Attention Deficit Hyperactivity Disorder Research Articles

A novel brain network analysis method for pediatric ADHD using RFE-GA feature selection strategy

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent childhood disorder, and related research has been increasing in recent years. However, it remains a challenging issue to accurately identify individuals with ADHD. The research proposes a method for ADHD detection using Recursive Feature Elimination-Genetic Algorithm (RFE-GA) for the feature selection of EEG data. Firstly, this study employed Transfer Entropy (TE) to construct brain networks from the EEG data of the ADHD and Normal groups, conducting an analysis of effective connectivity to unveil causal relationships in the brain's information exchange activities. Subsequently, a dual-layer feature selection method combining Recursive Feature Elimination (RFE) and Genetic Algorithm (GA) was proposed. Using the global search capability of GA and the feature selection ability of RFE, the performance of each feature subset is evaluated to find the optimal feature subset. Finally, a Support Vector Machine (SVM) classifier was employed to classify the ultimate feature set. The results revealed the control group exhibited lower connectivity strength in the left temporal alpha and beta bands, but higher frontal connectivity strength compared to the ADHD group. Additionally, in the gamma frequency band, the control group had higher top lobe connectivity strength than the ADHD group. Through the RFE-GA feature selection method, the optimized feature set was more concise, achieving classification accuracies of 91.3%, 94.1%, and 90.7% for the alpha, beta, and gamma frequency bands, respectively. The proposed RFE-GA feature selection method significantly reduced the number of features, thereby improving classification accuracy.&#xD.

The impact of climate change-related disasters on mental health and epigenetics: a narrative review

Climate change has contributed to an increase in the frequency and intensity of natural disasters such as droughts, wildfires, hurricanes, and floods, leading to both immediate physical harm and long-term mental health consequences. Survivors often experience psychological distress, including anxiety, depression, and post-traumatic stress disorder (PTSD), as a result of these traumatic events. This narrative review explores the intersection of climate change-related disasters, mental health outcomes, and epigenetic modifications. Specifically, we summarize recent findings on how environmental stressors influence both mental health and epigenetic changes, such as DNA methylation. Emerging evidence suggests that epigenetic mechanisms, particularly DNA methylation, could mediate the effects of climate change-related stress on mental health, potentially contributing to the onset of mental disorders like depression, panic disorder, autism spectrum disorder, and attention deficit hyperactivity disorder. We also discuss other epigenetic mechanisms, such as histone modifications and non-coding RNAs, and emphasize the importance of longitudinal studies to capture the dynamic nature of epigenetic changes over time. Finally, we propose future research directions to deepen our understanding of the complex relationships between climate change-related disasters, mental health outcomes, and epigenetic mechanisms, which will pave the way for more effective mental health interventions and policy integration.

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

The Relationship Between Early Exposure to General Anesthesia and Neurobehavioral Deficits.

In contemporary medical practice, general anesthesia plays an essential role in pediatric surgical procedures. While modern anesthetic protocols have demonstrated safety and efficacy across various pathological conditions, concerns persist regarding the potential neurotoxic effects associated with early exposure to general anesthesia. Current research primarily examines the neurocognitive developmental impacts, with limited focus on neurobehavioral developmental disorders. This review presents a comprehensive analysis of clinical trial results related to five critical neurobehavioral developmental disorders: fine motor disability, attention-deficit-hyperactivity disorder (ADHD), impulse control disorders (ICDs), autism spectrum disorder (ASD), and developmental coordination disorder (DCD). Furthermore, the review synthesizes insights from basic research on the potential toxicological mechanisms of general anesthetic agents that could influence clinical neurobehavioral changes. These findings provide valuable guidance for the prudent and safe utilization of anesthetic agents in pediatric patients.

Recent Evidence of Non-Rapid Eye Movement Sleep Oscillation Abnormalities in Psychiatric Disorders.

We review recent studies published from 2019 to 2024 examining slow waves and sleep spindles abnormalities across neurodevelopmental, mood, trauma-related, and psychotic disorders using polysomnography and Electroencephalogram (EEG). Individuals with attention-deficit/hyperactivity disorder (ADHD) showed higher slow-spindle activity, while findings on slow-wave activity were mixed. Individuals with autism spectrum disorder (ASD) showed inconsistent results with some evidence of lower spindle chirp and slow-wave amplitude. Individuals with depression displayed lower slow-wave and spindle parameters mostly in medicated patients. Individuals with post-traumatic stress disorder (PTSD) showed higher spindle frequency and activity, which were associated with their clinical symptoms. Psychotic disorders demonstrated the most consistent alterations, with lower spindle density, amplitude, and duration across illness stages that correlated with patients' symptom severity and cognitive deficits, whereas lower slow-wave measures were present in the early phases of the disorders. Sleep spindle and slow-wave abnormalities are present across psychiatric populations, with the most consistent alterations observed in psychotic disorders. Larger studies with standardized methodologies and longitudinal assessments are needed to establish the potential of these oscillations as neurophysiological biomarkers and/or treatment targets.

Bidirectional effects of parenting and ADHD symptoms in young children: Effects of comorbid oppositional symptoms.

Psychosocial factors play an important role in the manifestation of attention-deficit/hyperactivity disorder (ADHD) symptoms and accompanying impairment levels in children. In a community sample of 796 children evaluated at 4, 5, and 6 years of age, bidirectional effects were examined for each of three components of parenting (parental support, hostility, scaffolding skills) and ADHD-specific symptoms that are not associated with symptoms of oppositional defiant disorder. Results indicated that (a) age 4 parenting factors were not associated with changes in ADHD-I (inattention) or ADHD-H (hyperactive-impulsive) symptoms in the subsequent year, (b) ADHD-I and ADHD-H symptoms at age 4 were not associated with changes in parenting factors at age 5, (c) age 5 ADHD-I and ADHD-H symptoms were associated with decreases in parental scaffolding skills and increases in parental hostility from ages 5 to 6 years, and (d) parental support at age 5 was associated with a decrease in ADHD-H symptoms at age 6. Findings suggest that ADHD symptoms can lead to poorer parenting attitudes and behavior, while parental support during kindergarten has a small effect on decreasing ADHD-H symptoms over time.

Measuring clinical outcomes in adult ADHD clinics: psychometrics of a new scale, the adult ADHD Clinical Outcome Scale.

Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate. To present the psychometrics of a short outcome measure of key clinical areas including symptoms. The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered. The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = -0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships. The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.

Level of Coping Mechanisms of Parents of Children with Attention Deficit/Hyperactivity Disorder (ADHD)

Attention Deficit/Hyperactivity Disorder (ADHD) stands as a formidable neurodevelopmental challenge, exerting profound impacts on a child’s academic, social, and familial spheres. Parents of children grappling with ADHD find themselves immersed in a multifaceted struggle, not only contending with the day-to-day management of their child’s symptoms but also grappling with societal preconceptions surrounding the disorder. Thus, this study aimed to determine the level of coping mechanisms of parents of children with ADHD in private schools in a highly urbanized city in Central Philippines for the School Year 2023-2024. This study used a descriptive research design. This study used the validated and trial-tested self-made questionnaire to gather data from the thirty-three parents of children with ADHD. The instrument yielded a validity index of 4.51 and a reliability index of 0.845. The coping mechanisms covered three areas: Emotion-focused, problem-focused, and avoidance-focused strategies. Overall, the level of coping mechanisms of parents was high. Subsequent analysis indicated no significant difference in the level of coping mechanisms of parents of children with ADHD. The study underscores the importance of comprehensive support programs for parents of children with ADHD. These programs should go beyond addressing behavioral issues and incorporate emotional well-being and problem-solving strategies. Through workshops or support groups, parents could learn relaxation techniques to manage stress, communication strategies to foster positive interactions, and positive behavior management techniques. By equipping parents with a diverse range of coping mechanisms, they become empowered to effectively navigate the challenges of ADHD and create a nurturing and supportive environment for their child’s overall development. Keywords: Coping Mechanisms, Attention Deficit/Hyperactivity Disorder ADHD, Parents

NON-PHARMACOLOGICAL TREATMENT STRATEGIES FOR ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD): THE CURRENT STATE OF THE ART

Attention deficit hyperactivity disorder (ADHD) consists of a set of symptoms, such as impulsivity, restlessness, difficulties in relationships with family and colleagues, which disrupt the individual's social, personal and academic life. The aim of this study was to analyze the state of the art on non-pharmacological treatment and its effectiveness as a first-line treatment and as an adjunct to medication. The research consisted of a synthesis of the literature, presenting different types of non-pharmacological methods and their effects on the manifestations of the disease, consequently improving the social and personal lives of these patients. In this sense, it was possible to observe the importance of non-pharmacological treatment in isolation and in association with pharmacological treatment as an important coping strategy for the symptoms of individuals with ADHD.

Increased Prevalence of Attention Deficit Hyperactivity Disorder in Individuals with Selective Immunoglobulin A Deficiency: A Nationwide Case-Control Study.

Background: Selective Immunoglobulin A Deficiency (SIgAD) is one of the most prevalent immunodeficiencies, characterized by an increased risk of mucosal infections. Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders and is associated with significantly higher rates of various infectious diseases, white blood cell abnormalities, and considerable morbidity. This study aimed to evaluate the prevalence of ADHD among patients with SIgAD. Methods: We conducted a retrospective, observational, population-based case-control study, within Leumit Health Services, by comparing individuals diagnosed with SIgAD to a matched control group. Data were extracted from electronic health records. Results: Of the >700,000 registered individuals, 772 aged ≥4 years with SIgAD were identified (mean age 22.0 ± 17.5 years; male/female ratio 1:1). The 5:1 matched control group consisted of 3860 subjects without SIgAD, with no significant differences between the groups regarding age, gender, ethnicity, and socioeconomic status. ADHD prevalence was significantly higher in the SIgAD group (16.2%) than in the control group (12.9%), with an odds ratio of 1.30 (95% confidence interval 1.05-1.61, p = 0.017), as was the use of methylphenidate (6.6% vs. 4%). Additionally, respiratory and intestinal infections were significantly more common in the SIgAD group (p < 0.001). Conclusion: A significantly higher prevalence of ADHD was observed in patients with SIgAD compared to strictly matched controls without SIgAD. These findings enhance our understanding of the pathophysiology of ADHD and its associated health complications.

Maternal adiposity and perinatal and offspring outcomes: an umbrella review.

Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31), as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects.

La melatonina nei disturbi del sonno in bambini e adolescenti con problemi neurocomportamentali

Melatonin, a neurohormone produced by the pineal gland, regulates the sleep-wake circadian rhythm. Sleep disorders are prevalent in children, especially those with neurodevelopmental disorders like autism and other neurodisabilities and affect about 50-75% of this population. The use of melatonin to improve sleep in this population has been debated for over 20 years, with recent reviews addressing its efficacy and safety. Melatonin significantly improves sleep latency and total sleep time in children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental disorders. However, its effectiveness in reducing night awakenings is limited. Short-term use shows no significant association with serious adverse effects, though mild side effects like headache, nausea, drowsiness, and mood changes are common. Long-term safety data are limited but suggest no significant impact on puberty onset or bone health. Dosing and timing of melatonin administration vary widely, and individualized treatment plans are recommended. The use of melatonin should be accompanied by behavioural interventions, and potential side effects should be monitored closely.

Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention.

Numerous recommendations have been made to address the high rates of mental health disorders among justice-involved youth. Few data are available on the use, quality, appropriateness, or availability of services to address these needs. This study examined the relationship between trauma-informed mental health screening, other referral pathways for diagnostic evaluation, subsequent DSM-5 diagnoses, and treatments for evaluated youth. Eligible participants were all youth admitted to New York City secure juvenile detention facilities from September 17, 2015 to October 30, 2016 who remained in the facility for at least five days (N = 786). Of those, 581 (73.9%) were voluntarily screened and 309 (53.2%) later received a diagnostic evaluation. Youth who screened positive for depression, posttraumatic stress disorder, and problematic substance use were more likely to be evaluated. Treatment received was related to diagnosis rather than reason for referral. For youth who were referred for behavioral or emotional concerns, 99.1 percent (114 of 115) of those diagnosed with a neurodevelopmental disorder had attention-deficit/hyperactivity disorder (ADHD). These data are among the first to describe DSM-5 diagnoses and treatment among youth detainees. They highlight the prevalence of ADHD in detained youth and argue for the coordination of universal trauma-informed mental health screening and a structured referral system for this population.

ADHD detection based on human action recognition

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent human neurobehavioral and neurodevelopmental disorder worldwide. Recently, deep learning-based techniques have been exploited in ADHD detection and diagnosis due to their outstanding performance. However, the majority of these methods relying on fMRI and EEG data suffer from the limitation of requiring expensive equipment and incurring high operational costs. Therefore, inspired by the fact that the symptoms of ADHD may manifest in actions and daily behaviors (as stated in the Medical Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)), we introduce a novel ADHD detection system based on human action recognition. We design a novel hyperactivity test for capturing ADHD features and record a real multimodal ADHD dataset (M-ADHD) for the first time. The proposed system detects ADHD symptoms based on acquired action characters from raw RGB videos from the M-ADHD. Our system outperforms conventional competitors in terms of accuracy and AUC on the real multimodal ADHD dataset. Our proposed method, based on simple, non-wearable sensors, has the advantages of being cost-efficient and easy to operate. It is widely applicable for remote ADHD screening and further applies to understanding, treating, and preventing brain disorders.

ADHD and Risk of Precocious Puberty: Considering the Impact of MPH.

The complex association between attention-deficit/hyperactivity disorder (ADHD) and methylphenidate (MPH) with precocious puberty (PP) is still unclear. This study aims to investigate the association between ADHD, MPH, and PP. This is a nationwide cohort study including a total of 3,342,077 individuals, 186,681 with ADHD and 3,155,396 without. First, we compared the risk of PP between ADHD cases and non-ADHD cases. Second, we compared the risk of PP between MPH users and non-MPH users in patients with ADHD. Patients with ADHD were at a greater risk of PP (adjusted hazard ratio [aHR], 2.01 [95% CI, 1.91-2.11]). In our moderation analyses, the female gender was a positive additive effect modifier of the association between ADHD and PP, whereas tics and intellectual disability were negative effect modifiers. In patients with ADHD, MPH users had a significantly lower risk of PP (aHR, 0.63 [95% CI 0.57-0.70]), and females had a negative effect modification on the association between MPH and PP. Our study found that children with ADHD were at a greater risk of PP. Girls with ADHD were a group particularly vulnerable to PP. Comorbid tics or intellectual disability was associated with a lower risk of PP. Among patients with ADHD, MPH was protective against PP, especially in girls. However, these preliminary results need further validation due to the nature of them being from an electronic database study. Unmeasured confounding factors might affect the association between MPH and PP.

Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults - National Center for Health Statistics Rapid Surveys System, United States, October-November 2023.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that develops during childhood and can last into adulthood. Data from the National Center for Health Statistics Rapid Surveys System collected during October-November 2023 were used to estimate the prevalence of ADHD diagnosis and treatment among U.S. adults. In 2023, an estimated 15.5 million U.S. adults (6.0%) had a current ADHD diagnosis based on self-report; approximately one half received the diagnosis at age ≥18 years. Approximately one third of adults with ADHD took a stimulant medication to treat their ADHD in the previous year, 71.5% of whom had difficulty getting their ADHD prescription filled because it was unavailable. Approximately one half of adults with ADHD have ever used telehealth for ADHD-related services. Telehealth might have benefits for persons with ADHD, including helping them access behavioral treatment or medication prescriptions for ADHD. This report provides national estimates of the prevalence and treatment of ADHD among U.S. adults to help guide clinical care and regulatory decision-making for ADHD among U.S. adults.

Clinical study on the intervention effect of digital therapy on children with attention deficit hyperactivity disorder (ADHD)

To evaluate the efficacy and safety of digital therapy for children aged 6 to 12 years with attention deficit hyperactivity disorder (ADHD). From January to March 2023, 52 children aged 6 to 12 years with attention deficit hyperactivity disorder (ADHD) from Wuhan Children’s Hospital, Hubei Province, China were selected for intervention using the “MindPro1” attention training software developed by Jiangsu Ruinao Qizhi Medical Technology Co., Ltd. Before the intervention, the children were in a stable treatment state, and no modifications were made to the original treatment plan during the MindPro1 intervention. Subjects with severe mental illness or other conditions that may affect the implementation and evaluation of disease treatment were excluded. Subjects completed the planned 4-week intervention, and changes in attention-related variables were assessed using the Test of Attention Variables (TOVA) and the parent version of the 18-item SNAP-IV scale (Swanson, Nolan, and Pelham, version IV scale) before and after the intervention. After 4 weeks of intervention, the lower limit of the 95% confidence interval of the response rate of the 18-item SNAP-IV-Parent scale, which was ≥ 30% improvement from baseline, was higher than 27.5% (better than similar products on the market); the SNAP-IV parent score improved (P < 0.001), with statistical significance; the TOVA-ACS score improved (P < 0.05), with statistical significance. The acceptance rate of parents of children was 100%, and the average compliance rate was 95%. There were 4 cases (7.69%) of adverse reactions that may be related to the device in this trial, which recovered spontaneously within 2 days of discontinuation, and no serious adverse events occurred. After 4 weeks of treatment with ADHD auxiliary treatment software, the objective attention assessment data and attention function assessment scale were significantly improved. Parents had a high acceptance of the software, the average compliance rate of participants was high, and the incidence of related adverse events was low and mild.

New Perspective of Multi-dimensional Approach for the Management of Attention-deficit Hyperactivity Disorder: A Review

One of the most common mental diseases in childhood, attention-deficit/hyperactivity disorder (ADHD) often lasts into adulthood for many individuals. The neurodevelopmental condition known as ADHD impacts three areas of the brain: hyperactivity, impulsivity, and attention. The visual field is where attention is most affected by ADHD. Non-strabismic binocular vision disorder (NSBVD), which impairs eye coordination and makes it challenging to focus, has been linked to ADHD. Through a critical cognitive process called visual attention, humans are able to take in and organize information from their visual environment. This greatly affects how one observes, processes, and understands visual information in day-to-day living. Vision therapy is a non-invasive therapeutic approach that aims to improve visual talents and address visual attention deficits. This study aims to provide an overview of the research on the many approaches to treating ADHD, the relationship between NSBVD and ADHD, and whether vision therapy is a viable treatment option for ADHD. After a comprehensive search of many online resources, relevant studies were found. The review's findings provide insight into the range of ADHD patients' treatment choices. In order to improve treatment outcomes, non-pharmacological treatments can be employed either alone or in conjunction with medicine. Medicine by itself is insufficient and has several severe side effects when used continuously. The efficacy of vision therapy in improving visual attention and making recommendations for potential directions for further research in this field. Multiple studies are needed to identify the most effective treatment modalities for achieving positive outcomes for ADHD patients.

Dopamine Transporter and CYP2D6 Gene Relationships with Attention-Deficit/Hyperactivity Disorder Treatment Response in the Methylphenidate and Atomoxetine Crossover Study.

Background: Few biological or clinical predictors guide medication selection and/or dosing for attention-deficit/hyperactivity disorder (ADHD). Accumulating data suggest that genetic factors may contribute to clinically relevant pharmacodynamic (e.g., dopamine transporter-SLC6A3 also commonly known as DAT1) or pharmacokinetic (e.g., the drug metabolizing enzyme Cytochrome P450 2D6 CYP2D6) effects of methylphenidate (stimulant) and atomoxetine (non-stimulant), which are commonly prescribed medications. This is the first study of youth with ADHD exposed to both medications examining the clinical relevance of genetic variation on treatment response. Methods: Genetic variations in DAT1 and CYP2D6 were examined to determine how they modified time relationships with changes in ADHD symptoms over a 4-week period in 199 youth participating in a double-blind crossover study following a stepped titration dose optimization protocol. Results: Our results identified trends in the modification effect from CYP2D6 phenotype and the time-response relationship between ADHD total symptoms for both medications (atomoxetine [ATX]: p = 0.058, Methylphenidate [MPH]: p = 0.044). There was also a trend for the DAT1 3' untranslated region (UTR) variable number of tandem repeat (VNTR) genotype to modify dose relationships with ADHD-RS total scores for atomoxetine (p = 0.029). Participants with DAT1 9/10 repeat genotypes had a more rapid dose-response to ATX compared to 10/10, while those with 9/9 genotypes did not respond as doses were increased. Regardless of genotype, ADHD symptoms and doses were similar across CYP2D6 metabolizer groups after 4 weeks of treatment. Conclusions: Most children with ADHD who were CYP2D6 normal metabolizers or had DAT1 10/10 or 9/10 genotypes responded well to both medications. While we observed some statistically significant effects of CYP2D6 and DAT1 with treatment response over time, our data indicate that genotyping for clinical purposes may have limited utility to guide treatment decisions for ATX or MPH because both medications were generally effective in the studied cohort after 3 weeks of titration to higher doses. The potential DAT1 association with ATX treatment is a novel finding, consistent with prior reports suggesting an association of the DAT1 in 9/9 genotypes with lower responsive rates to treatment at low and moderate doses.

Symptom validity testing in adults with clinically diagnosed ADHD: comparison of the Conner’s Adult ADHD Rating Scale (CAARS) and the Self-Report Symptom Inventory (SRSI)

ABSTRACT Objectives Compared to the number of performance validity measures, the range of available symptom validity measures is limited. The Self-Report Symptom Inventory (SRSI) is a recently developed freestanding symptom validity test with promising psychometric characteristics for use on non-criminal forensic and a range of clinical populations. The goal of this study was to evaluate the utility of the SRSI for symptom validity testing in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). Methods This analogue study compared 76 German patients diagnosed with ADHD (age range 19–63 years) with typically developing individuals from the Netherlands/Germany who were assigned to either a control group (N = 58; age range 18–73 years) or a simulation group (N = 46; age range 18–57 years). All participants completed the Conners’ Adult ADHD Rating Scale (CAARS) with its two embedded validity indicators Infrequency Index (CII) and ADHD Credibility Index (ACI), the SRSI, and the Digit Span (to derive the Reliable Digit Span). Results Specificity in controls was perfect for the CAARS, but reached only about 90% for the SRSI. In contrast, sensitivity in experimental simulators ranged from 24% to 65% for the CAARS, but reached high rates of 69% to 82% for the SRSI. In the sample of patients with ADHD, the failure rate ranged from 8% to 34% (CAARS), and 33% to 47% (SRSI). Further, we found limited classification agreement between the validity measures. Conclusion The divergent results on the different validity indicators reflects the ongoing discussion on poor construct unity and clarity, and calls for more research addressing the heterogeneous construct. The utility of the SRSI to reliably distinguish between valid and invalid symptom report in the clinical evaluation of adult ADHD has to be investigated by more refined studies including both symptom and performance validity indicators.