Reducing Attention-deficit/hyperactivity Disorder Symptoms Research Articles

Evaluating the relationship between Ex3 vNTR and rs3758653 polymorphisms in DRD4 genes in children with attention deficit hyperactivity disorder with respect to the dose of methylphenidate

Background. Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders starting at an early age with symptoms of attention deficit hyperactivity disorder and impulsivity. This study aimed to investigate the molecular alterations of the DRD4 gene, which have been linked to ADHD in previous studies with respect to the dose of methylphenidate. Methods. The study population included all ADHD patients needing drug therapy aged 5-18 years referred to Bozorgmehr psychiatric clinic in Tabriz in 2017 for one year. After diagnosis, symptoms severity was assessed using the Conners Scale for ADHD Assessment. Then, 4 ml of blood was collected from each individual and DNA was extracted using salting out method. After performing polymerase chain reaction (PCR), the products were separated using specific restriction enzymes and then polymorphisms of Ex3 VNTR and rs3758653 of DRD4 gene were analyzed in 2% agarose gel. The last dose to achieve the therapeutic response was recorded in mg/kg. Then, we investigated the relationship between the doses of drug used to achieve the therapeutic response and the existence of the mentioned polymorphisms. Results. There was no significant relationship between treatment response and type of polymorphism. Also, there was no significant relationship between the average dose of drug and the polymorphisms of three replicates, four replicates, six replicates, and more than six replicates in EX3VNTR in DRD4 gene. In addition, we witnessed no statistically significant relationship between the mean drug dose and CC, TC, and TT genotypes in DRD4rs3758653. Conclusion. There was no significant relationship between treatment response and type of polymorphism. There was no significant relationship between the average dose of drug and the polymorphisms of three replicate, four replicates, six replicates and more than six replicates in EX3VNTR in DRD4 gene. Between mean drug dose and CC, TC and TT genotypes in DRD4rs3758653, there was no statistically significant relationship. Practical Implications. Determining the reduction of ADHD symptoms by taking methylphenidate and evaluating the relationship between presence or absence of DRD4 polymorphisms and the dosage of drug to achieve a better response to treatment can collect enough evidence to determine the dose of methylphenidate according to the molecular analysis of DRD4 gene in patients with ADHD. This can reduce doctor visits, save time, and decrease the drug side effects.

Treatment of ADHD in preschool children

Attention-deficit hyperactivity disorder (ADHD) can be diagnosed in preschool children aged 3–5 years. Interventions for ADHD that are safe and effective, in the short and longer term, would be particularly relevant in the preschool-age period, to prevent or reduce the negative outcomes associated with the disorder. Efficacy and safety of methylphenidate and behavioural parent training for children aged 3–5 years with attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled, and sham behavioural parent training-controlled trialMethylphenidate was effective in reducing ADHD symptoms and improving functionality, and behavioural parent training was effective in improving functionality for preschool children with ADHD after 8 weeks of treatment. Full-Text PDF

Efficacy and safety of methylphenidate and behavioural parent training for children aged 3–5 years with attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled, and sham behavioural parent training-controlled trial

There is insufficient evidence to support treatment recommendations for preschool children aged 3-5 years with attention-deficit hyperactivity disorder (ADHD). We aimed to investigate the efficacy and safety of methylphenidate and behavioural parent training in reducing the frequency and severity of symptoms and improving global functioning in preschool children with ADHD. We did an 8-week, randomised, double-blind, placebo-controlled and sham behavioural parent training-controlled clinical trial (the MAPPA Study) in children aged 3-5 years with moderate-to-severe ADHD. The trial was conducted at the Institute of Psychiatry, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil. Participants were randomly assigned (1:1:1) to receive immediate-release methylphenidate plus educational intervention (sham behavioural parent training), placebo medication plus behavioural parent training, or placebo medication plus educational intervention. Randomisation was done by an independent research manager by use of a permuted block randomisation procedure. Parents, teachers, study staff, and evaluators remained masked to group allocation. Methylphenidate and placebo were titrated to a maximum dose of 1·25 mg/kg per day administered orally twice daily, and behavioural parent training and the educational intervention were delivered weekly through 90 min sessions with both the child and parent, conducted by two psychologists or learning therapists. The primary outcomes were parents' and teachers' composite scores of the Swanson, Nolan, and Pelham-IV scale (SNAP-IV-P/T), the Clinical Global Impressions Severity (CGI-S) scale, and the Children's Global Assessment Scale (CGAS). This trial is registered with ClinicalTrials.gov, NCT02807870, and is now complete. All participants were invited to participate in an open observational follow-up, which is ongoing. Between Aug 21, 2016, and Oct 21, 2019, 153 children were randomly assigned to receive methylphenidate plus the educational intervention (n=51), placebo plus behavioural parent training (n=51), or placebo plus the educational intervention (n=51). Nine (6%) children discontinued treatment. All participants were included in the intention-to-treat analysis. Children in the methylphenidate plus educational intervention group showed greater reductions in the SNAP-IV-P/T (endpoint mean difference -3·93 [95% CI -7·14 to -0·73], p=0·049; effect size -0·55 [95% CI -0·99 to -0·10]) and CGI-S scores (endpoint mean difference -0·49 [-0·82 to -0·17], p=0·0088; effect size -0·70 [-1·16 to -0·24]) and a greater increase in CGAS scores (endpoint mean difference 5·25 [95% CI 2·09 to 8·40], p=0·0036; effect size 0·80 [95% CI 0·32 to 1·28]) than children in the placebo plus educational intervention group. Children in the placebo plus behavioural parent training group did not have significantly different SNAP-IV-P/T scores (endpoint mean difference -3·18 [95% CI -6·38 to 0·02], p=0·077; effect size -0·44 [95% CI -0·89 to 0·003]) or CGI-S scores (endpoint mean difference -0·35 [-0·68 to -0·03], p=0·052; effect size -0·50 [-0·96 to -0·04]) compared to children in the placebo plus educational intervention group, but they had a greater increase in CGAS scores compared to the placebo plus educational intervention group (endpoint mean difference 3·69 [0·53 to 6·85], p=0·033; effect size 0·56 [0·08 to 1·04]). Children in the methylphenidate plus educational intervention versus placebo plus behavioural parent training group did not have statistically or clinically significant differences in primary outcomes. Children in the methylphenidate plus educational intervention group had more mild adverse events than the other two groups, and there were no between-group differences for moderate or severe adverse events. Methylphenidate was effective in reducing ADHD symptoms and improving functionality, and behavioural parent training was effective in improving functionality for preschool children with ADHD after 8 weeks of treatment. São Paulo Research Foundation and Brazilian National Council for Scientific and Technological Development.

Associations of Maternal Milk Feeding With Neurodevelopmental Outcomes at 7 Years of Age in Former Preterm Infants

Maternal milk feeding may have unique long-term neurodevelopmental benefits in very preterm infants. To examine the extent to which maternal milk feeding after very preterm birth is associated with cognitive, academic, and behavioral outcomes at school age. This prospective cohort study assessed 586 infants born at less than 33 weeks' gestation at 5 Australian perinatal centers and enrolled in the Docosahexaenoic Acid for Improvement of Neurodevelopmental Outcomes study (January 1, 2001, to December 31, 2005) who were evaluated at a corrected age of 7 years. The statistical analysis was completed on January 19, 2022. Maternal milk intake, including mean volume (milliliters per kilogram per day) during neonatal hospitalization and total duration (in months). Neurodevelopmental outcomes at 7 years of age were (1) IQ (Wechsler Abbreviated Scale of Intelligence), (2) academic achievement (Wide Range Achievement Test, Fourth Edition), (3) symptoms of attention-deficit/hyperactivity disorder (ADHD) (Conners Third Edition ADHD Index, parent reported), (4) executive function (Behavior Rating Inventory of Executive Functioning, parent reported), and (5) behavior (Strengths and Difficulties Questionnaire, parent reported). A total of 586 infants (mean [SD] gestational age at birth, 29.6 [2.3] weeks; 314 male [53.6%]) born to 486 mothers (mean [SD] age, 30.6 [5.5] years; 447 [92.0%] White) were included. Mean (SD) maternal milk intake in the neonatal intensive care unit was 99 (48) mL/kg daily, and mean (SD) maternal milk duration was 5.1 (5.4) months. Mean (SD) full-scale IQ was 98.5 (13.3) points. After covariate adjustment, higher maternal milk intake during the neonatal hospitalization was associated with higher performance IQ (0.67 points per additional 25 mL/kg daily; 95% CI, 0.10-1.23 points), reading scores (1.14 points per 25 mL/kg daily; 95% CI, 0.39-1.89 points), and math scores (0.76 points per 25 mL/kg daily; 95% CI, 0.14-1.37 points) and fewer ADHD symptoms (-1.08 points per 25 mL/kg daily; 95% CI, -1.96 to -0.20 points). Longer duration of maternal milk intake was associated with higher reading (0.33 points per additional month; 95% CI, 0.03-0.63 points), spelling (0.31 points per month; 95% CI, 0.01-0.62 points), and math (0.30 points per month; 95% CI, 0.03-0.58 points) scores. Maternal milk was not associated with improved full-scale IQ, verbal IQ, executive function, or behavior. Most associations were stronger among infants born at lower gestational ages, particularly less than 30 weeks (interaction P values <.01). In this cohort study of preterm infants, maternal milk feeding during the neonatal hospitalization and after discharge were associated with better school-age performance IQ and academic achievement and with a reduction in ADHD symptoms, particularly among infants born at less than 30 weeks' gestation.

Mediators of psychosocial treatment for adolescent ADHD.

Almost no studies identify mediators of psychosocial interventions for attention deficit/hyperactivity disorder (ADHD)-largely due to design limitations. Understanding mediators can promote streamlined interventions in usual care (UC) settings. When individual studies are insufficient to pursue complex questions, integrative data analysis (IDA) allows researchers to pool raw data from multiple studies to produce cumulative scientific knowledge. We leveraged IDA to pool and harmonize data from four randomized controlled trials of ADHD psychosocial treatment (N = 854) with three time points. Linear growth curve analyses examined the impact of four psychosocial treatment conditions on ADHD symptom outcomes and five candidate mediators (compared to no treatment). To test mediation, we examined whether treatment condition predicted linear growth in the mediator at posttreatment, and if the mediator predicted linear growth in the outcome at follow-up. Compared to no treatment, engagement-focused parent-teen treatment (d = .43-.72; Supporting Teens' Autonomy Daily [STAND]) and community-based usual care (d = .54-.99) led to greatest reductions in parent-rated ADHD symptoms, followed by the Summer Treatment Program-Adolescent (d = .29-.30; STP-A) and standard behavioral parent training + organization skills training (d = .26-.31; BPT/OST). Improvements in organization, time management, and planning skills mediated outcome for all treatments. BPT/OST and STP-A prevented deterioration of social skills, in turn mitigating escalation of ADHD symptoms. Improvements in parent-teen communication skills mediated outcome for STAND, BPT/OST, and the STP-A. Parent contingency management and disruptive classroom behavior were not treatment mediators. Psychosocial treatments for adolescent ADHD primarily improve ADHD symptoms through development of teen organization, time management (OTP), and parent-teen communication skills, as well as slowing deterioration of social skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

OROS-methylphenidate to reduce ADHD symptoms in male prisoners aged 16–25 years: a RCT

Background It is estimated that 20–30% of prisoners meet diagnostic criteria for attention deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but its effect among prisoners remains uncertain. Objectives The primary objective was to estimate the efficacy of osmotic release oral system (OROS) methylphenidate in reducing ADHD symptoms in male prisoners aged 16–25 years who met diagnostic criteria for ADHD. Secondary objectives investigated change for associated clinical and behavioural problems and the role of ADHD symptoms in mediating change in behaviour. Design A Phase IV, 8-week, parallel-arm, double-blind, randomised, placebo-controlled trial of OROS-methylphenidate, compared with placebo, in young male adult prisoners with ADHD. Participants were randomised in a 1 : 1 ratio of OROS-methylphenidate to placebo, stratified by prison. Setting Participants were recruited from Her Majesty’s Prison and Young Offender Institution Isis (London, England) and Her Majesty’s Young Offender Institution Polmont (Falkirk, Scotland). Participants The participants were 200 male prisoners with ADHD aged 16–25 years who met the diagnostic criteria for ADHD. Exclusion criteria included moderate or severe learning disability; serious risk of violence to researchers; current major depression, psychosis, mania or hypomania, or a past history of bipolar disorder or schizophrenia; and drug-seeking behaviour that was of sufficient severity to affect the titration protocol. Intervention The intervention was overencapsulated OROS-methylphenidate (18 mg) or placebo capsules. Trial medication was titrated weekly for 5 weeks against symptom reduction and adverse effects to a final dose of one to four capsules per day, followed by a stable dose for 3 weeks. Main outcome measures The primary outcome was ADHD symptoms at 8 weeks using the investigator-rated Conners’ Adult ADHD Rating Scale-Observer. There were 13 secondary outcomes, including measures of emotional dysregulation, general psychopathology, reports of behaviour by prison staff and engagement with educational activities. Results For the primary outcome, the estimated improvement between the OROS-methylphenidate and placebo arms was 0.57 points on the Conners’ Adult ADHD Rating Scale-Observer (95% confidence interval –2.41 to 3.56) at 8 weeks, with a standardised effect size of 0.06. The difference was not statistically significant and was smaller than the difference the trial was powered to detect. Responder rate, defined as a 20% reduction in the Conners’ Adult ADHD Rating Scale-Observer score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. None of the 13 secondary outcomes that could be formally compared between the trial arms showed a significant effect and no mediators of change in behaviour were identified. Limitations Low adherence to trial medication and low medication dose might have affected the results. Conclusion OROS-methylphenidate was not found to have an effect, compared with placebo, on the primary and secondary outcomes investigated. The findings indicate that ADHD symptoms do not respond to a standard treatment for ADHD following titration to low doses in young adults in prison. The findings do not support the routine treatment with OROS-methylphenidate of young adult prisoners meeting diagnostic criteria for ADHD. Future research Investigations of adequate, maintained dosing, non-pharmacological interventions and community studies are suggested. Trial registration This trial is registered as ISRCTN16827947 and EudraCT 2015-004271-78. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health and Care Research (NIHR) partnership. Janssen-Cilag Ltd supplied OROS-MPH (Concerta-XL). This will be published in full in Efficacy and Mechanism Evaluation; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.

The Effectiveness of a Parent Involvement-Child Behavioral Management Program on Attention Deficit Hyperactivity Disorder Symptoms among Thai School-age Children

Objective: This study examined effect of a new Parent Involvement-Child Behavioral Management Program (PICBMP) on Attention Deficit Hyperactivity Disorder (ADHD) symptoms (inattention, hyperactivity, impulsivity) among school-age children with ADHD in a regional psychiatric hospital in Thailand.Material and Methods: In this pretest-posttest control group study, 60 children between 6 and 12 years of age diagnosed with ADHD and their parents were equally and randomly assigned to either the PICBMP or usual care group. The individuals assigned to the PICBMP group attended an 8-week of behavior management program for parents of ADHD children, which was in addition to a usual care program, while usual care was provided to individuals only provided to the control group. The Swanson, Nolan, and Pelham-IV tool was used to evaluate the ADHD symptoms in all children before and after the PICBMP intervention. Descriptive statistics and t-test were used for data analysis (p-value&lt;0.050).Results: Most of the children were male -75.0%, and -88.4% of the parents in the study were female. The average age of the children was 8.9 years (S.D.=1.67), and that of the parents was 40 years (S.D.=6.17). Significantly lower ADHD symptoms were found in the children who received the PICBMP compared to the children who received the usual care at pretest and posttest (t=-5.065, p-value&lt;0.050). The ADHD symptoms in the children in the intervention experimental group significantly decreased after their parents attended the PICBMP (t=14.986, p-value&lt;0.050).Conclusion: The findings of this study support the effectiveness of the PICBMP in reducing ADHD symptoms.

Adult Attention-Deficit Hyperactivity Disorder/Substance Use Disorder Dual Disorder Patients: A Dual Disorder Unit Point of View.

Substance Use Disorders (SUDs) are often associated with Attention-Deficit Hyperactivity Disorder (ADHD) in adult populations due to multiple neurobiological, genetic, and psychosocial risk factors. This chapter provides a picture of the clinical aspects of adults with both ADHD and SUDs at treatment entry into a Dual Disorder Unit introducing the concept of different types of craving that may lead to substance use and abuse. At treatment entry, the presence of different comorbid SUD clusters, characterized by either stimulants/alcohol or by the use of cannabinoids, has not been shown to influence ADHD-specific symptomatology or severity, despite being crucial for the identification of a specific type of craving. We identified four clinical presentations of adult ADHD: Emotional Dysregulation, Substance Use, Core-ADHD Symptoms, and Positive Emotionality variants, that offer a practical guide in diagnosing and managing adult ADHD patients. Although the evidence of an effective medical treatment for Cocaine Use Disorder is insufficient, in our experience, toxicomanic behavior during stimulant treatment is sharply reduced in ADHD patients with cocaine addiction. Moreover, caffeinated compounds in military soldiers with ADHD may help reduce ADHD symptoms, making caffeine a potential pharmacological tool worth further investigation. Finally, substance use comorbidity does not influence treatment retention rate.

The association between prenatal perfluoroalkyl substance exposure and symptoms of attention-deficit/hyperactivity disorder in 8-year-old children and the mediating role of thyroid hormones in the Hokkaido study.

Disruption of thyroid hormone (TH) levels during pregnancy contributes to attention deficit hyperactivity disorder (ADHD). Exposure to perfluoroalkyl substances (PFAS) during gestation may affect levels of maternal and neonatal TH; however, little is known about the effect of PFAS on ADHD mediated by TH. We investigated the impact of maternal PFAS exposure on children's ADHD symptoms with the mediating effect of TH. In a prospective birth cohort (the Hokkaido study), we included 770 mother-child pairs recruited between 2002 and 2005 for whom both prenatal maternal and cord blood samples were available. Eleven PFAS were measured in maternal serum obtained at 28-32weeks of gestation using ultra-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry. TH and thyroid antibody, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured in maternal blood during early pregnancy (median 11 gestational weeks) and in cord blood at birth. ADHD symptoms in the children at 8years of age were rated by their parents using the ADHD-Rating Scale (ADHD-RS). The cut-off value was set at the 80th percentile for each sex. Significant inverse associations were found between some PFAS in maternal serum and ADHD symptoms among first-born children. Assuming causality, we found only one significant association: maternal FT4 mediated 17.6% of the estimated effect of perfluoroundecanoic acid exposure on hyperactivity-impulsivity among first-born children. Higher PFAS levels in maternal serum during pregnancy were associated with lower risks of ADHD symptoms at 8years of age. The association was stronger among first-born children in relation to hyperactivity-impulsivity than with regard to inattention. There was little mediating role of TH during pregnancy in the association between maternal exposure to PFAS and reduced ADHD symptoms at 8years of age.

The Effect of Planning a Family-based Sensory Diet on Children With Attention-Deficit/Hyperactivity Disorder

Background and Objectives: The present study was conducted to determine the effect of a family-based sensory diet program on children with attention-deficit/hyperactivity disorder (ADHD). In this program, parents were directed to use activities stimulating the vestibular, deep, tactile, visual, and auditory senses to maintain the children’s focus and organized consciousness. Methods: This research was a quasi-experimental study with a Pretest-Posttest design with an experimental group. Wechsler Intelligence Scale for Children (WISC-IV) and Conners’ parent rating scale were used to measure the study variables. The study’s statistical population included all children with ADHD aged 6-12 years referred to Hasti, Bahar, and Masir-e Sabz health clinics in 2020. Of them, 30 participants were selected through a convenience sampling method. Results: Based on the analysis of covariance (ANCOVA), the obtained F values of attention deficit and hyperactivity were significant at a level less than 0.05. So the test hypothesis is accepted, and family-based sensory diet sessions effectively reduce ADHD symptoms in these children. Conclusion: According to the findings and the degree of effectiveness, implementing the sensory diet program by the child’s family can effectively reduce ADHD symptoms.

The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review.

Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.

Analysis of Association Between the Effects of Methylphenidate and DRD4 Gene Polymorphisms in Patients with Attention Deficit Hyperactivity Disorder

Background: Drug treatment is one of the most important treatments for attention deficit hyperactivity disorder (ADHD). The DRD4 gene is a transporter and receptor coding gene of dopamine and is one of the most important genes under investigation in the disorder and etiology of ADHD. In this study, the association between rs3758653 C/T and VNTR exon 3 repetition polymorphisms of the DRD4 gene and the effects of methylphenidate were investigated in patients with ADHD disorder consuming methylphenidate. Methods: The descriptive-analytical study was performed on 122 patients (5 - 18 years old) with ADHD who were treated with methylphenidate. DNA was extracted using salting out method. Subsequently, the rs3758653 polymorphism in the 5'UTR region of DRD4 gene was genotyped by PCR-RFLP method, and the VNTR fragment in exon III of DRD4 gene was investigated by electrophoresis gel on acrylamide gel method. After eight weeks from the start of drug treatment with methylphenidate, the intensity of symptoms was evaluated using the Conners scale. Finally, all data from questionnaires and information that were resulted from laboratory findings were analyzed using ANOVA and repeated measure analysis. Results: Of the 122 patients under study, 15 patients (12.3%) were responded to the drug treatment, and 107 patients (87.7%) were not responded. The significant differences were not revealed in genotype, and allele frequencies of between rs3758653 (C/T) and exon III 3'VNTR repeats polymorphisms of the DRD4 gene and responder and non-responder of ADHD groups to the drug treatment. Conclusions: The results showed that the reduction of ADHD symptoms with drug treatment is not related to DRD4 sub-types in patients with ADHD.

Neurofeedback Training Protocol Based on Selecting Distinctive Features to Treat or Reduce ADHD Symptoms.

Recent research has shown that electroencephalography (EEG) theta/beta ratio (TBR) in cases with attention deficit hyperactivity disorder (ADHD) has thus far been reported lower than that in healthy individuals. Accordingly, utilizing EEG-TBR as a biomarker to diagnose ADHD has been called into question. Besides, employing known protocol to reduce EEG-TBR in the vertex (Cz) channel to treat ADHD via neurofeedback (NFB) has been doubted. The present study was to propose a new NFB treatment protocol to manage ADHD using EEG signals from 30 healthy controls and 30 children with ADHD through an attention-based task and to calculate relative power in their different frequency bands. Then, the most significant distinguishing features of EEG signals from both groups were determined via a genetic algorithm (GA). The results revealed that EEG-TBR values in children with ADHD were lower compared with those in healthy peers; however, such a difference was not statistically significant. Likewise, inhibiting alpha band activity and enhancing delta one in F7 or T5 channels was proposed as a new NFB treatment protocol for ADHD. No significant increase in EEG-TBR in the Cz channel among children with ADHD casts doubt on the effectiveness of using EEG-TBR inhibitory protocols in the Cz channel. Consequently, it was proposed to apply the new protocol along with reinforced beta-band activity to treat or reduce ADHD symptoms.

Improving Engagement in ADHD Care.

Optimal treatment of a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) begins by establishing a collaborative care team consisting of the family, school personnel, primary care clinician (PCC), mental health and subspecialty clinicians, and other adults, such as tutors and coaches.1 To facilitate communication among care team members, a standardized, reliable system should be established to securely collect and share information about the child’s ADHD symptoms and functioning, medication side effects, receipt of ADHD treatments, family treatment preferences and goals, and educational resources.1Unfortunately, the fragmentation of ADHD care across health care, mental health, and education sectors is a substantial barrier to communication and collaboration among care team members.1,2 Each sector has its own rules and policies regarding confidentiality and privacy, and individual daily schedules are typically incompatible, making a meaningful, timely, and efficient exchange of information, whether synchronous (eg, phone call) or asynchronous (eg, e-mail), extremely challenging.In many quality improvement efforts to implement the ADHD guidelines, team communication and collaboration have been addressed, most commonly by focusing on improving the receipt of parent- and teacher-completed ADHD rating scales to inform clinician medical decision-making. These efforts have included developing extensive tool kits and online educational resources for PCCs3,4; redesigning office workflows (eg, designating a staff member to manage rating scale collection)5,6; using care managers to serve as the conduit of information across PCCs, parents, teachers, and other clinicians7,8; and developing or adopting ADHD-specific electronic systems or portals that may stand alone and/or be integrated with the electronic health record to varying degrees.9 Over time, these ADHD portals have become increasingly robust in their functionality and usability and have been shown to improve clinician adherence to ADHD guidelines as well as reduce ADHD symptoms in children.10 In some practices, ADHD portals have become the standard of care for children with ADHD.In this issue of Pediatrics, Guevara et al11 compare the effectiveness of a patient portal combined with care management with that of a patient portal alone on ADHD symptoms, treatment goal attainment, and other patient-reported outcome measures. Embedded in the electronic health record, the ADHD patient portal was designed to facilitate the collection and communication of ADHD symptoms and impairment, family treatment preferences and goals, and medication side effects among parents, teachers, and PCCs. ADHD-care managers contacted families and teachers by phone, text message, or e-mail at least once every 3 months to provide education on ADHD treatment, monitor the attainment of treatment goals, and address the patient’s and/or family’s emerging concerns. The authors found that, although both groups had reductions in ADHD symptoms over time, there was no difference between the 2 groups in ADHD symptom improvement, goal attainment, or other outcomes at any time point. This suggested that care management did not lead to improved ADHD symptoms beyond the effect of the patient portal alone.These results are somewhat surprising in light of other work revealing the benefits of care management for families of children with ADHD7,8 as well as for adults with depression and other chronic conditions.12 Indeed, in sensitivity analyses, Guevara et al11 did find that, although parent and teacher engagement with care managers was modest overall, children in families who received ≥2 care management sessions experienced greater ADHD symptom reduction than those with 1 or 0 sessions. The authors speculated that the virtual nature of their care management intervention (ie, e-mail, phone, or text message) may not have engaged parents as much as would otherwise be expected, compared with studies involving face-to-face care management.What should not be overlooked in this study, however, is that 68% of all study participants used the ADHD portal to complete rating scales at least once, and 30% had a teacher complete rating scales. Considering the impersonal nature of an electronic system, this is an impressive level of parent and teacher engagement, which is essential to the success of care for children and adolescents with ADHD. Engaged parents are more likely to participate in the collaboration activities that inform shared decision-making, such as completing ADHD rating scales regularly, scheduling and keeping ADHD follow-up appointments, and discussing treatment options, preferences, and goals with other care team members. Similarly, engaged teachers are more likely to complete rating scales and implement appropriate classroom-based interventions.Ultimately, the specific method by which to engage parents and teachers in ADHD collaborative care and treatment adherence matters less than the fact that there are a variety of effective methods that can be tailored for best fit with different families. Some will require the “high touch” of a human being; some will do well with a patient portal; others may need both. The overall goal remains the same: to reduce functional impairment and maximize the well-being of children with ADHD.

Individual Behavioral Reactions in the Context of Food Sensitivities in Children with Attention-Deficit/Hyperactivity Disorder before and after an Oligoantigenic Diet.

The influence of food intake on behavior problems of children with Attention-Deficit/Hyperactivity Disorder (ADHD) was already described in the early 20th century. Eliminating food components by using the Oligoantigenic Diet (OD) leads to reduction of ADHD symptoms for more than two-thirds of patients. The aim of our study was to reveal how to identify foods having an impact on ADHD symptomatology. Therefore, 28 children with ADHD participating in this uncontrolled, open trial were examined before and after a restricted elimination diet. They kept a daily 24-h recall nutrition and behavior journal and filled out the abbreviated Conners’ scale (ACS) to identify foods which increased ADHD symptoms. The study was completed by 16 children (13 m/3 f). After four weeks of elimination diet the individual food sensitivities were identified in a reintroduction phase. A repetitive increase of ADHD symptoms by at least two points in ACS after food introduction hints at food sensitivity. Twenty-seven food sensitivity reactions were identified. Most of the participants were sensitive to more than one food. Food intolerances could not be identified without preceding OD. The combination of OD and subsequent food challenge appears as a valid method to identify individual food sensitivity in ADHD.

EOG biofeedback protocol based on selecting distinctive features to treat or reduce ADHD symptoms

There are various evidences about existence of a difference between the electrooculography (EOG) signals of healthy individuals and that of people with attention deficit hyperactivity disorder (ADHD). Therefore, the use of EOG biofeedback might be effective in the decrease in ADHD symptoms. Therefore, the present study aimed to propose an EOG biofeedback protocol to treat ADHD. To this end, a set of diverse features of EOG signals was extracted in two groups of healthy children and subjects with ADHD during a focused attention task. Afterwards, the most effective features in distinguishing the EOG signals of the two groups were determined using the genetic algorithm. According to the results of the study, the values of low-frequency (0.5–4.125 Hz) band power, entropy, and fractal dimension were significantly lower in the EOG signals of the ADHD group, compared to the healthy children (P < .001). In addition, the scaling exponent was significantly higher in this regard (P < .001). Furthermore, entropy and fractal dimension were selected as the most effective features in distinguishing the two groups. It is recommended that entropy and fractal dimensions of EOG signals be increased as a protocol to treat or reduce ADHD symptoms.

Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use.

Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.

An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.

Child skills training for attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial of structured dyadic behavior therapy (SDBT).

This pilot study examined structured dyadic behavior therapy (SDBT) as a novel, child skills training intervention for attention-deficit/hyperactivity disorder (ADHD). The purpose of this study was to (a) pilot the feasibility of SDBT, a manualized, child skills training intervention, (b) determine the potential clinical benefits of SDBT as an independent psychotherapy for ADHD, and (c) examine parents' intervention acceptability. Children of 8-12 years of age with ADHD-combined type (N = 34) were randomly assigned to either SDBT or an "attention control" condition receiving child-centered dyadic therapy (CCDT). SDBT targeted high-frequency behavioral and social demands often challenging for children with ADHD. CCDT provided nondirective, experiential psychotherapy without any contingency management methods. Descriptive data revealed a high level of treatment attendance and completion (90%) for both conditions. General linear modeling techniques (multivariate analysis of variance) examined group differences in ADHD outcomes. Results indicated statistically significant differences between the two groups, with greater ADHD symptom reduction for SDBT (Wilks' λ = .61), F(3, 30) = 6.36, p = .002, ηp² = .39. SDBT also demonstrated clinically meaningful changes, with ADHD symptom severity reduced below categorical levels of functional impairment. Despite superior behavioral outcomes for SDBT, intervention acceptability did not significantly differ for the two psychotherapies. Results support SDBT as a feasible, clinically promising, and acceptable intervention for ADHD. Parent satisfaction ratings suggest dyadic therapies may benefit participants beyond symptom reduction. Implications for intervention portability and treating ADHD without direct adult participation are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

ADHD—What Types of Medication Reduce ADHD Symptoms?

Patient Education| 2021 ADHD—What Types of Medication Reduce ADHD Symptoms? Connected Content Translation: TDAH— ¿Qué tipo de medicamentos disminuyen los síntomas del trastorno por déficit de atención e hiperactividad? Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation ADHD—What Types of Medication Reduce ADHD Symptoms?. Pediatric Patient Education 2021; 10.1542/ppe_document163 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Helping children with attention deficit/hyperactivity disorder (ADHD) may mean they need medication. Read on for information from the American Academy of Pediatrics about medications for children with ADHD. For most children, stimulant medications are a safe and effective way to reduce ADHD symptoms. Just as glasses focus a person’s eyesight so that they can see better, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their activity. Stimulants may be used alone or in combination with behavioral therapy. Studies show that about 80% of children with ADHD who are treated with stimulants improve a great deal once the right medication and dose are determined. Two forms of stimulants are available: immediate-release (short-acting) and extended-release (intermediate- and long-acting). Immediate-release medications are usually taken every 4 hours when needed.... © 2020 American Academy of Pediatrics. All rights reserved. You do not currently have access to this content.