History Of ADHD Research Articles

Association of maternal diabetes during pregnancy with attention deficit hyperactivity disorder in offspring in an Iranian population: A case-control study

Background and aims: Gestational diabetes has long-term adverse consequences for both the mother and child and seems to be a risk factor for attention deficit hyperactivity disorder (ADHD) in children. However, no research has been conducted in this regard in Iran. Methods: This was a case-control study. The sample consisted of 225 children who were referred to the general and psychiatric clinic of Besat Hospital in Sanandaj and were evaluated for a history of maternal diabetes in the fetal period. The diagnosis of ADHD in children was based on a structured clinical interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) by a psychiatrist and a short and revised form of Conners’ parent scale. The data were analyzed using Stata 14. Results: The results showed that 25.3% of the mothers of children with ADHD had gestational diabetes during pregnancy, and 17.3% were taking diabetes medication. However, the results revealed that there is no statistically significant relationship between the history of gestational diabetes and ADHD (P=0.427). Furthermore, the logistic regression results demonstrated that the place of residence (P<0.027, OR=8.351) increases the probability of suffering from ADHD in children, while the age of the mother during pregnancy (P<0.031, OR=0.907) decreases the probability of the child suffering from ADHD. Conclusion: Although cohort studies have associated gestational diabetes with an increased risk of ADHD in children, the results of this case-control study do not support this association.

PMON110 Panhypopituitarism as a Rare Presentation of Erdheim – Chester disease (ECD) in an Adolescent Patient

Abstract Background Erdheim-Chester disease (ECD) is a rare multisystemic histiocytic disorder. Only a dozen pediatric cases are reported. Here, we present a case of ECD in a pediatric patient who presented with short stature and delayed puberty. Clinical Case A 14-year-old male with history of autism and ADHD presented with short stature and pubertal delay. He grew along the 40th percentile until age 7 years when growth velocity declined. On exam, his height was 145.6 cm (0.98%ile, z-score -2.34), weight was 55.6 kg (63.19%ile, z-score 0.34), and testicular size was 5-6 mL. He had increased thirst and episodes of bedwetting since age 7. Bone age was delayed at 11 years 6 months. Further workup was recommended, but family was lost to follow up. At 16, he returned with continued poor growth, polydipsia, and nocturia. Height was 153 cm (0.26%ile, z-score -2.80), weight 61.1 kg (40%ile, z-score -0.25). Labs revealed IGF-BP3 2.8mcg/mL(3.1-8.9), IGF-1 35ng/mL(245-522), LH 1.2mIU/mL(0.29-4.77), and total testosterone <7.0 ng/dL(250-1100). Prolactin, cortisol, thyroid, and karyotype were normal. Growth hormone (GH) stimulation test confirmed GH deficiency. He was referred to oncology clinic when a brain MRI revealed a nodular enhancing suprasellar mass extending from the third ventricular floor to the dorsum sella along the pituitary stalk and rounded sclerotic lesion in the frontal bone. Biopsy of the suprasellar lesion was remarkable for foamy histiocytes positive for CD68, negative for S100 and CD1a, an eosinophilic cell background highlighted by S100 and synaptophysin, SALL4 negative. A diagnosis of xanthomatous hypophysitis was made. Additionally, lab studies confirmed diabetes insipidus (DI), treated with DDAVP. Growth hormone was trialed for 2 weeks, but he developed acute pancreatitis, so it was discontinued. He subsequently developed recurrent pancreatitis of unclear etiology requiring frequent hospitalization with development of insulin-dependent diabetes mellitus due to pancreatic damage. He was lost to follow up for 12 months after leaving home at age 18. He returned to our institution after incidental findings of 7th right rib expansile lytic bony lesions on abdominal CT during a pancreatitis admission. Biopsy of the rib lesion was positive for a BRAF-V600E mutation. Skeletal survey revealed new multiple small lytic skull lesions. Repeat brain MRI demonstrated new calvarial lesions, increased suprasellar mass. Chest CT scan showed a micronodular pattern with mediastinal lymph node enlargement. PET confirmed widespread multifocal FDG hypermetabolic lesions. Final diagnosis of ECD was made; he was started on targeted therapy with Vemurafenib, a BRAF inhibitor. Conclusion Erdheim-Chester disease (ECD) is a non-Langerhans cell histiocytosis, which rarely affects pediatric patients who present with bone pain and DI; however, here we present a case of ECD in an adolescent with short stature and multiple pituitary deficiencies to highlight the varied presentation of the disorder. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP056 The Treatment of Opioid Addiction Leading to Secondary Adrenal Insufficiency

Abstract Background As we continue to learn about the opioid crisis in America, more patients are seeking treatment for their opioid addictions. This treatment includes buprenorphine/naloxone, a partial opioid agonist and opioid antagonist. Though there is known evidence of opioid-induced secondary adrenal insufficiency, there is scarce data regarding the effect of buprenorphine/naloxone on the hypothalamic-pituitary-adrenal (HPA) axis. Here we describe a case of secondary adrenal insufficiency in a patient who is on long-term treatment for her opioid addiction with buprenorphine/naloxone. Clinical Case A 30 year old female with a past medical history of ADHD, OCD, PTSD, and menorrhagia presented with extreme fatigue, 100-pound weight gain, hair loss, and intermittent red flushing on hands and face over the past year. Labs showed low androstenedione (21 ng/dL, n 41 - 262 ng/dL), low testosterone (6.5 ng/dL, n 10. 0 - 55. 0 ng/dL) and low DHEA-S levels (55.6 ug/dL, n 84.8 - 378. 0 ug/dL). Further history revealed that the patient had been on Buprenorphine/Naloxone for 4 years for opioid addiction. Testing revealed a low morning cortisol level (5.6 ug/dL, n 6.2 - 19.4 ug/dL). The patient was started on hydrocortisone 10mg in the morning and 5mg in the afternoon with improvement of symptoms. Repeat testing after holding hydrocortisone revealed a cortisol level (6.6 n 6.2 - 19.4 ug/dL) and an inappropriately low-normal ACTH level (16 pg/mL, n 6 - 50 pg/mL). Cosyntropin stimulation test did not show an adequate response with a baseline cortisol level of 3.4 ug/dL, (n 5. 0 - 23. 0 ug/dL), 30 minute cortisol level of 6.9 ug/dL and 60 minute cortisol level of 8.2 ug/dL (n >18. 0 ug/dL). ACTH drawn at that time was low (<5 pg/mL n 6 - 50 pg/mL). Pituitary MRI was completed and findings were insignificant. Due to continued fatigue, the hydrocortisone dose was increased to 15mg in the morning and 5mg in the afternoon with improvement in symptoms with a plan to retest the adrenal axis as she continues to wean off the Buprenorphine/Naloxone. Conclusion This case calls attention to secondary adrenal insufficiency caused by the treatment of opioid addiction with buprenorphine/naloxone. Further investigation of adrenal insufficiency secondary to buprenorphine/naloxone use is warranted given the frequency of use of this combination to treat the ongoing opiate addiction crisis in America. Presentation: No date and time listed

Association of prenatal modifiable risk factors with attention-deficit hyperactivity disorder outcomes at age 10 and 15 in an extremely low gestational age cohort.

The increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts. We examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life. Elevated maternal BMI and maternal diabetes were each associated with a 55-65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes. Contrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes.

A FATAL CASE OF ACCELERATED BLEOMYCIN-INDUCED PNEUMONITIS IN A PATIENT WITH STAGE IV NONSEMINOMATOUS GERM CELL TUMOR

A FATAL CASE OF ACCELERATED BLEOMYCIN-INDUCED PNEUMONITIS IN A PATIENT WITH STAGE IV NONSEMINOMATOUS GERM CELL TUMOR

27.1 Paths to Postsecondary Education Enrollment Among Adolescents With and Without Childhood ADHD

Despite the long-term deficits associated with ADHD, some adolescents with ADHD enroll in postsecondary education (PSE). Postsecondary students represent a relatively high-functioning segment of the population, but students with ADHD continue to experience academic difficulties in higher education. Beyond admittance to postsecondary programs, do adolescents with ADHD histories who enroll in postsecondary studies differ from those who do not? We aimed to determine whether symptoms and academic functioning are distinct developmentally from childhood through adolescence between adolescents with and without ADHD who did and did not enroll in PSE.

The Role of Gender Dysphoria in the Development of an Eating Disorder

The Role of Gender Dysphoria in the Development of an Eating Disorder

Replication of a predictive model for youth ADHD in an independent sample from a developing country.

Very few predictive models in Psychiatry had their performance validated in independent external samples. A previously developed multivariable demographic model for attention-deficit/hyperactivity disorder (ADHD) accurately predicted young adulthood ADHD using clinical and demographical information collected in childhood in three samples from developed countries, but failed to replicate its performance in a sample from a developing country. Furthermore, consolidated risk factors for ADHD were not included among its predictors. Participants were 1905 children and adolescents from a community-based sample and followed from ages 6 to 14 years at baseline to ages 14 to 23 years (mean age 18) at follow-up. We applied the intercept and weights of the original model to the data, calculating the predicted probability of each participant according to the set of predictors collected in childhood, and compared the estimates with the actual outcome (ADHD) collected during adolescence and young adulthood. We explored the performance of the original model, and of models including novel predictors (prematurity, family history of ADHD, and polygenic risk score for ADHD). The observed area under the curve of the original model was .76 (95% Confidence Interval .70 to .82). The multivariable demographical model outperformed single variable models using only prematurity, family history, or the ADHD PRS. Adding either of these variables, or all at once, did not improve the performance of the original demographical model. Our findings suggest that the originally developed ADHD predictive model is suitable for use in different settings for clinical and research purposes.

An exploration of early sleep development in preschool children with and without a familial history of ADHD

An exploration of early sleep development in preschool children with and without a familial history of ADHD

A-49 Sideline Concussion Assessment Tool symptoms predict poorer mental health outcomes in college athletes

Abstract Purpose: Assessment of emotional functioning is essential in sports-related concussion (SRC) management. This study investigated the prediction of mental health outcomes from the SCAT-3 Symptom Scale. Methods: Canadian university athletes who compete in contact sports participated in a large-scale study (Active Rehabilitation). A total of 235 participants (males = 67%) completed the Brief Symptom Inventory (BSI), Quality of Life Scale (QOLS), and Sideline Concussion Assessment Tool, 3rd edition (SCAT). Step-wise regression analysis using demographic variables (gender, age, history of Learning Disability, history of ADHD, diagnosis of psychiatric condition) and psychological symptoms from the SCAT were used as predictors for the BSI (Depression and Anxiety) and QOLS (Depression and Anxiety). Results: Regression analysis revealed female gender, previous psychiatric diagnosis and Nervousness (SCAT) significantly predicted higher scores on the Depression subscales of BSI (R2 = 0.21, F1,231 = 20.3, p < 0.001) and Quality of Life (R2 = 0.21, F1,231 = 18.0, p < 0.001). Female gender, previous psychiatric diagnosis, Nervousness and Irritability predicted higher scores on both the Anxiety subscales of the BSI (R2 = 0.23, F1,230 = 16.9, p < 0.001) and Quality of Life (R2 = 0.26, F1,230 = 20.2, p < 0.001). Contrary to other findings, history of concussion was not significantly predictive of higher Depression and/or Anxiety scores (although there was a trend between number of concussions and higher symptom report). Conclusions: SCAT symptoms may capture heightened emotional symptom report with more robust scales measuring emotional functioning. In contrast, concussion history did not predict emotional symptoms, a finding contrary to published literature.

A-20 Factors Associated with Additional Clinic Visits in the Treatment of Sports-Related Concussion

Abstract Purpose: To determine the variables associated with additional concussion clinic visits before discharge to athletic trainer (AT). Methods: This retrospective cohort study was performed at a multi-disciplinary sports concussion center. Patients were eligible if they were ages 12–23, sustained a SRC and were seen by a clinic provider between 11/01/2017 and 10/01/2020 for concussion (n = 1504), presented to clinic within 3 months of sustaining a concussion, and had negative acute head imaging. Of 524 patients, 236 were discharged to AT after the initial clinic visit, while 288 patients required additional clinic visits. The following independent variables were assessed: age, sex, initial visit symptom score, history of prior concussions, psychiatric disorders, migraines, ADHD, and learning disorders, head imaging following concussion, family history of psychiatric disorders and migraines, and ED/Urgent Care visit. The primary disposition was patients being discharged to an AT following the initial clinic visit vs. having additional clinic visits prior to discharge to an AT. Results: The additional visit group had higher initial visit symptom scores (p = 0.002), head imaging performed more frequently (p < 0.02), a family history of psychiatric disorders and/or migraines (p < 0.001), more often reported a prior concussion (p = 0.02), and was younger (p = 0.014) compared to athletes with only one clinic visit. In a multiple variable model, family history of psychiatric disorders (OR = 3.12 [95%CI 1.53–6.34], p = 0.002), prior concussions (OR = 1.39 [95%CI 1.02–1.89], p = 0.037), greater initial symptom score (OR = 1.05 [95%CI 1.03–1.06], p < 0.001), and younger age (OR = 0.87 [95%CI 0.77–0.98], p = 0.021) were strongly associated with additional visits. Conclusions: Among athletes treated at a regional sports concussion center, we determined that family history of psychiatric disorders, increased symptom score at initial visit, prior concussions, and younger age were each uniquely associated with needing additional clinic visits. Understanding these variables may guide treatment protocols to optimize efficiency.

A-19 Distress Predicts Poorer Cognitive Performance At Post-Injury In Concussed Athletes

Abstract Purpose: This study evaluated the consistency between athletes’ self-reported cognitive symptoms and cognitive test performance. Methods: The sample included 784 Canadian Football League athletes who underwent standardized cognitive testing with cognitive testing (ImPACT) and the Brief Symptom Inventory (BSI-18) at baseline. Over 2 consecutive seasons, 46 players were diagnosed with concussions following assessment with team physicians within 48 hours; 10 were eliminated due to missing data. Five cognitive symptoms (feeling slowed down, feeling in a fog, not feeling right, difficulties concentration, difficulties with memory) were used to create a composite score (Cog). The Cog index, the depression, anxiety, total index scores from the BSI, and the 5 ImPACT cognitive domains were correlated at baseline and post-injury. History of learning disabilities, ADHD, psychiatric diagnosis, and history of concussion were co-variates. Results: There were no significant correlations between Cog, depression, anxiety or total BSI scores and the ImPACT cognitive domains at baseline. At post injury there were no significant correlations between Cog or ImPACT index scores. In contrast, significant negative correlations were found between BSI Anxiety and verbal memory (r = 0.67, p < 0.01), visual memory (r = 0.68, p < 0.01), and visual-motor processing speed (r = 0.48, p < 0.05). In addition, there were significant negative correlations between the BSI total score and visual memory (r = 0.51, p < 0.05) and reaction time (r = 0.55, p < 0.05). Conclusions: Self-reported cognitive difficulties do not correlate with poorer cognitive outcomes in our sample of professional football players. However, distress at post-injury was significantly correlated to performance, suggesting psychological variables may play a role in cognitive functioning.

The Impact of ADHD on Maternal Quality of Life.

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior)associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.

ADHD prevalence in patients with hypersexuality and paraphilic disorders: a systematic review and meta-analysis.

Hypersexuality and paraphilic disorders have been associated with increased ADHD in several studies. To determine the prevalence of ADHD in hypersexuality and paraphilic disorders. Three databases (Medline, Web of Science and Google Scholar) were explored. Using random effects models, we calculated the pooled estimate of ADHD prevalence. The leave-1-out method and subgroup analyses were carried out to identify sources of heterogeneity. Seven studies from three countries (N = 730 patients with hypersexuality) were included (including five US studies). The overall estimate of the prevalence of ADHD in patients with hypersexuality or paraphilic disorders was 22.6% (95% interval: 17-29.4) with high heterogeneity (I2 = 63%). No publication bias was observed according to Egger's test. We found no significant difference in ADHD prevalence between the following subgroups: hypersexuality vs. paraphilic disorders, studies exploring the history of childhood ADHD vs. adult ADHD, US studies vs. others. The French study was a source of heterogeneity with a much lower rate than others (4.5%) but did not significantly change the prevalence estimate. Removing this study increases the prevalence to 25%. We found no association between the year of publication and ADHD prevalence. ADHD is much more frequent in populations with hypersexuality or paraphilic disorders compared to the general population. It should be systematically screened. The subgroup analyses were not sufficient to identify all sources of heterogeneity, other sources should be explored in further studies.

Thyroid storm without precipitating factors in a previous healthy child: A case report

The Thyroid Storm (TS) is the severest form of thyrotoxicosis and is associated with a high mortality rate. TS presents with fever, tachycardia, gastrointestinal symptoms, and central nervous system dysfunction and may be overlooked if patients do not present thyrotoxic symptoms or have precipitating factors. We reported a pediatric case of TS with mild proptosis but no obvious precipitating factors in a previously healthy child. A 9-year-old, female patient with a history of attention-deficit hyperactivity disorder presented with the complaint of frequent vomiting. She was alert but lethargic with fever and tachycardia. Physical examination was unremarkable except for coolness in the extremities and a delayed capillary refill time of two seconds. Fluid resuscitation was ineffective in alleviating the tachycardia. Additional history-taking revealed a one-month history of mild proptosis but no other thyrotoxic findings or precipitating factors were found. Markedly elevated thyroxine and triiodothyronine and suppressed thyroid-stimulating hormone on thyroid function tests led to a diagnosis of TS. Methimazole, potassium iodine, bisoprolol, and hydrocortisone were administered. Her vital signs and thyroid functions gradually improved, and she was discharged 18 days after admission without any serious complications. She is currently euthyroid and clinically stable on 5 mg of methimazole at three months after admission. When tachycardia that is resistant to usual resuscitation is found, careful history-taking and physical examination targeting thyroid disorders should be performed to assess for TS.

Early-life factors associated with increased risk of disability pension in the national real-world schizophrenia FACE-SZ cohort study.

Among severe psychiatric disorders, schizophrenia has one of the highest impacts on professional and personal functioning with important indirect costs including disability pension allowance for the patients with the more severe forms of schizophrenia. To explore early-life factors associated with disability pension in schizophrenia. 916 patients were consecutively recruited at a national level in 10 expert centers and received a comprehensive standardized evaluation. Their disability pension status and early-life variables were reported from medical records and validated scales. Eight factors were explored: age, male sex, parental history of severe mental illness, childhood trauma exposure, education level, childhood ADHD, early age at schizophrenia onset and duration of untreated psychosis. 739 (80.7%) participants received a disability pension. In the multivariate model, early age at schizophrenia onset and low education level were associated with disability pension independently of age and sex while no significant association was found for parent history of severe mental illness, childhood trauma, childhood ADHD or duration of untreated psychosis. Low education level and early age at schizophrenia onset seem the best predictors of increased risk of disability pension in schizophrenia.

ADHD and addictive behavior in crack-cocaine users

BackgroundCrack consumption is a major public health issue in Martinique with a poor prognosis. A preliminary study has found a high prevalence of history of childhood ADHD (C-ADHD) in crack users. ObjectiveTo determine the prevalence of C-ADHD and adult ADHD (A-ADHD) in crack users and their potential associations with substance use behavior. MethodsAll consecutive patients consulting in the public academic hospital covering 376,000 inhabitants were included in the present study and received a comprehensive battery measuring addictive behavior, psychiatric and somatic comorbidities. C-ADHD groups and A-ADHD groups were defined with the Wender-Utah Rating Scale-25 and the Brown ADD Rating Scale, respectively. Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). FindingsIn total, 111 participants were evaluated. Among them, 50 (45%) were classified in the C-ADHD group and 20 (18%) in the A-ADHD group. Compared to the patients without ADHD, those with ADHD were found to have higher impulsivity (C-ADHD: BIS total score 67.90 (10.1) vs. 63.28 (10.5), P=0.021, BIS attentional score 17.5 (3.6) vs. 15.3 (3.4), P=0.002, A-ADHD: BIS total score 75.1 (11.3) vs. 63.4 (9.2), P<0.001, BIS motor impulsivity 26.9 (5.3) vs. 22.6 (4.3), P<0.001, BIS attentional score 19.3 (3.3) vs. 15.6 (3.5), P<0.001, BIS planification 28.9 (5.7) vs. 25.10 (4.7), P=0.003). Fifty percent of A-ADHD patients were found with high impulsivity vs. 15% of patients without A-ADHD (P<0.001). However, ADHD was not associated with more severe addictive behavior or history of legal consequences. InterpretationADHD prevalence is high in cocaine-crack users and associated with increased impulsivity. However, neither ADHD nor impulsivity explains addictive behaviors or legal consequences.

Abstract 81: A case report of elevated TSH, elevated T3 and low T4 levels and mutation in SLCA5A gene: A diagnostic dilemma

Background: Iodide transport defect (ITD) is one of the causes of thyroid dyshormonogenesis. It is an uncommon disorder which is mediated by NIS mutations. They present with hypothyroidism and goitre due to the absence of active transport of iodide into the thyroid gland. The clinical presentation of patients with ITD due to different mutations of NIS gene has been described: including T354P, G395R, Q267E, and G543E mutations.Case Report: A 10-year-old boy born out of non – consanguineous marriage, with no antenatal, postnatal complications presented with history of goitre for 7 years. The child had a history of ADHD, average scholastic performance, and history of weight gain of 4-5 kilograms over past 2 months. Mother was diagnosed to have hypothyroidism during pregnancy. His Thyroid profile showed FT4 – 0.413 ng/dL, FT3 – 6.06 pg/mL, TSH – 12.75 mIU/mL and USG neck showed mild thyromegaly. A genetic analysis was done which revealed a homozygous mutation on Exon 7 in SLC5A5 gene. Child was started on Levothyroxine supplementation.Conclusion: The clinical picture is suggestive of hypothyroidism with elevated free T3 levels. This genetic mutation needs to be followed up in the global data base to ascertain its significance in future.

Electroencephalogram aperiodic power spectral slope can be reliably measured and predicts ADHD risk in early development.

The aperiodic exponent of the electroencephalogram (EEG) power spectrum has received growing attention as a physiological marker of neurodevelopmental psychopathology, including attention-deficit/hyperactivity disorder (ADHD). However, its use as a marker of ADHD risk across development, and particularly in very young children, is limited by unknown reliability, difficulty in aligning canonical band-based measures across development periods, and unclear effects of treatment in later development. Here, we investigate the internal consistency of the aperiodic EEG power spectrum slope and its association with ADHD risk in both infants (n=69, 1-month-old) and adolescents (n=262, ages 11-17 years). Results confirm good to excellent internal consistency in infancy and adolescence. In infancy, a larger aperiodic exponent was associated with greater family history of ADHD. In contrast, in adolescence, ADHD diagnosis was associated with a smaller aperiodic exponent, but only in children with ADHD who had not received stimulant medication treatment. Results suggest that disruptions in cortical development associated with ADHD risk may be detectable shortly after birth via this approach. Together, findings imply a dynamic developmental shift in which the developmentally normative flattening of the EEG power spectrum is exaggerated in ADHD, potentially reflecting imbalances in cortical excitation and inhibition that could contribute to long-lasting differences in brain connectivity.

Comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder: A descriptive analytic study

Background. Psychiatric studies are influenced by geographical conditions and research methods. Among them, the use of diagnostic tools may cause controversy over the results of studies on psychiatric disorders as such ADHD. The aim of this study was to investigate comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder. Methods. In this study, 400 children and adolescents with ADHD were selected from the clients of Razi and Sharif Hospital Psychiatric Clinic. For sample selection, a demographic questionnaire and semi-structured diagnostic interview (K-SADS-PL) were utilized to evaluate the presence of psychiatric disorders. The duration of the project was 4 months. Results. The mean age of the patients was 9.16±2.46 years and the highest frequency was in the age group of 6 to 9 years (63%). Of the 400 patients studied, 73.3% were boys. The highest frequency of education was related to preschool (61.5%). A history of ADHD was positive in 10.8% in the father, 2.3% in the mother and 3.8% in both parents. Also, 9.5% of patients had a history of ADHD in their brother and 4% had a positive history of ADHD in their sister. The most common psychiatric disorder in the present study was oppositional defiant disorder (92%). One comorbid disorder was identifiable in more than 54% of participants. Conclusion. The most common psychiatric disorder in children with ADHD includes oppositional defiant disorder, which is more common in boys, although no significant differences was founded in terms of sex and age. Practical Implications. Findings of this study suggest that the clinicians, child psychologists and psychiatrists ought to take into consideration the probability of comorbid disorders with ADHD, since failing to consider them might directly influence the quality and quantity of treatments utilized.