The underlying neuropsychological and neural correlates of the impaired Chinese reading skills in children with attention deficit hyperactivity disorder.

Impaired basic academic skills (e.g., word recognition) are common in children with Attention Deficit Hyperactivity Disorder (ADHD). The underlying neuropsychological and neural correlates of impaired Chinese reading skills in children with ADHD have not been substantially explored. Three hundred and two children with ADHD (all medication-naïve) and 105 healthy controls underwent the Chinese language skill assessment, and 175 also underwent fMRI scans (84 ADHD and 91 controls). Between-group and mediation analyses were applied to explore the interrelationships of the diagnosis of ADHD, cognitive dysfunction, and impaired reading skills. Five ADHD-related brain functional networks, including the default mode network (DMN) and the dorsal attention network (DAN), were built using predefined regions of interest. Voxel-based group-wise comparisons were performed. The ADHD group performed worse than the control group in word-level reading ability tests, with lower scores in Chinese character recognition (CR) and word chains (WS) (all P < 0.05). With full-scale IQ and sustained attention in the mediation model, the direct effect of ADHD status on the CR score became insignificant (P = 0.066). The underlying neural correlates for the orthographic knowledge (OT) and CR differed between the ADHD and the control group. The ADHD group tended to recruit more DMN regions to maintain their reading performance, while the control group seemed to utilize more DAN regions. Children with ADHD generally presented impaired word-level reading skills, which might be caused by impaired sustained attention and lower IQ. According to the brain functional results, we infer that ADHD children might utilize a different strategy to maintain their orthographic knowledge and character recognition performance.

The clinical, neuropsychological, and brain functional characteristics of the ADHD restrictive inattentive presentation.

Objectives: There is an ongoing debate about the restrictive inattentive (RI) presentation of attention deficit hyperactivity disorder (ADHD). The current study aimed to systematically investigate the clinical, neuropsychological, and brain functional characteristics of children with ADHD restrictive inattentive presentation. Methods: A clinical sample of 789 children with or without ADHD participated in the current study and finished clinical interviews, questionnaires, and neuropsychological tests. Those individuals with a diagnosis of ADHD were further divided into three subgroups according to the presentation of inattentive and/or hyperactive/impulsive symptoms, the ADHD-RI, the ADHD-I (inattentive), and the ADHD-C (combined) groups. Between-group comparisons were carried out on each clinical and neuropsychological measure using ANCOVA, with age and sex as covariates. Bonferroni corrections were applied to correct for multiple comparisons. Two hundred twenty-seven of the subjects also went through resting-state functional magnetic resonance imaging scans. Five ADHD-related brain functional networks, including the default mode network (DMN), the dorsal attention network (DAN), the ventral attention network, the executive control network, and the salience network, were built using predefined regions of interest (ROIs). Voxel-based group-wise comparisons were performed. Results: Compared with healthy controls, all ADHD groups presented more clinical problems and weaker cognitive function. Among the ADHD groups, the ADHD-C group had the most clinical problems, especially delinquent and aggressive behaviors. Regarding cognitive function, the ADHD-RI group displayed the most impaired sustained attention, and the ADHD-C group had the worst response inhibition function. In terms of brain functional connectivity (FC), reduced FC in the DMN was identified in the ADHD-C and the ADHD-I groups but not the ADHD-RI group, compared to the healthy controls. Subjects with ADHD-I also presented decreased FC in the DAN in contrast to the control group. The ADHD-RI displayed marginally significantly lower FC in the salience network compared to the ADHD-I and the control groups. Conclusion: The ADHD-RI group is distinguishable from the ADHD-I and the ADHD-C groups. It is characterized by fewer externalizing behaviors, worse sustained attention, and better response inhibition function. The absence of abnormally high hyperactive/impulsive symptoms in ADHD-RI might be related to less impaired brain function in DMN, but potentially more impairment in the salience network.

Behavioral and brain functional characteristics of children with Attention-Deficit/Hyperactivity disorder and anxiety trait.

The current study aimed to explore the behavioral, daily-life executive functional, and brain functional connectivity patterns in children with attention-deficit/hyperactivity disorder (ADHD) and anxiety. A total of 246 children with non-comorbid ADHD and 91 healthy controls (HCs) participated in the current study, among whom 175 subjects went through resting-state functional magnetic resonance imaging (fMRI) scans. The ADHD participants were divided into two subgroups: ADHD with a high level of anxiety (ADHD + ANX) and ADHD with a low level of anxiety (ADHD-ANX). The Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) were used to capture the behavioral and daily-life executive functional characteristics. Independent component analysis with dual regression models was applied to the fMRI data. All statistical models were estimated with age and sex as covariates. Compared with the ADHD-ANX group, the ADHD + ANX group showed more withdrawn, somatic, social, thought, attention, delinquent, and aggressive problems (all corrected p < 0.05). The ADHD + ANX group also displayed more impaired emotional control and working memory than the ADHD-ANX (all corrected p < 0.05). The ADHD-ANX group, but not the ADHD + ANX group, showed elevated functional connectivity within the default mode network compared with the HC group. The mean function connectivity within the default mode network significantly mediated the correlation between anxiety level and attention problems. In sum, anxiety in children with ADHD was associated with more social, emotional, and behavioral problems, more impaired daily-life executive function, and altered brain function. Our work provides important information on the heterogeneity of ADHD.

ADHD-inattentive versus ADHD-Combined subtypes: A severity continuum or two distinct entities? A comprehensive analysis of clinical, cognitive and neuroimaging data.

The current study aimed to explore the multimodal differences between the inattentive ADHD (ADHD-I) subtype and the combined ADHD (ADHD-C) subtype. A large sample of medication-naïve children with pure ADHD (i.e., without any comorbidity) (145 with ADHD-I, 132 with ADHD-C) and healthy controls (n = 98) were recruited. A battery of multiple scales and cognitive tests were utilized to assess the clinical and cognitive profiles of each individual. In addition, structural and diffusion magnetic resonance imaging (MRI) were acquired for 120 subjects with ADHD and 85 controls. Regional gray matter volume, white matter volume, and diffusion tensors, e.g., axial diffusivity (AD), were compared among the three groups in a whole-brain voxel-wise manner. Compared with healthy controls, both ADHD groups exhibited elevated levels of behavioral and emotional problems. The ADHD-C group had more behavioral problems and emotional liability, as well as less anxiety, than the ADHD-I group. The two ADHD groups were equally impaired in most cognitive domains, with the exception of sustained attention. Compared with healthy controls, the ADHD-C group showed a high gray matter volume (GMV) in the bilateral thalamus and a high white matter volume in the body of the corpus callosum, while the ADHD-I group presented an elevated GMV mainly in the left precentral gyrus and posterior cingulate cortex. Compared with participants with ADHD-C and healthy controls, subjects with ADHD-I showed increased AD in widespread brain regions. Our study has revealed a distinct, interconnected pattern of behavioral, cognitive, and brain structural characteristics in children with different ADHD subtypes.

Developmental brain structural atypicalities in autism: a voxel-based morphometry analysis.

BACKGROUND: Structural magnetic resonance imaging (sMRI) studies have shown atypicalities in structural brain changes in individuals with autism spectrum disorder (ASD), while a noticeable discrepancy in their results indicates the necessity of conducting further researches. METHODS: The current study investigated the atypical structural brain features of autistic individuals who aged 6-30 years old. A total of 52 autistic individuals and 50 age-, gender-, and intelligence quotient (IQ)-matched typically developing (TD) individuals were included in this study, and were assigned into three based cohorts: childhood (6-12 years old), adolescence (13-18 years old), and adulthood (19-30 years old). Analyses of whole-brain volume and voxel-based morphometry (VBM) on the sMRI data were conducted. RESULTS: No significant difference was found in the volumes of whole-brain, gray matter, and white matter between the autism and TD groups in the three age-based cohorts. For VBM analyses, the volumes of gray matter in the right superior temporal gyrus and right inferior parietal lobule in the autism group (6-12 years old) were smaller than those in the TD group; the gray matter volume in the left inferior parietal lobule in the autism group (13-18 years old) was larger than that in the TD group; the gray matter volume in the right middle occipital gyrus in the autism group (19-30 years old) was larger than that in the TD group, and the gray matter volume in the left posterior cingulate gyrus in the autism group was smaller than that in the TD group. CONCLUSION: Autistic individuals showed different atypical regional gray matter volumetric changes in childhood, adolescence, and adulthood compared to their TD peers, indicating that it is essential to consider developmental stages of the brain when exploring brain structural atypicalities in autism.

Frequency-specific age-related changes in the amplitude of spontaneous fluctuations in autism.

Background: Autism spectrum disorder is characterized by atypical developmental changes during brain maturation, but regional brain functional changes that occur with age and across different frequency bands are unknown. Therefore, the current study aimed to explore potential age and frequency band-related changes in the regional brain activities in autism. Methods: A total of 65 participants who met the DSM-IV criteria for autistic disorder and 55 typically developed (TD) participants (both age 6-30 years) were recruited in the current study. The two groups were matched in age (t=-1.314, P=0.191) and gender (χ2=2.760, P=0.097). The amplitude of low-frequency fluctuations (ALFF) was employed to explore the effect of development on spontaneous brain activity in individuals with autism and in TD participants across slow-5 (0.01-0.027 Hz), slow-4 (0.027-0.073 Hz), and slow-3 (0.073-0.1 Hz) frequency bands. The diagnosis-by-age interaction effect in the whole brain voxels in autism and TD groups was investigated. Results: Autism individuals showed significantly higher ALFF in the dorsal striatum in childhood (Caudate cluster: t=3.626, P=0.001; Putamen cluster: t=2.839, P=0.007) and remarkably lower ALFF in the dorsal striatum in adulthood (Caudate cluster: t=-2.198, P=0.038; Putamen cluster: t=-2.314, P=0.030) relative to TD, while no significant differences were observed in adolescence (all P>0.05). In addition, abnormal ALFF amplitudes were specific to the slow-4 (0.027-0.073 Hz) frequency band in the clusters above. Conclusions: The current study indicated abnormal development patterns in the spontaneous activity of the dorsal striatum in autism and highlighted the potential role of the slow-4 frequency band in the pathology of autism. Also, the potential brain mechanism of autism was revealed, suggesting that autism-related variations should be investigated in a specific frequency.

Atypicalities in the developmental trajectory of cortico-striatal functional connectivity in autism spectrum disorder.

LAY ABSTRACT: Autism spectrum disorder has long been conceptualized as a disorder of "atypical development of functional brain connectivity (which refers to correlations in activity levels of distant brain regions)." However, most of the research has focused on the connectivity between cortical regions, and much remains unknown about the developmental changes of functional connectivity between subcortical and cortical areas in autism spectrum disorder. We used the technique of resting-state functional magnetic resonance imaging to explore the developmental characteristics of intrinsic functional connectivity (functional brain connectivity when people are asked not to do anything) between subcortical and cortical regions in individuals with and without autism spectrum disorder aged 6-30 years. We focused on one important subcortical structure called striatum, which has roles in motor, cognitive, and affective processes. We found that cortico-striatal intrinsic functional connectivities showed opposite developmental trajectories in autism spectrum disorder and typically developing individuals, with connectivity increasing with age in autism spectrum disorder and decreasing or constant in typically developing individuals. We also found significant negative behavioral correlations between those atypical cortico-striatal intrinsic functional connectivities and autistic symptoms, such as social-communication deficits, and restricted/repetitive behaviors and interests. Taken together, this work highlights that the atypical development of cortico-subcortical functional connectivity might be largely involved in the neuropathological mechanisms of autism spectrum disorder.

Reliability and validity of the Chinese version of the kiddie-schedule for affective disorders and schizophrenia-present and lifetime version DSM-5 (K-SADS-PL-C DSM-5).

BACKGROUND: As the Diagnostic and Statistical Manual of Mental Disorders fifth version (DSM-5) was published, the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) was modified to adapt the new version (K-SADS-PL DSM-5). We translated it to Chinese (K-SADS-PL-C DSM-5) and described its reliability and validity. METHODS: A total of 154 groups of 6 to 18-year-old children and their guardians were included. Trained interviewers interviewed subjects using the K-SADS-PL-C DSM-5. Interrater reliability was assessed by audio recording. Parent-reported scales, like child behavior checklist (CBCL), the Chinese version of Swan-son Nolan and Pelham, version IV scale-parent form (SNAP-IV), social responsiveness scale (SRS-1), and children-reported scales like depression self-rating scale for children (DSRSC) and the screen for child anxiety related emotional disorders (SCARED) were used to examine the validity of depressive disorder, ADHD, ASD, and ODD. RESULTS: The K-SADS-PL-C DSM-5 had fair to excellent interrater (0.537-1.000) and test-retest (0.468-0.885) reliability of affective disorder and neurodevelopment disorder. The convergent validity of affective disorder and neurodevelopment disorder was good, and their divergent validity was acceptable. LIMITATIONS: i) Clinical questionnaires were insensitive in classifying disorders and had limitations in derived diagnoses. ii) Samples only came from clinical environment, iii) covered limited disease species, and iv) were small. CONCLUSION: The K-SADS-PL-C DSM-5 can support reliable and valid diagnoses for children with affect, neurodevelopmental, and behavioral disorders in China.

Cortical Morphometric Abnormality and Its Association with Working Memory in Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. The present study investigated the cortical morphology features and their relationship with working memory (WM). METHODS: In the present study, a total of 36 medication naïve children with ADHD (aged from 8 to 15 years) and 36 age- and gendermatched healthy control (HC) children were included. The digit span test was used to evaluate WM. The magnetic resonance imaging (MRI) was used to examine the characteristics of cortical morphology. Firstly, we compared the cortical morphology features between two groups to identify the potential structural alterations of cortical volume, surface, thickness, and curvature in children with ADHD. Then, the correlation between the brain structural abnormalities and WM was further explored in children with ADHD. RESULTS: Compared with the HC children, the children with ADHD showed reduced cortical volumes in the left lateral superior temporal gyrus (STG) (p=6.67×10-6) and left anterior cingulate cortex (ACC) (p=3.88×10-4). In addition, the cortical volume of left lateral STG was positively correlated with WM (r=0.36, p=0.029). CONCLUSION: Though preliminary, these findings suggest that the reduced cortical volumes of left lateral STG may contribute to the pathogenesis of ADHD and correlate with WM in children with ADHD.

Neural response to trauma-related and trauma-unrelated negative stimuli in remitted and persistent pediatric post-traumatic stress disorder.

INTRODUCTION: Most youths who suffer from post-traumatic stress disorder (PTSD) lose their diagnosis in the first 1-2 years. However, there are few studies on this brain mechanism, and the heterogeneity of the findings is partially due to the different stimuli applied and the mixed trauma history. Therefore, the use of trauma-related/unrelated stimuli to study the remittance mechanism of earthquake-induced PTSD could advance our knowledge of PTSD and inspire future treatment. METHODS: Thirteen youths with PTSD, 18 remitted participants, and 18 control participants underwent functional magnetic resonance imaging (fMRI), while viewing trauma-related pictures, trauma-unrelated negative pictures, and scrambled pictures. RESULTS: Under trauma-unrelated condition, the neural activity of the left hippocampus in the remitted group was between the two other groups. Under trauma-related condition, the PTSD and the remitted group exhibited higher neural activity in the right middle occipital gyrus than controls. The remitted group showed higher neural activity in the right parahippocampal gyrus and right lingual gyrus under trauma-related condition than trauma-unrelated condition, while no significant difference was found in PTSD group. CONCLUSION: PTSD status-related group differences are mainly reflected in the left hippocampus under the trauma-unrelated condition, while the hyperactivity in the right middle occipital gyrus under trauma-related condition could be an endophenotype for PTSD.

Altered brain white matter microstructural asymmetry in children with ADHD.

OBJECTIVES: We aimed to examine brain white matter integrity in children with ADHD. METHODS: In a cohort of children with ADHD (n = 83) and healthy controls (n = 122), we used tract-based spatial statistics on Diffusion Tensor Imaging (DTI) data to obtain the mean fractional anisotropy (FA) in 40 bilateral regions of interest (ROIs). Lateralization Index (LI) was calculated. The difference in LI between groups and correlations between the LI of each ROI and ADHD symptom scores as well as cognitive function were examined. RESULTS: Children with ADHD had significantly greater LI at the posterior thalamic radiation (PTR) compared with healthy controls (mean LI in ADHD = 0.0096; in Control = 0.0044, p = 0.0143), and LI of the external capsule (EC) was significantly correlated with inattention symptoms in both groups (ß = -0.00059, p = 0.0181). LI of the PTR was significantly correlated with inhibitory function in healthy controls (ß = -0.0008510, p = 0.0248), but not in children with ADHD. CONCLUSION: We found increased brain white matter asymmetry (leftward) in children with ADHD compared with healthy controls at the posterior thalamic radiation. Leftward lateralization of FA values at the external capsule was negatively correlated with ADHD symptoms in both children with ADHD and healthy controls.

Inconsistency in Abnormal Functional Connectivity Across Datasets of ADHD-200 in Children With Attention Deficit Hyperactivity Disorder.

Many studies have shown abnormal functional connectivity in children with attention deficit hyperactivity disorder (ADHD) by using resting-state functional magnetic resonance imaging (rs-fMRI). However, few studies illustrated that to what extent these findings were consistent across different datasets. The present study aimed to assess the consistency of abnormal functional connectivity in children with ADHD across the four datasets from a public-assess rs-fMRI ADHD cohort, namely, ADHD-200. We employed the identical analysis process of previous studies and examined a few factors, including connectivity with the seed regions of the bilateral dorsal anterior cingulate cortex, bilateral inferior frontal gyrus, and bilateral middle frontal gyrus; connectivity between default mode network and executive control network; stringent and lenient statistical thresholds; and the ADHD subtypes. Our results revealed a high inconsistency of abnormal seed-based connectivity in children with ADHD across all datasets, even across three datasets from the same research site. This inconsistency could also be observed with a lenient statistical threshold. Besides, each dataset did not show abnormal connectivity between default mode network and executive control network for ADHD, albeit this abnormal connectivity between networks was intensively reported in previous studies. Importantly, the ADHD combined subtype showed greater consistency than did the inattention subtype. These findings provided methodological insights into the studies on spontaneous brain activity of ADHD, and the ADHD subtypes deserve more attention in future studies.

Linked anatomical and functional brain alterations in children with attention-deficit/hyperactivity disorder.

OBJECTIVES: Neuroimaging studies have independently demonstrated brain anatomical and functional impairments in participants with ADHD. The aim of the current study was to explore the relationship between structural and functional brain alterations in ADHD through an integrated analysis of multimodal neuroimaging data. METHODS: We performed a multimodal analysis to integrate resting-state functional magnetic resonance imaging (MRI), structural MRI, and diffusion-weighted imaging data in a large, single-site sample of children with and without diagnosis for ADHD. The inferred subject contributions were fed into regression models to investigate the relationships between diagnosis, symptom severity, gender, and age. RESULTS: Compared with controls, children with ADHD diagnosis showed altered white matter microstructure in widespread white matter fiber tracts as well as greater gray matter volume (GMV) in bilateral frontal regions, smaller GMV in posterior regions, and altered functional connectivity (FC) in default mode and fronto-parietal networks. Age-related growth of GMV of bilateral occipital lobe, FC in frontal regions as well as age-related decline of GMV in medial regions seen in controls appeared reversed in children with ADHD. In the whole group, higher symptom severity was related to smaller GMV in widespread regions in bilateral frontal, parietal, and temporal lobes, as well as greater GMV in intracalcarine and temporal cortices. CONCLUSIONS: Through a multimodal analysis approach we show that structural and functional alterations in brain regions known to be altered in subjects with ADHD from unimodal studies are linked across modalities. The brain alterations were related to clinical features of ADHD, including disorder status, age, and symptom severity.

An improved approach to detection of amplitude of low-frequency fluctuation (ALFF) for resting-state fMRI: fractional ALFF.

Most of the resting-state functional magnetic resonance imaging (fMRI) studies demonstrated the correlations between spatially distinct brain areas from the perspective of functional connectivity or functional integration. The functional connectivity approaches do not directly provide information of the amplitude of brain activity of each brain region within a network. Alternatively, an index named amplitude of low-frequency fluctuation (ALFF) of the resting-state fMRI signal has been suggested to reflect the intensity of regional spontaneous brain activity. However, it has been indicated that the ALFF is also sensitive to the physiological noise. The current study proposed a fractional ALFF (fALFF) approach, i.e., the ratio of power spectrum of low-frequency (0.01-0.08 Hz) to that of the entire frequency range and this approach was tested in two groups of resting-state fMRI data. The results showed that the brain areas within the default mode network including posterior cingulate cortex, precuneus, medial prefrontal cortex and bilateral inferior parietal lobule had significantly higher fALFF than the other brain areas. This pattern was consistent with previous neuroimaging results. The non-specific signal components in the cistern areas in resting-state fMRI were significantly suppressed, indicating that the fALFF approach improved the sensitivity and specificity in detecting spontaneous brain activities. Its mechanism and sensitivity to abnormal brain activity should be evaluated in the future studies.

Altered baseline brain activity in children with ADHD revealed by resting-state functional MRI.

In children with attention deficit hyperactivity disorder (ADHD), functional neuroimaging studies have revealed abnormalities in various brain regions, including prefrontal-striatal circuit, cerebellum, and brainstem. In the current study, we used a new marker of functional magnetic resonance imaging (fMRI), amplitude of low-frequency (0.01-0.08Hz) fluctuation (ALFF) to investigate the baseline brain function of this disorder. Thirteen boys with ADHD (13.0+/-1.4 years) were examined by resting-state fMRI and compared with age-matched controls. As a result, we found that patients with ADHD had decreased ALFF in the right inferior frontal cortex, [corrected] and bilateral cerebellum and the vermis as well as increased ALFF in the right anterior cingulated cortex, left sensorimotor cortex, and bilateral brainstem. This resting-state fMRI study suggests that the changed spontaneous neuronal activity of these regions may be implicated in the underlying pathophysiology in children with ADHD.

[Brain functions in attention deficit hyperactivity disorder combined and inattentive subtypes: A resting-state functional magnetic resonance imaging study].

OBJECTIVE: To study the differences of brain functions between children with attention deficit hyperactivity disorder (ADHD) predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes in resting state using functional magnetic resonance imaging (fMRI). METHODS: A newly reported regional homogeneity (ReHo) approach was used to analyze blood oxygen level-dependent fMRI (BOLD-fMRI) data in resting state among 6 ADHDj C, 9 ADHD-I and 15 normal control boys. RESULTS: The brain regions showing differences among the three groups included bilateral frontal lobe, right cuneus and right inferior temporal gyrus. Compared with the normal controls, ADHD-C showed decreased ReHo in left frontal lobe and right inferior temporal gyrus, ADHD-I showed decreased ReHo in bilateral frontal and temporal lobe and right cerebellum and increased ReHo in bilateral occipital lobe and right inferior parietal gyrus. There were no brain regions showing different ReHo between ADHD-C and ADHD-I. CONCLUSION: Although both ADHD-C and ADHD-I showed abnormal neural activity in resting state compared with the normal controls, there were no differences for brain functions in resting state between ADHD-C and ADHD-I.

[Effect of extended-release methylphenidate on the ecological executive function for attention deficit hyperactivity disorder].

OBJECTIVE: To test the effect of extended-released methylphenidate (Concerta) on ecological executive function for attention deficit hyperactivity disorder (ADHD) and to evaluate the correlation between the improvement of ecological executive function and that of the core symptom of ADHD. METHODS: We conducted a 4-6-week open-trial study of extended-released methylphenidate (18-54 mg/d) in 26 children with ADHD, aged 8-14 years. Ecological executive function and ADHD symptoms were ascertained by the parent form of behavior rating inventory of executive function (BRIEF), ADHD-IV rating scale and Conners short form rating scales before and after the treatment. RESULTS: The mean item raw score of global executive composite (GEC), metacognition index (MI),working memory, monitor and inhibition subscale of BRIEF were significantly decreased after the treatment (t=2.763-3.380, P<0.05). The reduction rates of MI and the 5 subscales attached to MI were moderately correlated to the maximum reduction rates of the inattentive subscale of ADHD-IV rating scale (r=0.415-0.640, P<0.05). While the correlation between the reduction rate of inhibition subscale and the maximum reduction rates of ADHD symptom were not significant. CONCLUSION: The extended-released methylphenidate was proved to have the potential to improve ecological executive function of ADHD. The improvement of inhibition might not parallel that of the core symptom of ADHD.

[A pilot study on effect of methylphenidate on balance function of children with attention deficit hyperactivity disorder].

OBJECTIVE: To explore the effect of methylphenidate on the balance function of children with attention deficit hyperactivity disorder, and the correlation between the variations of balance function and subjective clinical assessment before and after treatment. METHODS: From July to December 2006, 23 children (19 boys and 4 girls) who met DSM-IV criteria for ADHD participated in an open study conducted at Institute of Mental Health, Peking University. The variation of their balance functions before and after methylphenidate extended-release tablets (OROS methylphenidate) treatment were evaluated, and the differences of balance functions between 19 ADHD boys pre- and post-treatment and 38 age-matched typically developing control boys were compared. Balance functions were assessed with sensory organization test (SOT) provided by SMART EquiTest system. Subjective clinical assessments were measured with ADHD rating scale-IV and IOWA Conners rating scale. RESULTS: The equilibrium score (ES) in SOT5, SOT6, and composite score (61.84+/-14.19, 65.88+/-15.41, and 75.70+/-10.30, respectively), and the strategy score (SS) in SOT4 and SOT5 (89.20+/-3.17 and 83.22+/-6.56), and the sensory analysis of vestibular ratio (67.64+/-14.43) improved significantly after OROS methylphenidate treatment compared to those before treatment (49.81+/-16.26, 57.61+/-16.72, 68.70+/-11.96, 86.84+/-4.49, 78.55+/-6.55, and 54.46+/-17.27, respectively, P<0.05); Before treatment, the ES in SOT1-6 (90.72 +/-2.49,85.47+/-6.11,83.42+/-9.95,70.18+/-18.03,47.89+/-16.93 and 57.00+/-15.68) and composite score (67.95+/-12.17), and the SS in SOT1 (98.02+/-1.52), and the sensory analysis of vestibular and visual ratios (77.20+/-19.23 and 52.62+/-18.15) of ADHD boys were significantly lower than those of typical control boys (93.14+/-2.45, 89.59+/-4.22, 89.13+/-5.06, 83.11+/-5.75, 60.11+/-10.11, 69.75+/-12.03, 77.71+/-6.20, 98.68+/-0.39, 89.22+/-5.43 and 64.41+/-10.03, respectively, P<0.05); After treatment, only in SOT1 the ES (90.82+/-2.98) and SS (97.91+/-1.16) of ADHD boys were significantly lower than those of control boys (93.14+/-2.45 and 98.68+/- 0.39, P<0.05).We did not observe significant correlations between the improvement percentages of SOT results and score reduction percentages on ADHD rating scale-IV and IOWA Conners rating scale before and after treatment (P>0.05). CONCLUSION: This study suggests that methylphenidate can improve the balance function of children with ADHD through direct effect on the balance system.

[Effect of methylphenidate on executive function for children with attention deficit hyperactivity disorder].

OBJECTIVE: To explore whether methylphenidate (MPH) can improve the executive function (EF) of attention deficit hyperactivity disorder (ADHD) children and the degree of the improvements. METHOD: We conducted an open study of 29 children (25 boys and 4 girls) who met DSM-IV criteria for ADHD. The variations of their EF before and after methylphenidate extended-release tablets [osmotic release oral system(OROS) methylphenidate] treatment were evaluated, and the differences of EF between 24 ADHD boys before and after treatment and 24 age-matched typically developing control boys were compared. The research instruments included Stroop color-word task, Rey complex figure test, digit span test, trail making test, tower of Hanoi and verbal fluency test. RESULTS: The performances of errors in Stroop 1, time and errors of Stroops 2 and 4; the immediate memory and delay recalling of structure and detail score of RCFT; time of number-letter trail making, shifting time; total time and steps, rule violation of tower of Hanoi improved significantly after OROS methylphenidate treatment as compared with those before treatment. They were no significant differences between ante- and post-treatment. The initiation planning time of tower of Hanoi was significantly shorter after treatment as compared with that before treatment . CONCLUSION: This study suggests that methylphenidate can improve the executive function in the aspects of inhibition, visual working memory, set shifting and planning in ADHD children, and almost all aspects of EF can reach the normal level except the inhibition.

Effect of an Ecological Executive Skill Training Program for School-aged Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial.

BACKGROUND: As medication does not normalize outcomes of children with attention deficit hyperactivity disorder (ADHD), especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample. METHODS: The children (aged 6-12 years) with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program for multiple executive skills. Executive function (EF), ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls (HCs) were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups. RESULTS: Thirty-eight children with ADHD in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function (BRIEF) total score (135.89 ± 16.80 vs. 146.09 ± 23.92, P= 0.04) and monitoring score (18.05 ± 2.67 vs. 19.77 ± 3.10, P= 0.02), ADHD-IV overall score (41.11 ± 7.48 vs. 47.20 ± 8.47, P< 0.01), hyperactivity-impulsivity (HI) subscale score (18.92 ± 5.09 vs. 21.93 ± 4.93, P= 0.02), and inattentive subscale score (22.18 ± 3.56 vs. 25.27 ± 5.06, P< 0.01), compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale (F = 5.06, P= 0.03), working memory (F = 4.48, P= 0.04), ADHD-IV overall score (F = 21.72, P< 0.01), HI subscale score (F = 19.08, P< 0.01), and inattentive subscale score (F = 12.40, P< 0.01). Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form (WFIRS-P) among the intervention and waitlist groups at posttreatment and HCs at baseline. CONCLUSIONS: This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social functioning in school-aged children with ADHD. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov; NCT02327585.