History Of ADHD Research Articles

Reliability and validity of a semi-structured DSM-based diagnostic interview module for the assessment of Attention Deficit Hyperactivity Disorder in adult psychiatric outpatients

Despite growing recognition that the symptoms and functional impairments of Attention Deficit/Hyperactivity Disorder (ADHD) persist into adulthood, only a few psychometrically sound diagnostic measures have been developed for the assessment of ADHD in adults, and none have been validated for use in a broad treatment-seeking psychiatric sample. The current study presents the reliability and validity of a semi-structured DSM-based diagnostic interview module for ADHD, which was administered to 1194 adults presenting to an outpatient psychiatric practice. The module showed excellent internal consistency and interrater reliability, good convergent and discriminant validity (as indexed by relatively high correlations with self-report measures of ADHD and ADHD-related constructs and little or no correlation with other, non-ADHD symptom domains), and good construct validity (as indexed by significantly higher rates of psychosocial impairment and self-reported family history of ADHD in individuals who meet criteria for an ADHD diagnosis). This instrument is thus a reliable and valid diagnostic tool for the detection of ADHD in adults presenting for psychiatric evaluation and treatment.

Influenza Encephalitis in a Collegiate Baseball Player

HISTORY: A 20 year old male, NCAA Division I baseball player presents to athletic trainer with a chief complaint of a severe headache. Associated symptoms included numbness in bilateral fingertips and lips, disoriented and look tired and fatigued. Athlete could answer questions asked but could not recall details of the morning prior to presenting to the athletic trainer. He had a previous history of headaches, coughing and congestion over past few months. Previous headaches were treated with over the counter medications and sleep. Athlete also had a medical history of ADHD and surgical history of tonsillectomy and adenoidectomy 2013. PHYSICAL EXAM: No obvious deformity and no visible sites of trauma. Full strength in upper extremities bilaterally; normal sensation bilaterally except for fingertips and lips. Deterioration of mental status over the following hour and was unable to understand simple commands or reply verbally. Athlete was transported to the Emergency Department. Upon arrival, athlete became combative due to disorientation and was intubated for his safety. DIFFERENTIAL DIAGNOSIS: 1. Migraine Headache 2. Intracranial Hemorrhage 3. Meningitis TESTS & RESULTS: Complete Blood Count Test- mild elevated white blood cell count (13.4) Comprehensive Metabolic Panel- within normal limits Urine Toxicology- within normal limits CT Scan- normal MRI- normal Lumbar Puncture- elevated with white blood cell count Influenza Test- positive for influenza b FINAL/WORKING DIAGNOSIS: Influenza Encephalitis TREATMENT & OUTCOMES: • Intubated and admitted to the ICU • Hospital day #2 was extubated • Treated with Tamiflu for influenza b • Discharged to go home and follow up with athletic training staff • No residual symptoms, feeling well • Athlete successfully participated in 2015 baseball season

Symptom Provocation More Likely Following Vestibular/Ocular Motor Screening in Athletes with Attention Deficit Hyperactivity Disorder

Vestibular and ocular-motor impairments are routinely reported in patients with a sports-related concussion (SRC) and may result in delayed return to play. The Vestibular/Ocular Motor Screening (VOMS), a brief clinical assessment for vestibular and ocular-motor impairments, has been shown to be a sensitive clinical assessment for identifying patients with a concussion. However, in athletes with attention deficit hyperactivity disorder (ADHD), the VOMS may not be indicated as these patients exhibit impairment of the ocular-motor system in the absence of concussive injury. Thus, VOMS findings in an athlete with ADHD may be overstated and a higher proportion of athletes reporting symptom provocation are likely. PURPOSE: To determine if differences exist between those athletes with and without ADHD in relation to symptom provocation during VOMS. METHODS: A retrospective chart review of patient (n = 223; 80 girls, 143 boys) records (age range: 11-19 yr; mean ± SD; 15±2) of those presenting with SRC from Jan - Dec 2014 was conducted. As part of the initial visit a VOMS assessment was performed by trained medical personnel who documented symptom provocation using a dichotomous scale (0=not present, 1=present). The VOMS used in this clinic consisted of the following domains: smooth pursuits (SMO_PUR), horizontal (HOR_) and vertical saccades (VER_SAC), horizontal (HOR_) and vertical vestibular ocular reflex (VER_VOR), convergence (CONV), and accommodation (ACCOM). Diagnostic history of ADHD was self-reported. χ2 analyses for categorical variables was used to examine relationship between ADHD and VOMS symptom provocation. RESULTS: ADHD was present in 14.3% of patients. A greater proportion of patients with ADHD reported symptom provocation in the following VOMS domains: SMO_PUR (57.6% vs. 36.6%; p = 0.023), HOR_SAC (69.7% vs. 48.7%; p =0.026), HOR_VOR (64.5% vs. 41.8%; p = 0.019). VER_SAC (69.7% vs. 53.8%; p = 0.089) approached significance. No difference was observed in proportion presenting with or without ADHD in domains of VER_VOR, ACCOM, or CONV. CONCLUSION: Athletes with ADHD may report symptom provocation during specific domains of the VOMS assessment more often than those athletes without ADHD. These findings may have important implications in the diagnosis and treatment of concussions in athletes with ADHD.

Cognitive Symptoms Are More Prevalent Post-Concussion in Athletes with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is characterized by cognitive and attentional impairments, which may have implications for athletes recovering from a sports-related concussion (SRC) as symptoms and deficits of ADHD overlap with those assessed following SRC. A longer recovery from head trauma has been reported in patients with ADHD compared to those without ADHD. Additionally, increased or persistent cognitive symptoms following concussion are a risk factor for protracted recovery, independent of ADHD status. The Post-Concussion Symptom Scale (PCSS), a widely used clinical assessment, contains six symptoms associated with cognitive function: feeling “dazed”, confusion, feeling “slowed down”, difficulty concentrating, difficulty remembering, feeling like “in a fog”. PURPOSE: Therefore, we examined the relationship between cognitive symptoms and the presence of ADHD in athletes with SRC diagnosis. METHODS: A retrospective chart review of patient (n = 223; 80 girls, 143 boys) records (age range: 11-19 yr; mean ± SD; 15±2) for those presenting with SRC from Jan - Dec 2014 was conducted. Initial PCSS response to symptoms associated with cognitive dysfunction was summed and secondarily recorded using a dichotomous scale (0=not present, 1=present). Diagnostic history of ADHD was self-reported. χ2 analyses were employed to examine the relationship between ADHD and PCSS cognitive symptoms. RESULTS: ADHD was present in 14.3% of patients. The average cognitive symptom severity (sum) was greater for those with ADHD (7.4±6.4) than those without (5.1±6.1; p = 0.051). A greater proportion of patients with ADHD reported feeling “dazed” (66.7% vs. 46.8%; p = 0.036), confusion (60.6% vs. 36.3%; p = 0.009), feeling slowed down (75.8% vs. 55.8%; p = 0.031), and having difficulty concentrating (75.8% vs. 57.4%; p = 0.046). No difference was observed in proportion presenting with or without ADHD with PCSS symptoms feeling like “in a fog” (p = 0.148) or having difficulty remembering (p = 0.107). CONCLUSION: These data suggest that symptoms associated with cognitive dysfunction are more likely to be present in athletes with ADHD following SRC. However, it is unclear whether the observed longer recovery following SRC in individuals with ADHD is due to increased susceptibility to cognitive symptoms.

Prenatal Exposure to Perfluoroalkyl Substances and Behavioral Development in Children.

Background: In recent years, prevalence rates of behavioral disorders in children have increased. One factor possibly implied in the etiology of behavioral disorders is exposure to perfluoroalkyl substances (PFASs). The use of PFASs is highly integrated into everyday life, and exposure is ubiquitous. Exposure to PFASs during early life may be particularly harmful, as it represents a critical time window for brain development. However, research in the area is limited, especially among preschool children. The objective of the current study was to explore the relationship between prenatal exposure to several PFASs and behavioral development at the age of 18 months. Methods: Data from the Dutch cohort LINC (Linking Maternal Nutrition to Child Health) were used. Perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) were measured in cord plasma. The total exposure of PFASs was also calculated (ΣPFASs). Behavioral development was assessed with the Child Behavior Checklist 1.5–5 (CBCL 1.5–5). The CBCL scales “Attention Deficit Hyperactivity Disorder” (ADHD) and “Externalizing problems” were used for further analysis. Separate regression models were composed for each combination, in which exposure levels were classified in tertiles. Both whole population and sex-stratified analyses were performed. A family history of ADHD, the educational level, smoking or using alcohol or illicit drugs during pregnancy were considered as confounders. In total, data from 76 mother-child pairs was included. Results: No significant associations were found between prenatal PFAS exposure and ADHD scores in the whole population and in the sex-stratified analyses. With regard to externalizing behavior, a significant negative association was found between the highest levels of ΣPFAS exposure and externalizing problem behavior in the whole population, but only in the crude model. After stratifying for sex, boys in the second and third tertile of exposure to PFOA presented significantly lower scores on the Externalizing Problem Scale than boys with the lowest exposure levels in the adjusted model. Girls exposed to higher levels of ΣPFAS exposure (T2) showed significantly lower scores on the Externalizing Problem Scale, in both crude and adjusted models. No significant associations with PFOS were found. Conclusions: Results from the current study show that prenatal exposure to PFOA was negatively related to externalizing behavior in boys. Results were different for boys and girls, emphasizing that mechanisms at work might be sex-dependent. However, results should be interpreted with caution as the sample size was small.

Adult Attention Deficit Hyperactivity Disorder and Suicide Attempters: A Case Control Study From Iran, West Asia

Background: Childhood attention deficit hyperactivity disorder (ADHD) persists into adulthood in up to two thirds of affected patients. Usually, ADHD has co-morbidities with several psychiatric disorders, and its symptoms occur more frequently in suicide attempters and may thus be a reason for the completed act of suicide. Objectives: The aim of the current study was to compare adult suicide attempters affected by ADHD with other suicide attempters without a history of suicide attempts that referred to the outpatient clinic. Patients and Methods: This case control study was conducted at Loghman-Hakim hospital, Tehran, during a one year period. A total of 394 hospitalized patients in the poison control center that had attempted suicide were recruited. In the control group, 394 individuals without a history of suicide attempts were recruited from referrals to the outpatient clinic of Loghman-Hakim hospital, which provides services for almost all medical specialties. We used Conners’ adult ADHD rating scale, including the screening version form and subscale (CAARS-S: SV), the Wender Utah rating scale (WURS), and clinical interviews for diagnosis of ADHD. The hypothesis was tested using an independent samples t-test and ANOVA. Results: The results of our study showed that a history of psychiatric disorders and a family history of ADHD and suicide were significantly higher (P > 0.01) in the case group than the control group. In addition, both children and adult ADHD among suicide attempters were significantly higher (P > 0.01) than the corresponding rates in the control group. Conclusions: ADHD is a common co-morbidity among suicide attempters. Hence, early diagnosis and treatment with consideration of ADHD may reduce suicide attempt risk.

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.

Psychosocial co-morbidities in adolescents and adults with histories of communication disorders

BackgroundFew studies have considered the long-term psychosocial outcomes of individuals with histories of early childhood speech sound disorders (SSD). Research on long-term psychosocial outcomes of individuals with language impairment (LI) have frequently failed to consider the effects of co-morbid SSD. The purpose of this study was to compare individuals with histories of SSD-only versus SSD with LI on these outcomes and to examine the contributions of other comorbid conditions including reading disorders (RD) and Attention Deficit Hyperactivity Disorder (ADHD). MethodsParticipants were adolescents aged 11–17 years (N=129) and young adults aged 18–33 years (N=98). Probands with SSD were originally recruited between 4 and 6 years of age and classified into SSD-only and SSD+LI groups. Siblings of these children were also assessed at this time and those without SSD or LI were followed as controls. Outcome measures at adolescence and adulthood included ratings of hyperactivity, inattention, anxiety, and depression, as well as internalizing, externalizing, social, and thought problems. Adult outcomes also included educational and employment status and quality of life ratings. Regression modeling was performed to examine the association of SSD, LI, RD, and ADHD with psychosocial outcomes using Generalized Estimating Equations. ResultsIn the adolescent group, LI was associated with poorer ratings of psychosocial problems on all scales except depression. Histories of SSD-only, RD and ADHD did not independently predict any of the adolescent psychosocial measures. In contrast, LI in the adult sample was not significantly associated with any of the behavior ratings, though RD was related to higher ratings of hyperactivity and inattention and with higher parent ratings of internalizing and externalizing symptoms and thought problems. SSD did not predict any of the adult measures once other comorbid conditions were taken into account. ConclusionsPoor adolescent psychosocial outcomes for individuals with early childhood SSD were primarily related to comorbid LI and not to SSD per se. At adulthood, comorbid RD and ADHD may influence outcomes more significantly than LI.

Gambling behaviors and psychopathology related to Attention-Deficit/Hyperactivity Disorder (ADHD) in problem and non-problem adult gamblers

Previous studies showed that Pathological Gambling and Attention Deficit/Hyperactivity Disorder (ADHD) often co-occur. The aim of this study was to examine whether ADHD is associated with specific severity patterns in terms of gambling behavior, psychopathology and personality traits. 599 problem and non-problem-gamblers were recruited in addiction clinics and gambling places in France. Subjects were assessed with the Wender-Utah Rating Scale-Child, the Adult ADHD Self-Report Scale, the Mini International Neuropsychiatric Interview, the Temperament and Character Inventory, the South Oaks Gambling Screen and questionnaires assessing gambling related cognitive distortions and gambling habits. 20.7% (n=124) of gamblers were screened positive for lifetime or current ADHD. Results from the multivariate analysis showed that ADHD was associated with a higher severity of gambling-related problems and with more psychiatric comorbidity. Among problem gamblers, subjects with history of ADHD were also at higher risk for unemployment, psychiatric comorbidity and specific dysfunctional personality traits. This study supports the link between gambling related problems and ADHD in a large sample of problem and non-problem gamblers, including problem-gamblers not seeking treatment. This points out the necessity to consider this disorder in the prevention and in the treatment of pathological gambling.

Persistence and Subtype Stability of ADHD Among Substance Use Disorder Treatment Seekers

Objective: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. Method: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. Results: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. Conclusion: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance.

Long-term, prospective follow-up studies of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) show that symptoms tend to decline with age, but impairments in daily life functioning often persist into adulthood. We examined the developmental progression of impairments before and after the transition out of high school in relation to parent involvement during adolescence, parent support during adulthood, and college attendance, using 8 waves of data from the prospective 16-year follow-up of the Multimodal Treatment of ADHD (MTA) study. Participants were 548 proband children diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV; American Psychiatric Association, 2000) ADHD Combined Type and 258 age- and sex-matched comparison children (Local Normative Comparison Group; LNCG) randomly sampled from probands' schools. Impairment was assessed consistently by parent report from childhood through adulthood. Results showed that impairment worsens over time both before and after the transition to adulthood for those with ADHD histories, in contrast to non-ADHD peers, whose impairments remained stably low over time. However, impairment stabilized after leaving high school for young adults with ADHD histories who attended college. Involved parenting in adolescence was associated with less impairment overall. Attending college was associated with a stable post-high school trajectory of impairment regardless of parents' involvement during adolescence, but young adults with histories of involved parenting and who attended college were the least impaired overall.

Change over time in adolescent and friend alcohol use: Differential associations for youth with and without childhood attention-deficit/hyperactivity disorder (ADHD).

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for experiencing alcohol-related problems by adulthood. However, few studies have examined contextual factors that may contribute to this risk. The current study examined 1 widely investigated social-contextual risk factor, friend alcohol use, in a sample of adolescents with and without a history of ADHD. One hundred and 59 adolescents (14-17 years old) with childhood ADHD and 117 demographically similar youth without ADHD were interviewed annually in the Pittsburgh ADHD Longitudinal Study. Adolescents reported the frequency of their own alcohol use in the prior 12 months and the number of friends who used alcohol regularly or occasionally (perceived friend alcohol use). Multiple-group parallel process models indicated that increases in friend alcohol use were more strongly associated with increases in adolescent alcohol use over time for individuals with ADHD (r = .15, SE = 0.04; 95% confidence interval [CI] = [0.08, 0.22]) than for those without ADHD (r = .06, SE = 0.03; 95% CI [0.00, 0.11]). These results suggest that social factors are an important part of escalating alcohol use among adolescents with ADHD histories, and they highlight the possibility that interventions focused on the peer context could be important for these at-risk youth. Additional social network research on adolescent alcohol use within the larger context of other relationships (e.g., family and romantic relationships) is indicated.

Early development of comorbidity between symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are among the most common childhood disorders and frequently co-occur. The present study sought to advance our understanding of how comorbidity between ADHD and ODD develops during the preschool years by testing a cross-lagged model that integrates 2 prominent models: the developmental precursor model and the correlated risk factors model. Participants were 199 children (107 boys) who took part in a longitudinal study of preschoolers with behavior problems. Parent reports of ADHD and ODD symptoms were collected annually from ages 3 to 6 and a family history interview was administered at age 3. In support of the developmental precursors model, ADHD symptoms predicted later argumentative/defiant symptoms. In support of the correlated risk factors model, family histories of ADHD and ODD/CD symptoms were correlated risk factors that uniquely predicted ADHD and anger/irritable symptoms in children. Results suggest that the correlated risk factors model may best explain the development of comorbidity between symptoms of ADHD and anger/irritability, whereas the developmental precursors model may better explain the development of comorbidity between symptoms of ADHD and argumentative/defiance.

Are childhood externalizing disorders the harbinger of early-onset alcohol dependence?

Background & objectives:The subtyping of alcohol dependence (AD) into early-onset (EO) and late-onset (LO) subgroups has been shown to have clinical and biological validity. As externalizing disorders (EDs) predate AD, the link of ED with age of onset of alcohol dependence needs to be investigated. The aim of this study was to examine the relationship of EDs such as disruptive behaviour disorder (DBD) and attention deficit hyperactivity disorder (ADHD) with age at onset of AD in a sample of male subjects.Methods:One hundred consecutive male subjects with AD presenting to the De-Addiction Services and an equal number of biologically unrelated non-substance-dependent control subjects were included in the study. The AD subjects were divided into EO (age of onset of AD ≤25 yr; n = 21) and LO (age of onset of AD >25 yr; n = 79). Subjects were examined for evidence of DBD and ADHD in childhood, and current ADHD using structured instruments such as Semi-Structured Assessment for the Genetic of Alcoholism-IV (SSAGA-IV) and Kiddie – SADS – Present and Lifetime Version (K-SADS-PL). The odds ratio of association of EDs with EO and LO AD was calculated by comparing these subgroups with the biologically unrelated control group. Later, both the subgroups of alcohol dependence were compared for the presence of EDs.Results:All EDs (DBDs/childhood or adult ADHD) were more common in AD individuals as compared to the controls. However, when AD subgroups were compared with controls, the association of DBDs and ADHD reached a significant level only in the EO subgroup. A comparison of EO and LO AD showed that more EO individuals had history of both childhood disruptive disorder and ADHD compared to LO subgroup. Adult ADHD was also over-represented in EO subgroup.Interpretation & conclusions:Our study showed more EDs in alcohol dependent individuals compared to controls. Further, the association observed between EDs and EO alcohol dependence points towards a developmental continuum between these two conditions.

Dystonia with MPH/Risperidone Combined Therapy for ADHD.

Investigators from Child Neurology and Pediatrics, University of Texas Health Science Center, Houston, report extrapyramidal symptoms in a 13-year-old boy with a psychiatric history of schizophrenia, bipolar disorder, ADHD, and autism, responsive to combination risperidone, oxcarbazepine, and MPH.

Hyperactive: The Controversial History of ADHD by Matthew Smith

Hyperactive: The Controversial History of ADHD by Matthew Smith

Predictors of delayed recovery following pediatric sports-related concussion: a case-control study

OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score < 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.

Genotype and haplotype frequencies of the DRD4 VNTR polymorphism in the men with no history of ADHD, convicted of violent crimes

PurposeThe dopamine receptor 4 gene variable number of tandem repeats (DRD4 VNTR) polymorphism is associated either with an increased risk of ADHD, or with a higher incidence rate of violent criminal behavior and aggression in the human populations. However, it cannot be excluded that the risk variants of the DRD4 VNTR polymorphism, the 7-repeat and 5-repeat (7R and 5R) alleles might be associated with the increased occurrence of violent behavior in adults with no history of ADHD. MethodsThis study was to examine the prevalence of the certain risk variants of the DRD4 VNTR polymorphism in the men convicted of violent crimes, with no history of ADHD (n=161). ResultsThe prevalence of the 5R and 7R DRD4 VNTR alleles was higher in the men convicted of violent crimes, with no history of ADHD than in the general Russian Caucasian population (Novosibirsk city, n=425). ConclusionsThis is the first evidence that both 7R and 5R, the ADHD-linked DRD4 VNTR alleles are directly associated with the incidence of violent behavior in the men with no history of ADHD. Results support the hypothesis that proactive aggression might be a genetically-based, separate feature of personality that is independent of ADHD.

The Complicated Journey of a Family

Questions are presented at “consideration points” that follow a section that gives information about the case. One or more choices may be correct for each question; make your choices on the basis of your clinical knowledge and the history provided. Read all of the options for each question before making any selections. You are given points on a graded scale for the best possible answer(s), and points are deducted for answers that would result in a poor outcome or delay your arriving at the right answer. Answers that have little or no impact receive zero points. At the end of the exercise, you will add up your points to obtain a total score.

Go/No Go task performance predicts cortical thickness in the caudal inferior frontal gyrus in young adults with and without ADHD.

Response inhibition deficits are widely believed to be at the core of Attention-Deficit Hyperactivity Disorder (ADHD). Several studies have examined neural architectural correlates of ADHD, but research directly examining structural correlates of response inhibition is lacking. Here we examine the relationship between response inhibition as measured by a Go/No Go task, and cortical surface area and thickness of the caudal inferior frontal gyrus (cIFG), a region implicated in functional imaging studies of response inhibition, in a sample of 114 young adults with and without ADHD diagnosed initially during childhood. We used multiple linear regression models to test the hypothesis that Go/No Go performance would be associated with cIFG surface area or thickness. Results showed that poorer Go/No Go performance was associated with thicker cIFG cortex, and this effect was not mediated by ADHD status or history of substance use. However, independent of Go/No Go performance, persistence of ADHD symptoms and more frequent cannabis use were associated with thinner cIFG. Go/No Go performance was not associated with cortical surface area. The association between poor inhibitory functioning and thicker cIFG suggests that maturation of this region may differ in low performing participants. An independent association of persistent ADHD symptoms and frequent cannabis use with thinner cIFG cortex suggests that distinct neural mechanisms within this region may play a role in inhibitory function, broader ADHD symptomatology, and cannabis use. These results contribute to Research Domain Criteria (RDoC) by revealing novel associations between neural architectural phenotypes and basic neurobehavioral processes measured dimensionally.