Hyperactivity Disorder Symptoms Research Articles

Symptomatology of attention deficit, hyperactivity and defiant behavior as predictors of academic achievement

BackgroundIt is essential to understand the factors that affect the academic achievement of schoolchildren, both in general and in terms of the major subsectors of each grade. Although symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Negative Defiant Disorder (NDD—which are commonly recognized as externalizing problems in childhood and adolescence—have been associated with lower academic achievement in the international literature, few studies have addressed this problem in Latin America. This study aimed to analyze the possible predictive relationship of attention problems, hyperactivity, and defiant behavior on academic achievement.MethodsWe recruited a sample of 4580 schoolchildren (50.9% female, 1754 belonging to primary school, and 2826 to secondary school, ranging from 9 to 18 years old). This cross-sectional study used the scales pertaining to attention problems, hyperactivity, and challenging behavior from the Child and Adolescent Evaluation System.ResultsThe analysis showed that attention problems significantly affected all academic achievement areas, while hyperactivity and challenging behavior affected only some of them. The regression models explained 24% of the variability in overall academic achievement in primary school and 17% in secondary school. Other predictors included sex, age, socioeconomic level, and school attendance.ConclusionsIt is important to consider this symptomatology in the design of educational interventions.

Sleep disorders and ADHD symptoms in children and adolescents with typical absence seizures: An observational study

ObjectiveTo assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS. MethodsThe Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS. ResultsCompared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03). ConclusionsThis study demonstrates that children with TAS are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.

Delineating the autistic phenotype in children with neurofibromatosis type 1

BackgroundExisting research has demonstrated elevated autistic behaviours in children with neurofibromatosis type 1 (NF1), but the autistic phenotype and its relationship to other neurodevelopmental manifestations of NF1 remains unclear. To address this gap, we performed detailed characterisation of autistic behaviours in children with NF1 and investigated their association with other common NF1 child characteristics.MethodsParticipants were drawn from a larger cross-sectional study examining autism in children with NF1. The population analysed in this study scored above threshold on the Social Responsiveness Scale-Second Edition (T-score ≥ 60; 51% larger cohort) and completed the Autism Diagnostic Interview-Revised (ADI-R) and/or the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). All participants underwent evaluation of their intellectual function, and behavioural data were collected via parent questionnaires.ResultsThe study cohort comprised 68 children (3–15 years). Sixty-three per cent met the ADOS-2 ‘autism spectrum’ cut-off, and 34% exceeded the more stringent threshold for ‘autistic disorder’ on the ADI-R. Social communication symptoms were common and wide-ranging, while restricted and repetitive behaviours (RRBs) were most commonly characterised by ‘insistence on sameness’ (IS) behaviours such as circumscribed interests and difficulties with minor changes. Autistic behaviours were weakly correlated with hyperactive/impulsive attention deficit hyperactivity disorder (ADHD) symptoms but not with inattentive ADHD or other behavioural characteristics. Language and verbal IQ were weakly related to social communication behaviours but not to RRBs.LimitationsLack of genetic validation of NF1, no clinical diagnosis of autism, and a retrospective assessment of autistic behaviours in early childhood.ConclusionsFindings provide strong support for elevated autistic behaviours in children with NF1. While these behaviours were relatively independent of other NF1 comorbidities, the importance of taking broader child characteristics into consideration when interpreting data from autism-specific measures in this population is highlighted. Social communication deficits appear similar to those observed in idiopathic autism and are coupled with a unique RRB profile comprising prominent IS behaviours. This autistic phenotype and its relationship to common NF1 comorbidities such as anxiety and executive dysfunction will be important to examine in future research. Current findings have important implications for the early identification of autism in NF1 and clinical management.

Klinik Olmayan Örneklemde Evlilik Uyumunun Erişkinlerde Görülen Dikkat Eksikliği Hiperaktivite Bozukluğu Belirtileri ve Çocukluk Çağı Ruhsal Travma Düzeyleri ile İlişkisi

The main aim of the current study is to examine the relationship between childhood trauma, attention deficit hyperactivity disorder (ADHD) symptoms in adulthood and marital adjustment. For this purpose, the role of ADHD symptoms in adulthood as a potential mediator of the relationship between childhood trauma and marital adjustment was tested. The study involved 301 participants (164 women and 137 men) who were married once and officially, for at least one year, aged 22-61, and had at least high school degree. A demographic information form, Adult Self-Report Scale (ASRS-v1.1), Childhood Trauma Questionnaire (CTQ) and Dyadic Adjustment Scale (DAS) were administered. Spearman Correlation Analysis and “PROCESS” macro developed by Hayes in regression analysis for the instrument variable were used to test the hypothesis. It’s depicted that there is a positive relationship between adult attention deficit and hyperactivity disorder symptoms and childhood trauma levels while there is a negative one between adult attention deficit and hyperactivity disorder symptoms and marital adjustment. The association between childhood trauma and marital adjustment is also identified as negative. It was indicated that there was a mediator role of adult attention deficit and hyperactivity disorder symptoms in relation to childhood trauma and marital adjustment. The results were found to be consistent with the literature in general and were discussed in the context of the literature.

Attention deficit hyperactivity disorder symptoms and cannabis use after one year among students of the i-Share cohort.

AbstractBackgroundCannabis use in university students is associated with academic achievement failure and health issues. The objective of the study was to evaluate the association between attention deficit hyperactivity disorder (ADHD) symptoms and cannabis use after 1 year among students according to previous cannabis use.MethodsStudents in France were recruited from February 2013 to July 2020 in the i-Share cohort. 4,270 participants were included (2,135 who never used cannabis at inclusion and 2,135 who did). The Adult ADHD Self-Report Scale (ASRS) was used to assess ADHD symptoms at inclusion. Cannabis use frequency was evaluated 1 year after inclusion. Multinomial regressions were conducted to assess the association between inclusion ADHD symptoms and cannabis use after 1 year.ResultsIncrease in ASRS scores was linked with a greater probability to use cannabis after 1 year and to have a higher cannabis use frequency (once a year—once a month adjusted odds ratio [OR]: 1.24 (1.15–1.34), more than once a month adjusted OR: 1.43 (1.27–1.61)). Among participants who never used cannabis at inclusion, this association disappeared (once a year—once a month adjusted OR: 1.15 (0.95–1.39), more than once a month adjusted OR: 1.16 (0.67–2)) but remained in participants who ever used cannabis at inclusion (once a year—once a month adjusted OR: 1.17 (1.06–1.29), more than once a month adjusted OR: 1.35 (1.18–1.55)).ConclusionsHigh levels of ADHD symptoms in students could lead to continued cannabis use rather than new initiations.

Structure of Child Externalizing Behavior and Associated Parental Stress in Family Situations

All three cardinal symptoms of attention deficit hyperactivity disorder (ADHD) describe impaired stimulus control over behavior. Children with ADHD require more frequent and explicit behavioral cues from others and thereby increase parental stress. Both self-control deficits and parental stress manifest depending on the situation and possess intra-individual variability. Common measures of externalizing behavior and parental stress rarely address this and target generalized impressions instead. Intraindividual differences in externalizing and stressful child behavior can be assessed with a family situations inventory including two rating scales. It rests on the HSQ and supplements the original with a parental stress scale. Method: Parents of children with (male = 204, female = 33; mean = 8.6 years) and without confirmed ADHD (male = 206, female = 155; mean = 7.6 years) took part. They were asked to rate 16 family situations concerning the extent of child externalizing behavior and their own associated stress. Three established scales (CBCL, PSI, BAP) were employed in the clinical sample to determine the external validity of the German HSQ adaption. Results: Both HSQ scales share the same two-factorial structure with satisfying explained variance (56.02–60.38%) and acceptable external and discriminant validity. “Accomplishments” (factor 2) discriminates better than “agreeableness” (factor 1) between children with and without ADHD. Discussion: “Accomplishments” refers to behavior in regularly recurring situations and demands rule following. Parental stress associated with child externalizing behaviors in family situations appears to represent regulation load rather than mental load.

Evaluation of the coexistence of attention-deficit hyperactivity disorder and anxiety disorder symptoms

Evaluation of the coexistence of attention-deficit hyperactivity disorder and anxiety disorder symptoms

Comparison of the effectiveness of group training to modify the parent-child interaction pattern and the stress reduction program based on mindfulness on the symptoms of attention deficit/hyperactivity disorder and defiant disorder in children with attent

Background and Purpose: The present study was conducted with the aim of comparing the effectiveness of group training to modify the parent-child interaction pattern and the stress reduction program based on mindfulness of hyperactivity and defiant disorder symptoms in children with attention deficit hyperactivity disorder and oppositional defiant disorder. Method: The present study is a semi-experimental type in which a pre-test-post-test design was carried out with a control group with measurement at the baseline after the intervention and a 3-month follow-up with the control group. A number of 36 elementary school boys were studying in 10 boys' public elementary schools in the 3rd district of Tehran province in the school year of 2011-2014 and were randomly selected to the experimental group (mindfulness-based stress reduction program) n=12. Modification of parent-child interaction model) (n=12) and control (n=12) were assigned. Due to the spread of Corona, all the participants completed the demographic questionnaire (created by the researcher), the questionnaire of symptoms of disobedience disorder, the behavioral list (Achenbach and Rescular 2017) and the hyperactivity questionnaire (Swanson, Nolan and Pelham. 1981) by sending a link in three stages. . The intervention sessions were conducted face-to-face in compliance with health protocols. Hypotheses related to the effectiveness of the research intervention were analyzed using multivariate covariance analysis (MANCOVA) as well as LSD follow-up tests. Results: The results of the present study showed that there is no significant difference between the variable mean of disobedience disorder symptoms and hyperactivity symptoms in the pre-test stage between the three groups, which indicates the homogeneity of the three research groups in the pre-test stage, the comparison of the two test groups also showed that There is a significant difference between the two test groups in the components, and the comparison of the averages indicated that the test group of the mindfulness-based stress reduction program was more effective.

ADHD symptoms persist even when PTSD symptoms progress: An EMDR case report

Although many studies report that attention deficit and hyperactivity disorder (ADHD) symptoms will improve after eye movement desensitization and reprocessing (EMDR), it is thought that the symptoms of ADHD, which is an organic disease, will not improve with psychotherapy. In this case report, significant improvements were reported in post-traumatic stress disorder (PTSD) symptoms with EMDR therapy in a 9-year-old boy, who was previously followed up with the diagnosis of ADHD and who was sexually abused by his cousin at the age of 7 years. A total of 5 EMDR sessions that lasted for an average of 45 min were applied to the patient. The symptoms of the case were followed up with Atilla Turgay Screening and Evaluation Scale that is based on the DSM-IV and with Post-traumatic Stress Index for Conduct Disorders in Children and Adolescents. At the end of the therapy and after the 4-week follow-up, the ADHD symptoms continued at the same level as they were before the traumatic event, and the symptoms of the oppositional defiant disorder (ODD) improved more when compared with the period before the event, and significant improvements were also detected in PTSD symptoms. However, ODD symptoms can mimic PTSD symptoms; EMDR may therefore be good. It was also observed that the bilateral stimulation types that were employed during EMDR should be changed more frequently than normal. As a conclusion, it was found that EMDR can be used as an effective psychotherapy method in children with ADHD and PTSD for PTSD and ODD symptoms except for ADHD symptoms.

The effects of ADHD symptomatology and academic enabling behaviours on undergraduate academic achievement

AbstractUniversity students demonstrating higher levels of Attention‐Deficit Hyperactivity Disorder (ADHD) symptom severity largely experience lower academic achievement. Educational research has found that a group of behaviours (i.e., study skills, interpersonal skills, engagement, and motivation) known as academic enablers (AE) facilitate positive outcomes within a classroom‐based learning environment. The current study recruited 617 undergraduate students to explore whether ADHD symptomatology and AE emerge as significant predictors of academic achievement at the university level, and whether demonstration of AE contribute to predicting achievement above and beyond that of ADHD effects. Results from simple linear regression analysis indicated that higher ADHD symptom severity predicted poorer academic achievement. Greater application of AE—excluding interpersonal skills—predicted greater academic achievement among university students. Exploratory results from hierarchical linear regression analysis suggested that demonstration of engagement, motivation, and especially study skills contribute towards predicting greater academic achievement while controlling for negative effects from ADHD symptom presentation. These findings imply that undergraduate academic outcomes can potentially be improved for students struggling with more severe ADHD symptom presentation if more emphasis is placed by universities to promote academic enabling behaviours within the educational framework and environment.

Sex/gender differences in individual and joint trajectories of common mental health symptoms in early to middle adolescence.

Early to middle adolescence is a critical period of development for mental health issues. Illuminating sex/gender differences in mental health trajectories in this period is important for targeting screening and preventive interventions; however, evidence to date on the extent and nature of sex/gender differences in common mental health issue trajectories in this period has produced mixed findings. There is a particular gap in our knowledge of sex/gender differences in the joint trajectories of commonly co-occurring mental health issues in adolescence, given the strong tendency for mental health issues to co-occur. We applied sex/gender-stratified latent class growth analysis to an age-heterogeneous cohort (age 10-15) derived from the population-representative UK Household Longitudinal Study. We explored sex/gender differences in attention deficit hyperactivity disorder (ADHD) symptoms, internalizing problems, and conduct problems individually and jointly. We found indications of sex/gender differences in a number of areas. There were fewer classes in the optimal model to describe the heterogeneity in internalizing problems and conduct problems trajectories in males and females respectively. Further, for ADHD, affected males were more likely to enter adolescence with already elevated symptoms whereas affected female trajectories were characterized by an escalation of symptoms during adolescence. There are sex/gender differences in the levels and trajectories of specific mental health symptoms in early to middle adolescence; however, in both males and females there is a strong tendency for multiple issues to co-occur.

Prenatal smoking, alcohol and caffeine exposure and maternal-reported attention deficit hyperactivity disorder symptoms in childhood: triangulation of evidence using negative control and polygenic risk score analyses.

Studies have indicated that maternal prenatal substance use may be associated with offspring attention deficit hyperactivity disorder (ADHD) via intrauterine effects. We measured associations between prenatal smoking, alcohol and caffeine consumption with childhood ADHD symptoms accounting for shared familial factors. First, we used a negative control design comparing maternal and paternal substance use. Three models were used for negative control analyses: unadjusted (without confounders), adjusted (including confounders) and mutually adjusted (including confounders and partner's substance use). The results were meta-analysed across the cohorts. Secondly, we used polygenic risk scores (PRS) as proxies for exposures. Maternal PRS for smoking, alcohol and coffee consumption were regressed against ADHD symptoms. We triangulated the results across the two approaches to infer causality. We used data from three longitudinal pregnancy cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom, Generation R study (GenR) in the Netherlands and Norwegian Mother, Father and Child Cohort study (MoBa) in Norway. Phenotype data available for children were: NALSPAC = 5455-7751; NGENR = 1537-3119; NMOBA = 28 053-42 206. Genotype data available for mothers was: NALSPAC = 7074; NMOBA = 14 583. A measure of offspring ADHD symptoms at age 7-8years was derived by dichotomizing scores from questionnaires and parental self-reported prenatal substance use was measured at the second pregnancy trimester. The pooled estimate for maternal prenatal substance use showed an association with total ADHD symptoms [odds ratio (OR)SMOKING = 1.11, 95% confidence interval (CI) = 1.00-1.23; ORALCOHOL = 1.27, 95% CI = 1.08-1.49; ORCAFFEINE = 1.05, 95% CI = 1.00-1.11], while not for fathers (ORSMOKING = 1.03, 95% CI = 0.95-1.13; ORALCOHOL = 0.83, 95% CI = 0.47-1.48; ORCAFFEINE = 1.02, 95% CI = 0.97-1.07). However, maternal associations did not persist in sensitivity analyses (substance use before pregnancy, adjustment for maternal ADHD symptoms in MoBa). The PRS analyses were inconclusive for an association in ALSPAC or MoBa. There appears to be no causal intrauterine effect of maternal prenatal substance use on offspring attention deficit hyperactivity disorder symptoms.

Novel screen-printed sensors with chemically deposited boron-doped diamond and their use for voltammetric determination of attention deficit hyperactivity disorder medication atomoxetine

A novel lab-made disposable screen-printed sensor with chemically deposited boron-doped diamond (LM-SP/BDDE) was characterized by scanning electron microscopy (SEM), Raman spectroscopy, and compared to bulk boron-doped diamond electrode (BDDE) and commercially available screen-printed sensor with BDD working electrode (SP/BDDE). The sensors were applied for the determination of atomoxetine (ATX), a pharmaceutically active ingredient used to treat symptoms of attention deficit hyperactivity disorder (ADHD). Using bulk BDDE and a newly developed differential pulse voltammetric (DPV) method with optimized pre-treatment, DPV parameters, and in Britton-Robinson buffer of pH 2, obtained limit of detection (LOD) was 3.7×10−8 mol L−1. Subsequently, this new method was successfully transferred to the tested SP/BDDE sensors and verified on analysis of an ATX-containing drug Strattera 60MG with excellent repeatability (relative standard deviation (RSD) < 2.5% (n = 5)). Moreover, elimination voltammetry with linear scan (EVLS) uncovered multiple (3-5) diffusion-controlled irreversible oxidation steps at all tested sensors.

Influence of Atomoxetine on Relationship Between ADHD Symptoms and Prefrontal Cortex Activity During Task Execution in Adult Patients.

Objective: We conducted this non-randomized prospective interventional study to clarify the relationship between improved attention-deficit hyperactivity disorder (ADHD) symptoms and regional brain activity.Methods: Thirty-one adult patients underwent near-infrared spectroscopy examinations during a go/no-go task, both before and 8 weeks after atomoxetine administration.Results: Clinical symptoms, neuropsychological results of the go/no-go task, and bilateral lateral prefrontal activity significantly changed. A positive correlation was observed between right dorsolateral prefrontal cortex activity and Conners’ Adult ADHD Rating Scales scores. Before atomoxetine administration, no correlations between prefrontal cortex activity and clinical symptoms were observed in all cases. When participants were divided into atomoxetine-responder and non-responder groups, a positive correlation was observed between prefrontal cortex activity and clinical symptoms in the non-responder group before treatment but not in the responder group, suggesting that non-responders can activate the prefrontal cortex without atomoxetine.Conclusions: Individuals with increased ADHD symptoms appear to recruit the right dorsolateral prefrontal cortex more strongly to perform the same task than those with fewer symptoms. In clinical settings, individuals with severe symptoms are often observed to perform more difficultly when performing the tasks which individuals with mild symptoms can perform easily. The atomoxetine-responder group was unable to properly activate the right dorsolateral prefrontal cortex when necessary, and the oral administration of atomoxetine enabled these patients to activate this region. In brain imaging studies of heterogeneous syndromes such as ADHD, the analytical strategy used in this study, involving drug-responsivity grouping, may effectively increase the signal-to-noise ratio.

Prenatal maternal stress, child internalizing and externalizing symptoms, and the moderating role of parenting: findings from the Norwegian mother, father, and child cohort study.

Few studies have examined how parenting influences the associations between prenatal maternal stress and children's mental health. The objectives of this study were to examine the sex-specific associations between prenatal maternal stress and child internalizing and externalizing symptoms, and to assess the moderating effects of parenting behaviors on these associations. This study is based on 15 963 mother-child dyads from the Norwegian Mother, Father, and Child Cohort Study (MoBa). A broad measure of prenatal maternal stress was constructed using 41 self-reported items measured during pregnancy. Three parenting behaviors (positive parenting, inconsistent discipline, and positive involvement) were assessed by maternal report at child age 5 years. Child symptoms of internalizing and externalizing disorders (depression, anxiety, attention-deficit hyperactivity disorder, conduct disorder, and oppositional-defiant disorder) were assessed by maternal report at age 8. Analyses were conducted using structural equation modeling techniques. Prenatal maternal stress was associated with child internalizing and externalizing symptoms at age 8; associations with externalizing symptoms differed by sex. Associations between prenatal maternal stress and child depression, and conduct disorder and oppositional-defiant disorder in males, became stronger as levels of inconsistent discipline increased. Associations between prenatal maternal stress and symptoms of attention-deficit hyperactivity disorder in females were attenuated as levels of parental involvement increased. This study confirms associations between prenatal maternal stress and children's mental health outcomes, and demonstrates that these associations may be modified by parenting behaviors. Parenting may represent an important intervention target for improving mental health outcomes in children exposed to prenatal stress.

Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing.

ABSTRACTAims and objectivesPersistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing.Materials and methodsA cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant.ResultsOut of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01).ConclusionChildren with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication.Clinical significanceChildren with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD.How to cite this articleKalaskar R, Bhaje P, Kalaskar A, et al. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Mouth Breathing. Int J Clin Pediatr Dent 2021;14(5):604–609.

Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Associated With Greater Pain Interference and Depression, and Reduced Health-Related Quality of Life in Children With Chronic Pain.

Previous research indicates elevated levels of clinically significant traits and symptoms of autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD) in children with chronic pain, but associations with functioning and depression are yet unclear. The current study examined the relationships of autistic traits and ADHD symptoms with pain interference, depression, and health-related quality of life, as well as the mediating roles of insomnia and psychological inflexibility, in children with chronic pain (n = 146, 8–17 years, 102 girls) presenting at a tertiary pain clinic. Children completed measures of pain intensity, depression, pain interference, health-related quality of life, insomnia, and psychological inflexibility. Parents (n = 146, 111 mothers) completed measures to assess autistic traits and ADHD symptoms in their children. Children with clinically significant autistic traits and ADHD symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower health-related quality of life, than did the other children. Autistic traits and ADHD symptoms contributed significantly to the prediction of pain interference and depressive symptoms, as well as health-related quality of life. Psychological inflexibility mediated the relationships between ADHD symptoms and autistic traits on the one hand and depression, pain interference, and health-related quality of life on the other, while insomnia mediated the relationships between ADHD symptoms and depression, pain interference, and health-related quality of life. All analyses were adjusted for demographics and pain intensity. Results suggest the utility of screening for neurodevelopmental disorders in children with chronic pain. Furthermore, the findings may indicate insomnia and skills related to psychological flexibility as potential treatment targets in interventions aiming at improving functioning and health-related quality of life in children with chronic pain and co-occurring symptoms of neurodevelopmental disorders.

Screening for Adult Attention-Deficit Hyperactivity Disorder in the Korean Community Sample: Prevalence and Association with Mood and Sleep Symptoms.

Attention-deficit hyperactivity disorder (ADHD) symptoms start in early childhood and continue into adulthood, and are frequently associated with comorbid symptoms of depression, bipolar, insomnia, and daytime sleepiness. The aim of this study was to screen adult ADHD symptoms in a community sample and investigate the association of adult ADHD symptoms with mood and sleep symptoms. Respondents (n = 1500) from the general adult population, aged between 19 and 49 years, were recruited. The sample consisted of a population in Busan, Korea that was representative in terms of sex, age, and residential area. ADHD symptoms and mood/sleep symptoms were assessed using validated questionnaires with cut-off threshold. The screening for adult ADHD documented ADHD symptoms in 3% (45 out of 1500) of the participants. The ADHD screen-positive group was more likely to have depression symptoms (OR = 14.97, 95% CI: 7.94-28.25, P < .001) and daytime sleepiness symptoms (OR = 3.18, 95% CI: 1.55-6.52, P < .001). Present result indicates high prevalence of adult ADHD symptoms in a community sample in Korea. The findings of this study also suggest significant association between adult ADHD symptoms and depression symptoms and daytime sleepiness. Optimal management of adult ADHD requires the consideration of not only ADHD symptoms but also the assessment and treatment of symptoms associated with comorbid conditions.

Organizational skills training for children with ADHD: study protocol for a randomized, controlled trial

BackgroundProblems with sustained attention, impulsivity, and hyperactivity are the most prominent symptoms of attention-deficit hyperactivity disorder (ADHD), but many children with this diagnosis also present with poor organizational skills that are important in relation to school. These problems tend to increase from childhood to adolescence and are often not well managed by medication. Organizational skills training (OST) is a range of behavioral interventions that specifically target organizational skills deficits. Evidence supports the effect of OST on improving organizational skills, inattention, and academic performance in children with ADHD. Because previous clinical trials included mostly children above the age of 8 years, this trial includes children in the age range 6–13 years to expand the knowledge on the effects of OST in younger children. Previous OST research has also shown improvement on inattention in parent ratings; we will investigate if a change in inattention can be confirmed with neurocognitive tests. Finally, little is known about predictors of treatment response in OST.ObjectivesThe primary objective is to investigate if OST has positive effects on organizational skills in children with ADHD. The primary outcome measurement is the parent-rated Children’s Organizational Skills Scale (COSS), collected before and at the end of the 10 week intervention. Secondary and exploratory outcomes include inattention ratings, family and school functioning, and cognitive functions measured before the intervention period, immediately after, and at a 6 month follow-up. Additional objectives are to investigate both neurocognitive outcomes and age as predictors of treatment response.MethodsThis is a randomized clinical superiority trial investigating the effect of OST vs a treatment-as-usual (TAU) control group for children with ADHD in the age range of 6–13 years. All participants (n = 142) receive TAU. OST is administered in a group format of 10 weekly sessions. Adverse events are monitored by study clinicians during weekly therapy sessions and all assessments. Data analyses will be conducted using mixed linear regression models with random intercepts for patients, adjusted for the stratification variables and the baseline value.PerspectivesThis study will provide important new knowledge and expand on existing research in the field of non-pharmacological treatment of children with ADHD. OST can potentially have a significant impact on the lives of children with ADHD by helping them learn how to cope with their present deficits and to become more independent and self-reliant. It is also important to investigate predictors of treatment response in order to optimize OST.Trial registrationClinicalTrials.gov NCT03160378. Registered on May 19, 2017.

A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study.

BackgroundInternalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier.ObjectiveThis study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada.MethodsIn this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants.ResultsMore severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=−0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=−0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit.ConclusionsPassively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on.