Physical activity and psychopathology: are long-term developmental trajectories of physical activity in children and adolescents associated with trajectories of general mental health problems and of attention-deficit hyperactivity (ADHD) symptoms?

A medium-to-high level of physical activity (PA) may have at least a short-term positive effect on psychopathology in children and adolescents. Hence, the objective of this study was to investigate the long-term effects of PA in non-adult age groups on their general mental health problems and/or ADHD symptoms, using trajectories of concurrent development over a period of 10 years. This study employed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) collected at three time points (baseline, Wave 1, Wave 2, over 10 years) from 17,640 children and adolescents. Using parent-reported data from the Strengths and Difficulties Questionnaire (SDQ), different developmental trajectories of general mental health problems (SDQ-total) and ADHD symptoms (SDQ-H/I) were identified with latent class mixed models (LCMM) statistics. This was also applied to parent- and self-reported data of three levels of PA. The latter was assessed according to WHO recommendations. The joint probability of class membership for SDQ-total as well as ADHD symptoms with PA was calculated to generate the concurrent developmental trajectories between variables. Results showed a 4-class trajectory model for both SDQ-total and ADHD symptoms among boys and girls. The majority of children and adolescents showed "low general difficulties" and "low ADHD symptoms" over the period of 10 years. Three distinct trajectories in boys and four distinct trajectories in girls were found for PA. Most of the participants showed an "increasing-decreasing activity" trajectory. No statistically significant correlations were found between the different SDQ-total or ADHD symptom trajectories and the trajectories of PA in the two genders. Taken together, our findings did not indicate any significant relationship between waxing and waning PA course over 10 years and various classes of mental health problems for children and adolescents. In contrast to our cross-sectional findings, no steady long-term medium/high-level of PA was present, which could (at least partly) explain the non-significant findings.

Long-term changes in serum levels of lipoproteins in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of children worldwide. The causal mechanisms of ADHD remain unclear as the aetiology of this disorder seems to be multifactorial. One research field addresses the impact on lipid metabolism and particularly serum lipid fractions on the development of ADHD symptoms. This post hoc analysis aimed to investigate long-term changes in serum levels of lipoproteins in children and adolescents with ADHD and controls. Data of German children and adolescents from the nationwide and representative "Kinder- und Jugendgesundheitssurvey (KiGGS)" study were analysed at baseline and at a ten-year follow-up. At the two time points, participants in the control group were compared with those in the ADHD group, both before and after propensity score matching. Differences in total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides were assessed between matched children with and without ADHD. In addition, subgroups with versus without methylphenidate use were compared at both time points. At baseline before matching, there were no significant differences for lipid parameters between participants in the ADHD group (n = 1,219) and the control group (n = 9,741): total cholesterol (Exp(ß) = 0.999, 95%-CI 0.911-1.094, p = .979), LDL (Exp(ß) = 0.967, 95%-CI 0.872-1.071, p = .525), HDL (Exp(ß) = 1.095, 95%-CI 0.899-1.331, p = .366) and triglycerides (Exp(ß) = 1.038, 95%-CI 0.948-1.133, p = .412). Propensity score matching confirmed the non-significant differences between the ADHD and non-ADHD group at baseline. At the 10-year follow-up, n = 571 participants fulfilled complete inclusion criteria, among them 268 subjects were classified as ADHD. The two groups did not significantly differ in lipid fractions, neither cross-sectionally nor with regard to long-term changes. There was also no significant difference between methylphenidate subgroups. In this sample of children and adolescents we could not reveal any significant associations between serum lipid fractions and the diagnosis of ADHD, neither cross-sectionally nor longitudinally; even when methylphenidate use was considered. Thus, further studies using larger sample sizes are required to investigate putative long-term changes in serum lipid fractions related to ADHD.

Is only-child status associated with a higher blood pressure in adolescence? An observational study.

Growing up with siblings may affect quality of life as well as hemodynamic parameters including blood pressure. Using weighted data from the nationwide and representative German KiGGs study, we assessed the relationship between only-child status, birth order, and arterial blood pressure in a cohort of 7311 adolescents aged between 11 and 17 years. Our data showed that only-children had the highest mean arterial blood pressure (87.3 ± 8.4 mmHg) as compared to first-born (86.3 ± 8.0), middle-born (86.4 ± 8.7), and youngest-born siblings (86.6 ± 8.2; p = 0.012). The two groups of only-children and first-borns differed significantly with respect to their age- and sex-specific, z-scored data for systolic (p = 0.047), diastolic (p = 0.012), and mean arterial blood pressure (p = 0.005). Linear regression models with blood pressure recordings as dependent variable adjusted to age, migration background, and age- and sex-specific z-scores of body-mass index confirmed that only-child status was an independent predictor of a higher diastolic blood pressure (p = 0.037). A similar result was observed for mean arterial blood pressure (p = 0.033), whereas systolic blood pressure was not associated with only-children status (p = 0.258).   Conclusion: In summary, we found a significant and positive relationship between only-child status and blood pressure, with the highest recordings in only-children and the lowest in first-borns. Models adjusted for relevant clinical confounders demonstrated slightly higher blood pressure in only-children compared to first-borns, who are both in an alpha birth order. Although these blood pressure differences were statistically significant, they have limited, if any, clinical meaning in this age group. What is Known: • In children and adults, blood pressure is significantly higher in only-children compared to children with siblings. However, it is unclear whether there are also similar blood pressure differences in adolescents and between only-children and first-borns. What is New: • Among adolescents in the alpha birth order, growing up as an only-child is associated with significantly higher mean blood pressure than among first-borns living with younger siblings.

Co-Occurrence of Tic Disorders and Attention-Deficit/Hyperactivity Disorder-Does It Reflect a Common Neurobiological Background?

BACKGROUND: The co-existence of tic disorders and attention-deficit/hyperactivity disorder (TD + ADHD) has proven to be highly important in daily clinical practice. The factor ADHD is not only associated with further comorbidities, but also has a long-term negative psychosocial effect, while the factor TD is usually less disturbing for the major part of the patients. It remains unclear how far this is related to a different neurobiological background of the associated disorders or whether TD + ADHD reflects a common one. OBJECTIVE: This review provides an update on the neurobiological background of TD + ADHD in order to better understand and treat this clinical problem, while clarifying whether an additive model of TD + ADHD holds true and should be used as a basis for further clinical recommendations. METHOD: A comprehensive research of the literature was conducted and analyzed, including existing clinical guidelines for both TD and ADHD. Besides genetical and environmental risk factors, brain structure and functions, neurophysiological processes and neurotransmitter systems were reviewed. RESULTS: Only a limited number of empirical studies on the neurobiological background of TD and ADHD have taken the peculiarity of co-existing TD + ADHD into consideration, and even less studies have used a 2 × 2 factorial design in order to disentangle the impact/effects of the factors of TD versus those of ADHD. Nevertheless, the assumption that TD + ADHD can best be seen as an additive model at all levels of investigation was strengthened, although some overlap of more general, disorder non-specific aspects seem to exist. CONCLUSION: Beyond stress-related transdiagnostic aspects, separate specific disturbances in certain neuronal circuits may lead to disorder-related symptoms inducing TD + ADHD in an additive way. Hence, within a classificatory categorical framework, the dimensional aspects of multilevel diagnostic-profiling seem to be a helpful precondition for personalized decisions on counselling and disorder-specific treatment in TD + ADHD.

Physical activity and the development of general mental health problems or attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents: A cross-lagged panel analysis of long-term follow-up epidemiological data.

Studies have shown that physical activity (PA) can provide a helpful, low-risk, and cost-effective intervention for children and adolescents suffering from mental health problems. This longitudinal study aimed to assess whether PA prevents the development of mental health problems, such as attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Data were analyzed from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) collected from more than 15.000 children and adolescents at three different time points over a period of more than 10 years. Parents scored the PA of the study participants on three frequency levels according to WHO recommendations, and mental health problems were assessed by means of the Strengths and Difficulties Questionnaire (SDQ). The total problem score (SDQ-Total) and the hyperactivity/inattention symptoms sub-scale (SDQ-H/I) were used in an autoregressive cross-lagged model to examine their relationship with PA. The results showed that PA of boys and girls at preschool age was inversely associated with the occurrence of mental health problems and, in particular, ADHD symptoms about 6 years later. Higher levels of PA were associated with better general mental health and fewer ADHD symptoms at the next time point (Wave 1). These effects were not observed from preadolescence (Wave 1) to adolescence (Wave 2), neither for girls nor for boys. These findings indicate that medium-to-high PA may be a supportive factor for good mental health in children in preschool and elementary school. Future studies will have to show whether PA may be a helpful add-on for interventional programs for improving general mental health and alleviating ADHD symptoms among children and adolescents.

ADHD subtypes: Do they hold beyond core symptoms? A multilevel testing of an additive model.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized as a behavioral syndrome with core symptoms of inattention and/or hyperactivity/impulsivity that constitute, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), predominantly Inattentive and Hyperactive-Impulsive and a combined (additive) presentation that fulfills both criteria. The question remains if the pathophysiological background of both factors is also separate at levels of investigation beyond core symptoms. This would allow a clearer understanding and a more focused treatment approach even with tools derived from these levels. Hence, we assumed that an implicit additive diagnostic model also holds at the levels of associated psychopathology, neuropsychological performance and brain oscillations. We investigated this hypothesis using data of 61 boys (7-12 years old) with ADHD and 43 typically developing children. There were no significant differences in age and IQ between groups. Children were examined with Child Behavior Checklist (CBCL), the Integrated Visual and Auditory Test (IVA), and brain oscillations during eyes closed resting state. Inattention characteristics were associated with more pronounced internalizing problems, lower attention, and vigilance during IVA performance and at the Electroencephalography level with elevated Theta and diminished Beta power during eyes closed rest. In contrast, hyperactivity/impulsivity characteristics led to general psychopathology problems and showed at the neuropsychological level faster response speed and deficits in cognitive control and performance consistency, but were on the electroencephalography level without any deficits in EEG power. Considering differences in behavioral, neuropsychology, and electroencephalography levels in each subtype, separate clinical approaches should be recommended for them and an additive model for their combination.

Dysregulation profile (DP) as a transdiagnostic psychopathological factor in clinically referred children - comparisons between disorders and latent structure.

BACKGROUND: Dysregulation Profile (DP) describes the psychopathological construct of concurrent impairments in the ability to regulate emotion, behaviour, and cognition measured by the Child Behaviour Checklist (CBCL). Such transdiagnostic dimensions of psychopathology play an important role in addition to core symptoms of psychiatric diagnosis in clinical practice. Evaluation of DP in children with different mental disorders may improve our understanding and treatment of both contents. METHODS: 911 clinically referred children between 6 and 18 years were investigated. The sample consisted of five 'pure' disorders groups, that is, tic disorder (TIC), anxiety disorder, obsessive compulsive disorder, depression, Attention Deficit Hyperactivity Disorder (ADHD), and two comorbid disorder group, that is, ADHD + TIC and ADHD + oppositional defiant disorder (ODD). DP level and latent structure were compared across groups. RESULTS: The rate of severe/abnormal dysregulation rates varied from 15% to 44% when the 210 cut-off was used, and 5% to 18% when stringent cut-off was used (i.e. ≥70 on all DP-subscales). The most affected population were children with comorbid ADHD with ODD/TIC, while least were those with TIC only. Five different latent phenotypes of DP were found. CONCLUSION: DP above clinical cut-off level widely exists in clinically referred children in parallel to core symptoms of their diagnosis, especially among children with comorbidities. During clinical assessment it would be worth to clarify the role of DP-related problems within the general psychosocial impairment of the patient to improve a personalized approach.

Polygenic association between attention-deficit/hyperactivity disorder liability and cognitive impairments.

BACKGROUND: A recent genome-wide association study (GWAS) identified 12 independent loci significantly associated with attention-deficit/hyperactivity disorder (ADHD). Polygenic risk scores (PRS), derived from the GWAS, can be used to assess genetic overlap between ADHD and other traits. Using ADHD samples from several international sites, we derived PRS for ADHD from the recent GWAS to test whether genetic variants that contribute to ADHD also influence two cognitive functions that show strong association with ADHD: attention regulation and response inhibition, captured by reaction time variability (RTV) and commission errors (CE). METHODS: The discovery GWAS included 19 099 ADHD cases and 34 194 control participants. The combined target sample included 845 people with ADHD (age: 8-40 years). RTV and CE were available from reaction time and response inhibition tasks. ADHD PRS were calculated from the GWAS using a leave-one-study-out approach. Regression analyses were run to investigate whether ADHD PRS were associated with CE and RTV. Results across sites were combined via random effect meta-analyses. RESULTS: When combining the studies in meta-analyses, results were significant for RTV (R2 = 0.011, ß = 0.088, p = 0.02) but not for CE (R2 = 0.011, ß = 0.013, p = 0.732). No significant association was found between ADHD PRS and RTV or CE in any sample individually (p > 0.10). CONCLUSIONS: We detected a significant association between PRS for ADHD and RTV (but not CE) in individuals with ADHD, suggesting that common genetic risk variants for ADHD influence attention regulation.

European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment.

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients' self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient's needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician's preferences, experience, and local regulatory requirements.

Can neurophysiological markers of anticipation and attention predict ADHD severity and neurofeedback outcomes?

Neurophysiological measures of preparation and attention are often atypical in ADHD. Still, replicated findings that these measures predict which patients improve after Neurofeedback (NF), reveal neurophysiological specificity, and reflect ADHD-severity are limited. METHODS: We analyzed children's preparatory (CNV) and attentional (Cue-P3) brain activity and behavioral performance during a cued Continuous Performance Task (CPT) before and after slow cortical potential (SCP)-NF or semi-active control treatment (electromyogram biofeedback). Mixed-effects models were performed with 103 participants at baseline and 77 were assessed for pre-post comparisons focusing on clinical outcome prediction, specific neurophysiological effects of NF, and associations with ADHD-severity. RESULTS: Attentional and preparatory brain activity and performance were non-specifically reduced after treatment. Preparatory activity in the SCP-NF group increased with clinical improvement. Several performance and brain activity measures predicted non-specific treatment outcome. CONCLUSION: Specific neurophysiological effects after SCP-NF were limited to increased neural preparation associated with improvement on ADHD-subscales, but several performance and neurophysiological measures of attention predicted treatment outcome and reflected symptom severity in ADHD. The results may help to optimize treatment.

Headache Is Associated with Low Systolic Blood Pressure and Psychosocial Problems in German Adolescents: Results from the Population-Based German KiGGS Study.

Studies have reported controversial results on the relationship between headache and blood pressure. The aim of this post hoc study was twofold: first, to further investigate this relationship and, second, to assess the impact of psychosocial factors on this association in a population-based study of German children and adolescents. The analysis was conducted on study participants aged between 11 and 17 years (n = 5221, weighted from the total study cohort) from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Health-related quality of life was assessed by self- and parent-rated German-language KINDL-R questionnaires (Children's Quality of Life Questionnaire), while mental problems were analyzed using the Strengths and Difficulties Questionnaire (SDQ). Our findings confirmed that blood pressure was significantly lower in adolescents reporting episodes of headache than in those without headache (114.0 ± 10.2 mmHg vs. 115.5 ± 11.0 mmHg, p < 0.001). Logistic regression models adjusted to sex, age, body mass index, contraceptive use, and serum magnesium concentration demonstrated that headache was significantly associated with self-rated KINDL-R (Exp(B) = 0.96, 95% confidence interval (95% Cl) = 0.96-0.97, p < 0.001), parent-rated KINDL-R (Exp(B) = 0.97, 95% CI = 0.96-0.98, p < 0.001), as well as self-rated SDQ (Exp(B) = 1.08, 95% CI = 1.07-1.10, p < 0.001), and parent-rated SDQ (Exp(B) = 1.05, 95% CI = 1.04-1.06, p < 0.001). There was evidence that quality of life and mental problems mediated the effect of blood pressure on headache, as revealed by mediation models. Our results from the nationwide, representative KiGGS survey showed that low blood pressure is a significant predictor of headache, independent of quality of life and mental problems. However, these psychosocial factors may mediate the effect of blood pressure on headache in a still unknown manner.

Electrophysiology Echoes Brain Dynamics in Children and Adolescents With Tourette Syndrome-A Developmental Perspective.

The development of the complex clinical picture of motor and vocal tics in children and adolescents with Tourette syndrome (TS) must be paralleled by changes in the underlying pathophysiology. Electrophysiological methods such as EEG and event-related potentials (ERPs) are non-invasive, safe and easy to apply and thus seem to provide an adequate means to investigate brain dynamics during this brain maturational period. Also, electrophysiology is characterized by a high time resolution and can reflect motor, sensory and cognitive aspects as well as sleep behavior. Hence, this narrative review focuses on how electrophysiology echoes brain dynamics during development of youngsters with TS and might be useful for the treatment of tics. A comprehensive picture of developmental brain dynamics could be revealed showing that electrophysiological parameters evolve concurrently with clinical characteristics of TS. Specifically, evidence for a maturational delay of motor inhibition related to cortico-spinal hyper-excitability and brain mechanisms for its cognitive compensation could be shown. Moreover, deviant sleep parameters and probably a stronger perception-action binding were reported. For neuromodulatory treatments (e.g., neurofeedback; repetitive transcranial magnetic stimulation, rTMS/transcranial direct current stimulation, tDCS) targeting neuronal deficits and/or strengthening compensatory brain mechanisms, pilot studies support the possibility of positive effects regarding tic reduction. Finally, attention-deficit/hyperactivity disorder (ADHD), as a highly frequent co-existing disorder with TS, has to be considered when using and interpreting electrophysiological measures in TS. In conclusion, application of electrophysiology seems to be promising regarding clinical and research aspects in youngsters with TS.

The Association between Low Blood Pressure and Attention-Deficit Hyperactivity Disorder (ADHD) Observed in Children/Adolescents Does Not Persist into Young Adulthood. A Population-Based Ten-Year Follow-Up Study.

Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood and adolescence associated with relevant psychosocial impairments. The basic pathophysiology of ADHD may be related, at least partly, to a deficit in autonomic arousal processes, which not only influence core symptoms of the disorder, but may also lead to blood pressure (BP) deviations due to altered arousal regulation. Objectives: This study examined long-term changes in BP in children and adolescents with ADHD up to young adulthood. Methods: In children and adolescents aged between 7 and 17 years at baseline, we compared BP recordings in subjects with (n = 1219, 11.1%) and without (n = 9741, 88.9%) ADHD over a 10-year follow-up using data from the nationwide German Health Survey for Children and Adolescents (KiGGS). Propensity score matching was used to improve the comparability between children in the ADHD and control groups with now n = 1.190 in each group. Results: The results of these matched samples revealed that study participants with ADHD showed significantly lower systolic BP (107.6 ± 10.7 mmHg vs. 109.5 ± 10.9 mmHg, p < 0.001, Cohen's d = 0.17) and diastolic BP (64.6 ± 7.5 mmHg vs. 65.8 ± 7.4 mmHg, p < 0.001, Cohen's d = 0.16) at baseline. In a sensitivity analysis with a smaller (n = 272) and more stringently diagnosed ADHD group, the significant differences remained stable with somewhat higher Cohen's d; i.e., 0.25 and 0.27, respectively. However, these differences did not persist after 10-year follow-up in a smaller matched longitudinal sub-group (ADHD n = 273; control n = 323), as subjects with and without ADHD had similar levels of systolic (123.4 ± 10.65 vs. 123.78 ± 11.1 mmHg, p = 0.675, Cohen's d = 0.15) and diastolic BP (71.86 ± 6.84 vs. 71.85 ± 7.06 mmHg, p = 0.992, Cohen's d = 0.16). Conclusions: At baseline, children and adolescents with ADHD had significantly lower BP (of small effect sizes) compared to the non-ADHD group, whereas this difference was no longer detectable at follow-up ten years later. These developmental alterations in BP from adolescence to early adulthood may reflect changes in the state of autonomic arousal, probably modulating the pathophysiology of ADHD.

Physical Activity Improves Mental Health in Children and Adolescents Irrespective of the Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)-A Multi-Wave Analysis Using Data from the KiGGS Study.

Physical activity (PA) may have positive effects on mental health in children and adolescents. This post hoc study aimed to further investigate the relationship between different frequency levels of PA and general mental health as well as specific hyperactivity/inattention symptoms in children and adolescents. METHODS: The analyses were based on data drawn from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study, a regularly conducted large-scale, epidemiological investigation of somatic and mental health of children and adolescents in Germany. Parents were asked about their children's attention deficit hyperactivity disorder (ADHD) records and answered questionnaires concerning any mental health problem behavior of the children and adolescents using the Strengths and Difficulties Questionnaire (SDQ). The overall problem score as well as the hyperactivity/inattention symptoms subscale (SDQ-H/I) were entered as outcomes in a regression model controlling for parental socio-economic status and participants' sex, age, and body mass index (BMI). Cross-sectional analyses were conducted at three time points of the KiGGS study (baseline, wave 1, and wave 2) using general linear models (GLM). This was performed for different age groups (4-5, 6-9, 10-17 years). RESULTS: Significant negative relationships were found between PA and general mental health problems. For the relationship between PA and SDQ-H/I, different patterns emerged at the three time points. There was no interaction between PA frequency levels and diagnosis of ADHD (ADHD vs. non-ADHD controls) regarding the SDQ total score. CONCLUSION: This study underlines the importance of a high frequency level of PA for a good mental health status among children and adolescents, irrespective of the diagnosis of ADHD.

Classifying ADHD subtypes/presentations considering the joint effect of three levels of investigation.

AIM: Discriminant validity of the Attention Deficits/Hyperactive Disorders (ADHD) subtypes/presentations is not yet clear. The purpose of this study was to investigate joint contribution of the strongest factors of the three dimensions, namely psychopathology, neuropsychology and electrophysiology for subtyping of presentations. METHOD: A sample of 104 boys aged 7-12 years was subdivided into three groups with ADHD combined (n = 22), inattentive (n = 25) and hyperactive/impulsive subtype (n = 14), and 43 typically developing controls (TDC). Children were investigated regarding the Child Behavior Checklist (CBCL), the Integrated Visual and Auditory Test (IVA), and EEG spectral power during eyes closed resting state. Subsequently, statistical analysis included discriminant functional analysis and principle component analysis. RESULTS: Neuropsychological parameters had the highest contribution in classifying of the groups. EEG parameters had no effect on differentiation of the groups, and among the psychopathological parameters, only the oppositional behavioral disorder score contributed to correctly classify 74.3% of the groups. Furthermore, we found four factors with eigenvalues higher than 1 in the ADHD and typical groups, with one factor characterized by four CBCL scales, another one by auditory and visual vigilance, speed and beta band power, the third by auditory and visual prudence, and forth by theta band power. CONCLUSIONS: Our results demonstrated that ADHD subtypes/presentations can be differentiated from each other at different levels of investigation despite some clinical symptoms overlap. The results suggested that not only psychopathology but also the impairment of sensory processing should be assessed in children with ADHD in order to use this additional information for a jointly multilevel clinical intervention, which may improve treatment success.

Differential utility of teacher and parent-teacher combined information in the assessment of Attention Deficit/Hyperactivity Disorder symptoms.

BACKGROUND: Consistent research findings indicate that parents and teachers observe genuinely different Attention Deficit/Hyperactivity Disorder (ADHD) behaviours in their respective settings. OBJECTIVE: To evaluate the utility of information provided by teacher informant assessments (INFAs) of ADHD symptoms, and the implications of aggregation algorithms in combing parents' information, i.e. using 'or-rule' (endorsement by either one informant) versus 'and-rule' (endorsement by both informants). METHOD: Teacher ratings on Conners scales and clinical data from parental accounts on 1383 probands and their siblings from the IMAGE study were analysed. The psychometric properties of teacher and combined ratings using the item response theory model (IRT) are presented. Kappa coefficients, intraclass correlations and linear regression were employed. RESULTS: First, teacher endorsement of symptoms is located in a narrow part of the trait continuum close to the average levels. Symptoms exhibit comparable perception in the measurement of the trait(s) with similar discrimination ability and information (reliability). Second, the IRT properties of the 'or-rule' ratings are predominantly influenced by parent-INFAs; and the 'and-rule' ratings predominantly by teacher-INFAs ratings. Third, parent-teacher INFAs agreement was low, both for individual items (κ = 0.01-0.15) and for dimensional scores (r = 0.12-0.16). The 'or-rule' captured milder expressions of ADHD symptoms, whereas the 'and-rule' indexed greater severity of ADHD. CONCLUSIONS: Parent and teacher-INFAs provide different kinds of information, while both are useful. Teacher-INFA and the 'and-rule' provide a more accurate index of severity than an additive symptom count. Parent-INFA and the 'or-rule' are more sensitive for detecting cases with milder ADHD.

Yes, I can - maybe Effects of placebo-related instructions on neuroregulation in children with ADHD.

Neurofeedback training (NFT) provides strategies for children with ADHD to achieve changes on the neurophysiological and behavioral level to attenuate ADHD symptoms. We assume self-efficacy (an "active attitude"), a core variable in successful NFT. In a randomized, double-blind controlled study, we investigated the impact of a "placebo instruction" on the EEG-regulation performance during two sessions of Theta-Beta-NFT in children with ADHD (age 8-12 years). Children receiving the information "this might be a placebo-training" showed inferior neuroregulation (n = 10) compared to children receiving a standard instruction (n = 12). Results of our pilot study are discussed in view of factors necessary for a valid training (ensuring maximal self-efficacy in the participants) and the fidelity of placebo-controlled trials in NFT-research.

Effects of neurofeedback on the dysregulation profile in children with ADHD: SCP NF meets SDQ-DP - a retrospective analysis.

BACKGROUND: As children with attention-deficit/hyperactivity disorder (ADHD) usually show psychopathological signs beyond their core symptoms (e.g. elevated scores of the dysregulation profile (DP) in 30-40%), treatments with a broader approach to self-regulation skills may be supportive. Neurofeedback (NF) may reflect such an option. Aim of the present analysis was to compare the effects of slow cortical potential (SCP) NF and θ/ß NF on the DP using data from a previous trial. METHODS: Thirty children with ADHD (aged 8-12 years) and a DP score in the Strengths and Difficulties Questionnaire (SDQ-DP) ⩾ 3 were included. NF treatment consisted of one block of SCP NF and one block of θ/ß NF (18 units per block) allowing an intraindividual comparison. Effects of the NF protocols were also contrasted to a control group (n = 18) that completed an attention skills training (between-group analysis). RESULTS: Regarding the SDQ-DP, SCP NF was superior to θ/ß NF and the control condition. Effects of SCP NF and θ/ß NF on ADHD symptom severity were not significantly different. The SDQ-DP score did not correlate with EEG-related measures previously found to be predictors for SCP NF on ADHD symptoms. CONCLUSIONS: SCP NF may reflect a more general approach to improve cognitive, emotional and behavioral self-regulation skills. If confirmed in a larger sample, the SDQ-DP score could be used as an indication criterion and contribute to the individualization of NF in ADHD. Overall, the differential effect provides further evidence for the specificity of NF effects.