Quantified assessment of hyperactivity in ADHD youth using IR-UWB radar.

Research on the quantification of hyperactivity in youth with attention-deficit/hyperactivity disorder (ADHD) has been limited and inconsistent. The purpose of this study was to test the discriminative value of impulse-radio ultra-wideband (IR-UWB) radar for monitoring hyperactive individuals with ADHD and healthy controls (HCs). A total of 10 ADHD patients and 15 HCs underwent hyperactivity assessment using IR-UWB radar during a 22-min continuous performance test. We applied functional ANOVA to compare the mean functions of activity level between the 2 groups. We found that the mean function of activity over time was significantly different and that the activity level of the ADHD group slightly increased over time with high dispersion after approximately 7 min, which means that the difference in activity level between the two groups became evident at this period. Further studies with larger sample sizes and longer test times are warranted to investigate the effect of age, sex, and ADHD subtype on activity level function.

Evaluating relationships among clinical working memory assessment and inattentive and hyperactive/impulsive behaviors in a community sample of children.

OBJECTIVE: This study examined relationships between inattentive and hyperactive/impulsive behaviors and working memory (WM) functioning, and the utility of WM in categorical diagnosis of ADHD versus considering ADHD symptoms on a continuum. METHOD: The study included 50 male children (6-12 years). Inattentive and hyperactive/impulsive behaviors were measured by the Conners-3P parent report, and WM was assessed by the WISC-IV WM subtests and Working Memory Index (WMI). RESULTS: WISC-IV Arithmetic and Digit Span Backward were most consistently related to inattentive behaviors, and no WM measure was consistently related to ADHD hyperactive/impulsive behaviors. Arithmetic and Digit Span Backward also accounted for significant variance in inattentive behaviors and ADHD inattention symptoms, respectively. Neither the WMI nor the Arithmetic subtest correctly classified individuals diagnosed with ADHD. CONCLUSION: Measurement of inattentive behaviors on a continuum best characterized relationships between symptoms of ADHD and WM functioning; WM functioning did not have utility in categorical understanding of ADHD.

Comparative Validity of DSM-IV and Alternative Empirically Derived Approaches for the Assessment of ADHD.

OBJECTIVE: To identify ADHD symptoms that are most highly predictive of ADHD diagnostic status and compare them against Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) algorithms in predictions of functional impairment. METHOD: Parent and teacher ratings of ADHD were obtained from an ethnically diverse (46% non-White) sample of 151 five- to ten-year-old children (27% female) with ( n = 76) and without ( n = 75) DSM-IV ADHD. We calculated total predictive values to estimate how ratings of each ADHD symptom predicted ADHD diagnostic status based on a structured parent diagnostic interview. Optimal symptom thresholds (i.e., not at all, just a little, pretty much, very much) for predicting ADHD caseness differed for inattention and hyperactivity and parents versus teachers. Algorithms consisting of highly predictive symptoms were then created and compared against DSM-IV-based algorithms to predict independent measures of functional impairment. RESULTS: Several empirically derived symptom algorithms were more strongly associated with functional impairment than DSM-IV-based algorithms. CONCLUSION: These preliminary findings suggest that alternative methods to aggregating ADHD symptoms may improve predictions of impairment.

The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder.

There is a clinical need for objective evidence-based measures that are sensitive and specific to ADHD when compared with other neurodevelopmental disorders. This study evaluated the incremental validity of adding an objective measure of activity and computerised cognitive assessment to clinical rating scales to differentiate adult ADHD from Autism spectrum disorders (ASD). Adults with ADHD (n=33) or ASD (n=25) performed the QbTest, comprising a Continuous Performance Test with motion-tracker to record physical activity. QbTest parameters measuring inattention, impulsivity and hyperactivity were combined to provide a summary score ('QbTotal'). Binary stepwise logistic regression measured the probability of assignment to the ADHD or ASD group based on scores on the Conners Adult ADHD Rating Scale-subscale E (CAARS-E) and Autism Quotient (AQ10) in the first step and then QbTotal added in the second step. The model fit was significant at step 1 (CAARS-E, AQ10) with good group classification accuracy. These predictors were retained and QbTotal was added, resulting in a significant improvement in model fit and group classification accuracy. All predictors were significant. ROC curves indicated superior specificity of QbTotal. The findings present preliminary evidence that adding QbTest to clinical rating scales may improve the differentiation of ADHD and ASD in adults.

What does delirium cost? An economic evaluation of hyperactive delirium.

BACKGROUND: Demographic changes have resulted in an increase in the number of older (> 75 years) multimorbid patients in clinics. In addition to the primary acute diagnoses that lead to hospitalization, this group of patients often has cognitive dysfunctions, such as delirium. According to clinical experience, delirium patients are more time-consuming for clinicians and their function is often poor. The costs caused by delirium patients are currently unknown. In the present study, a retrospective examination of a database was carried out to calculate the costs that arise during the clinical treatment of documented delirium patients. SETTING AND METHODS: The purpose of this retrospective analysis was to collect information recorded by nursing personnel trained in the treatment of delirium and information from a manual documentation matrix for additional time expenditure. In the database analysis anonymous data of previously discharged patients for a time window of 3 months were analyzed. Documented additional expenditure for patients with hyperactive delirium at hospitalization were analyzed by personnel. Material costs, the duration of hospitalization by main diagnosis and age clusters during hospitalization until discharge were also examined. The analysis was performed in a hospital with internal wards. RESULTS: Data for 82 hyperactive delirium patients were examined and an average of approximately 240 min of additional personnel expenditure for these patients was found. These patients were approximately 10 years older (p < 0.01) and were hospitalized for an average of 4.2 days longer (p < 0.01) than non-delirium patients. Hyperactive delirium usually developed within the first 5 days of hospitalization and lasted 1.6 days on average. Patients for whom hyperactive delirium was detected early were hospitalized for significantly less time than those for whom it was detected late (6.85 versus 13.61 days, p = 0.002). Additionally, calculated personnel and material costs, including costs affecting the hospitalization period, amounted to approximately 1200 € per hyperactive delirium patient. This corresponds to approximately 0.3 CMP (casemix points) per patient. CONCLUSION: The calculations of personnel and material costs and duration of hospitalization in patients with hyperactive delirium demonstrated significant additional costs. Early routine detection of delirium can be achieved through training and this approach leads to a shortening of the hospitalization period and lower costs.

One-week temporal stability of hyperactivity in preschoolers with ADHD during psychometric assessment.

AIM: To examine the usefulness of temporal measures of motor activity during psychometric assessment on two different assessment days, 1 week apart with a scope to help the early identification of hyperactivity. METHODS: Actigraph measures at the ankle and the waist were compared on the first and the second days of psychometric assessment in a total of 169 children (93 children in ADHD group; 76 children in Non-ADHD group) aged 3 years and 4 years. RESULTS: There was a significant interaction effect between group and time on the activity level at the waist. Although the activity level of the waist in the children with ADHD did not significantly differ between Day 1 and Day 2, the activity level of the children without ADHD declined significantly from Day 1 to 2. A total of 70% of children were correctly classified into ADHD or Non-ADHD groups based only on Day 2 waist activity data. CONCLUSION: The temporal consistency of hyperactivity in young children with ADHD during psychometric assessment is confirmed, indicating that objective measures of motor activity at the waist over different days of psychometric assessment can provide additional information for the stability of hyperactivity.

CAOS contribution to understanding cultural/ethnic differences in the prevalence of bipolar affective disorder in New Zealand.

OBJECTIVE: To examine whether data on the clinical profiles of psychiatric service users can inform the claim that Maori in the New Zealand community have an increased rate of bipolar disorder. METHOD: The standardized recordings of a variety of clinical phenomena previously collected in a New Zealand study of psychiatric service users was extracted for those persons who were diagnosed with a bipolar mental disorder. The individual clinical phenomena were then compared by ethnicity. RESULTS: The most dramatic result was the increased recording of high levels of overactivity or disruptive aggressive behaviour in Maori compared with European in psychiatric service users, despite which, the rates of the disorder did not significantly differ by ethnicity. CONCLUSION: In the community survey lay raters were deciding on the presence or absence of phenomena including hyperactivity without the contextual knowledge that clinicians use. It is possible that the Composite International Diagnostic Interview decision tree was being fed an excessive amount of that criterion.

Hyperactive boys in their classroom: assessment of teacher and peer perceptions, interactions, and classroom behaviors.

Teacher ratings, peer perceptions, peer interactions, and classroom behaviors of 17 hyperactive and 17 active elementary school-age boys, nominated by their teachers, were compared using multivariate analyses and planned comparisons in order to better describe and assess hyperactivity in its most probable setting--the classroom. Hyperactive boys were found to be significantly different from actives on measures from all data sources in that they were perceived and interacted more negatively. Cluster analyses of teacher ratings of 90 hyperactives from a clinical sample and 17 hyperactives from the current sample were used to discriminate among different types of hyperactives. Four types were named anxious, conduct problems, inattentive, and low problem hyperactives. The fact that six conduct problem hyperactives were found to be more disruptive and have higher activity level ratings than six inattentive hyperactives, when observed in their classrooms, points to the need to study and treat hyperactives as heterogeneous groups.

Hyperactivity among white middle-class children. Psychogenic and other causes.

This paper investigates the problem of hyperactivity in school children and draws on the literature in the field, data collected from comprehensive examinations of 37 hyperactive children, and extensive field interviews with Chicago-area school nurses, social workers, psychologists, teachers, and principals. The research indicates that although constitutional factors are at times responsible for this problem, hyperactivity is due to psychogenic factors much more frequently than is often recognized. It also was found that school teachers seem overly inclined to identify hyperactivity in their students and to recomment that it be counteracted with prescribed drugs. The suggestion is offered that any child thought to be hyperactive undergo a comprehensive examination before such drugs as Ritalin and Dexedrine are prescribed.

Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome.

Thirty-one children with behavioural problems and learning difficulties were allergy tested for sensitivity to salicylates, artificial colours and flavours, eighteen children had a positive response, and 15 of these were given the Australian Version of the Feingold K.P. diet. Ninety-three per cent responded with improved behaviour in the areas of overactivity, distractability, impulsiveness and excitability. Sleep and enuresis problems were resolved partially or completely. This study demonstrates that the aforementioned elimination diet significantly affects behaviour.

The school health team and school health physician: new role and operation.

A new concept of school health redefines the school physician's role as dealing primarily with behavior and learning disorders in children. It is an on-site operation, using a multidisciplinary team of professionals. We outlined internal team operations, as well as modes of remediation. Many types of behavior and learning problems were seen by our school health team during the first year of operation. It is important to recognize the multiplicity of diagnoses on individual elementary school children, as well as the differentiation of early organics from late functional primary causes. We need to reassess the delivery of school health care. The expansion of school health to include the multidisciplinary team approach to behavior and learning problem is a primary priority. We suggest using outside medical agencies for periodic physical illness.