Treatment experiences of children and adolescents with attention-deficit/hyperactivity disorder

Aim: To gain insight into the treatment experiences of children and adolescents diagnosed with attention‐deficit/hyperactivity disorder (ADHD). Methods: Convenience sampling was used to recruit eligible parents and carers at paediatric clinics of the Children's, Youth and Women's Health Service to participate in an interview to discuss experiences, using a semi‐structured questionnaire. Results: Thirty‐five interviews were conducted. Twenty‐five subjects had trialled an average of 1.5 interventions prior to receiving an ADHD diagnosis, namely, dietary modifications (46%), behavioural therapy (24%), learning assistance (8%) and natural remedies (8%). Following an ADHD diagnosis, 25 subjects tried an average of 2.8 interventions, most commonly behavioural therapies (48%), expressive therapies (48%) and fish oil (36%). All subjects started psychostimulant medication after receiving an ADHD diagnosis. Despite 52% of parents expressing initial reluctance towards psychostimulants, 97% reported positive experiences with use in terms of schooling, social interaction and family life. Of those being treated with psychostimulants, 22 (73%) were concurrently using other treatments at the time of interview. Conclusions: Few patients use psychostimulant medication in isolation, with the majority of parents using multiple approaches to manage their child's behaviour. Parents tried a variety of therapies before commencing psychostimulant medication, often because of fears regarding psychostimulant safety. Parents were generally happy with the results gained; however adolescents interviewed were less convinced of the benefits of psychostimulants.     

Drug therapy for attention-deficit/hyperactivity disorder-like symptoms in autistic disorder

Problems of inattention and hyperactivity affect one half of individuals with autistic disorder. Care must be taken to ensure that inattention and hyperactivity are not manifestations of other behavioural pathology seen in association with autistic disorder, as this will affect treatment decisions. The prescribing of psychotropic agents to individuals with autistic disorder is increasing but the evidence base is limited, with some exceptions, to uncontrolled studies. Substantial benefit in reducing inattention and hyperactivity is seen with atypical antipsychotics such as risperidone and quetiapine, although weight gain and sedation are common side effects. Moderate benefit is derived from methylphenidate, atomoxetine, some anticonvulsant medications, guanfacine and donepezil. Data show dexamphetamine, clonidine, clomipramine, mirtazapine, and fluoxetine are of unlikely benefit.     

Perinatal risk factors interacting with catechol O‐methyltransferase and the serotonin transporter gene predict ASD symptoms in children with ADHD

Background: Symptoms of autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) often co‐occur. Given the previously found familiality of ASD symptoms in children with ADHD, addressing these symptoms may be useful for genetic association studies, especially for candidate gene findings that have not been consistently replicated for ADHD. Methods: We studied the association of the catechol O‐methyltransferase (COMT) Val158Met polymorphism and the serotonin transporter (SLC6A4/SERT/5‐HTT) 5‐HTTLPR insertion/deletion polymorphism with ASD symptoms in children with ADHD, and whether these polymorphisms would interact with pre‐ and perinatal risk factors, i.e., maternal smoking during pregnancy and low birth weight. Analyses were performed using linear regression in 207 Dutch participants with combined type ADHD of the International Multicenter ADHD Genetics (IMAGE) study, and repeated in an independent ADHD sample (n = 439) selected from the TRracking Adolescents’ Individual Lives Survey (TRAILS). Dependent variables were the total and subscale scores of the Children’s Social Behavior Questionnaire (CSBQ). Results: No significant main effects of COMT Val158Met, 5‐HTTLPR, maternal smoking during pregnancy and low birth weight on ASD symptoms were found. However, the COMT Val/Val genotype interacted with maternal smoking during pregnancy in increasing stereotyped behavior in the IMAGE sample (p = .008); this interaction reached significance in the TRAILS sample after correction for confounders (p = .02). In the IMAGE sample, the 5‐HTTLPR S/S genotype interacted with maternal smoking during pregnancy, increasing problems in social interaction (p = .02), and also interacted with low birth weight, increasing rigid behavior (p = .03). Findings for 5‐HTTLPR in the TRAILS sample were similar, albeit for related CSBQ subscales. Conclusions: These findings suggest gene–environment interaction effects on ASD symptoms in children with ADHD.     

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目的探讨孤独症患儿感觉统合失调和注意缺陷多动障碍(ADHD)症状的发生情况。方法 2007年7月至2007年11月北京大学精神卫生研究所儿科门诊4岁以上的孤独症患儿56例,进行孤独症行为检查量表(ABC)、Conner父母症状问卷、感觉统合能力发展评定量表(SIS)的评定,并运用DSM-IVADHD诊断标准对年龄≥6岁者进行诊断。结果 49例(87.5%)患儿存在感觉统合失调,其中38例(77.55%)为重度感觉统合失调;大肌肉及平衡感、触觉防御及情绪、本体感及协调3个因子分与ABC总分及ABC各因子分呈显著负相关(r=-0.272～-0.685,P<0.05及0.01);感觉统合失调组ABC总分、ABC感觉、交往及躯体因子分均明显高于非感觉统合失调组(P=0.036～0.003)。33例(58.9%)患儿存在多动症状,≥6岁29例中22例(75.9%)符合ADHD症状学诊断标准;伴多动症状或符合ADHD症状学诊断标准组ABC总分及躯体因子分均明显高于不伴多动症状或不符合ADHD症状学诊断标准组(P<0.05);存在多动症状组大肌肉及平衡感分明显低于不存在多动症状组(P<0.05);符合ADHD症状学诊断标准...     

Response to atomoxetine in boys with high-functioning autism spectrum disorders and attention deficit/hyperactivity disorder

Aim: To study the efficacy and tolerability of atomoxetine in high‐functioning boys with autism spectrum disorders (ASD) and comorbid attention deficit/hyperactivity disorder (AD/HD). Methods: Fourteen boys (age 7–17) participated in a 10‐week open‐label study. Atomoxetine doses were 0.5 mg/kg/day in week 1 and 1.2–1.4 mg/kg/day in weeks 2–10. Changes in AD/HD symptoms were measured by the AD/HD Rating Scale, and global improvements by the Clinical Global Improvement Scale. Both measures were used to assess drug response. Assessments were done at baseline and at weeks 2, 4, 6 and 10. Teacher ratings were done at baseline and 10 weeks. Results: There were significant reductions in AD/HD symptoms rated by parents (p < 0.005) and by teachers (p < 0.05). One participant was rated as ‘Much improved’, five as ‘Moderately improved’, seven as ‘Minimally improved’, and one as ‘Unchanged or worse’. Seven subjects were classified as clinical responders. The most common adverse events were nausea and headache. Two participants discontinued treatment. Conclusion: Seven out of 14 boys with high‐functioning ASD and comorbid AD/HD showed significant reductions in AD/HD symptoms and were classified as responders to atomoxetine. Most children tolerated the drug well.     

Ferritin and hyperactivity ratings in attention deficit hyperactivity disorder

Background: Iron is a co‐factor of tyrosine hydroxylase which is a critical enzyme in dopamine synthesis. Dopamine has been implicated in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Our objective was to investigate the association of ferritin level with parent and teacher ratings and cognitive measures after controlling for age, sex, ADHD subtype, comorbid conditions, hemoglobin, mean corpuscular volume and reticulocyte distribution width in a large sample. Methods: The study included 713 children and adolescents with ADHD (613 boys; age 7–15 years). Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale (CTRS) were obtained. In a subgroup of patients we conducted Digit Span, Digit Symbol, Trail‐making Tests as measures of attention and executive functioning. Results: Multiple regression analysis indicated that CPRS Hyperactivity score was significantly associated with ferritin level (B =?0.12; t =?3.1; P < 0.01). Other CPRS and CTRS scores as well as cognitive measures were not associated with ferritin level. Conclusions: Although it is not possible to make an inference on causality in cross‐sectional studies, the results of this largest‐scale cross‐sectional field study to date suggest that lower ferritin level might be associated with parent‐reported hyperactivity after controlling for important confounding factors.     

孤独症谱系障碍共患注意力缺陷多动障碍的研究进展

研究发现,很多孤独症谱系障碍(autism spectrum disorders,ASD)儿童伴有不同程度的注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的症状.与单纯ASD儿童相比,共患病儿童的ASD症状更明显,认知功能也受损更严重,其生活也会受到影响.该文对目前共患ADHD的ASD儿童临床表现以及执行功能的相关研究做出综述.     

Thyroid function in a population of children with attention deficit hyperactivity disorder

To determine the prevalence of thyroid hormone abnormalities and generalized resistance to thyroid hormone in a population of children with attention deficit hyperactivity disorder (ADHD) as compared to reference ranges determined from a control population and hence to determine if routine thyroid hormone screening in children with non-familial ADHD is indicated.

Method:

Children attending the State Child Development Centre in Perth, Western Australia with ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) provided the study population. The control population consisted of 353 normal children with a history of allergy in whom radioallergosorbent (RAST) testing was being performed.

Results:

The prevalence of thyroid hormone abnormalities in the study population was 2.3% (95% CI 0.6%, 5.7%). There were no cases of generalized resistance to thyroid hormone. The prevalence of thyroid hormone abnormalities in the general population of children and adolescents has been reported to vary between 1 and 3.7%.

Conclusion:

Routine thyroid hormone screening is not indicated in children with non-familial ADHD.     

注意缺陷多动障碍儿童父母养育方式调查

目的分析注意缺陷多动障碍(ADHD)儿童的行为特征及父母养育态度和行为特征,探讨其临床干预方式。方法采用Conners父母问卷(PSQ)和父母养育方式评价量表(EMBU),对146例6～15岁ADHD儿童及父母进行问卷调查分析。结果与常模对比,ADHD儿童在品行问题、学习问题、心身障碍、冲动-多动、焦虑和多动指数6个因子差异有统计学意义(P<0.01);ADHD家庭父亲在养育过程中的情感温暖、理解,惩罚、严厉,偏爱被试,拒绝、否认,过度保护5个因子差异有统计学意义(P<0.01);母亲在养育过程中情感温暖、理解,拒绝、否认,惩罚、严厉和偏爱被试4个因子差异有统计学意义(P<0.01)。结论 ADHD儿童的父母存在不恰当的养育态度和行为,提示对ADHD儿童应根据个体情况给予药物治疗、心理干预和父母不良教养方式纠正等临床综合治疗。     

A multiple deficit model of reading disability and attention-deficit/hyperactivity disorder: searching for shared cognitive deficits

Background: This study tests a multiple cognitive deficit model of reading disability (RD), attention‐deficit/hyperactivity disorder (ADHD), and their comorbidity. Methods: A structural equation model (SEM) of multiple cognitive risk factors and symptom outcome variables was constructed. The model included phonological awareness as a unique predictor of RD and response inhibition as a unique predictor of ADHD. Processing speed, naming speed, and verbal working memory were modeled as potential shared cognitive deficits. Results: Model fit indices from the SEM indicated satisfactory fit. Closer inspection of the path weights revealed that processing speed was the only cognitive variable with significant unique relationships to RD and ADHD dimensions, particularly inattention. Moreover, the significant correlation between reading and inattention was reduced to non‐significance when processing speed was included in the model, suggesting that processing speed primarily accounted for the phenotypic correlation (or comorbidity) between reading and inattention. Conclusions: This study illustrates the power of a multiple deficit approach to complex developmental disorders and psychopathologies, particularly for exploring comorbidities. The theoretical role of processing speed in the developmental pathways of RD and ADHD and directions for future research are discussed.