Attention Deficit Hyperactivity Problems Research Articles

Deep neural network technique for automated detection of ADHD and CD using ECG signal

Background and objectiveAttention Deficit Hyperactivity problem (ADHD) is a common neurodevelopment problem in children and adolescents that can lead to long-term challenges in life outcomes if left untreated. Also, ADHD is frequently associated with Conduct Disorder (CD), and multiple research have found similarities in clinical signs and behavioral symptoms between both diseases, making differentiation between ADHD, ADHD comorbid with CD (ADHD+CD), and CD a subjective diagnosis. Therefore, the goal of this pilot study is to create the first explainable deep learning (DL) model for objective ECG-based ADHD/CD diagnosis as having an objective biomarker may improve diagnostic accuracy. MethodsThe dataset used in this study consist of ECG data collected from 45 ADHD, 62 ADHD+CD, and 16 CD patients at the Child Guidance Clinic in Singapore. The ECG data were segmented into 2 s epochs and directly used to train our 1-dimensional (1D) convolutional neural network (CNN) model. ResultsThe proposed model yielded 96.04% classification accuracy, 96.26% precision, 95.99% sensitivity, and 96.11% F1-score. The Gradient-weighted class activation mapping (Grad-CAM) function was also used to highlight the important ECG characteristics at specific time points that most impact the classification score. ConclusionIn addition to achieving model performance results with our suggested DL method, Grad-CAM's implementation also offers vital temporal data that clinicians and other mental healthcare professionals can use to make wise medical judgments. We hope that by conducting this pilot study, we will be able to encourage larger-scale research with a larger biosignal dataset. Hence allowing biosignal-based computer-aided diagnostic (CAD) tools to be implemented in healthcare and ambulatory settings, as ECG can be easily obtained via wearable devices such as smartwatches.

Shortened Infant Telomere Length Is Associated with Attention Deficit/Hyperactivity Disorder Symptoms in Children at Age Two Years: A Birth Cohort Study.

Environmental factors can accelerate telomere length (TL) attrition. Shortened TL is linked to attention deficit/hyperactivity disorder (ADHD) symptoms in school-aged children. The onset of ADHD occurs as early as preschool-age, but the TL-ADHD association in younger children is unknown. We investigated associations between infant TL and ADHD symptoms in children and assessed environmental factors as potential confounders and/or mediators of this association. Relative TL was measured by quantitative polymerase chain reaction in cord and 12-month blood in the birth cohort study, the Barwon Infant Study. Early life environmental factors collected antenatally to two years were used to measure confounding. ADHD symptoms at age two years were evaluated by the Child Behavior Checklist Attention Problems (AP) and the Attention Deficit/Hyperactivity Problems (ADHP). Associations between early life environmental factors on TL or ADHD symptoms were assessed using multivariable regression models adjusted for relevant factors. Telomere length at 12 months (TL12), but not at birth, was inversely associated with AP (β = −0.56; 95% CI (−1.13, 0.006); p = 0.05) and ADHP (β = −0.66; 95% CI (−1.11, −0.21); p = 0.004). Infant secondhand smoke exposure at one month was independently associated with shorter TL12 and also higher ADHD symptoms. Further work is needed to elucidate the mechanisms that influence TL attrition and early neurodevelopment.

Understanding the effects of neighborhood disadvantage on youth psychopathology.

In 1942, Shaw and McKay reported that disadvantaged neighborhoods predict youth psychopathology (Shaw & McKay, ). In the decades since, dozens of papers have confirmed and extended these early results, convincingly demonstrating that disadvantaged neighborhood contexts predict elevated rates of both internalizing and externalizing disorders across childhood and adolescence. It is unclear, however, how neighborhood disadvantage increases psychopathology. Our study sought to fill this gap in the literature by examining the Area Deprivation Index (ADI), a composite measure of Census tract disadvantage, as an etiologic moderator of several common forms of psychopathology in two samples of school-aged twins from the Michigan State University Twin Registry (N = 4815 and 1030 twin pairs, respectively), the latter of which was enriched for neighborhood disadvantage. Across both samples, genetic influences on attention-deficit hyperactivity problems were accentuated in the presence of marked disadvantage, while nonshared environmental contributions to callous-unemotional traits increased with increasing disadvantage. However, neighborhood disadvantage had little moderating effect on the etiology of depression, anxiety, or somatic symptoms. Such findings suggest that, although neighborhood disadvantage does appear to serve as a general etiologic moderator of many (but not all) forms of psychopathology, this etiologic moderation is phenotype-specific.

Cognitive, emotional, and social functioning of preschoolers with attention deficit hyperactivity problems

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is associated with deficits in different functional domains. It remains unclear if deficits in different domains are equally strong in early childhood, and which deficits are specific to ADHD. Here, we describe functional domains in preschoolers and assess deficits in children with ADHD problems, by comparing them to preschoolers with other mental health problems or who develop typically.MethodsThe ADHD Study assessed 1195 ca. 3.5 years old preschoolers through a semi-structured parent interview, parent questionnaires, and with neuropsychological tests. We determined functional domains by applying factor analytic methods to a broad set of questionnaire- and test-scales. Using resulting factor scores, we employed a Bayesian hierarchical regression to estimate functional deficits in children with ADHD.ResultsWe found that preschoolers’ functioning could be described along the seven relatively independent dimensions activity level and regulation, executive function, cognition, language, emotion regulation, introversion, and sociability. Compared to typically developing preschoolers, those with ADHD had deficits in all domains except introversion and sociability. Only deficits in activity level regulation and executive functions were larger than 0.5 standardised mean deviations and larger than deficits of children with other mental health problems.ConclusionsPreschoolers with ADHD have deficits in multiple functional domains, but only impairments in activity level and regulation and executive functions are specific for ADHD and large enough to be clinically significant. Research on functioning in these domains will be important for understanding the development of ADHD, and for improving treatment and prevention approaches.

Salivary cytokine cluster moderates the association between caregivers perceived stress and emotional functioning in youth

Some individuals exposed to early life stress show evidence of enhanced systemic inflammation and are at greater risk for psychopathology. In the current study, caregivers and their offspring (0–17 years) were recruited at a pediatric clinic visit at the University of California, San Francisco (UCSF). Mothers and seven-year-old children from the Growing Up inSingaporeTowards healthy Outcomes (GUSTO) prospective birth cohort were used as a replication cohort. Caregivers perceived stress was measured to determine potential intergenerational effects on the children’s functioning and inflammation levels. Children’s emotional functioning in the UCSF cohort was evaluated using the Pediatric Quality of Life (PedsQL) inventory. Child emotional and behavioral functioning was measured using the Child Behavior Checklist (CBCL) in GUSTO. Saliva was collected from the children and salivary levels of IL-6, IL-1β, IL-8 and TNF-α were measured using an electrochemiluminescent cytokine multiplex panel. Child IL-6, IL-1β, IL-8 cytokine levels were clustered into low, average, and high cytokine cluster groups using hierarchical cluster analysis. We did not find that salivary cytokine clusters were significantly associated with children’s emotional or behavioral function. However, cytokine clusters did significantly moderate the association between increased caregiver perceived stress and reduced child emotional functioning (UCSF cohort) and increased Attention-Deficit-Hyperactivity (ADH) problems (GUSTO cohort, uncorrected Cohen’s F2 = 0.02). Using a cytokine clustering technique may be useful in identifying those children exposed to increased caregiver perceived stress that are at risk of emotional and attention deficit hyperactivity problems.

Parents of children with psychopathology: psychiatric problems and the association with their child's problems.

Knowledge is lacking regarding current psychopathology in parents whose children are evaluated in a psychiatric outpatient clinic. This especially accounts for fathers. We provide insight into the prevalence rates of parental psychopathology and the association with their offspring psychopathology by analyzing data on psychiatric problems collected in 701 mothers and 530 fathers of 757 referred children. Prevalence rates of parental psychopathology were based on (sub)clinical scores on the adult self report. Parent–offspring associations were investigated in multivariate analyses taking into account co-morbidity. Around 20 % of the parents had a (sub)clinical score on internalizing problems and around 10 % on attention deficit hyperactivity (ADH) problems. Prevalence rates did not differ between mothers and fathers. Parent–offspring associations did not differ between girls and boys. Maternal anxiety was associated with all offspring problem scores. In addition, maternal ADH problems were associated with offspring ADH problems. Paternal anxiety and ADH problems scores were specifically associated with offspring internalizing and externalizing problem scores, respectively. Associations with offspring psychopathology were of similar magnitude for mothers and fathers and were not influenced by spousal resemblance. Our study shows that both fathers and mothers are at increased risk for psychiatric problems at the time of a child’s evaluation and that their problems are equally associated with their offspring problems. The results emphasize the need to screen mothers as well as fathers for psychiatric problems. Specific treatment programs should be developed for these families in especially high need.

Aetiological overlap between anxiety and attention deficit hyperactivity symptom dimensions in adolescence.

BackgroundAnxiety and attention‐deficit/hyperactivity (ADH) problems are common in adolescence, often co‐occur, and are characterised by high heterogeneity in their phenotypic expressions. Although it is known that anxiety and ADH problems correlate, the relationships between subtypes of anxiety and ADH problems have been scarcely investigated.MethodsUsing a large population sample of adolescent twins and siblings we explored the phenotypic and aetiological association between anxiety subtypes (panic/agoraphobia, separation anxiety, social anxiety, physical injury fears, obsessive‐compulsive symptoms and generalised anxiety) and the two ADH dimensions (attention problems and hyperactivity/impulsivity). Both phenotypes were assessed using self‐report questionnaires.ResultsThe association between ADH problems and anxiety could be entirely attributed to attention problems, not hyperactivity/impulsivity. Most of the correlations between anxiety subtypes and attention problems showed an approximately equal role of genetic and nonshared environmental factors.ConclusionsThe high heterogeneity within anxiety and ADH problems should be taken into account in order to better understand comorbidity between them.

Early Childhood Assessments of Community Pediatric Professionals Predict Autism Spectrum and Attention Deficit Hyperactivity Problems

For clinically referred children with Autism Spectrum Disorder (ASD) or Attention Deficit/Hyperactivity Disorder (ADHD) several early indicators have been described. However, knowledge is lacking on early markers of less severe variants of ASD and ADHD from the general population. The aim of the present study is to identify early indicators of high risk groups for ASD and ADHD problems based on routine data from community pediatric services between infancy and age four. Data are from 1,816 participants who take part in Tracking Adolescents’ Individual Lives Survey (TRAILS), a longitudinal study. Information on early developmental factors was extracted from charts of routine Preventive Child Healthcare (PCH) visits. To assess ASD and ADHD problems, respectively, we used the Children’s Social Behavior Questionnaire (CSBQ) and the Child Behavior Checklist (CBCL), filled out by parents three times between the ages of 11 and 17. Note that these are parent ratings and not diagnostic instruments performed by trained clinicians. Male gender, low birth weight, low level of education of the mother, social, behavioral, language, psychomotor and eating problems significantly predicted ASD problems (odds ratios (OR) between 1.34 and 2.41). ADHD problems were also predicted by male gender and low level of education of the mother and by maternal smoking during pregnancy, good gross motor skills in first year, early attention and hyperactivity problems, and absence of parent-reported positive behavior (ORs between 1.36 and 1.74). Routine data on early childhood from PCH services are predictive for ASD and ADHD problems in adolescents in the general population. The PCH services are a useful setting to identify high risk groups, and to monitor them subsequently.

Clumsiness and psychopathology: Causation or shared etiology? A twin study with the CBCL 6–18 questionnaire in a general school-age population sample

In a sample of 398 twin pairs aged 8–17 belonging to the Italian Twin Registry we explored the extent to which physical clumsiness/motor problems covary with a broad spectrum of behavioral problems identified by the Child Behavior Checklist 6–18/DSM oriented scales, and the causes of such covariation. Only Anxiety and Attention Deficit Hyperactivity (ADH) Problems maintained significant correlation with Clumsiness after partialling out the effects of the other problem scales. By the co-twin control method we found no indication of clear, direct causal effect of Clumsiness upon Anxiety or ADH Problems, or vice versa. Twin bivariate analyses showed that the co-occurrence of motor problems and Anxiety/ADH Problems is best explained by genetic factors shared between Clumsiness and the behavioral problems phenotypes.

Standardized Observational Assessment of Attention Deficit Hyperactivity Disorder Combined and Predominantly Inattentive Subtypes. II. Classroom Observations

.Trained classroom observers used the Direct Observation Form (DOF; McConaughy & Achenbach, 2009) to rate observations of 163 6- to 11-year-old children in their school classrooms. Participants were assigned to four groups based on a parent diagnostic interview and parent and teacher rating scales: Attention Deficit Hyperactivity Disorder (ADHD)—Combined type (n = 64); ADHD—Inattentive type (n = 22); clinically referred without ADHD (n = 51); and nonreferred control children (n = 26). The ADHD—Combined group scored significantly higher than the referred without ADHD group and controls on the DOF Intrusive and Oppositional syndromes, Attention Deficit Hyperactivity Problems scale, Hyperactivity-Impulsivity subscale, and Total Problems; and significantly lower on the DOF On-Task score. The ADHD—Inattentive group scored significantly higher than controls on the DOF Sluggish Cognitive Tempo and Attention Problems syndromes, Inattention subscale, and Total Problems; and significantly lower on the DOF On-Task score. Implications are discussed regarding the discriminative validity of standardized classroom observations for identifying children with ADHD and differentiating between the two ADHD subtypes.

Paternal Alcoholism and Offspring ADHD Problems: A Children of Twins Design

A recent Children-of-Female-Twin design suggests that the association between maternal alcohol use disorder and offspring ADHD is due to a combination of genetic and environmental factors, such as prenatal nicotine exposure. We present here a complementary analysis using a Children-of-Male-Twin design examining the association between paternal alcoholism and offspring attention deficit hyperactivity problems (ADHP). Children-of-twins design: offspring were classified into 4 groups of varying genetic and environmental risk based on father and co-twin's alcohol dependence status. Univariate results are suggestive of a genetic association between paternal alcohol dependence and broadly defined offspring ADHP. Specifically, offspring of male twins with a history of DSM-III-R alcohol dependence, as well as offspring of non-alcohol dependent monozygotic twins whose co-twin was alcohol dependent, were significantly more likely to exhibit ADHP than control offspring. However, multivariate models show maternal variables independently predicting increased risk for offspring ADHP and significantly decreased support for a genetic mechanism of parent-to-child transmission. In support of earlier work, maternal variables (i.e., maternal ADHD and prenatal exposure) were strongly associated with child ADHP; however, the role of paternal alcohol dependence influences was not definitive. While genetic transmission may be important, the association between paternal alcohol dependence and child ADHP is more likely to be indirect and a result of several pathways.

Smoking during pregnancy and offspring externalizing problems: An exploration of genetic and environmental confounds

Previous studies have documented that smoking during pregnancy (SDP) is associated with offspring externalizing problems, even when measured covariates were used to control for possible confounds. However, the association may be because of nonmeasured environmental and genetic factors that increase risk for offspring externalizing problems. The current project used the National Longitudinal Survey of Youth and their children, ages 4-10 years, to explore the relations between SDP and offspring conduct problems (CPs), oppositional defiant problems (ODPs), and attention-deficit/hyperactivity problems (ADHPs) using methodological and statistical controls for confounds. When offspring were compared to their own siblings who differed in their exposure to prenatal nicotine, there was no effect of SDP on offspring CP and ODP. This suggests that SDP does not have a causal effect on offspring CP and ODP. There was a small association between SDP and ADHP, consistent with a causal effect of SDP, but the magnitude of the association was greatly reduced by methodological and statistical controls. Genetically informed analyses suggest that unmeasured environmental variables influencing both SDP and offspring externalizing behaviors account for the previously observed associations. That is, the current analyses imply that important unidentified environmental factors account for the association between SDP and offspring externalizing problems, not teratogenic effects of SDP.

Onset of antisocial behavior, affiliation with deviant friends, and childhood maladjustment: A test of the childhood- and adolescent-onset models

Predictors and concurrent correlates of childhood-onset and adolescent-onset antisocial behavior were studied in a sample of 165 boys and 151 girls, followed from age 6 to age 15. An integrated general growth mixture model was used to determine the number and shape of developmental trajectories of antisocial behavior exhibited by boys and girls. Associations of these trajectories with trajectories of attention-deficit/hyperactivity (ADH) problems and deviant peer affiliation were examined. A childhood-onset, an adolescent-onset, and a low antisocial behavior trajectory were identified. A minority of the sample (11%), mostly males, followed the childhood-onset trajectory. This trajectory was predicted by prior membership in the high ADH trajectory in childhood. The adolescent-onset trajectory (46%) was associated with increases in friends' antisocial behavior but not with ADH problems. Most females (60%) followed the low antisocial trajectory. A substantial proportion of females, however, followed the childhood (5%) and adolescent-onset trajectories (35%). The male-female ratios in the childhood and adolescent-onset trajectories were similar. The results largely supported theories that distinguish between childhood and adolescent onsets of antisocial behavior, but they did not suggest that boys and girls differ in the age of onset of antisocial behavior.

No hyperactive–impulsive subtype in teacher-rated attention-deficit/hyperactivity problems

The aim of this study was to investigate which homogeneous groups, according to teacher reports of attention-deficit/hyperactivity (ADH) Problems on the Teacher's Report Form (TRF), can be identified in a referred sample (n = 4,422; age = 6-18 years; mean age = 9.9 years; 66% boys, 34% girls). Latent class analysis (LCA) was conducted on ADH Problems. In addition, co-morbidity levels in the different ADH Problems groups were compared. LCA yielded three different groups of children and adolescents with both Inattention and hyperactivity-impulsivity, and one group with high scores on Inattention but low scores on hyperactivity-impulsivity. A group of patients with predominantly hyperactivity and impulsivity was not found. Individuals in groups with higher levels of ADH Problems had significantly higher levels of oppositional defiant (OD) and conduct problems, and, although to a lesser extent, significantly higher levels of affective and anxiety problems than individuals in groups with lower levels of ADH Problems. It may not be useful to discern the hyperactive-impulsive type of ADHD.

MENTAL HEALTH AND JUVENILE ARRESTS: CRIMINALITY, CRIMINALIZATION, OR COMPASSION?*

Juveniles in secure confinement allegedly suffer from more mental health problems than their peers. This may reflect background and behavioral characteristics commonly found in clients of both mental health and juvenile justice systems. Another explanation is that mental disorders increase the risk of arrest. These interpretations were tested on a sample of Pittsburgh boys (n = 736). Findings indicate that arrested youth exhibit more attention deficit hyperactivity (ADH) problems, oppositional defiant (OD) problems, and nondelinquent externalizing symptoms prior to their first arrests compared to their never‐arrested peers. However, arrested and nonarrested youth score similarly on prior affective and anxiety problems and internalizing symptoms. Net of delinquency, substance use, and other selection factors, internalizing problems lower the risk of subsequent arrest, whereas OD problems and nondelinquent externalizing symptoms increase it. ADH problems have no effect on arrest net of delinquency and substance use. These findings lend only partial support to the criminalization hypothesis. Whereas some mental health symptoms increase the risk of arrest, others elicit more cautious or compassionate official responses.

Assessment of Attention in Children with Attention Deficit Hyperactivity Problems in Primary Care Settings

Clinical child psychologists in primary care settings are often asked to evaluate children with suspected attention and learning problems. This paper will review some of the methods and assessments available to child psychologists to enable them to perform this task. Some problems with current practice will be described and some of the newer techniques will be introduced. A research-based understanding of areas of chronic impairment of children with Attention Deficit Hyperactivity Disorder (ADHD) will be discussed, and a new approach to the assessment of both executive functions and attention will be explored. This paper will primarily explore assessment in the primary care setting.