A Preliminary Investigation of Deficits in Executive Functions of Adults With Attention Deficit Hyperactivity Disorder.

Several studies over the past two decades have investigated the neuropsychological deficits in children with attention deficit hyperactivity disorder (ADHD), but much less has been done on adults. This study aimed to assess the deficits in executive functions of adults with ADHD, especially in the areas of attention, inhibition, impulsivity, and planning. Twenty-four adults (18 years and older) diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria, and also assessed with Conners' Adult ADHD Rating Scale, participated in the study. Executive functions in cases were compared with 20 matched controls through the three instruments of Tower of London (TOL), Continuous Performance Test (CPT), and Stroop test. Performance of cases was weaker than that of the control group in TOL. The difference was significant in subsequent thinking time in most of the trials and number of movements only at level 2. In CPT, the adults with ADHD made more commission errors. In addition, the ADHD cases made more errors in the word card of the Stroop test, and the time they spent reading all three cards was significantly longer than that of the control group. Our study suggests that several deficits in executive functions related to ADHD persist into adulthood, such as impairments in planning time and set shifting, response inhibition, impulsivity, and visuolingual processing. However, simple (visual-motor processing) and sustained attention might improve with age.

It takes a village: a realist synthesis of social pediatrics program.

OBJECTIVES: To better understand how social pediatric initiatives (SPIs) enact equitable, integrated, embedded approaches with high-needs children and families while facilitating proportionate distribution of health resources. METHODS: The realist review method incorporated the following steps: (1) identifying the review question, (2) formulating the initial theory, (3) searching for primary studies, (4) selecting and appraising study quality, (5) synthesizing relevant data and (6) refining the theory. RESULTS: Our analysis identified four consistent patterns of care that may be effective in social pediatrics: (1) horizontal partnerships based on willingness to share status and power; (2) bridged trust initiated through previously established third party relationships; (3) knowledge support increasing providers' confidence and skills for engaging community; and (4) increasing vulnerable families' self-reliance through empowerment strategies. CONCLUSIONS: This research is unique because it focused on "how" outcomes are achieved and offers insight into the knowledge, skills and philosophical orientation clinicians need to effectively deliver care in SPIs. Research insights offer guidance for organizational leaders with a mandate to address child and youth health inequities and may be applicable to other health initiatives.

Consanguineous Iranian kindreds with severe Tourette syndrome.

The search for vulnerability genes for Tourette syndrome has been ongoing for nearly three decades. The contribution of recessive loci with reduced penetrance is one possibility that has been difficult to explore. Homozygosity mapping has been successfully used to detect recessive loci within populations with high rates of consanguinity. Using this technique, even quite small inbred families can be informative due to autozygosity in which the two alleles at an autosomal locus are identical by descent (i.e., copies of a single ancestral gene). To explore the utility of this approach, we identified 12 consanguineous Iranian families. Remarkably, these families were seen with an unusual natural history characterized by the early onset of vocal tics and coprolalia and frequent comorbidity with obsessive-compulsive disorder. Genotyping the affected and unaffected members of these pedigrees has the potential to identify rare recessive contributions to this disorder.