Effective Treatment Of Attention-deficit/hyperactivity Disorder Research Articles

EEG-Based Effective Connectivity Analysis for Attention Deficit Hyperactivity Disorder Detection Using Color-Coded Granger-Causality Images and Custom Convolutional Neural Network

Background: Attention deficit hyperactivity disorder (ADHD) is prevalent worldwide, affecting approximately 8-12% of children. Early detection and effective treatment of ADHD are crucial for improving academic, social, and emotional outcomes. Despite numerous studies on ADHD detection, existing models still lack accuracy distinguishing between ADHD and healthy control (HC) children. Methods: This study introduces an innovative methodology that utilizes granger causality (GC), a well-established brain connectivity analysis technique, to reduce the required EEG electrodes. We computed GC indexes (GCI) for the entire brain and specific brain regions, known as regional GCI, across different frequency bands. Subsequently, these GCIs were transformed into color-coded images and fed into a custom-developed 11-layer convolutional neural network. Results: The proposed model is evaluated through a five-fold cross-validation, achieving the highest accuracy of 99.80% in the gamma frequency band for the entire brain and an accuracy of 98.50% in distinguishing the theta frequency band of the right hemisphere of ADHD and HC children by only using eight electrodes. Conclusion: The proposed framework provides a powerful automated tool for accurately classifying ADHD and HC children. The study’s outcome demonstrates that the innovative proposed methodology utilizing GCI and a custom-developed convolutional neural network can significantly improve ADHD detection accuracy, improving affected children’s overall quality of life.

Sleep problems in children and adolescents in an attention deficit hyperactivity disorder service.

Sleep problems are common amongst children and adolescents with attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate sleep problems in children and adolescents attending a specialist ADHD service. This was a cross-sectional online survey combined with a retrospective chart review, conducted in the ADHD Assessment, Diagnosis, Management, initiation, Research and Education (ADMiRE) service, the first public specialist ADHD service for young people in Ireland. Participants were caregivers of children and adolescents with ADHD attending ADMiRE. Sleep was assessed using The Children's Sleep Habits Questionnaire (CSHQ) and ADHD symptoms were assessed using an abbreviated version of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV). Details regarding patient demographics, co-morbidities and medication were collected from patient records. Eighty-four percent of young people scored above the clinical cut-off for a sleep disorder. The most frequently reported sleep problems were related to sleep onset and sleep duration, and 64% of respondents met the criteria for two or more sleep problems. ADHD severity was associated with greater sleep problems. Co-morbid physical, neurodevelopmental, and mental health disorders as well as stimulant use were not associated with greater sleep problems. Sleep problems are very common amongst children and adolescents with ADHD. This study has demonstrated an association between more sleep problems and ADHD severity. These findings highlight the need for both effective ADHD treatment to ensure optional sleep in young people as well as effective interventions for sleep problems to prevent worsening of ADHD symptoms.

"Jing-Ning Granules" Can Alleviate Attention Deficit Hyperactivity Disorder in Rats by Modulating Dopaminergic D2/D1-Like Receptor-Mediated Signaling Pathways.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficit, hyperactivity, and impulsivity. Jing-Ning Granules (JNG) is a traditional Chinese medicine (TCM) that can alleviate ADHD. Although JNG is commonly used for the effective treatment of ADHD and has obtained the national invention patent, the exact mechanism of action remains unclear. In this study, we examined the effect and mechanism of JNG in spontaneously hypertensive rats (SHRs). We hypothesized that JNG affects dopaminergic D2/D1-like receptors and related pathways. Six rat groups were used in the experiment: Wistar-Kyoto rats (WKY, control group) and five SHR groups, including a model group; atomoxetine (ATX, positive control) group; and low, medium, and high-dose JNG groups. The corresponding treatments were daily administered to each group for 6 weeks. A behavioral test, including a step-down test and open field test (OFT), was carried out at the end of treatment. After the behavioral test, all animals were sacrificed, and the brain tissue was collected and analyzed ex vivo; histopathological analysis was performed to assess the pathological changes of the hippocampus; expression of D1-like and D2-like receptors, sensor protein calmodulin (CaM), protein kinase A (PKA), and calcium/calmodulin-dependent serine/threonine protein kinase (CaMKII) in the striatum and hippocampus was measured by western blot and real-time quantitative PCR (RT-PCR); cyclic adenosine monophosphate (cAMP) levels in the striatum were analyzed using an enzyme-linked immunosorbent assay (ELISA), while the level of Ca2+ in the striatum was analyzed by a calcium kit. Our results showed that ATX or JNG could ameliorate the hyperactive/impulsive behavior and cognitive function of ADHD by promoting neuroprotection. Mechanistically, ATX or JNG could prompt the expressions of Dl-like and D2-like receptors and improve the mRNA and protein levels of cAMP/PKA and Ca2+/CAM/CAMKII signaling pathways. These results indicate that JNG can produce therapeutic effects by regulating the balance of D2/D1-like receptor-mediated cAMP/PKA and Ca2+/CaM/CaMKII signaling pathways.

Experiences of neurofeedback therapists in treating attention-deficit hyperactivity disorder.

BackgroundNeurofeedback is a neurostimulatory biofeedback behavioural therapy that regulates brain wave levels for optimal cognitive functioning. It has shown promising results for the treatment of attention-deficit hyperactivity disorder (ADHD).AimTo explore and describe the experiences of neurofeedback therapists (NTs) using neurofeedback to treat children and adults with ADHD and their experience of its role and value in treating this condition.SettingInterviews were conducted in participants’ private consultation rooms in Gauteng, South Africa.MethodsIn this qualitative study using a descriptive phenomenological approach, six registered NTs with experience of treating ADHD were interviewed. Participants were asked: ‘Tell me about your experiences of neurofeedback with ADHD patients in your practice.’ Responses were audio-recorded, transcribed and underwent thematic analysis.ResultsParticipants experienced neurofeedback as an effective treatment for ADHD and other coexisting conditions, such as anxiety and insomnia. Participants felt that the neurofeedback process facilitates a beneficial therapeutic relationship and integrates well with other treatment methods. Challenges faced in practice included certain underlying comorbidities, home environment, poor patient compliance and NTs’ level of expertise, which impact treatment outcomes.ConclusionNeurofeedback therapists expressed an overall positive perception of the value of neurofeedback to reduce ADHD symptom severity and improve quality of life, particularly when used as part of a multimodal approach. Participants identified a need for further education and awareness regarding the use of neurofeedback for ADHD.ContributionThis study has contributed to our understanding of the role of neurofeedback in treating ADHD in the South African setting.

The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review.

Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.

How Are Attention-deficit Hyperactivity and Internet Gaming Disorders Related in Children and Youth?

This review addresses important practical questions facing clinicians regarding internet gaming disorder (IGD) and attention-deficit/hyperactivity disorder (ADHD) in children and youth (C-Y). The authors investigated data concerning the risk that C-Y who have ADHD will develop IGD, whether effective treatment of ADHD positively influences the course of IGD in C-Y who have both, and other findings that might be of benefit to clinicians who treat C-Y with these conditions. We conducted a literature review using 4 databases: PubMed, Scopus, PsychInfo, and Embase. C-Y with ADHD are at greater risk for developing IGD than those without ADHD. A close association exists between the severity of ADHD symptoms and the severity of IGD. It is unknown what proportion of C-Y with ADHD will develop IGD during their developmental trajectory; however, C-Y with IGD are at risk for developing ADHD, and ADHD can also increase the vulnerability of C-Y to IGD. Adolescents with ADHD and IGD have greater deficits in social skills than those with ADHD but no IGD. Lower parental occupational and socioeconomic status and poor family relationships are associated with more severe IGD symptoms. Atomoxetine and methylphenidate are equally effective in alleviating IGD symptoms comorbid with ADHD. C-Y with ADHD are at increased risk for developing IGD compared with C-Y without ADHD, but it has not been determined at what developmental stage IGD is likely to emerge. Since IGD and ADHD are strongly associated, it is imperative to consider ADHD as a significant risk factor for IGD and vice versa, which can help psychiatrists be alert for early signs of IGD and manage them accordingly.

Cognitive Skill Enhancement System Using Neuro-Feedback for ADHD Patients

The National Health Interview Survey (NHIS) shows that there are 13.2% of children at the age of 11 to 17 who are suffering from Attention Deficit Hyperactivity Disorder (ADHD), globally. The treatment methods for ADHD are either psycho-stimulant medications or cognitive therapy. These traditional methods, namely therapy, need a large number of visits to hospitals and include medication. Neurogames could be used for the effective treatment of ADHD. It could be a helpful tool in improving children and ADHD patients’ cognitive skills by using Brain–Computer Interfaces (BCI). BCI enables the user to interact with the computer through brain activity using Electroencephalography (EEG), which can be used to control different computer applications by processing acquired brain signals. This paper proposes a system based on neurofeedback that can improve cognitive skills such as attention level, mediation level, and spatial memory. The proposed system consists of a puzzle game where its complexity increases with each level. EEG signals were acquired using the Neurosky headset; then sent the signals to the designed gaming environment. This neurofeedback system was tested on 10 different subjects, and their performance was calculated using different evaluation measures. The results show that this game improves player overall performance from 74% to 98% by playing each game level.

Association of methylphenidate use and traditional and cyberbullying in adolescents with ADHD.

This study aimed to determine whether there is a difference in terms of traditional/cyberbullying or victimization among adolescents receiving methylphenidate for attention-deficit/hyperactivity disorder (ADHD) and treatment-naïve adolescents with ADHD during a 1-year period. The Sociodemographic Data Form, Schedule for Affective Disorders and Schizophrenia for School-Aged Children (Present and Lifetime Version), Peer Bullying Scale-Adolescent Form and the Cyberbully/Victim Scale were administered to male adolescents with ADHD. Adolescents who did not receive methylphenidate during the last 1-year were exposed to higher rates of physical victimization, isolation, destroying of property by others, and sexual victimization, all of which are subtypes of traditional victimization; they also reported higher rates of destroying others' property. Furthermore, cyberbullying victimization and cyberbullying behaviors were more common in the non-treated group. Effective treatment of ADHD could lessen involvement in the bullying cycle in adolescents with ADHD.

ADHD Diagnosis and Treatment Guidelines: A Historical Perspective.

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.

A cross sectional survey of adherence, perceived efficacy and side effects of methylphenidate among children at a teaching hospital in Sri Lanka

Introduction Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric condition in childhood, which if untreated may have a negative effect on education, peer relationships and family disharmony. Methylphenidate is an effective treatment for ADHD, although its use is limited by poor compliance and side effects. Studies on effects of side effects on efficacy, and adherence of methylphenidate in developing countries are scarce. Methods We assessed the adherence, efficacy, and side effects of methylphenidate in children and adolescents treated at a child and adolescent psychiatry clinic of North Colombo Teaching Hospital, Ragama. We gathered information from guardians of the children treated with methylphenidate for at least 2 months, using an interviewer administered questionnaire. Results Among the 149 participants, a majority were males and the mean age of the population was 10.4 years. More than 52% participants reported 100% compliance with methylphenidate, but only 12% complied with non-pharmacological therapies. While 75% believed the medication to be effective, only 17% perceived psychosocial strategies to be useful. Poor appetite (44%) was the most common side effect of methylphenidate and 43% did not report any side effect. There was a negative correlation between compliance with methylphenidate and the occurrence of poor appetite, as well as with not increasing the initial dose. Discussion The results of this study suggest that methylphenidate is an effective and well-tolerated treatment for children in Sri Lanka with ADHD.

ADHD is associated with migraine: a systematic review and meta-analysis.

An association between primary headaches and attention-deficit/hyperactivity disorder (ADHD) has long been suggested. Moreover, headache is regarded as a common side effect of stimulants, the most effective treatment for ADHD. So far, no systematic review has evaluated the potential association between ADHD and headache. We performed a systematic review of the literature and a meta-analysis of all reported studies on ADHD and primary headaches. Our analysis showed a positive association between ADHD and migraine (OR 1.322, 95% CI 1.018-1717, p value 0.036), but not with tension-type headache. There is a significant association between migraine and ADHD. The mechanisms underlying this association remain to be elucidated, warranting further studies.

Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic psychiatric disorder characterized by hyperactivity and/or inattention and is often associated with a substantial impact on psychosocial functioning. Methylphenidate (MPH), a central nervous system stimulant, is commonly used for pharmacological treatment of adults and children with ADHD. Current practice guidelines recommend optimizing MPH dosage to individual patient needs; however, the clinical benefits of individual dose optimization compared with fixed-dose regimens remain unclear. Here we review the available literature on MPH dose optimization from clinical trials and real-world experience on ADHD management. In addition, we report safety and efficacy data from the largest MPH modified-release long-acting Phase III clinical trial conducted to examine benefits of dose optimization in adults with ADHD. Overall, MPH is an effective ADHD treatment with a good safety profile; data suggest that dose optimization may enhance the safety and efficacy of treatment. Further research is required to establish the extent to which short-term clinical benefits of MPH dose optimization translate into improved long-term outcomes for patients with ADHD.

Non-Pharmacological treatment of ADHD across the lifespan

Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences over the lifespan. Given this background, there is a need for an effective treatment of ADHD patients.In the lecture, evidence-based psychosocial interventions for ADHD will be presented.Disclosure of interestBooks and articles on ADHD.Ad Boards, Phase-III Studies on ADHD in the last five years.

Effective treatment of attention-deficit hyperactivity disorder also helps control symptoms of comorbid oppositional defiant disorder

The most common comorbidity of attention-deficit hyperactivity disorder (ADHD) is oppositional defiant disorder (ODD), and children with this combination have increased symptom severity and impairment. Treatment strategies include education, behavioural management therapy approaches, providing school and academic supports, and the use of stimulant or non-stimulant ADHD medications, depending on symptom severity and consideration of child and parental wishes. Effective ADHD treatment is also helpful for comorbid ODD symptoms.

A study of pathway of care in children and adolescents with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India. 57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma. The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%). Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents.

Predicted effect size of lisdexamfetamine treatment of attention deficit/hyperactivity disorder (ADHD) in European adults: Estimates based on indirect analysis using a systematic review and meta-regression analysis

BackgroundThere are few approved therapies for adults with attention-deficit/hyperactivity disorder (ADHD) in Europe. Lisdexamfetamine (LDX) is an effective treatment for ADHD; however, no clinical trials examining the efficacy of LDX specifically in European adults have been conducted. Therefore, to estimate the efficacy of LDX in European adults we performed a meta-regression of existing clinical data. MethodsA systematic review identified US- and Europe-based randomized efficacy trials of LDX, atomoxetine (ATX), or osmotic-release oral system methylphenidate (OROS-MPH) in children/adolescents and adults. A meta-regression model was then fitted to the published/calculated effect sizes (Cohen's d) using medication, geographical location, and age group as predictors. The LDX effect size in European adults was extrapolated from the fitted model. Sensitivity analyses performed included using adult-only studies and adding studies with placebo designs other than a standard pill-placebo design. ResultsTwenty-two of 2832 identified articles met inclusion criteria. The model-estimated effect size of LDX for European adults was 1.070 (95% confidence interval: 0.738, 1.401), larger than the 0.8 threshold for large effect sizes. The overall model fit was adequate (80%) and stable in the sensitivity analyses. ConclusionThis model predicts that LDX may have a large treatment effect size in European adults with ADHD.

Long-Term Effects of Stimulant Treatment for ADHD: What Can We Tell Our Patients?

Stimulant medication is a well-researched treatment for attention deficit hyperactivity disorder (ADHD) and is among the most effective treatments in psychiatry. Parents often want to know more about the long-term risks and benefits of medication. Our objective was to review the seminal papers on long-term outcomes of stimulant treatment for ADHD for the purpose of providing clinicians with the background they need to interpret these findings for patients. We reviewed key articles on long-term outcome of symptoms, comorbidity, substance use, executive functioning, academics, side effects, neurobiology, functioning, and quality of life. Stimulants are very effective medications in the short term when used optimally. Long-term randomized, placebo-controlled studies are not feasible. Long-term naturalistic studies are limited by absence of controls. When administered properly with careful titration, follow-up, and dose adjustment, stimulants are a safe and effective treatment for ADHD with minimal long-term risk and possible long-term benefit.

Stimulation of postsynapse adrenergic α2A receptor improves attention/cognition performance in an animal model of attention deficit hyperactivity disorder

A 5-trial inhibitory avoidance test using spontaneously hypertensive rat (SHR) pups has been used as an animal model of attention deficit hyperactivity disorder (ADHD). However, the roles of noradrenergic systems, which are involved in the pathophysiology of ADHD, have not been investigated in this model. In the present study, the effects of adrenergic α2 receptor stimulation, which has been an effective treatment for ADHD, on attention/cognition performance were investigated in this model. Moreover, neuronal mechanisms mediated through adrenergic α2 receptors were investigated. We evaluated the effects of both clonidine, a non-selective adrenergic α2 receptor agonist, and guanfacine, a selective adrenergic α2A receptor agonist, using a 5-trial inhibitory avoidance test with SHR pups. Juvenile SHR exhibited a shorter transfer latency, compared with juvenile Wistar Kyoto (WKY) rats. Both clonidine and guanfacine significantly prolonged the transfer latency of juvenile SHR. The effects of clonidine and guanfacine were significantly blocked by pretreatment with an adrenergic α2A receptor antagonist. In contrast, the effect of clonidine was not attenuated by pretreatment with an adrenergic α2B receptor antagonist, or an adrenergic α2C receptor antagonist, while it was attenuated by a non-selective adrenergic α2 receptor antagonist. Furthermore, the effects of neither clonidine nor guanfacine were blocked by pretreatment with a selective noradrenergic neurotoxin. These results suggest that the stimulation of the adrenergic α2A receptor improves the attention/cognition performance of juvenile SHR in the 5-trial inhibitory avoidance test and that postsynaptic, rather than presynaptic, adrenergic α2A receptor is involved in this effect.

Is methylphenidate useful for teenagers with attention deficit/hyperactivity disorder (ADHD)?

Evidence-Based Answer Methylphenidate is an effective treatment for ADHD in teenagers (SOR: B, meta-analysis and RCT). Stimulants, including methylphenidate, have also been found to decrease substance use and cigarette smoking in teenagers with ADHD (SOR: B, prospective study).

A Meta-analysis of the Consistency of Atomoxetine Treatment Effects in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder from 15 Clinical Trials Across Four Geographic Regions

Atomoxetine has been approved as a treatment for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in the United States, throughout Europe, and in other countries. This meta-analysis was to assess the consistency of the treatment effect of atomoxetine across four global geographic regions. Data from 15 acute, double-blind, placebo-controlled trials were pooled (2 in Asia, 4 in Europe, 8 in North America, and 1 in Russia), yielding 2569 pediatric patients with ADHD. Improvements during 6-10 weeks of atomoxetine treatment were evaluated using the ADHD Rating Scale-IV or the Swanson, Nolan, and Pelham Scale-Revised. Consistency across regions was assessed by an interaction test and Higgins I(2). Consistency of one region versus other regions was assessed by effect sizes of individual regions and pairwise differences. Patient demographics were generally similar across regions. More patients from Asia met diagnostic criteria for ADHD inattentive subtype and fewer for combined subtype compared with patients from Europe, North America, or Russia. Asian patients had a lower mean baseline ADHD total score and mean hyperactivity/impulsivity subscore. Treatment effects showed marginal inconsistency and moderate heterogeneity among the regions (percentage of patients achieving a 40% decrease from baseline ADHD scores, atomoxetine versus placebo: Asia 39.6%, 24.0%; Europe 40.2%, 12.1%; North America 45.3%, 21.7%; Russia 54.2%, 33.3%). Inconsistency was observed primarily in Asia versus the other regions. Completion rates with atomoxetine were higher in Asia and Russia (94.4% and 94.3%, respectively) than in Europe (84.3%) or North America (80.4%). Atomoxetine was demonstrated as an effective treatment for ADHD in 15 clinical trials from four global regions. The current meta-analysis has revealed a degree of heterogeneity in treatment efficacy across regions, most notably in the comparison of Asian patients relative to those from the other regions.