Inattentive Subtype Research Articles

MMP-2, MMP-9, TNF-α Levels in Relation to Sub types of Attention Deficit Hyperactivity Disorder

Many authors have suggested the association between Attention Deficit Hyperactivity Disorder (ADHD) and inflammation through various mechanisms among which increased serum cytokines.30 newly diagnosed ADHD children, aged 6-12and of both sexes were collected from outpatient clinic, Psychiatry Department, Al Zahraa University Hospital and a matched control group of 30 children. They were subjected to Clinical assessment, Whechsler Intelligence Scale for children (WISC), Conners' Parent Rating Scale-Revised & serum MMP-2, MMP-9, TNF-α levels were determined. There was statistical significant difference between patient and control groups regarding MMP-2 level (648.50 ± 81.94 vs 344.13 ± 32.02), MMP-9 level (143.00±16.98 vs 102.90 ± 4.13) & TNF-α level (345 ± 7.1.vs 202 ± 22.3). Hyperactive/impulsive subtype represented 16(53.3%), Inattentive subtype represented 6(20%), Combined subtype represented 8(26.7%) of the ADHD group. MMP-2, MMP-9, TNF-α levels were all higher among the Hyperactive/impulsive subtype, followed by thecombined subtype then the Inattentive subtype with high statistical significant difference. A high statistical significant difference was found in all subscales of Conners' scale among the 3 subtypes of ADHD. A positive correlation was found between TNF-α level and age, whereas, a negative correlation exists between MMP-2, MMP-9, TNF-α level and IQ. In addition, correlation was found between MMP-2, MMP-9 levels and cognitive problems, TNF-α level and inattention.Our study illustrates the co-occurrence of inflammatory process and ADHD, but further studies on larger sample are needed.

Prevalence of Attention Deficit Hyperactivity Disorder among Primary School Children in Tikrit City, Iraq

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most widely recognizedneurobehavioral problem of children, which can interfere with the social and academic level.Objectives: To detect the prevalence of ADHD among primary school students in Tikrit city,Iraq, and to find the effect of the disease on school performance.Materials and methods: A cross-sectional study was done among students in 6 primary schoolsfor boys and girls during the studying year 2012-2013. The criteria of diagnosis were done accordingto the American Psychiatric Association. Students who fulfill the criteria were included andthe following parameters were studied including age, gender, family history, mother education,socioeconomic status of the family, and school performance.Results: The prevalence rate of ADHD in this study was 8.67%. Boys were mostly affected (65%).Most of them were under 9 years old (49%). Inattention subtype was mostly found in this study(38%) followed by combined (34%) and then hyperactive (28%). Positive family history was foundin (43%) of cases. The education level of their mothers was intermediate or secondary school level(37%). The majority of the cases were from the middle socioeconomic status (53%). Poor schoolperformance was seen in 69% of the cases.Conclusion: ADHD is a big problem among students of primary schools in Tikrit city with asignificant effect on the academic state

Socio-Demographic and Clinical Profiles of Adult Attention Deficit Hyperactivity Disorder Patients in a University Hospital in Oman.

ObjectivesAlthough attention deficit hyperactivity disorder (ADHD) is typically considered a condition affecting children, there is evidence that children diagnosed with ADHD continue to suffer from this condition after the age of 18. This study aimed to describe the socio-demographic and clinical characteristics of adult ADHD patients in Oman and evaluate their association with the disorder’s different subtypes.MethodsThis retrospective study included adult patients with ADHD from the outpatient clinic at Sultan Qaboos University Hospital, Muscat, Oman. Data from medical records from January 2018 to April 2020 were collected. Socio-demographic characteristics, clinical profiles and psychiatric comorbidities were examined.ResultsThis study included 100 adults who fulfilled the standard diagnosis of ADHD, with 54.0% (n = 54) and 46.0% (n = 46) from the inattentive and combined subtypes, respectively. It was found that ADHD was more prevalent among males (64.0%) than females (36.0%), with the inattentive subtype being more predominant among females. The ADHD patients with the inattentive subtype were associated with comorbid substance use disorders (odds ratio [OR] = 11.29; P = 0.049), personality disorders (OR = 7.96; P = 0.017) and major depressive disorder (OR = 15.94; P = 0.002) compared to patients predominantly with the combined subtype.ConclusionThis study echoes the findings from the current literature that adult patients with ADHD commonly have comorbid psychiatric disorders, leading to significant functional impairment. Psychiatric comorbidities must be identified and urgently treated for better clinical and functional outcomes in adult patients with ADHD.

Does Cannabis, Cocaine and Alcohol Use Impact Differently on Adult Attention Deficit/Hyperactivity Disorder Clinical Picture?

While the association between adult Attention Deficit/Hyperactivity Disorder (A-ADHD) and Substance Use Disorders (SUDs) has been widely explored, less attention has been dedicated to the various substance use variants. In a previous paper, we identified two variants: type 1 (use of stimulants/alcohol) and type 2 (use of cannabinoids). In this study, we compared demographic, clinical and symptomatologic features between Dual Disorder A-ADHD (DD/A-ADHD) patients according to our substance use typology, and A-ADHD without DD (NDD/A-ADHD) ones. NDD patients were more frequently diagnosed as belonging to inattentive ADHD subtype compared with type 1 DD/A-ADHD patients, but not with respect to type 2 DD/ADHD. NDD/A-ADHD patients showed less severe symptoms of hyperactivity/impulsivity than DD/A-ADHD type 1, but not type 2. Type 1 and type 2 patients shared the feature of displaying higher impulsiveness than NDD/A-ADHD ones. General psychopathology scores were more severe in type 2 DD/ADHD patients, whereas type 1 patients showed greater similarity to NDD/A-ADHD. Legal problems were more strongly represented in type 1 than in type 2 patients or NDD/A-ADHD ones. Our results suggest that type 1 and type 2 substance use differ in their effects on A-ADHD patients—an outcome that brings with it different likely implications in dealing with the diagnostic and therapeutic processes.

Impact of attention deficit hyperactivity disorder and gender differences on academic and social difficulties among adolescents in Qatari Schools.

Background: To evaluate the social and academic impact of adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and gender differences compared with their non-ADHD peers.Methods: A cross-sectional descriptive study using a standardized rating scale of teacher observations was conducted in the schools of Qatar from 7th to 12th grades. Teachers completed Swanson, Nolan, and Pelham (SNAP-IV) rating scale questionnaires for the ADHD core symptoms together with nine questions to evaluate the academic and social difficulties in all participants.Results: A total of 1775 students (mean age: 15 ± 1.5 years; boys/girls: 717/1058) were included in this study. Based on the SNAP-IV rating scale, 150 students were showing core symptoms of ADHD and classified as having ADHD (8.5%; boys/girls; 93/57) and 1625 students as non-ADHD peers (91.5%; boys/girls; 624/1001). Prevalence of ADHD among adolescent students is 8.5%, and it varied significantly between genders with 13% of boys and 5.4% of girls affected by this disorder. Adolescents with ADHD had more academic and social difficulties than their non-ADHD peers, the boys more so than the girls. Boys with inattentive subtype of ADHD had more academic difficulties than girls, while girls had more social difficulties than boys.Conclusion: The results of this study revealed that ADHD among adolescents is substantially associated with academic and social difficulties in the school environment. Gender differences among students with ADHD should be considered in the school and clinical environment.

The effect of lowering school entry age on attention deficit hyperactivity disorder diagnosis

The school entry age was changed from 72 to 66 months in 2012 with a new education system adjustment in Turkey. The aim of the study was to investigate the effects of lowering school entry age on Attention Deficit Hyperactivity Disorder (ADHD) diagnosis and symptom severity. The records of children at first and second grade diagnosed with ADHD according to the DSM-IV diagnostic criteria in the Child Psychiatry outpatient clinic between January and July 2010 (when the old system was in use) and between January-July 2013 (when the new system was in use) were retrospectively screened to create the old-system and new system groups. Among the two groups, T-DSM-IV-S fulfilled by parents and teachers were used to assess symptom severity. The frequency of ADHD and ADHD predominantly inattentive subtype diagnosis we found to be significantly higher among the girls in the new system compared to old system (25.8%, 8.9%, p=0.027 - 56.3%, 0%, p=0.012). Additionally, mother’s subscale scores of T-DSM-IV-S were lower among the children in the new system compared to the ones in the old system. By lowering school entry age due to the new education system, frequency of ADHD diagnosis increased while symptom severity rates decreased among the first-grade girls. Thus, it may be suggested that despite decreased symptom severity, the girls who started school with the new system were diagnosed with ADHD more frequently due to a marked disruption in academic, social, and behavioral functionality associated with insufficient neurodevelopmental maturity.

Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms

Background. Impulsivity and perfectionism are transdiagnostic personality factors that have been studied extensively and shown to relate to externalizing and internalizing pathology respectively. Typically, these personality factors are antithesized, with impulsivity characterized by lack of control and perfectionism characterized by rigid overcontrol. Methods. The current study (N = 1,353 undergraduate students) used latent profile analysis to identify subgroups based on impulsivity and perfectionism dimensions and tested the relations of these subgroups with the symptomatology of ten prevalent types of psychopathology (depression, worry, social anxiety, attention-deficit hyperactivity disorder inattentive subtype, attention-deficit hyperactivity disorder impulsive-hyperactive subtype, alcohol use, obsessive-compulsive disorder, posttraumatic stress disorder, restrictive eating pathology, and binge eating pathology). Results. The latent profile analysis identified four meaningful subgroups: high perfectionism, high impulsivity, combined impulsivity and perfectionism, and low impulsivity and perfectionism. The combined group was the most prevalent, comprising almost half of the sample. Further, the perfectionism group had the highest scores for obsessive-compulsive disorder, worry, and restrictive eating pathology, the impulsivity group had the highest scores for alcohol use disorder, and the combined group had the highest or second-highest scores across all types of psychopathology. Limitations. Limitations include the undergraduate sample, self-report, cross-sectional study design, and high bivariate residuals. Conclusions. These findings suggest impulsivity and perfectionism can co-occur. Further, the co-occurrence of these personality traits may heighten risk for psychopathology and help explain comorbidity across internalizing and externalizing disorders. Future research should continue to investigate the presentation, prevalence, and treatment for individuals high in both perfectionism and impulsivity.

Desarrollo de la teoría de la mente en niños con Trastorno por Déficit de Atención e Hiperactividad

Objetivo: Se buscó determinar y describir el desarrollo de la Teoría de la Mente (ToM) en niños con diagnóstico por Déficit de Atención / Hiperactividad (TDAH) con edades entre los 6 y 12 años. Metodología: Fue un estudio empírico-analítico de corte exploratorio descriptivo con grupo experimental y grupo control, los casos no fueron asignados aleatoriamente, sino que se escogió un grupo de niños con TDAH adscritos al Programa de Clínica Atencional de u Hospital Infantil, los controles se escogieron en instituciones educativas. Población: Participaron en el estudio 74 niños y niñas entre casos y controles, el 31,1 % fueron de tipo combinado y 18,9 % del subtipo inatento Instrumentos: Se aplicó una batería de pruebas de ToM: Test de Expresiones Faciales, Falsas Creencias de primer y segundo orden, Historias Extrañas de Happé, Test de Lectura de Miradas y Test de Metidas de Pata; para evaluar las funciones ejecutivas (FES) se aplicó el Stroop Test, Prueba de Retención de Dígitos del WISC III y la Prueba de Clasificación de Tarjetas de la ENI-Evaluación Neuropsicológica Infantil-. Variables: Se controló la edad, que estuvieran escolarizados y que tuvieran diagnóstico de TDAH. Resultados: Se encontró que hay una relación directa entre las dificultades en el desarrollo de la ToM y el TDAH, los niños con TDAH puntuaron más bajo en las pruebas aplicadas que los controles, aunque las diferencias no fueron estadísticamente significativas. Conclusión: Se concluye que los sujetos con TDAH tienen un mayor riesgo de presentar dificultades en el desarrollo de la ToM.

Self esteem and clinical features in a clinical sample of children with ADHD and social anxiety disorder

Objective In this study, we aimed to investigate self-esteem and clinical features in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and comorbid Social Anxiety Disorder (SAD) and compare these to children and adolescents without SAD. Methods One hundred and twenty child and adolescent drug-naïve outpatients (6–15 years of age) with a primary diagnosis of ADHD were included. Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL), was used to evaluate ADHD and comorbidities. Parents filled in clinical and sociodemographic data form, Conners Parent Rating Scale (CPRS) and patients filled in Rosenberg Self-esteem Scale (RSES) and Çapa Social Phobia Scale for children and adolescents (ÇESFÖ). Results Forty-six of the 120 (38.3%) children had comorbid SAD. Forty-six patients with SAD (ADHD + SAD group) and 74 patients without SAD (ADHD without SAD group) were compared in terms of the sociodemographic and clinical features, rate of psychiatric comorbidities, and rating scale scores. The rate of inattentive subtype of ADHD (p = 0.009), and social anxiety symptom scores (p < 0.001) were higher and self-esteem was lower (p < 0.001) in the ADHD + SAD group. Additionally, there was a statistically significant correlation between ÇESFÖ scores and CPRS anxiety subscale scores (r = 0.300, p = 0.001), and also Rosenberg self-esteem scale scores (r = 0.470, p < 0.001). Conclusion Children and adolescents with ADHD who had comorbid SAD may differ from ADHD patients without SAD in terms of ADHD subtype, clinical features and self-esteem.

The Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) Among Elementary School Children: The Effect of Certain Demographic Variables

The study aimed to determine the prevalence of ADHD symptoms in Saudi children aged 6 to 13 years in Jeddah city. The study also explored the effect of variables namely teacher's knowledge, years of experience and teachers' gender on reported ADHD symptoms among primary grade students. A questionnaire survey methodology was adopted for the study. 550 children were included in the teachers' survey. Teachers assessed the ADHD symptoms in children using an 18-item scale based on DSM-V. The results indicated that the prevalence rates of ADHD among school-age differed according to ADHD subtypes. The Inattention type was rated by 35.34%, Hyperactivity/Impulsivity type was rated by 28.60%, and ADHD-C type was rated by 21.3% of the respondents. According to gender, for the Inattention subtype, the ratio between boys and girls was 1.7:1, for the Hyperactivity/Impulsivity subtype, the ratio between boys and girls was 2.03:1, and for combined subtype, the ratio between boys and girls was 2.2:1. According to the grade level, the highest prevalence of ADHD overall was found in grade three and the lowest prevalence was in grade six in all ADHD types. The present findings indicated that teachers' knowledge and gender (female) successfully predicted teacher-rated ADHD status.

Electroclinical features and outcome of ANKRD11-related KBG syndrome: A novel report and literature review

Electroclinical features and outcome of ANKRD11-related KBG syndrome: A novel report and literature review

Inhibitory control and impulsive responses in neurodevelopmental disorders.

The impairment of inhibitory control is often assumed to be the core deficit of several neurodevelopmental disorders characterized by poor impulse control. However, could the same deficit explain different clinical phenotypes? Evidence from behavioural studies is very mixed. This is partly because inhibition is a highly complex executive function. Thus, the different types of tasks that generically tap into inhibitory control are likely to provide different outcomes. Additionally, sample inhomogeneity in terms of age, comorbidity, and medical treatment are confounding factors. Therefore, to make a reliable assessment of the deficit of inhibitory control in a given disorder, the same task and samples with similar characteristics must be employed. This article reviews and discusses studies on five neurodevelopmental disorders with impaired impulse control where these criteria have been used: Tourette syndrome; obsessive-compulsive disorder; attention-deficit/hyperactivity disorder; primary motor stereotypies; and autism spectrum disorder. Overall, they suggest that the mechanisms underlying the inability to control urges are extremely heterogeneous and cannot be ascribed to a general impairment of inhibition. These findings do not support the hypothesis that inhibitory deficits represent a transdiagnostic feature of neurodevelopmental disorders with poor impulse control. WHAT THIS PAPER ADDS: The mechanisms underlying the inability to control urges in neurodevelopmental disorders are heterogeneous. Inhibition impairments cannot generally explain all neurodevelopmental disorders characterized by poor urge control.

Utility of EEG on attention deficit–hyperactivity disorder (ADHD)

ObjectiveThe aim of our study was to analyze electrophysiological findings in patient with Attention Deficit Hyperactivity Disorder (ADHD) by electroencephalography (EEG) recording, estimate the prevalence of epilepsy in ADHD population and assess its clinical characteristics. MethodsWe conducted a retrospective and analytic study that concerned children with ADHD, followed for at least two-years in the Tunisian National Center for School and University Medicine (NCSUM). All patients recruited underwent at the diagnosis of ADHD, neurological examination and EEG recording in the department of Neurology of Charles Nicolle Hospital. Medical data including family history, ictal semiology and ADHD features were assessed. ResultsThirty patients were enrolled in our study. Mean age was 12.27 years with a sex ratio of 3.28. Mean age at diagnosis of ADHD was 6.6 years. Attention Deficit Hyperactivity Disordercombined subtype was seen in 18/30 patients, Hyperactive/ Impulsive subtype in 7/30 patients and Inattentive subtype in 5/30 patients. Epilepsy-disease was reported in 20% (Seizures preceded the diagnosis of ADHD in 3/6 cases and appeared after an average of 3.67 years in 3/6 cases). Mean age of seizure onset was 7 years. Seizure-types were generalized (motor 4/6 cases, absence-type (1/6 case)) and focal (1/6 case). Electroencephalography revealed Epileptiform discharges in 30% with frontal and left dominance. Interictal discharges were significantly associated with younger age of onset (p: 0.02), inattentive subtype (p: 0.04) and intellectual disability (p: 0.04). These discharges was not associated with epilepsy. ConclusionOur results have shown that epileptiform discharges could be used as risk factor for seizures and cognitive impairment which may influence outcome in ADHD population.

Impact of ADHD symptoms on family functioning, family burden and parents’ quality of life in a hospital area in Spain

Background and objectivesThe aim of this study was to evaluate whether ADHD symptom severity and ADHD subtype are associated with family functioning, family burden and quality of life, in a sample of parents of children diagnosed with ADHD. MethodsSeventy-four parents of children diagnosed with ADHD were recruited at an Outpatient Child & Adolescent Mental Health Clinic in Madrid (Spain) and afterwards completed four electronical self-administered scales to determine their perceived family functioning, family burden and quality of life, as well as the severity and subtype of ADHD symptoms in their children. ResultsSeverity of children’s ADHD symptoms negatively affected parents’ quality of life, family functioning and family burden. Higher scores in inattention and combined subtypes were correlated with lower results in those domains. In adjusted correlations, the SWAN hyperactivity/impulsivity subscale significantly correlated with the four scales. ConclusionsThese results suggest that severity of the ADHD symptoms has a negative impact on parent’s quality of life and family functioning in inattention and combined subtypes. Family therapy and other interventions targeted towards improving family relationships and caregivers’ wellbeing should be considered when managing ADHD in the clinical practice. Electronic measurement tools are a promising method of evaluation in mental health research.

Should children with sub-threshold ADHD predominantly inattentive subtype (ADHD-I) symptoms be treated with Sensory ıntegration therapy? A case-control study.

Objective: Sensory integration therapy is one of the promising preventive therapy options for behavioral and developmental disorders. Hypothesizing a degree of parallelism, this study provides an insight into the effectiveness of the sensory integration therapy potencies for school-aged children with subthreshold ADHD predominantly inattentive subtype. Method: The study was a single-arm clinical trial and 20 patients aged 7–10 years with subthreshold ADHD predominantly inattentive subtype, were included. The sensory integration intervention was prepared in accordance with sensory modulation principles and intervention strategies and lasted 12 weeks with two sessions per week. The effectiveness was assessed using the Conner’s teacher/parent scales, the Clinical Global Impression scale, the Canadian Sensory integration Performance Measure and the Sensory Profile. Results: The rate of patients with typical or better performance in auditory processing domain of the Sensory Profile was found significantly increased after sensory integration therapy; 9 patients (45%) before and 15 patients after (75%) (p=0.031). The rates of participants with typical or better performance in inattention–distractibility factor score of the Sensory Profile were found significantly increased after sensory integration therapy; 6 before (30%) and 16 after (80%) (p=0.006). Conclusion: Sensory integration therapy focuses on supporting persons with varied disability terms to engage in daily life activities that they find significant and purposeful. Difficulties experienced by individuals with subthreshold attention-deficit hyperactivity disorder are addressed in this study and aspects of daily life are explored while swiping through different sensory modalities. Impaired auditory processing improvable through sensory integration therapy was observed in these children.

ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference

BackgroundAttention-deficit hyperactivity disorder (ADHD) is a major neurodevelopmental disorder with heterogeneous symptoms, subtypes, and cognitive deficits. Cognitive deficits are central to ADHD pathophysiology and one potential source of heterogeneity in ADHD. Subtype-specific cognitive correlates are not, however, well-studied. We explored cognitive correlates of ADHD subtypes based on the Wechsler Intelligence Scale for Children (WISC-IV) scores. We also assessed subtype-specific self-esteem rating in ADHD subtypes and explored its association with cognitive correlates.MethodsOne hundred thirty-nine children with ADHD (80.6% boy, 19.4% girl) were categorized into the predominantly “hyperactive (ADHD-H)”, “inattentive (ADHD-I)” and “combined (ADHD-C)” subtype based on their symptoms and scores on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and Conners Parent-Rating Scale (CPRS-RS). They were then individually administrated the WISC-IV and completed a self-esteem inventory. Group differences in the WISC-IV indices and their predictability in discriminating ADHD subtypes were analyzed.ResultsWe found a quantitative differentiation of cognitive abilities among ADHD subtypes with “working memory” as the most compromised cognitive domain. ADHD-I had the poorest cognitive profile while ADHD-H scored highest in all cognitive domains. Importantly, cognitive abilities were negatively correlated with inattention and positively correlated with hyperactive symptoms. Moreover, self-esteem ratings were positively correlated with the cognitive domains and were rated differently based on the subtypes. ADHD-H, with the highest cognitive strength, reported the highest level of self-esteem among all subtypes.ConclusionsADHD subtype-specific symptoms, cognitive deficits, and self-esteem problems should be considered for precise diagnosis and effective and personalized treatment in ADHD in light of further supporting evidence and assessments. Cognitive interventions might be more compatible with and effective in inattentive and combined subtypes of ADHD. Working memory improving-based interventions can benefit all ADHD subtypes. A supportive educational system in school and providing adjunct supportive interventions should be considered for children with ADHD as well.

Cortical source analysis of resting state EEG data in children with attention deficit hyperactivity disorder

ObjectiveThis study investigated age-dependent and subtype-related alterations in electroencephalography (EEG) power spectra and current source densities (CSD) in children with attention deficit and hyperactivity disorder (ADHD). MethodsWe performed spectral and cortical source (exact low-resolution electromagnetic tomography, eLORETA) analyses using resting state EEG recordings from 40 children (8–16 years) with combined and inattentive subtypes of ADHD and 41 age-matched healthy controls (HC). Group differences in EEG spectra and CSD were investigated at each scalp location, voxel and cortical region in delta, theta, alpha and beta bands. We also explored associations between topographic changes in EEG power and CSD and age. ResultsCompared to healthy controls, combined ADHD subtype was characterized with significantly increased diffuse theta/beta power ratios (TBR) with a widespread decrease in beta CSD. Inattentive ADHD subtype presented increased TBR in all brain regions except in posterior areas with a global increase in theta source power. In both ADHD and HC, older age groups showed significantly lower delta source power and TBR and higher alpha and beta source power than younger age groups. Compared to HC, ADHD was characterized with increases in theta fronto-central and temporal source power with increasing age. ConclusionsOur results confirm that TBR can be used as a neurophysiological biomarker to differentiate ADHD from healthy children at both the source and sensor levels. SignificanceOur findings emphasize the importance of performing the source imaging analysis in order to better characterize age-related changes in resting-state EEG activity in ADHD and controls.

Resting state functional magnetic resonance imaging in attention deficit hyperactivity disorder

ObjectiveTo explore whether children and adolescents with attention deficit/hyperactivity disorder (ADHD) have altered the functional connectivity between the executive control network and the default mode network. MethodsExploratory study of a diagnostic test, prospective, case and control design. A total of 56 participants were recruited consecutively (29 inattentive or combined ADHD subtype and 27 controls) between 7 and 16 years old, male, right dominance. DSM-5 was applied as reference test and a battery of neuropsychological tests to confirm the diagnosis and assess comorbidities. Resting state functional magnetic resonance imaging was performed as an index test. The application and evaluation of the tests was blind. The brain regions were chosen a priori and the region of interest technique was used. The functional connectivity of the anterior cingulate cortex (ACC) was evaluated with: the precuneus (P), the posterior cingulate cortex (PCC) and the dorsomedial prefrontal cortex (DMPC). ResultsThe functional connectivity in each of the associations evaluated in the patients with ADHD compared with the controls were: P_D = 0.41 vs 0.44; CCP_D = 0.43 vs 0.53; CPDM_D = 0.75 vs. 0.79; P_I = 0.40 vs 0.41; CCP_I = 0.48 vs 0.53; CPDM_I = 0.76 vs. 0.72). D: right side I: left side. Value of p > 0.05. ConclusionCerebral functional connectivity at rest is lower in ADHD patients when compared with healthy controls, however, the difference was not statistically significant.

An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder.

This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data. Children (n = 93, mean age 7.3 +/- 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU. Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009-0.01) while non-responders improved on none (p = 0.27-0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003). Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.

Neurodevelopmental outcomes of preterm infants: a recent literature review.

BackgroundOver the past several decades, improvements in technology in the Neonatal Intensive Care Unit (NICU) have led to improved survival of preterm infants. Some studies have found that premature infants are at higher risk of behavioral problems, motor and sensory abnormalities, developmental delay, and poorer academic performance, while other studies have found no significant difference.MethodsA literature search was conducted through PubMed for articles published between January 2018 and September 2019. Studies that concentrated on preterm infants with relatively uncomplicated NICU courses and without extensive medical interventions were selected.ResultsHistorically, preterm infants have been found to be at increased risk for the inattentive subtype of attention deficit hyperactivity disorder (ADHD), depression, anxiety, autism spectrum disorder (ASD), avoidant personality, and anti-social personality, when compared to full term infants. However, some studies found that this difference between the two groups decrease as they enter adolescence and adulthood. Preterm infants are at increased risk for language, cognitive, sensory and motor deficits. Greater gestational age (GA) at birth and higher birth weight is associated with a lower risk of developmental delay. Cohort studies focusing on motor development showed that the degree of impairment decreased over time. Adverse childhood experiences (ACEs) have a negative correlation on multiple domains of development. The overall outcome of these infants may be influenced by socioeconomic status (SES), neonatal morbidities, demographics and parental education. Hearing and vision deficits are relatively infrequent among premature infants. A significant risk factor for hearing impairment involves the use of ototoxic agents such as gentamicin and infants with a patent ductus arteriosus (PDA).ConclusionsPreterm infants are at higher risk of adverse neurodevelopmental outcomes when compared to their full-term counter parts. However, in recent years it appears that rates of certain neurologic and developmental conditions are occurring in rates lower than historically noted. Premature individuals with possible developmental or mental health concerns should be identified early on so that interventions can be implemented immediately. Those meeting developmental milestone should continue to be monitored closely as deficits may develop later.