Inattentive Type Research Articles

The Power of Play: Strategies for Enhancing Development in Children with Autism Spectrum Disorders.

The increasing prevalence of autism spectrum disorder (ASD) underscores its significant impact on individuals and the importance of early intervention. ASD affects various aspects of life, including education, emotional development, and social interactions. Besides traditional therapeutic approaches, a novel strategy incorporating digital games has been introduced. Four games developed using Makey Makey and Scratch aim to enhance cognitive skills in children with ASD. This approach facilitates emotional and intellectual development, tracks progress, and offers personalized and engaging interventions. This study demonstrated significant improvements in memory and concentration among participants, with an average improvement of 23.38 points. The most notable enhancements were observed in children aged 10, who showed an average improvement of 25.67 points. Additionally, female participants exhibited a slightly higher average improvement compared to males. The Memory Maze game also effectively enhanced cognitive skills in children with different types of ADHD. Children with the Hyperactive-Impulsive type showed the highest average improvement, with 25.00 points, followed by those with the Combined type, with 24.15 points, and the Inattentive type, with 23.53 points. These findings highlight the potential use of these tools in both ASD and ADHD therapy, providing a structured and enjoyable learning environment that supports cognitive development and therapeutic outcomes.

Examine the Effects of Atomoxtine Alone Versus Atomoxtine Combined with Risperidone at Sample of Egyptian Children Suffering from ADHD.

Background: An estimated 7% of elementary school children suffer from Attention Deficit Hyperactivity Disorder (ADHD), a mental neuro-developmental condition marked by impulsivity, hyperactivity, and lack of attention. Atomoxetine is one of the most important medications for ADHD however Risperidone has been used as a label for the treatment of ADHD. Aim: To study the Efficacy of Atomoxetine alone vs. Atomoxtine with Antipsychotic (Risperidone) in ADHD children. Subjects and Methods: 54 Egyptian children with ADHD, ranging in age from 6 to 18. They meet the DSM-IV criteria for ADHD and have been receiving therapy at Al Hussian Hospital's psychiatry clinic. Conner's 2 scale was used to evaluate each patient for ADHD. Between January and June of 2024, a study was carried out on all children receiving therapy for all forms of ADHD using either Atomoxetine alone or in combination with an antipsychotic (Risperidone). Results: When Atomoxetine was administered to 27 children, it demonstrated a moderate level of efficacy in 12 of 27 patients (44.4%) for all children with ADHD, regardless of type, but it significantly improved the inattention type of ADHD in 4 from 4 patients (100%). Given to 27 children, the combination of Atomoxetine and Risperidone demonstrated a greater effect on 24 of 27 patients with (88.9%) for all ADHD children, and it showed a discernible improvement on 9 out of 9 with (100%) for ADHD hyperactivity type. Conclusion: Patients with Attention deficit variant responded well to Atomoxetine., Patients with attentiondeficit/hyperactivity variant responded well to Atomoxetine/Antipsychotic (Risperidone) combination., Patients with Hyperactivity variants show good responses to Antipsychotics (Risperidone)., All types of ADHD are responsive to Atomoxetine or Atomoxetine / Antipsychotic (Risperidone) combination, But the Atomoxetine effect is more on the Attention deficit variant than other variants, while Antipsychotic (Risperidone) is more effective on hyperactivity and aggression.

A - 59 An Exploration of a Passive Decision Making Style within the Cognitive Disengagement Syndrome Population and its Contribution to Social Isolation

Abstract Objective Recent research has shown that Cognitive Disengagement Syndrome (CDS) may reduce decision-making independence. In this way, CDS may include a prognosis of social disengagement due to symptoms of the disorder such as apathy, low motivation, passivity, and low energy. This poster investigates the relationship between CDS symptoms and social disengagement and explores possible treatment focuses that could increase individuals’ connection to others and the world around them. Data Selection Information regarding this poster was obtained through a review of the literature including peer-reviewed articles from 2019–2024. Articles were gathered from the Journal of Clinical Child and Adolescent Psychology, Journal of Attention Disorders, Journal of Pediatric Psychology, Child Neuropsychology, and Research in Developmental Disabilities. Informal analyses were used to determine themes including keywords such as sluggish cognitive tempo, cognitive disengagement syndrome, decision-making, social isolation, and apathy. Data Synthesis CDS is associated with lower levels of assertiveness and higher levels of passivity than in the Attention Deficit Hyperactivity Disorder Inattentive Type (ADHD-IN) population. Current research suggests CDS is associated with social isolation influenced by difficulty initiating conversations and being more likely to engage in anxious rumination during conversations. Treatment interventions for CDS should target shyness, task-unrelated thought patterns, behavioral inhibition, hyperreactivity to social stressors, socially isolating behavioral addictions, verbal inhibition, and difficulty with divided attention. Conclusions Based on conclusions drawn in this poster, future studies should examine the impact of loneliness on social initiation frequency within the CDS population. The development of a questionnaire that aims to differentiate ADHD-IN from CDS may also be useful.

Frequency-specific static and dynamic neural activity indices in children with different attention deficit hyperactivity disorder subtypes: a resting-state fMRI study.

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood. Numerous resting-state functional magnetic resonance imaging (rs-fMRI) studies in ADHD have been performed using traditional low-frequency bands (0.01-0.08 Hz). However, the neural activity patterns of frequency subbands in ADHD still require further investigation. The purpose of this study is to explore the frequency-dependent characteristics and neural activity patterns of ADHD subtypes. We selected the ADHD combined type (ADHD-C, N = 25), ADHD inattentive type (ADHD-I, N = 26) and typically developing (TD, N = 28) children from the ADHD-200 Consortium. Based on the slow-5 band (0.01-0.027 Hz) and slow-4 band (0.027-0.073 Hz), we generated static and dynamic fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) maps for each participant. A flexible-factorial analysis of variance model was performed on static and temporal dynamic rs-fMRI measurements within two subbands. Results revealed that the orbital-frontal gyrus, precuneus, superior temporal gyrus and angular gyrus were found to have obvious frequency band and group interaction effects. The intrinsic neural activity differences among three groups were more prominent in the slow-5 frequency band compared to the slow-4 band. In addition, the indices of significant interaction regions showed correlations with the progression of the disease and the features in slow-5 showed an advantageous diagnostic performance compared with those in slow-4. The results suggested the intrinsic neural activities of ADHD subtypes were frequency-dependent. The frequency-specific analysis of static and dynamic brain activity may provide a deeper understanding of neurophysiological dysfunction patterns in ADHD subtypes and provide supplementary information for assessing ADHD subtypes.

A Comparison of Cognitive Disengagement Syndrome in Children with Major Depression Versus Attention Deficit and Hyperactivity Disorder

Objective: There is growing evidence that Cognitive Disengagement Syndrome (CDS) is a distinct construct, supported by both empirical research and clinical differentiation. CDS demonstrates a stronger association with the inattentive type of Attention Deficit Hyperactivity Disorder (ADHD-IA), compared to its correlation with hyperactivity/impulsivity symptoms. Several studies have identified a significant positive relationship between CDS and internalizing symptoms such as anxiety and depression. To our knowledge, no study has explored CDS in children with major depression (MD). In the present study, we compared children with MD but without ADHD to children with ADHD but without depression in terms of CDS. We examined whether children with MD would have greater CDS when compared to children with ADHD. Methods: Thirty-six adolescents with ADHD, and twenty-five adolescents with MD, aged 12 to 18 years old, were administered the Barkley Child Attention Scale (BCAS), Turgay's DSM-IV Based ADHD and Disruptive Behavior Disorders Screening Scale, and the Children’s Depression Rating Scale-Revised (CDRS-R). Results: The majority of the ADHD and MD groups were boys. The MD group had significantly higher BCAS scores than the ADHD group (U=287.0, p=0.016). In the ADHD group, the severity of BCAS scores was inversely correlated with ADHD-Hyperactivity/impulsivity scores (r=-0.681, p<0.001). In the MD group, there was a significant positive relationship between BCAS and CDRS scores (r= 0.493, p=0.012). Conclusions: The findings of this study highlight the transdiagnostic relevance of CDS by demonstrating its association with depression, independent of ADHD. This underscores the importance of considering CDS in the assessment and treatment of depression across various clinical contexts.

Healthcare resource utilization and costs associated with psychiatric comorbidities in pediatric patients with attention-deficit/hyperactivity disorder: a claims-based case-cohort study

BackgroundAttention-deficit/hyperactivity disorder (ADHD) has been shown to pose considerable clinical and economic burden; however, research quantifying the excess burden attributable to common psychiatric comorbidities of ADHD among pediatric patients is scarce. This study assessed the impact of anxiety and depression on healthcare resource utilization (HRU) and healthcare costs in pediatric patients with ADHD in the United States.MethodsPatients with ADHD aged 6–17 years were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was the date of initiation of a randomly selected ADHD treatment. Patients with ≥ 1 diagnosis for anxiety and/or depression during both the baseline (6 months pre-index) and study period (12 months post-index) were classified in the ADHD+anxiety/depression cohort; those without diagnoses for anxiety nor depression during both periods were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts. All-cause HRU and healthcare costs during the study period were compared using regression analyses. Cost analyses were also performed in subgroups by comorbid conditions.ResultsThe reweighted ADHD-only cohort (N = 204,723) and ADHD+anxiety/depression cohort (N = 66,231) had similar characteristics (mean age: 11.9 years; 72.8% male; 56.2% had combined inattentive and hyperactive ADHD type). The ADHD+anxiety/depression cohort had higher HRU than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 10.3; emergency room visits: 1.6; outpatient visits: 2.3; specialist visits: 5.3; and psychotherapy visits: 6.1; all p < 0.001). The higher HRU translated to greater all-cause healthcare costs; the mean per-patient-per-year (PPPY) costs in the ADHD-only cohort vs. ADHD+anxiety/depression cohort was $3,988 vs. $8,682 (p < 0.001). All-cause healthcare costs were highest when both comorbidities were present; among patients with ADHD who had only anxiety, only depression, and both anxiety and depression, the mean all-cause healthcare costs were $7,309, $9,901, and $13,785 PPPY, respectively (all p < 0.001).ConclusionsComorbid anxiety and depression was associated with significantly increased risk of HRU and higher healthcare costs among pediatric patients with ADHD; the presence of both comorbid conditions resulted in 3.5 times higher costs relative to ADHD alone. These findings underscore the need to co-manage ADHD and psychiatric comorbidities to help mitigate the substantial burden borne by patients and the healthcare system.

Depressive symptoms and coping patterns in a sample of Egyptian mothers of ADHD children

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is considered to be one of the most common neurodevelopmental conditions found in children. The global prevalence in the age group 6–17 years falls between 2 and 18%. Studies have found that mothers of ADHD children are more prone to experience depression, anxiety, social isolation, stress, and self-blame.Aims and objectivesTo assess the prevalence of depression and its severity among mothers with children found to have ADHD compared to mothers of the control group, we also investigate the coping mechanisms employed by mothers with ADHD children and identify any potential correlation between coping strategies utilized by mothers in the case group and the severity of depression.Patients and methodsIn this cross-sectional study, we recruited 100 participants from the outpatient child psychiatry clinic at Ma’amoura Psychiatric Hospital in Alexandria, Egypt. Two participant groups were assembled: Group I (case) consisted of 50 mothers whose children had ADHD, and Group II (control) consisted of 50 mothers whose children did not have ADHD. Both groups underwent the General Health Questionnaire (GHQ-28), Beck Depression Inventory (BDI-II), and Coping Orientation to Problems Experienced (COPE) inventory.ResultsA significant relationship was observed between the Beck Score and hyperactive and combined ADHD types; however, no significant correlation was found between the Beck Score and the inattentive ADHD type. Regarding the coping styles with stress, the current study’s results found that in (case group) turning to religion had the highest sub-scale mean, followed by seeking social support and emotional support, while the lowest sub-scale score mean was humor, followed by denial. By employing univariate logistic regression analysis to identify depression predictors in group I, the results showed that the increase in the score of less useful coping by 1 was a probable factor to increase the possibility of depression by OR = 1.438 (1.186–1.743). Combined and hyperactive ADHD types were found to increase the risk of depression by OR 6.706 (1.309–34.353).ConclusionDepressive complaints were more prevalent among mothers of children with ADHD compared to the control group. We found a statistically important relationship between Beck Depression Scores (depressive symptom severity) in mothers with ADHD children and having hyperactive or combined ADHD types in their children. We also found a statistically significant positive correlation between the severity of depression and some coping styles as turning to religion and seeking social support.

Sleep quality, PIU in adolescents with ADHD. Is there a relationship between sleep quality and problematic internet use in adolescents with attention deficit hyperactivity disorder?

AbstractThis research aimed to compare the sleep quality and problematic internet use (PIU) of adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) compared to the group of healthy control. There were 53 ADHD-diagnosed individuals (19 ADHD- combined type, 34 ADHD- inattentive type) in the research population, ages 12 to 18, and 53 healthy adolescents in the control group. A child psychiatrist applied the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) to each case, and sociodemographic information was collected. The Pittsburgh Sleep Quality Index (PSQI) and the Internet Addiction Test (IAT) were also applied to all the cases. The Turgay DSM-IV-Based Disruptive Behaviour Disorders, Child and Adolescent Evaluation and Screening Scale (T-DSM-IV-S) was completed by the parents of all the adolescents. The ADHD group's IAT and PSQI total points were found to be statistically significantly higher than those of the healthy control group (p &lt; 0.001). The results of the covariance analysis showed a significant positive correlation between the T-DSM-IV-S subscales and the IAT mood points in the ADHD patients. The T-DSM-IV-S attention deficit points were found to be significantly higher in the ADHD children with PIU (independently of age and gender) compared to those without PIU. The results of the study showed that adolescents with ADHD had greater rates of poor sleep quality and PIU than the control group. The study results also suggested that the severity of the inattentive subtype of ADHD could play a potential role in the development of PIU in children diagnosed with ADHD. Based on this foundation, it is crucial to acknowledge and address poor sleep quality and PIU in adolescents with ADHD.

Autism and attention-deficit/hyperactivity disorder in children with Dravet syndrome: A population-based study.

To identify on a population basis the prevalence of autism and attention-deficit/hyperactivity disorder (ADHD) in children with Dravet syndrome and factors associated with symptoms of autism and ADHD. Forty-one of 48 children with Dravet syndrome living in Sweden, born between 1st January 2000 and 31st December 2018 underwent assessment including measures of autism and ADHD. Diagnoses of autism and ADHD were made with respect to DSM-5 criteria. Factors associated with features of autism and ADHD were analysed via regression. Twenty-five of the 41 children fulfilled DSM-5 criteria for autism spectrum disorder and 12 of 37 children considered for an ADHD diagnosis fulfilled DSM-5 criteria for ADHD. Severe intellectual disability was significantly associated with a greater degree of autistic features (p < 0.001) and a DSM-5 diagnosis of autism spectrum disorder (p = 0.029). Younger children had significantly more features of ADHD (p = 0.004) and features of inattention were significantly more common than features of hyperactivity/impulsivity (p < 0.001). Children with Dravet syndrome often have significant features of autism and ADHD, primarily inattentive type. Screening for autism and ADHD should be routine in children with Dravet syndrome. In total, 25 of 41 assessed children with Dravet syndrome fulfilled DSM-5 criteria for autism. Twelve of 37 assessed children with Dravet Syndrome met DSM-5 criteria for attention-deficit/hyperactivity disorder (ADHD). Severe intellectual disability was significantly associated with a greater degree of autism spectrum disorder features. Younger children had significantly more features of ADHD.

Attention-deficit/hyperactivity disorder and dopamine receptor D4 (DRD4) exon 3 variable number of tandem repeats (VNTR) 2-repeat allele.

To investigate the association of attention-deficit/hyperactivity disorder (ADHD) with the 48-base pair (bp) variable number of tandem repeats (VNTR) in exon 3 of the dopamine receptor D4 (DRD4) gene, we genotyped 240 ADHD patients and their parents from Hong Kong. The 4R allele was most common, followed by 2R. We examined association between the 2R allele (relative to 4R) and ADHD by Transmission Disequilibrium Test (TDT). The odds ratio (OR) (95% confidence interval) was 0.90 (0.64-1.3). The p-value was 0.6. Examining subgroups revealed nominally significant association of 2R with inattentive ADHD: OR=0.33 (0.12-0.92) and p=0.03. Because our study used TDT analysis, we meta-analyzed the association of 2R with ADHD in Asians (1329 patient alleles), revealing results similar to ours: OR=0.97 (0.80-1.2) and p=0.8. To examine the association of 2R with inattentive ADHD, we meta-analyzed all studies (regardless of analysis type or ethnicity, in order to increase statistical power): 702 patient alleles, 1420 control alleles, OR=0.81 (0.57-1.1) and p=0.2. Overall, there is no evidence of association between ADHD and the 2R allele, but the suggestive association with the inattentive type warrants further investigation.

The Prevalence of Attention Deficit Hyperactivity Disorder in Children and Adolescents: An Umbrella Review of Global Evidence

IntroductionFrom recent epidemiological studies to emerging epidemiological evidence, it becomes evident that numerous primary studies have investigated the prevalence of ADHD in children and adolescents. Additionally, several systematic reviews and meta-analyses have explored this subject. The objective of this umbrella review is to offer a robust synthesis of evidence derived from these systematic reviews and meta-analysesObjectivesTo conduct a comprehensive umbrella review that synthesizes emerging epidemiological evidence regarding the prevalence of ADHD in children and adolescents, drawing insights from numerous primary studies as well as systematic reviews and meta-analyses.MethodsWe conducted a systematic search across multiple databases, including PubMed, Web of Science, PsychINFO, and Scopus, to identify relevant studies. The study was preregistered with PROSPERO (registration number: CRD42023389704). To assess the quality of these studies, we utilized the Measurement Tool to Assess Systematic Reviews (AMSTAR). We employed an inverse variance-weighted random-effects meta-analysis to combine prevalence estimates from the included studies.ResultsThe final analysis incorporated thirteen meta-analytic systematic reviews, encompassing 588 primary studies and a total of 3,277,590 participants. A random-effects meta-analysis of these studies revealed that the global prevalence of ADHD in children and adolescents stood at 8.0% (95% CI: 6.0%–10%). Notably, the prevalence estimate was twice as high in boys (10%) compared to girls (5%). Among the three subtypes of ADHD, the inattentive type (ADHD-I) emerged as the most prevalent, followed by the hyperactive type (ADHD-HI) and the combined type (ADHD-C).ConclusionsThe comprehensive umbrella review findings emphasize the high prevalence of ADHD in children and adolescents, with a notable gender disparity, wherein boys are twice as likely to be affected compared to girls. These results underscore the urgency of prioritizing prevention, early identification, and treatment strategies for ADHD in children and adolescents.Disclosure of InterestNone Declared

Prevalence of ADHD in Adults: An Umbrella Review of International Studies

IntroductionAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly diagnosed in school-age children. However, it can affect individuals of all age groups. This study aimed to provide a comprehensive analysis of the prevalence of ADHD in adults by conducting an umbrella review of systematic reviews and meta-analyses.Objectives To provide a comprehensive synthesis of published evidence on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adults through an umbrella review of systematic reviews and meta-analyses, with the aim of highlighting the significance of addressing and managing ADHD in the adult population.Methods To conduct this study, we adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). We systematically searched databases such as PsychINFO, Web of Science, PubMed, and Scopus to identify relevant studies. Our review protocol was registered with PROSPERO (registration number: CRD42023389704). The quality of the studies included in our analysis was assessed using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). For the purpose of conducting a meta-analysis, we employed a random-effects model.ResultsOur umbrella review examined findings from five systematic reviews that encompassed data from 57 unique international primary studies undertaken between 2009 and 2021. These studies involved a total of 21,142,129 adult participants. The meta-analysis, employing an inverse variance-weighted random effect model, yielded a pooled prevalence estimate for ADHD in adults of 3.10% (95% confidence interval: 2.60%–3.60%). Regarding ADHD subtypes, our analysis revealed that ADHD-I (inattentive type) remained the most prevalent among adults, followed by ADHD-HI (hyperactive type) and ADHD-C (combined type).ConclusionsOur results underscore the relatively high prevalence of ADHD among adults, with ADHD-I emerging as the most common subtype. These findings emphasize the need for proactive measures to prevent, mitigate, identify, and effectively manage ADHD in the adult population.Disclosure of InterestNone Declared

Increased risk of attention-deficit/hyperactivity disorder in adolescents with high salivary levels of copper, manganese, and zinc

Exposure to toxic heavy metals has been associated with the development of attention-deficit/hyperactivity disorder (ADHD). However, fewer studies have examined the associations between abnormal levels of essential trace metals and ADHD, and none have done so using saliva. We investigated whether salivary metals were associated with ADHD in adolescents aged 12 from the Family Life Project (FLP) using a nested case–control study design that included 110 adolescents who met diagnostic criteria for inattentive (ADHD-I), hyperactive-impulsive (ADHD-H), or combined type ADHD (ADHD-C) (cases) and 173 children who did not (controls). We used inductively coupled plasma optical emission spectrophotometry to measure chromium, copper, manganese, and zinc in saliva samples. We employed logistic regression models to examine associations between quartile levels of individual metals and ADHD outcomes by subtype. Salivary copper levels were significantly associated with increased odds of any ADHD diagnosis (OR = 3.31, 95% CI: 1.08–10.12; p = 0.04) and with increased odds of ADHD-C diagnosis (OR = 8.44, 95% CI: 1.58–45.12; p = 0.01). Salivary zinc levels were significantly associated with increased odds of ADHD-C diagnosis (OR = 4.06, 95% CI: 1.21–13.69; p = 0.02). Salivary manganese levels were also significantly associated with increased odds of ADHD-C diagnosis (OR = 5.43, 95% CI: 1.08–27.27, p = 0.04). This is the first study using saliva to assess metal exposure and provide a potential link between salivary levels of copper, manganese, and zinc and ADHD diagnoses in adolescents. Public health interventions focused on metal exposures might reduce ADHD incidence in low-income, minority communities.

Behavioral and emotional functioning of children with specific learning disorders

Background: Specific learning disorder (SLD) is distinct from other Diagnostic and Statistical Manual (DSM)-5 mental disorders as it is recognized clinically in medicine and as a separate category in special education. Aims and Objectives: The study aimed to study the behavioral patterns and emotional functioning in children with SLD. Materials and Methods: This observational cross-sectional study was conducted at Tirunelveli Medical College, Tirunelveli, from January 2019 to April 2020 on 100 patients (study group 50 and control group 50) diagnosed with SLDs as per DSM5 criteria. A patient’s history includes age, gender, symptoms, and diagnosis. Assessments were done through a semi-structured proforma, Rutter Children’s Behavior Questionnaire (parent form), the Vanderbilt attention deficit hyperactivity disorder (ADHD) diagnostic rating scale, and the Rosenberg self-esteem scale (RSES). Results: The patient’s domicile in rural areas was 82% compared to urban areas, which is 18%. The Rutter scale – total score was higher in the study group, with a mean of 3.24, compared to the control group, with a mean of 0.44. The RSES compared self-esteem scores and the mean self-esteem scores of 21.56 and 14.72, respectively (P&lt;0.0001). The deviant/antisocial behavior subscale scores were higher for the study group, with a mean score of 1.08, than the control group, with a mean score of 0.02 (&lt;0.05). The ADHD (inattentive type) Vanderbilt scale was compared, and it was found to be positive for the study group and none for the control group (P=0.022). Conclusion: The scores show a significant correlation between higher rates of neurotic behavior and behavioral problems, predominantly inattentive types, in SLD children.

Phosphatidylserine enriched with polyunsaturated n-3 fatty acid supplementation for attention-deficit hyperactivity disorder in children and adolescents with epilepsy: Arandomized placebo-controlled trial.

Attention-deficit hyperactivity disorder (ADHD) is a frequent comorbidity in children with epilepsy, which management mostly relies on the usual treatments of ADHD, especially methylphenidate. Supplementation with polyunsaturated n-3 Fatty Acid (PUFA) has been proposed as an alternative therapeutic approach in ADHD without epilepsy but has never been evaluated in epilepsy-associated ADHD. A multicenter double blind randomized placebo-controlled trial evaluating supplementation with PUFA, in eicosapentaenoic- and docosahexaenoic-acid form, conjugated to a phospholipid vector (PS-Omega3) in children aged >6 and <16-years old, and suffering from any type of epilepsy and ADHD (inattentive or combined type) according to DSM-V. After a 4-week baseline period, patients were allocated (1:1) either to placebo group or to PS-Omega 3 group and entered a 12 week-double-blind treatment period which was followed by a 12 week-open-label treatment period. The primary outcome was the reduction of the ADHD-rating scale IV attention-deficit subscore after 12 weeks of treatment. The study was stopped early because of lack of eligible participants and the expected sample size was not reached. Seventy-four patients were randomized, 44 in PS-Omega3, and 30 in the placebo group. The reduction after 12 weeks of treatment in the inattention subscore of the ADHD-IV scale was -1.57 in the PS-Omega3 group, and -2.90 in the placebo group (p = 0.33, α = 5%). Results were similar after 24 weeks of treatment and for all other ADHD-related secondary outcomes, with no difference between placebo and PS-Omega3. Our study remaining underpowered, no formal conclusion about the effect of Ps-Omega3 could be drawn. However, our data strongly suggested that the PS-Omega 3 formulation used in the current study did not improve ADHD symptoms in children with epilepsy. Supplementation with polyunsaturated n-3 Fatty Acid (PUFA) has been proposed in ADHD but has never been evaluated in patients with both epilepsy and ADHD. To address this issue, we conducted a multicenter double blind randomized placebo-controlled trial evaluating supplementation with PUFA in children with epilepsy and ADHD. The study was stopped early because of lack of eligible participants, hampering formal conclusion. However, the evolution of the ADHD symptoms at 12 and 24 weeks did not differ between placebo and PUFA supplementation, strongly suggesting that PUFA did not improve ADHD symptoms in children with epilepsy.

The Prevalence of Risk Factors Among Children Diagnosed With Attention-Deficit/Hyperactivity Disorder, Aged 4-17 Years: A Cross-Sectional Study.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly observed in children. Although the etiology of ADHD is still unclear, many risk factors have been shown to increase the prevalence of ADHD, such as genetics, environmental factors, socioeconomic status, maternal smoking, and low birth weight. The current cross-sectionalstudy aimed to assess the prevalence of several risk factors associated with ADHD-diagnosed children aged 4-17 years using parent-reported data. An observational cross-section study was conducted between December 2022 and February 2023 using a self-constructed questionnaire that we sent to parents whose children were diagnosed with ADHD. The questionnaire included socioeconomic information (income, gender, parent education, number of children), child information (age, ADHD type, academic achievement), pregnancy and neonatal period (smoking status, gestation age, mode of delivery, child weight), and if there is a history of ADHD in the family. A total of 306 parents responded to the questionnaire. The majority of our study population was males (77.8%). The combined type, which includes symptoms of both hyperactivity and inattention, represented 70% of the population in our study, which is higher than the inattention type (23%) and the hyperactivity type (6%). The prevalence of several risk factors known to be associated with ADHD, such as family income, parental education, complications during pregnancy, and the low birth weight of the child, were also reported. To the best of our knowledge, this is the first study that examines the frequency of risk factors among children diagnosed with ADHD in Saudi Arabia. The study revealed that males are more likely to be diagnosed with ADHD than females. We also found that the combined type is the most diagnosed ADHD among children. Furthermore, there are no significant differences in the prevalence of the risk factors during the gestational or neonatal period among ADHD-diagnosed children. Therefore, a large-scale prospective study is needed to aid in evaluating the frequency and significance of various risk factors among diagnosed children.

Childhood Absence Epilepsy- Electroclinical Profile and Prevalence of Attention-Deficit/Hyperactivity Disorder Among a Cohort of 47 Children

BackgroundWe aimed to find the proportion of attention-deficit/hyperactivity disorder (ADHD) among children with childhood absence epilepsy (CAE) and to describe their electroclinical features. MethodsVideo electroencephalography (EEG) was performed on 47 children who fulfilled International League Against Epilepsy criteria for CAE. These children were also assessed for the presence of ADHD. ResultsOf the 47 children, 27 (57%) met criteria for the diagnosis of ADHD. Majority (74%) of them had inattentive type of ADHD. Age at onset of absences ranged from three to 12 years (mean 7.2 ± 2.47). We analyzed 219 seizures (154 electroclinical and 65 electrographic). The average seizure duration was 7.1 seconds (range 1 to 38 [S.D. 5.81]). Of the 154 clinical absences, ictal discharges were less than or equal to two seconds in nine of 154 (5.8%); greater than two to less than or equal to four seconds in 33 of 154 (21.4%), and longer than 20 seconds in 11 of 154 (7%). The longest duration of ictal discharge recorded was 38 seconds, and the shortest duration was one second. The onset of ictal discharge had a “lead in” focus in 81% (177 of 219). ConclusionsThe proportion of ADHD among children with CAE is high. A “lead in” focus of the generalized ictal discharges was observed frequently, lending support to the theory that the origin of seizure discharges in CAE is indeed cortical. The shortest ictal discharge recorded was one second.

Frequency characteristics of temporal and spatial concordance among dynamic indices in inattentive and combined subtypes of attention deficit hyperactivity disorder.

Numerous voxel-based resting-state functional magnetic resonance imaging (rs-fMRI) measurements have been used to characterize spontaneous brain activity in attention deficit hyperactivity disorder (ADHD). However, the practical distinctions and commonalities among these intrinsic brain activity measures remain to be fully explored, and whether the functional concordance is related to frequency is still unknown. The study included 25 ADHD, combined type (ADHD-C); 26 ADHD, inattentive type (ADHD-I); and 28 typically developing (TD) children. We calculated the voxel-wise (temporal) and volume-wise (spatial) concordance among dynamic rs-fMRI indices in the slow-5 (0.01-0.027 Hz) and slow-4 (0.027-0.073 Hz) frequency bands, respectively. The spatiotemporal concordance within the slow-4 and slow-5 bands among the ADHD-C, ADHD-I, and TD groups was compared. Although the ADHD-C and ADHD-I groups showed similar volume-wise concordance, comparison analysis revealed that compared with ADHD-C patients, ADHD-I patients exhibited decreased voxel-wise concordance in the right median cingulate and paracingulate gyrus (MCC) and right supplementary motor area (SMA) in the slow-5 band. In addition, the voxel-wise concordance was negatively correlated with the diagnostic scores of ADHD subtypes. Our results suggest that functional concordance is frequency dependent, and dynamic concordance analysis based on specific frequency bands may provide a novel approach for investigating the pathophysiological differences among ADHD subtypes.

Prevalence of Attention Deficit Hyperactivity Disorder in Girls With Central Precocious Puberty

Objective: The purpose of the current study was to examine the prevalence of attention deficit hyperactivity disorder (ADHD) in girls with central precocious puberty. Method: Girls with central precocious puberty were prospectively recruited from the pediatric clinic. Screening was done with ADHD Rating Scale (ADHD-RS) and Child Behavior Checklist (CBCL). Those who screened positive on ADHD-RS were referred for the diagnostic evaluation which included a Computerized Performance Test (CPT) and a clinical interview conducted by a child adolescent psychiatrist. Results: Among the 81 girls (mean age = 8.97 ± 0.91) who completed the study, 11 girls (13.58%) were diagnosed with ADHD: 5 of them were inattentive type and 6 of them were combined type. Conclusion: The present exploratory study showed that the prevalence of ADHD in girls with central precocious was higher than the known worldwide prevalence of ADHD in children

Screening of attention deficit hyperactivity disorder among preschool children Gharbia Governorate, Egypt

BackgroundChildren who experience mental health issues, such as attention deficit hyperactivity disorder (ADHD), experience significant distress and impairment at home, at school, and in the community. Without adequate care or prevention, this frequently results in adulthood-long distress and impairment at large societal costs. Determining the prevalence of ADHD cases among preschoolers as well as some associated maternal and child risk factors was the aim of this study.MethodsAn analytical cross-sectional study including 1048 preschool children aged 3–6 years was carried out in Tanta City, Gharbia Governorate. From March to April 2022, a proportionate stratified cluster random sample of them was picked. Data were gathered using a predesigned instrument that included sociodemographic information, family history, maternal and child risk factors, and the Arabic version of the ADHD Rating Scale IV questionnaire.ResultsThe prevalence of ADHD among preschoolers was 10.5%. The inattention type was the most common (5.3%), followed by the hyperactivity type (3.4%). There were statistically significant associations regarding positive family history of psychological and neurological symptoms (17.9% positive vs. 9.7% negative), family history of ADHD symptoms (24.5% positive vs. 9.4% negative), active smoking by the mother (21.1% positive vs. 5.3% negative), cesarean section delivery (66.4% positive vs. 53.9% negative), elevated blood pressure during pregnancy (19.1% positive vs. 12.4% negative), and history of taking drugs during pregnancy (43.6% positive vs. 31.7% negative). Significant child risk factors were: exposure to any source containing lead that causes slow poisoning (25.5% positive vs. 12.3% negative), children with cardiac health problems (38.2% positive vs. 16.6% negative), and hours spent by a child in front of the TV or mobile phone (any screens) per day (60.0% of those with positive screening spent more than 2 h/day vs. 45.7% negative).ConclusionIn the Gharbia governorate, 10.5% of preschoolers suffer from ADHD. Significant maternal risk factors for ADHD included a positive family history of psychiatric and neurological symptoms, a family history of ADHD symptoms, active maternal smoking, caesarean section delivery, increased blood pressure during pregnancy, and a history of drug use during pregnancy. Youngsters who had cardiac health issues and who spent more time each day watching TV or using a mobile device (screen use) were at substantial risk.