Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.

Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation.

OBJECTIVE: Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood. METHODS: Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed. RESULTS: At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women. CONCLUSION: Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.

[Symptoms, diagnostic process and outcome in girls and women with ADHD]. / Symtom, diagnostik och förlopp vid ADHD hos flickor och kvinnor.

ADHD in girls is usually an impairing disorder that persists into adulthood in most cases. The negative consequences include school failure, psychiatric problems, substance abuse, self-harm, suicide attempts, increased risk of being physically and sexually maltreated, and unplanned/unwanted pregnancies. Chronic pain, overweight and sleep problems/disorders are also common. The symptom presentation is one with fewer obvious hyperactive and impulsive behaviours as compared with boys. Attention deficits, emotional dysregulation and verbal aggression are more common. Many more girls are now being diagnosed with ADHD than 20 years ago, but ADHD symptoms in girls are still quite often overlooked, and underdiagnosis is more common than in boys. Girls with ADHD are less often receiving pharmacological treatment for equally impairing symptoms of inattention and/or hyperactivity/impulsivity. There is a need for more studies of ADHD in girls and women, awareness among professionals and the general public needs to be increased, focused support in schools needs to be implemented and better intervention methods need to be developed.

Reading comprehension, word decoding and spelling in girls with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (AD/HD): performance and predictors.

BACKGROUND: Difficulties with aspects of literacy are often seen in children with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (AD/HD). The bases of the connections between these disorders and literacy difficulties are poorly understood. Furthermore, it is not clear if existing research is representative for girls. AIMS: There were three aims: (1) to compare performance in reading comprehension, word decoding, and spelling in girls with ASD (n = 20), AD/ HD (n = 36), and community girls with typical developing (girls; n = 54); (2) to assess rates of reading and writing disorders within groups; and (3) to examine the predictive value of measures of autistic and AD/HD symptomatology to reading comprehension in the whole girl sample. METHODS & PROCEDURES: Participants were aged between 8 and 17 years, and had a full scale IQ>70. Standardized tests of literacy, oral vocabulary, and non-verbal ability were administered. Parent ratings of degree of autistic symptomatology and both parent and teacher ratings of AD/HD symptomatology were collected for all girls. OUTCOMES & RESULTS: Girls with diagnosed ASD could not be separated significantly from typically developing girls or girls with AD/HD on average performance on any literacy test. However, among girls with ASD, 40% had at least one reading and writing disorder. Girls with AD/HD performed lower than typically developing girls in reading comprehension, word decoding, and spelling, and 56% had at least one reading and writing disorder. In regression analysis, using the total sample, both degrees of autistic and AD/HD symptomatology negatively contributed to the variance in reading comprehension after controlling for oral vocabulary, word decoding, and non-verbal ability. Whereas AD/HD contributed to the variance in reading comprehension once autistic symptomatology was controlled for, the opposite was not true. However, a large bivariate correlation between autistic and AD/HD symptomatology somewhat complicates the interpretation of that result. CONCLUSIONS & IMPLICATIONS: The findings highlight the importance of monitoring and supporting the literacy development in girls with ASD or AD/HD. Results from regression analyses suggested that word decoding and/or oral vocabulary training may not be sufficient for the girls fully to overcome difficulties in the important skill of reading comprehension.

An investigation of ribosomal protein L10 gene in autism spectrum disorders.

BACKGROUND: Autism spectrum disorders (ASD) are severe neurodevelopmental disorders with the male:female ratio of 4:1, implying the contribution of X chromosome genetic factors to the susceptibility of ASD. The ribosomal protein L10 (RPL10) gene, located on chromosome Xq28, codes for a key protein in assembling large ribosomal subunit and protein synthesis. Two non-synonymous mutations of RPL10, L206M and H213Q, were identified in four boys with ASD. Moreover, functional studies of mutant RPL10 in yeast exhibited aberrant ribosomal profiles. These results provided a novel aspect of disease mechanisms for autism--aberrant processes of ribosome biosynthesis and translation. To confirm these initial findings, we re-sequenced RPL10 exons and quantified mRNA transcript level of RPL10 in our samples. METHODS: 141 individuals with ASD were recruited in this study. All RPL10 exons and flanking junctions were sequenced. Furthermore, mRNA transcript level of RPL10 was quantified in B lymphoblastoid cell lines (BLCL) of 48 patients and 27 controls using the method of SYBR Green quantitative PCR. Two sets of primer pairs were used to quantify the mRNA expression level of RPL10: RPL10-A and RPL10-B. RESULTS: No non-synonymous mutations were detected in our cohort. Male controls showed similar transcript level of RPL10 compared with female controls (RPL10-A, U = 81, P = 0.7; RPL10-B, U = 61.5, P = 0.2). We did not observe any significant difference in RPL10 transcript levels between cases and controls (RPL10-A, U = 531, P = 0.2; RPL10-B, U = 607.5, P = 0.7). CONCLUSION: Our results suggest that RPL10 has no major effect on the susceptibility to ASD.

A Hyperlexic-Like Reading Style Is Associated With Increased Autistic Features in Girls With ADHD.

OBJECTIVE: Hyperlexic-like reading (defined as word decoding much better than comprehension) has been associated with autism spectrum disorder (ASD). Here we study correlates of a hyperlexic-like reading style (HPL) in ADHD, a condition known to co-occur both with reading difficulties and ASD. METHOD: We compared 10 girls with an ADHD diagnosis plus HPL with 26 with ADHD minus HPL. RESULTS: Girls with HPL scored marginally lower in reading comprehension but did not differ from non-HPL girls in IQ, vocabulary, or in the severity of ADHD ratings. However, in addition to scoring much better on word decoding, HPL readers also displayed higher levels of social-communication deficits on the ADOS-G and the ADI-R. Moreover, correlation analysis in the full sample revealed an association between increasing autistic features and word reading. CONCLUSION: The study underscores the heterogeneity of reading skills in ADHD, and shows the relevance of subclinic autistic features for understanding this variability.

Chronic Pain And Health-Related Quality Of Life In Women With Autism And/Or ADHD: A Prospective Longitudinal Study.

PURPOSE: To investigate the prevalence of chronic pain and its association with health-related quality of life (HRQoL) in a group of women, diagnosed with autism spectrum disorder (ASD) and/or attention deficit hyperactive disorder (ADHD) in childhood. PATIENTS AND METHODS: Prospective longitudinal 16-19 years follow-up study of 100 Swedish females diagnosed with ASD and/or ADHD in childhood/adolescence. Seventy-seven of the women were included in the current sub-study, using validated measures of pain perception and quality of life. RESULTS: A large majority of the women (76.6%) reported chronic pain. HRQoL was low overall and lower still for those reporting chronic pain. Women with ADHD who had ongoing treatment with stimulants reported a significant lower prevalence of chronic widespread pain (CWP) than those not treated. CONCLUSION: Comorbidity with chronic pain is common in women with ASD and/or ADHD and important to address in the clinic since it is associated with an already low HRQoL. Treatment for ADHD might reduce the pain in some cases.

Girls with social deficits and learning problems: Autism, atypical Asperger syndrome or a variant of these conditions.

Six girls aged 6-10 years meeting criteria for autistic disorder are presented. They were all high-functioning in that they had IQs in the 60-100 range and spoke in complicated sentences. Their clinical picture had not led a variety of specialists to consider an autism diagnosis before age 6 years in spite of the fact that they had shown mild motor delays, uncharacteristic developmental deviance and social, communicative and imaginative deficits already before age 2 years in all cases. It is suggested that the autism phenotype might be different in girls as compared with boys. It is further speculated that if female cases such as those described - and others given a whole host of different diagnostic labels - were only considered for an autism diagnosis, the high male:female ratio traditionally encountered in autism might drop considerably.

Spelling difficulties in school-aged girls with attention-deficit/hyperactivity disorder: behavioral, psycholinguistic, cognitive, and graphomotor correlates.

Writing difficulties are common among children with attention-deficit/hyperactivity disorder (ADHD), but the nature of these difficulties has not been well studied. Here we relate behavioral, psycholinguistic, cognitive (memory/executive), and graphomotor measures to spelling skills in school-age girls with ADHD (n = 30) and an age-matched group of typically developed spellers (TYPSP, n = 35). When subdividing the ADHD group into those with poor (ADHDPSP, n = 19) and typical spelling (ADHDTYPSP, n = 11), the two subgroups did not differ with regard to inattentive or hyperactive-impulsive symptom severity according to parent or teacher ratings. Both ADHD subgroups also had equally severe difficulties in graphomotor control-handwriting and (parent ratings of) written expression as compared to the TYPSP group. In contrast, ADHDPSP had problems relative to ADHDTYPSP and TYPSP on phonological and orthographic recoding (choice tasks) and verbal memory (digit span) and were more likely to make commissions on a continuous performance task (CPT). Further analyses using the collapsed ADHD group showed that both digit span and the presence of CPT commissions predicted spelling performance independently of each other. Finally, results showed that phonological recoding skills mediated the association between digit span and spelling performance in ADHD. Theoretical and educational implications are discussed.

The Autism Spectrum Screening Questionnaire (ASSQ)-Revised Extended Version (ASSQ-REV): an instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls.

We wanted to develop and validate an extension of the Autism Spectrum Screening Questionnaire (ASSQ)-the ASSQ Revised Extended Version (ASSQ-REV)--for better capturing the female phenotype of autism spectrum disorders (ASD). Clinic girls and Clinic boys, most of whom with ASD and/or attention-deficit/hyperactivity disorder (ADHD), and Community girls without a clinical diagnosis of any kind of neuropsychiatric disorder were compared on the results of the parent-rated ASSQ and on a new set of items (ASSQ-GIRL). The ASSQ-REV discriminated well between cases and non-cases. Certain single ASSQ-GIRL items were much more typical of girls than of boys with ASD. The most striking of these were "avoids demands", "very determined", "careless with physical appearance and dress" and "interacts mostly with younger children". The issue of whether or not there is a gender-specific ASD for phenotype is discussed.

Developmental coordination disorder and other motor control problems in girls with autism spectrum disorder and/or attention-deficit/hyperactivity disorder.

Examine the rate, predictors, and effect on daily life skills of developmental coordination disorder (DCD) and other motor control difficulties in school age girls with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD), in preschool age girls with ASD referred to a neuropsychiatric clinic, and in a community sample of school age girls. The girls (131 in total) were examined with standardised test of motor function and parent interviews and questionnaires. The school girls were compared with 57 age-and IQ-matched girls from the community. DCD was diagnosed in 25% of clinic school girls with ASD, in 32% of those with ADHD, and in 80% of the clinic preschool girls with ASD. Parents reported more motor problems in the school age clinic group. Agreement between a brief motor screening test and a full comprehensive motor examination was moderate to good in the clinic group. Young age, autistic symptomatology, and low performance IQ predicted more motor coordination problems. Motor coordination problems were related to lower ability in daily life skills even when the effect of PIQ was controlled for. A large minority of school girls with ASD and/or ADHD, and a majority of preschool girls with ASD meet full diagnostic criteria for DCD. Their motor problems contribute to reduced activity in daily life even when the effects of IQ have been partialled out.

Girls with social and/or attention deficits: a descriptive study of 100 clinic attenders.

OBJECTIVE: Examine clinical correlates and distinguishing features of autism spectrum disorders (ASD), ADHD, and tic disorders in girls referred for social impairment, attention/academic deficits, and/or tics. METHOD: One hundred 3- to 18-year-old girls referred for social impairment and attention symptoms were assessed in detail. Sixty of these girls, 7 to 16 years of age (IQ >or= 80) were compared with age-matched girls (IQ >or= 80) from the community. RESULTS: Main diagnoses of ASD, ADHD, tic disorders, and "other psychiatric disorder" were made in 46, 46, 3, and 5, respectively, of the referred girls. The ASD and ADHD groups (mean age at diagnosis 8.8 and 13.0 years, respectively) had the same types and high rates of psychiatric comorbidity. Girls with ASD had more problems with global functioning and adaptive levels of daily living skills than girls with ADHD. Differences between these girls referred for investigation and the community sample of girls were very considerable across a range of factors. CONCLUSIONS: Girls referred for social and/or attention deficits usually meet diagnostic criteria for either ASD or ADHD. They have severe psychiatric comorbidities and low global levels of functioning.

Screening for genomic rearrangements and methylation abnormalities of the 15q11-q13 region in autism spectrum disorders.

BACKGROUND: Maternally derived duplications of the 15q11-q13 region are the most frequently reported chromosomal aberrations in autism spectrum disorders (ASD). Prader-Willi and Angelman syndromes, caused by 15q11-q13 deletions or abnormal methylation of imprinted genes, are also associated with ASD. However, the prevalence of these disorders in ASD is unknown. The aim of this study was to assess the frequency of 15q11-q13 rearrangements in a large sample of patients ascertained for ASD. METHODS: A total of 522 patients belonging to 430 families were screened for deletions, duplications, and methylation abnormalities involving 15q11-q13 with multiplex ligation-dependent probe amplification (MLPA). RESULTS: We identified four patients with 15q11-q13 abnormalities: a supernumerary chromosome 15, a paternal interstitial duplication, and two subjects with Angelman syndrome, one with a maternal deletion and the other with a paternal uniparental disomy. CONCLUSIONS: Our results show that abnormalities of the 15q11-q13 region are a significant cause of ASD, accounting for approximately 1% of cases. Maternal interstitial 15q11-q13 duplications, previously reported to be present in 1% of patients with ASD, were not detected in our sample. Although paternal duplications of chromosome 15 remain phenotypically silent in the majority of patients, they can give rise to developmental delay and ASD in some subjects, suggesting that paternally expressed genes in this region can contribute to ASD, albeit with reduced penetrance compared with maternal duplications. These findings indicate that patients with ASD should be routinely screened for 15q genomic imbalances and methylation abnormalities and that MLPA is a reliable, rapid, and cost-effective method to perform this screening.