Pure Attention Deficit Hyperactivity Disorder Research Articles

The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder.

The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD). This study included 842 children aged 8-12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used. According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children. This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.

Social Cognition and Functioning in Patients With Social Anxiety Disorder and/or Attention-Deficit/Hyperactivity Disorder.

In recent years, social cognition and one of its dimensions, the theory of mind, have been more commonly investigated in patients with social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD). In this study, SAD, ADHD, comorbid SAD-ADHD, and healthy control (HC) groups, each consisting of 30 participants, were included and compared in terms of social cognition and functionality. Mean global functioning assessment scores were found to be significantly higher in the HC group compared with the other three groups and in the ADHD group compared with the SAD and SAD-ADHD groups. Mean Dokuz Eylül Theory of Mind Index total scores were found to be significantly higher in the HC group compared with the other three groups and in the SAD and SAD-ADHD groups compared with the ADHD group. These findings suggest that SAD patients with or without ADHD show better social cognition but worse functioning compared with pure ADHD patients.

Distinct frontoparietal brain dynamics underlying the co-occurrence of autism and ADHD.

Previous diagnostic systems precluded the co-existence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in one person; but, after many clinical reports, such diagnostic criteria were updated to allow their co-occurrence. Despite such a clinical change, the neurobiological bases underpinning the comorbidity remain poorly understood, and whether the ASD+ADHD condition is a simple overlap of the two disorders is unknown. Here, to answer this question, we compared the brain dynamics of high-functioning ASD+ADHD children with age-/sex-/IQ-matched pure ASD, pure ADHD, and typically developing children. Regarding autistic traits, the socio-communicational symptom of the ASD+ADHD children was explained by the same over-stable brain dynamics as seen in pure ASD. In contrast, their ADHD-like traits were grounded on a unique neural mechanism that was unseen in pure ADHD: the core symptoms of pure ADHD were associated with the overly flexible whole-brain dynamics that were triggered by the unstable activity of the dorsal-attention network and the left parietal cortex; by contrast, the ADHD-like cognitive instability of the ASD+ADHD condition was correlated with the atypically frequent neural transition along a specific brain state pathway, which was induced by the atypically unstable activity of the frontoparietal control network and the left prefrontal cortex. These observations need to be validated in future studies using more direct and comprehensive behavioural indices, but the current findings suggest that the ASD+ADHD comorbidity is not a mere overlap of the two disorders. Particularly, its ADHD-like traits could represent a unique condition that would need a specific diagnosis and bespoke treatments.Significance statementChildren with autism spectrum disorder (ASD) have cognitive rigidity and tend to persist in specific thoughts, whereas those with ADHD exhibit overly flexible cognition and have trouble with concentration. Despite such contrast, clinically, the two neurodevelopmental disorders are often reported to co-exist in one person. How can such a co-occurrence happen? By investigating the global and local brain dynamics, this study found that the comorbidity of ASD and ADHD is not a simple overlap of the two conditions. Instead, the cognitive instability seen in ASD+ADHD children was underpinned by unique brain dynamics that were not observed in pure ADHD. These findings indicate that the comorbid condition would need a bespoke diagnosis and treatment.

Executive Functions and Emotion Regulation Relationship of Suicidal Ideation in Children with ADHD

Objective: There is evidence that suicidal thoughts are increased in attention deficit/hyperactivity disorder (ADHD). The aim of this study is to investigate the relationship between executive function (EF) deficits and emotion regulation negativity/lability (ERNL) in children with ADHD who reported suicidal ideation. Method: This study was conducted in children aged 8-12 years with ADHD. Thirty-eight cases (ADHD + SI) with suicidal ideation and 41 cases without suicidal ideation (pure ADHD) were included in the study. Participants completed using the Children's depression inventory (CDI), the Screen for child anxiety-related emotional disorders (SCARED), the Behavior rating inventory of executive function (BRIEF) and the Emotion regulation checklist (ERC). Results: A significant difference was found between the 3 groups in terms of EF deficits and ERNL, CDI and SCARED. BRIEF subcomponents; there was a significant difference between inhibit, emotion control, monitor and behavior regulation index. Conclusion: Suicidal ideation is an important psychiatric health problem. Recognizing suicidal ideation in children; It can be effective in preventing suicidal behavior. Cognitive features such as EF deficits and ERNL may contribute negatively to suicidal ideation, especially in children with ADHD.

The relationship between speech difficulties and brain laterality in Attention Deficit Hyperactivity Disorder and Specific Learning Disorder

Aim: We aimed to examine the behavioral determinants of brain laterality and their associations with speech difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) and Specific Learning Disorder (SLD).Methods: This cross-sectional study was conducted with a clinical sample of 7-18 years old patients with ADHD and/or SLD diagnosis. Patients’ sociodemographical, developmental and medical information were taken during their clinical interviews. Behavioral determinants of brain laterality were assessed by several motor tasks. These tasks were “handwriting” for handedness, “looking through the telescope” for eyedness, and “hitting the ball or standing on one foot” for footedness.Results: A total of 130 patients participated in the study. Left side preference and crossed laterality were common in patients with SLD (with or without comorbid ADHD) but not in patients with pure ADHD. Left eyedness/footedness were associated with speech disorders (p<0,05).Conclusion: This study has shown that even after controlling for other factors affecting the development of brain laterality SLD, but not ADHD, is associated with left-sided preference and cross laterality. The relationship between speech disorders and left-eyedness/footedness in ADHD and SLD patients suggests that development of brain laterality is actually mediated by speech development.

Reward-Related Dysfunctions in Children Developing Attention Deficit Hyperactivity Disorder-Roles of Oppositional and Callous-Unemotional Symptoms.

Objectives: Neurocognitive functions might indicate specific pathways in developing attention deficit hyperactivity disorder (ADHD). We focus on reward-related dysfunctions and analyze whether reward-related inhibitory control (RRIC), approach motivation, and autonomic reactivity to reward-related stimuli are linked to developing ADHD, while accounting for comorbid symptoms of oppositional defiant disorder (ODD), and callous-unemotional (CU) traits.Methods: A sample of 198 preschool children (115 boys; age: m = 58, s = 6 months) was re-assessed at age 8 years (m = 101.4, s = 3.6 months). ADHD diagnosis was made by clinical interviews. We measured ODD symptoms and CU traits using a multi-informant approach, RRIC (Snack-Delay task, Gift-Bag task) and approach tendency using neuropsychological tasks, and autonomic reactivity via indices of electrodermal activity (EDA).Results: Low RRIC and low autonomic reactivity were uniquely associated with ADHD, while longitudinal and cross-sectional links between approach motivation and ADHD were completely explained by comorbid ODD and CU symptoms.Conclusion: High approach motivation indicated developing ADHD with ODD and CU problems, while low RRIC and low reward-related autonomic reactivity were linked to developing pure ADHD. The results are in line with models on neurocognitive subtypes in externalizing disorders.

Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

BackgroundClinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD.MethodsData with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day.ResultsIndividuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD.ConclusionsThe findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

Visual Search in Chinese Children With Attention Deficit/Hyperactivity Disorder and Comorbid Developmental Dyslexia: Evidence for Pathogenesis From Eye Movements.

In this study, a visual search task was conducted on children with comorbid attention deficit/hyperactivity disorder (ADHD) and developmental dyslexia (DD), children with pure ADHD, and typically developing children to explore the pathogenesis of comorbidity between ADHD and DD. Participants searched for the target character from five characters in each trial during the task. The distractors included orthographically similar characters, homophones, unrelated characters, and characters of a different color (i.e., red). Results showed that the clinical groups produced longer first fixation duration than the control group in all types of distractors. Children with ADHD comorbid DD were also more susceptible to characters with the distracting red color in gaze duration and total viewing time than were children with pure ADHD and healthy controls. The implication of comorbidity (ADHD + DD) on the pathogenesis was discussed. These results may be helpful for the diagnosis and treatment of ADHD with comorbid DD.

Altered brain morphology in boys with attention deficit hyperactivity disorder with and without comorbid conduct disorder/oppositional defiant disorder.

About 50% of attention deficit hyperactivity disorder (ADHD) patients suffer from comorbidity with oppositional defiant disorder/conduct disorder (ODD/CD). Most previous studies on structural morphology did not differentiate between pure (ADHD‐only) and comorbid ADHD (ADHD+ODD/CD). Therefore, we aimed to investigate the structural profile of ADHD‐only versus ADHD+ODD/CD spanning the indices subcortical and cortical volume, cortical thickness, and surface area. We predicted a reduced total gray matter, striatal, and cerebellar volume in both patient groups and a reduced amygdalar and hippocampal volume for ADHD+ODD/CD. We also explored alterations in prefrontal volume, thickness, and surface area. We acquired structural images from an adolescent sample ranging from 11 to 17 years, matched with regard to age, pubertal status, and IQ—including 36 boys with ADHD‐only, 26 boys with ADHD+ODD/CD, and 30 typically developing (TD) boys. We analyzed structural data with FreeSurfer. We found reductions in total gray matter and total surface area for both patient groups. Boys with ADHD+ODD/CD had a thicker cortex than the other groups in a right rostral middle frontal cluster, which was related to stronger ODD/CD symptoms, even when controlling for ADHD symptoms. No group differences in local cortical volume or surface area emerged. We demonstrate the necessity to carefully differentiate between ADHD and ADHD+ODD/CD. The increased rostral middle frontal thickness might hint at a delayed adolescent cortical thinning in ADHD+ODD/CD. Patients with the double burden ADHD and ODD or CD seem to be even more affected than patients with pure ADHD.

Visual Perceptual Skills in Attention-deficit/Hyperactivity Disorder Children: The Mediating Role of Comorbidities.

Attention-deficit/hyperactivity disorder (ADHD) has been commonly associated with alterations in visual perception. However, the individual behavior of visual perceptual skills and its relationship with different comorbidities remain unknown. The purpose of this study was to examine whether visual perceptual skills are impaired in children with ADHD, as well as to test the possible mediating role of comorbidities. Thirty-five nonmedicated ADHD (20 pure and 15 with comorbidities) and 35 age-matched controls completed the performance-based Test of Visual Perceptual Skills. The analysis between total ADHD and controls favored the alternative hypothesis (greater values for children with ADHD) for visual memory, spatial relationships, sequential memory, and all the composite measures (Bayes factor [BF] range, 4.26 to 366.85). The analysis between pure ADHD and controls showed that data are more likely under the alternative hypothesis for spatial relationships, sequential memory, overall, basic, and sequencing (BF range, 3.82 to 21.71), whereas the comparison between ADHD with comorbidities and controls additionally favored the alternative hypothesis for visual discrimination (BF = 5.37). Lastly, data from the comparison between pure ADHD and ADHD with comorbidities were insensitive for favoring the null or alternative hypotheses in any subtest or composite scaled score (BF range, 0.33 to 0.66). Our results suggest that some specific patterns of visual perception are altered in ADHD, especially for the total ADHD group. The current findings also evidence that comorbidities play an important role in the association between ADHD and visual perceptual skills. Future studies should address the mediating role of each specific type of comorbidity.

Stress response genes associated with attention deficit hyperactivity disorder: A case-control study in Chinese children

To explore the associations between stress response genes and attention deficit hyperactivity disorder (ADHD) in children, we conducted a case-control study consisting of 406 newly diagnosed ADHD cases and 432 controls in Wuhan, China. We genotyped the candidate genes, nuclear receptor subfamily 3 group C member 1(NR3C1) and solute carrier family 6 member 4(SLC6A4), using the Sequenom MassARRAY technology. After correction by Bonferroni (α' = 0.05/6 = 0.008), the rs6191 SNP was found to be associated with a reduced risk of ADHD in the dominant model (OR = 0.564, 95% CI = 0.389-0.819, P = 0.003) while the rs25531 SNP was associated with an increased risk of ADHD in the multiplicative model (OR = 1.380, 95% CI = 1.111–1.714, P = 0.004). Additionally, both the rs6191 and rs25531 SNPs were significantly associated with the attention deficit factor (P = 0.006, P = 0.003, respectively) but not with the hyperactivity/impulsivity factor in the Swanson, Nolan and Pelham-IV Questionnaire (SNAP-IV) scale. Furthermore, we found that these two SNPs were significantly associated with pure ADHD, and not affected by the comorbidities (P = 0.001, P = 0.007, respectively). Besides, there was an interaction between these two SNPs. This study demonstrated the role of NR3C1 and SLC6A4 polymorphisms in ADHD, yet independent replication of the findings of this study in multi-center and multi-stage studies with large samples is warranted in the future.

Neural Correlates of Duration Discrimination in Young Adults with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder and Their Comorbid Presentation.

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often co-occur and share neurocognitive deficits. One such shared impairment is in duration discrimination. However, no studies using functional magnetic resonance imaging (fMRI) have investigated whether these duration discrimination deficits are underpinned by the same or different underlying neurofunctional processes. In this study, we used fMRI to compare the neurofunctional correlates of duration discrimination between young adult males with ASD (n = 23), ADHD (n = 25), the comorbid condition of ASD+ADHD (n = 24), and typical development (TD, n = 26) using both region of interest (ROI) and whole brain analyses. Both the ROI and the whole-brain analyses showed that the comorbid ASD+ADHD group compared to controls, and for the ROI analysis relative to the other patient groups, had significant under-activation in right inferior frontal cortex (IFG) a key region for duration discrimination that is typically under-activated in boys with ADHD. The findings show that in young adult males with pure ASD, pure ADHD and comorbid ASD+ADHD with no intellectual disability, only the comorbid group demonstrates neurofunctional deficits in a typical duration discrimination region.

Are patients with bipolar disorder and comorbid attention-deficit hyperactivity disorder more neurocognitively impaired?

Research on neurocognitive impairment in adult patients with comorbid bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) is very scarce. This study assessed the neurocognitive profile of a comorbid group (BD+ADHD) compared with that of pure BD (pBD) group, pure ADHD (pADHD) group and healthy controls (HCs). This was a three-site study comprising 229 subjects: 70 patients with pBD, 23 with BD+ADHD, 50 with pADHD, and 86 HCs. All patients with BD had been euthymic for at least 6months. Neuropsychological performance was assessed using a comprehensive neurocognitive battery. Our results showed that all the clinical groups had poorer performance than the HCs in all the neurocognitive domains except for executive functions. No significant differences were observed between the pBD and BD+ADHD groups in any of the cognitive domains, with these two groups showing greater impairment than the pADHD group in executive functions and visual memory. Our results, although preliminary, suggest that the BD+ADHD group showed the same neurocognitive profile as pBD patients, most likely reflecting the same neurobiological basis. On the other hand, the pADHD group showed a more selective moderate impairment in attention.

Executive Function Features in Drug-naive Children with Oppositional Defiant Disorder.

BackgroundOppositional defiant disorder (ODD) that is characterized by markedly defiant, disobedient, and disruptive behavior in younger children has been regarded as disruptive behavior disorder (DBD), together with conduct disorder (CD). However, in contrast to CD, ODD does not include severe aggressive or antisocial behavior.AimThis study aimed to examine executive function (EF) features of children with oppositional defiant disorder (ODD).MethodsCross sectional design was used in this study. The EF of children with ODD and pure attention deficit hyperactivity disorder (ADHD) were compared with children without a psychiatric disorder, using the Stroop Color-Word Tests A and B, Wechsler Intelligence Scale for Children (Fourth Edition; WISC-IV), Wisconsin Card Sorting Test (WCST), and Cambridge Neuropsychological Test Automated Battery (CANTAB) corrected for age. Logistic regression analysis was conducted to identify risk factors for EF deficits characteristic of ODD and ADHD.ResultsThe ODD group exhibited significantly lower scores in both Stroop Color-Word Tests, the backwards digital span of the WISC-IV, and the categories completed and perseverative responses of the WCST, and significantly higher scores in spatial working memory (SWM) between errors, and the strategy in SWM of the CANTAB compared with the control group. When the ODD group was designated as 1 and the ADHD group was designated as 0, digital span (X1) fit the regression equation very well.ConclusionsChildren with ODD perform substantially worse in EF tasks. Responsive inhibition appears to be uniquely associated with ODD development, while responsive inhibition and working memory appear to be associated with ADHD.

Differences in Resting-state Quantitative Electroencephalography Patterns in Attention Deficit/Hyperactivity Disorder with or without Comorbid Symptoms

ObjectiveThe aim of the present study was to evaluate the role of comorbid psychiatric symptoms on quantitative electroencephalogram (QEEG) activities in boys with the attention deficit/hyperactivity disorder (ADHD).MethodsAll participants were male students in the second, third or fourth grade in elementary school. Therefore, there were no significant differences in age or sex. Participants with ADHD were assigned to one of three groups: pure ADHD (n=22), ADHD with depressive symptoms (n=11), or ADHD with problematic internet use (n=19). The Korean version of the Children’s Depression Inventory and the Korean Internet Addiction Self-scale were used to assess depressive symptoms and problematic internet use, respectively. Resting-state EEG during eyes closed was recorded, and the absolute power of five frequency bands was analyzed: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), and gamma (30–50 Hz).ResultsThe ADHD with problematic internet use group showed decreased absolute theta power at the central and posterior region compared with the pure ADHD group. However, The ADHD with depressive symptoms group showed no significant differences compared with the other groups.ConclusionThese findings will contribute to a better understanding of brain-based electrophysiological changes in children with ADHD in accordance with comorbid psychiatric symptoms.

Cognitive Function of Children and Adolescents with Attention Deficit Hyperactivity Disorder and Learning Difficulties: A Developmental Perspective.

Background:The cognitive function of children with either attention deficit hyperactivity disorder (ADHD) or learning disabilities (LDs) is known to be impaired. However, little is known about the cognitive function of children with comorbid ADHD and LD. The present study aimed to explore the cognitive function of children and adolescents with ADHD and learning difficulties in comparison with children with ADHD and healthy controls in different age groups in a large Chinese sample.Methods:Totally, 1043 participants with ADHD and learning difficulties (the ADHD + learning difficulties group), 870 with pure ADHD (the pure ADHD group), and 496 healthy controls were recruited. To investigate the difference in cognitive impairment using a developmental approach, all participants were divided into three age groups (6–8, 9–11, and 12–14 years old). Measurements were the Chinese-Wechsler Intelligence Scale for Children, the Stroop Color-Word Test, the Trail-Making Test, and the Behavior Rating Inventory of Executive Function-Parents (BRIEF). Multivariate analysis of variance was used.Results:The results showed that after controlling for the effect of ADHD symptoms, the ADHD + learning difficulties group was still significantly worse than the pure ADHD group, which was, in turn, worse than the control group on full intelligence quotient (98.66 ± 13.87 vs. 105.17 ± 14.36 vs. 112.93 ± 13.87, P < 0.001). The same relationship was also evident for shift function (shifting time of the Trail-Making Test, 122.50 [62.00, 194.25] s vs. 122.00 [73.00, 201.50] s vs. 66.00 [45.00, 108.00] s, P < 0.001) and everyday life executive function (BRIEF total score, 145.71 ± 19.35 vs. 138.96 ± 18.00 vs. 122.71 ± 20.45, P < 0.001) after controlling for the effect of the severity of ADHD symptoms, intelligence quotient, age, and gender. As for the age groups, the differences among groups became nonsignificant in the 12–14 years old group for inhibition (meaning interference of the Stroop Color-Word Test, 18.00 [13.00, 25.00] s vs. 17.00 [15.00, 26.00] s vs. 17.00 [10.50, 20.00] s, P = 0.704) and shift function (shifting time of the Trail-Making Test, 62.00 [43.00, 97.00] s vs. 53.00 [38.00, 81.00] s vs. 101.00 [88.00, 114.00] s, P = 0.778).Conclusions:Children and adolescents with ADHD and learning difficulties have more severe cognitive impairment than pure ADHD patients even after controlling for the effect of ADHD symptoms. However, the differences in impairment in inhibition and shift function are no longer significant when these individuals were 12–14 years old.

Clinical application of the integrated visual and auditory continuous performance test on Tourette syndrome children with attention deficit hyperactivity disorder

Objective To explore the value of the integrated visual and audio continuous performance test(IVA-CPT) in the diagnosis of Tourette syndrome(TS) patients who have comorbid attention deficit hyperactivity disorder(ADHD). Methods IVA-CPT was performed in 519 TS patients with comorbid ADHD (observation group) and 857 patients with pure ADHD (control group). The gold standard for the diagnosis of ADHD was based on the Diagnostic and Statistical Manual of Mental Disorders (4th version, USA) (DSM-Ⅳ). Results (1) When DSM-Ⅳ was used as the gold standard , the sensitivity, specificity and coincidence rate of IVA-CPT were 62.4%, 81.9% and 75.7%, respectively.(2) IVA-CPT misdiagnosed 62 cases in TS+ ADHD group, including 30.3% (10/33 cases) inattentive subtype (ADHD-I), 51.4% (37/72 cases) hyperactive subtype (ADHD-H) and 25.0% (15/60 cases) combined subtype (ADHD-C). Significant difference in misdiagnosis rate was found among ADHD-H and ADHD-I and ADHD-C (χ2=10.646, P<0.05). (3) There were 449 cases in which 2 diagnostic methods were both positive in both observation group and control group, including 103 cases in observation group and 346 cases in control group.The full scale response control quotient, visual reaction control, auditory reaction control in observation group and control group were 89.0±19.5/77.4±18.2, 92.4±19.0/84.3±18.9, 89.6±16.8/77.4±19.7, and there were significant differences between 2 groups(t=-5.024, -3.533, -5.255, all P<0.05). The full scale response control quotient, visual response control quotient, full scale attention quotient and visual attention quotient between the 2 groups were statistically significant (t=-2.510, -2.836, -1.402, -2.501, all P<0.05). Conclusions (1)IVA-CPT can be used as an effective and objective tool for the diagnosis of TS children with comorbid ADHD.(2)Compared with TS children with comorbid ADHD, pure ADHD children have a higher attention and control impairment. Key words: Tourette syndrome; Attention deficit hyperactivity disorder; Integrated visual and audio continuous performance test; Diagnostic and Statistical Manual of Mental Disorders Ⅳ; Child

Attention-deficit/hyperactivity disorder-related symptoms improved with allergic rhinitis treatment in children.

Increased prevalence of attention-deficit/hyperactivity disorder (ADHD) in children with allergic rhinitis (AR) has been reported. Our previous study showed that children with untreated AR had higher ADHD scores than did the controls. This prospective follow-up study aimed to investigate whether elevated ADHD scores in children with AR could be decreased by AR treatment. Sixty-eight children with AR (age range, 6-14 years) and who were drug naive were enrolled and evaluated by AR symptom score, ADHD symptom scores, and computerized continuous performance test, before and after AR therapy, which included nonpharmacologic intervention, oral antihistamines, and topical steroids. Thirty-one age-matched controls and 13 children with pure ADHD were also enrolled for comparison. The relationship between the AR and ADHD score change was analyzed by a partial correlation test, and univariate and multivariate linear regression models were applied to investigate possible predictors for the improvement of ADHD scores by AR treatment. AR symptom scores in children with AR decreased significantly after treatment (p < 0.001), and their ADHD scores also decreased significantly (p < 0.001). An improved AR symptom score was positively correlated with improved detectability (rp = 0.617, p = 0.001) and commission error (rp = 0.511, p = 0.011). Significant predictors for the improvement of ADHD scores included age, AR drugs, AR subtypes, and multiple atopic diseases (ps < 0.05). Higher ADHD scores in children with AR compared with healthy controls decreased significantly with AR treatment. For children with AR and borderline ADHD symptoms, who do not meet full ADHD diagnostic criteria, we recommend initially treating their AR and monitoring improvement of ADHD symptoms.

ALTERED RESPONSE WITH METHYLPHENIDATE TO ADHD-LIKE SYMPTOMS IN PERVASIVE DEVELOPMENTAL DISORDER: DOES CES-1 ENZYME GENE POLYMORPHISM HAVE A ROLE?

Methylphenidate is the first-choice medication for the Pervasive Developmental Disorders (PDDs), and comorbid Attention Deficit Hyperactivity Disorder (ADHD). But this approach generally results with poor outcomes, and increased adverse effects. It is aimed to investigate the comparison of cases who diagnosed with PDDs and Mild Mental Retardation (MR) and cases with pure ADHD in terms of the clinical response to MPH. Also we aimed to investigate the relations between CES-1 polymorphism gene and the clinical response to MPH. For clarifying this we searched for three polymorphisms (Arg199/His, Ser75/Asn, and Ile49/Val) in carboxylesterase-1 gene (CES-1) in the saliva of patients diagnosed with PDD+ADHD. Also, we assessed the clinical response to MPH by dimensional approach using the Attention Deficit Hyperactivity Disorder Rating Scale IV and Clinical Global Impression-Improvement scale. PDD+ADHD groups had significantly higher Arg199/His polymorphism, and clinically responded poorer with symptoms sometimes even worsening to the MPH treatment compared with "pure" ADHD and ADHD+MR groups. This is the first study that an association between Arg199/His polymorphism in CES1 and altered treatment response to MPH in patients with PDD that presents with symptoms of ADHD.

Cortisol and its effects on cognitive function in a sample of Egyptian school-aged children with attention-deficit hyperactivity disorder

Background Several studies have suggested that cortisol level influences the development and functioning of the brain in children and that it is implicated in a variety of processes including memory and attention. Objective This study was conducted to investigate the relation between cortisol level in children with attention-deficit/hyperactivity disorder (ADHD) and their cognitive function profile. Methods The participants of the study, held in Suez Canal University Hospital in Ismailia, were recruited from among those attending the childhood and adolescent psychiatry clinic. They were divided into two groups, the ADHD group [diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) through a structured clinical interview], composed of 43 children (pure ADHD children with no comorbid conditions), and the control group, composed of 31 typically developing children. All of them participated voluntarily in this study. The participants' ages ranged from 6 to 12 years; both sexes were included. Early morning awakening salivary cortisol levels were collected on two different days 2 months apart. The Stanford-Binet intelligence test 4th edition, the Wisconsin Card Sorting Test, Conner's test, and the child behavioral checklist were administered on all participants. Results Early morning salivary cortisol levels in both groups showed a statistically significant difference. Comparison shows that there was a statistically significant difference in the mean total score and the mean subdomain score of Stanford-Binet intelligence test 4th edition and Wisconsin Card Sorting Test (total number of errors, perseverative errors) between ADHD children and the comparison group. These results were positively correlated with decrease in mean cortisol awakening response. Conclusion There are significant associations between salivary cortisol levels and cognitive and executive function impairment in children with ADHD.