Edition. Their parents completed the ADHD Rating Scale, Korean-Child Behavioral Checklist, and Junior Temperament and Character Inventory. ResultsThe participants with both internalizing and externalizing problem had more severe ADHD symptoms and significantly higher novelty seeking, harm avoidance, and self-transcendence, as well as lower self-directedness and cooperativeness than those who had not comorbid problems. Harm avoidance was correlated with their level of internalizing problems regardless of severity of ADHD symptoms. In addition, novelty seeking and sex (male) were being associated with the level of externalizing problems. ConclusionDifferences were observed in the temperament and character profiles of children with ADHD according to their comorbid psychopathology. Results suggested that temperament and character profiles may affect the comorbid psychopathology in children with ADHD regardless of ADHD symptom severity.