Attention Deficit Hyperactivity Disorder: the current debate and neglected dimensions..

Blew H, Kenny G.

Musgrove Park Hospital, Taunton, UK.

J Child Health Care. 2006 Sep;10(3):251-63.

The aim of this article is to identify and highlight the issues facing children, young people and families experiencing Attention Deficit Hyperactivity Disorder (ADHD) in an United Kingdom context. In presenting these issues it is hoped that wider discussion and awareness of the challenges of this condition may have an effect on the planning and delivery of services within the UK. We seek to highlight that an overreliance on a medical perspective has the effect of neglecting the wider context of the rights of the child and the needs of the family. We advocate for an approach that recognizes the importance of the contributions of other professionals and the implementation of locally-agreed guidelines that incorporate the perspectives of families and the rights of the child.

Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder..

Chronis AM, Gamble SA, Roberts JE, Pelham WE Jr.

University at Buffalo, State University of New York.

Behav Ther. 2006 Jun;37(2):143-58. Epub 2006 Mar 29.

An adaptation of the Coping With Depression Course (CWDC) was evaluated in mothers of children with attention-deficit/hyperactivity disorder (ADHD), a population at risk for depression. Mothers were randomly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child's behavior or after a wait-list period. Measures of maternal functioning, cognitions about child behavior, parent-child and marital relationship quality, child behavior, and ADHD-related family impairment were obtained at pretreatment, posttreatment, and 5-month follow-up. The CWDC resulted in improvements in maternal depressive symptoms, maternal self-esteem, child-related cognitions, and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up. Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD, particularly those with current depressive symptomatology.

Functional and psychosocial impairment in adults with undiagnosed ADHD.

Able SL, Johnston JA, Adler LA, Swindle RW.

US Outcomes Research, Lilly Research Laboratories, Indianapolis, IN, USA.

Psychol Med. 2006 Aug 29;:1-11 [Epub ahead of print]

BACKGROUND. Identify a group of adults with 'undiagnosed' attention deficit hyperactivity disorder (ADHD) and compare their personal and family medical histories, psychosocial profiles, functional impairment and quality of life with non-ADHD controls. Additionally, compare adults with undiagnosed and diagnosed ADHD to investigate possible reasons why the undiagnosed avoid clinical detection.

METHOD. ICD-9 codes for ADHD in administrative claims records and responses to a telephone-administered adult ADHD screener [the Adult ADHD Self-Report Scale (ASRS)] were used to classify approximately 21000 members of two large managed health-care plans as 'undiagnosed' (no coded diagnosis; ASRS positive) or 'non-ADHD' controls (no coded diagnosis; ASRS negative). Patients identified as 'undiagnosed' ADHD were compared with samples of non-ADHD controls and 'diagnosed' ADHD patients (ICD-9 coded ADHD diagnoses) on the basis of demographics, socio-economic status, past and present mental health conditions, and self-reported functional and psychosocial impairment and quality of life.

RESULTS. A total of 752 'undiagnosed' ADHD subjects, 199 'non-ADHD' controls and 198 'diagnosed' ADHD subjects completed a telephone interview. Overall, the 'undiagnosed' ADHD cohort demonstrated higher rates of co-morbid illness and greater functional impairment than 'non-ADHD' controls, including significantly higher rates of current depression, and problem drinking, lower educational attainment, and greater emotional and interpersonal difficulties. 'Undiagnosed' ADHD subjects reported a different racial composition and lower educational attainment than 'diagnosed' ADHD subjects.

CONCLUSION. Individuals with 'undiagnosed' ADHD manifest significantly greater functional and psychosocial impairment than those screening negative for the disorder, suggesting that ADHD poses a serious burden to adults even when clinically unrecognized.

Association between polymorphisms in serotonin transporter gene and attention deficit hyperactivity disorder in Chinese Han subjects.

Li J, Wang Y, Zhou R, Zhang H, Yang L, Wang B, Faraone SV.

Institute of Mental Health, Peking University (Peking University Sixth Hospital), Beijing, PR China.

Am J Med Genet B Neuropsychiatr Genet. 2006 Aug 29; [Epub ahead of print]

Prior work has shown reduced serotonin transmission to be associated with impulsivity and behavioral problems. The current study assessed the association between ADHD and two variants of the serotonin transporter gene: the 44-bp deletion/insertion polymorphism (5-HTTLPR) and the 17 bp-repeat polymorphism in intron 2 (STin2.VNTR). We hypothesized that ADHD phenotypes associated with impulsivity would show an association with these variants. Two-hundred and ninety-three ADHD trios were genotyped and analyzed using transmission disequilibrium test (TDT) analysis and haplotype analysis. We found no association between the STin2.VNTR and ADHD, but did find preferential transmission of the S allele of the 5-HTTLPR polymorphism (chi(2) = 5.751, P = 0.016) to probands with ADHD. Haplotype analysis found the L/10 haplotype was over-transmitted (chi(2) = 6.172, P = 0.013), while L/12 was under-transmitted to probands with ADHD (chi(2) = 4.866, P = 0.027). (c) 2006 Wiley-Liss, Inc.

Test-retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR.

Leung PW, Kwong SL, Tang CP, Ho TP, Hung SF, Lee CC, Hong SL, Chiu CM, Liu WS.

Department of Psychology, The Chinese University of Hong Kong, Hong Kong.

J Child Psychol Psychiatry. 2006 Sep;47(9):970-3.

Psychometric properties of the Chinese version of CBCL, TRF, and YSR were understudied. This study aimed at examining their test-retest reliability and criterion validity. Three Chinese community and clinic samples were recruited in Hong Kong. The parents, teachers, and youths respectively completed the CBCL, TRF, and YSR. The Chinese CBCL, TRF, and YSR were test-retest reliable and valid. However, there was score/case attenuation at retest. CBCL and TRF appeared to screen externalizing and ADHD problems better, while YSR screened internalizing problems better. Clinicians should be cautious about score/case attenuation at retest while using CBCL, TRF, and YSR to chart patients' progress. They should also recognize their different strengths in screening various disorders.

Treatment of ADHD with French maritime pine bark extract, Pycnogenol®

Jana Trebatická, Sona Kopasová, Zuzana Hradecná, Kamil Cinovský, Igor Škodácek, Ján Šuba, Jana Muchová, Ingrid Žitnanová, Iweta Waczulíková, Peter Rohdewald, Zdenka Duracková

European Child & Adolescent Psychiatry, Volume 15, Number 6 / September, 2006 p.329-335

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder in children. Pycnogenol®, an extract from the bark of the French maritime pine, consisting of phenolic acids, catechin, taxifolin and procyanidins, has shown improvement of ADHD in case reports and in an open study. Aim of the present study was to evaluate the effect of Pycnogenol® on ADHD symptoms. Sixty-one children were supplemented with 1 mg/kg/day Pycnogenol® or placebo over a period of 4 weeks in a randomised, placebo-controlled, doubleblind study. Patients were examined at start of trial, 1 month after treatment and 1 month after end of treatment period by standard questionnaires: CAP (Child Attention Problems) teacher rating scale, Conner’s Teacher Rating Scale (CTRS), the Conner’s Parent Rating Scale (CPRS) and a modified Wechsler Intelligence Scale for children. Results show that 1-month Pycnogenol® administration caused a significant reduction of hyperactivity, improves attention and visual–motoric coordination and concentration of children with ADHD. In the placebo group no positive effects were found. One month after termination of Pycnogenol® administration a relapse of symptoms was noted. Our results point to an option to use Pycnogenol as a natural supplement to relieve ADHD symptoms of children.

Relative Benefits of Stimulant Therapy With OROS Methylphenidate Versus Mixed Amphetamine Salts Extended Release in Improving the Driving Performance of Adolescent Drivers With Attention-Deficit/Hyperactivity Disorder.

Daniel J. Cox, R. Lawrence Merkel, Melissa Moore, Frances Thorndike, Carrie Muller, and Boris Kovatchev

Department of Psychiatric Medicine, University of Virginia, Charlottesville, Virginia

Pediatrics 2006;118 e704-e710

OBJECTIVE. Automobile accidents are the leading cause of death among adolescents, and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder. Studies have demonstrated that stimulants improve driving performance. This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations.

METHODS. Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylphenidate, 30 mg of mixed amphetamine salts extended release, or placebo in a randomized, double-blind, placebo-controlled, crossover study design. During laboratory testing, adolescents drove a driving simulator at 5:00 PM, 8:00 PM, and 11:00 PM. Driving performance was rated by adolescents and investigators.

RESULTS. The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder (19 boys/16 girls). The mean age was 17.8 years. The overall Impaired Driving Score demonstrated that OROS methylphenidate led to better driving performance compared with placebo and mixed amphetamine salts extended release, whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo. Specifically, relative to placebo, OROS methylphenidate resulted in less time driving off the road, fewer instances of speeding, less erratic speed control, more time executing left turns, and less inappropriate use of brakes. OROS methylphenidate and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder.

CONCLUSIONS. This study validates the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder. In the study, OROS methylphenidate promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release.