Comorbid Attention-deficit Disorder Research Articles

Intervention through metacognitive development: A case study of a student with dyslexia and comorbid attention deficit disorder (ADD)

Metacognition can be defined as taking control of and directing one's own thinking processes, and being aware of one's own cognitive strengths and limitations. It is the ability to understand, monitor and self-regulate cognition and is inseparable from intellectual functioning and learning. An important aspect of metacognition is the ability to show reflective awareness about the self, and knowledge in tandem with conscious monitoring during learning. Students with dyslexia and with associated learning disabilities appear to lack these metacognitive skills, which can be seen as a critical aspect of cognition. Metacognition is a bridge between areas and reflects all aspects of cognitive processing. An approach to metacognition within the framework of literacy development is presented through the case study of a 17 year old adolescent who has dyslexia with the co-morbidity of an attention deficit disorder (ADD). This paper illustrates the effectiveness of metacognition in general cognitive processing. The cyclic relationship between the two processes, namely cognition and metacognition is illustrated and the reciprocal nature of these two processes is emphasized. The objective is to show that the development of metacognitive awareness is an important tool in intervention for dyslexic and/or learning-disabled students and provides a case for general recognition of its importance in cognitive intervention. As metacognition is complex, the development of self-awareness is the focus of this qualitative study. The student’s name has been altered to maintain confidentiality but the specific data on his learning disabilities and his progress in learning have been accurately reported. Key words: Cognitive intervention, dyslexia, attention deficit/hyperactivity disorder (ADHD), metacognition, self-awareness.

Multiple Episodes in Children and Adolescents with Bipolar Disorder: Comorbidity, Hospitalization, and Treatment (Data from a Cohort of 8,129 Patients of a National Managed Care Database)

The purpose of this study was to delineate the prevalence, demographic characteristics, comorbidity, hospitalization, and medication use of a large cohort of patients with and without multiple episodes per year. We hypothesized that children and adolescents with multiple episodes per year would have a higher comorbidity and require more hospitalizations and pharmacological treatment than their counterparts without multiple episodes. Analysis was conducted on a cohort of 8,129 children and adolescents patients (< or = 18 y.o.) with bipolar disorders (BD), from the Integrated Healthcare Information Services (IHCIS) identified from June 30, 2000 to July 1, 2003. Demographics variables, type of hospitalization, and psychotropic medication used in the year of follow-up were compared between children and adolescents with multiple and those without multiple episodes per year. Included were 58 patients with multiple episodes (defined as: > or = 4 or more reports of inpatient treatment for any affective disorders per year) and 8,071 without multiple episodes. Children and adolescents with multiple episodes versus those without multiple episodes were differentiated as follows: more comorbid attention deficit disorder (ADD) (80.9% versus 29.4%) (chi2 = 70.61, df = 1, p < 0.0001); higher rate of hospital admission for depression (12.1% vs. 1.8%, chi2 = 27.86, df = 1, p < 0.0001); for other psychiatric conditions (48.3% vs. 11.2, chi2 = 74.47, df = 1, p < 0.0001) and for medical conditions (22.4% vs. 3.9%, chi2 = 46.26, df = 1, p < 0.0001). Patients with multiple episodes per year were more likely than those without multiple episodes to be given mood stabilizers (91.4% vs. 60.3%, chi2 = 22.02, df = 1, p < 0.0001), antidepressants (79.3% vs. 59.2%, chi2 = 8.82, df = 1, p = .0003), and antipsychotics (89.7% vs. 45.8%, chi2 = 42.91, df = 1, p < 0.0001). The use of stimulants did not differ between the two groups (24.1% vs. 23.0%), chi2 = 0.02, df = 1, p = 0.96). Our findings support previous studies demonstrating that children and adolescents with multiple episodes per year present a higher comorbidity and require more hospitalizations and pharmacological treatment than those without multiple episodes. The diagnosis and treatment of children and adolescents with BD will have to take into account the high comorbidity of ADD mainly in children and adolescents with multiple episodes. Future prospective studies will help to better characterize the impact of multiple episodes in the course of pediatric BD and facilitate appropriate treatment strategies.

Handedness in Patients With Developmental Coordination Disorder

Developmental coordination disorder affects 5% to 8% of the general population, and about 50% to 60% of these children have a comorbid attention-deficit disorder with hyperactivity and learning disorders. Left-handedness is relatively common among children with dyslexia, learning disabilities, and autism; however, its frequency in children with developmental coordination disorder is less clear. The present study investigated the distribution of hand dominance in 98 children (age range, 5.5-17 years) with developmental coordination disorder compared with their parents or siblings. Thirty children (30.6%) were left-handed and 13 (13.3%) were ambidextrous. The prevalence of left-handedness among their parents and siblings was similar to that of the general population. The results suggest that children with developmental coordination disorder, like children with learning disorders and deficit disorder with hyperactivity, present with higher frequency of left-hand dominance compared with the general population.

Impact of Comorbid Attention Deficit Disorder on the Direct Medical Costs of Treating Adults With Depression in Managed Care

To assess the impact of comorbid attention deficit disorder (ADD) on the direct medical costs of treating adults with depression in a mixed-model health maintenance organization. Annual mean and marginal health care costs were calculated for adults who were continuously enrolled at Group Health Cooperative during 2001 and who were diagnosed with depression, ADD, or both ADD and depression according to ICD-9-CM criteria during 2001. Of 249,874 adults continuously enrolled during 2001, 17,792 (7.1%) were diagnosed with depression, 1023 (0.4%) were diagnosed with ADD, and 454 (0.2%) were diagnosed with both depression and ADD. The mean total annual cost for an adult with a diagnosis of depression in 2001 exceeded that for the average adult enrolled in Group Health by 109% ($6029 vs. $2880). Of the $6029 mean total annual cost for treating an adult with a diagnosis of depression, $1872 (31%) was specifically attributable to depression. The presence of comorbid ADD resulted in ADD- and depression-attributed marginal costs approximately 29% higher than the costs specifically attributed to depression alone ($2418 vs. $1872). In fact, among patients with a diagnosis of ADD and depression, ADD- and depression-attributed costs approached the mean total cost of health care in the sample as a whole ($2880). Depression is associated with high direct medical costs. The marginal costs of treating comorbid depression and ADD substantially exceed those of treating depression alone. These results underline the importance of considering the costs of comorbidities in estimating the economic burden of depression and developing cost-effective disease-management strategies.

Cognition in anxious children with attention deficit hyperactivity disorder: a comparison with clinical and normal children

BackgroundCognition in children with anxiety disorders (ANX) and comorbid Attention Deficit Disorder (ADHD) has received little attention, potentially impacting clinical and academic interventions in this highly disabled group. This study examined several cognitive features relative to children with either pure condition and to normal controls.MethodsOne hundred and eight children ages 8–12 and parents were diagnosed by semi-structured parent interview and teacher report as having: ANX (any anxiety disorder except OCD or PTSD; n = 52), ADHD (n = 21), or ANX + ADHD (n = 35). All completed measures of academic ability, emotional perception, and working memory. Clinical subjects were compared to 35 normal controls from local schools.ResultsGroups did not differ significantly on age, gender, or estimated IQ. On analyses of variance, groups differed on academic functioning (Wide Range Achievement Test, p < .001), perception of emotion (auditory perception of anger, p < .05), and working memory (backwards digits, p < .01; backwards finger windows, p < .05; Chipasat task, p < .001). ANX + ADHD and children with ADHD did poorly relative to controls on all differentiating measures except auditory perception of anger, where ANX + ADHD showed less sensitivity than children with ANX or with ADHD.ConclusionThough requiring replication, findings suggest that ANX + ADHD relates to greater cognitive and academic vulnerability than ANX, but may relate to reduced perception of anger.

Epilepsy‐related Injuries

Only one prospective, controlled study has compared the risk of accidental injury in persons with epilepsy to controls without seizures. A mildly increased risk in the epilepsy group was found, predominantly due to injuries that result directly from a seizure. With regard to injury type, this study found significantly higher rates of only head and soft tissue injury; however, most injuries were minor. Several retrospective, population-based studies have suggested increased rates of more serious injury types. Submersion injury has a high mortality; the risk of submersion in children with epilepsy is 7.5-13.9 fold higher than in the general population. The risk of fracture is elevated approximately twofold, either resulting directly from seizure-induced injury or predisposed by drug-induced reduction in bone mineral density. Burns due to seizures account for between 1.6% and 3.7% of burn unit admissions. The risk of motor vehicle accidents in drivers with epilepsy also appears increased, albeit marginally. Several factors predispose to a higher risk of injury among those with epilepsy. Seizures resulting in falls increase the risk of concussion and other injuries. Higher seizure frequency, lack of a prolonged seizure-free interval, comorbid attention deficit disorder, or cognitive handicap may also increase the risk of injury. While some restrictions are necessary to protect the safety of the person with epilepsy, undue limitations may further limit achievement of independence. Given the high morbidity and mortality of submersion injury, those with active epilepsy should bathe or swim only with supervision; however, showering is a reasonable option. Appropriate vitamin D and calcium supplementation and periodic measurement of bone mineral density in those at risk for osteopenia are recommended.

What Do We Know for Sure About Bipolar Disorder?

What Do We Know for Sure About Bipolar Disorder?

Monotherapy treatment of bipolar disorder with levetiracetam

Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.

Assessing varying degrees of lethality in depressed adolescent suicide attempters.

Understanding the lethality of suicide attempts and its relation to other psychological variables may improve clinical judgement with regard to suicide risk. The lethality of suicidal behaviour was examined in 60 hospitalized adolescent in-patients who had recently attempted suicide. Subjects were divided into non-lethal, low-lethal and high-lethal groups based on the qualities of their suicidal acts. The groups did not differ in terms of hopelessness, depression, substance abuse or self-esteem. Moreover, they did not differ significantly in diagnoses of major depression, adjustment disorder, substance abuse and bipolar disorder. The group of high-lethal attempters was the only group with several individuals diagnosed with a major depressive episode and comorbid attention deficit disorder. The high-lethal group also reported the strongest desire to end their lives. Based on lethality of suicide attempts, adolescent suicide attempters can be differentiated in terms of the wish to die as well as some instances of diagnostic comorbidity. However, they may not be differentiated in terms of severity of depression or hopelessness, demographic variables and other aspects of suicidal behaviour.