Higher Hyperactivity Scores Research Articles

A prospective analysis of physical activity and mental health in children: the GECKO Drenthe cohort

BackgroundMental health problems in young people have become a global health burden. The positive effects of physical activity on mental health in adults are well known but still not clear in children. The aim of this study was to investigate to what extent physical activity in early childhood would affect mental health in middle childhood.MethodsFrom the Dutch GECKO Drenthe birth cohort, 850 children (51.5% boys) were enrolled in this analysis. Physical activity and sedentary time were measured at age 5–6 using ActiGraph GT3X. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) at age 5–6 and age 10–11. Multiple linear regression models were used to estimate the associations between physical activity, sedentary time and SDQ subscales, stratified by gender, adjusting for age, BMI, maternal education level, family size, accelerometer wear time and season, and additionally adjusting for SDQ scores at age 5–6 to take tracking of mental health over time into account.ResultsGreater physical activity volume at age 5–6 was associated with lower peer problems scores at age 10–11 in boys and girls. An increase in MVPA was associated with lower peer problems scores in boys (b = -0.445, -0.713 to -0.176) and girls (b = -0.354, -0.601 to -0.107), however, increased sedentary time was linked to higher peer problems scores in boys (b = 1.18, 0.455 to 1.906) and girls (b = 0.870, 0.191 to 1.550). For hyperactivity, higher levels of physical activity volume and MVPA were associated with higher hyperactivity scores in boys. Increased sedentary time was related to lower hyperactivity scores in boys. Further adjustment for SDQ scores at age 5–6 attenuated associations between physical activity and hyperactivity in boys but hardly changed the relationships with peer problems. No significant associations between physical activity and other SDQ subscales or total difficulties scores were observed, neither in boys nor in girls.ConclusionsChildren who are more physically active at age 5–6 have fewer peer problems at age 10–11, and for boys, greater activity levels at age 5–6 could be an indicator of hyperactivity at age 10–11.

Simultaneous exposure to both Zika virus and household insecticides during pregnancy, and fetal growth and infant developmental behavior outcomes at 18 months, in Guadeloupe

BackgroundPerinatal infection with Zika virus (ZIKV) could result in adverse growth, developmental and behavioral outcomes, while insecticides used to control mosquitoes are neurotoxic. ObjectivesWe aim to study the role played by exposure during pregnancy to both ZIKV and household insecticides in newborn health, development and behavior at age of 18 months. MethodsMaternal and cord blood samples from a cohort of pregnant women (created during Guadeloupe's Zika epidemic of 2016) were used to identify ZIKV infection during pregnancy. A self-administered questionnaire at birth documented prenatal household use of insecticides. Birth weight and head circumference were collected from maternity records (n = 708). Infant development and behaviors were documented at 18 months of age through the Ages and Stages Questionnaire and the Quebec Longitudinal Study of Child Development (n = 409). Logistic and linear regression models were performed, taking into account confounding factors. ResultsUse of household insecticides was associated with smaller head circumference and lower birth weight among newborns from mothers not exposed to ZIKV: 0.3 cm (95% CI: 0.6, 0) and −82 g (95% CI: 165, 0), respectively. Similar decreases were observed with ZIKV exposure among mothers not reporting household insecticides use, and with presence of both exposures. The combined presence of ZIKV exposure and insecticide use was associated with lower ASQ fine motor scores (−3.9; 95% CI: 7.3, −0.4), and higher hyperactivity scores (0.8; 95% CI: 0.0, 1.5), compared to no exposure to either. A higher opposition score was observed in association with ZIKV exposure among non-users of insecticide (0.6; 95% CI: 0.0, 1.2). ConclusionAdverse neurodevelopmental outcomes at 18 months of age were observed with prenatal ZIKV exposure, and with higher magnitude when mothers reported use of household insecticides. At birth, rates of adverse fetal growth were however similar for the combined presence of exposure and either of the exposures.

Gestational Age at Term and Teacher-Reported Attention-Deficit Hyperactivity Disorder Symptom Patterns

The objective of this study was to estimate associations between gestational age and teacher-reported attention-deficit hyperactivity disorder (ADHD)-related symptom patterns at age 9 years among children born at term (37-41weeks). A secondary data analysis of approximately 1400 children in the Fragile Families and Child Wellbeing study, a US birth cohort study that oversampled nonmarital births, was conducted. At age 9 years, students were evaluated by their teachers using the Conners Teacher Rating Scale-Revised Short Form that included subscales for symptoms of hyperactivity, ADHD, oppositional behavior, and cognitive problems/inattention. Unadjusted and adjusted negative binomial and logistic regression models of associations between gestational age and teacher-reported scores were estimated. Each week of gestational age at term was associated with hyperactivity scores that were 6% lower (adjusted incidence rate ratio [IRR]: 0.94; 95% CI: 0.89-0.99) and ADHD and cognitive problems/inattention scores that were 5% lower (adjusted IRR: 0.95; 95% CI: 0.91-0.98 in both cases). Early-term birth (37-38weeks) was associated with 23% higher hyperactivity scores (adjusted IRR: 1.23; 95% CI:1.07-1.41), 17% higher ADHD scores (adjusted IRR: 1.17; 95% CI: 1.05-1.30), and ∼50% higher odds of scoring 1.5+ SDs above the sample mean for hyperactivity (aOR: 1.51; 95% CI: 1.05-2.18) when compared with birth at 39-41weeks. There were no significant associations between gestational age and oppositional behavior scores. The findings add to growing evidence supporting current recommendations for delaying elective deliveries to at least 39weeks and suggest that regular screenings for ADHD symptoms are important for children born at 37- to 38-weeks gestation.

Impaired early information processing in adult ADHD: a high-density ERP study

BackgroundChildren with attention-deficit/hyperactivity disorder (ADHD) often demonstrate sensory processing difficulties in the form of altered sensory modulation, which may contribute to their symptomatology. Our objective was to investigate the neurophysiological correlates of sensory processing deficits and the electrophysiological characteristics of early information processing in adult ADHD, measured by the P1 event-related potential (ERP).MethodsWe obtained ERPs during a Go/NoGo task from 26 adult patients with ADHD and 25 matched controls using a high-density 128-channel BioSemi ActiveTwo recording system.ResultsADHD patients had a significantly reduced P1 component at occipital and inferotemporal scalp areas compared to controls. The reduction was associated with inattention and hyperactivity symptom severity, as measured by the Conners’ Adult ADHD Rating Scale. ADHD patients with higher inattention scores had significantly smaller P1 amplitudes at posterior scalp sites, while higher hyperactivity scores were associated with higher P1 amplitudes.ConclusionsDeficits in early sensory processing, as measured by the P1 ERP component, are present in adult ADHD patients and are associated with symptom severity. These findings are suggestive of bottom-up cognitive deficits in ADHD driven by impairments in early visual processing, and provide evidence that sensory processing problems are present at the neurophysiological level in this population.

Atypical gamma functional connectivity pattern during light sleep in children with attention deficit hyperactivity disorder

IntroductionWe examined functional connectivity analyses in electroencephalograms (EEGs) of patients with attention deficit hyperactivitydisorder (ADHD) and in those of typically developing children (TDC) to uncover neurobiological abnormalities. MethodologyWe enrolled 31 children with ADHD (mean age 11.1 years; 23 boys) and 17 sex-, age-, and intelligence-matched TDC to undergo 19-channel EEGs during light sleep. We estimated functional connectivity using the phase lag index (PLI) and coherence measurements that capture the synchronization of EEG signals and graphed metrics with GRETNA. We also performed continuous performance tests (CPTs) on the children and obtained answered questionnaires on ADHD and autism spectrum disorder. ResultsThe central-to-posterior gamma PLI was lower in children with ADHD than that in TDC. The other PLI frequency bands and all coherence frequency bands were not statistically different between both groups. Individuals with high hyperactivity scores on questionnaires and low reaction times (SDs) on CPT had low motor and occipital pairs of gamma PLIs. Graph metrics showed no differences between the groups. ConclusionsThe difference in averaged gamma PLI (especially with motor and occipital pairs) between groups was more suitable for diagnosis than the averaged coherence. Lower averaged gamma PLIs reflected more severe ADHD symptoms. A prospective study with more controlled conditions is warranted to determine if gamma-band PLI can be used as an auxiliary tool for ADHD diagnosis.

Mental health and risk behaviors of children in rural China with different patterns of parental migration: a cross-sectional study

BackgroundOne in seven members of China’s population are migrants. There are an estimated 41 million children left behind in rural areas who are living without one or both of their parents. The impact of two- and single-parent migration on child mental health and risk behaviors is unclear. The aim of this study was to compare the mental health and risk behaviors among children whose parents are either both migrating (B-LBC), have one parent migrating (O-LBC) or those whose parents do not migrate (N-LBC).MethodsThis study was a cross-sectional survey using a self-administered questionnaire conducted in rural areas with high proportions of left behind children (LBC) in Anhui Province, southeast China. The tools used were the Strength and Difficulties Questionnaires, Youth Risk Behavior Survey and the Young’s Internet Addiction Test for Chinese.ResultsFull data were available for 699 B-LBC, 552 O-LBC and 741 N-LBC. After adjusting for gender, age, grade, number of siblings and self-rated socio-economic status, B-LBC were significantly more likely to have higher emotional symptoms scores (B(SE) = 0.36(0.11), p < 0.01), higher hyperactivity scores (B(SE) = 0.22(0.11), p < 0.01) and higher total difficulties scores (B(SE) = 0.79(0.29), p < 0.01) than N-LBC. B-LBC were also more likely to be an addicted internet user (OR(95%CI) = 1.91(1.33, 2.76), p < 0.01) compared to N-LBC. However, there were no identified differences between O-LBC and N-LBC or between O-LBC and B-LBC in any measures.ConclusionsOur findings found that living with one parent or both parents was associated with better mental health and fewer risk behaviors than was being separated from both parents. Future research is needed to consider the implications of these findings for policies and programs to protect LBC, especially for those with two migrating parents.

Initiation of the Hypothalamic-Pituitary-Gonadal Axis in Young Girls Undergoing Central Precocious Puberty Exerts Remodeling Effects on the Prefrontal Cortex.

Central precocious puberty (CPP) has been shown to exert significant effects on psychosocial development. These early puberty-related hormones and psychosocial functional changes are considered to be associated with specific brain development. However, the biological mechanisms underlying the sculpting of human brain architecture and modulation of psychosocial transformation by puberty-related hormonal maturation remain elusive, especially during the early phase of CPP. The current investigation aims to specify the brain regions in which early hormone-related maturation effects occur during CPP and their relationships with psychological functions. 65 young girls (aged 4.3–8.0 years) underwent structural imaging on a 3T MR system, completed psychological tests and performed the gonadotropin-releasing hormone (GnRH) stimulation test to identify hormonal manifestations of hypothalamic–pituitary–gonadal axis (HPG axis) activation. Based on the GnRH test, 28 young girls were identified with CPP, whereas the other 37 girls were identified with non-central precocious puberty (NCPP). Cortical parameters were calculated and compared between the two groups after adjusting for age, weight, and height. Brain regions showing group differences were extracted and correlated with serum hormone levels and psychological parameters. The CPP girls showed thinner cortices primarily in the right rostral middle frontal cortex. This morphological difference was positively correlated with stimulated estradiol (E2) levels. Further, higher E2 levels were significantly associated with higher hyperactivity scores. Premature HPG axis activation in CPP girls at an early stage appears to exert remodeling effects on brain anatomy, primarily in the prefrontal cortex, which may affect psychological development following the emergence of robust changes in sex hormones.

Prenatal and Postnatal PCB-153 and p,p'-DDE Exposures and Behavior Scores at 5–9 Years of Age among Children in Greenland and Ukraine.

Background:Studies have reported some evidence of adverse effects of organochlorine exposures on child development, but the results have been inconsistent, and few studies have evaluated associations with child behavior.Objective:We investigated the association between prenatal and early-life exposures to 2,2′,4,4′,5,5′-hexachlorobiphenyl (PCB-153) and 1,1-dichloro-2,2-bis(p-chlorophenyl)-ethylene (p,p′-DDE) and behaviors in children between 5 and 9 y of age.Methods:In the Biopersistent organochlorines in diet and human fertility: Epidemiologic studies of time to pregnancy and semen quality in Inuit and European populations (INUENDO) cohort, consisting of mother–child pairs from Greenland and Ukraine (), maternal serum PCB-153 and p,p′-DDE concentrations were measured during pregnancy, and cumulative postnatal exposures during the first 12 months after delivery were estimated using a pharmacokinetic model. Parents completed the Strengths and Difficulties Questionnaire (SDQ), and children’s behaviors were dichotomized as abnormal (high) versus normal/borderline for five SDQ subscales and the total difficulties score.Results:The total difficulties score, an overall measure of abnormal behavior, was not clearly associated with pre- or postnatal exposures to PCB-153 or to p,p′-DDE. However, pooled adjusted odds ratios (ORs) for high conduct problem scores with a doubling of exposure were 1.19 (95% CI: 0.99, 1.42) and 1.16 (95% CI: 0.96, 1.41) for pre- and postnatal PCB-153, respectively, and 1.25 (95% CI: 1.04, 1.51) and 1.24 (95% CI: 1.01, 1.51) for pre- and postnatal p,p′-DDE, respectively. Corresponding ORs for high hyperactivity scores were 1.24 (95% CI: 0.94, 1.62) and 1.08 (95% CI: 0.81, 1.45) for pre- and postnatal PCB-153, respectively, and 1.43 (95% CI: 1.06, 1.92) and 1.27 (95% CI: 0.93, 1.73) for pre- and postnatal p,p′-DDE, respectively.Conclusion:Prenatal and early postnatal exposures to p,p′-DDE and PCB-153 were associated with a higher prevalence of abnormal scores for conduct and hyperactivity at 5–9 y of age in our study population. These findings provide further support for the importance of minimizing organochlorine exposures to young children and to women of childbearing age. https://doi.org/10.1289/EHP553

Manual morphometry of hippocampus and amygdala in adults with attention-deficit hyperactivity disorder

Previous studies have pointed to the involvement of limbic structures in the genesis of attention deficit hyperactivity disorder (ADHD). The present researchers manually segmented magnetic resonance images of 30 individuals with ADHD and 30 individually matched controls, focusing on amygdala and hippocampus volumes. Neither hippocampus nor amygdala volume differed significantly between individuals with and without ADHD. However, ADHD patients with higher hyperactivity scores had significantly smaller left amygdala volumes. This finding suggests that limbic alterations are significant in hyperactive symptoms in the pathophysiology of ADHD.

Prenatal exposure to perfluoroalkyl substances (PFASs) and ADHD-related behaviors in 3 year old children

Introduction Perfluoroalkyl substances (PFASs) are ubiquitous in human sera, and have been associated with ADHD in some but not all epidemiology studies. Few studies have examined associations between prenatal PFAS exposures and ADHD-related behaviors in children. Methods We measured plasma levels of perfluorooctanoate (PFOA), perfluorooctanesulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) in first trimester pregnant women from 6 Canadian cities. Child behavior at 3 years was assessed with the Behavioral Assessment System for Children (BASC-2, maternal report). We used linear regression with generalized estimating equations to estimate associations of prenatal log2 PFAS levels with hyperactivity and inattention (mean:50, SD:10), adjusting for maternal age, race, education, income, parity, marital status, smoking during pregnancy, alcohol during pregnancy, folic acid, and child sex (n=790). We also examined differences by child sex. Results Geometric means for PFHxS, PFOA and PFOS in plasma were 1.1, 1.7, and 4.7 ng/mL. PFHxS was significantly associated (p&lt;0.05) with higher scores [β (95% CI)] for hyperactivity [0.3 (0.0, 0.6)] in all children combined. Associations between PFOA and hyperactivity were null with all children combined [0.0 (-0.5, 0.5)], but were highly sex-specific, with lower scores in boys and higher scores in girls [Boys: -0.9 (-1.4, -0.3); Girls: 0.9 (0.2,1.6), p interaction &lt;0.01]. A similar pattern was found for PFOS and hyperactivity [Boys: -0.3 (-0.9, 0.2); Girls: 1.0 (0.3, 1.7), p interaction &lt;0.01]. None of the PFASs were associated with attention scores. Conclusions In a Canadian cohort with low PFAS exposure, PFHxS was associated with higher hyperactivity scores in 3 yr children. PFOA and PFOS were associated with lower hyperactivity scores in boys, and higher hyperactivity scores in girls. No associations were found with attention. Our results suggest that PFASs may be associated with hyperactive-type ADHD behaviors, especially in girls.

Prenatal polybrominated diphenyl ether exposures and neurodevelopment in U.S. children through 5 years of age: the HOME study.

Background: Polybrominated diphenyl ethers (PBDEs) are persistent chemicals that have been widely used as flame retardants in furniture, carpet padding, car seats, and other consumer products during the past three decades.Objective: We examined whether in utero exposure to PBDEs is associated with child cognitive function and behavior in a U.S. study sample.Methods: In a prospective birth cohort, we measured maternal serum concentrations of BDE-47 and other PBDE congeners in 309 women at 16 weeks of gestation during 2003–2006 and followed their children in Cincinnati, Ohio. We measured cognitive and motor abilities using the Bayley Scales of Infant Development-II at ages 1, 2, and 3 years; intelligence using the Wechsler Preschool and Primary Scale of Intelligence-III at age 5 years; and children’s behaviors using the Behavioral Assessment System for Children-2 annually at ages 2–5 years. We used linear mixed models or generalized estimating equations with adjustment for potential confounders to estimate associations between these outcomes and log10-transformed PBDE concentrations.Results: The geometric mean of BDE-47 in maternal serum (20.1 ng/g lipid) was comparable with U.S. adult national reference values. Prenatal BDE-47 was not significantly associated with Bayley Mental or Psychomotor Development Indices at 1–3 years, but a 10-fold increase in prenatal BDE-47 was associated with a 4.5-point decrease (95% CI: –8.8, –0.1) in Full-Scale IQ and a 3.3-point increase (95% CI: 0.3, 6.3) in the hyperactivity score at age 5 years.Conclusions: Prenatal exposure to PBDEs was associated with lower IQ and higher hyperactivity scores in children.Citation: Chen A, Yolton K, Rauch SA, Webster GM, Hornung R, Sjödin A, Dietrich KN, Lanphear BP. 2014. Prenatal polybrominated diphenyl ether exposures and neurodevelopment in U.S. children through 5 years of age: the HOME study. Environ Health Perspect 122:856–862; http://dx.doi.org/10.1289/ehp.1307562

Traffic-Related Air Pollution Exposure in the First Year of Life and Behavioral Scores at 7 Years of Age

Background: There is increasing concern about the potential effects of traffic-related air pollution (TRAP) on the developing brain. The impact of TRAP exposure on childhood behavior is not fully understood because of limited epidemiologic studies.Objective: We explored the association between early-life exposure to TRAP using a surrogate, elemental carbon attributed to traffic (ECAT), and attention deficit/hyperactivity disorder (ADHD) symptoms at 7 years of age.Methods: From the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort we collected data on exposure to ECAT during infancy and behavioral scores at 7 years of age. Children enrolled in CCAAPS had at least one atopic parent and a birth residence either < 400 m or > 1,500 m from a major highway. Children were followed from infancy through 7 years of age. ECAT exposure during the first year of life was estimated based on measurements from 27 air sampling sites and land use regression modeling. Parents completed the Behavioral Assessment System for Children, 2nd Edition, when the child was 7 years of age. ADHD-related symptoms were assessed using the Hyperactivity, Attention Problems, Aggression, Conduct Problems, and Atypicality subscales.Results: Exposure to the highest tertile of ECAT during the child’s first year of life was significantly associated with Hyperactivity T-scores in the “at risk” range at 7 years of age, after adjustment [adjusted odds ratio (aOR) = 1.7; 95% CI: 1.0, 2.7]. Stratification by maternal education revealed a stronger association in children whose mothers had higher education (aOR = 2.3; 95% CI: 1.3, 4.1).Conclusions: ECAT exposure during infancy was associated with higher Hyperactivity scores in children; this association was limited to children whose mothers had more than a high school education.

Neurodevelopment after moderate hyperbilirubinemia at term

The aim of this work was to investigate in a prospective study whether moderate hyperbilirubinemia in healthy term neonates is associated with an increase of minor neurological dysfunction (MND) and behavioral problems up to 18 mo. We enrolled 43 healthy term infants with a bilirubin level ≥ 220 µmol/l (BILI group) at 72-96 h postnatally at the University Medical Center Groningen (UMCG), including eight referrals for hyperbilirubinemia. Seventy healthy term infants born at the UMCG with bilirubin level <220 µmol/l served as comparisons (COMP group). We evaluated the neurologic condition neonatally and at 3 and 18 mo; behavior was evaluated at birth and 18 mo. Rates of MND in BILI and COMP groups were similar at all ages. However, bilirubin levels of ≥ 300 µmol/l (n = 10) were associated with an increased risk of complex MND (odds ratio: 4.21; 95% confidence interval: 1.02-17.37). Neonatally, BILI infants were more often lethargic than COMP infants (odds ratio: 3.54; 95% confidence interval: 1.32-9.51); at 18 mo, they had higher hyperactivity scores (effect: 0.32; 95% confidence interval: 0.08-0.56). Occurrence of complex MND at 18 mo in infants with moderate hyperbilirubinemia was not different from that in comparison infants, but bilirubin level ≥ 300 was associated with an increased risk of complex MND. This study also suggests that minor behavioral effects of moderate hyperbilirubinemia cannot be excluded.

Short Nighttime Sleep-Duration and Hyperactivity Trajectories in Early Childhood

Our objectives were to investigate the developmental trajectories of nighttime sleep duration and hyperactivity over the preschool years and to identify the risk factors associated with short nighttime sleep duration and high hyperactivity scores. Nighttime sleep duration and hyperactivity were measured yearly by questionnaires administered to mothers of 2057 children from age 1.5 to 5 years. Developmental trajectories of nighttime sleep duration and hyperactivity throughout early childhood were analyzed to determine interassociations. A multinomial logistic regression was performed to determine which factors among selected child, maternal, and family characteristics and parental practices surrounding sleep periods in early childhood were associated with short nighttime sleep duration and high hyperactivity scores. The trajectories of nighttime sleep duration and hyperactivity were significantly associated. The odds ratio (OR) of reporting short nighttime sleep duration was 5.1 for highly hyperactive children (confidence interval [CI]: 3.2-7.9), whereas the OR of reporting high hyperactivity scores was 4.2 for persistently short sleepers (CI: 2.7-6.6). The risk factors for reporting short nighttime sleep duration and high hyperactivity scores were (1) being a boy, (2) having insufficient household income, (3) having a mother with a low education, and (4) being comforted outside the bed after a nocturnal awakening at 1.5 years of age. The risk of short nighttime sleep duration in highly hyperactive children is greater than the risk of high hyperactivity scores in short sleepers. Preventive interventions that target boys living in adverse familial conditions could be used to address these concomitant behavioral problems.

Host Factors and Childhood Injury: The Influence of Hyperactivity and Aggression

This study examined the association between hyperactivity, aggression, and unintentional childhood injury among a cohort of children aged 5-12 years. Participants were recruited utilizing a two-tier randomization process from primary schools in Brisbane, the capital city of Queensland, Australia. Information on hyperactivity and aggression was collected by trained interviewers using a semi structured questionnaire and episodes of injury were reported by parents using an injury event report form. Eight hundred and seventy-one children were recruited into the study of which 811 (93%) completed the full 12 months of follow-up. All subsequent analysis was limited to the children who were retained for the full study period. One hundred and twenty-one children were categorized as hyperactive and 48 as aggressive. Boys were nearly twice as likely as girls to be categorized as hyperactive or aggressive, although this difference was not statistically significant for aggression. Lower socioeconomic status (SES) as measured by household income was also associated with aggression while more children from middle SES households as measured by both household income and maternal education were hyperactive compared with children from either low or high SES households. After adjusting for key confounding factors, children with high hyperactivity scores had an increased risk of all injuries (OR 1.98, 95% CI 1.48-2.64) and medically treated injuries (OR 1.56, 95% CI 1.01-2.43). Male gender was also a significant predictor of injury. Initiatives to prevent childhood injuries should take into account that child temperament may act as a mediating factor in the injury pathway. Further research is necessary to determine the success of preventive efforts in higher risk children who may react to their environment in a substantially different manner compared with less hyperactive children.

Relation of ferritin levels with symptom ratings and cognitive performance in children with attention deficit–hyperactivity disorder

The aim of the present paper was to investigate the relationship between behavioral symptoms and attentional and executive functions and hematological variables related to iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and red cell distribution width (RDW) in children and adolescents with attention deficit-hyperactivity disorder (ADHD). The sample consisted of 52 ADHD children (42 boys, 10 girls; age 7-13 years; mean +/- SD, 9.9 +/- 2.1 years). Conners Parent and Teacher Rating Scales were obtained. The neuropsychological test battery included Wisconsin Card-Sorting Test (WCST), Stroop, Continuous Performance Test, Digit Symbol and Digit Span subtests of the Wechsler Intelligence Scale for Children Revised (WISC-R), and Trail Making Test A and B, which taps abstraction-flexilibity (WCST), sustained attention (CPT), mental tracking and complex attention (WISC-R Digit Span, Digit Symbol, Trail Making A and B) and interference control (Stroop). Multiple linear regression was used to evaluate the relation of ferritin, hemoglobin, MCV, RDW, age, gender, and presence of comorbidity. While seven children had iron deficiency, none of them was anemic. Lower ferritin levels were associated with higher hyperactivity scores in parental ratings. While performance increased with age for most of the neuropsychological tests utilized, ferritin, hemoglobin, MCV and RDW and gender were not significantly related with cognitive performance in this sample. At least for the present clinical sample, ferritin levels might be related with behavioral but not cognitive measures in ADHD cases.

“Emily, Please Step Away from That Soft Drink!”

Artificial food colorings and additives (AFCA) have been associated with higher hyperactivity, impulsivity, and inattention scores in preschoolers.

Sleep and the Developing Brain

Sleep and the Developing Brain

Hyperactivity and polysomnographic findings in children evaluated for sleep-disordered breathing.

Children with sleep-disordered breathing (SDB) or periodic leg movements during sleep (PLMS) often have hyperactive behavior that improves when the sleep disorder is treated. Some children with SDB also have PLMS. To determine what polysomnographic features of SDB might be associated with hyperactive behavior, we studied behavior, SDB, and PLMS in a series of patients. Prospective and observational. University-based sleep disorders laboratory. Children (n=113) aged 2 to 18 years, referred for suspected SDB. Parents completed the hyperactivity index of the Connors' Parental Rating Scale, and results were converted to age-adjusted t-scores. Children underwent laboratory-based polysomnography, with esophageal pressure monitoring when requested (n=19) by referring physicians. Children with SDB (n=59) showed high hyperactivity scores (mean 59.5+/-18.3 SD, 95% C.I. [54.7, 64.2]) but these scores were no higher than those of children without SDB (59.0+/-15.1, [54.8, 63.1]). Hyperactivity showed no significant associations with the rate of apneas and hypopneas, minimum oxygen saturation, or most negative esophageal pressure (p>0.10), but was associated with the presence of 5 or more PLMS per hour (p=0.02). The rate of PLMS showed a linear association with hyperactivity among those subjects with SDB (p = 0.002), but no association among those subjects without SDB (p = 0.64). These findings suggest that hyperactive behavior is common among children referred for suspected SDB, regardless of the presence or severity of SDB. Current observations cannot prove causality, but they are consistent with the hypothesis that PLMS may contribute to hyperactivity and SDB may act as an effect modifier.

Behavior Disorders in Persons With Mental Retardation Receiving Antipsychotic Medication

The behavior disorders of mentally retarded individuals receiving antipsychotic medication and the relationship between behavior disorders and the daily dose of drug were investigated. Of 355 residents of residential facilities in Wakayama Prefecture, Japan (age range, 7–64 years), the problem behaviors of 54 subjects receiving antipsychotic drugs were compared to those of 52 subjects receiving anticonvulsants and of 202 subjects without any medication at all, using the Japanese version of the Aberrant Behavior Checklist (ABC-J). All five subscale scores of the ABC-J were significantly higher for the antipsychotic group than for those of the other groups, whereas only the Irritability subscale was prominent in the subjects receiving anticonvulsants. The mean chlorpromazine equivalent dose was higher in the subjects with severe/profound disability than in those with mild/moderate disability and correlated with the Hyperactivity subscale scores. The problem behaviors of individuals with mental retardation prescribed antipsychotic drugs were more severe than those without medication; more severe disability and higher Hyperactivity scores were associated with dose of antipsychotic drugs.