Developmental profiles of childhood attention-deficit/hyperactivity disorder and irritability: association with adolescent mental health, functional impairment, and suicidal outcomes.

BACKGROUND: Irritability is frequently comorbid with ADHD. Although irritability alone has been linked to deleterious mental health and adaptive issues, the joint developmental course of ADHD and irritability symptoms during childhood as well as its association with later mental health and suicidal outcomes is not fully understood. We aimed to describe the developmental trajectories of childhood ADHD and irritability symptoms and to quantify their association with adolescent mental health and suicidal outcomes. METHODS: The Quebec Longitudinal Study of Child Development (QLSCD) included 1407 participants from the general population followed up from age 5 months to 17 years. We used a multitrajectory approach to identify developmental trajectories of childhood (6-12 years) ADHD and irritability symptoms. Outcome measures were adolescent (13-17 years) mental health (psychiatric symptoms/functional impairment) and suicidal outcomes. RESULTS: We identified distinct developmental profiles: combined absent or very low ADHD and absent or very low irritability (940 [66.8%]; reference group), moderately high irritability and low ADHD (158 [11.2%]), moderately high ADHD and low irritability (198 [14.1%]), and combined high ADHD and high irritability (111 [7.9%]). Multivariate modeling showed that, compared to children in the reference group, those in the combined high ADHD and high irritability profile showed higher levels of ADHD continuity (d ranges = 0.40-0.50), externalizing (d ranges = 0.25-0.59), internalizing (d ranges = 0.20-0.29), and functional impairments (d ranges = 0.17-0.48) and suicidal behaviors (odds ratio (OR) = 2.12, confidence interval (CI) = 1.47-3.06) in adolescence. CONCLUSIONS: The presence of persistently high levels of irritability along with ADHD symptoms during childhood significantly predicts adolescent ADHD continuity, externalizing, internalizing, and suicidal outcomes. Systematic consideration of irritability when assessing and treating ADHD may improve long-term mental health outcomes.

Virtual Remediation Versus Methylphenidate to Improve Distractibility in Children With ADHD: A Controlled Randomized Clinical Trial Study.

Objective: Virtual environments have been used to assess children with ADHD but have never been tested as therapeutic tools. We tested a new virtual classroom cognitive remediation program to improve symptoms in children with ADHD. Method: In this randomized clinical trial, 51 children with ADHD (7-11 years) were assigned to a virtual cognitive remediation group, a methylphenidate group, or a psychotherapy group. All children were evaluated before and after therapy with an ADHD Rating Scale, a Continuous Performance Test (CPT), and a virtual classroom task. Results: After therapy by virtual remediation, children exhibited significantly higher numbers of correct hits on the virtual classroom and CPT. These improvements were equivalent to those observed with methylphenidate treatment. Conclusion: Our study demonstrates for the first time that a cognitive remediation program delivered in a virtual classroom reduces distractibility in children with ADHD and could replace methylphenidate treatment in specific cases.

Developmental changes in face visual scanning in autism spectrum disorder as assessed by data-based analysis.

Individuals with autism spectrum disorder (ASD) present reduced visual attention to faces. However, contradictory conclusions have been drawn about the strategies involved in visual face scanning due to the various methodologies implemented in the study of facial screening. Here, we used a data-driven approach to compare children and adults with ASD subjected to the same free viewing task and to address developmental aspects of face scanning, including its temporal patterning, in healthy children, and adults. Four groups (54 subjects) were included in the study: typical adults, typically developing children, and adults and children with ASD. Eye tracking was performed on subjects viewing unfamiliar faces. Fixations were analyzed using a data-driven approach that employed spatial statistics to provide an objective, unbiased definition of the areas of interest. Typical adults expressed a spatial and temporal strategy for visual scanning that differed from the three other groups, involving a sequential fixation of the right eye (RE), left eye (LE), and mouth. Typically developing children, adults and children with autism exhibited similar fixation patterns and they always started by looking at the RE. Children (typical or with ASD) subsequently looked at the LE or the mouth. Based on the present results, the patterns of fixation for static faces that mature from childhood to adulthood in typical subjects are not found in adults with ASD. The atypical patterns found after developmental progression and experience in ASD groups appear to remain blocked in an immature state that cannot be differentiated from typical developmental child patterns of fixation.

Excessive daytime sleepiness in adult patients with ADHD as measured by the Maintenance of Wakefulness Test, an electrophysiologic measure.

OBJECTIVE: To quantify the objective level of sleepiness in adult attention-deficit/hyperactivity disorder (ADHD) patients and to determine the relationship between excessive daytime sleepiness and simulated driving performance. METHOD: Forty adult ADHD patients (DSM-IV criteria) and 19 matched healthy control subjects were included between June 30, 2010, and June 19, 2013. All participants completed the Epworth Sleepiness Scale and the Manchester Driving Behavior Questionnaire. After nocturnal polysomnography, they performed 2 neuropsychological tests, a 4 × 40-minute Maintenance of Wakefulness Test, and a 1-hour driving session. The primary outcome measure was the mean sleep latency on the Maintenance of Wakefulness Test. ADHD patients were divided into 3 groups defined by their Maintenance of Wakefulness Test scores. Participants (patients and control subjects) were allocated as follows: sleepy ADHD (0-19 min), intermediate ADHD (20-33 min), alert ADHD (34-40 min), and control group (34-40 min). The driving performance outcome was the mean standard deviation of lateral position of the vehicle during the simulated session. RESULTS: The group mean (SD) Epworth Sleepiness Scale score was higher in ADHD patients (12.1 [4.4]) than in controls (6.0 [2.7]) (P < .001). On the basis of the Maintenance of Wakefulness Test scores, 14 patients (35%) were in the sleepy group, 20 (50%) were in the intermediate group, and only 6 (15%) were in the alert group. Sleepy ADHD patients exhibited significantly deteriorated driving performance compared to the other 3 groups (P < .01). CONCLUSIONS: Our study shows that a significant proportion of adult ADHD patients exhibit an objective excessive daytime sleepiness, which, in addition, has an impact on simulated driving performance. Excessive daytime sleepiness, therefore, may be a key element needed to better evaluate these ADHD patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01160874.

A late-emerging auditory deficit in autism.

OBJECTIVE: Individuals with autism spectrum disorders (ASD) show enhanced perceptual and memory abilities in the domain of pitch, but also perceptual deficits in other auditory domains. The present study investigated their skills with respect to "echoic memory," a form of short-term sensory memory intimately tied to auditory perception, using a developmental perspective. METHOD: We tested 23 high-functioning participants with ASD and 26 typically developing (TD) participants, distributed in two age groups (children vs. young adults; mean ages: ∼11 and ∼21 years). By means of an adaptive psychophysical procedure, we measured the longest period for which periodic (i.e., repeated) noise could be reliably discriminated from nonperiodic (i.e., plain random) noise. On each experimental trial, a single noise sample was presented to the participant, who had to classify this sound as periodic or nonperiodic. RESULTS: The TD adults performed, on average, much better than the other three groups, who performed similarly overall. As a function of practice, the measured thresholds improved for the TD participants, but did not change for the ASD participants. Thresholds were not correlated to performance in a test assessing verbal memory. The variance of the participants' response biases was larger among the ASD participants than among the TD participants. CONCLUSION: The results mainly suggest that echoic memory takes a long time to fully develop in TD humans, and that this development stops prematurely in persons with ASD.

Attention-deficit/hyperactivity disorder in young French male prisoners.

While forensic studies have reported higher than community rates of mental disorders in imprisoned populations, few studies have focused on attention-deficit/hyperactivity disorder (ADHD) in these subjects. The aim of this study was to investigate ADHD prevalence among young French male prisoners. A specific diagnostic interview (Conners' Adult ADHD Diagnostic Interview for DSM-IV, CAADID) was used. Correlations between ADHD, subsyndromal ADHD, and criminal features were investigated. 11% of young male prisoners among 93 male subjects aged 18-35 years met the criteria for actual ADHD, and 17% met those for childhood ADHD. Considering ADHD and subsyndromal ADHD, prevalence was about 43% in adulthood. ADHD and subsyndromal ADHD in adulthood were significantly associated with a higher number of imprisonments and a younger age at first arrest. It could be advisable to better identify subjects with ADHD symptoms among prison populations.

Early risk factors for hyperactivity-impulsivity and inattention trajectories from age 17 months to 8 years.

CONTEXT: Attention-deficit/hyperactivity disorder is an etiologically heterogeneous neurodevelopmental condition with long-term negative outcomes. However, the early developmental course of hyperactivity-impulsivity and inattention symptoms and their association with previous environmental risk factors are still poorly understood OBJECTIVES: To describe the developmental trajectories of hyperactivity-impulsivity and inattention symptoms and to identify their prenatal, perinatal, and postnatal risk factors. DESIGN: Birth cohort from the general population. SETTING: Quebec Longitudinal Study of Child Development. PARTICIPANTS: The sample consisted of 2057 individuals, followed up from age 5 months to 8 years. MAIN OUTCOME MEASURES: Prenatal, perinatal, and postnatal risk factors assessed at age 5 months were considered predictors of group membership in high hyperactivity-impulsivity and inattention trajectories from age 17 months to 8 years. RESULTS: The frequency of hyperactivity-impulsivity symptoms tended to slightly decrease with age, whereas the frequency of inattention symptoms substantially increased up to age 6 years. However, trajectories of hyperactivity-impulsivity and inattention symptoms were significantly associated with each other. Risk factors for high trajectories of both types of symptoms were premature birth (adjusted odds ratio [aOR], 1.93; 95% CI, 1.07-3.50), low birth weight (2.11; 1.12-3.98), prenatal tobacco exposure (1.41; 1.03-1.93), nonintact family (1.85; 1.26-2.70), young maternal age at birth of the target child (1.78; 1.17-2.69), paternal history of antisocial behavior (1.78; 1.28-2.47), and maternal depression (1.35; 1.18-1.54). CONCLUSIONS: A large range of early risk factors, including prenatal, perinatal social, and parental psychopathology variables, act independently to heighten the likelihood of having persistently high levels of hyperactivity-impulsivity and inattention symptoms from infancy to middle childhood. Early interventions should be experimented with to provide effective tools for attention-deficit/hyperactivity disorder prevention.

Left-right facial orientation of familiar faces: developmental aspects of « the mere exposure hypothesis ¼.

We investigated the developmental aspect of sensitivity to the orientation of familiar faces by asking 38 adults and 72 children from 3 to 12 years old to make a preference choice between standard and mirror images of themselves and of familiar faces, presented side-by-side or successively. When familiar (parental) faces were presented simultaneously, 3- to 5-year-olds showed no preference, but by age 5-7 years an adult-like preference for the standard image emerged. Similarly, the adult-like preference for the mirror image of their own face emerged by 5-7 years of age. When familiar or self faces were presented successively, 3- to 7-year-olds showed no preference, and adult-like preference for the standard image emerged by age 7-12 years. These results suggest the occurrence of a developmental process in the perception of familiar face asymmetries which is retained in memory related to knowledge about faces.

Attention deficit/hyperactivity disorder and video games: a comparative study of hyperactive and control children.

INTRODUCTION: This study describes and compares the behavior of hyperactive and control children playing video games. SUBJECTS AND METHODS: The sample consisted of 29 ADHD children and 21 controls aged between 6 and 16 years playing video games. We used the Child Behavior Checklist and the Problem Videogame Playing scale (PVP scale). This instrument gives objective measures of problem use, which can be considered as an indication of addictive videogame playing. We designed a questionnaire for the parents, eliciting qualitative information about their child's videogame playing. There were no significant differences concerning frequency or duration of play between ADHD children and controls but differences were observed on the PVP scale. None of the controls scored above four whereas 10 hyperactive children answered affirmatively to five or more questions. These children presented a greater intensity of the disorder than the other ADHD children. CONCLUSION: While no differences concerning video game use were found, ADHD children exhibited more problems associated with videogame playing. It seems that a subgroup of ADHD children could be vulnerable to developing dependence upon video games.

[Etio-pathogenic hypothesis of attention deficit disorder in children]. / Hypothèses étiopathogéniques de l'hyperactivité avec troubles de l'attention de l'enfant.

The aetiological factors of "attention deficit hyperactivity disorder" (ADHD) are multiple, and have an importance that vary according to the individual. Nevertheless, the current state of knowledge suggests a significant biological component to the pathophysiology of this problem, and a genetic influence in particular. It thus seems that ADHD is essentially characterised by its dimension of impulsivity, linked to a defect of inhibitor control, specifically implying certain cerebral structures as well as a dysfunction of the catecholaminergic systems, and in particular, the dopaminergic system. Certainly, environmental factors influence the symptomotology and expression of the problem, but it is noted that ADHD itself influences these factors.