Diagnosis Of ADHD In Children Research Articles

A-33 Pediatric Intraindividual Variability: Examining Dispersion across Cognitive Domains

Abstract Objective Intraindividual variability (IIV), defined as variability in performance across different cognitive domains within an individual, has been studied in adults and found to be linked to sex, age, and mean cognitive performance, and associated with developmental disorders (e.g., ADHD), focal disorders, and cognitive decline. In contrast, IIV in children is thought to be related to cognitive development rather than impairment, but has not been well studied with relation to differences across sex, age, diagnoses, or mean cognitive performance. Method Participants included 426 children/young adults (ages 3–25; M = 11.75, SD = 4.01; 62.3% male) referred for neuropsychological evaluation at a hospital-based outpatient clinic. A battery of tests was administered measuring several domains, including intelligence, academics, attention, executive functions, language, memory, visual motor integration, and fine motor skills. Intraindividual standard deviation (ISD) and maximum deviation (MD) were used as measures of IIV. Results Sex was not related to ISD or MD, ts(423) = −1.15 – -0.09, ps = 0.251–0.930. Age, measured categorically, was not related to ISD, F(3) = 0.07, p = 0.974, but was related to MD, F(3) = 3.45, p = 0.017 with children age 3–5 having lower MD. ADHD diagnosis was not related to ISD or MD, ts(417) = −1.25 – −1.19, ps = 0.211–0.234. An inverse relationship was observed between mean cognitive performance and ISD, F(1) = 36.43, p < 0.001, and MD, F(1) = 25.92, p < 0.001. Conclusions The current study did not replicate differences in IIV based on sex or diagnosis of ADHD in children. However, differences based on age and mean cognitive performance are consistent with previous literature, suggesting that IIV may reflect differences in cognitive development, secondary to both skill and age, in children.

Sex-specific trajectories of ADHD symptoms from adolescence to young adulthood.

Reports of current ADHD symptoms in adults with a childhood diagnosis of ADHD are often discrepant: While one subgroup reports a particularly high level of current ADHD symptoms, another reports-in contrast-a very low level. The reasons for this difference remain unclear. Although sex might play a moderating role, it has not yet been examined in this regard. In an epidemiological cohort study from birth to young adulthood, childhood ADHD diagnoses were assessed at the ages of 4.5, 8, and 11years based on parent ratings. Sex-specific development of ADHD symptoms was analyzed from the age of 15 to 25years via self-reported ADHD symptoms in participants with (n=47) and without childhood ADHD (n = 289) using a random coefficient regression model. The congruence between parent reports and adolescents' self-ratings was examined, and the role of childhood ADHD diagnosis, childhood OCC/CD, and childhood internalizing disorder as possible sex-specific predictors of self-reported ADHD symptoms at age 25years was investigated. With regard to self-reported ADHD symptoms, females with a childhood ADHD diagnosis reported significantly more ADHD symptoms compared to females without childhood ADHD and males with and without ADHD throughout adolescence and young adulthood. In contrast, males with childhood ADHD did not differ from control males either at age 15 or at age 25years. Only in females did a childhood diagnosis of an externalizing disorder (ADHD and CD/ODD) predict self-reported ADHD symptoms by age 25years. Our findings suggest that self-reports of young adults with a childhood diagnosis of ADHD are influenced by sex. Specifically, females with childhood ADHD report increased levels of ADHD symptoms upon reaching adulthood. To correctly evaluate symptoms and impairment in this subgroup, other, more objective, sources of information may be advisable, such as neurophysiological measures.

Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children

Objective: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. Method: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children (n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls (n = 19) and healthy peers (n = 30). Results: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients (n = 21) from healthy controls (n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children (n = 11) from clinical controls (n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). Conclusion: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.

The Diagnosis of ADHD in Children with Language Delay in Saudi Arabia: The Impacts and Consequences

The diagnosis of communication and behavioral difficulties in Saudi Arabia is currently still an emerging field and there are few governmental schools in the field of speech therapy in Saudi Arabia. These schools offer a bachelor degree in speech hearing rehabilitation, which started only a few years ago. For this reason, the number of Saudis certified as speech and language therapists is very limited, which has led to several issues regarding diagnosis, therapy and speech services in the kingdom being raised. First hand reports from trained speech and language practitioners suggest that it is common for children with a range of communication difficulties to receive a diagnosis of Autism Spectrum Disorder, with other internationally recognized diagnostic labels (e.g. Attention Deficit Hyperactivity Disorder; ADHD) being far less commonly used. Due to limitation of number of certified professional speech language therapists in Saudi Arabia, a number of teachers, psychologists and even some religious individuals claim to be speech therapists. They provide unauthorized speech therapy sessions without any experience or permission, in non-authorized centres such as private schools, private centers and even in their homes. This study is aimed at highlighting the importance of accurate diagnosis and the impact of unauthorized workers on children with ADHD and autism inside Saudi Arabia.

1.24 A Resting State Functional Magnetic Resonance Imaging (fMRI) Study of Attention Network Dysfunction in Adolescents With Bulimia Nervosa

The onset of bulimia nervosa (BN) in adolescence typically involves loss-of-control (LOC) eating followed by compensatory behaviors to avoid weight gain. Patients often exhibit a preoccupation with food- and weight-related stimuli, and these maladaptive cognitions are thought to impair information processing by influencing or disrupting attentional processes. In addition to these attentional problems, recent evidence suggests that childhood diagnosis of ADHD is associated with more severe BN symptoms in adolescents. Despite these clinical findings, little is known about the underlying neural mechanisms that govern attentional processes in BN.

Distinct effects of childhood ADHD and cannabis use on brain functional architecture in young adults.

One of the most salient long-term implications of a childhood diagnosis of ADHD is an increased risk for substance use, abuse, or dependence in adolescence and adulthood. The extent to which cannabis use affects ADHD-related alterations in brain functional organization is unknown, however. To address this research gap, we recruited a sample of 75 individuals aged 21–25 years with and without a childhood diagnosis of ADHD Combined Type, who were either frequent users or non-users of cannabis. These participants have been followed longitudinally since age 7–9.9 years as part of a large multi-site longitudinal study of ADHD, the Multimodal Treatment Study of Children with ADHD (MTA). We examined task-independent intrinsic functional connectivity (iFC) within 9 functional networks using a 2 × 2 design, which compared four groups of participants: (1) individuals with a childhood diagnosis of ADHD who currently use cannabis (n = 23); (2) individuals with ADHD who do not currently use cannabis (n = 22); (3) comparisons who currently use cannabis (n = 15); and (4) comparisons who do not currently use cannabis (n = 15). The main effects of childhood ADHD were primarily weakened iFC in networks supporting executive function and somatomotor control. Contrary to expectations, effects of cannabis use were distinct from those of diagnostic group and no interactions were observed. Exploratory brain-behavior analyses suggested that ADHD-related effects were primarily linked with poorer neurocognitive performance. Deficits in the integrity of functional networks supporting executive function and somatomotor control are consistent with the phenotypic and neurocognitive features of ADHD. Our data suggest that cannabis use does not exacerbate ADHD-related alterations, but this finding awaits replication in a larger sample. Longitudinal neuroimaging studies are urgently required to delineate the neurodevelopmental cascade that culminates in positive and negative outcomes for those diagnosed with ADHD in childhood.

Childhood-Diagnosed ADHD, Symptom Progression, and Reversal Learning in Adulthood

Objective: ADHD persists in up to 60% into adulthood, and the reasons for persistence are not fully understood. The objective of this study was to characterize the neurofunctional basis of decision making in those with a childhood diagnosis of ADHD with either persistent or remitted symptoms in adulthood versus healthy control participants. Method: Thirty-two adults diagnosed with ADHD as children were split into persistent (n = 18) or remitted (n = 14) ADHD groups. Their neural activity and neurofunctional connectivity during a probabilistic reversal learning task were compared with 32 healthy controls. Results: Remitters showed significantly higher neural connectivity in final reversal error and probabilistic error conditions, and persisters depict higher neural connectivity in reversal errors than controls at a family-wise error (FWE) corrected whole-brain corrected threshold. Conclusion: Remitters may have utilized higher neural connectivity than controls to make successful decisions. Also, remitters may have utilized compensatory strategies to override any potential underlying ADHD deficits.

Reading Performance of Young Adults With ADHD Diagnosed in Childhood

Objective: To study reading performance of young adults with ADHD and its relation with executive functioning. Method: Thirty young adults with a childhood diagnosis of ADHD and 30 with normal development (ND) were compared on reading accuracy, fluency, and comprehension. Furthermore, ADHD with reading disabilities (ADHD+RD) and ADHD without reading disabilities (ADHD-RD) subgroups were compared using self-report and informant-report versions of the Behavior Rating Inventory of Executive Function–Adult version (BRIEF-A). Results: Adults with ADHD obtained significantly worse results than the ND adults on reading speed, responses to literal questions, and a cloze test. Although the comparison of the ADHD+RD and ADHD-RD groups did not show significant differences on the BRIEF-A subscales, the ADHD+RD group surpassed the critical percentile (85) on more subscales, with working memory and metacognition especially affected. Conclusion: The findings point out that reading should be assessed in individuals with ADHD as part of their evaluation to design effective early interventions.

Factors predicting treatment adherence in patients with adult attention-deficit/hyperactivity disorder: a preliminary study.

This study aimed to elicit patient- and treatment-related factors that can potentially predict treatment adherence in adult ADHD. Subjects who were over 18 and received a diagnosis of ADHD were included in the study. Chart review data of 102 subjects regarding demographics, medications, comorbidities, concomitant medications and domains of functional impairment were collected, and predictors were assessed using a binominal logistical regression model. One hundred and two patients (78.4% male) with a mean age of 28.8 (SD=9.8, range=18-55) years were enrolled in the study. Childhood diagnosis of ADHD, agents used for treatment (MPH or atomoxetine), individual domains of dysfunction and use of additional psychotropic drugs were not found to be related to treatment adherence. Patients with a university education and those referred for family history of ADHD were more likely to adhere to treatment (p=0.05 and 0.03, respectively). On the other hand, reasons for referral other than ADHD were significantly more frequently related to non-adherence (p=0.02). Treatment noncompliance remains a significant problem despite therapeutic effects of medications. Identification of predictors of non-adherence can lead to heightened awareness of special populations at risk. We have found that prior awareness on ADHD (via past history/media/friends) leading to self/clinician referral to rule out ADHD and pervasiveness of symptoms across functional domains led to better compliance in our sample. Future research with prospective design utilizing objective tools for adherence is required.

Linking early ADHD to adolescent and early adult outcomes among African Americans

PurposeThe purpose of this study is to propose a mediational model for the mechanisms through which a diagnosis of Attention-Deficit/Hyperactivity Disorder between the ages of 10 and 12 predicts positive and negative early adult outcomes for African Americans. MethodsThe study sample (n=211) was drawn from the Des Moines, Iowa subsample of the Family and Community Health Study. Participants were first assessed between the ages of 10 and 12, again between the ages of 12 and 18, and finally at 18 to 23. ResultsFindings indicate that a diagnosis of ADHD before age 13 indirectly predicted subsequent exclusionary school discipline and juvenile arrest in adolescence, and both arrests and educational attainment in young adulthood. ConclusionsThese findings offer support for the School to Prison Pipeline model, showing that for some African American children, a childhood diagnosis of ADHD can lead to negative school experiences that result in harsh school-based discipline, which in turn open the door to justice system involvement spanning several developmental stages.

Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD

Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment.

Parental Income, Education and the Diagnosis of ADHD in Children and Adolescents: The Case for Germany

Using survey data for Germany, we examine how parental income and education are associated with the severity of ADHD symptoms and the likelihood of diagnosis in children and adolescents. We find that children from low-income families tend to have higher ADHD symptom scores and are more likely to be diagnosed than children from higher-income families. However, they were also shown to have a higher likelihood of being underdiagnosed (conditional on not having a diagnosis) and were less likely to visit a pediatrician. Interestingly, migrants were significantly less likely to be diagnosed than non-migrants, but were more likely to visit a pediatrician. Parental education variables were shown to “absorb” the effect of income when added to all of these regressions, considerably reducing the significance of the effect of income on all outcome variables. These results seem to suggest that children from families of low socioeconomic status in Germany may be at a “double jeopardy” in terms of having a higher prevalence of ADHD, and yet not receiving the appropriate diagnoses necessary for further treatment.

Co-Occurrence of ADHD and High IQ

Objective: The validity of a diagnosis of ADHD in children with a high intelligence quotient (IQ) remains controversial. Using a multidisciplinary approach, rigorous diagnostic criteria, and worldwide-validated psychometric instruments, we identified a group of children attending public schools in southern Brazil for co-occurrence of high IQ and ADHD. Method: Students attending public schools, in the first to fifth grades, were referred to our Research Center for behavioral and/or learning difficulties. These children completed clinical, psychiatric, psychological, and pedagogical evaluations for assessment of IQ, ADHD, learning, and other emotional or behavioral disorders. Results: Fifteen of the participants were identified to have a full-scale IQ ≥ 120. Data show that 10 of these high-IQ children met the DSM-IV criteria diagnosis for ADHD combined type, 5 met criteria for current oppositional-defiant disorder, 2 had current major depression, and 2 had a learning disorder. Here we present the results as a case series. Conclusion: Our data support the hypothesis that ADHD is a valid diagnosis in children with high IQs.

Diagnosis Based on Parent and Teacher Rating for Attention Deficit Hyperactivity Disorder

Parents and teachers play a significant role in the diagnosis of ADHD in children in the clinical setting. With the same in consideration a study was conducted to compare the perception between parents and teachers on the rating scales for ADHD children. The study was conducted on a sample of parents and teachers of 100 children diagnosed as having ADHD as per ICD-10 diagnostic criteria. A newly constructed and standardized parent rating scale for parents of ADHD children and attention deficit comprehensive teacher rating scale for teachers was administered on the target sample. Results indicate that there was statistically no significant difference in the rating of perception between parents and teachers on four dimensions, viz (i) attention (ii) hyperactivity (iii) social skills (iv) oppositional behaviour of ADHD children. To verify these findings, positive correlation was found between parents and teachers perception on all the four dimensions.J Med Sci.2010;13(1);11-14

Assessment of ADHD: Differences Across Psychology Specialty Areas

Child psychologists are frequently involved in the assessment of ADHD symptoms among school-aged youth. There is limited information regarding the extent to which psychologists adhere to recommended assessment practices and whether differences exist in assessment strategies among psychologists from different specialty areas (clinical, counseling, and school) and/or who practice in different settings (university, school, or outpatient clinic). A 3 (specialty area) × 3 (employment setting) between-groups design is used wherein 230 child psychologists completed surveys regarding diagnostic practice. Psychologists differ in adherence with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) diagnostic criteria, use of clinical interviews, and type of behavior observation. Only 15% of psychologists report using multiple methods consistent with recommended standards of best practice. Differences between groups of psychologists indicate that the diagnosis of ADHD in children is influenced by the type of psychologist conducting the evaluation and the setting in which the evaluation is conducted.

Attention deficits in adolescents with ADHD and other clinical groups

Abstract Adolescents with a childhood diagnosis of ADHD were compared to adolescents with other psychiatric disorders and to a control group on aspects of attentional functioning. IQ was covaried in the analyses. The ADHD group performed significantly more poorly than did comparison groups except on the Stroop test, where all clinical groups showed reduced resistance to interference. On the Paced Auditory Serial Addition Test and the Letter Cancellation Task the adolescents with ADHD were markedly poorer and could not develop appropriate strategies to cope with the task demands. It is argued that the concept of the Supervisory Attentional System (SAS; Shallice, 1991) has heuristic value in understanding the persisting attentional problems of individuals with ADHD.