RESUMO
Objective.Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children. While numerous intelligent methods are applied for its subjective diagnosis, they seldom consider the consistency problem of ADHD biomarkers. In practice, these data-driven approaches lead to varying learned features for ADHD classification across diverse ADHD datasets. This phenomenon significantly undermines the reliability of identified biomarkers and hampers the interpretability of these methods.Approach.In this study, we propose a cross-dataset feature selection (FS) module using a grouped SVM-based recursive feature elimination approach (G-SVM-RFE) to enhance biomarker consistency across multiple datasets. Additionally, we employ connectome gradient data for ADHD classification. In details, we introduce the G-SVM-RFE method to effectively concentrate gradient components within a few brain regions, thereby increasing the likelihood of identifying these regions as ADHD biomarkers. The cross-dataset FS module is integrated into an existing binary hypothesis testing (BHT) framework. This module utilizes external datasets to identify global regions that yield stable biomarkers. Meanwhile, given a dataset which waits for implementing the classification task as local dataset, we learn its own specific regions to further improve the performance of accuracy on this dataset.Main results.By employing this module, our experiments achieve an average accuracy of 96.7% on diverse datasets. Importantly, the discriminative gradient components primarily originate from the global regions, providing evidence for the significance of these regions. We further identify regions with the high appearance frequencies as biomarkers, where all the used global regions and one local region are recognized.Significance.These biomarkers align with existing research on impaired brain regions in children with ADHD. Thus, our method demonstrates its validity by providing enhanced biological explanations derived from ADHD mechanisms.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Biomarcadores , Máquina de Vetores de Suporte , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Humanos , Biomarcadores/análise , Criança , Masculino , Feminino , Conectoma/métodos , Encéfalo/metabolismo , Bases de Dados Factuais , Reprodutibilidade dos TestesRESUMO
The heterogeneous presentation of inattentive and hyperactive-impulsive core symptoms in attention deficit hyperactivity disorder (ADHD) warrants further investigation into brain network connectivity as a basis for subtype divisions in this prevalent disorder. With diffusion and resting-state functional magnetic resonance imaging data from the Healthy Brain Network database, we analyzed both structural and functional network efficiency and structure-functional network (SC-FC) coupling at the default mode (DMN), executive control (ECN), and salience (SAN) intrinsic networks in 201 children diagnosed with the inattentive subtype (ADHD-I), the combined subtype (ADHD-C), and typically developing children (TDC) to characterize ADHD symptoms relative to TDC and to test differences between ADHD subtypes. Relative to TDC, children with ADHD had lower structural connectivity and network efficiency in the DMN, without significant group differences in functional networks. Children with ADHD-C had higher SC-FC coupling, a finding consistent with diminished cognitive flexibility, for all subnetworks compared to TDC. The ADHD-C group also demonstrated increased SC-FC coupling in the DMN compared to the ADHD-I group. The correlation between SC-FC coupling and hyperactivity scores was negative in the ADHD-I, but not in the ADHD-C group. The current study suggests that ADHD-C and ADHD-I may differ with respect to their underlying neuronal connectivity and that the added dimensionality of hyperactivity may not explain this distinction.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Conectoma , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Cognição , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
BACKGROUND: Approximately half of the children with attention-deficit hyperactivity disorder continue to meet diagnostic criteria in adulthood. The prevalence of adult attention-deficit hyperactivity disorder is reported between 2.5% and 4.4% and is associated with significant impairment in quality of life and increased psychiatric comorbidity. Attention-deficit hyperactivity disorder in adults remains mostly undiagnosed and/or untreated despite the availability of effective treatments. The majority of people who do not receive necessary treatment are in the nonclinical or nonpsychiatric clinical population. Screening is an important step for diagnosing adults with attention-deficit hyperactivity disorder. Yet, there are no valid and reliable screening questionnaires calibrated for the Diagnostic and Statistical Manual for Mental Disorders-5 in Turkish. AIMS: We aimed to test the reliability and the validity of the Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 screening questionnaire designed according to DSM-5 in the Turkish population. STUDY DESIGN: Methodological and cross-sectional study. METHODS: The translation was carried out according to the World Health Organization Composite International Diagnostic Interview translation guide using a linguistic adaptation approach. We used a convenience sampling method to recruit an individual with adult attention-deficit hyperactivity disorder (n = 68) and a control group (n = 68). The participants completed a sociodemographic form, 6-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, and the previous version 18-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 for the concurrent validity analysis. For the diagnostic validity, clinical diagnosis made by psychiatrists according to the Diagnostic and Statistical Manual for Mental Disorders-5 criteria was used. Internal consistency and item-total correlation coefficients, exploratory factor analyses, correlation with Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1, and receiver operating characteristic curve analysis were conducted. RESULTS: The internal consistency measured by Cronbach alpha was 0.869. Item-total correlation coefficients were calculated to be between 0.602 and 0.717, and the correlations were statistically significant (P < 0.0001). The Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 showed to have a unidimensional factor structure explaining 60.54% of the variance. The correlation between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 total score was calculated as 0.992 (P < 0.0001), and that between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 attention-deficit subdimension was 0.868 (P < 0.0001). In the receiver operating characteristic analysis of Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, the area under the curve was found to be 0.916. The cut-off score was calculated as 9 of 10 with a sensitivity of 85.2% and specificity of 89.7%. CONCLUSION: Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 is a valid and reliable self-report measure to assess and screen attention-deficit hyperactivity disorder in the Turkish population. It may be useful for both clinical and population studies.
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Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Programas de Rastreamento/normas , Autorrelato/normas , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Reprodutibilidade dos Testes , Autorrelato/estatística & dados numéricos , Tradução , TurquiaRESUMO
AIM: Previously, we reported on the efficacy and safety of guanfacine extended-release (GXR) in Japanese adults with attention-deficit/hyperactivity disorder (ADHD) from a phase 3, double-blind, placebo-controlled, randomized trial. In this exploratory post hoc analysis, we assessed the efficacy and/or safety of GXR in the following subgroups: ADHD-combined (ADHD-C) and ADHD-predominantly inattentive (ADHD-I) subtypes, age (≥31, <31 years), sex (male, female), and body weight (≥50, <50 kg). METHODS: The primary efficacy endpoint was change from baseline in the Japanese version of the investigator-rated ADHD-Rating Scale-IV (ADHD-RS-IV) with adult prompts (total scores) at week 10. RESULTS: The efficacy analysis population included 200 patients (GXR, 100; placebo, 100). ADHD-RS-IV total score effect sizes (GXR vs placebo) were similar across all subgroups (total population: 0.52, ADHD-C: 0.51, ADHD-I: 0.52, ≥31 years: 0.61, <31 years: 0.47, male: 0.50, female: 0.57). There were no major differences in the incidence/types of treatment-emergent adverse events (TEAEs) across the subgroups. The incidence of significant TEAEs (34.3%, 10.6%) and TEAEs leading to discontinuation (34.3%, 12.1%) were approximately three times higher in females than males, respectively. The incidence of TEAEs in patients weighing <50 kg and ≥50 kg was 100% and 73.6% during dose optimization and 40% and 24.4% during the maintenance period, respectively. CONCLUSION: Findings from this post hoc analysis in adults with ADHD support the efficacy and safety of GXR regardless of ADHD subtype, age, or sex and suggest that careful monitoring for TEAEs and GXR dose optimization is considered for all patients, as needed.
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Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Guanfacina/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Interpretação Estatística de Dados , Preparações de Ação Retardada , Método Duplo-Cego , Feminino , Guanfacina/administração & dosagem , Guanfacina/efeitos adversos , Humanos , Japão , Masculino , Adulto JovemRESUMO
A reliable diagnosis of adult Attention Deficit/Hyperactivity Disorder (ADHD) is challenging as many of the symptoms of ADHD resemble symptoms of other disorders. ADHD is associated with gambling disorder and obesity, showing overlaps of about 20% with each diagnosis. It is important for clinical practice to differentiate between conditions displaying similar symptoms via established diagnostic instruments. Applying the LightGBM algorithm in machine learning, we were able to differentiate subjects with ADHD, obesity, problematic gambling, and a control group using all 26 items of the Conners' Adult ADHD Rating Scales (CAARS-S: S) with a global accuracy of .80; precision (positive predictive value) ranged between .78 (gambling) and .92 (obesity), recall (sensitivity) between .58 for obesity and .87 for ADHD. Models with the best 5 and best 10 items resulted in less satisfactory fits. The CAARS-S seems to be a promising instrument to be applied in clinical practice also for multiclassifying disorders displaying symptoms resembling ADHD.
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Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Aprendizado de Máquina , Programas de Rastreamento , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Feminino , Humanos , Masculino , Escalas de Graduação PsiquiátricaRESUMO
INTRODUCTION: The eleventh revision of the International Classification of Diseases (ICD-11) is planned to be published in 2018. So called, "beta version" of the chapter of mental and behavioral disorders (ICD-11) is already available and it is considered that there will be no significant deviations in the final version. The DSM-5 was released in 2013. Changes related to mental disorders in child and adolescent psychiatry have been made in both of these classifications. To identify changes in the classifications of mental disorders in childhood and adolescent age in beta version of ICD-11 and DSM-5. METHODS: Review of mental disorders in childhood and adolescent age and their classification in ICD-11 and DSM-5. RESULTS: For disorders that are classified as "mental retardation" in ICD-10, a new term "intellectual development disorders" has been introduced in ICD-11, ie "intellectual disabilities" in DSM-5. Hyperactivity disorders and attention deficit is a separate entity in relation to ICD-10, in which it is classified as a hyperkinetic disorder. Asperger's syndrome, which is isolated from autism spectrum disorders in DSM-5, does not appear under that name in ICD-11 either. Elimination disorders are in a separate block MKB-11 and DSM-5. Speech and language disorders are classified as communication disorders in the DSM-5 classification. Selective mutism and anxiety separation disorder in childhood are in the block of anxiety and fear-related disorders in ICD-11, and among anxiety disorders in DSM-5, respectively. Reactive emotional disorder and disinhibited attachment disorder of childhood are classified as stress-related disorders in ICD-11 and DSM-5. CONCLUSIONS: The new classifications (ICD-11 and DSM-5) classify mental disorders in child and adolescent psychiatry somewhat differently from their antecedents. New entities have also been formed.
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Manual Diagnóstico e Estatístico de Transtornos Mentais , Classificação Internacional de Doenças , Transtornos Mentais/classificação , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Criança , Humanos , Distúrbios da Fala/classificaçãoRESUMO
OBJECTIVE: This study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA). METHOD: Three latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16. RESULTS: The PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention. CONCLUSION: Neuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Atenção , Função Executiva , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Feminino , Humanos , Recém-Nascido , MasculinoRESUMO
OBJECTIVE: Research supports the importance of emotional symptoms in adults with attention-deficit/hyperactivity disorder (ADHD), which are not reflected in the DSM-5 or ICD-10 criteria. The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) assesses these symptoms, plus inattention, hyperactivity, and impulsivity. This scale allowed us to divide adult ADHD into 2 subtypes in a 2015 publication: ADHD inattentive presentation and ADHD emotional dysregulation presentation. The present study refines this observation using a larger, more diverse sample. METHODS: Eight double-blind adult ADHD clinical trials (encompassing 1,490 subjects) were selected because they included assessment with the WRAADDS; a second, alternative ADHD measure; and the Clinical Global Impressions-Severity of Illness scale (CGI-S). These data were subjected to confirmatory factor analyses, and ADHD presentations were compared, including treatment response. RESULTS: The original factor structure fit poorly with these new data. However, an alternative 2-factor solution fit both the original and the new subjects. ADHD inattentive presentation (n = 774) was defined by the inattention factor, and ADHD emotional dysregulation presentation (n = 620) was defined by additional elevation of the emotional dysregulation factor. The proportion of ADHD emotional dysregulation presentation ranged from 25% to 73% across the 8 studies. The emotional dysregulation presentation was associated with both a greater severity as measured by the CGI-S (P < .001) and more manifestations of childhood ADHD as measured by the Wender Utah Rating Scale (P < .001). CONCLUSIONS: Factor analytic results supported the validity of 2 adult ADHD presentations based on levels of emotional dysregulation. This system offers a more clinically relevant approach to the diagnosis of ADHD in adults than does the DSM system.
Assuntos
Sintomas Afetivos , Transtorno do Deficit de Atenção com Hiperatividade , Ensaios Clínicos como Assunto/estatística & dados numéricos , Adulto , Sintomas Afetivos/etiologia , Sintomas Afetivos/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Análise Fatorial , HumanosRESUMO
The DSM-5 confirmed that autism spectrum disorder (ASD) might be comorbid with attention-deficit/hyperactivity disorder (ADHD). This study investigated the executive function of ASD comorbid with ADHD (ASD + ADHD), ASD, and typically developed (TD) children using the Keio version of the modified Wisconsin card sorting test (KWCST). Children with ASD + ADHD (n = 43), ASD (n = 69), and TD (n = 69) were examined in two age groups: 5-9 years and 10-15 years. Both of the younger clinical groups showed significantly unfavorable scores for many indices in the second step compared to the TD group. As for the older groups, the ASD children showed significantly unfavorable scores in total errors in the second step, while the ASD + ADHD children did not show significant differences in either step. However, some index scores of the two older clinical groups were comparable to the older TD group in the second step. For the cognitive differences between clinical groups, the younger ASD + ADHD showed unfavorable scores in numbers of response cards until the first category achieved in the second step, while the older ASD showed unfavorable scores in categories achieved and perseverative errors of Nelson in the first step. For the degree of improvements in the second step, the older groups did not show significant group differences, while the younger ASD group showed significantly fewer improvements compared to the TD group. Based on these results, it is presumed that younger ASD + ADHD individuals are not sufficiently able to sustain attention and/or memory, and that the older ASD patients have difficulty in terms of flexibility.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Espectro Autista/fisiopatologia , Função Executiva/fisiologia , Adolescente , Fatores Etários , Atenção , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/psicologia , Criança , Desenvolvimento Infantil , Pré-Escolar , Cognição/fisiologia , Comorbidade , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Teste de Classificação de Cartas de WisconsinRESUMO
The symmetrical bifactor model is often applied to attention-deficit/hyperactivity disorder (ADHD)-hyperactive/impulsive (HI), ADHD-inattentive (IN), and oppositional defiant disorder (ODD) symptoms, but this model frequently yields anomalous or inadmissible results. An alternative model, the bifactor S - 1 model, is more appropriate for examining the hierarchical structure of ADHD/ODD symptoms. Both models were applied to ADHD-HI, ADHD-IN, and ODD symptom ratings by mothers, fathers, and teachers for 2142 Spanish children (49.49% girls; ages 8-13 years). The symmetrical bifactor model yielded the typical anomalous loadings, with a weakly defined ADHD-HI specific factor and difficult to interpret associations of general and specific factors with correlates. In contrast, the bifactor S - 1 model with ADHD-HI symptoms as general reference factor produced clearly interpretable results. For mothers and fathers, slightly more than 50% of true score variance in ADHD-IN and ODD symptoms represented specific residual variance not shared with the general ADHD-HI reference factor. For teachers, approximately 69% and 39% of true score variance in ADHD-IN and ODD symptoms, respectively, represented specific residual variance not shared with the general ADHD-HI reference factor. The general ADHD-HI reference factor and specific ADHD-IN and ODD residual factors showed convergent and discriminant validity across sources, along with unique associations with peer rejection, social impairment, and academic impairment factors. The bifactor S - 1 model also yielded results consistent with predictions from trait-impulsivity theory of ADHD/ODD development. Researchers should use the bifactor S - 1 model rather than the symmetrical bifactor model if hypotheses involve the latent hierarchical structure of ADHD/ODD symptoms.
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Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/fisiopatologia , Modelos Psicológicos , Modelos Estatísticos , Psicometria/normas , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/classificação , Escala de Avaliação Comportamental , Criança , Pai , Feminino , Humanos , Masculino , Mães , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Professores Escolares , Sensibilidade e EspecificidadeRESUMO
The objective of this study was to investigate the prevalence and clinical correlates of ADHD patients with mind wandering. 255 consecutively referred 18- to 55-year-old adults of both sexes with ADHD were assessed. Subjects completed a demographic interview, the Mind Wandering Questionnaire (MWQ), the ADHD Rating Scale (ADHD RS), the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A), the Social Responsiveness Scale - Second Edition (SRS-2) Adult Self-Report Form, the Adult Self-Report (ASR), the Barkley Emotional Dysregulation Scale, and the Quality of Life Enjoyment & Satisfaction Questionnaire (Q-LES-Q). We used receiver operator characteristic (ROC) curves to identify the optimal cut-off on the MWQ to categorize patients as having high-versus low-level mind wandering and compared demographic and clinical characteristics between the two groups. Participants were categorized by ROC analysis as having high- (Nâ¯=â¯127) and low-level (Nâ¯=â¯128) mind wandering based on an MWQ total scoreâ¯≥â¯orâ¯<â¯than 24, respectively. Compared with low-level mind wandering participants, those with high-level mind wandering had significantly more Inattentive and Hyperactive symptoms (all pâ¯<â¯0001), worse executive functioning as measured by the BRIEF-A, more impaired mean (all pâ¯≤â¯0.001) and dichotomized scores (t-score ≥65) (all pâ¯<â¯0.005) on subscales and composite ASR scales, more impaired scores on the Barkley Emotional Dysregulation Scale (pâ¯<â¯0.001), and more impaired quality of life scores. High-level mind wandering is prevalent in adults with ADHD and is associated with more severe ADHD symptoms, more executive function deficits, more emotional dysregulation, higher levels of associated psychopathology, and more impaired quality of life.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Regulação Emocional/fisiologia , Função Executiva/fisiologia , Qualidade de Vida , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Autorrelato , Adulto JovemRESUMO
INTRODUCTION: Attention Deficit Hyperactivity Disorder (ADHD) is an early onset clinical condition characterized by attention difficulties, hyperactivity and impulsivity which can persist across the lifespan, significantly influencing the evolutionary course and facilitating the rise of psychiatric comorbidities. The presence of different ADHD subtypes in adults is a heterogeneity factor to be recognized in order to orient prognosis and treatment, as indicated by studies that described differences in the characterization of different subtypes in relation to both severity and comorbidities. MATERIALS AND METHODS: In the present study we evaluated the socio-demographic and clinical characteristics of a sample of adults with ADHD and the characteristics associated with the different disorder subtypes. We described 60 patients aged between 18 and 65 years (mean age 34.1) with primary diagnosis of ADHD consecutively admitted to the Regional Centre for diagnosis and treatment of ADHD in adults in Milan. RESULTS: We observed high severity of symptoms and low quality of life, in particular in the "life outlook" dimension. The subtypes distribution was the following: 18.3% inattentive subtype, 8.3% hyperactive/impulsive subtype and 70% combined subtype. The hyperactive/impulsive subtype showed a significantly higher frequency in females, while the inattentive subtype was more frequent in males. Patients with the hyperactive/impulsive subtype showed worse quality of life and more frequent anxiety disorders. CONCLUSIONS: Considering the different clinical profiles among various subtypes, these data add relevance to subtypes classification of adult ADHD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/classificação , Qualidade de Vida , Índice de Gravidade de Doença , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Avaliação de Sintomas , Adulto JovemRESUMO
Objective: Psychiatric comorbidities are highly prevalent among individuals affected by substance use disorders and those with non-substance-related addictive disorders such as gambling disorder. More recently, the frequent co-occurrence of substance use disorders and attention-deficit hyperactivity disorder (ADHD) has received particular attention. The aim of our study was to identify patterns of psychiatric comorbidity and to examine associations between patient group and ADHD status with class membership. Methods: Participants were patients with opioid use disorder enrolled in opioid maintenance treatment (OMT), either recruited from the community (n = 142; M age = 35.8 years; 38.7% female) or prison (n = 133; M age = 35.7 years; 21.8% female), and patients undergoing treatment for problem gambling (PrG; n = 80; M age = 43.1 years; 20% female). To enable direct comparisons, the following instruments were applied: Mini International Neuropsychiatric Interview, Adult ADHD self-report scale, Wender Utah Rating Scale, and European Addiction Severity Index. We used a latent class analysis (LCA) to identify psychiatric comorbidity patterns and a multinomial logistic regression to examine associations between patient group, ADHD status, age, and gender with class membership. Results: The LCA resulted in a three-class solution: (1) a class of individuals with a relatively low probability of current psychiatric comorbidities, except for a high probability of substance use disorders; (2) a class with markedly increased probabilities of current and recurrent psychiatric comorbidities, especially for major depression; and (3) a class with very low probabilities of psychiatric comorbidities, except for moderate probabilities of substance use disorders and antisocial personality disorder. Both OMT patients recruited from the community and those in prison were less likely than PrG patients to be assigned to the most burdened class with respect to psychiatric comorbidity (class 2). Further, both individuals with ADHD in childhood and those with adult ADHD were more likely members of class 2. Conclusions: PrG patients seem to be at an even higher risk for psychiatric comorbidities compared to OMT patients. Raising awareness among practitioners for the high prevalence of psychiatric comorbidities among patients with gambling disorder and individuals with ADHD is crucial to initiate adequate treatment and to improve response.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Jogo de Azar/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Comorbidade , Feminino , Jogo de Azar/classificação , Humanos , Análise de Classes Latentes , Masculino , Transtornos Relacionados ao Uso de Opioides/classificação , Prisioneiros/estatística & dados numéricos , Fatores de Risco , Adulto JovemRESUMO
El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.
Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Inibidores da Captação Adrenérgica/uso terapêutico , Cloridrato de Atomoxetina/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Metilfenidato/uso terapêutico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Estudos Retrospectivos , Distribuição por Sexo , Distribuição por IdadeRESUMO
Attention deficit hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder, of a chronic nature, of multifactorial etiology, mainly due to genetic and environmental factors. We conducted a retrospective analytical study of the t herapeutic management of children diagnosed with ADHD. A sample of 82 children diagnosed with ADHD (74.4% children and 25.6% girls) was studied. 96.3% of the cases presented some associated disorder. Pharmacological treatment was the treatment of choice (90.2%). 46.0% received immediate release methylphenidate, 51.4% sustained release methylphenidate and atomoxetine was only prescribed in 2.7% of patients. 20.3% of the sample abandoned pharmacological treatment at some point. Pharmacological treatment was the most frequent option in our sample, and methylphenidate immediate release the drug of choice for treatment initiation. The alternatives to stimulants are used in very low percentage of the patient. No significant differences were found between the type of treatment regarding the subtype of ADHD or gender, but we found significant difference in relation with the age of onset of treatment.
El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo, de carácter crónico, de etiología multifactorial, principalmente debida a factores genéticos y ambientales. Realizamos un estudio analítico retrospectivo del tratamiento de niños diagnosticados de TDAH. Se estudió una muestra de 82 niños diagnosticados de TDAH (74.4% niños y 25.6% niñas). El 96.3% de los casos presentaba algún trastorno asociado. El tratamiento farmacológico fue el tratamiento de elección (90.2%). El 46.0% recibía metilfenidato de liberación inmediata, un 51.4% metilfenidato de liberación sostenida y la atomoxetina solo se recetó en un 2.7% de los casos. El 20.3% de la muestra abandonó en algún momento el tratamiento farmacológico. El tratamiento farmacológico fue la opción más utilizada en nuestra muestra, y el metilfenidato de liberación inmediata el fármaco de elección para inicio del tratamiento. Se utilizan poco las alternativas a los estimulantes. No se encontraron diferencias significativas entre el tipo de tratamiento y el subtipo de TDAH o el género, aunque sí en cuanto a la edad de inicio del tratamiento.
Assuntos
Inibidores da Captação Adrenérgica/uso terapêutico , Cloridrato de Atomoxetina/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Metilfenidato/uso terapêutico , Adolescente , Distribuição por Idade , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Feminino , Humanos , Masculino , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia , Estudos Retrospectivos , Distribuição por SexoRESUMO
Virtual reality (VR) neuropsychological assessments have the potential for the ecological measurement of attention. We analyzed the newly developed VR continuous performance test (VR-CPT) for Korean children with attention-deficit/hyperactivity disorder (ADHD) and typically developing children (TDC). To identify specific features of a virtual environment that influence the attention performance of children, we investigated whether the presence of a virtual teacher and social cues in the VR environment affects their attention performance. A total of 38 participants (18 TDC and 20 ADHD children and adolescents) were recruited for VR-CPT testing. Bivariate correlational analysis was conducted to examine the associations between the results of the VR-CPT and ADHD questionnaires to determine the capacity of VR-CPT to mirror real-life attention behaviors. Mixed-design analysis of variables was conducted to compare the effects of the social aspects of the VR-CPT on attention performance in groups. There were significant associations between ADHD rating scores and the omission error, commission error, reaction time (RT), reaction time variability (RTV), and total accuracy of the VR-CPT in the ADHD group. In addition, the ADHD group exhibited comparable performance with the TDC group for all measures of the VR-CPT. Also there seemed to be a trend of decreasing RTV when a virtual teacher with social cues was present compared with the equipment control condition in the ADHD group. Performance in the VR-CPT program was associated with behavioral measures of ADHD symptoms. Adding social aspects to a VR environment commonly encountered by children and adolescents has the potential to make a difference in the attention performance of youths with ADHD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Sinais (Psicologia) , Testes Neuropsicológicos , Realidade Virtual , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Humanos , República da Coreia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Motivated by an inconsistency between reports of high diagnosis-classification accuracies and known heterogeneity in attention-deficit/hyperactivity disorder (ADHD), this study assessed classification accuracy in studies of ADHD as a function of methodological factors that can bias results. We hypothesized that high classification results in ADHD diagnosis are inflated by methodological factors. METHODS: We reviewed 69 studies (of 95 studies identified) that used neuroimaging features to predict ADHD diagnosis. Based on reported methods, we assessed the prevalence of circular analysis, which inflates classification accuracy, and evaluated the relationship between sample size and accuracy to test if small-sample models tend to report higher classification accuracy, also an indicator of bias. RESULTS: Circular analysis was detected in 15.9% of ADHD classification studies, lack of independent test set was noted in 13%, and insufficient methodological detail to establish its presence was noted in another 11.6%. Accuracy of classification ranged from 60% to 80% in the 59.4% of reviewed studies that met criteria for independence of feature selection, model construction, and test datasets. Moreover, there was a negative relationship between accuracy and sample size, implying additional bias contributing to reported accuracies at lower sample sizes. CONCLUSIONS: High classification accuracies in neuroimaging studies of ADHD appear to be inflated by circular analysis and small sample size. Accuracies on independent datasets were consistent with known heterogeneity of the disorder. Steps to resolve these issues, and a shift toward accounting for sample heterogeneity and prediction of future outcomes, will be crucial in future classification studies in ADHD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Biomarcadores , Encéfalo/fisiopatologia , Humanos , Aprendizado de Máquina , Neuroimagem , Reprodutibilidade dos Testes , Tamanho da AmostraRESUMO
ADHD symptoms show considerable individual variation in the contexts in which they are expressed. It has previously been proposed that subtyping individuals according to the contexts in which symptoms are expressed may be clinically useful. We examined context-based patterns of ADHD symptoms in a longitudinal cohort study of n = 1388 children, as well as context-specific and context-general predictors of symptoms. Participants were community-ascertained and provided ADHD symptom data at ages 7, 9, and 11. Using growth mixture modelling we identified five inattention and five hyperactivity/impulsivity categories that differed in the developmental patterns of symptoms reported by parent and teacher informants. We found some evidence that context-specific predictors were related to context-specific expressions. Specifically, after controlling for other risk factors for ADHD symptoms, relationships with teachers predicted school-specific (teacher-reported) but not home-specific (parent-reported) symptom levels. However, no subtypes defined by exclusively home-based symptoms emerged, suggesting that while symptoms may sometimes be specific to the school context, they are only rarely confined to the home context. Subtyping by context could be informative; however, further work will required to uncover the nature of any etiological, functional, or outcome differences between those who show symptom expression in different contexts.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Atenção , Comportamento Impulsivo , Relações Interpessoais , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/psicologia , Criança , Emoções Manifestas , Feminino , Humanos , Estudos Longitudinais , Masculino , Pais/psicologia , Agitação Psicomotora/psicologia , Professores Escolares/psicologia , Avaliação de Sintomas/métodosRESUMO
AIM: Findings on neurophysiological alterations in attention deficit hyperactivity disorder (ADHD) have been proposed to underlie ADHD symptoms, with different etiological pathways for different patient biotypes. We aimed at determining whether neurophysiological deviations confirm distinct neurophysiological profiles in ADHD, thus providing direct evidence for the endophenotype concept. METHODS: Neurophysiological biotypes were investigated in 87 adult patients with ADHD using cluster analysis. Parameters fed into the analysis comprised both hemodynamic and electrophysiological data. To validate results, the independent variables of the clusters were compared with healthy controls. RESULTS: Cluster analysis yielded three neurophysiologically based ADHD biotypes showing: (i) above-average functioning in attention allocation; (ii) difficulties in attention allocation and inhibitory control but elevated frontal activation during a working memory task; and (iii) functional impairments in state regulation. CONCLUSION: Classifying patients with ADHD into neurophysiological biotypes sheds light on etiological pathways, with implications for diagnostics and (individualized) treatment options.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/classificação , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Atenção/fisiologia , Função Executiva/fisiologia , Inibição Psicológica , Memória de Curto Prazo/fisiologia , Córtex Pré-Frontal/fisiopatologia , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Eletroencefalografia , Potenciais Evocados/fisiologia , Feminino , Neuroimagem Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho , Adulto JovemRESUMO
BACKGROUND: A challenge facing clinical neuroscientists is how best to synthesize diverse and sometimes inconsistent evidence for neuropsychological deficits and brain system dysfunction found in psychiatric disorders into models that guide etiological and treatment research. Multiple-pathway models suggest that psychiatric symptoms might arise from pathophysiology in different neural systems. This study tested dual-pathway model predictions for attention-deficit/hyperactivity disorder (ADHD) that reward and executive function cognitive deficits should be related to abnormalities in corresponding functionally specialized neural systems. METHODS: Behavioral inhibition and preference for immediate rewards were assessed in N = 251 adolescent boys and girls ages 12 to 18 diagnosed with DSM-IV combined-subtype ADHD or non-ADHD control subjects. Following taxometric analyses of test performance, the resulting subgroups were compared on a functional magnetic resonance imaging monetary incentive delay task probing reward anticipation and go/no-go task of motor response inhibition. RESULTS: Three ADHD subgroups were identified consistent with different proposed pathways-ADHD with executive function/motor inhibition deficits, ADHD with both executive and reward deficits, and ADHD with relatively normal test performance. Each cognitive domain mapped to different ADHD brain dysfunction features as expected. However, no brain abnormalities were found common to all ADHD subgroups despite the fact they had nearly identical ADHD-related clinical characteristics. CONCLUSIONS: The results suggest that combined-subtype ADHD is a collection of discrete disorders for which a comparable behavioral end point arises through different neurobiological pathways. The findings raise caution about applying common cause, single-deficit conceptual models to individual ADHD patients and should prompt researchers to consider biologically defined, multifactorial etiological models for other psychiatric diagnoses.