Treatment Of ADHD Research Articles

Predictors of Methylphenidate response in children and adolescents with ADHD: the role of sleep disturbances.

Sleep Disturbances (SD) have been linked to children and adolescents with ADHD, impacting its progression and outcomes. Methylphenidate (MPH), a commonly used stimulant medication for ADHD treatment, has been observed to potentially influence SD as a side effect, while SD can in turn potentially affect the response to MPH. This study aimed to explore the potential role of SD on MPH response in children and adolescents with ADHD. At this aim, 43 children and adolescents with ADHD received a single dose of MPH and were assessed for attention before and after medication administration. As expected, the administration of MPH resulted in improved attention levels. Our data indicate that patients with higher SD experienced greater benefits from the medication, stabilizing Reaction Times Variability (VRTs). This suggests that SD might influence the response to MPH, with individuals exhibiting higher SD deriving more advantages from the treatment. In addition, we found that other factors, such as externalizing problems and IQ, interact with each other and with SD, influencing the response to stimulant medication. Early detection of SD, along with the study of cognitive and emotional-behavioral characteristics, could assist clinicians in predicting the effectiveness of MPH therapy in children and adolescents with ADHD. However, further research is necessary to gain a deeper understanding of the role of SD and other factors in the long-term effects of MPH.

Self-rated costs and benefits of conventional and alternative adult ADHD treatments.

Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments.

Abstract 4138514: From Treatment to Trigger: A Case of Atomoxetine-Induced Brugada Pattern

Introduction: Brugada syndrome is an inherited cardiac disorder characterized by specific ECG patterns, notably the coved-type ST-segment elevation in the right precordial leads (V1-V3), leading to an increased risk of sudden cardiac death. This condition often stems from mutations in the SCN5A gene, which impair cardiac sodium channel function. The manifestation of Brugada Pattern, showing typical ECG findings without clinical criteria like sudden cardiac arrest or syncope, is significant. We highlight a case where atomoxetine, a selective norepinephrine reuptake inhibitor used for ADHD, unveiled a type 1 Brugada pattern. Case Presentation: A 26-year-old male with a history of ADHD on atomoxetine only presented to the emergency department with sudden substernal chest pain radiating to his left arm. His initial ECG showed right bundle branch block and type 1 Brugada pattern (Figure.1). Despite normal troponin levels and a negative coronary CT angiography, the patient's ECG abnormalities raised concerns. With no personal or familial history of arrhythmia or SCD and no other medications, atomoxetine was suspected as the trigger. Upon discontinuation, the patient's ECG type 1 Brugada pattern resolved (Figure. 2), and he remained asymptomatic with a normal Holter monitor at a 1-month follow-up. Discussion: Brugada syndrome is marked by dynamic ECG abnormalities, which can surface due to triggers like fever, certain medications, and electrolyte imbalances. Atomoxetine, an ADHD treatment and selective norepinephrine reuptake inhibitor, affects the human cardiac sodium channel (hNav1.5), encoded by the SCN5A gene. This interaction can disrupt heart action potentials, leading to conditions like long QT syndrome and Brugada pattern, by slowing cardiomyocyte depolarization and conduction. Its effect on hNav1.5 resembles that of antidepressants like Fluoxetine, increasing the risk of Brugada pattern. In our case, a patient's type 1 Brugada pattern, with no underlying heart disease or family history, pointed to atomoxetine as the cause. Discontinuing the drug resolved the ECG abnormalities. Conclusion: This case emphasizes the importance of assessing cardiovascular risk before prescribing atomoxetine, especially in individuals at risk for cardiac sodium channel dysfunctions. Immediate intervention and monitoring are critical to prevent severe arrhythmias.

Research progress of tDCS in the treatment of ADHD.

TDCS is one of the most widely used non-invasive neuromodulation techniques, which changes the excitability of local cortical tissue by applying weak continuous direct current to the scalp, effectively improves the attention and concentration of ADHD children, and improves the impulse disorder of patients, but related research is still in its infancy. Based on a review of a large number of existing literatures and an analysis of the pathogenesis and principle of ADHD, this paper summarized the research on tDCS in the treatment of ADHD in recent years from the aspects of treatment mechanism, safety and stimulation parameters, and simply compared the application of tDCS with other non-traumatic neuromodulation techniques in the treatment of ADHD. The future development direction of this technology is further discussed.

TRANSTORNO DE DÉFICIT DE ATENÇÃO E HIPERATIVIDADE (TDAH) EM CRIANÇAS E ADOLESCENTES: REVISÃO DA ABORDAGEM TERAPÊUTICA

Introduction: The management of patients with ADHD remains complex, especially due to the high prevalence of associated comorbidities, which may require adjusted therapeutic approaches. Objective: To evaluate, through a literature review, the main medications used in the treatment of ADHD in children and adolescents, and compare the benefits of these medications on the main symptoms (hyperactivity/impulsivity/inattention). Materials and Methods: This is a literature review conducted according to the items of the report for the systematic review and meta-analyses guidelines (PRISMA). The search strategy was conducted through PubMed, Virtual Health Library, Scopus, and Embase for all relevant articles that directly addressed attention deficit hyperactivity disorder. The identified studies were selected based on titles and abstracts, excluding irrelevant or restricted access articles. Results: After an extensive search of articles in the databases mentioned here, three articles from 2016, three from 2017, four from 2018, one from 2019, five from 2020, seven from 2021, four from 2022, eight from 2023, and five from 2024 were selected for this literature review, totaling 40 articles included from the years 2016 to 2024. Conclusion: Through the development of this literature review, it was observed that the treatment of ADHD in children and adolescents requires a personalized and multimodal approach, combining pharmacological therapy with behavioral interventions, taking into account the associated comorbidities and the side effect profile.

An investigation of the Bernstein’s strengths Scale: factorial validity and network analysis of attention-deficit/hyperactivity symptoms, mental health, and the strengths of the healthy adult self

BackgroundBernstein’s heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein’s Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach.MethodsFive hundred and twenty-eight adults filled out an online questionnaire, including Bernstein’s Strengths Scale (BSS), the Mental Health Continuum – Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS).ResultsThough our data showed an acceptable fit to the 16-factor model, the Self-control subscale and item 28 of the Compassion subscale were excluded because of reliability issues. The final model with 15 factors and 44 items showed excellent fit, χ2(797) = 1130.149, p < .001, RMSEA = 0.028, 90% CI [0.024, 0.032], SRMS = 0.049, CFI = 0.993, TLI = 0.991. Principal component analysis revealed three instead of four second-order factors. In the network model, Self-confidence and Wisdom emerged as the most influential nodes. ADHD symptoms were negatively connected to Responsibility, Self-care, Identity, Emotional balance, Self-confidence, and mental health, while they had positive edges with Humor, Self-reflection, and Imagination/creativity. Mental health was positively related to several strengths, with the strongest association being between mental health and Gratitude.ConclusionThe BSS has acceptable factorial validity and is a reliable tool for assessing the personal strengths of the healthy adult self. ADHD symptoms in adults may be associated with deficits in personal strengths, but protective factors could also be identified. Addressing personal strengths in psychosocial interventions for ADHD in adults may improve patients’ emotional well-being and everyday functioning.

Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study

Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study

High vs. Low Intensity Behavior Therapy Delivered to Adolescents with ADHD: Potential Adverse Long-Term Effects on Substance Use Outcomes.

Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.

Efficacy of pharmacological interventions for ADHD: protocol for an updated systematic review and dose–response network meta-analysis

BackgroundAttention-deficit/hyperactivity disorder (ADHD) affects approximately 5% of children globally, with symptoms often persisting into adulthood. While pharmacological interventions are commonly employed for management, understanding the optimal dosing for efficacy and tolerability remains crucial. This study aims to conduct a dose–response network meta-analysis to estimate the efficacy of pharmacological treatments across different doses, aiming to inform clinical decision-making and improve treatment outcomes.MethodsThis updated systematic review will include randomized controlled trials evaluating ADHD medication efficacy in children, adolescents, and adults. An updated search from a 2018 NMA will be conducted across multiple electronic databases with no language restrictions, using specific eligibility criteria focused on randomized controlled trials. The primary outcome will assess the severity of ADHD core symptoms, while secondary outcomes will consider treatment tolerability. A dose–response Bayesian hierarchical model will be used to estimate dose–response curves for each medication, identifying optimal dosing strategies.DiscussionWith this dose–response network meta-analysis, we aim to better understand the dose–response relationship of pharmacological treatment in ADHD, which could help clinician to the identification of optimal doses.Systematic review registrationOSF https://doi.org/10.17605/OSF.IO/3MY4A.

Vitamin D’s Capacity to Increase Amphetamine-Induced Dopamine Release in Healthy Humans: A Clinical Translational [11C]-PHNO Positron Emission Tomography Study

BackgroundDopaminergic tone and phasic release have transdiagnostic relevance. Preclinical research suggests that the active form of vitamin D, calcitriol, increases subcortical tyrosine hydroxylase, D2/3 receptors, and amphetamine-stimulated dopamine release in rodents. Comparable studies have not been conducted in humans. MethodsHealthy, vitamin-D-sufficient adults (N=18; 32.8 ±6.6 years; 33% female) participated in a randomized, double-blind, placebo-controlled within-subjects study involving four total scans over two visits consisting of same-day pre-amphetamine and post-amphetamine (0.3 mg/kg) 11C-PHNO positron emission tomography (PET) scanning to examine D2/3 receptor availability (BPND) following active calcitriol (1.5 μg night before experimental day and 1.5 μg morning of experimental day) or placebo at least six days apart. Parametric images of 11C-PHNO PET BPND were computed using a simplified reference tissue model with the cerebellum as reference. Blood samples were acquired to measure serum calcitriol, amphetamine, and calcium levels. Regions of interest examined were the dorsal caudate, dorsal putamen, ventral striatum, globus pallidus, and substantia nigra. ResultsFor pre-amphetamine scans, there was a medication-by-region-of-interest interaction (F4,153=2.59, p=0.039) and a main effect of medication (F1,153=4.88, p=0.029) on BPND, with higher BPND values on calcitriol in the ventral striatum (t=2.89, p=0.004) and dorsal putamen (t=2.15, p=0.033). There was a main effect of medication on post-amphetamine change in BPND (F4,153=5.93, p=0.016), with greater decreases on calcitriol in the ventral striatum (t=3.00, p=0.003), substantia nigra (t=2.49, p=0.014), and dorsal caudate (t=2.29, p=0.023). ConclusionsResults provide translational support for vitamin D to target dopaminergic tone, with implications for clinical disorders involving dysregulated dopamine function. Clinical Trial RegistrationVitamin D as a Therapeutic Adjunct in the Stimulant Treatment of ADHD; https://clinicaltrials.gov/study/NCT03103750; ClinicalTrials.gov ID: NCT03103750

A Psychometric Evaluation of the Revised Version of the Adult ADHD Self-Report Scale in Chinese Adolescents.

Adolescent-specific ADHD self-report screening measures can greatly increase the likelihood of correct diagnosis and timely treatment of ADHD in adolescents. This study provides preliminary evidence for evaluating the reliability and validity of the Adult ADHD Self-Report Scale-Revised (ASRS-R) in a school-based sample of Chinese adolescents. The ASRS-R and the Strengths and Difficulties Questionnaire (SDQ) were administered to 867 adolescents aged 12 to 16 years (Mage = 13.08 years). Construct validity was assessed using correlation analysis of the ASRS-R with the SDQ. Moreover, confirmatory factor analysis (CFA), internal consistency, retest reliability, and measurement invariance of the scales were examined by gender. CFA showed a two-dimensional factor structure of the ASRS-R, and the model fitted the data well (χ2/df = 4.370, RMSEA = 0.062, TLI = 0.932, CFI = 0.940, GFI = 0.927, AGFI = 0.907, and SRMR = 0.038). The ASRS-R scale was invariant across gender and had satisfactory internal consistency (Cronbach's alpha = .934) and test-retest reliability (intraclass correlation coefficient = .874). The construct validity, as calculated using the SDQ, was also acceptable. The ASRS-R can be a psychometrically reliable self-report instrument and provide preliminary support as a simple tool for identifying ADHD symptoms in Chinese adolescents. The findings provide evidence for extending the application of the ASRS, previously limited to adults, to the adolescent populations.

Low utility of serum folic acid blood tests in healthy children and adolescents, a nationwide cohort.

Pediatric folic acid deficiency rates were low in this nationwide cohort and not linked to megaloblastic anemia, likely due to concomitant iron deficiency anemia. Although retrospective, this might suggest low utility for routine serum folic acid testing in healthy children in developed countries, except in cases of celiac disease or specific medication use such psychostimulants or antipsychotics. • Folic acid deficiency is common among children in developing countries, causing megaloblastic anemia, growth delays, and cognitive impairments. In developed countries, the prevalence is considered low. • Of 20,411 pediatric patients tested for serum folate, in a developed country, only 4.3% had folate deficiency. • Risk factors for deficiency included celiac, antipsychotics, and psychostimulant treatment for ADHD. • Routine folate testing in developed countries may have limited utility; Targeted screening is recommended.

Exploring the associations between symptom severity, metacognition, problematic social media use and cyberbullying in treatment naïve adolescents with Attention Deficit and Hyperactivity Disorder

This study investigates the relationship between ADHD symptom severity, metacognition, problematic social media use, and cyberbullying/cybervictimization in treatment-naïve adolescents. Understanding these relationships is vital for enhancing ADHD intervention strategies. Using a cross-sectional design, 97 adolescents meeting DSM-5 criteria for ADHD without any comorbidity and 97 healthy controls were assessed. Measures included the Metacognitions Questionnaire for Children, Social Media Disorder Scale, Revised Cyberbullying Inventory-II, and Revised Conners’ Parent Rating Scale-Short. The comparisons were performed with independent samples’ t tests and the associations were estimated by using Pearson’s bivariate correlations and multiple regression analyses. Results revealed that adolescents with ADHD exhibited higher levels of dysfunctional metacognitions, problematic social media use, cyberbullying, and cybervictimization compared to controls. Regression analysis showed significant positive associations between ADHD symptoms, specific metacognitions (e.g., positive meta-worry, cognitive monitoring), and problematic social media use. This study, the first of its kind among treatment-naïve ADHD adolescents, provides valuable insights into the relationship between ADHD symptoms and particular metacognitions (i.e. positive meta-worry, cognitive monitoring) and problematic social media use. These findings contribute to a deeper understanding of ADHD in adolescence and may inform the development of targeted prevention and treatment strategies, particularly relevant given adolescents’ susceptibility to social media’s influence and their potential for cognitive flexibility in rehabilitation contexts.

Depressive Symptoms and Quality of Life Among Women Living With a Partner Diagnosed With ADHD

Objective: This study explores the depressive symptoms and quality of life (QoL) of women in relationships with partners diagnosed with ADHD, as well as the role of engagement in health-promoting activities (HPA) on these outcomes, spotlighting the often-neglected perspective of these women. Methods: Employing a cross-sectional approach, the study used Structural Equation Modeling (SEM) to explore associations between partners’ ADHD functional impairment, women’s involvement in HPA, and their depressive symptoms and QoL. Results: Functional impairment in partners with ADHD was positively associated with women’s depressive symptoms and negatively associated with their QoL, whereas women’s engagement in HPA was positively associated with their QoL and negatively associated with their depressive symptoms. Conclusions: The findings suggest that women partnered with individuals diagnosed with ADHD may face an elevated risk of depressive symptoms and lowered QoL. The results highlight the potential need for a more comprehensive clinical approach to adult ADHD treatment that considers functional impairments and the experiences of partners. Incorporating HPA into therapeutic strategies appears beneficial. However, longitudinal research is needed to examine the direction of these associations and to develop potential interventions to support these women.

A Study of the Effectiveness of Camp Baker, an Adapted Summer Treatment Program for Children with ADHD

ABSTRACT Background Although the Summer Treatment Program (STP) is a well-established treatment for ADHD, STPs are only offered at a few sites in the United States, suggesting opportunities for improved implementation. Objective This study aimed to evaluate the effectiveness and caregiver satisfaction of Camp Baker, an adapted STP for children with ADHD designed to address implementation barriers. Methods Adaptations included condensing the length of treatment and augmenting the STP to cover additional skills (e.g. educational opportunities, therapeutic skills training, enhanced parent training). Children (N = 159; 84.3% male; 65.4% White; 5–12 years old) with ADHD participated in Camp Baker throughout 2019, 2021, and 2022. Families who participated in Camp Baker in 2019 were asked to complete an anonymous survey that contained choice-select (e.g. “My child is better at handling daily life”) and open-ended questions (e.g. “From your perspective, how did Camp Baker most help your child?”) to assess their perceptions of and satisfaction with Camp Baker. Qualitative survey responses (n = 30) were double-coded using an inductive content analysis approach. Results Commonly endorsed themes included positive feelings about the program (e.g. “fun camp experience at Camp Baker”), positive feelings about parent training (e.g. “the training is amazing”), and positive child outcomes (e.g. “gave him newfound confidence”). Caregivers reported significant improvement in child behavioral, attentional, and emotional problems from pre- to post-camp. Conclusion With intentional adaptations made, Camp Baker was easily implementable while demonstrating promise for the retainment of effectiveness and satisfaction.

High prevalence of treatment with ADHD medicines indicates overdiagnosis of ADHD in Iceland

ADHD is a neurodevelopmental disorder characterized by hyperactivity, inattention and impulsivity. For many the core symptoms become less troubling in adulthood. Treatment with stimulants is considered the most efficacious treatment for ADHD. Large high-quality studies have estimated the prevalence of AHDH to be 3,4-7,2% for children and adolescents and 2,5-6,8% for young adults. The aim of this study was to estimate the proportion of Icelanders who have received an ADHD diagnosis based on ADHD-medication prescriptions since an ADHD diagnosis is a prerequisite for such prescriptions in Iceland. This population-based retrospective cohort study included all Icelanders 7-70 years old who received a prescription for an ADHD drug from 1.1.2004-31.12.2023. Every citizen receiving a prescription is included in the Icelandic Prescription Medicines Registry (IPMR). In 2023 14,7% of youth, 7-17 years of age, received a prescription for an ADHD medication, 17,7% of boys and 11,6% of girls. Among 12-17 years old youth the proportion was higher still, 17,6%, 20,1% for boys and 14,6% for girls. For 18-44 years old adults the proportion was 10,2%, 9,4% for males and 11,0% for females. From 2010-2023 the increase in prescriptions for 7-17 years old boys has been 93% but 224% for girls. For 18-44 years old males the increase has been 414% for males and 543% for females during this period. The incidence of new ADHD prescriptions for 7-17 years old boys from 2021-2023 was 10,9 and 13,5 for girls per 1000, respectively. For 18-44 years old the incidence in the years 2021-2023 was 18,7 for males and 19,2 for females per 1000, respectively. The prevalence of Icelanders who have received an ADHD diagnosis is double to treble that observed in the best available studies in other populations. We therefore call for an urgent review of how ADHD diagnoses are made in Iceland because it is obvious that the current system leads to overdiagnosis and inappropriate treatment.

TDAH : quels sont les effets cardiovasculaires du méthylphénidate et quelles sont les conséquences éventuelles pour la pratique clinique ?

ContextMethylphenidate is the first-line pharmacological treatment for ADHD, and its prevalence continues to grow, with an increase of 116% over the last ten years in France. Its use in hospitals has been extended to neurologists, psychiatrists and pediatricians, and its prescription can be renewed by a general practitioner. Cardiovascular complications are rare, but life-threatening. Management practices currently vary widely from one medical center or doctor to another. ObjectivesReviewing the cardiovascular effects of methylphenidate in adults and children with ADHD, aiming to propose a practical management plan without intending to replace existing recommendations. MethodsThe subject under study aimed to answer the following PICO question “What are the cardiovascular consequences (outcomes) when using MPH (intervention) for an ADHD population (population) regardless of age”. We carried out systematic review of international reviews and meta-analyses, selected using the PRISMA methodology via the PubMed, Cochrane Library and Google Scholar databases. Their methodological quality was assessed using the AMSTAR-2 scale. Cardiovascular events considered were the adrenergic effects of MPH on the cardiovascular system, looking for changes in blood pressure and heart rate, and the serious cardiovascular effects represented by sudden death/arrhythmia, myocardial infarction and stroke. A total of 17 systematic reviews and meta-analyses met the eligibility criteria. ResultsOf the 734 articles found, twelve were finally selected. Four concerned a population of children, five a mixed population of adults and children and three a population of adults only. They included two systematic reviews and ten meta-analyses. Three reviews included cohort studies and nine included randomized controlled trials. Three clinical situations can be distinguished depending on the age of the patient and the length of exposure to methylphenidate. The first, on initiation of treatment, there was a marked by a short-term increase in blood pressure and heart rate. The second involves a patient under the age of 35 with short- to medium-term exposure to MPH. A persistent adrenergic effect tends to increase the risk of sudden death by 12% (if the resting heart rate increases by ten beats per minute). This risk is further increased if the patient has psychiatric comorbidities and their associated treatments, congenital heart disease and uses recreational substances. Finally, the last situation involves a patient exposed to MPH for several years and aged over 35, whose main risk is the onset of atheromatous disease with myocardial infarction and ventricular arrhythmia. In this case, a comprehensive approach is required, identifying risk factors and behavioral factors likely to exacerbate the risk of CV disease. ConclusionsThe short-term cardiovascular effects of MPH are well documented and statistically significant, with a moderate but significant increase in blood pressure (+2mmHg) and heart rate (+5bpm). Longer-term cardiovascular safety data are often lacking, leading to conflicting conclusions. Meta-analyses of cohort studies conclude that there is an increase in cardiovascular risk, while meta-analyses of randomized trials find no significant statistical association. This means that patients and their families need to be made aware of this lack of data. Personalized management based on age, duration of exposure to MPH and the clinical profile of patients as defined by cohort studies seems to us to be the most appropriate approach. In people under 35, the main risk is sudden death. In this population, it is important to identify any congenital heart disease and to look for psychiatric comorbidities, and by assessing the substance abuse. For people over 35, the main risk is coronary heart disease. In this case, a comprehensive approach is required, identifying risk factors and behavioral factors likely to exacerbate the risk of CV disease. Our daily practice is more in line with cohort studies including patients with co-morbidities associated with their ADHD, as well as a significant risk of having risky behaviors, depressive episodes, heart disease and prolonged exposure to MPH and other drugs. Prescribing MPH in this context is tricky, with a higher risk of cardiovascular events. Close clinical monitoring is therefore necessary, and specialist advice may be required.

Developing a Sustainable Education Protocol for Children with Attention Deficit Hyperactivity Disorder (adhd) in the Context of Developing Country

Abstract Attention Deficit Hyperactivity Disorder (adhd) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity, and impulsivity that may significantly impact children’s academic, social, and emotional health. This study has examined the most recent scholarly research on the influence of adhd on children’s academic performance as well inclusive education protocol in different country contexts. Legal and academic interventions for adhd are well-established in developed countries, but there is a significant gap in addressing the needs of children with adhd in developing countries. This research study aims to fill the gap by suggesting a sustainable formal education protocol designed to meet the specific problems and situations of developing countries. The proposed Strategies-Support Services-Collaboration (ssc) protocol is influenced by concepts of inclusion, equity, and sustainability, aiming to address the different challenges encountered by children with adhd in obtaining quality education. The protocol includes measures for early detection and assessment of adhd, customised academic accommodations and support services, teacher training and capacity-building programmes, and collaborations with community resources and healthcare professionals. This research intends to empower educators, policymakers, and communities by proposing a sustainable formal education protocol. The goal is to establish more inclusive and supportive learning settings for children with adhd, thereby enhancing their academic success and general well-being. Integrating children with adhd into formal school aligns with the Sustainable Development Goal (sdg) 4 which aims to offer inclusive and quality education for everyone.

Examining the Myth of Prescribed Stimulant Misuse among Individuals with Attention-Deficit/Hyperactivity Disorder: A Systematic Review.

The literature emphasizes the importance of addressing the misuse of ADHD medications as a potential significant healthcare issue within the general population. Nevertheless, there are no systematic reviews that specifically examine whether the misuse of psychostimulant medication among clinical populations diagnosed with ADHD who are undergoing prescribed stimulant therapy is a rational concern or a false myth. This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. We searched PubMed databases for articles indexed up to 12th July 2023, without language restrictions. Our systematic search generated 996 unique articles. After a full-text revision, 13 studies met the eligibility criteria and were included in the systematic review. In the 50% of the study on the adult population, the reported prevalence of stimulant misuse was 0%. In other studies, the range of stimulant misuse rates varied from 2% to 29%, with no available data specifically focusing on the youth population. It has been noted that misuse of prescribed stimulant treatment is linked with particular subject characteristics, such as older age, prior or more frequent use of ADHD medication, use of short-acting medication, and a history of alcohol/substance misuse diagnosis. Despite certain limitations, our study highlights that while a significant proportion of individuals undergoing psychostimulant treatment for ADHD follow their prescribed medication regimens without resorting to misuse behaviors, there is variability in adherence, with occurrences of misuse behaviors. The misuse of prescribed ADHD treatment appears to be associated with distinct subject characteristics, underscoring the importance for tailored interventions addressing the specific requirements of these individuals to attain optimal treatment outcomes while mitigating misuse risks.

Phenotyping sleep disturbances in ADHD and identifying harmonised outcome measures

AbstractAttention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD in children and adolescents is primarily centred on daytime functioning and the associated impairment of academic performance, although disrupted and restless sleep have been frequently reported in individuals with ADHD. Further, it has been recognised that sleep disorders not only intensify existing ADHD symptoms but in some cases can also mimic ADHD symptoms in the paediatric population with primary sleep disorders. Under the title ‘The blind spot: sleep as a child’s right issue?’, professionals from diverse disciplines, including medicine and social sciences as well as individuals with an interest in ADHD and sleep medicine, including laypeople, have initiated a unifying discourse. The objective of this discourse is to improve our understanding of the diagnosis and treatment of ADHD and disruptive behaviours and to develop personalised and precision medicine. Research has shown that the existing, primarily descriptive and categorical diagnostic systems do not capture the heterogeneous nature of youth with attentional and behavioural difficulties and the phenotypic expressions thereof, including nighttime behaviours and sleep. New strategies for clinical phenotyping and the exploration of patient-reported behaviours are necessary to expand our understanding and develop personalised treatment approaches. In this position paper, we outline gaps in the clinical care of ADHD and related sleep disturbances, review strategies for closing these gaps to meet the needs of individuals with ADHD, and suggest a roadmap for escaping the one-size-fits-all approach that has characterised ADHD treatment algorithms to date.