Diagnostic Criteria For Attention-deficit/hyperactivity Disorder Research Articles

Trastorno por déficit de atención/hiperactividad del adulto: estudio descriptivo en una Unidad de Memoria

Attention-deficit/hyperactivity disorder (ADHD) is the main neurological diagnosis in Chilean children. Its profile and evolution in adults has not been appropriately studied, despise its personal and social impact. To describe the characteristics of adults with ADHD evaluated in a memory unit, verifying the existence of differences depending on gender. A demographic and symptomatic evaluation protocol was applied to all patients diagnosed with ADHD who consulted at the Memory Unit of the Pontificia Universidad Católica de Chile, during the year 2004. Eighty six patients were included. Average age was 37, being 53% male. Most patients were diagnosed for the first time in adulthood, corresponding to an ADHD of combined type. The main patients' complaints were forgetfulness and distraction. A stressing factor capable of worsening the symptoms was identified in 59% of patients. Depression was the principal comorbidity, with a significantly higher incidence in women. The limitations of ADHD diagnostic criteria available for adult patients are discussed. Differences depending on gender were analyzed, describing a predominantly disruptive profile in men and depressive profile in women. There is a clear under-diagnosis of female children with ADHD, with a potential negative impact on their neuropsychological development. The differential diagnosis with mild cognitive impairment, in patients complaining of recent memory decline is discussed.

Sleep and Alertness in Children With Attention-Deficit/Hyperactivity Disorder: A Systematic Review of the Literature

Abstract Study Objective: To review evidence on sleep and alertness in children with attention-deficit/hyperactivity disorder (ADHD) controlling for potential confounding factors. Methods: A PubMed search. Studies using ADHD diagnostic criteria other than DSM-III-R or IV and studies not excluding or controlling for psychiatric comorbidity or medication status were not included in the review. Results from objective studies were combined using meta-analysis. Results: From the 46 studies located, 13 were retained. With regard to objective studies, the proportion of subjects who fell asleep during the Multiple Sleep Latency Test, the number of movements in sleep, and the apnea-hypopnea index were significantly higher in children with ADHD than in controls. We found no significant differences in other objective parameters (sleep-onset latency; number of stage changes; percentages of stage 1 sleep, stage 2 sleep, slow-wave sleep, or rapid eye movement sleep; rapid eye movement sleep latency; and sleep efficiency). Limited evidence from subjective studies suggests no significant differences in sleep-onset difficulties and bedtime resistance between children with ADHD and controls, after controlling for comorbidity and medication status. Data on sleep duration, night and morning awakenings, and parasomnias are still very limited. Conclusion: Results from our systematic review suggest that children with ADHD have higher daytime sleepiness, more movements in sleep, and higher apnea-hypopnea indexes compared with controls. Given the limited number of studies controlling for confounding factors, further subjective and objective studies are needed to better understand alterations in sleep and alertness in children with ADHD.

Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates*

This study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates. We investigated 129 prison inmates (mean age+/-SE: 19.2+/-2.0 years) and 54 healthy male control subjects (mean age+/-SE: 22.2+/-3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM-IV and ICD-10-research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM-IV (SCID). The overall prevalence of ADHD according to DSM-IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD-10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases). The prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5% had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.

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To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training.The Children’s ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks.Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ2[4] = 19.47, p < .001), hyperactivity (χ2[4] = 11.91, p = .02), combined ADHD (χ2[4] = 14.90, p = .005), ODD (χ2[4] = 10.05, p = .04), and VADRS-Caregiver role performance (χ2 [4] = 12.40, p = .01) and CIS-P impairment (χ2[4] = 20.52, p < .001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ2[4] = 11.28, p = .02) and combined ADHD (χ2[4] = 9.72, p = .045).The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to specialty mental health services.Clinical trial registration information—Children’s Attention Deficit Disorder With Hyperactivity (ADHD) Telemental Health Treatment Study; http://clinicaltrials.gov; NCT00830700.

Drug therapy for adults with attention-deficit hyperactivity disorder.

Practitioners are increasingly called upon to diagnose and treat attention deficit hyperactivity disorder (ADHD) in adults. Although the use of pharmacotherapy in children with ADHD is well studied, the use of drugs for the treatment of adults with ADHD remains less well established.A systematic review of the literature identified 15 studies (n = 482 patients) of stimulants, and 27 studies of nonstimulant medications (n = 1179 subjects) including antidepressants, norepinephrine reuptake inhibitors, antihypertensive agents, amino acids and wake-promoting agents for the treatment of ADHD in adults. Controlled clinical trials in adults showed that stimulants, antidepressants and norepinephrine reuptake inhibitors demonstrated significant short-term improvements in ADHD symptoms compared with placebo. The two longer term trials with methylphenidate in adults confirmed the ongoing effectiveness and tolerability of stimulants. The response to amphetamine and methylphenidate appears to be dose-dependent. Methylphenidate and amphetamine had an immediate onset of action, whereas responses to pemoline, antidepressants and norepinephrine reuptake inhibitors appeared delayed. Controlled data on nicotinic/cholinergic compounds appear promising. Considerable variability was found in the diagnostic criteria for ADHD in adults, drug dosages and response rates between the various studies. Under controlled conditions, the aggregate literature comprised mainly of short-term studies, shows that stimulants, norepinephrine reuptake inhibitors and specific antidepressants had clinically and statistically significant beneficial effects in the treatment of ADHD in adults. Cholinergic agents appear promising. Further studies are necessary to evaluate the long-term effectiveness and tolerability of various agents, functional and neuropsychological outcomes, and the use of various agents in specific subgroups of adults with ADHD.

Risperidone in Children and Adolescents with Conduct Disorder: A Single-Center, Open-Label Study

Background: Risperidone is one of the most commonly used atypical antipsychotic drugs in the treatment of children and adolescents. However, the data about its use in children and adolescents with conduct disorder (CD) are limited. Objective: The aim of this study was to investigate the effectiveness and tolerability of risperidone in controlling major symptoms of CD in children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and severe CD. Methods: Children and adolescents were eligible for this single-center, open-label study if they met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) diagnostic criteria for ADHD and ODD and also were diagnosed with severe CD. The patients were treated with risperidone in an open-label fashion for 8 weeks, starting at a daily dosage of 0.25 mg or 0.5 mg (depending on their body weight) in 2 divided doses. Results: The study population comprised 21 children and adolescents (17 boys, 4 girls) with a mean (SD) age of 10.8 (3.6) years. The mean (SD) dosage of risperidone at the end of 8 weeks of treatment was 1.27 (0.42) mg/d (range, 0.75–2.0 mg/d). On the basis of the global improvement subscale of the Clinical Global Impression scale, 16 of 20 patients (80%) were classified as responders. Significant improvements were observed after risperidone treatment in the inattention, hyperactivity/impulsivity, ODD, and CD subscales of the Turgay DSM-IV–Based Child and Adolescent Behavior Disorders Screening and Rating Scale (parent and teacher forms). No severe adverse events were reported. Conclusions: The results of this study are consistent with previous findings and suggest that risperidone may be an effective and well-tolerated atypical antipsychotic drug for the treatment of children and adolescents with CD. However, further studies, particularly placebo-controlled and double-blinded, are needed to better define the clinical use of risperidone in children and adolescents with CD.

Inattention, hyperactivity and impulsiveness: their impact on academic achievement and progress.

Children with Attention Deficit Hyperactivity Disorder (ADHD) have been found to achieve lower grades at school than their peers. Does this extend to pupils who are apparently exceptionally inattentive, hyperactive or impulsive, but have not been diagnosed as having ADHD? This study determined the proportion of children who were assessed by their teachers as exceptionally inattentive, hyperactive or impulsive in the classroom. The relationships between these traits, achievement and progress were examined. The participants comprised 4148 children from a nationally representative sample of schools in England. Reading and mathematics achievement of the participants was assessed at the start and end of the reception year, and in year 2. Behaviour was assessed at the end of reception using a rating scale based on the diagnostic criteria for ADHD (American Psychiatric Association, 1994). The proportion of children with exceptional scores on the behaviour rating scale was reported. The reading and mathematics attainment and value-added of children with high scores on the behaviour rating scale were found to be educationally and statistically significantly lower than children with zero scores. The achievement of children with high scores on the behaviour rating scale replicated previous studies which investigated the achievement of children with ADHD. The behaviour rating scale could be a useful tool for raising the awareness of teachers to young children with severe behavioural problems of inattention, hyperactivity and impulsivity who have not been diagnosed as having ADHD but may nevertheless be at risk of similar outcomes.

Are Stimulants Overprescribed? Treatment of ADHD in Four U.S. Communities

To address rising concerns about the possible overdiagnosis of attention-deficit hyperactivity disorder (ADHD) and overtreatment with stimulants. To date, almost no studies have examined ADHD in unbiased community-based studies, ascertaining both the prevalence of the diagnosis within nonreferred populations and the extent to which various treatments (i.e., stimulant medication, mental health treatments, and educational interventions) are used. As a part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, the authors examined epidemiological survey data obtained from 1,285 children and their parents across 4 U.S. communities. Analyses examined the frequency of children's ADHD diagnosis, the extent to which medications were prescribed, as well as the provision of other services (e.g., psychosocial treatments, school-based educational interventions). Findings indicated that 5.1% of children met full DSM-III-RADHD criteria across the pooled sample. Only 12.5% of children meeting ADHD criteria had been treated with stimulants during the previous 12 months. Some children who had been prescribed stimulants did not meet full ADHD diagnostic criteria, but these children manifested high levels of ADHD symptoms, suggesting that the medication had been appropriately prescribed. Children with ADHD were generally more likely to receive mental health counseling and/or school-based interventions than medication. Medication treatments are often not used in treating ADHD children identified in the community, suggesting the need for better education of parents, physicians, and mental health professionals about the effectiveness of these treatments. On the basis of these data it cannot be concluded that substantial "overtreatment" with stimulants is occurring across communities in general.

Segregation analysis of attention deficit hyperactivity disorder

We performed segregation analysis on 495 nuclear families, ascertained for the father's substance abuse diagnosis, in an attempt to determine the role of genetic and other influences in determining the variability of DSM-III-R-defined attention deficit hyperactivity disorder (ADHD). For our analyses, ADHD was treated as a quantitative variable, utilizing the semicontinuous scale provided by the 15-item symptom count within DSM-III-R. Analyses consisted of both class A and class D regressive models for which covariate effects (socioeconomic status) and sex dependence were estimated. Segregation analysis of the quantitative trait (ADHD symptom count) in the entire data set supported a transmissible non-Mendelian major effect. Models which were sex-dependent and included covariate effects provided the best fit to the data. In addition, similar analyses were performed on a 130-nuclear family subgroup of the data set in which at least one of the members of the nuclear family met DSM-III-R diagnostic criteria for ADHD. The sex-dependent Mendelian codominant model was best supported by the data, while other models could be rejected. Incorporating covariate effects did not provide a better fit for the data. Thus, this study is consistent with Mendelian transmission of ADHD symptom count in a clinically relevant population. Overall, our results support the presence of a heritable continuous trait of which ADHD represents an extreme.

Cognitive factors differentiating attention deficit-hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.

Profile Comparisons between ADHD and Non-ADHD Children on the Temperament Assessment Battery for Children

The purpose of this study was to examine the temperament of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). A separate profile analysis was performed on each of the temperament scales of the Temperament Assessment Battery for Children Parent and Teacher Forms (Martin, 1988). The results demonstrated that parents and teachers rate the temperament of children classified as ADHD and normal children differently. In addition, parents and teachers tended to be consistent in their ratings of children classified as ADHD, resulting in similar profile patterns on each form of the TABC. Therefore, children with ADHD appear to display similar patterns of temperament at home and at school. Parents and teachers both reported that children classified as ADHD tended to display temperaments with high activity levels, high distractibility, and low persistence, which is consistent with the ADHD diagnostic criteria.

Comorbidity of central auditory processing disorder and attention-deficit hyperactivity disorder.

Research has indicated that children with attention-deficit hyperactivity disorder (ADHD) demonstrate significant difficulty on tasks used to assess central auditory processing skills. These findings have raised the question of whether ADHD and central auditory processing disorder (CAPD) represent a singular disorder. The current study explored the incidence of ADHD in a group of 30 children who met diagnostic criteria for CAPD. Consecutive referrals specifically for this project were assessed on a variety of measures. In addition, rating scales were completed by teachers and structured interviews were completed with parents. Results indicate that although the incidence rate of ADHD (50%) in this sample significantly exceeds that found in the normative population (p < .001), not all children with CAPD demonstrated behaviors consistent with diagnostic criteria for ADHD. Furthermore, there was a low incidence of any other behavioral disorder in this sample. In contrast, it was found that the sample as a whole demonstrated impaired language abilities. No significant differences emerged across cognitive, auditory, or language measures. This study further supports the need for increased collaboration of those professionals who work with these children given the extent of overlap of language and behavioral difficulties in this sample.

Diagnosis and assessment of attention deficit-hyperactivity disorder in children

This article provides an overview of Attention Deficit-Hyperactivity Disorder (AD-HD) in children and its behavioral correlates, emphasizing clinical issues in assessment. Diagnostic criteria for AD-HD that are presented in DSM-III-R are briefly reviewed as are additional guidelines used in making the diagnosis. A clinical assessment protocol for evaluating this disorder among children is proposed that includes parent, teacher, and child interviews, standardized parent and teacher behavior rating scales, laboratory test measures, and direct observational procedures. A multimethod assessment protocol that utilizes sources of information obtained from different settings and informants is advocated because of the inherent complexities encountered when evaluating AD-HD. The importance of differential diagnosis and the need to assess for coexisting behavioral, learning, or emotional problems is emphasized. A clinical case is presented to illustrate the diagnostic and assessment process in evaluating children for AD-HD.

Attention-deficit hyperactivity disorder: recent literature.

A review of the literature of attention-deficit hyperactivity disorder (ADHD) for the last four years shows parsimonious progress in research and on other fronts. Prospective studies are steadily replacing retrospective investigations, and the assessment of measures used to determine symptomatology and response to treatment is becoming increasingly sophisticated. A major development was the publication in 1987 of DSM-III-R, which significantly revised the diagnostic criteria for ADHD and reconceptualized ADHD and related disorders. The authors review this area along with questions about the validity of the classification, conditions associated with ADHD, current etiological theories, differential diagnosis, and treatment.