Attention-deficit/hyperactivity Disorder Symptoms In Children Research Articles

Low perceived social support in mothers during pregnancy and early childhood; associations with anxiety and ADHD symptoms in children at 3 and 8 years.

Low perceived social support is associated with adverse effects on maternal mental health, and often coexists with other risk factors for offspring anxiety and attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate whether low maternal social support during pregnancy and early childhood predicted anxiety and ADHD symptoms in children at ages 3.5 and 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father, and Child Cohort Study. Mothers were queried about perceived social support twice during pregnancy, and again at child ages 18 months and 3 years. They were interviewed about their children's symptoms of anxiety and ADHD at 3.5 years. At 8 years (n = 781), the Child Symptom Inventory-4 was used to identify children who fulfilled the criteria for anxiety disorders and ADHD. Logistic regression models estimated the risk of child anxiety and ADHD, depending on maternal social support. Low maternal social support predicted child anxiety symptoms at both ages 3.5 and 8 years as well as ADHD symptoms at 8 years. When including other maternal stressors and child risk factors, low maternal social support remained a significant predictor for child anxiety symptoms at 3.5 years, and there was a trend towards also predicting child anxiety and ADHD symptoms at 8 years. The associations between low maternal social support and child symptoms of anxiety and ADHD found in the present study, suggest that focusing on mothers with low social support may hold significance for child symptoms years later.

Persistent organic pollutants and developmental trajectories of ADHD symptoms: The Rhea cohort study

Abstract Background Prenatal exposure to persistent organic pollutants (POPs) has been linked to elevated symptoms related to attention deficit hyperactivity disorder (ADHD) in a few studies, but findings remain inconclusive. We aimed to explore how prenatal exposure to POPs affects the developmental course of ADHD symptoms from early childhood to adolescence in the Rhea cohort in Crete, Greece. Methods We determined concentrations of HCB, DDE, and PCBs in first-trimester maternal serum. Child ADHD symptoms were reported by mothers using the ADHD Test at 4 years and the Conners’ Parent Rating Scale at 6, 11 and 15 years. Group-Based Trajectory Modeling was used to classify 551 participants into 4 distinct groups: Stable low (60.1%), Stable high (9.6%), Low-increasing (14.6%), and High-decreasing (15.7%) symptoms. Adjusted multinomial regression models were applied to assess the risk of being grouped into an adverse developmental trajectory as compared to the reference group (stable low), in relation to prenatal POP exposure in 465 children. The analyses were performed in sex-specific manner. Results Prenatal HCB exposure was associated with elevated risk of being grouped in the stable high ADHD symptoms trajectory only in girls (RRR [95%CI]: 2.0 [1.04, 3.82]). Overall, exposure to DDE and sum of PCBs was linked to decreased risk of membership in an adverse ADHD symptoms trajectory. More specifically, in utero exposure to DDE and sum of PCBs was associated with lower risk of being grouped in the low-increasing trajectory for boys (RRR [95%CI]: 0.7 [0.54, 0.95] and 0.5 [0.32, 0.88], respectively) and in the high-decreasing symptoms group for girls (RRR [95%CI]: 0.6 [0.44, 0.84] and 0.5 [0.30, 0.93], respectively). Conclusions The findings suggest that prenatal exposure to HCB is linked to increased risk of stable high ADHD symptoms from preschool age and up to adolescence. The association was pronounced only in girls, a group for which less is understood in relation to ADHD. Key messages • Prenatal exposure to HCB increases the risk of persistently high ADHD symptoms from preschool age to adolescence. • The impact of prenatal HCB exposure on ADHD symptoms is evident in girls.

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.

Does Temperament Constitute a Risk Factor for Adult Attention Deficit Hyperactivity Disorder?

The aim of this study was to examine the temperament characteristics of adults with attention deficit hyperactivity disorder (ADHD) and the relationship between ADHD subtypes and temperament. Additionally, the study aimed to investigate the relationship between childhood ADHD symptoms and temperament. The study included 59 ADHD patients aged between 18 and 60 years and 44 healthy controls. All participants completed the Wender-Utah Rating Scale (WURS) and the Adult Attention Deficit Hyperactivity Disorder Diagnosis and Rating Scale. Temperament characteristics were assessed using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire scale (TEMPS-A). The ADHD group had significantly higher scores for cyclothymic, irritable, and anxious temperament compared to the control group (p<0.001). The number of individuals with cyclothymic, irritable, and anxious temperament was also significantly higher in the ADHD group (p=0.007, p=0.018, p=0.029, respectively). Positive correlations were found between cyclothymic and depressive temperament scores and WURS scores (r=0.278, p=0.033; r=0.326, p=0.012, respectively), between hyperthymic temperament scores and hyperactivity scores (r=0.399, p=0.002), and between depressive temperament scores and attention deficit scores (r=0.303, p=0.020). There was no relationship between ADHD subtypes and dominant temperament (p>0.05). The most common dominant temperament in the ADHD group was cyclothymic, irritable, and anxious. The positive correlation between WURS scores and cyclothymic temperament suggests that cyclothymic temperament may be a risk factor for adult ADHD.

Exploring the pathways linking prenatal and early childhood greenness exposure to attention-deficit/hyperactivity disorder symptoms during childhood: An approach based on robust causal inference

BackgroundEpidemiological studies suggest that exposure to greenness during childhood may protect children from developing attention-deficit hyperactivity disorder (ADHD). ObjectiveWe analyzed the effect of both prenatal (pregnancy) and early childhood (4-5-year follow-up) residential greenness exposure and green space availability on ADHD symptoms during childhood (up to the age of 12 years) and further explored the potential mediating role of PM2.5 and physical activity in the association. MethodsThe study population included participants from the INfancia y Medio Ambiente (INMA) prospective birth cohort (Gipuzkoa, Sabadell, and Valencia). Average Normalized Difference Vegetation Index (NDVI) in buffers of 100-, 300- and 500-m around the residential addresses was used as an indicator of greenness, while green space availability was determined based on the presence of a major green space within 150-m from the residence. Childhood ADHD symptoms were assessed at the 6-8- and 10-12-year follow-ups using Conners Parents Rating Scale-Revised: Short Form. ResultsAlthough no association was found for the prenatal exposure period, increased early childhood NDVI inversely associated with the OR of clinically significant ADHD symptoms during the 6-8-year follow-up at the 100-m (OR 0.03, 95% CI: 0.003 to 0.44), 300-m (OR 0.04, 95% CI: 0.003 to 0.42) and 500-m (OR 0.08, 95% CI: 0.01 to 0.76) buffers, but exclusively in the context of direct effects. Additionally, the 10-12-year follow-up analysis found moderate to weak evidence of potential total and direct effects of NDVI at both 100- and 300-m buffers on inattention scores, as well as for NDVI at the 300-m buffer on ADHD index scores. The analysis did not reveal evidence of mediation through PM2.5 or physical activity. ConclusionsThe evidence suggests that early childhood greenness exposure may reduce the risk of developing ADHD symptoms later in childhood, and that this association is not mediated through PM2.5 and physical activity.

How accurate is the QbTest for measuring symptoms of ADHD in children and adults?

This literature review aimed to assess the reliability and validity of the quantified behavioural test (QbTest) to measure the symptoms of attention deficit hyperactivity disorder (ADHD), determining the extent to which results of the selected studies were accurate and generalisable. A literature review was undertaken, with each paper appraised using the Critical Appraisal Skills Programme randomised controlled trial checklist. Thematic analysis was also implemented to identify key themes and relationships between data sets. Three papers concluded that the QbTest increases clinical efficiency without compromising diagnostic accuracy, while others identified limitations relating to its ability to identify symptoms of impulsivity correctly. Additional issues were identified relating to external validity, generalisability and the extent to which the QbTest could differentiate ADHD from other conditions. It is concluded that the QbTest is an unreliable means of assessing ADHD in both children and adults, particularly when used as a stand-alone assessment tool. Thematic analysis highlighted concerns around diagnostic accuracy and the QbTest's inability to differentiate symptoms of ADHD from other conditions – fundamental flaws affecting the overarching fidelity of QbTesting.

The Association between Hyperactivity and Suicidal Behavior and Attempts among Children Referred from Emergency Departments.

The global prevalence of suicidal behaviors in children is rising, with attention-deficit hyperactivity disorder (ADHD) proposed as a contributing factor. This study examines the association between ADHD facets (hyperactivity and inattention) and suicidal behavior and attempts in children. Additionally, it seeks to compare self-reported ADHD symptoms and suicide-related incidents with parental reports. A cohort of 71 children referred from emergency departments due to suicidal thoughts and behaviors completed self- and parental report questionnaires. The results revealed that elevated hyperactivity scores, surpassing the ADHD diagnosis threshold, were significantly associated with increased rates of suicidal behavior. Hyperactivity demonstrated a stronger association with lifetime suicide attempts compared to inattention. Moreover, children's self-reported ADHD symptoms exhibited a stronger correlation with suicide attempts than parental reports. This study highlights the critical role of hyperactivity in understanding suicidal behaviors among children with ADHD. It underscores the importance of considering hyperactivity-related symptoms in assessment and treatment approaches for suicidal behavior in this population.

What types of objective measures have been used to assess core ADHD symptoms in children and young people in naturalistic settings? A scoping review

ObjectivesWe described the range and types of objective measures of attention-deficit/hyperactivity disorder (ADHD) in children and young people (CYP) reported in research that can be applied in naturalistic settings.DesignScoping review...

Associating prenatal antibiotics exposure with attention deficit hyperactivity disorder symptoms in preschool children: The role of maternal vitamin D

BackgroundThe associations between prenatal antibiotics exposure and attention-deficit/hyperactivity disorder (ADHD) in preschoolers, and the role of maternal vitamin D in these associations, remain to be explored. ObjectivesTo evaluate the relationships between multiple maternal urinary antibiotics levels and preschoolers’ ADHD symptoms, and to identify the potential modifying effects of maternal vitamin D. MethodsBased on a prospective birth cohort, the present study included 2033 motherchild pairs. Maternal urine and serum samples were collected during all three trimesters to measure the urinary concentrations of 43 antibiotics (including two metabolites) and the serum vitamin D levels. The ADHD symptoms of preschoolers were assessed using the Diagnostic and Statistical Manual–oriented ADHD problems scale in the Achenbach Child Behavior Checklist. Multiple informant models in the form of logistic regression were conducted to investigate the associations between prenatal antibiotics exposure and preschooler ADHD symptoms, and these associations were stratified by child sex and maternal vitamin D status. ResultsCompared with the lowest tertile concentrations, maternal exposure to the middle tertile concentrations of doxycycline and human antibiotics/preferred as human antibiotics (HAs/PHAs), and the highest tertile concentrations of doxycycline during the first trimester were associated with an increased risk of ADHD symptoms in children. An increased risk of ADHD symptoms was observed in girls exposed to the highest tertile levels of sulfamethazine during the second trimester. Furthermore, pregnant women with vitamin D deficiency have a greater risk of ADHD symptoms in their offspring after exposure to doxycycline in the first trimester. ConclusionsMaternal exposure to doxycycline and HAs/PHAs during the first trimester increases the risk of ADHD symptoms in preschoolers. Mid-pregnancy sulfamethazine exposure increases the risk of ADHD symptoms in girls. Maternal vitamin D deficiency during pregnancy may exacerbate the adverse effects of doxycycline exposure on ADHD symptoms.

The effect of a single dose of methylphenidate on attention in children and adolescents with ADHD and comorbid Oppositional Defiant Disorder.

The co-occurrence Oppositional Defiant Disorder (ODD) in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) has been associated to difficulties in regulating adverse states, elevated functional impairment, deficits in Executive Functions and high risk for psychopathology. Recent studies have shown that ODD is a negative predictor of a positive response to methylphenidate (MPH) treatment for ADHD symptoms in children and adolescents and that patients with a diagnosis of comorbid ADHD and ODD are less likely to respond favorably to pharmacological treatment with MPH. We conducted a naturalistic study to understand the clinical characteristics of drug-naïve children and adolescents with ADHD that influence the response to MPH by measuring the effect on attention. Specifically, we investigated whether a single dose of MPH differently affects the performance of 53 children and adolescents with ADHD with or without ODD comorbidity. In addition, participant characteristics such as symptom severity, functional impairment, and associated behavioral and emotional symptoms at baseline were examined to better understand what aspects affect the response to MPH. We found that a single dose of MPH improved the attention of children and adolescents with ADHD without ODD more than those with comorbid ADHD and ODD, resulting in reduced reaction times. Our findings indicated that children and adolescents with comorbid ADHD and ODD and those with ADHD alone did not exhibit differences in measures of attention prior to taking MPH, nor in demographic variables (age, intelligence quotient, gender), clinical characteristics related to symptom severity, and adaptive behaviors. However, we observed differences between the two groups in certain behavioral aspects, including the Dysregulation Profile and disruptive behaviors. Assessing symptoms in combination with the presence of ADHD can be beneficial in determining which individuals would derive the greatest benefits from treatment.

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.

Attention-Deficit/Hyperactivity Disorder Symptoms as a Function of Arousal and Executive Vigilance: Testing Halperin and Schulz’s Neurodevelopmental Model in a Sample of Community Adults

Halperin and Schulz’s neurodevelopmental model postulates that the onset of attention-deficit/hyperactivity disorder (ADHD) in childhood is due to subcortical alterations, whereas the disorder’s trajectory into adulthood depends on the development of executive functions. Based on a dimensional framework of ADHD, Coll-Martín et al. (2021) found support for the model in an adult community sample assessed on arousal and executive vigilance. The present study is a preregistered (https://osf.io/tkdq7) close replication of Coll-Martín et al. expressly aimed to test the two predictions of the model. A sample of college students (N = 292 valid; 49% women; 18–30 years, M = 21.7) from a Spanish university completed self-reports of ADHD symptoms in childhood (retrospectively) and adulthood and performed the online version of an attentional task (the ANTI-Vea). Our preregistered hypotheses achieved an acceptable statistical power for the effects of interest, even after accounting for random measurement error. Despite this, none of them replicated the findings of the original study: Only the unexpected negative correlation between executive vigilance and symptoms in childhood was significant, thereby not supporting the theoretical predictions. The lack of support for the dissociation pattern hypothesized by the neurodevelopmental model was robust to multiverse and exploratory analyses. At least in terms of vigilance, ADHD symptoms seem to share altered neurocognitive pathways across the lifespan, regardless of their time of onset. This challenges the notion of late-onset ADHD as a condition neuropsychologically distinct from child-onset ADHD. Future studies need to include complementary assessment methods and clinical groups.

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.

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.

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.

Prevalence of attention deficit hyperactivity disorder in school-going children in rural Konkan region of Maharashtra.

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder of childhood characterised by attention deficit, hyperactivity and impulsiveness. The present study was designed to compute the prevalence of ADHD and assess the association of the predetermined demographic variables and ADHD in school-going children aged 6-12 years in rural areas of Konkan. The present study was a descriptive, cross-sectional study. Using the first edition of Vanderbilt's scale - D4 (Teacher's informant) by National Institute for Children's Health Quality (NICHQ) for identifying symptoms of ADHD in children, a questionnaire was filled out for each child with input from their class teacher. These data were then compiled and analysed. Out of the 133 participants in the study aged 6-12 years, the gender distribution was 69 boys and 64 girls. The mean age was 9.2 ± 2.3 years. Of which, one student (0.75%) was found to have a predominantly inattentive subtype of ADHD (ADHD-IA). The prevalence was found to be 1.5% (2/133). In addition, one student (0.75%) was found to have a combined ADHD-IA and hyperactive (ADHD-H/I) subtype of ADHD (ADHD-C). The latter was also positive for the anxiety/depression screening scale administered as part of the same questionnaire. The total symptom score for questions 1-18 was 8.44 ± 7.29. One of the most common neurodivergent conditions among school-age children is ADHD. Using an easy-to-use questionnaire, teachers and parents can report those experiencing symptoms of ADHD. Early diagnosis and treatment are recommended to avoid complications and aid in the improvement of quality of life.

Attention-deficit/hyperactivity disorder (ADHD) in cultural context II: a comparison of the links between ADHD symptoms and waiting-related responses in Hong Kong and UK.

The concept of attention-deficit/hyperactivity disorder (ADHD) is considered to have cross-cultural validity, but direct comparisons of its psychological characteristics across cultures are limited. This study investigates whether preschool children's ADHD symptoms expressed in two cultures with different views about child behaviour and parenting, Hong Kong and the UK, show the same pattern of associations with their waiting-related abilities and reactions, an important marker of early self-regulation. A community sample of 112 preschoolers (mean age = 46.22 months; 55 from UK, 57 from HK) completed three tasks measuring different waiting elements - waiting for rewards, choosing the amount of time to wait, and having to wait unexpectedly when a task is interrupted. Participants' waiting-related behavioural and emotional reactions were coded. Parents rated their children's ADHD symptoms and delay aversion. Our findings revealed that the associations between ADHD symptoms and waiting-related responses were comparable in both UK and HK samples. This suggests that the core psychological characteristics of ADHD, particularly in relation to waiting behaviours, may exhibit similarity across cultural contexts. Future research can extend this cross-cultural analysis to other ADHD-related psychological domains and explore additional cultural settings.

Growing evidence of pharmacotherapy effectiveness in managing attention-deficit/hyperactivity disorder in young children with or without autism spectrum disorder: a minireview.

Many children with autism spectrum disorder (ASD) also have attention-deficit/hyperactivity disorder (ADHD). ADHD in children is associated with increased risk of negative outcomes, and early intervention is critical. Current guidelines recommend psychosocial interventions such as behavioral training as the first line of therapy in managing ADHD symptoms in children with or without ASD. Where symptoms are refractory to these interventions, medications such as stimulants, α2-adrenergic agonist inhibitors, selective norepinephrine reuptake inhibitors, and second-generation antipsychotics are recommended. However, these pharmacotherapies do not have regulatory approval for use in children of preschool age, and evidence on their safety and efficacy in this population has historically been very limited. Since publication of the current guidelines in 2020, several new randomized controlled trials and real-world studies have been published that have investigated the efficacy and tolerability of these medications in preschool children with ADHD, with or without comorbid ASD. Here, we provide a review of the key findings of these studies, which suggest that there is growing evidence to support the use of pharmacological interventions in the management of ADHD in preschool children with comorbid ASD.

The neural and genetic underpinnings of different developmental trajectories of Attention-Deficit/Hyperactivity Symptoms in children and adolescents

BackgroundThe trajectory of attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents, encompassing descending, stable, and ascending patterns, delineates their ADHD status as remission, persistence or late onset. However, the neural and genetic underpinnings governing the trajectory of ADHD remain inadequately elucidated.MethodsIn this study, we employed neuroimaging techniques, behavioral assessments, and genetic analyses on a cohort of 487 children aged 6–15 from the Children School Functions and Brain Development project at baseline and two follow-up tests for 1 year each (interval 1: 1.14 ± 0.32 years; interval 2: 1.14 ± 0.30 years). We applied a Latent class mixed model (LCMM) to identify the developmental trajectory of ADHD symptoms in children and adolescents, while investigating the neural correlates through gray matter volume (GMV) analysis and exploring the genetic underpinnings using polygenic risk scores (PRS).ResultsThis study identified three distinct trajectories (ascending-high, stable-low, and descending-medium) of ADHD symptoms from childhood through adolescence. Utilizing the linear mixed-effects (LME) model, we discovered that attention hub regions served as the neural basis for these three developmental trajectories. These regions encompassed the left anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC), responsible for inhibitory control; the right inferior parietal lobule (IPL), which facilitated conscious focus on exogenous stimuli; and the bilateral middle frontal gyrus/precentral gyrus (MFG/PCG), accountable for regulating both dorsal and ventral attention networks while playing a crucial role in flexible modulation of endogenous and extrinsic attention. Furthermore, our findings revealed that individuals in the ascending-high group exhibited the highest PRS for ADHD, followed by those in the descending-medium group, with individuals in the stable-low group displaying the lowest PRS. Notably, both ascending-high and descending-medium groups had significantly higher PRS compared to the stable-low group.ConclusionsThe developmental trajectory of ADHD symptoms in the general population throughout childhood and adolescence can be reliably classified into ascending-high, stable-low, and descending-medium groups. The bilateral MFG/PCG, left ACC/mPFC, and right IPL may serve as crucial brain regions involved in attention processing, potentially determining these trajectories. Furthermore, the ascending-high pattern of ADHD symptoms exhibited the highest PRS for ADHD.

ADHD Symptoms in Childhood and Big Five Personality Traits in Adolescence: A Five-Year Longitudinal Study in Girls

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by developmentally extreme and impairing symptoms of inattention and/or hyperactivity/impulsivity. Great interest has emerged in the ways ADHD and its underlying symptom dimensions relate to the development of personality traits. Much extant research on this topic is cross-sectional, relying on self-report measures and male samples. Herein, we present data from a prospective, longitudinal study of a socioeconomically and racially diverse sample of girls, including those with ADHD and a matched neurotypical comparison sample. We examined how parent- and teacher-reported ADHD in middle childhood relate to self-reported Big Five personality traits in adolescence. As expected, childhood ADHD diagnosis prospectively predicted lower self-reported Conscientiousness, lower Agreeableness, and higher Neuroticism in adolescence. With ADHD diagnosis covaried, Inattention (IA) predicted only low Conscientiousness, Hyperactivity/Impulsivity (HI) predicted only low Agreeableness, and neither predicted adolescent Neuroticism. An exploratory moderator analysis showed that family income moderated the effects of IA and HI on the negativity of adolescent self-descriptions of their own personalities, with more pronounced negative effects for girls in families with higher (rather than lower) income. Familial pressures to achieve in higher-income families may be linked to more pronounced negative ramifications of ADHD on personality development.