1) Central nicotinic cholinergic systems: A role in the cognitive dysfunction in Attention-Deficit/Hyperactivity Disorder?

Potter AS, Newhouse PA, Bucci DJ.

Clinical Neuroscience Research Unit, Department of Psychiatry, College of Medicine, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States.

Behav Brain Res. 2006 Oct 31; [Epub ahead of print]

Theories of the neurobiological basis of Attention-Deficit/Hyperactivity Disorder (ADHD) have largely focused on dysregulation of central dopaminergic function. However, other neurotransmitter systems may be implicated in specific cognitive deficits in ADHD. Interest in the potential involvement of nicotinic cholinergic systems in ADHD has arisen in part from the observation that adolescents and adults with ADHD smoke cigarettes at significantly higher rates than people without this disorder. In addition, several studies report that nicotine alleviates ADHD symptoms, and recent neuro-genetics studies indicate that cholinergic systems may be altered in persons with ADHD. In this review, we describe the evidence for a role of central nicotinic cholinergic systems in cognitive deficits in ADHD. We also propose mechanisms by which alterations in cholinergic function may contribute directly and/or indirectly to these deficits. Finally, we identify specific paradigms and models to guide future investigations into the specific involvement of nicotinic cholinergic systems in ADHD, possibly leading to the development of more effective pharmacotherapies for ADHD.

2) Cognitive Engagement and Story Comprehension in Typically Developing Children and Children With ADHD From Preschool Through Elementary School.

Lorch EP, Milich R, Astrin CC, Berthiaume KS.

Department of Psychology, University of Kentucky, Lexington, KY, US. elorch@uky.edu

Dev Psychol. 2006 Nov; 42(6): 1206-1219.

The present study examined children's cognitive engagement with television as a function of the continuity of central or incidental content and whether this varied with age and clinical status. In Experiment 1, 9- to 11-year-old children's response times on a secondary task were slower the later a probe occurred in a sequence of central events, and response times predicted recall. Experiment 2 extended these results to 6- to 8-year-old children. Experiment 3 revealed that children with attention-deficit/hyperactivity disorder (ADHD) failed to show the pattern consistently observed for comparison children. The results support the hypothesis that typically developing children build a representation during viewing that reflects the causal structure of the televised story but that this skill is deficient in 4- to 9-year-old children with ADHD.

3) Sleep and sleep disorders in adults with attention deficit/hyperactivity disorder.

Philipsen A, Hornyak M, Riemann D.

Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Hauptstrasse 5, 79104 Freiburg, Germany.

Sleep Med Rev. 2006 Nov 2; [Epub ahead of print]

Attention deficit/hyperactivity disorder (ADHD) is a frequent disorder that often persists in adulthood. Persistent ADHD is known to be a serious risk factor for other disorders in adulthood, and adults with ADHD often report on sleep disorders. Despite this, only few studies have investigated the subjective and objective quality of sleep in adults suffering from ADHD. Previous studies have revealed seriously impaired subjective sleep quality and increased nocturnal motor activity in spite of essentially normal standard polysomnographic parameters in this patient group. However, primary sleep disorders such as sleep apnea syndrome or restless legs syndrome (RLS) may be misdiagnosed as ADHD. Moreover, ADHD and primary sleep disorders may occur as comorbidities. In particular, RLS was suggested to be highly associated with ADHD, indicating a probable common central nervous dopaminergic dysfunction. To date, larger studies with adequate sample sizes that compare sleep in adult patients with ADHD, healthy control groups and patients with other primary sleep disorders are still lacking.

4) Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6-15 in Taiwan.

Susan Shur-Fen G.

Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.

J Sleep Res. 2006 Dec;15(4):403-414.

This study investigated the 6-month prevalence rates of sleep-related problems and their association with daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms in children and adolescents. A representative school-based sample of 2463 first to ninth graders was recruited using a multistage sampling method. The instruments included the Sleep Habits Questionnaire (including dyssomnia, parasomnia, sleep schedules, and sleep-disordered breathing), the Chinese Health Questionnaire, and the Chinese versions of the Conners' Parent and Teacher Rating Scales-Revised: Short forms. The informants were mothers and teachers. The linear and nonlinear mixed models were used for statistical analyses and sex and age were controlled in the model. Results showed that the rates of middle insomnia, disturbed circadian rhythm, mouth breathing, and daytime inadvertent napping increased with age; whereas those of bedwetting, bruxism, sleep terrors decreased with age. Dyssomnia, sleep-disordered breathing problems, daytime inadvertent napping, and sleep schedules were related to attention-deficit/hyperactivity disorder (ADHD)-related symptoms as assessed by mothers' and teachers' ratings. Parasomnia was associated with ADHD-related symptoms as assessed by mothers' ratings. Our findings suggest an age trend of sleep problems similar to those found in the literature and the association of daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms with sleep-related problems.

5) Quality of Life Assessment in Adult Patients With Attention-deficit/Hyperactivity Disorder Treated With Atomoxetine.

Adler LA, Sutton VK, Moore RJ, Dietrich AP, Reimherr FW, Sangal RB, Saylor KE, Secnik K, Kelsey DK, Allen AJ.

*Department of Psychiatry, New York University School of Medicine, New York, NY; daggerLilly Research Laboratories, Indianapolis, IN; double daggerNeuropsychiatric Associates, Woodstock, VT; section signDepartment of Psychiatry, University of Utah Health Science Center, Salt Lake City, UT; parallelClinical Neurophysiology Services, Troy, MI and paragraph signNeuroScience, Inc, Bethesda, MD.

J Clin Psychopharmacol. 2006 Dec;26(6):648-652

BACKGROUND:: Attention-deficit/hyperactivity disorder (ADHD) has its onset during childhood and is estimated to affect 3% to 7% of school-aged children. Unfortunately, the disorder frequently persists into adult life. The burden of this disorder is considerable and is often characterized by academic (or occupational) impairment and dysfunction within the family and society. Despite the existence of research demonstrating the effects of ADHD on certain aspects of life, the clinical trials of treatments for this disorder have focused primarily on efficacy and safety.

METHODS:: Atomoxetine was approved in the United States in November 2002 for the treatment of ADHD in children, adolescents, and adults. The present study uses data from a clinical trial of atomoxetine in adult patients with ADHD that incorporated a measure of health-related quality of life (the Medical Outcomes Study 36-item short-form health survey [SF-36]) as part of the overall assessment of the success of this relatively new treatment. The primary outcome measure for ADHD symptoms was the Conners Adult ADHD Rating Scale-Investigator Rated: Screening Version (CAARS) ADHD total symptom score.

RESULTS:: In agreement with previous studies, adult patients with ADHD treated with atomoxetine at typical doses showed significant amelioration of ADHD symptoms, as measured on the CAARS. At baseline, the measures of overall mental health (one aspect of quality of life) of adult patients with ADHD were below the average level, as measured on the SF-36. Treatment with atomoxetine significantly improved the measures of mental health and ameliorated the ADHD symptoms. In addition, the 2 measures were correlated.

CONCLUSIONS:: These data suggest that pharmacological intervention with atomoxetine not only ameliorates ADHD symptoms in adult patients but also improves their perceived quality of life.