Identification Of Attention Deficit Hyperactivity Disorder Research Articles

Demand and capacity in an ADHD team: reducing the wait times for an ADHD assessment to 12 weeks

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterised by the core symptoms of hyperactivity, impulsivity and inattention. ADHD is thought to affect about 3%–9% of school-age children and...

A Survey of Attention Deficit Hyperactivity Disorder Identification Using Psychophysiological Data

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurological disorders among children, that affects different areas in the brain that allows executing certain functionalities. This may lead to a variety of impairments such as difficulties in paying attention or focusing, controlling impulsive behaviors and overreacting. The continuous symptoms may have a severe impact in the long-term. This paper discusses the existing literature on the identification of ADHD using eye movement data and fMRI together including different deep learning techniques, existing models and a thorough analysis of the existing literature. We have identified the current challenges and possible future directions to provide computational support for early identification of ADHD patients that enable early treatments.

Changes in brain structural network connection of children with attention deficit hyperactivity disorder

Objective To explore the changes in brain structure network connection in children with attention deficit hyperactivity disorder(ADHD), and to provide novel markers for early identification of ADHD in clinical practice. Methods Deterministic diffusion-tensor tractography and graph theory approaches were used to investigate the topologic organization of the brain structural connectome in 25 children with ADHD and 23 healthy control children from May 2017 to May 2018, at Children′s Hospital of Xuzhou Medical University.Individual white matter networks were constructed for each participant, then the global properties, nodal properties and edge-wise distributions were compared between the two groups. Results (1)The global efficiency of the ADHD group (0.30±0.13) was significantly lower than that of the healthy control group (0.38±0.11), but the clustering coefficient (0.35±0.28) and the characteristic path length (2.94±0.38) were significantly higher than those of the healthy control group (0.28±0.10, 2.65±0.37), and the differences were statistically significant (t=-2.41, 2.31, 2.62, all P<0.05). (2)In the ADHD group, the nodal efficiency of the left inferior frontal gyrus, triangular part (0.13±0.06), left supramarginal gyrus (0.30±0.10), left inferior parietal, angular gyri (0.29±0.10), left precuneus (0.26±0.12)were significantly lower than the healthy control group(0.17±0.07, 0.38±0.10, 0.40±0.12, 0.35±0.12), while the nodal efficiency of the right superior frontal gyrus, orbital part and right paracentral lobule were significantly higher than the healthy control group(0.49±0.17, 0.43±0.14), and the differences were statistically significant[t=-2.52, -2.62, -3.11, -2.77, 2.34, 2.79, all P<0.05, false discovery rate(FDR) corrected]. (3)A disrupted subnetwork was observed that consisted of left frontoparietal areas, basal ganglia, thalamus and insular network (P<0.05, FDR corrected), which has the potential to discriminate individuals with ADHD from healthy control children(area under receiver operating characteristic curve was 0.78). (4)Diminished strength of the subnet work connections was correlated with the attention defect in patients with ADHD(r=-0.607, P=0.003). Conclusions Using magnetic resonance diffusion tensor imaging, with the help of graph theory analysis technology, ADHD children can be observed changes in brain structure network at multiple levels.The distribution pattern of brain network structure connection changes is expected to become a new marker for identifying ADHD. Key words: Attention deficit hyperactivity disorder; Diffusion tensor image; Graph theory; Structural network

Study on the level of peripheral serum glial-derived neurotrophic factor in children with attention deficit hyperactivity disorder

Objective To explore the changes of peripheral serum glial-derived neurotrophic factor(GDNF) levels in children with attention deficit hyperactivity disorder(ADHD), and to provide a new marker for early identification of ADHD in clinical practice. Methods Totally 42 drug-naive children with ADHD(ADHD group) and 45 healthy children(HC group) were included. General demographic information, scale scores, and fasting peripheral serum GDNF levels were compared between the two groups. Meanwhile, the correlation between GDNF level and symptom severity score of children with ADHD was analyzed. Results There were significant differences in FSIQ, attention deficit, and hyperactivity/impulsivity scores between ADHD group and HC group(FSIQ(105.26±13.82) vs (114.73±9.93); attention deficit(23.60±5.06) vs (20.04±2.85); hyperactivity/impulsivity(19.43±3.47) vs (15.93±2.42), all P<0.05). Serum level of GDNF in the ADHD patients was significant lower than that in the HC group ((442.52±70.01)pg/ml vs (554.02±101.37)pg/ml, P<0.01). In addition, GDNF levels were negatively correlated with attention deficit scores in children with ADHD (radj=-0.447, P<0.01). More importantly, ROC curve results show that GDNF had good diagnostic value (AUC=0.81). Conclusion GDNF levels decreased child with ADHD.Decreased serum GDNF levels have certain promising value in the diagnosis of ADHD. Key words: Attention deficit hyperactivity disorder; Glial-derived neurotrophic factor; Children

Screening with an ADHD-specific rating scale in preschoolers: A cross-cultural comparison of the Early Childhood Inventory-4.

The Early Childhood Inventory-4 (ECI-4) Hyperactivity-Impulsivity (HI) and Inattention (IA) subscales are screeners for attention-deficit/hyperactivity disorder (ADHD). There have been few studies of the screening properties of these subscales, particularly outside the United States. We investigated the classification accuracy of the parent and teacher versions of the HI and IA subscales and the cross-cultural validity of the cutoff values based on norms from a United States sample. The present study was part of the Norwegian Mother and Child Cohort Study. Parents and teachers rated boys (n = 332) and girls (n = 319) with the ECI-4 (mean Age 3.5 years). Interviewers who were blind to the ratings used the Preschool Age Psychiatric Assessment Interview to assign ADHD diagnoses. The ECI-4 HI and IA subscales showed acceptable accuracy in identifying ADHD in boys and girls (areas under the curve ranged from .67 to .85). In a multivariate regression analysis, the parent and teacher HI subscale scores significantly contributed to ADHD identification, but not the IA subscale scores. To achieve the necessary sensitivity to detect children with ADHD, lower cutoff levels than those specified by the United States ECI-4 norms were needed. For screening purposes, the parent and teacher ECI-4 showed acceptable accuracy in identifying preschoolers at risk for ADHD, and it may be sufficient to use the HI subscale scores. The suggested cutoff values provided by the United States ECI-4 norms had limited cross-cultural validity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A deep learning framework for identifying children with ADHD using an EEG-based brain network

The convolutional neural network (CNN) is a mainstream deep learning (DL) algorithm. However, the application of DL techniques in attention-deficit/hyperactivity disorder (ADHD) studies is still limited. Electroencephalography (EEG) is an informative neuroimaging tool. In this study, we propose a DL framework for the ADHD identification problem by combining an EEG-based brain network with the CNN. By reorganizing the order of the channels, we proposed a new form of the connectivity matrix to adapt the concept of the convolution operation of the CNN. The correlations between the deep features derived from the CNN models and 13 hand-crafted measures of the brain network were also analyzed. We collected EEG data from 50 children with ADHD (9 girls, mean age: 10.44 ± 0.75) and 51 handedness- and age-matched controls, and we used mutual information (MI) to quantify the synchronization between channels. We demonstrated the feasibility of the framework and discussed some critical concerns in the application of the framework. Some of the practical suggestions were also given based on the validation results. The proposed framework achieved a convincing performance with an accuracy of 94.67% on the test data. We also validated the validity of the form of the connectivity matrix, which enabled the models to achieve better performance. This finding suggests that the data representation in the DL framework is important. Seventeen deep features showed significant between-group differences, and had significant correlations with hand-crafted measures, thereby reflecting the amazing learning ability of the method for finding the deviations in the brain network of children with ADHD. The proposed framework is broadly applicable to the ADHD identification problem. Nevertheless, the validation of this methodology with a large and well-matched sample of children is needed in the future.

A Qualitative Analysis of Contextual Factors Relevant to Suspected Late-Onset ADHD

Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.

Public recognition of attention-deficit hyperactivity disorder in Korea: Correct identification, causes, treatments, and social distance.

To examine the Korean public's recognition of attention deficit hyperactivity disorder (ADHD), its sociodemographic correlates, and its implications for lay beliefs and social attitudes. Six hundred seventy-three Korean adults were recruited for an online survey. Participants completed questionnaires on sociodemographic characteristics and their familiarity with ADHD. Participants were then provided with a vignette describing a person with ADHD symptoms, and subsequently were asked to answer whether the person had any sort of problem. Among the 673 participants who were initially recruited, those who recognized any problem responded to subsequent questions concerning the exact identification of the disorder, their beliefs about its etiology and treatment, and their preferences for social distance. It was found that 30.8% of participants perceived no problem and that 23.9% of those who did recognize a problem correctly identified ADHD as the diagnosis. Female gender, younger age, higher family income, higher education level, and having had any acquaintance with ADHD were associated with the correct identification of ADHD. The correct identification of ADHD was positively associated with behavioral/discipline beliefs and decreased social distance toward persons with ADHD, whereas it was negatively associated with beliefs concerning diet and personal characteristics. The present study highlights the importance of the accurate recognition of ADHD in relation to appropriate beliefs about its etiology, treatment strategies, and better social attitudes toward persons with ADHD.

Wender Utah Rating Scale-25 (WURS-25): psychometric properties and diagnostic accuracy of the Swedish translation

Objective: The aim of this study was to examine the psychometric properties and diagnostic accuracy of the Swedish version of the Wender Utah Rating Scale (WURS) in psychiatric patients with similar symptoms but diagnosed with either attention deficit hyperactivity disorder (ADHD), bipolar disorder (BP), and/or borderline personality disorder (BPD).Methods: A total of 121 patients from an outpatient psychiatric clinic for young adults (18–25 years) were diagnosed using the Structured Clinical Interview for DSM Axis I and Axis II (SCID-I and SCID-II), and ADHD was diagnosed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). WURS were filled in by the participants and compared with a diagnosis of ADHD according to K-SADS.Results: Internal consistency of the WURS was 0.94. The principal component analysis resulted in a three-factor solution that accounted for 61.3% of the variance. The ADHD group had significantly higher mean scores compared to all other groups. The diagnostic accuracy of the WURS was examined using AUC and ROC analysis, and the optimal cut-off score was 39, with a sensitivity of 0.88 and specificity of 0.70, with AUC 0.87, 95% CI 0.80–0.94, PPV 0.59, and NPV 0.92.Conclusion: The psychometric properties of the Swedish WURS were good. For assessment of adult ADHD, in patients with symptoms of emotional instability, impulsivity, and attention problems but of different origins, a somewhat higher cut-off score than the originally suggested was preferable for identification of ADHD.

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

Verbal Working Memory as a Longitudinal Mechanism of Vocabulary Problems in Preschoolers with ADHD.

Elucidation of early potential risk factors of Attention-Deficit/Hyperactivity Disorder (ADHD) is important to allow for early identification of ADHD and targeted early intervention for children with ADHD. Delayed language skills, particularly poor vocabulary, is an early-developing potential risk factor that is thought to be involved in developmental pathways to ADHD; however, mechanisms explaining the relationship between poor vocabulary skills and ADHD symptoms are unclear and warrant investigation. The present study examines the relationship between poor vocabulary skills and ADHD symptoms by testing cognitive mechanisms, namely verbal working memory (WM), that might account for this link. Participants were 109 young children between the ages of three and six and their primary caregivers. Diagnostic information on ADHD symptoms was available from parents and teachers/daycare providers via standardized rating forms. Vocabulary skills and WM were measured through child performance on laboratory tasks. Mediation analyses found poor verbal working memory significantly partially explained the vocabulary-ADHD association for both parent and teacher-rated ADHD symptoms. Further, effects of verbal WM on the association between poor vocabulary and increased ADHD symptoms largely held at one-year follow-up. Development of early interventions targeting verbal WM may be a promising new direction for early ADHD intervention work.

Identification of ADHD in youth with epilepsy

To further characterize Attention-Deficit/Hyperactivity Disorder (ADHD) in a clinic-referred sample of youth with epilepsy. Children and adolescents with epilepsy who were referred for comprehensive neuropsychological evaluation comprised the sample. Data were obtained via archival record review. Youth with epilepsy were grouped according to ADHD diagnosis (no ADHD, ADHD - Combined Type, and ADHD - Predominantly Inattentive Type) and compared for a number of neurocognitive variables, seizure-related variables, and parent and teacher completed behavior rating scale variables. Data was examined via analysis of variance and logistic regression models with post hoc pairwise comparisons, employing Tukey procedure where appropriate. Youth in this clinical case series (N = 204) demonstrated a high rate of ADHD diagnosis. ADHD - Combined Type was identified with slightly greater frequency than ADHD - Predominantly Inattentive Type. Age of seizure onset, seizure classification, and seizure frequency did not differ significantly between the groups. The groups also did not differ on most cognitive variables examined. Significant group differences were found for parent and teacher completed behavior rating scales assessing inattention, hyperactivity, and executive dysfunction. Screening for ADHD in youth with epilepsy is important as these symptoms can significantly interfere with rehabilitative efforts. Behavior rating scales may be the most efficient and cost effective way to identify ADHD in youth with epilepsy.

Predicting ADHD by Assessment of Rutter's Indicators of Adversity in Infancy.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with early onset. ADHD is associated with significant morbidity and mortality, partly due to delayed diagnosis. Identification of children at high risk for developing ADHD could lead to earlier diagnosis and potentially change the negative trajectory of the illness for the better. Since early psychosocial adversity is considered to be a likely etiological risk factor for ADHD, markers of this construct may be useful for early identification of children at high risk. Therefore, we sought to investigate whether Rutter’s indicators of adversity (low social class, severe marital discord, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care) assessed in infancy could serve as early predictors for the development of ADHD.Methods and FindingsUsing data from the Danish nationwide population-based registers, we established a cohort consisting of all 994,407 children born in Denmark between January 1st 1993 and December 31st 2011 and extracted dichotomous values for the six Rutter’s indicators of adversity at age 0–12 months (infancy) for each cohort member. The cohort members were followed from their second birthday and the association between the sum of Rutter’s indicators of adversity (RIA-score) in infancy and subsequent development of ADHD was estimated by means of Cox regression. Also, the number needed to screen (NNS) to detect one case of ADHD based on the RIA-scores in infancy was calculated. During follow-up (9.6 million person-years), 15,857 males and 5,663 females from the cohort developed ADHD. For both males and females, there was a marked dose-response relationship between RIA-scores assessed in infancy and the risk for developing ADHD. The hazard ratios for ADHD were 11.0 (95%CI: 8.2–14.7) and 11.4 (95%CI: 7.1–18.3) respectively, for males and females with RIA-scores of 5–6, compared to males and females with RIA-scores of 0. Among males with RIA-scores of 5–6, 37.6% (95%CI: 27.0–50.7) had been diagnosed with ADHD prior to the age of 20, corresponding to a NNS of 3.0 (95%CI: 2.2–4.0).ConclusionsRutter’s indicators of adversity assessed in infancy strongly predicted ADHD. This knowledge may be important for early identification of ADHD.

Continuous performance task in attention deficit hyperactivity disorder children

Background Poor behavioural inhibition is the central impairment in attention deficit hyperactivity disorder (ADHD). At present, there is no reliable objective measure to detect ADHD. A proper pinpointing evaluation for ADHD depends mainly on the history from parents, family members as well as teachers and schoolmates, by means of questionnaires and conduct rating scales. Objective The aim of this study was to detect continuous performance task (CPT) (test of variants of attention) changes in children suffering from ADHD compared with normal children. Patients and methods CPT, Conners' parent rating scale and Wechsler intelligence scale were done for two groups of children each containing 39 children, a group of ADHD children and the other a normal control group. Results We found a significant difference between the mean total IQ score among the ADHD patients group compared with control group. Comparing both groups revealed statistically significant increase in omission, commission and reaction time among patients. A significant negative correlation was found between age on one side and IQ, hyperactivity and psychosomatic subscales, hyperactivity and total DSM-IV scores on the other hand and between commission and opposition, restlessness subscales and ADHD index and also between reaction time and restlessness and emotional index. There was a significant positive correlation between omission and hyperactivity and anxiety subscales, restlessness and emotional indices and DSM-IV hyperactive and total scores. In addition, there was a significant positive correlation between perfectionism and commission and also between reaction time and inattention and social problems subscales. Conclusion CPT can have a substantial role in objective identification of ADHD.

Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters.

Attention Deficit Hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD is known to negatively impact children, their families, and their community. About one-third to one-half of patients with ADHD will have persistent symptoms into adulthood. The prevalence in the United States is estimated at 5-11%, representing 6.4 million children nationwide. The variability in the prevalence of ADHD worldwide and within the US may be due to the wide range of factors that affect accurate assessment of children and youth. Because of these obstacles to assessment, ADHD is under-diagnosed, misdiagnosed, and undertreated. We examined factors associated with making and receiving the diagnosis of ADHD. We sought to review the consequences of a lack of diagnosis and treatment for ADHD on children's and adolescent's lives and how their families and the community may be involved in these consequences. We reviewed scientific articles looking for factors that impact the identification and diagnosis of ADHD and articles that demonstrate naturalistic outcomes of diagnosis and treatment. The data bases PubMed and Google scholar were searched from the year 1995 to 2015 using the search terms "ADHD, diagnosis, outcomes." We then reviewed abstracts and reference lists within those articles to rule out or rule in these or other articles. Multiple factors have significant impact in the identification and diagnosis of ADHD including parents, healthcare providers, teachers, and aspects of the environment. Only a few studies detailed the impact of not diagnosing ADHD, with unclear consequences independent of treatment. A more significant number of studies have examined the impact of untreated ADHD. The experience around receiving a diagnosis described by individuals with ADHD provides some additional insights. ADHD diagnosis is influenced by perceptions of many different members of a child's community. A lack of clear understanding of ADHD and the importance of its diagnosis and treatment still exists among many members of the community including parents, teachers, and healthcare providers. More basic and clinical research will improve methods of diagnosis and information dissemination. Even before further advancements in science, strong partnerships between clinicians and patients with ADHD may be the best way to reduce the negative impacts of this disorder.

ADHD Diagnosis May Increase Risk of Premature Death, Study Finds

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessADHD Diagnosis May Increase Risk of Premature Death, Study FindsAaron Levin, Vabren WattsAaron LevinSearch for more papers by this author, Vabren WattsSearch for more papers by this authorPublished Online:2 Apr 2015https://doi.org/10.1176/appi.pn.2015.3b23AbstractRisk of death by unnatural causes, especially accidents, is found to be increased in people who have been diagnosed with ADHD, but treatment may lower this risk.A huge study using Denmark’s population and health registries found that individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) have twice the risk of premature death and a lower life expectancy than those without ADHD.Researchers from Aarhus University looked at health records of 1.92 million people—including 32,061 with ADHD—born in Denmark from 1981 to 2011 to investigate any associations between an ADHD diagnosis and premature mortality.Previous research has shown that an association between ADHD and other mental illnesses (such as oppositional defiant disorder and substance use disorder) is likely to increase mortality, but it was unknown whether an ADHD diagnosis itself increased risk for premature death. Overall, 5,580 people in the study population (including 107 with ADHD) died during the study period, which ended in 2013. The fully adjusted mortality rate ratio (MRR) for the general population was 2.21 per 10,000 person-years. But the MRR was 5.85 for decedents with ADHD, wrote Søren Dalsgaard, Ph.D., of the National Centre for Register-Based Research at Aarhus University, and colleagues in The Lancet online February 26.Women had a higher mortality rate (3.01) than men (1.93). Older patients were at greater risk of premature death. The MRR for those first diagnosed between ages 1 and 5 was 1.86 but for those diagnosed at age 17 or later, it was 4.25.“This finding could be caused by persistent ADHD being a more severe form of the disorder,” the researchers suggested.“[F]ailure to identify and treat ADHD in a timely manner might worsen the course of the disorder and increase the risk to enter one of the pathways to premature death,” wrote Stephen Faraone, Ph.D., a professor of psychiatry, neuroscience, and physiology at SUNY Upstate Medical University in Syracuse, N.Y., commenting on the study in The Lancet.Comorbidities played an important role, too. A combination of oppositional defiant disorder, conduct disorder, and substance use disorder increased mortality to an adjusted MRR of 8.29, compared with those without ADHD or those comorbidities.Cause of death was available for 79 of the 107 people with ADHD who died; 54 died from unnatural causes, including 42 from accidents.Earlier research pointed to a higher risk of injury among children with ADHD, the researchers noted. “Similarly, other studies have noted that people with ADHD anticipate less severe results of risk-taking behaviour and have poorer skills for prevention of injuries than do peers without ADHD.”The study adds to the medical literature emphasizing the importance of properly diagnosing and treating ADHD, Timothy Wilens, M.D., chief of child and adolescent psychiatry at Massachusetts General Hospital for Children, told Psychiatric News.“While the risk of premature death in this age group remains low, the overall findings are a reminder for individuals with ADHD, their families, and practitioners that early identification and treatment of ADHD may help to improve overall long-term outcome, including issues of safety,” said Wilens. “Moreover, individuals with ADHD must continue to be vigilant about the increased risk for addictions as well as mishaps related to driving.”In addition to the value of early identification, the results also suggest a need for more research on how to improve life expectancy in this vulnerable group, said Dalsgaard and colleagues.“Although talk of premature death will worry parents and patients, they can seek solace in the knowledge that the absolute risk for premature death is low and that this and other risks can be greatly reduced with evidence-based treatments for the disorder,” added Faraone. ■An abstract of “Mortality in Children, Adolescents, and Adults With Attention-Deficit/ Hyperactivity Disorder: A Nationwide Cohor Study” can be accessed here. ISSUES NewArchived

Reconsidering “Inattention” in Attention-Deficit Hyperactivity Disorder: Implications for Neuropsychological Assessment and Intervention

Attention-deficit hyperactivity disorder (ADHD) does not exist. This explicit statement needs elucidation of course given ADHD is a common neurodevelopmental disorder, but it provides the reader with the impetus to reconsider long-held beliefs about this condition and its treatment. Surely, there is a disorder called ADHD from which this thesis is framed, but primary attention and hyperactivity-impulsivity problems are mediated by different albeit interrelated brain systems. Like many neurodevelopmental disorders (e.g., learning disabilities, autism spectrum disorder), the medical and psychological professions have used a single, large inclusive ADHD diagnostic category to represent children with different etiologies for their overt symptoms. Despite neurobiological differences among children diagnosed with ADHD, the clinical position that attention-deficit or primary attention problems are sufficient for ADHD identification undermines clinical practice. This commonly accepted dubious position not only undermines the diagnostic utility of our neuropsychological measures, but it attenuates treatment effects as well. Supported with evidence from our ongoing ADHD research program, this data-based review will support these contentions and provide implications for diagnosis and treatment of children with attention problems.

Quantitative electroencephalographic changes in attention deficit hyperactivity disorder children

Background The electroencephalogram (EEG) has long been used to pick up and analyze the electrical activity of the outermost layer of the brain. Attention deficit hyperactivity disorder (ADHD) patients revealed increased power in the lower frequency bands (δ and θ power) and a raised θ/β ratio. Objective The aim of this study was to detect the quantitative EEG changes in children with ADHD compared with normal children. Patients and methods The sampled group consisted of 45 children suffering from ADHD and represented the patient group, and 45 normal children represented the control group. EEG was recorded under resting conditions for all participants. Data from frontal areas were digitally processed and analyzed to calculate the four frequency bands' power (β, α, θ, and δ) and then θ/β ratio was computed. For the patient group, the Wechsler Intelligence Scale for Children was applied and parents of these patients filled out the Arabic version of Conners' Parent Rating Scale-revised-long version. Results The patient group showed significantly higher θ/β ratio in frontal areas compared with the control group ( P P P Conclusion Quantitative EEG markers - namely, the θ/β ratio - could play a role in the understanding and identification of ADHD.

Extreme Learning Machine-Based Classification of ADHD Using Brain Structural MRI Data

BackgroundEffective and accurate diagnosis of attention-deficit/hyperactivity disorder (ADHD) is currently of significant interest. ADHD has been associated with multiple cortical features from structural MRI data. However, most existing learning algorithms for ADHD identification contain obvious defects, such as time-consuming training, parameters selection, etc. The aims of this study were as follows: (1) Propose an ADHD classification model using the extreme learning machine (ELM) algorithm for automatic, efficient and objective clinical ADHD diagnosis. (2) Assess the computational efficiency and the effect of sample size on both ELM and support vector machine (SVM) methods and analyze which brain segments are involved in ADHD.MethodsHigh-resolution three-dimensional MR images were acquired from 55 ADHD subjects and 55 healthy controls. Multiple brain measures (cortical thickness, etc.) were calculated using a fully automated procedure in the FreeSurfer software package. In total, 340 cortical features were automatically extracted from 68 brain segments with 5 basic cortical features. F-score and SFS methods were adopted to select the optimal features for ADHD classification. Both ELM and SVM were evaluated for classification accuracy using leave-one-out cross-validation.ResultsWe achieved ADHD prediction accuracies of 90.18% for ELM using eleven combined features, 84.73% for SVM-Linear and 86.55% for SVM-RBF. Our results show that ELM has better computational efficiency and is more robust as sample size changes than is SVM for ADHD classification. The most pronounced differences between ADHD and healthy subjects were observed in the frontal lobe, temporal lobe, occipital lobe and insular.ConclusionOur ELM-based algorithm for ADHD diagnosis performs considerably better than the traditional SVM algorithm. This result suggests that ELM may be used for the clinical diagnosis of ADHD and the investigation of different brain diseases.

Twelve-year retrospective analysis of outpatients with Attention-Deficit/Hyperactivity Disorder in Shanghai.

BackgroundAttention-Deficit/Hyperactivity Disorder (ADHD) is the most common diagnosis among children treated in outpatient psychiatric clinics in China, accounting for up to 50% of all patients.ObjectiveUnderstand changes over time in the characteristics and treatment of children with ADHD seen at specialty psychiatric clinics in China. MethodsFor each year from 2000 through 2011, 250 charts of patients who made their initial visit to the Child and Adolescent Psychological Counseling Clinic of the Shanghai Mental Health Center were randomly selected. Among the 3000 selected patients, 998 (33%) had a diagnosis of ADHD.ResultsAbout 80% of the ADHD patients were male and the majority of them fell ill prior to the age of seven. The mean (sd) age at the time of first attendance at the clinic was 10.0 (2.6) years and the mean duration of illness at the time of the initial visit was 2.9 (1.2) years; both of these values decreased significantly over time. About 20% of them were non-residents of Shanghai and about 11% had comorbid psychiatric diagnoses (primarily depression and tic disorder); both of these proportions increased significantly over time. Among the 576 (58%) who visited the clinic more than once, 77% were treated with central nervous system stimulants, but the proportion administered behavioral treatments (either solely on in combination with medications) increased significantly over time.ConclusionADHD remains the most common diagnosis of children seen in specialty psychiatric clinics in China but the proportion of clinic attendees with ADHD is gradually declining as non-specialty treatment services expand and other diagnoses become more prominent. There are encouraging trends of earlier identification and treatment of ADHD and of increasing use of non-pharmacological interventions. Nevertheless, most children with ADHD have been ill for at least two years at the time of the initial diagnosis, so continued research efforts are needed to identify the best ways to speed up the recognition and treatment of this disabling condition.