non-ADHD Control Group Research Articles

Health care costs of incident ADHD in children and adolescents in Germany - A claims data analysis within the framework of the consortium project INTEGRATE-ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased costs for the family, the health care system and the society. Previous cost-of-illness studies in Germany usually focused on prevalent ADHD. This study addressed the research gap on health care resource utilisation and costs of children and adolescents with incident ADHD diagnosis using nationwide claims data from the statutory health insurance DAK-Gesundheit. A matched-control design (propensity score matching, 1:3 ratio) was used to examine the health care costs of incident ADHD patients compared with a non-ADHD control group, considering an observation period of four quarters. Besides bivariate statistics, multivariate analyses of total costs were used to consider relevant covariates. Total health care costs for children and adolescents with ADHD in the first year after diagnosis exceeded those of the control group by € 1,505.3. According to the multivariate analysis, the group with incident ADHD had significantly higher (2.86-fold) health care costs when compared with non-ADHD peers. Sensitivity analyses proved these findings. In addition, the analyses identified children's age and comorbidity index to be significantly associated with increased costs. ADHD in children and adolescents is associated with a significant economic burden. The results emphasise the need for social awareness, prevention, appropriate treatment and research efforts.

Methylphenidate and Sleep Difficulties in Children and Adolescents With ADHD: Results From the 2-Year Naturalistic Pharmacovigilance ADDUCE Study

Objective: Short-term RCTs have demonstrated that MPH-treatment significantly reduces ADHD-symptoms, but is also associated with adverse events, including sleep problems. However, data on long-term effects of MPH on sleep remain limited. Methods: We performed a 2-year naturalistic prospective pharmacovigilance multicentre study. Participants were recruited into three groups: ADHD patients intending to start MPH-treatment (MPH-group), those not intending to use ADHD-medication (no-MPH-group), and a non-ADHD control-group. Sleep problems were assessed with the Children’s-Sleep-Habits-Questionnaire (CSHQ). Results: 1,410 participants were enrolled. Baseline mean CSHQ-total-sleep-scores could be considered clinically significant for the MPH-group and the no-MPH-group, but not for controls. The only group to show a significant increase in any aspect of sleep from baseline to 24-months was the control-group. Comparing the MPH- to the no-MPH-group no differences in total-sleep-score changes were found. Conclusion: Our findings support that sleep-problems are common in ADHD, but don’t suggest significant negative long-term effects of MPH on sleep.

The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project

Objective: The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age. Method: Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age. Results: The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable. Conclusion: Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.

Effects of long-term methylphenidate use on growth and blood pressure: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

BackgroundConcerns have been raised over the safety of methylphenidate (MPH), with regard to adverse effects on growth and blood pressure. Our study investigates whether, and to what extent, methylphenidate use in boys with ADHD is associated with having low body mass index (BMI), having low height, and increased systolic and diastolic blood pressure.MethodsData used for this study stem from the German KiGGS dataset. Three different groups of boys aged 6–15 years were included in the analysis: ADHD patients who used MPH for less than 12 months; ADHD patients who used MPH for 12 months or more; and ADHD patients without current MPH treatment. Each of these three groups was compared to a non-ADHD control group regarding low weight (BMI ≤ 3rd percentile), low height (≤3rd percentile) and raised systolic and diastolic blood pressure. For growth outcomes, boys were categorized according to age (< 11 years/≥11 years, to account for pubertal maturation). Multivariable logistic regression was conducted to test for associations.Results4244 boys were included in the study; MPH < 12 months: n = 65 (n = 36 < 11 years), MPH ≥ 12 months: n = 53 (n = 22 < 11 years), ADHD controls: n = 320 (n = 132 < 11 years), non-ADHD controls: n = 3806 (n = 2003 < 11 years). Pre-pubertal boys with MPH use less than 12 months and pubertal/postpubertal boys with MPH use of 12 months or greater were significantly more likely to have a BMI ≤ 3rd percentile compared to non-ADHD controls. Boys from the ADHD control group were significantly less likely to have a raised systolic blood pressure compared to non-ADHD controls. Beyond that, no significant between group differences were observed for any other growth and BP parameter.ConclusionThe analyses of the KiGGS dataset showed that MPH use in boys with ADHD is associated with low BMI. However, this effect was only observed in certain groups. Furthermore, our analysis was unable to confirm that MPH use is also associated with low height (≤3rd percentile) and changes in blood pressure.

Research Review: Language problems in children with Attention-Deficit Hyperactivity Disorder - a systematic meta-analytic review.

Children with Attention-Deficit Hyperactivity Disorder (ADHD) appear to have a higher risk of language problems compared with typically developing children, although the types of language problems experienced are less clear. This review aims to establish the types of language problems experienced by children with ADHD according to systematically reviewed literature and determine the empirical evidence for language problems in children with ADHD compared with non-ADHD controls. A standardized search protocol was used on databases: CINAHL, Medline, and PsychINFO. We identified studies with the following inclusion criteria: (a) confirmed ADHD status at the time of the study, (b) inclusion of a non-ADHD control group, (c) use of a validated language measure, and (d) age≤18. t-Tests, Pearson's r, and Hedges g effect sizes (ES) were calculated using summary statistics. Random effects meta-analyses were conducted for the language domain suitable for analysis. Publication bias was investigated using both the trim and fill and p-curve techniques. Twenty-one studies were included in the systematic review (ADHD=1,209; Control=1,101), within which 60 of 68 separate analyses found significant differences between the ADHD and control group on the language measures (p<.05). Follow-up meta-analyses found evidence for large deficits in the ADHD groups overall (10/11 studies met p<.05; weighted mean ES [WMES]: 1.04); expressive (10/10 met p<.05; WMES: 1.23); receptive (12/14 met p<.05; WMES: 0.97), and pragmatic language (4/4 studies met p<.05; WMES: 0.98) compared with controls. This study demonstrates that children with ADHD have poorer performance on measures of overall, expressive, receptive, and pragmatic language compared with controls. A screening of language functioning may be a valuable addition to the assessment of ADHD.

Sociodemographics, Comorbidities, Healthcare Utilization and Work Productivity in Japanese Patients with Adult ADHD.

ObjectivesThis study compared the sociodemographic characteristics, comorbidities, healthcare resource utilization, and work productivity among Japanese adults who reported being diagnosed with attention-deficit/hyperactivity disorder (ADHD) to those of a non-ADHD control population.MethodsData for this study were captured from an online survey of adults in Japan conducted by Kantar Health using consumer panels. A total of 84 survey participants reported they had received a diagnosis of ADHD from a physician. Survey responses pertaining to functional status and resource utilization from this ADHD group were compared to those from a non-ADHD control group of 100 participants. Comparisons between the ADHD and non-ADHD groups were made using chi-square tests for categorical variables and t-tests for continuous variables.ResultsParticipants in the ADHD group were on average slightly younger with a higher proportion of males. ADHD respondents reported significantly more comorbid depression, sleep difficulties, headaches, and anxiety than non-ADHD controls. Over the previous 6 months, the ADHD group made more visits to healthcare providers and the emergency room, and had more hospitalizations than non-ADHD controls. The ADHD group also rated their overall health status lower than the non-ADHD control group. Respondents with ADHD reported a significantly higher degree of health-related work impairment compared to non-ADHD, with greater absenteeism and decreased work productivity. The ADHD group indicated their symptoms negatively impacted relationships, self-esteem, and regular daily activities.ConclusionsJapanese adults with ADHD face a substantial burden of illness, including lower overall health status, increased number of comorbidities, greater healthcare utilization, and significant health-related occupational impairment compared to those without ADHD. Additional research is needed to develop a better understanding of both the consequences and treatment approaches for Japanese adults with ADHD.

How Good Am I? Implicit and Explicit Self-Esteem as a Function of Perceived Parenting Styles Among Children With ADHD

Objective: To investigate implicit and explicit self-esteem and academic self-evaluation among children with ADHD as a function of parenting styles, namely, authoritarian, authoritative and permissive parenting. Method: Participants included 43 children with ADHD and 35 non-ADHD controls who filled out self-concept and perceived parenting style questionnaires. They also took an Implicit Association Test (IAT) that measured unacknowledged self-esteem. Results: Lower self-esteem was found among children with ADHD than among controls, with stronger effect on the implicit level. Perceived authoritarian parenting was related to lower implicit self-esteem among children with ADHD. Higher self-esteem was found in the authoritative than in the permissive parenting groups in the non-ADHD control group but not among children with ADHD. Conclusion: The role of parental support versus authoritarian parenting in terms of implicit self-esteem points to the importance of promoting responsiveness strategies among parents in the treatment of children with ADHD.

Cognitive Complaints and Neuropsychological Functioning in Adults With and Without Attention-Deficit Hyperactivity Disorder Referred for Multidisciplinary Assessment

The present study aims to gain insight into the clinical presentation (viz., self-reported complaints and neuropsychological functioning) of adults referred for an attention-deficit hyperactivity disorder (ADHD) diagnosis. The investigation evaluated group differences between an ADHD and a non-ADHD sample (n = 30 and n = 42, respectively), all of which had been clinically referred for multidisciplinary assessment of ADHD. Forty-two percent of all referred patients were diagnosed with adult ADHD. Adults with ADHD made significantly more errors on a verbal learning task than the non-ADHD control group, which could indicate an impairment of the self-monitoring function in adult ADHD. The ADHD group reported more problems than the control group in the domains of executive functioning but not in the domains of attention and hyperactivity. More attention should be paid to executive complaints and functioning (present and past) when referring adults suspected of ADHD for multidisciplinary assessment. Also, characteristics that are thought to be striking symptoms of adult ADHD, such as problems with concentration and hyperactive behavior, are in fact not distinctive symptoms of ADHD at all.

Impulsivity and Attention Deficit-Hyperactivity Disorder: Subtype Classification Using the UPPS Impulsive Behavior Scale

This study examined the classification accuracy of the UPPS Impulsive Behavior Scale (UPPS) in discriminating several attention deficit/hyperactivity disorder (ADHD) subtypes, including predominantly inattentive type (ADHD/I), combined type (ADHD/C), and combined type with behavioral problems (ADHD/ODD), between each other and a non-ADHD control group using logistic regression analyses. The sample consisted of 88 children ranging in age from 9.0 years to 12.8 years, with a mean of 10.9 years. Children were predominantly male (74%) and Caucasian (86%) and in grades 3-7. Results indicated that the UPPS performed well in classifying ADHD subtypes relative to traditional diagnostic measures. In addition, analyses indicated that differences in symptoms between subtypes can be explained by specific pathways to impulsivity. Implications for the assessment of ADHD and conceptual issues are discussed.

Differences Between ADHD Inattentive and Combined Types on the CPT

Two samples of school-age boys with attention-deficit/hyperactivity disorder (ADHD-Combined and ADHD-Inattentive Types) and a non-ADHD control group were administered an “AX” version of the continuous performance task (CPT) to examine specific sustained attention deficits. Three levels of time-on-task were included to study performance declines, and 3 interstimulus intervals were included to examine vigilance deficits. As predicted by R. A. Barkley's and H. C. Quay's behavior inhibition deficit models (R. A. Barkley, 1997; H. C. Quay, 1997), the performance of the ADHD-Combined Type (ADHD-C) participants deteriorated more quickly than the other samples. No significant evidence of vigilance deficits among the inattentive (ADHD-IA) sample was found. These findings suggest that distinct criteria for the two ADHD subtypes may be warranted when the CPT is used for diagnostic assessment, and sustained attention-related declines in performance may be typical of the ADHD-C Type only.

Assessing ADHD Across Settings: Contributions of Behavioral Assessment to Categorical Decision Making

Adapted methods of behavioral assessment to assess home and school functioning in a way that maps directly to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., [DSM-IV]; American Psychiatric Association, 1994). The study was conducted in a school-based sample with 5- to 12-year-old children referred to a school intervention team. A multigate set of procedures was used to assign children to one of 3 groups: attention deficit hyperactivity disorder (ADHD), inattentive group; ADHD, combined group; and a non-ADHD control group. The ADHD Rating Scale-IV was used to assess parent and teacher ratings of ADHD symptoms as delineated in DSM-IV. The findings suggest that the use of a fixed cutoff point (i.e., 6 or more symptoms), which is employed in the DSM-IV, is often not the best strategy for making diagnostic decisions. The optimal approach depends on whether diagnostic information is being provided by the parent or teacher and whether the purpose of assessment is to conduct a screening or a diagnostic evaluation. Also, the results indicate that a strategy that aggregates symptoms in the order in which they are accurate in predicting a diagnosis of ADHD is a more effective strategy than the approach used in DSM-IV, which aggregates any combination of a specific number of items. Implications for using methods of behavioral assessment to make diagnostic decisions using DSM-IV criteria are discussed.