The Effect of Long-Acting Methylphenidate and Modafinil on Attention and Impulsivity of Children with ADHD using a Continuous Performance Test: A Comparative Study.

Objectives: Given the importance of having a continuous performance for the academic and social life of children with attention-deficit/hyperactivity disorder (ADHD), in this study, a Continuous Performance Test (CPT) was used to compare the effect of long-acting methylphenidate and modafinil on attention and impulsivity of these children. Materials & Methods: A randomized clinical trial was conducted on 50 children with ADHD aged 6 to 12 years in the child and adolescent psychiatric departments of Imam Hossein and Mofid hospitals, Tehran, Iran. The children were selected by availability sampling and randomly assigned into two equal groups (n=25 in each). While the first group was treated with long-acting methylphenidate, the second was treated with modafinil for 14 days. The CPT was carried out before and after the treatment. The obtained data were analyzed by F and t tests. Results: Long-acting methylphenidate and modafinil were both effective in improving attention and impulsivity in children with ADHD. There was no significant difference between the two drugs in terms of effectiveness on attention and impulsivity. Conclusion: The findings of this study showed that long-acting methylphenidate and modafinil are equally effective in improving attention and impulsivity in children with ADHD aged 6 to 12 years.

Experiences of parents of children with psychiatric disorder from Covid-19 pandemic and its related quarantine: A qualitative study.

Introduction: Owing to the considerable mortality caused by Covid-19, different countries have made some decisions for dealing with this virus, one of which was quarantine. It was shown that a range of behavioral and emotional changes may exacerbate in children while staying more at home, and parents may then experience these positive or negative behavioral changes. The present study was conducted to examine the experiences of families with children with psychiatric disorders in a psychiatric outpatient clinic in Iran. Method: The phenomenological method, which is a qualitative approach, was used in this study. The population was the parents of children with psychiatric disorders referred to the pediatric psychiatric clinic of Imam Hossein Hospital. Sampling was purposeful, which continued until data saturation. Finally, the number of included participants reached 14. As well, the Colaizzi method was used for data analysis. Results: The results of this study included 12 secondary codes and 10 tertiary codes, which were divided into three main thematic groups as follows: effective factors for improving behavior, effective factors for worsening behavior, and affective factors on creating a new behavior during quarantine. Conclusion: In conclusion, quarantine, social restrictions, closure of schools, and online classes can affect the mental health status of children and adolescents in different ways, especially in children with a history of psychiatric disorders.

Relation between ADHD and COVID-19: A Narrative Review to Guide Advancing Clinical Research and Therapy.

Objective: To cope with the COVID-19 pandemic, national health authorities temporarily closed cultural, religious, and educational institutions such as universities and schools. Children and adolescents with ADHD were challenged with the restrictions caused by the Covid-19 pandemic such as homeschooling and reduced physical activity. The present narrative review aimed to summarize the state-of-the-art regarding associations between COVID-19-related social restrictions and possible psychological and behavioral issues in children and adolescents with ADHD. Additionally, we discussed the underlying possible reasons of the association focusing on the role of parental influence and physical activity, vulnerabilities of individuals with ADHD to Covid-19 infection and to school closure and remote learning. Method: To collect data for the present narrative review, recent publications on these topics between February 1st, 2020 and January 10th, 2021 were retrieved from the most popular search engines (PubMed; Scopus; Google Scholar; Psych Info; Embase) through a comprehensive search using relevant keywords. Results: During confinement, children and adolescents with ADHD reported increased behavioral and ADHD-related symptoms and overall decreased psychological well-being. Factors negatively impacting children's and adolescents' behavioral symptoms and well-being were: less physical activity, adverse parental behavior, difficulties in coping with preventive guidelines, and school closure and remote learning consequences. Conclusion: Children and adolescents with ADHD and their caregivers faced both specific and general psychological issues related to the school lockdowns and homeschooling. Additionally, Individuals with ADHD seem to be more vulnerable to Covid-19 infection which highlights the need for better healthcare adaptation.

An investigation into the frequency of addiction to video games in children with attention-deficit hyperactivity disorder.

BACKGROUND AND OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is known as the most common neurological disorder in childhood. Failure to timely diagnose ADHD can lead to harmful effects for the individual and the family. The relationship between this disorder and the addiction to video games has been reported in children. Therefore, this study aimed to investigate the degree of addiction to video games in Iranian children with ADHD, compared with normal children. MATERIALS AND METHODS: In this applied research, 99 children with ADHD referring to Imam Hossein Hospital and 99 normal children in elementary schools of Tehran (control group) were recruited. Data were collected using Conner's Scale and Young's Internet Addiction Test (video games). The data were analyzed using SPSS (version 22). RESULTS: In this study, 11% of the children with ADHD and 4% of the normal children had addiction to video games. This difference was significant between the two groups (P < 0.05). Moreover, 58% of the children with ADHD and 27% of the normal children were exposed to video games. This difference was also significant between the two groups (P < 0.05). CONCLUSION: The results showed that the frequency and prevalence of addiction to video games were higher in children with ADHD than in normal children. Therefore, it can be concluded that timely diagnosis of this disorder leads to better treatment.

Association between Attention Deficit Hyperactivity Disorder and Suicide Attempts in Patients with Bipolar Disorder.

Objective: The present study aimed to examine the association between ADHD and suicide attempts among adolescents with bipolar disorder. Method : Participants were 168 adolescents who fulfilled DSM-IV-TR criteria for bipolar disorder. They were divided into 2 groups: The first group of patients with bipolar disorder with a history of suicide attempts (n = 84) and the second group without a history of suicide attempts (n = 84). ADHD and other variables were analyzed using a chi-squared test and logistic regression model. Results: No significant difference was observed between the 2 groups in comorbidity of ADHD and other psychiatric disorders (P > 0/05). In the logistic regression model, and after controlling for other factors, gender (OR = 3.9, CI 95%: 1.5-9.6) and history of sexual abuse (OR = 3.4; CI 95%: 1.06-11.3) were the only 2 factors associated with a history of suicide attempts. Conclusion: No significant association was found between ADHD and suicide attempts in adolescents with bipolar disorder.

The data on the relationship between polymorphism of HTR1B and DBH genes and attention-deficit hyperactivity disorder in adults with or without substance use disorders.

There is a positive relationship between attention-deficit hyperactivity disorder and tendency toward drug use in numerous studies. The present study was aimed to investigate the relationship between polymorphism of serotonin receptor 1B gene (HTR1B) and Dopamine beta-hydroxylase gene (DBH) with attention-deficit hyperactivity disorder in adults with or without substance use disorders. In the present case-control study, as many as 355 individuals entered the present study and was categorized in different groups: control healthy group, substance use disorders group, and attention-deficit hyperactivity disorder group. For confirming attention-deficit hyperactivity disorder in adults, demographic and Conners forms were used. Moreover, SCID-I questionnaire was used to confirm or reject the individual׳s suffering from substance use disorders and other psychiatric diseases. The polymorphism of abovementioned genes was conducted by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). In case of DBH gene-Rs2519152, the findings indicated that TT, TC, and CC genotypes and T and C alleles are not different in the attention-deficit hyperactivity disorder group, substance use disorder group, the group with patients suffering from both disorders, and control group. Moreover, the frequency of TT, TA, and AA genotypes as well as T and A alleles was same in the attention-deficit hyperactivity disorder group, substance use disorder group, the group with patients suffering from both disorders, and control group.

Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial.

OBJECTIVES: Previous studies have shown that serum levels of vitamin D were lower in attention deficit hyperactivity disorder (ADHD) children compared to healthy controls. The aim of the study was to determine the effect of vitamin D supplementation as adjunctive therapy to methylphenidate on symptoms of children with ADHD. METHODS: Sixty-two children aged 5-12 years with a diagnosis of ADHD based on DSM-IV criteria were randomly assigned into two groups to receive either 2000IU vitamin D or placebo in addition to methylphenidate for 8 weeks. Symptoms severity was assessed by Conner's Parent Rating Scale-Revised[S] (CPRS), ADHD rating scale-IV (ADHD-RS), and Weekly Parent Ratings of Evening and Morning Behavior (WPREMB) at weeks 0, 4, and 8. Serum levels of 25(OH)D were measured at baseline and after 8 weeks. Anthropometric variables, dietary intake, physical activity, sun exposure, and side effects were assessed. RESULTS: Fifty-four participants completed the trial. After 8 weeks of supplementation, serum levels of 25(OH)D significantly increased in the vitamin D group. ADHD symptoms decreased significantly in both groups (P < 0.05). Evening symptoms and total score of WPREMB scale were significantly different at weeks 4 and 8 between the two groups (P = 0.013, 0.016, respectively), but no differences were found in symptoms by CPRS and ADHD-RS scales. DISCUSSION: Vitamin D supplementation as adjunctive therapy to methylphenidate improved ADHD evening symptoms. Future research is needed to clarify vitamin D effects as monotherapy in ADHD and its mechanism. The trial was registered in www.irct.ir is (IRCT201404222394N10).

Efficacy of Polyunsaturated Fatty Acids (PUFA) in the Treatment of Attention Deficit Hyperactivity Disorder.

OBJECTIVE: We aimed to investigate the efficacy of polyunsaturated fatty acids (PUFAs) as an adjuvant treatment in patients with ADHD receiving methylphenidate as well as its side effects. METHOD: This randomized clinical trial was conducted on 40 ADHD patients aged between 6 and 12 years. Both treatment and placebo groups received methylphenidate. Treatment arm also received omega-6 once daily. The Parent ADHD Rating Scale was used to evaluate disease improvement. RESULTS: The Parent ADHD Rating Scale scores of the two groups were similar at baseline. Although total score and scores of three categories decreased significantly in both groups, total score and scores of inattention, hyperactivity, and impulsivity were not significantly different between the groups. CONCLUSION: The results did not support the efficacy of PUFA in the treatment of ADHD, and adding PUFAs to the therapeutic regimen of ADHD is not recommended at the moment.

Comparison of Creativity between Children with and without Attention Deficit Hyperactivity Disorder: A Case-Control Study.

OBJECTIVE: The aim of this study was to compare creativity in children with and without attention deficit hyperactivity disorder. METHOD: This was an analytic and descriptive study. Participants were 33 children aged 7-12 years selected from a child and adolescent psychiatric clinic at Imam Hossein hospital (Tehran, Iran), who were diagnosed with ADHD by a child and adolescent psychiatrist. They met the DSM-IV diagnostic criteria for ADHD and had no comorbidity according to K-SADS (Kiddi-Scadule for Affective disorders and Schizophrenia). They were requested not to take any medication. They took the Figural TTCT (Torrance Test of Creativity Thinking) and Raven Intelligence test after using medication. Thirty-three age and sex-matched children selected from the regional schools were recruited for the control group. They did not have any psychiatric disorders according to K-SADS. The Figural TTCT and Raven Intelligence test were conducted for the controls as well. RESULTS: No statistically significant difference was found in the intelligence score and the mean±SD of the total score of creativity between children with ADHD (125.2 ± 42.6) and the control group (130.6 ± 47.5) (P value = 0.49). Children with ADHD had worse function in fluency and flexibility items and were not different in originality and elaboration items. CONCLUSION: The creativity of children with ADHD is not different from that of the control group.

No Evidence for Association Between Norepinephrine Transporter-3081 (A/T) Polymorphism and Attention Deficit Hyperactivity Disorder in Iranian Population.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) can lead to drastic problems for the patient and its worldwide prevalence is 5%-12%. It also has many comorbidities with other disorders, and the genetic contribution seems the most significant cause. OBJECTIVES: The current study was conducted to investigate the association between norepinephrine transporter-3081 (A/T) polymorphisms and ADHD in Iranian population. PATIENTS AND METHODS: Participants were chosen from children and adolescents diagnosed with ADHD referred to Imam Hoseyn Hospital. A child and adolescent psychiatrist confirmed the diagnosis using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL) semi-structural interview. The control group was from pupils of schools in Tehran (capital city of Iran) who had no history or presence of psychiatric and medical complications. Also, a child and adolescent psychiatrist confirmed their health using the K-SADS-PL semi-structural interview. Genetic examinations were DNA distraction, Polymerase Chain Reaction (PCR), and Restricted Fragment Length Polymorphism (RFLP), which were conducted according to standard protocols. The statistical analysis was performed using chi-square and Fisher's exact test in SPSS version 21. RESULTS: The percentages of ADHD subtypes for combined, inattentive, and hyperactive/impulsive were 72.2%, 17.2%, and 11.9%, respectively. There was no significant association between norepinephrine transporter polymorphism and ADHD (P = 0.81). Moreover, no significant relationship was found between gender [male (P = 0.92) and female (P = 0.63)] and polymorphism. No significant association was found between subtypes of ADHD [combined (P = 0.46), inattentive (P = 0.41), hyperactive/impulsive (P = 0.32)] and polymorphism SCL6A2. This lack of association can also be seen in gender in every subtype. CONCLUSIONS: The results of the study show no significant association between norepinephrine transporter polymorphism SCL6A2 and ADHD.

Monoamine oxidase a gene polymorphisms and bipolar disorder in Iranian population.

BACKGROUND: Bipolar disorder (BPD) is a common and severe mood disorder. Although genetic factors have important rolesin the etiology of bipolar disorder, no specific gene has been identified in relation to this disorder. Monoamine oxidase gene is suggested to be associated with bipolar disorder in many studies. OBJECTIVES: This study aimed to investigatethe role of MAOA gene polymorphisms in the etiology of bipolar disorder in Iranian population. PATIENTS AND METHODS: This study is a case-control study, with convenient sampling. Three common polymorphisms, a CA microsatellite, a VNTR, and a RFLP were typed in 156 bipolar patients and 173 healthy controls. Patients were chosen from Imam Hossein General Hospital, Psychiatry Ward (Tehran/Iran). Controlsamples for this study consisted of 173 healthy individuals recruitedby convenient sampling. Allelic distributions of these polymorphisms were analyzed in bipolar and control groups to investigate any association with MAOA gene. RESULTS: Significant associations were observed regarding MAOA-CA (P = 0.016) and MAOA-VNTR (P = 0.004) polymorphisms in the bipolar females. There was no association between MAOA-RFLP and bipolar disorder. CONCLUSIONS: The obtained results confirm some previous studies regardinga gender specific association of MAOA gene with the bipolar disorder.

How Mental Illness is Perceived by Iranian Medical Students: A Preliminary Study.

The study aimed to assess medical students' attitudes toward mental illness following a 4-week psychiatry clerkship. All fifth-year medical students from three academic centers in Tehran were asked to participate in the study. They completed the questionnaire on the last day of their 4-week psychiatry clerkship. A self-administered questionnaire was used to examine participants' Attitudes Toward Mental Illness (ATMI). One hundred and sixty eight students completed the questionnaires (88.9% response rate). In general, the students had favorable attitudes toward mental illness at the end of their clerkship, with mean (± SD) ATMI total score of 78.6 (± 8.1) (neutral score, 66.0). The students showed the most favorable opinion (95.2%) about Category 5 (stereotypic attitude toward people with mental illness) whilst they revealed the least favorable opinion (64.3%) regarding Category 1 (social relations with people affected by mental illness). In addition, the students thought that movies were on the top of influential media on shaping the attitudes toward mental illness. Overall, most of Iranian medical students had generally favorable attitudes toward people with mental illness at the end of their clerkship. Therefore, it may be expected next generation of medical doctors show more favorable attitude toward mental illness.

Buspirone versus methylphenidate in the treatment of attention deficit hyperactivity disorder: a double-blind and randomized trial.

The efficacy and side effects of buspirone compared with methylphenidate (MPH) in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). A total of 34 children with ADHD as defined by DSM-IV-TR were randomized to buspirone or methylphenidate dosed on weight-adjusted basis at buspirone (0.5 mg/kg/day) and methylphenidate (0.3-1 mg/kg/day) for a 6-week double-blind clinical trial. The principle measures of outcome were the teacher and parent ADHD Rating Scale. The side effects were assessed by the special side effect checklist of each drug. In both groups, the scores of teacher and parent ADHD Rating Scale significantly declined on the 6th week as compared to baseline (p = 0.001). These effects were observed in the subscales too. No significant differences were observed between the two protocols on the total scores of parent and teacher ADHD Rating Scale, but methylphenidate was superior to buspirone in decreasing the symptoms of inattention. The side effects of buspirone were mild and rare in comparison with MPH. Buspirone has a favorable side-effects profile. It also has clinically and statistically significant impacts on improving the ADHD symptoms in children. These preliminary findings of the efficacy of buspirone in children with ADHD need large and cross-over studies.

A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: psychometric properties.

OBJECTIVE: The aim of this study is to assess the reliability and validity of a Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders (SCID-I) through a multicenter study in a clinical population in Iran. METHOD: The sample consisted of 299 subjects admitted to outpatient or inpatient services of 3 psychiatric centers in Tehran, Iran. The SCID was administered by trained interviewers. To study the test-retest reliability, a second independent SCID interview was administered to 104 of the entire sample within 3 to 7 days of the first interviews. For the assessment of validity, the SCID diagnoses were compared with the consensus clinical diagnoses made by 2 psychiatrists for all 299 patients. RESULTS: Diagnostic agreements between test and retest SCID administration were fair to good for most diagnostic categories. Overall weighted kappa was 0.52 for current diagnoses and 0.55 for lifetime diagnoses. Specificity values for most psychiatric disorders were high (>0.85); the sensitivity values were somewhat lower. CONCLUSIONS: The Persian translation of the SCID yields diagnoses with acceptable to good reliability and validity in a clinical population in Iran. This supports the cross-cultural use of the instrument.

Diagnostic stability in patients with first-episode psychosis.

OBJECTIVE: To examine the short-term stability of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) and International Classification of Diseases (10th revision; ICD-10) diagnoses in a group of patients with first-episode psychosis. METHOD: Sixty patients with first-episode psychosis admitted consecutively to Roozbeh Hospital, Tehran, were sampled; their illnesses could not be attributed to any medical or substance-induced conditions. Patients were assessed at the time of discharge from the hospital, and at 3, 6 and 12 month intervals following admission. At each visit, two psychiatrists made consensus DSM-IV and ICD-10 diagnoses, based on all available information. Stability was discerned as the consistency between diagnoses at the time of discharge and at 12 month follow up. RESULTS: Forty-eight patients completed follow up. Affective psychotic disorders and schizophrenia in both classification systems were highly stable. In addition, all patients with DSM-IV brief psychotic disorder and ICD-10 acute and transient psychotic disorders remained the same at follow up. CONCLUSIONS: Affective psychoses and schizophrenia, in line with previous findings, remained stable. Diagnoses of brief psychoses were highly stable as well; this could reflect a non-relapsing course of acute brief psychoses, especially in developing countries.

Selegiline in the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial.

Attention deficit hyperactivity disorder (ADHD) is a common disorder of childhood that affects 3% to 6% of school-age children. Conventional stimulant medications are recognized by both specialists and parents as useful symptomatic treatment. Nevertheless, approximately 30% of ADHD children treated with them do not respond adequately or cannot tolerate the associated adverse effects. Such difficulties highlight the need for alternative safe and effective medications in the treatment of this disorder. Selegiline is a type B monoamine oxidase inhibitor (MAOI) that is metabolized to amphetamine and methamphetamine stimulant compounds that may be useful in the treatment of ADHD. The authors undertook this study to further evaluate, under double-blind and controlled conditions, the efficacy of selegiline for ADHD in children. A total of 28 children with ADHD as defined by DSM IV were randomized to selegiline or methylphenidate dosed on an age and weight-adjusted basis at selegiline 5 mg/day (under 5 years) and 10 mg/day (over 5 years) (Group 1) and methylphenidate 1 mg/kg/day (Group 2) for a 4-week double-blind clinical trial. The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist at baseline, 14 and 28 days after the medication started. No significant differences were observed between the two protocols on the Parent and Teacher Rating Scale scores. Although the number of dropouts in the methylphenidate group was higher than in the selegiline group, there was no significant difference between the two protocols in terms of the dropouts. Decreased appetite, difficulty falling asleep and headaches were observed more in the methylphenidate group. The results of this study must be considered preliminary, but they do suggest that selegiline may be beneficial in the treatment of ADHD. In addition, a tolerable side effect profile may be considered as one of the advantages of selegiline in the treatment of ADHD.