Attention Deficit Hyperactivity Disorder Children Research Articles

Effect of probiotics as an adjunctive therapy with Ritalin among ADHD children and adolescents: a triple-blind randomized controlled trial.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders in children. Evidence regarding the impact of probiotics supplementation in ADHD children is limited and controversial. Thus, this study aimed to assess the effect of probiotics as an adjunctive therapy with Ritalin among ADHD children and adolescents. This study was a triple-blind, randomized controlled trial of 60 Iranian ADHD patients aged four to sixteen. The participants were randomly assigned to receive probiotics supplements containing both Lactobacillus plantarum PTCC 1896™ (A7) and Bifidobacterium animalis subsp. Lactis (BB-12®) (n = 30) or placebo (n = 30) for 8 weeks. ADHD symptoms were assessed using Conners' Parent Rating Scale (CPRS) and Integrated Visual and Auditory Continuous Performance Test (IVA/CPT) at baseline and during the study. This study showed a significant decrease in the CPRS total score after 4 weeks of intervention in the probiotic group (baseline: 43.96 ± 21.52; fourth week: 37.22 ± 23.01; p = 0.01). However, no significant finding was found for the total score of the CPRS after 8 weeks. Moreover, at the end of the study, a significant increase was observed in score of auditory response control in the probiotic versus the placebo group (probiotic: 91.55 ± 16.69; placebo: 80.55 ± 17.43; p = 0.02). Probiotics supplementation with Ritalin may have some beneficial effects among ADHD children and adolescents, such as improving auditory response control and total score of CPRS. However, further clinical trials are required to clarify the impact of probiotics on ADHD.

Co-occurring autism, ADHD, and gender dysphoria in children, adolescents, and young adults with eating disorders: an examination of pre- vs. post-COVID pandemic outbreak trends with real-time electronic health record data.

Incidence rates of autism, attention-deficit/hyperactivity disorder (ADHD), and gender dysphoria (GD) are rising not only in the general population, but particularly among children, adolescents, and young adults with eating disorders (EDs). While ED rates have risen during the COVID pandemic, trends in co-occurring autism, ADHD, and GD have yet to be investigated in detail or at scale by way of large electronic medical record data. To investigate trends in rates of co-occurring autism, ADHD, and GD among children, adolescents, and young adults with EDs in years prior to and during the COVID-19 pandemic. We utilized a de-identified multinational electronic health records database (TriNetX) with 48,558 individuals aged 5-26 diagnosed with eating disorders (EDs) at least twice between 2017 and 2022. The primary predictor variable differentiated between the years of each person's index (first) ED diagnosis (2017-2019 vs. 2020-2022). The primary outcome variable was the rate of new co-occurring psychiatric diagnoses of autism, ADHD, and GD in the year following each patient's first ED diagnosis. We applied propensity score-matched multivariable logistic regressions to compare primary outcomes between 2017-2019 and 2020-2022. Our analysis included 17,445 individuals diagnosed with EDs in 2017-2019 (8% autism, 13.5% ADHD, 1.9% GD) and 31,113 diagnosed with EDs in 2020-2022 (8% autism, 14.6% ADHD, 3.2% GD). After 1:1 propensity score matching, 17,202 individuals from the 2017-2019 cohort were matched to peers mirroring the 2020-2022 cohort. Those diagnosed in 2020-2022 showed a 19% (aOR[95%CI]=1.19[1.07-1.33]), 25% (aOR=1.25[1.04-1.49]), and 36% (aOR=1.36[1.07-1.74]) increase in odds for autism, ADHD, and GD diagnoses, respectively, within the 365 days after the index EDs diagnosis, compared to the 2017-2019 cohort. Rates of autism, ADHD, and GD are significantly higher in individuals with ED in the post-pandemic 2020-2022 cohort in comparison to the pre-pandemic 2017-2019 cohort, even after controlling for baseline levels of co-occurring psychiatric diagnoses. Such findings reveal a critical gap in our current understanding of the totality of ways in which COVID-19 may have impacted the onset and clinical course of EDs, autism, ADHD, and GD among children, adolescents, and young adults.

What Are the Challenges of Mothers with Attention Deficit Hyperactivity Disorder Children in Hebron District: Cross-Sectional Study

Aim: To identify the most frequent challenges of mothers raising ADHD children. Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral childhood disorder. The impulsivity and inattention by the child make parenting challenging. Methods: A cross-sectional study with67 mothers of ADHD children recruited from ADHD child management center, filled out the Zarit Burden Interview (ZBI), simple linear regression analysis was used to find an association between total burden score and variables (p<0.05) Results: 70% of mothers had a high Burden of care,24% with a moderate burden of care, and 6% with a low burden. Feelings of loss of control and insufficient time for self were the most significant correlated variables to the high burden of care (p<0.05), deterioration of the mother's health and social life, stigma, mistrust about proper treatment, and lack of school cooperation Conclusions: Mothers of ADHD children face difficulties and challenges in raising ADHD children, high level of burden among mothers correlated to psychological and social difficulties. Relevance to clinical practice: Positive parenting programs are recommended for parents with ADHD children to empower them in the management of their ADHD children's behavior to gain a better quality of life for ADHD children and their caregivers.

Association between heavy metals exposure and risk of attention deficit hyperactivity disorder (ADHD) in children: a systematic review and meta-analysis.

Heavy metals can negatively affect children's neurodevelopment, yet the relationship between heavy metals exposure and attention deficit hyperactivity disorder (ADHD) in children remains unclear. We aimed to examine associations between exposure to five common heavy metals (lead, arsenic, mercury, cadmium, and manganese) with neurodevelopmental toxicity and the risk of ADHD in children. Online databases of PubMed, Web of Science, and Embase were searched before February 29, 2024. A total of 31 studies involving 25,258 children were included in the final analysis. Our findings revealed that lead exposure was positively associated with ADHD risk in children (OR = 1.95, 95% CI: 1.57-2.41) overall, while the associations varied among different WHO regions, with the strongest in the Americas. Sensitivity analyses revealed significant associations between arsenic (OR = 1.53, 95% CI: 1.01-2.32) and manganese (OR = 1.79, 95% CI: 1.28-2.49) exposure and ADHD risk after omitting one study. Arsenic exposure was positively associated with ADHD risk in studies conducted in the Americas and adjusted for environmental smoke exposure. Positive associations between manganese exposure and ADHD risk were also found in several subgroup analyses. No significant associations were found for mercury and cadmium exposure. Dose-response meta-analysis suggested that children with higher blood lead levels exhibited a higher probability of ADHD diagnosis. Lead exposure consistently increases the risk of ADHD in children, while arsenic and manganese exposure may be associated with ADHD under different occasions. More research is required to understand heavy metals' impact on ADHD across varying exposure levels, particularly in less contaminated regions.

Placebo-related improvement with methylphenidate treatment in children with ADHD.

Non-specific effects of methylphenidate treatment, including expectancy and regression to the mean effects, contribute to the overall effect of methylphenidate on attention-deficit/hyperactivity disorder (ADHD) symptoms. Knowledge on the extent to which non-specific effects contribute to the overall effect and whether regression to the mean explains part of the non-specific effects, is currently lacking. A double-blind, randomized, placebo-controlled, cross-over trial was used to compare parent and teacher ratings of child ADHD symptoms at baseline and during treatment with placebo and 5, 10, 15 and 20mg of methylphenidate, twice daily. Participants were 5-13-year-old children with a DSM-5 diagnosis of ADHD (N = 45). The extent to which non-specific effects contributed to the effects of methylphenidate was determined by ADHD symptom reductions observed with placebo versus reductions observed with active doses of methylphenidate. The influence of regression to the mean was examined by estimating the contribution of baseline ADHD symptom severity to the effects observed with placebo treatment. Data were analyzed using multilevel analyses. We observed significant non-specific effects of methylphenidate for parent-rated ADHD symptoms, but not for teacher-rated symptoms. For parent reported hyperactive/impulsive symptoms, higher baseline symptoms predicted larger effects with placebo, indicating regression to the mean effects. For parent-reports, a significant part of the overall effect of methylphenidate treatment is explained by non-specific effects. Our findings stress the importance of taking non-specific effects into account when evaluating methylphenidate treatment, by including teacher-reports and using a double baseline assessment during titration. Comparing active medication with a placebo in the titration trial has the potential to identify non-specific effects.

СИНДРОМ ДЕФИЦИТА ВНИМАНИЯ С ГИПЕРАКТИВНОСТЬЮ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ

Attention deficit hyperactivity disorder (ADHD) is one of the most widespread forms of neurodevelopmental disorders. Modern clinical criteria for the ADHD diagnosis, issues of differential diagnosis in the pediatric practitioner’s routine (with asthenic syndrome in somatic diseases, primary sleep disorders, fetal alcohol syndrome, thyroid diseases) are described in the Article. The data of recent studies on the ADHD pathogenesis mechanisms are discussed as well. ADHD requires comprehensive treatment approach. The results of a multicenter randomized double-blind placebo-controlled clinical trial on the efficiency and safety of the new domestically produced medication, “Prospecta,” in the treatment of ADHD in children are presented.

Correlational Insights into Attention-Deficit/Hyperactivity Disorder in Lebanon.

Attention-Deficit/Hyperactivity Disorder (ADHD), a prevalent childhood neurodevelopmental disorder with complex etiology involving genetic and environmental factors, causes impairments across various life domains and substantial social and economic burden. Identifying correlates to prevent its onset and decrease its incidence is crucial. To our knowledge, our study represents the first case-control investigation of Lebanese ADHD patients to explore potential correlations between familial, maternal, and child health variables and ADHD to enhance understanding of its etiology and aid in prevention efforts. We recruited 61 Lebanese ADHD patients and 58 matched controls aged 6-24 years from all districts of Lebanon. The data to analyze were collected using a questionnaire. We employed statistical tests, including the independent samples t-test and the Chi-square test or Fisher's exact test. We conducted a multivariate logistic regression analysis to identify the statistically significant factors explaining ADHD likelihood. We observed male predominance (68.9%) among patients. Maternal anemia during pregnancy (OR = 3.654; 95% CI [1.158-11.529]), maternal self-reported stress during pregnancy (OR = 3.268; 95% CI [1.263-8.456]), neonatal jaundice (OR = 5.020; 95% CI [1.438-17.532]), and familial history of ADHD (OR = 12.033; 95% CI [2.950-49.072]) were significantly associated with increased odds of the disorder. On the other hand, breastfeeding (OR = 0.263; 95% CI [0.092-0.757]) was identified as a protective factor against ADHD. This pilot study shed light on risk and protective factors associated with ADHD in the Lebanese population. The results are relevant, as some identified correlates could be avoidable. Further rigorous investigation is required to expand upon the observed correlations and to assist in early detection, prevention, and intervention strategies targeting ADHD.

Comparison of Brain Function Between Medication-Naïve ADHD with and without Comorbidity in Chinese Children Using Resting-State fNIRS.

This study used functional near-infrared spectroscopy (fNIRS) to investigate brain activation patterns in children with attention deficit hyperactivity disorder (ADHD) with and without additional comorbidities to identify disease-related biomarkers by the neuroimaging that will facilitate to make a diagnosis decision. In this study, 165 medication-naive children aged 7 to 15 years were recruited and categorized into four groups: ADHD, ADHD with learning disabilities (ADHD&LD), ADHD with oppositional defiant disorder (ADHD&ODD), and healthy controls. A multichannel fNIRS system was used to monitor hemodynamic changes at rest state in the prefrontal and temporal lobes of the brain. The amplitude of a low-frequency fluctuation (ALFF) matrix was calculated by summation and averaging of the square root of the signal power spectrum. One-way analysis of variance was used to identify statistical differences between channels. All ADHD children presented significantly higher ALFF values in different brain regions when compared with the healthy controls. Patients with ADHD&LD exhibited higher ALFF values in the medial prefrontal cortex (P Ch38 = .01, P Ch48 = .01), temporal cortex (P Ch22 = .04, P Ch41 = .002, P Ch51 = .001), and the left ventrolateral prefrontal cortex (P Ch39 = .0009, P Ch50 = .001), whereas ADHD&ODD children were not significantly different to those diagnosed with ADHD. ADHD with learning disabilities (LD) possessed a different pathogenesis from ADHD, manifested as lower functional brain activity in the medial prefrontal cortex, temporal cortex, and the left ventrolateral prefrontal cortex, while ADHD&ODD did not present significant changes compared with ADHD. ODD-related symptoms may be part of ADHD symptoms rather than being an independent disorder.

Toward an endophenotype for ADHD: Exploring the duration mismatch negativity in drug-free children with ADHD

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in children that is considered to affect early stages of information processes. Inefficient processing of temporal information, which is a vital auditory processing skill suggests itself as a potential candidate for investigating ADHD deficits. The Research Domain Criteria (RDoC), a neuroscience-based research framework, has been introduced to study mental illness without relying on pre-established diagnostic categories. In this regard, Mismatch Negativity (MMN) has been considered an ideal electrophysiological marker for investigating ADHD deficits. This study investigates alterations in the amplitude and latency of the MMN component in response to changes in the duration and Inter-Stimulus Interval (ISI) of basic sound stimuli within an oddball task. The MMN paradigm was employed to examine duration deviations in ADHD (n = 25, 84% male, mean age: 7.3 years, SD = 2.01) compared to Control group of typically developing (TD) children (n = 25, 72% male, mean age: 7.2 years, SD = 1.92). Participants with ADHD were introduced from an accredited psychiatrist. TD children were recruited from social media and online forms. Both groups were matched in terms of gender, age and IQ. The psychological tests conducted in this study included Conners’ Parent Rating Scale (CPRS), Gilliam Autism Rating Scale|Third Edition (Gars3), Sensory profile questionnaire and Edinburgh Handedness inventory. Our findings revealed reduced MMN amplitudes in response to two blocks of duration and ISI-based deviations in ADHD children. To elaborate in greater detail, at Fz, in Duration and ISI block, respectively, the ADHD group showed an amplitude of −1.2097 ± 0.2938 and −0.8553 ± 0.4423, while the normal group showed an amplitude of −1.8325 ± 0.3689 and −2.0855 ± 0.3802. Additionally, at Cz, the ADHD group exhibited a shorter amplitude (-1.2515 ± 0.3261 and −0.9367 ± 0.3432) compared to the normal group (−2.1319 ± 0.4445 and −2.7561 ± 0.4883), in the duration and ISI blocks, respectively. Furthermore, children with ADHD display longer MMN latencies in both experimental blocks, suggesting atypical responses. To provide more detail, at Fz, the ADHD group displayed MMN latencies of 239.68 ± 5.059 and 226.88 ± 4.885 in the Duration and ISI blocks, respectively, whereas the normal group showed MMN latencies of 228.56 ± 6.584 and 213.56 ± 4.153. Similarly, at Cz, the ADHD group exhibited longer MMN latencies (234.40 ± 5.741 and 231.44 ± 5.464) compared to the normal group (227.52 ± 6.710 and 218.00 ± 5.261) in the Duration and ISI blocks, respectively. Our findings were interpreted in the context of the internal clock model, which involves the pace of an internal pacemaker regulated by dopamine (DA) levels. The convergence of MMN and auditory timing abnormalities within the RDoC framework suggests their potential as endophenotypes for ADHD, highlighting the significance of sensory processing in understanding the disorder.

Retrospective assessment of ICD-10/DSM-5 criteria of childhood ADHD from descriptions of academic and social behaviors in German primary school reports.

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood is particularly challenging because retrospective confirmation of previous childhood ADHD is mandatory. Therefore, collecting valid diagnostic information about behavior at school is important. Primary school reports often contain descriptions of academic performance and social behaviors associated with ADHD criteria. Yet, there is no systematic approach available how to assess such reports quantitatively, and therefore, there is also no study on how valid such an approach could predict an ADHD diagnosis. We examined primary school reports from Germany (ADHD: n = 1197, typically developing controls: n = 656) for semantic references to ICD-10/DSM-5 main and sub-criteria of ADHD. Descriptions were assessed on a quantitative scale (blinded clinical expert rating) for disorder-associated behaviors (symptoms scale) as well as for desired, adaptive behaviors (competencies scale) according to these criteria. The scores of these developed scales have been summarized to summary scores. Scores were analyzed using linear mixed models, and sensitivity and specificity were estimated using receiver operating characteristics (ROC). Ratings showed highly significant differences between school reports of children with and without ADHD. For the summary scores, both symptoms and competencies scales showed high diagnostic accuracy (ROC area under the curve at least 0.96) with best discrimination when combining both into an integrated index (sensitivity and specificity > 0.97). Our findings suggest that systematic quantitative analysis of primary school reports should be further explored to construct a valid instrument for retrospective assessment of childhood ADHD criteria to aid the diagnostic process in adolescents and adults.

Применение машинного обучения к данным нейроанатомии и физиологии в области диагностики СДВГ

<p style="text-align: justify;">Attention Deficit\Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. While traditional diagnostic methods rely on clinical interviews, tests and behavioral observations, machine learning methods provide an opportunity to simplify the ADHD diagnostic process and make it more accurate. This review tries to explore the application of machine learning (ML) algorithms to physiological and neuroanatomical data: magnetic resonance imaging (MRI), functional MRI (fMRI), near-infrared spectroscopy (fNIRS), electroencephalography (EEG), magnetoencephalography (MEG), electrocardiogram (ECG), pupil parameters, eye tracking and activity in the field of exploring biomarkers for ADHD diagnosis. Deep learning models and support vector machines (SVM) are considered the most promising approaches for identifying ADHD in both children and adults. However, despite the fact that with the help of machine learning methods researchers are able to achieve high levels of specificity and sensitivity when solving problems of ADHD assessment, their use in clinical practice requires preliminary work to verify the results on large samples, as well as addressing data security and ethical issues.</p>

Push-Pull Mechanism of Attention and Emotion in Children with Attention Deficit Hyperactivity Disorder.

Background/Objectives: While deficits in executive attention and alerting systems in children with attention deficit hyperactivity disorder (ADHD) are well-documented, findings regarding orienting attention in ADHD have been inconsistent. The current study investigated the mechanism of attentional orienting in children with ADHD by examining their attentional bias towards threatening stimuli. Furthermore, we explored the modulating role of anxiety levels in ADHD on this attentional bias. Methods: In Experiment 1, 20 children with ADHD and 26 typically developing children (TDC) performed a continuous performance task that included task-irrelevant distractions consisting of angry faces and neutral places. In Experiment 2, 21 children with ADHD and 25 TDC performed the same task, but with angry and neutral faces as distractors. To measure children's anxiety levels, the State-Trait Anxiety Inventory was administered before each experiment. Results: In Experiment 1, results revealed no attentional bias effects in children with ADHD, whereas TDC exhibited attentional capture effects by both types of distractors. However, in Experiment 2, ADHD children demonstrated an attentional bias towards angry faces, which revealed a significant positive correlation with their trait anxiety levels (r = 0.61, p < 0.05). Further analyses combining all ADHD children showed that trait anxiety levels in Experiment 2 were significantly higher than those in Experiment 1. Finally, a significant positive correlation was found between anxiety levels and attentional bias towards angry faces in all ADHD children (r = 0.36, p < 0.01). Conclusions: Children with ADHD exhibited atypical attentional-orienting effects to threats, and their levels of trait anxiety appeared to modulate such attentional-orienting mechanisms.

Links Among Attention-Deficit/Hyperactivity Disorder Symptoms and Psycholinguistic Abilities Are Different for Children With and Without Developmental Language Disorder.

Both developmental language disorder (DLD) and attention-deficit/hyperactivity disorder (ADHD) represent relatively common and chronic neurodevelopmental conditions associated with increased risk for poor academic and interpersonal outcomes. Reports of common co-occurrence suggest these neurodevelopmental disruptions might also be linked. Most of the data available on the issue have been based on case-control studies vulnerable to ascertainment and other biases. Seventy-eight children, representing four neurodevelopmental profiles (DLD, ADHD, co-occurring ADHD + DLD, and neurotypical development), were administered a battery of psycholinguistic tests. Parents provided standardized ratings of the severity of their children's inattention, hyperactivity/impulsivity, and executive function symptoms. Examiners were blinded to children's clinical status. Group differences, correlations, and best subset regression analyses were used to examine potential impacts of children's ADHD symptoms on their psycholinguistic abilities. For children with DLD, significant links between their ADHD symptoms and psycholinguistic abilities were limited to the contributions of elevated hyperactivity/impulsivity symptoms to lower pragmatic abilities. For children without DLD, inattention symptoms contributed to lower levels of performance in pragmatic, sentence recall, receptive vocabulary, and narrative abilities. Links among children's ADHD symptoms and their psycholinguistic abilities were different for children with and without DLD. Implications for the provision of clinical services are discussed.

Atypical local and global biological motion perception in children with attention deficit hyperactivity disorder

Perceiving biological motion (BM) is crucial for human survival and social interaction. Many studies have reported impaired BM perception in autism spectrum disorder, which is characterised by deficits in social interaction. Children with attention deficit hyperactivity disorder (ADHD) often exhibit similar difficulties in social interaction. However, few studies have investigated BM perception in children with ADHD. Here, we compared differences in the ability to process local kinematic and global configurational cues, two fundamental abilities of BM perception, between typically developing and ADHD children. We further investigated the relationship between BM perception and social interaction skills measured using the Social Responsiveness Scale and examined the contributions of latent factors (e.g. sex, age, attention, and intelligence) to BM perception. The results revealed that children with ADHD exhibited atypical BM perception. Local and global BM processing showed distinct features. Local BM processing ability was related to social interaction skills, whereas global BM processing ability significantly improved with age. Critically, general BM perception (i.e. both local and global BM processing) may be affected by sustained attentional ability in children with ADHD. This relationship was primarily mediated by reasoning intelligence. These findings elucidate atypical BM perception in ADHD and the latent factors related to BM perception. Moreover, this study provides new evidence that BM perception is a hallmark of social cognition and advances our understanding of the potential roles of local and global processing in BM perception and social cognitive disorders.

Atypical local and global biological motion perception in children with attention deficit hyperactivity disorder

Perceiving biological motion (BM) is crucial for human survival and social interaction. Many studies have reported impaired BM perception in autism spectrum disorder, which is characterised by deficits in social interaction. Children with attention deficit hyperactivity disorder (ADHD) often exhibit similar difficulties in social interaction. However, few studies have investigated BM perception in children with ADHD. Here, we compared differences in the ability to process local kinematic and global configurational cues, two fundamental abilities of BM perception, between typically developing and ADHD children. We further investigated the relationship between BM perception and social interaction skills measured using the Social Responsiveness Scale and examined the contributions of latent factors (e.g. sex, age, attention, and intelligence) to BM perception. The results revealed that children with ADHD exhibited atypical BM perception. Local and global BM processing showed distinct features. Local BM processing ability was related to social interaction skills, whereas global BM processing ability significantly improved with age. Critically, general BM perception (i.e. both local and global BM processing) may be affected by sustained attentional ability in children with ADHD. This relationship was primarily mediated by reasoning intelligence. These findings elucidate atypical BM perception in ADHD and the latent factors related to BM perception. Moreover, this study provides new evidence that BM perception is a hallmark of social cognition and advances our understanding of the potential roles of local and global processing in BM perception and social cognitive disorders.

Influence of maternal attention-deficit hyperactive disorder on child dental neglect - An analytical cross-sectional study.

Attention-deficit hyperactivity disorder (ADHD) is a condition that is characterized by symptoms such as inattentiveness, hyperactivity, and impulsivity. The influence of mothers with ADHD and their attitude towards their wards' oral health has not been explored in the Indian scenario. The aim of this study was to assess the prevalence of ADHD in mother-child dyads in western Tamil Nadu and the mothers' dental neglect toward their children. The prevalence of ADHD in mothers and children was assessed using the Adult ADHD Self-report Scale screener and ADHD Rating Scale, respectively. The Child Dental Neglect Scale (CDNS) was used to assess dental neglect in children. The responses were recorded on a Likert scale and statistical analyses were done. The prevalence of ADHD in mothers and children was 10.65% and 10.57%, respectively. The impulsivity and hyperactivity type of ADHD was commonly seen in both the mothers and their children. Mothers without ADHD felt that their children maintained their oral health well. Mothers with ADHD deferred the needed dental treatment for their children. Mothers with ADHD have four times more risk of having children with ADHD. Maternal ADHD influences their child's oral health. Child dental neglect was more prevalent among mothers with ADHD.

INTEGRATE-ADHD: Comparison and Integration of Administrative and Epidemiological ADHD Diagnosis Data through Clinical Assessment - Presentation of the Project

As one of the most frequently diagnosed mental disorders in children and adolescents with sometimes serious individual, family and social consequences, attention deficit/hyperactivity disorder (ADHD) is highly relevant to society and health policy. In Germany, data from statutory health insurance companies has reported increasing ADHD diagnosis prevalence rates over years, while epidemiological data has shown constant and recently even decreasing prevalence rates. The clinical validity of diagnoses from either data sources is unknown. In the framework of the consortium project INTEGRATE-ADHD, 5461 parents of children aged 0 to 17 years with a confirmed administrative ADHD diagnosis insured with the third-largest German statutory health insurance provider (DAK-Gesundheit) in at least one quarter of 2020 were surveyed with the questionnaires from the epidemiological German Health Interview and Examination Survey (KiGGS study) and its in-depth module on child mental health (BELLA study) on their child's ADHD diagnosis and symptoms and on other topics, including comorbidity, utilisation of healthcare services, quality of care and satisfaction, psychosocial risk and protective factors and health-related quality of life. In addition, a subsample of 202 children and adolescents with a clinical diagnosis based on the AMWF S3 guideline on ADHD was analysed. An important aim of the project is to use data linkage on person-level to identify possible causes for the often divergent prevalence estimates from epidemiological and administrative data and to integrate and validate the data sources using a guideline-based clinical diagnosis, thereby contributing to a more accurate population-based prevalence estimate of ADHD in children and adolescents and clarifying actual or supposed contradictions between the data sources. The INTEGRATE-ADHD data linkage project combines administrative, epidemiological and clinical ADHD diagnosis data to create a "three-dimensional view" of the ADHD diagnosis. The results will be used to identify fields of action for healthcare policy and self-administration in the German healthcare system and to derive recommendations for the actors and stakeholders in the field of ADHD. The first results will be published in 2024.

Quand penser à l’existence d’un trouble spécifique du développement et des apprentissages associé au TDAH de l’enfant ?

After the initial recommendations in 2014 on child attention deficit hyperactivity disorder (ADHD) published by the French Haute Autorité de santé (HAS), followed in 2018 by those devoted to specific learning and developmental disorders, and the new recommendations on child ADHD published in the third quarter of 2024 by the HAS, the issue of comorbidities between ADHD and other neurodevelopmental disorders remains a daily challenge for both families and professionals. This work therefore suggests that professionals who have suspected or diagnosed ADHD in a child or adolescent broaden their consideration, particularly concerning specific developmental and learning disorders that may be associated. They should rely on already available information, particularly from schools, and on screening tools accessible to primary and secondary care physicians before prescribing any additional assessments. Neurodevelopmental disorders include a large variety of conditions involving ADHD, motor disorders (among them developmental coordination disorder [DCD]), language and communication disorders (among them specific language disorder [SLD]), specific learning disorders (SLD) (written language both on the receptive and expressive side and mathematical disorders), autism spectrum disorders (ASD), and intellectual development disorder. We propose herein a brief description of these potential comorbid conditions, together with alert signs, which might give clues towards a diagnostic procedure of associated troubles. Moreover, comorbidities are often potential differential diagnosis. We therefore propose in our publication the tables published by the French HAS to help professionals to be aware of these conditions, with alert signs. Prevalence of these comorbidities benefit from our preliminary but exhaustive data from Parcours de Santé TSLA Occitanie on the prevalence of ADHD among complex neurodevelopmental disorders (NDD) with an estimation of more than 80% of concerned children and adolescent being eligible to a diagnosis of ADHD, representing an incidence of 5.6% between age 6 to 15. Among diagnosed ADHD children, comorbidities remain the rule, with specific learning disorders involving reading and spelling (dyslexia/dysorthographia): 46 to 62%, followed by developmental disorders: 41%, developmental language disorders: 24%, and specific learning disorders of mathematical abilities: 17%. This high-level of comorbidities confirms the need for each child to benefit from a multidisciplinary evaluation in various areas of development, particularly to detect secondary difficulties in learning (written language and math) or development (language, motricity), which might be masked by significant behavioural difficulties, or more subtly by pure inattention forms with primarily academic impact. Other comorbidities also need to be investigated, both towards social abilities, and secondary emotional consequences or comorbidities of ADHD including anxiety and depression. Our work also reviews data from literature about the conceptual framework between comorbidity and cause/consequence relationships, within a more comprehensive developmental perspective of various cognitive functions.

Environmental Risk Factors Associated with Behavioral Problems among Children with Attention Deficit Hyperactivity Disorder: Maternal Perceptions

OBJECTIVE This study aims to identify environmental risk factors associated with behavioral problems in children and adolescents with attention deficit hyperactivity disorder (ADHD). METHODS A case-control study was conducted in children aged 4-15 years comprising 92 children diagnosed with ADHD and 92 controls without ADHD. Stratified sampling was used to select 184 participants residing in Chiang Mai and Lamphun provinces, Thailand. Data were collected from the mothers of the participants using a self-report questionnaire between May and August 2022. The questionnaire consisted of three parts: child characteristics (gender, age, underlying diseases, past illness history), mother’s characteristics (age, income, occupational status, history of cigarette smoking and alcohol drinking), and maternal perceptions about caring for the child and the child’s behavioral problems (exposure to chemicals/toxicants, frequent punishment, excessive use of digital media and games). Data were analyzed using descriptive statistics, chi-squared test, odds ratio (OR) and logistic regression using SPSS version 21. RESULTS Most of participants were males (86.96%) while 13.04% were females. The results showed that the ADHD cases were significantly more likely than the controls to have underlying diseases such as G6PD, allergy, and asthma (p = 0.006). There was also a statistically significant correlation with smoking history in the mothers of ADHD cases (OR = 2.64; 95% CI: 1.36-5.13 p = 0.004). In terms of maternal perceptions, the mothers of ADHD children were significantly more likely than the controls to have frequently punished the child (OR = 6.26; 95% CI: 3.24-12.07; p &lt; 0.001), to have children who were exposed to chemicals (pesticides and fertilizer) or toxicants (passive smoking) (OR = 4.14; 95%CI: 1.76-9.73; p = 0.001), and to have allowed their child to use digital media and play video games excessively (OR = 2.82; 95% CI: 1.55-5.16; p = 0.001). After adjustment for other environmental risk factors, frequent child punishment (ORadj = 4.32; 95% CI: 2.13-8.78; p &lt; 0.001) and exposure of the child to chemicals/toxicants (ORadj = 2.66; 95% CI: 1.00-7.02; p = 0.049) were found to be significantly related with ADHD. CONCLUSIONS Frequent child punishment was the most significant environmental risk factor related to behavioral problems among children with ADHD. This indicates the importance of healthcare providers developing strategies and/or interventions to enhance knowledge and awareness in mothers of ADHD which can improve treatment outcomes. KEYWORDS ADHD, risk factors, behavioral problems, maternal percep- tions

Rhinorrhea and watery eyes in infancy and risk of attention-deficit hyperactivity disorder in school-age children.

Increased parasympathetic nervous system (PNS) activity is associated with attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms, but not hyperactive-impulsive symptoms, and may contribute to inattentive subtype etiology. Guided by prior work linking infant rhinorrhea and watery eyes without a cold (RWWC) to PNS dysregulation, we examined associations between infant RWWC and childhood ADHD symptoms in a longitudinal cohort of Black and Latinx children living in the context of economic disadvantage (N=301 youth: 158 females, 143 males). Infant RWWC predicted higher inattentive (relative risk [RR] 2.16, p<.001) but not hyperactive-impulsive (RR 1.53, p=.065) ADHD symptoms (DuPaul scale), administered to caregivers at child age 8-14 years. Stratified analyses revealed that these associations were present in females but not males, who were three times more likely to have higher ADHD current total symptoms if they had infant RWWC than if they did not. Additionally, associations between RWWC and inattention symptoms were observed only in females. RWWC may thus serve as a novel risk marker of ADHD inattentive-type symptoms, especially for females.