Hyperactivity Impulsivity Research Articles

ADHD, Lifestyles and Comorbidities: A Call for an Holistic Perspective - from Medical to Societal Intervening Factors.

The review examines Attention Deficit Hyperactivity Disorder (ADHD in its Child and Adult form) and its various presentations (Hyperactive Impulsive, Inattentive, and Combined) with a particular focus on environmental (incl. social factors), lifestyles and comorbidities. It is argued that ADHD is best understood in a holistic and interactive context and a vast empirical literature is presented to illustrate the point: Environmental factors include stress in general as well as exposure to toxins (phthalates, bisphenol A). Social factors are illustrated by effects of social deprivation and seduction to unhealthy lifestyles. Maternal lifestyle during pregnancy is pointed out (particularly her exposure to nicotine, alcohol, caffeine, and drugs, even seemingly benign medications like acetaminophen), which all tend to be related to ADHD. Family environment is discussed with respect to protective effect of (mainly authoritative and autocratic) parenting styles. Societal factors include mainly economic and political issues: income inequality and poverty (low SES is an ADHD risk factor) and a growing moral dilemma between a humanistic effort to globally spread the knowledge of ADHD and the medicalization and commercialization of the disorder. The second part of the review is devoted to ADHD related lifestyles and resulting comorbidities (e.g., food addiction and obesity, substance abuse, electronic media dependencies and conduct and personality disorders). Although ADHD is a neurodevelopmental disorder, its assessment and treatment are also linked to environmental, behavioral and social factors and their interactions.

A crossroad in ADHD – adult-onset ADHD

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a common disorder characterized by inattention or hyperactivity–impulsivity, or both. For a long time, ADHD was thought of as a disorder of children which would sometimes persist into adulthood. DSM 5 uses as a criterion that several symptoms have to be present prior to age 12 years.ObjectivesTo discuss the findings of 3 recent cohorts that show the onset of ADHD in adulthood.MethodsA review of selected articles of interest using PubMed database.Results3 large, longitudinal, population studies from Brazil, New Zealand (NZ) and the United Kingdom (UK) show that we are at a crossroads in our understanding of ADHD. In each study, the prevalence of adult-onset ADHD (Brazil, 10.3%; UK, 5.5%; and NZ, 2.7%) was much larger than the prevalence of childhood-onset adult ADHD (UK, 2.6%; Brazil, 1.5%; and NZ, 0.3%). They all propose different conclusions that would result in a paradigmatic shift in ADHD: in Brazil, that child and adult ADHD are “distinct syndromes”; in the UK, “that adult ADHD is more complex than a straightforward continuation of the childhood disorder” and in NZ, that adult ADHD is “not a neurodevelopmental disorder”. Faraone et al., in an editorial in JAMA Psychiatry, propose that these findings might correlate to subthreshold child ADHD before it emerges as adolescent- or adult-onset ADHD.ConclusionsIt's an exciting time in ADHD research. These new data work as an incentive to study adult-onset ADHD and how it emerges. Future research will shape our understanding of adult ADHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Peer Problems and Hyperactivity-Impulsivity Among Norwegian and American Children: The Role of 5-HTTLPR.

Peer problems are linked to attention deficit hyperactivity disorder (ADHD) symptoms and the serotonin system is thought to be involved in ADHD-related behavior. Hence, from a Gene×Environment perspective, the serotonin transporter 5-HTTLPR may play a moderating role. In two large community samples, the moderating role of 5-HTTLPR was examined related to more hyperactivity-impulsivity symptoms (HI symptoms) predicted by more peer problems. In Study 1, involving 642 Norwegian children, results indicated that for s-allele carriers only, caregiver-reported peer problems at age 4 predicted more parent-reported HI symptoms at age 6. In Study 2, similar results emerged involving 482 American children. Discussion focuses on differential sensitivity to the adverse effects of poor peer relations.

Elevated serum ubiquitin-proteasome pathway related molecule levels in attention deficit hyperactivity disorder

Abstract Introductıon We aimed to determine the serum levels of transactive response of DNA-binding protein 43 (TDP-43) and ubiquitin C-terminal hydrolase-L1 (UCH-L1), which are ubiquitin-proteasome pathway related molecules and have not been investigated so far, in children with attention-deficit/hyperactivity disorder (ADHD). Methods The study group was composed of thirty children aged between 6 and 10. They were diagnosed with ADHD according to DSM-IV criteria. They were the subjects who applied to Dicle University, Faculty of Medicine, and Department of Child Psychiatry in Diyarbakır, Turkey. Children with ADHD were assessed via Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale and Stroop test. Serum TDP-43 and UCH-L1 levels were analysed with enzyme-linked immunosorbent assay. Results The TDP-43 and UCH-L1 serum levels of children with ADHD were found to be statistically significantly higher than those of controls. On the other hand, we found that serum levels of TDP-43 correlated with interference effect and hyperactivity–impulsivity in children with ADHD. Conclusıon Imbalances in serum UCH-L1 and TDP-43 levels, and the correlation of TDP-43 levels with clinical parameters in children with ADHD may suggest that ubiquitin-proteasome pathway alterations are associated with ADHD. Deterioration of this pathway may cause intracellular TDP-43 aggregation.

Temperamental predictors of developmental trajectories of inattention and hyperactivity–impulsivity problems in schoolchildren

BackgroundThe current study aimed to examine the temperamental predictors of developmental trajectory subgroups of children's inattention and hyperactivity–impulsivity problems through a short-term longitudinal study. MethodsChildren (n = 1344) were divided into younger (age 6–8 years) and older (age 9–11 years) groups in order to observe changes in inattention and hyperactivity–impulsivity problems. Inattention and hyperactivity–impulsivity problems were measured three times at 5-month intervals and Cloninger's four temperaments (novelty seeking, harm avoidance, reward dependence, and persistence) were examined on the first occasion only. A cohort sequential design and growth mixture model were used for investigating trajectory subgroups and multiple logistic regression analysis to examine the temperamental predictors. ResultsDevelopmental trajectories of inattention and hyperactivity–impulsivity showed different subgroupings depending on the age group of children. Temperament (high score on novelty seeking and low score on persistence as well as high score on reward dependence) and gender predicted the likelihood of belonging to high-risk versus low-risk subgroups. ConclusionSuggestions taking into account the predictors of developmental trajectories in inattention and hyperactivity–impulsivity problems for future research are discussed along with the limitations of the current study.

Can Sluggish Cognitive Tempo Be Distinguished From ADHD Inattention in Very Young Children? Evidence From a Sample of Korean Preschool Children

Objective: This study evaluated whether sluggish cognitive tempo (SCT) is separable from ADHD–inattention (IN) and uniquely associated with internalizing dimensions in preschool children in South Korea. Method: Mothers of 172 preschool children (ages 4-6 years; 52% girls) rated children’s SCT, ADHD-IN, ADHD–hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), aggression, emotional reactivity, anxiety/depression, somatic complaints, withdrawal, and sleep problems. Results: Eight of 10 SCT symptoms showed convergent and discriminant validity with ADHD-IN. ADHD-IN remained significantly positively associated with ADHD-HI, ODD, and aggressive behavior after controlling for SCT, whereas SCT was no longer positively associated with these externalizing behaviors after controlling for ADHD-IN. Both SCT and ADHD-IN were uniquely associated with greater emotionally reactivity, anxiety/depression, and withdrawal. Only SCT was uniquely associated with somatic complaints, and only ADHD-IN was uniquely associated with sleep problems. Conclusion: Findings replicate results with children and adolescents, thus expanding evidence for the validity of SCT in early development.

Attention-Deficit/Hyperactivity Disorder, Trait Impulsivity, and Externalizing Behavior in a Longitudinal Sample.

Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid with and predictive of externalizing behavior, yet is most often examined categorically, not dimensionally. We tested a recently proposed trait impulsivity model by dimensionally examining measures of childhood inattention and hyperactivity/impulsivity separately as predictors of later externalizing behavior in an all-female longitudinal sample of 228 young women. We also examined influences of parenting and peer relations, given the transactional nature and importance of environmental factors. We analyzed the relative contribution of hyperactive/impulsive (HI) and inattentive (IA) symptoms of girls with and without childhood-diagnosed ADHD (M age = 9.5; 140 ADHD and 88 Comparison) to the development of externalizing behaviors in adolescence (M age = 14.2) and early adulthood (M age = 19.6). Authoritarian parenting was examined as a moderator and adolescent externalizing behavior as a mediator of the relation between childhood HI and later externalizing behavior. Childhood HI symptoms significantly predicted multiple externalizing behaviors in adolescence and early adulthood, after accounting for IA and covariates (ΔR 2 ranged from 2.6 to 7.5%). Mother's authoritarian parenting moderated this relation. Adolescent externalizing behavior mediated the relation between childhood HI symptoms and early adult externalizing behavior. In no case did childhood IA significantly predict externalizing behavior after accounting for HI symptoms. Findings support a trait impulsivity model, as HI symptoms, but not IA symptoms, significantly predicted later externalizing behavior. Results support the importance of dimensional predictors of developmental trajectories. We discuss implications for assessment, intervention, and future research.

Predictors of Response to Behavioral Treatments Among Children With ADHD-Inattentive Type

The goal of the study was to examine baseline characteristics—child gender, IQ, age, internalizing problems, symptoms of hyperactivity/impulsivity (HI), oppositional defiant disorder, and sluggish cognitive tempo, and parent income, education, attention deficit/hyperactivity disorder (ADHD) severity, and anxiety/depression (A/D)—associated with response to behavioral treatments for ADHD, predominantly inattentive type. We employed data from 148 children (M = 8.7 years), 58% male, and 57% Caucasian in a randomized clinical trial. Positive treatment response was defined as (a) 5 or fewer inattentive symptoms and (b) a decrease of at least 3 inattentive symptoms from baseline to posttreatment. Child HI, parental A/D, and child IQ were associated with positive response, as follows: Child HI had a main effect in which it was negatively associated with treatment response (36% with 2 or more HI symptoms were positive responders vs. 59% of those with 1 or no symptoms) that was qualified by parental A/D and child IQ. When children had 2 or more symptoms of HI and higher parental A/D, positive response rate was low at 25%; when children had 2 or more symptoms of HI, low parental A/D, and an IQ of 105 or higher, positive response rate was 85%. Furthermore, the group with the poorest response rate (25%) had parents who self-reported greater ADHD severity, and the group with a relatively good rate of positive response (59%) had the lowest number of oppositional defiant disorder symptoms. Likelihood of positive response to our behavioral treatment for ADHD-I is dependent on child and parent factors.

DAT1 methylation is associated with methylphenidate response on oppositional and hyperactive-impulsive symptoms in children and adolescents with ADHD

Objectives: To examine the association of the DNA methylation of DAT1 and DRD4 gene with methylphenidate (MPH) response in attention deficit hyperactivity disorder (ADHD).Methods: One hundred and eleven DSM-IV defined ADHD Chinese Han children were recruited. Inattention, hyperactivity–impulsivity and oppositional symptoms were evaluated by the Swanson, Nolan and Pelham–IV–parent rating scale (SNAP-IV-P) at baseline and 6 weeks after MPH treatment. DNA methylation of CpG sites in the promoter sequences of DAT1 and DRD4 was examined for association with treatment response.Results: Greater improvement on the SNAP-IV-P total score and percentage change from baseline score were both significantly correlated with DAT1 methylation (rho =−0.222, P = .019 and rho = −0.203, P = .032, respectively). A secondary analysis demonstrated that the effect of DAT1 methylation on symptom response was primarily related to the percentage change in oppositional symptoms (rho = −0.242; P = .012), with a smaller significant effect on hyperactivity–impulsivity (rho = −0.192; P = .045). No significant correlation was found between the treatment effect on inattention and DAT1 methylation (rho = −0.101; P = .292). No significant correlation was observed between mean DRD4 methylation and measures of treatment outcome or baseline symptoms.Conclusions: Our findings provide initial evidence for the involvement of the epigenetic alterations of DAT1 in modulating the response to MPH treatment in ADHD, primarily on oppositional and hyperactive-impulsive symptoms.

Understanding sleep problems in children with epilepsy: Associations with quality of life, Attention-Deficit Hyperactivity Disorder and maternal emotional symptoms

PurposeThis study aimed to (1) compare sleep problems between children and adolescents with epilepsy and non-epileptic controls, and (2) examine whether there is an association between sleep problems and quality of life, Attention-Deficit Hyperactivity Disorder (ADHD) and mothers’ emotional symptoms. MethodFifty-three patients from a cohort of epilepsy (aged 7–18 years) and 28 controls with minor medical problems (aged 7–18 years) were included. Parents completed Children's Sleep Habits Questionnaire (CSHQ) and Kinder Lebensqualitätsfragebogen: Children's Quality of Life Questionnaire-revised (KINDL-R) for patients and controls. Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) parent and teacher forms were used to assess ADHD symptoms for patients. Mothers of the patients completed Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables. ResultsChildren with epilepsy had a higher CSHQ Total score than the control group. Those with a CSHQ score >56 (which indicates moderate to severe sleep problems) had lower scores on KINDL-R. Parent-rated T-DSM-IV-S Total and Hyperactivity–Impulsivity scores, STAI trait and Beck scores were found to be higher in those with a CSHQ score >56. Significant positive correlations were found between CSHQ Total score and T-DSM-IV-S, STAI trait and Beck scores. Binary logistic regression analysis revealed that T-DSM-IV-S Total, Inattention and Hyperactivity–Impulsivity scores were significantly associated with a higher CSHQ Total score. None of the epilepsy-related variables were found to be related with the CSHQ Total score. ConclusionAmong children with epilepsy, sleep problems lead to a poor quality of life. The link between sleep problems and psychiatric symptoms must be conceptualized as a bilateral relationship. ADHD appears to be the strongest predictor of sleep problems.

Double-dissociation between the mechanism leading to impulsivity and inattention in Attention Deficit Hyperactivity Disorder: A resting-state functional connectivity study

Two core symptoms characterize Attention Deficit Hyperactivity Disorder (ADHD) subtypes: inattentiveness and hyperactivity–impulsivity. While previous brain imaging research investigated ADHD as if it was a homogenous condition, its two core symptoms may originate from different brain mechanisms. We, therefore, hypothesized that the functional connectivity of cortico-striatal and attentional networks would be different between ADHD subtypes. We studied 165 children (mean age 10.93 years; age range, 7–17 year old) diagnosed as having ADHD based on their revised Conner's rating scale score and 170 typical developing individuals (mean age 11.46 years; age range, 7–17 year old) using resting state functional fMRI. Groups were matched for age, IQ and head motion during the MRI acquisition. We fractionated the ADHD group into predominantly inattentive, hyperactive–impulsive and combined subtypes based on their revised Conner's rating scale score. We then analyzed differences in resting state functional connectivity of the cortico-striatal and attentional networks between these subtypes. We found a double dissociation of functional connectivity in the cortico-striatal and ventral attentional networks, reflecting the subtypes of the ADHD participants. Particularly, the hyperactive–impulsive subtype was associated with increased connectivity in cortico-striatal network, whereas the inattentive subtype was associated with increased connectivity in the right ventral attention network. Our study demonstrated for the first time a right lateralized, double dissociation between specific networks associated with hyperactivity–impulsivity and inattentiveness in ADHD children, providing a biological basis for exploring symptom dimensions and revealing potential targets for more personalized treatments.

Testing for the mediating role of endophenotypes using molecular genetic data in a twin study of ADHD traits.

Family and twin studies have identified endophenotypes that capture familial and genetic risk in attention‐deficit/hyperactivity disorder (ADHD), but it remains unclear if they lie on the causal pathway. Here, we illustrate a stepwise approach to identifying intermediate phenotypes. First, we use previous quantitative genetic findings to delineate the expected pattern of genetically correlated phenotypes. Second, we identify overlapping genetic associations with ADHD‐related quantitative traits. Finally, we test for the mediating role of associated endophenotypes. We applied this approach to a sample of 1,312 twins aged 7–10. Based on previous twin model‐fitting analyses, we selected hyperactivity–impulsivity, inattention, reading difficulties (RD), reaction time variability (RTV) and commission errors (CE), and tested for association with selected ADHD risk alleles. For nominally significant associations with both a symptom and a cognitive variable, matching the expected pattern based on previous genetic correlations, we performed mediation analysis to distinguish pleiotropic from mediating effects. The strongest association was observed for the rs7984966 SNP in the serotonin receptor gene (HTR2A), and RTV (P = 0.007; unadjusted for multiple testing). Mediation analysis suggested that CE (38%) and RTV (44%) substantially mediated the association between inattention and the T‐allele of SNP rs3785157 in the norepinephrine transporter gene (SLC6A2) and the T‐allele of SNP rs7984966 in HTR2A, respectively. The SNPs tag risk‐haplotypes but are not thought to be functionally significant. While these exploratory findings are preliminary, requiring replication, this study demonstrates the value of this approach that can be adapted to the investigation of multiple genetic markers and polygenic risk scores. © 2016 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

Associations between ADHD symptoms and smoking outcome expectancies in a non-clinical sample of daily cigarette smokers.

Smoking outcome expectancies for positive reinforcement (PR: beliefs that smoking produces desirable outcomes) and negative reinforcement (NR: beliefs that smoking alleviates negative affect) are modifiable cognitive manifestations of affect-mediated smoking motivation. Based on prior data and theory, we hypothesized that NR and PR expectancies are associated with ADHD symptom levels in a non-clinical sample of cigarette smokers. (Am J Addict 2016; XX:XX -XX) METHODS: Daily cigarette smokers (N = 256) completed self-report measures of ADHD symptoms and smoking outcome expectancies. Cross-sectional associations of overall ADHD symptomatology and the ADHD symptom dimensions of inattention (IN: difficulty concentrating and distractibility) and hyperactivity impulsivity (HI: poor inhibitory control and motor activity restlessness) with PR and NR smoking outcome expectancies were examined. Higher levels of overall, IN and HI ADHD symptoms were positively associated with NR smoking expectancies after statistically controlling for anxiety, depression, alcohol/drug use problems, nicotine dependence, and other smoking expectancies. Although neither HI nor IN symptom dimensions exhibited empirically unique relations to NR expectancies over and above one another, the collective variance across IN and HI was associated with NR expectancies. PR expectancies were not associated with ADHD symptoms. Although PR and NR expectancies may be important etiological influences in the overall population of smokers, NR outcome expectancies appear to be disproportionately expressed in smokers with elevated ADHD symptoms. Cognitive manifestations of NR motivation, which may be modifiable via intervention, are prominent in smokers with elevated ADHD symptoms. Beliefs that smoking alleviates negative affect may underlie ADHD-smoking comorbidity.

Bifactor latent structure of attention-deficit/hyperactivity disorder (ADHD)/oppositional defiant disorder (ODD) symptoms and first-order latent structure of sluggish cognitive tempo symptoms.

The objective was to determine if the latent structure of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms is best explained by a general disruptive behavior factor along with specific inattention (IN), hyperactivity/impulsivity (HI), and ODD factors (a bifactor model) whereas the latent structure of sluggish cognitive tempo (SCT) symptoms is best explained by a first-order factor independent of the bifactor model of ADHD/ODD. Parents' (n = 703) and teachers' (n = 366) ratings of SCT, ADHD-IN, ADHD-HI, and ODD symptoms on the Child and Adolescent Disruptive Behavior Inventory (CADBI) in a community sample of children (ages 5-13; 55% girls) were used to evaluate 4 models of symptom organization. Results indicated that a bifactor model of ADHD/ODD symptoms, in conjunction with a separate first-order SCT factor, was the best model for both parent and teacher ratings. The first-order SCT factor showed discriminant validity with the general disruptive behavior and specific IN factors in the bifactor model. In addition, higher scores on the SCT factor predicted greater academic and social impairment, even after controlling for the general disruptive behavior and 3 specific factors. Consistent with predictions from the trait-impulsivity etiological model of externalizing liability, a single, general disruptive behavior factor accounted for nearly all common variance in ADHD/ODD symptoms, whereas SCT symptoms represented a factor different from the general disruptive behavior and specific IN factor. These results provide additional support for distinguishing between SCT and ADHD-IN. The study also demonstrates how etiological models can be used to predict specific latent structures of symptom organization. (PsycINFO Database Record

ADHD Symptoms in a Non-Referred Low Birthweight/Preterm Cohort: Longitudinal Profiles, Outcomes, and Associated Features

Objective: This study’s objective is to differentiate possible ADHD syndromes on the basis of symptom trajectories, prognosis, and associated clinical features in a high-risk cohort. Method: Latent class analysis of inattentive (IA) and hyperactive–impulsive (HI) symptoms in 387 non-disabled members of a regional low birthweight/preterm birth cohort who were evaluated for ADHD at 6, 9, and 16 years. Adolescent functional outcomes and other clinical features were examined across the classes. Results: Three latent classes were identified: unaffected (modest IA and HI symptom prevalences at six, remitting by nine), school age limited (relatively high IA and HI symptom prevalences at six and nine, declining by 16), and persistent inattentive (high IA and HI prevalences at six and nine, with high IA levels persisting to 16). The persistent inattentive class was distinctively associated with poor functioning, motor problems, other psychiatric disorders, and social difficulties as indexed by a positive screen for autism spectrum disorder at 16. Conclusion: These findings differentiate a potential persistent inattentive syndrome relevant to ADHD evaluation and treatment.

Do personality traits explain the association between childhood attention-deficit hyperactivity disorder symptoms and substance use and problems in young adults?

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk of substance-related problems in adulthood. While comorbid disorders have been hypothesized to account for this risk, the role of personality factors has not yet been examined, despite findings of robust associations between temperament and personality traits and both ADHD and substance use problems. 349 young adults ages 18–38years (M=23.22years, SD=4.79, 54.7% male) completed a multi-informant assessment protocol, including self and informant retrospective measures of childhood ADHD symptoms, self-report measures of personality traits (NEO-FFM), and ratings of substance use and related problems. A multiple mediational framework was used to examine whether personality traits explained the association between childhood ADHD symptoms and substance use and problems in adulthood. Results revealed that childhood hyperactivity–impulsivity, but not inattention, directly influenced substance use and problems in adulthood. However, several indirect effects involving personality traits also emerged. Neuroticism and agreeableness appeared to be more relevant for explaining links between childhood ADHD symptom dimensions and substance-related problems, whereas conscientiousness and openness appeared to explain associations between childhood ADHD symptom dimensions and substance use. Overall, findings highlight the importance of personality traits for understanding the overlap among disorders on the externalizing spectrum.

Prenatal Smoke Exposure Predicts Hyperactive/Impulsive but Not Inattentive ADHD Symptoms in Adolescent and Young Adult Girls.

We examined the longitudinal associations between prenatal tobacco smoke exposure (PSE) and attention-deficit hyperactivity disorder (ADHD) symptom domains in adolescence and young adulthood. A sample of girls with ADHD combined presentation (N=93), ADHD predominantly inattentive presentation (N=47), and matched comparisons (N= 88) was assessed prospectively. Symptoms of hyperactivity/impulsivity (HI), inattention (IA), and oppositionality (oppositional defiant disorder) were measured via multiple informants 5 (M age =14 years; retention rate =92%) and 10 years (M age =20 years; retention rate =95%) following childhood ascertainment. PSE was captured via maternal self-report. We used linear regressions to examine the prediction from PSE to both HI and IA in adolescence and early adulthood after stringent control of relevant confounding variables. PSE significantly predicted HI during adolescence and young adulthood across multiple informants but did not predict IA at either wave. Symptoms of HI may have partial etiological independence from IA symptoms.

Longitudinal study of very low birth weight infants until 9 years of age; attention deficit hyperactivity and autistic features are correlated with their cognitive functions

BackgroundIncreasing attention has been given to neuro-developmental problems of very low birth weight infants (VLBWIs) at school age. However, it remains unknown whether their neuro-cognitive function and psychiatric symptoms are mutually associated. AimThe aim of this study was to investigate the characteristics of neuro-cognitive functions in VLBWIs and their relationship with psychiatric symptoms. MethodsA total of 160 VLBWIs who were born at our institute between 2001 and 2005 were recruited consecutively and followed up until nine years of age. The developmental profiles were obtained from 77 children (45 males and 32 females) at six to nine years of age using the ADHD Rating Scale—Fourth edition (ADHD-RS), Autism Screening Questionnaire—Japanese version (ASQ-J) and the Wechsler Intelligence Scale for Children—Third edition (WISC-III). ResultsThe full-scale intelligence quotient did not significantly differ between the male and female VLBWIs (median: 91 vs. 99, p=0.17). The males had higher total scores (median: 13 vs. 4, p<0.01) and higher scores on the subscales of Inattention (8 vs. 2, p<0.01) and Hyperactivity–Impulsivity (5 vs. 1, p<0.01) of the ADHD-RS compared with the females. The Verbal Comprehension Index (VCI) of the WISC-III was inversely correlated with the total scores of the ASQ-J for all VLBWIs (n=77, rc: −0.32, 95% CI: −0.19 to −0.01, p=0.04). We also observed that the Freedom from Distractibility Index (FDI) of the WISC-III was significantly correlated with the Inattentive scores of the ADHD-RS (n=45, rc: −0.18, 95% CI: −0.35 to −0.02, p=0.03) in male, but not female VLBWIs. ConclusionsWe herein report that the VCI and FDI of the WISC-III were correlated with the autism spectrum disorder and attention deficit hyperactivity disorder symptoms, respectively, in male VLBWIs.

Impact of adenotonsillectomy on ADHD and nocturnal enuresis in children with chronic adenotonsillar hypertrophy

ObjectiveChildren with chronic adenotonsillar hypertrophy (CAH) are more likely to have symptoms of attention deficit hyperactivity disorder (ADHD) and enuresis nocturna (EN) and benefit from surgery. The aim of this study was to evaluate the effect of adenotonsillectomy on ADHD and EN symptoms in children with CAH. Study designCross-sectional study was conducted. SettingParent-based questionnaires. MethodsParents of children with CAH were given Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV) and Nocturnal Enuresis Questionnaire (NEQ) before and six months after adenotonsillectomy. Inattention (IA) and hyperactivity–impulsivity (HI) subscores of T-DSM-IV were used in the present study. The rates of ADHD and EN were compared before and after surgery. ResultsA total of 75 children between 5 and 16years of age and their families participated in the study. All 75 families completed T-DSM-IV and NEQ. Mean IA (5.69±4.88 versus 4.46±4.40) and HI (6.53±5.60 versus 5.93±5.45) scores as well as total ADHD scores (12.22±8.99 versus 10.42±8.70) improved significantly after surgery. This significance was found to be statistically important (p<0.05). Furthermore 26 of the subjects were diagnosed with primer EN before adenotonsillectomy and 14 of these enuretic children had total remission six months after surgery. The frequency of EN dropped from 34.7% to 16.0% and this remission rate was found to be statistically significant (p<0.05). ConclusionChildren with CAH had high frequency of ADHD and EN symptoms in the present study. Adenotonsillectomy was found to be effective in improvement of these symptoms.

Reliability and validity of ADHD diagnostic criteria in the Assessment System for Individuals with ADHD (ASIA): a Japanese semi-structured diagnostic interview.

BackgroundWith reports of a high prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults, publication of ADHD diagnostic criteria in DSM-5, and the urgent need for a relevant diagnostic instrument conforming to DSM-5, we developed the Assessment System for Individuals with ADHD (ASIA), a Japanese semi-structured diagnostic interview. We report here the reliability and validity of ASIA ADHD diagnostic criteria.MethodsASIA ADHD criterion A corresponds to DSM-5 ADHD criterion A and has 144 original questions assessing nine inattention symptoms and nine hyperactivity–impulsivity symptoms, each having four childhood and four adulthood questions. The 144 questions are evaluated on a 3-point frequency scale. ASIA ADHD criteria B to E correspond to DSM-5 ADHD criteria B to E and are evaluated on a 2-point scale. ASIA was administered to 60 adults (mean age, 29.9 ± 9.0 years; 28 males; 36 ADHD and 24 non-ADHD participants diagnosed by consensus of two experts).ResultsFor ASIA ADHD criterion A, values of Cronbach’s α for the adulthood and childhood inattention and hyperactivity–impulsivity symptoms ranged from 0.64 to 0.90. Values of κ for two independent raters ranged from 0.98 to 1.00 for the 144 questions and raw agreement rates ranged from 0.97 to 1.00 for criteria B, C, D, and E. The consensus DSM-5 diagnoses endorsed 59 of the 60 ASIA diagnoses (ADHD and non-ADHD). The ADHD group scored significantly higher on 125 of the 144 questions for criterion A than the non-ADHD group. Correlations between ASIA total and subscale scores in adulthood and corresponding scores on the Japanese version of the Conners’ Adult ADHD Scales-Self Report were high.ConclusionsASIA ADHD criteria showed acceptable psychometric properties, although further investigation is necessary. The use of ASIA ADHD criteria could facilitate clinical practice and research into adult ADHD in Japan.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0525-7) contains supplementary material, which is available to authorized users.