Symptoms Of Inattention Research Articles

Effectiveness of pharmacological interventions for managing ADHD symptoms in individuals with autism spectrum disorder: A systematic review and meta-analysis

ObjectivesThis systematic review sought to provide evidence for the effectiveness of common pharmacological interventions used for treating attention deficit hyperactivity disorder (ADHD) symptoms in the autism spectrum disorder (ASD) population, considering studies attempting to find safe and effective drugs. MethodsWe searched for randomized controlled trials describing the effectiveness and/or safety profile of pharmacological interventions for treating ASD and ADHD or ASD with ADHD symptoms using three bibliographic databases: PubMed, Cochrane Library, and Embase. We have chosen ADHD symptoms measured by any clinical scale as the primary outcome. As additional outcomes, we have used other symptoms of aberrant behavior measured by the aberrant behavior checklist, satisfaction with treatment, and peer satisfaction. ResultsTwenty-two publications met the inclusion criteria for the systematic review and eight for the meta-analysis. In our investigation, we found a few articles using clonidine, modafinil, and bupropion as interventions when compared to methylphenidate (MPH). Our meta-analysis showed that MPH had positive changes compared to placebo in symptoms such as hyperactivity, irritability, or inattention. However, no effect was found in stereotyped symptoms, and our data's quantitative analysis revealed a large effect of MPH-induced adverse effects on the dropout rate. On the other hand, atomoxetine initiation had positive effects when compared to placebo on symptoms of hyperactivity and inattention. We have found no effect of atomoxetine on stereotypes or irritability. Furthermore, atomoxetine did not influence side effects that caused dropouts from studies. ConclusionOur results indicated that atomoxetine has a modest effect on hyperactivity and inattention symptoms, with a relatively benign profile of side effects. MPH appears to be effective in handling hyperactivity, inattention, and irritability symptoms. However, our results on atomoxetine revealed increased dropouts due to adverse effects when compared to MPH or placebo. Evidence for other substances such as guanfacine, clonidine, bupropion, or modafinil is either preliminary or nonexistent.

Comorbid ADHD and Pediatric Sickle Cell Disease: Prevalence and Risk Factors.

Sickle cell disease (SCD) is a genetic blood condition that places youth at increased risk for deficits in complex attention suggestive of increased risk for Attention-Deficit/Hyperactivity Disorder (ADHD). We used systematic screening to assess the prevalence of ADHD in a clinic-based sample of youth with SCD and explored factors related to ADHD. Caregivers of 107 children with SCD (ages 7-11years) completed routine psychosocial screening which included inattentive symptoms of ADHD. Follow-up diagnostic procedures were completed for patients with elevated inattentive symptoms to assess for ADHD diagnoses. Biomedical and social-environmental variables were examined from the screening and medical records. Twenty-six percent of patients showed elevated inattentive symptoms with 13% meeting diagnostic criteria for ADHD diagnoses. Most children (75%) who met criteria for ADHD had not been previously diagnosed. Disease severity did not predict inattentive symptoms or ADHD diagnoses, though a measure of chronic inflammation was associated with ADHD. Family functioning was related to elevated inattentive symptoms but not ADHD diagnoses. Children with SCD show relatively high rates of ADHD with many cases not detected through routine care. Screening for ADHD as part of hematology care may be a feasible strategy to improve identification and access to intervention.

Links Among Attention-Deficit/Hyperactivity Disorder Symptoms and Psycholinguistic Abilities Are Different for Children With and Without Developmental Language Disorder.

Both developmental language disorder (DLD) and attention-deficit/hyperactivity disorder (ADHD) represent relatively common and chronic neurodevelopmental conditions associated with increased risk for poor academic and interpersonal outcomes. Reports of common co-occurrence suggest these neurodevelopmental disruptions might also be linked. Most of the data available on the issue have been based on case-control studies vulnerable to ascertainment and other biases. Seventy-eight children, representing four neurodevelopmental profiles (DLD, ADHD, co-occurring ADHD + DLD, and neurotypical development), were administered a battery of psycholinguistic tests. Parents provided standardized ratings of the severity of their children's inattention, hyperactivity/impulsivity, and executive function symptoms. Examiners were blinded to children's clinical status. Group differences, correlations, and best subset regression analyses were used to examine potential impacts of children's ADHD symptoms on their psycholinguistic abilities. For children with DLD, significant links between their ADHD symptoms and psycholinguistic abilities were limited to the contributions of elevated hyperactivity/impulsivity symptoms to lower pragmatic abilities. For children without DLD, inattention symptoms contributed to lower levels of performance in pragmatic, sentence recall, receptive vocabulary, and narrative abilities. Links among children's ADHD symptoms and their psycholinguistic abilities were different for children with and without DLD. Implications for the provision of clinical services are discussed.

An exploratory investigation of the association between severities of the adverse impact of stuttering and co-occurring disorders

ABSTRACT Stuttering is a multi-dimensional disorder that affects diverse life aspects of people who stutter. This study aimed to investigate the association between severities of the adverse impact of stuttering and co-occurring disorders. Thirty adults who stutter (mean age, 37.6 ± 14.1 years; 26 males and four females) participated in this study. The Liebowitz Social Anxiety Scale (LSAS-J), Autism-Spectrum Quotient short form (AQ-10-J), and Conners’ Adult ADHD Rating Scales (CAARS) were used to assess symptoms of social anxiety disorders (SAD), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD), respectively. The index of ratio of disfluencies (RDF) was calculated to assess cluttering. The Japanese version of the Overall Assessment of the Speaker’s Experience of Stuttering for Adults (OASES-A-J) was used to assess the adverse impact of stuttering. A moderate positive correlation was found between the LSAS-J and OASES-A-J scores. Inattention and ADHD symptoms total scores were significantly correlated with the OASES-A-J scores. The adverse impact of stuttering was associated with symptoms of co-occurring disorders, namely, SAD, ADHD, and cluttering. A negative correlation was observed between the RDF and OASES-A-J Section III score. Cluttering symptoms were associated with less communication impact in daily situations. This study sheds light on the importance of comprehensive assessments from professionals with relevant expertise for adults who stutter.

Reciprocal relations between dimensions of attention-deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sample.

Symptoms of anxiety and attention-deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD-inattention and hyperactivity-impulsivity-are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown. Two birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross-lagged panel model, adjusting for all unobserved time-invariant confounding effects. In girls, increased inattention, but not hyperactivity-impulsivity, predicted increased anxiety 2 years later across all time-points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity-impulsivity. In boys, increased hyperactivity-impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity-impulsivity. The two ADHD dimensions were differentially related to anxiety, and the relations were sex-specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity-impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time-points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity-impulsivity may reduce anxiety risk in boys during late childhood (at ages 8-10).

Gender-specific motivational pathways in ADHD-related inattention and gaming disorder symptoms

Comorbidity between attention-deficit/hyperactivity disorder (ADHD) and gaming disorder (GD) is widely recognized in the literature. Previous research has indicated gender-dependent underlying mechanisms in the development and maintenance of problematic gaming. Motivational research presents an opportunity to provide further insight regarding the nature of this association. Self-report data were collected from videogame players (N = 14,740) using an online survey in collaboration with a popular gaming magazine. The survey included items concerning symptoms of ADHD and GD, motives for gaming, and time spent playing videogames. Structural equation modeling was used to create two parallel mediation models (one for males, one for females), including motives to play games as mediators. This was done to potentially explain psychological drivers of the association between ADHD and GD. Results demonstrated a common pathway from inattention to GD symptom severity through the immersion/escapism motivation for both males (β = 0.068; p < 0.001) and females (β = 0.081; p < 0.05), while the path from inattention to GD symptom severity through the habit/boredom motive (β = 0.094; p < 0.001) and competition motive (β = 0.021; p < 0.001) was only significant for males. Gamers experiencing symptoms of ADHD, especially inattentive symptoms, are at risk of the occurrence of GD symptoms through videogames becoming a source of maladaptive coping with daily psychological disturbances. Males experiencing inattentive symptoms tend to additionally develop problematic patterns of use through videogame playing, becoming a subjectively meaningless and boredom-reduction-oriented habitual activity or a platform of virtual competition. Unique differences suggest the necessity of different treatment approaches for males and females.

Rhinorrhea and watery eyes in infancy and risk of attention-deficit hyperactivity disorder in school-age children.

Increased parasympathetic nervous system (PNS) activity is associated with attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms, but not hyperactive-impulsive symptoms, and may contribute to inattentive subtype etiology. Guided by prior work linking infant rhinorrhea and watery eyes without a cold (RWWC) to PNS dysregulation, we examined associations between infant RWWC and childhood ADHD symptoms in a longitudinal cohort of Black and Latinx children living in the context of economic disadvantage (N=301 youth: 158 females, 143 males). Infant RWWC predicted higher inattentive (relative risk [RR] 2.16, p<.001) but not hyperactive-impulsive (RR 1.53, p=.065) ADHD symptoms (DuPaul scale), administered to caregivers at child age 8-14 years. Stratified analyses revealed that these associations were present in females but not males, who were three times more likely to have higher ADHD current total symptoms if they had infant RWWC than if they did not. Additionally, associations between RWWC and inattention symptoms were observed only in females. RWWC may thus serve as a novel risk marker of ADHD inattentive-type symptoms, especially for females.

Mid-childhood autism sibling recurrence in infants with a family history of autism.

Autism sibling recurrence in prospective infant family history studies is ~20% at 3 years but systematic follow-up to mid-childhood is rare. In population and clinical cohorts autism is not recognized in some children until school-age or later. One hundred and fifty-nine infants with an older sibling with autism underwent research diagnostic assessments at 3 years and mid-childhood (6 to 12 years (mean 9)). We report the autism sibling recurrence rate in mid-childhood and compare developmental and behavioral profiles at mid-childhood and 3 years in those with earlier versus later recognized autism, and those who had, or had not, received a community autism diagnosis. The autism recurrence rate in this sample in mid-childhood was 37.1%, 95% CI [29.9%, 44.9%] and higher in boys than girls. Around half of those diagnosed with autism in mid-childhood had not received a diagnosis at 3 years. Later, diagnosis was more common in girls than boys. While some had sub-threshold symptoms at 3, in others late diagnosis followed a largely typical early presentation. Sibling recurrence based on community clinical diagnosis was 24.5%, 95% CI [18.4%, 31.9%]. Those who also had a community diagnosis tended to be older, have lower adaptive function and higher autism and inattention symptoms. Notwithstanding limitations of a single site study, modest sample size and limits to generalisability, autism sibling recurrence in family history infants may be higher in mid-childhood than in studies reporting diagnostic outcome at 3 years. Findings have implications for families and clinical services, and for prospective family history studies.

A Comparison of Effectiveness of Attention Process Training (APT) with Parenting Management Training (PMT) in Reducing Symptoms of Attention Deficit Hyperactivity Disorder.

Objective: Child-oriented psychotherapies, such as Attention Process Training (APT), target ADHD symptoms directly, whereas family-oriented interventions, like Parent Management Training (PMT), address its functional impairments. The aim of this study was to compare the effectiveness of APT and PMT in treating ADHD symptoms. Method : This research was a randomized controlled trial in which 45 children (26 females and 19 males, with a mean age of 8.47 ± 1.66 years) with ADHD were selected conveniently and assigned randomly to one of three groups (PMT = 15, APT = 15, and CTRL = 15). The groups had no significant differences in ADHD severity. The PMT children were managed with parenting techniques. Children in the APT group practiced attention techniques, while children in the control group did not receive any intervention. Ritalin was prescribed to all the children in the three groups. The score on the Conners Parenting Rating Scale-Revised: Short form was the outcome variable. Results: Both interventions decreased ADHD symptoms severity more than the control group. Howver, the reduction in the APT group was more than in the PMT group (P-value < 0.001). The scores of 40% of the APT group and 80% of the PMT group did not fall below the cut-off point. In the APT group after the intervention, the inattention subscale was significantly lower than the hyperactivity subscale, while in the PMT group, the hyperactivity subscale was lower. The effect sizes of APT and PMT were 2.18 and 2.09, respectively. Conclusion: For ADHD, psychological interventions are crucial in addition to medication. According to the results of this study, APT is more effective for inattention symptoms, while PMT is more effective for hyperactivity symptoms. When selecting psychotherapy, the subtype of ADHD should be taken into account. Treatment sessions must also be completed according to intervention protocols.

Later ("evening") circadian preference is associated with poorer executive, academic, and attentional functioning in adolescents with and without ADHD.

Adolescents vary considerably in their circadian phase preference; those with greater "eveningness" (also known as "night owls") have later bedtimes, wake times, and peak arousal compared to those with greater "morningness." Prior research suggests that (a) greater eveningness is associated with worse academic, executive, and attentional functioning; and (b) adolescents with attention-deficit/hyperactivity disorder (ADHD) tend to be high in eveningness and to have deficits in these school-related constructs. However, few studies have examined circadian preference alongside two potential confounds-sleep duration and sleep quality-as predictors of daytime functioning, or whether the strength of associations differs across adolescents with and without ADHD. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White); approximately half (52%) had ADHD. A multi-method, multi-informant design was used. Specifically, adolescents reported on their circadian preference, school night sleep duration, and sleep quality. Adolescents provided ratings of their academic motivation (intrinsic, extrinsic, and amotivation) and were administered standardized achievement tests in reading and math. Adolescents and parents completed ratings of daily life executive functioning (behavioral, emotion, and cognitive regulation), and they and teachers also provided ratings of ADHD inattentive symptoms. Above and beyond sleep duration, sleep quality, and covariates (sex, family income, pubertal development, medication use), greater eveningness was uniquely associated with poorer academic, executive, and attentional functioning across most measures. Sleep quality was uniquely associated with a handful of outcomes, and sleep duration was not significantly uniquely associated with any outcome in the regression analyses. ADHD status did not moderate effects. This study provides compelling evidence that poorer academic, executive, and attentional functioning are more closely associated with greater eveningness than with sleep duration or quality in adolescents. Findings suggest that targeting circadian preference may be important to reduce these problems in adolescents, especially in clinical samples such as ADHD for whom academic, executive, and attentional difficulties are exceptionally common.

Two single arm trials of AKL-T01, a digital therapeutic for adolescents and adults with ADHD

Inattention symptoms represent a key driver of functional impairment in ADHD and often persist into adolescence and adulthood, underscoring a need for novel treatments targeting attentional control. We evaluated AKL-T01—a digital therapeutic that is FDA-cleared for children 8–12 y with ADHD—in adolescents and adults with ADHD in two independent single-arm trials: STARS-ADHD-Adolescent, a 4-week trial in adolescents 13–17 y (n = 162 enrolled), and STARS-ADHD-Adult, a 6-week trial in adults 18 and older (n = 221 enrolled). AKL-T01 was linked with improvements on the Test of Variables of Attention (TOVA®) Attention Comparison Score (ACS) of 2.6 (95% CI: 2.02, 3.26; p < 0.0001) in adolescents and 6.5 in adults (95% CI: 5.35, 7.57; p < 0.0001), along with improvements in secondary endpoints. 15 participants reported adverse device effects, all mild or moderate. Though limited by a single-arm design, results provide preliminary support for the safety and efficacy of AKL-T01 for adolescents and adults with ADHD.

Exploring bi-directional impacts of Lisdexamfetamine dimesylate on psychological comorbidities and quality of life in people with Binge Eating Disorder

BackgroundLisdexamfetamine dimesylate (LDX) has demonstrated safety and efficacy for treatment of Binge Eating Disorder (BED). However, to date, trials have not included participants with co-occurring psychiatric disorders. This study explores how LDX affects eating disorder psychopathology, symptoms of common psychiatric comorbidities of BED (ADHD, depression, anxiety), and psychological quality of life, in people with moderate to severe BED.MethodsThese are secondary analyses of an open-label LDX trial conducted in 41 adults (18–40 years) over eight-weeks. Participants received LDX titrated to 50 or 70 mg. Clinical assessments and self-report questionnaires were conducted at baseline and 8-week follow-up.ResultsEating disorder psychopathology and psychological quality of life improved after 8-weeks of LDX. No significant group-level changes in depression, anxiety or ADHD severity scores were observed. However, the majority within the small subsets with elevated depression and ADHD symptoms experienced reduced depressive and inattentive symptom severity, respectively.ConclusionsWe provide proof-of-concept evidence that LDX may provide broader psychological benefits to individuals with BED, beyond reducing their BE frequency. Effects of LDX on anxiety should be monitored closely by clinicians. Early indications suggest that LDX may be effectively used in people with BED, with and without co-occurring psychiatric conditions, however tolerability may be lower in highly complex cases.Trial registration: Australian and New Zealand Clinical Trials Registry (anzctr.org.au) #ACTRN12618000623291.

Comorbid Attention Deficit Hyperactivity Disorder in Women with Premenstrual Dysphoric Disorder.

Background: This study evaluated the associations between inattention, impulsivity, and attention deficit hyperactivity disorder (ADHD) in women with premenstrual dysphoric disorder (PMDD) across the menstrual cycle. Methods: This study enrolled 58 women with PMDD and 50 controls. Symptoms were assessed using the Attention and Performance Self-Assessment Scale and the Dickman Impulsivity Inventory during the pre-ovulatory (PO), mid-luteal (ML), and late luteal (LL) phases of the menstrual cycle. Results: The chi-square analysis revealed a significant association between ADHD and PMDD. Women with PMDD experienced a greater increase in scores of prospective everyday memory problems and difficulties maintaining focused attention from the PO phase to LL phase than the controls; in addition, they had higher scores in dysfunctional impulsivity during the LL phase than the controls. Among women in the PMDD group, those with ADHD had higher scores in prospective everyday memory problems and dysfunctional impulsivity during the PO and ML phases than those without ADHD. Women in the PMDD group without ADHD had a greater increase in scores of prospective everyday memory problems, difficulties maintaining focused attention, and dysfunctional impulsivity from the PO phase to the LL phase than the controls. Conclusion: Our study demonstrated that women with PMDD were more likely to have comorbid ADHD and higher levels of inattention across the menstrual cycle. PMDD was associated with increased impulsivity during the LL phase, independent of ADHD, but it was not associated with a persistent elevation of impulsivity. Furthermore, PMDD women with comorbid ADHD experienced higher inattention and impulsivity during the PO and ML phases than those without it. Thus, ADHD comorbidity should be assessed when assessing or intervening in the symptoms of inattention and impulsivity in women with PMDD.

ADHD Symptoms in Childhood and Big Five Personality Traits in Adolescence: A Five-Year Longitudinal Study in Girls

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by developmentally extreme and impairing symptoms of inattention and/or hyperactivity/impulsivity. Great interest has emerged in the ways ADHD and its underlying symptom dimensions relate to the development of personality traits. Much extant research on this topic is cross-sectional, relying on self-report measures and male samples. Herein, we present data from a prospective, longitudinal study of a socioeconomically and racially diverse sample of girls, including those with ADHD and a matched neurotypical comparison sample. We examined how parent- and teacher-reported ADHD in middle childhood relate to self-reported Big Five personality traits in adolescence. As expected, childhood ADHD diagnosis prospectively predicted lower self-reported Conscientiousness, lower Agreeableness, and higher Neuroticism in adolescence. With ADHD diagnosis covaried, Inattention (IA) predicted only low Conscientiousness, Hyperactivity/Impulsivity (HI) predicted only low Agreeableness, and neither predicted adolescent Neuroticism. An exploratory moderator analysis showed that family income moderated the effects of IA and HI on the negativity of adolescent self-descriptions of their own personalities, with more pronounced negative effects for girls in families with higher (rather than lower) income. Familial pressures to achieve in higher-income families may be linked to more pronounced negative ramifications of ADHD on personality development.

The impacts associated with having ADHD: an umbrella review.

Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD. An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications. Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality. This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning. International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).

The symptomatology of Attention-Deficit/Hyperactivity Disorder and the genetic control of vitamin D levels.

Vitamin D deficiency has been associated with psychiatric disorders and behavioral phenotypes such as Attention-Deficit/Hyperactivity Disorder (ADHD). Considering that vitamin D levels are polygenic, we aim to evaluate the overall effects of its genetic architecture on symptoms of inattention, hyperactivity, and impulsivity and on the serum levels of vitamin D in two independent samples of adults, as well as the specific effects of five relevant polymorphisms in vitamin D-related genes. We evaluated 870 subjects from an ADHD sample (407 cases and 463 controls) and 319 subjects from an academic community (nutrigenetic sample). Vitamin D serum levels were obtained through Elisa test and genetic data by TaqMan™ allelic discrimination and Infinium PsychArray-24 BeadChip genotyping. Polygenic Scores (PGS) were calculated on PRSice2 based on the latest GWAS for Vitamin D and statistical analyses were conducted at Plink and SPSS software. Vitamin D PGSs were associated with inattention in the ADHD sample and with hyperactivity when inattention symptoms were included as covariates. In the nutrigenetic sample, CYP2R1 rs10741657 and DHCR7 rs12785878 were nominally associated with impulsivity and hyperactivity, respectively, and both with vitamin D levels. In the clinical sample, RXRG rs2134095 was associated with impulsivity. Our findings suggest a shared genetic architecture between vitamin D levels and ADHD symptoms, as evidenced by the associations observed with PGS and specific genes related to vitamin D levels. Interestingly, differential effects for vitamin D PGS were found in inattention and hyperactivity, which should be considered in further studies involving ADHD.

Listening Comprehension Skills in Children with Attention Deficit and Hyperactivity Disorder: A Review Study

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity and impulsivity that may begin in early childhood and continue into adolescence and adulthood and are incompatible with the developmental level of the individual. Most children with ADHD are at risk of facing significant academic problems throughout their educational life. In recent studies aiming to reveal the causes of academic problems experienced by children with ADHD, academic problems have been associated with the difficulties in reading and listening comprehension skills of children with ADHD. The relatively common prevalence of ADHD, the extent of academic problems experienced by children with ADHD, and the lack of clarity about reading difficulties require further examination of the relationship between ADHD and reading and listening comprehension skills, which are often based on the same language and cognitive skills. Listening comprehension, which is defined as the ability to understand, interpret, organise and evaluate the ideas and thoughts in a speech heard or a text read aloud, is one of the most important early literacy skills necessary for the ultimate goal of reading, which is reading comprehension. In this review study, listening comprehension skills of children with ADHD were discussed together with the literature.

Secondary analyses of sex differences in attention improvements across three clinical trials of a digital therapeutic in children, adolescents, and adults with ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated in girls. Inattentive symptoms, often predominant in girls with ADHD, represent a key driver of impairment and often persist into adulthood. AKL-T01 is a regulated digital therapeutic targeting inattention. We examined potential sex differences in the efficacy of AKL-T01 in three separate trials for 1) children, 2) adolescents, and 3) adults.MethodsWe conducted secondary analyses of clinical outcomes by sex in three AKL-T01 randomized clinical trials in ADHD (n1 = 180 children 30.6% female, M(SD) age = 9.71 (1.32); n2 = 146 adolescents; 41.1% female, M(SD) age = 14.34 (1.26); n3 = 153 adults; 69.9% female, M(SD) age = 39.86 (12.84)). Active treatment participants used AKL-T01 for 25 min/day over 4–6 weeks. Primary outcomes included change in attention on the Test of Variables of Attention (TOVA) and symptom change on the clinician-rated ADHD Rating Scale (ADHD-RS). To evaluate study hypotheses, we conducted a series of robust linear regressions of TOVA and ADHD-RS change scores by sex, adjusting for baseline scores.ResultsIn children, girls demonstrated greater improvement in objective attention relative to boys following AKL-T01 (TOVA Attentional Composite Score; Cohen’s d = .36 and Reaction Time Mean Half; Cohen’s d = .54), but no significant sex differences in ADHD rating scale change. We did not observe significant sex differences in outcomes in the adolescent or adult trials. Limitations include binary sex categorization and slight study design variation across the three samples.ConclusionAKL-T01 might notably improve attentional functioning in girls with ADHD relative to boys. Objective attention measures may be particularly important in the assessment of attentional improvement in childhood, given known gender biases in ADHD symptom reporting. We emphasize the importance of considering sex and gender-specific factors in ADHD treatment evaluation.Trial registrationsSTARS ADHD CHILD: ClinicalTrials.gov ID NCT03649074;STARS ADHD ADOLESCENT: ClinicalTrials.gov ID NCT04897074;STARS ADHD ADULT: ClinicalTrials.gov ID NCT05183919.

Atypical procedural learning in children with developmental coordination disorder: A combined behavioral and neuroimaging study

While procedural learning (PL) has been implicated in delayed motor skill observed in developmental coordination disorder (DCD), few studies have considered the impact of co-occurring attentional problems. Furthermore, the neurostructural basis of PL in children remains unclear. We investigated PL in children with DCD while controlling for inattention symptoms, and examined the role of fronto-basal ganglia-cerebellar morphology in PL. Fifty-nine children (6–14 years; nDCD = 19, ncontrol = 40) completed the serial reaction time (SRT) task to measure PL. The Attention-Deficit Hyperactivity Disorder Rating Scale-IV was administered to measure inattention symptoms. Structural T1 images were acquired for a subset of participants (nDCD = 10, ncontrol = 28), and processed using FreeSurfer. Volume was extracted for the cerebellum, basal ganglia, and frontal regions. After controlling for inattention symptoms, the reaction time profile of controls was consistent with learning on the SRT task. This was not the case for those with DCD. SRT task performance was positively correlated with cerebellar cortical volume, and children with DCD trended towards lower cerebellar volume compared to controls. Children with DCD may not engage in PL during the SRT task in the same manner as controls, with this differential performance being associated with atypical cerebellar morphology.

Adult ADHD and pathological narcissism: A retrospective-analysis

Adult attention deficit hyperactivity disorder (ADHD) is often associated with personality pathology. However, only few studies have been conducted on the link between ADHD and pathological narcissism (PN), with or without a diagnosis of narcissistic personality disorder (NPD). In order to fill this gap, PN and NPD were assessed in 164 subjects suffering from ADHD, with several other measures including ADHD severity, quality of life, depression, anxiety, impulsivity, and emotion dysregulation (ED). We found that a significant proportion of ADHD patients suffered from NPD, and that both narcissistic grandiosity and vulnerability were associated with ADHD hyperactivity and impulsivity symptoms, but not with inattentive symptoms. These two dimensions seemed to be negatively associated with well-being and positively associated with most of the other studied psychiatric dimensions except ED, the latter being only associated with vulnerability, even after adjustment on borderline symptoms. Overall, despite important limitations that limit the generalizability of our findings to the overall ADHD population (notably linked to selection bias), we believe that this exploratory study sheds light on the potential clinical relevance of narcissistic pathology in adult ADHD patients.