Does Temperament Constitute a Risk Factor for Adult Attention Deficit Hyperactivity Disorder?

OBJECTIVE: The aim of this study was to examine the temperament characteristics of adults with attention deficit hyperactivity disorder (ADHD) and the relationship between ADHD subtypes and temperament. Additionally, the study aimed to investigate the relationship between childhood ADHD symptoms and temperament. METHODS: The study included 59 ADHD patients aged between 18 and 60 years and 44 healthy controls. All participants completed the Wender-Utah Rating Scale (WURS) and the Adult Attention Deficit Hyperactivity Disorder Diagnosis and Rating Scale. Temperament characteristics were assessed using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire scale (TEMPS-A). RESULTS: The ADHD group had significantly higher scores for cyclothymic, irritable, and anxious temperament compared to the control group (p<0.001). The number of individuals with cyclothymic, irritable, and anxious temperament was also significantly higher in the ADHD group (p=0.007, p=0.018, p=0.029, respectively). Positive correlations were found between cyclothymic and depressive temperament scores and WURS scores (r=0.278, p=0.033; r=0.326, p=0.012, respectively), between hyperthymic temperament scores and hyperactivity scores (r=0.399, p=0.002), and between depressive temperament scores and attention deficit scores (r=0.303, p=0.020). There was no relationship between ADHD subtypes and dominant temperament (p>0.05). CONCLUSION: The most common dominant temperament in the ADHD group was cyclothymic, irritable, and anxious. The positive correlation between WURS scores and cyclothymic temperament suggests that cyclothymic temperament may be a risk factor for adult ADHD.

Relationships between screen time and childhood attention deficit hyperactivity disorder: a Mendelian randomization study.

Background: In previous observational studies and meta-analyses, childhood attention deficit hyperactivity disorder (ADHD) is found to have a significant association with screen time. However, the causal associations between them remain unclear. Method: This study performed a bidirectional two-sample Mendelian randomization (MR) analysis to confirm the causality between screen time and childhood ADHD. Large-scale genome-wide association studies (GWAS) datasets derived from the Psychiatric Genomics Consortium (PGC) and the UK Biobank were used to identify single nucleotide polymorphisms (SNPs) associated with exposure and outcome. Four categories of datasets were selected to represent screen time. The SNPs that are significantly associated with exposure data (P < 5e-08) and have a strong correlation with the exposure in the F-statistic (F > 10) were selected as instrumental variables. This study also used the PhenoScanner V2 database and the LDlink webtool to exclude confounding factors, and the MR-PRESSO method (p < 0.05) was employed to eliminate outliers with bias. Five commonly used methods were employed to assess the interaction and the Inverse Variance Weighted (IVW) method was utilized as the primary basis for determining the MR estimates in this study. Results: The MR analysis revealed that the length of mobile phone use (OR, 1.848; 95% CI, 1.3360-2.5558; p=2.07e-4) and the time spent watching television (OR, 2.104; 95% CI, 1.3958-3.1703; p=3.8e-4) increased the risk of childhood ADHD. Although the causal relationships were exclusively identified through the IVW and weighted median methods, the results retained their statistical significance following correction. In the reverse analysis, no evidence was found to support an effect of childhood ADHD on screen time. The sensitivity analysis conducted on the significant findings revealed no evidence of horizontal pleiotropy or heterogeneity. Conclusion: This study provides some evidence for the causality of screen time and childhood ADHD. Given the limitations of our study, further research is required to comprehensively investigate this relationship.

Comparison of Brain Function Between Medication-Naïve ADHD with and without Comorbidity in Chinese Children Using Resting-State fNIRS.

Background: This study used functional near-infrared spectroscopy (fNIRS) to investigate brain activation patterns in children with attention deficit hyperactivity disorder (ADHD) with and without additional comorbidities to identify disease-related biomarkers by the neuroimaging that will facilitate to make a diagnosis decision. Methods: In this study, 165 medication-naive children aged 7 to 15 years were recruited and categorized into four groups: ADHD, ADHD with learning disabilities (ADHD&LD), ADHD with oppositional defiant disorder (ADHD&ODD), and healthy controls. A multichannel fNIRS system was used to monitor hemodynamic changes at rest state in the prefrontal and temporal lobes of the brain. The amplitude of a low-frequency fluctuation (ALFF) matrix was calculated by summation and averaging of the square root of the signal power spectrum. One-way analysis of variance was used to identify statistical differences between channels. Results: All ADHD children presented significantly higher ALFF values in different brain regions when compared with the healthy controls. Patients with ADHD&LD exhibited higher ALFF values in the medial prefrontal cortex (P Ch38 = .01, P Ch48 = .01), temporal cortex (P Ch22 = .04, P Ch41 = .002, P Ch51 = .001), and the left ventrolateral prefrontal cortex (P Ch39 = .0009, P Ch50 = .001), whereas ADHD&ODD children were not significantly different to those diagnosed with ADHD. Conclusions: ADHD with learning disabilities (LD) possessed a different pathogenesis from ADHD, manifested as lower functional brain activity in the medial prefrontal cortex, temporal cortex, and the left ventrolateral prefrontal cortex, while ADHD&ODD did not present significant changes compared with ADHD. ODD-related symptoms may be part of ADHD symptoms rather than being an independent disorder.

The neurodivergent perinatal experience - A systematic literature review on autism and attention deficit hyperactivity disorder.

BACKGROUND: Neurodivergent individuals often face unique challenges during the perinatal period, which can significantly impact their experiences of pregnancy, childbirth, and early parenting. Despite growing awareness of neurodiversity, there remains a gap in perinatal care that fully addresses the lived experiences and needs of those with neurodivergent conditions such as Autism (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). OBJECTIVE: To compile and analyse recent literature on the perinatal experiences of neurodivergent parturients. To provide an overview of current knowledge, identify prevalent challenges, and suggest opportunities for improving perinatal services. Additionally, we aim to highlight research gaps that guide future studies and enhance care quality for neurodivergent individuals during the perinatal period. METHODS: The Systematic Reviews methodological process was utilised to search relevant scientific databases to gather current research articles on neurodivergent perinatal experiences. Eleven studies met the inclusion criteria and were appraised using a rigorous quality checklist. Thematic analysis identified recurring themes across the selected papers. RESULTS: Three major themes emerged: Care provider support, Perinatal mental health needs, and Resilience and growth of neurodivergent parturients. These themes highlight significant differences in perinatal experiences between neurodivergent and neurotypical individuals, underscoring the need for tailored care approaches. CONCLUSION: The findings reveal that current perinatal care practices do not adequately address the specific challenges faced by perinatal neurodivergent individuals. There is a critical need for perinatal care systems to integrate neurodiversity-affirming practices. Future research should consider intersectionality to include marginalised and underrepresented neurodivergent voices.

Scheduling of methylphenidate: Preventing misuse or impeding ADHD treatment adherence?

Background: Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, with a chronic, and potentially debilitating course if untreated. Medication adherence is poor - negatively affecting emotional, social, educational and employment outcomes. The current Schedule 6 status of methylphenidate (MPH) drives healthcare resource utilisation and costs - a potential barrier to care. Aim: This study explored stakeholders' understanding and perceptions of the potential impact of a regulatory shift in the scheduling of MPH on treatment accessibility and adherence for ADHD. Setting: Participants from multiple stakeholder groups, involved in ADHD management in South Africa, were recruited via professional networks. Methods: A qualitative analysis of semi-structured interviews with 23 stakeholders was conducted to explore their views on the utility, benefits and risks associated with rescheduling MPH. Results: Six key themes emerged from the interviews: 'adherence', 'accessibility', 'affordability', 'stigma', 'rescheduling of MPH' and 'risk mitigation'. Core to these themes is the role of the scheduling of MPH - which can have a protective societal role, but also acts as a barrier to care for individuals with ADHD. Conclusion: The current Schedule 6 status of MPH is not an effective strategy to prevent misuse and diversion but negatively impacts on treatment adherence. The positive outlook from stakeholders on rescheduling MPH holds significant implications for the ADHD landscape in South Africa. Contribution: It is crucial to address stigma, facilitate fundamental change in service delivery and remove structural and practical barriers to care to improve outcomes for individuals with ADHD. A framework for ADHD treatment adherence is provided.

Comparative analysis of electroencephalogram (EEG) data gathered from the frontal region with other brain regions affected by attention deficit hyperactivity disorder (ADHD) through multiresolution analysis and machine learning techniques.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by repeated patterns of hyperactivity, impulsivity, and inattention that limit daily functioning and development. Electroencephalography (EEG) anomalies correspond to changes in brain connection and activity. The authors propose utilizing empirical mode decomposition (EMD) and discrete wavelet transform (DWT) for feature extraction and machine learning (ML) algorithms to categorize ADHD and control subjects. For this study, the authors considered freely accessible ADHD data obtained from the IEEE data site. Studies have demonstrated a range of EEG anomalies in ADHD patients, such as variations in power spectra, coherence patterns, and event-related potentials (ERPs). Some of the studies claimed that the brain's prefrontal cortex and frontal regions collaborate in intricate networks, and disorders in either of them exacerbate the symptoms of ADHD. , Based on the research that claimed the brain's prefrontal cortex and frontal regions collaborate in intricate networks, and disorders in either of them exacerbate the symptoms of ADHD, the proposed study examines the optimal position of EEG electrode for identifying ADHD and in addition to monitoring accuracy on frontal/ prefrontal and other regions of brain our study also investigates the position groupings that have the highest effect on accurateness in identification of ADHD. The results demonstrate that the dataset classified with AdaBoost provided values for accuracy, precision, specificity, sensitivity, and F1-score as 1.00, 0.70, 0.70, 0.75, and 0.71, respectively, whereas using random forest (RF) it is 0.98, 0.64, 0.60, 0.81, and 0.71, respectively, in detecting ADHD. After detailed analysis, it is observed that the most accurate results included all electrodes. The authors believe the processes can detect various neurodevelopmental problems in children utilizing EEG signals.

Subclinical attention-deficit hyperactivity disorder symptoms and unhealthy lifestyle behaviours.

BACKGROUND: Literature emphasises the importance of identifying and intervening in the adoption of unhealthy lifestyle behaviours (ULBs) during adolescence at an early stage, to mitigate their long-term detrimental effects. Among the possible associated factors contributing to ULBs, attention-deficit hyperactivity disorder (ADHD) has been shown to play an important role. However, little is known about ADHD subclinical manifestations. AIMS: The present study aimed to bridge the gap in the literature and shed light on the relationship between subclinical ADHD and early adoption of ULBs during adolescence. Through a clinimetric approach, prevalence of ULBs, severity of ADHD symptoms and psychosocial factors (i.e. allostatic overload, abnormal illness behaviour, quality of life, psychological well-being) were investigated among adolescents. The associations between different degrees of ADHD, ULBs and psychosocial factors were also explored. METHOD: This multicentre cross-sectional study involved 440 adolescents (54.5% females; mean age 14.21 years) from six upper secondary schools. Participants completed self-report questionnaires on sociodemographic characteristics, ULBs, ADHD symptoms and psychosocial factors. RESULTS: The most common ULBs were energy drinks/alcohol consumption and problematic smartphone use. Of the sample, 22% showed subclinical ADHD and 20.2% showed clinical ADHD. The subclinical ADHD group showed several ULBs (i.e. altered mindful eating, impaired quality of sleep, problematic technology use) and psychosocial factors, akin to those of ADHD group and different from peers without ADHD symptoms. CONCLUSIONS: Since subclinical ADHD manifestation is associated with ULBs, similarly to clinical ADHD, identifying subthreshold symptoms during adolescence is crucial, as it could improve health-related outcomes in adulthood across different domains.

Attention deficit hyperactivity disorder diagnoses and prescriptions in UK primary care, 2000-2018: population-based cohort study.

Attention-deficit hyperactivity disorder (ADHD), a common developmental disorder, affects 5-7% of children and 2.5% of adults globally. Recent increases in ADHD medication prescriptions have sparked the debate on overdiagnosis and overtreatment. McKechnie et al. examine UK ADHD prevalence and medication trends over 18 years, with implications for mental health services.

Feasibility of the Understanding and Managing Adult ADHD Programme: open-access online group psychoeducation and acceptance and commitment therapy for adults with attention-deficit hyperactivity disorder.

BACKGROUND: Psychoeducational interventions are a critical aspect of supporting adults with attention-deficit hyperactivity disorder (ADHD). The Understanding and Managing Adult ADHD Programme (UMAAP) is a six-session, group-based webinar intervention that incorporates psychoeducation with acceptance and commitment therapy. UMAAP relies on self-referrals and is facilitated by a charity, to promote accessibility. AIMS: The present study aimed to evaluate the feasibility of UMAAP and explore preliminary effectiveness. METHOD: Adults with formally diagnosed or self-identified ADHD (n = 257) participated in an uncontrolled pre-post design. Feasibility was indicated by attendance, confidence in completing the home practice and satisfaction. Quality of life, psychological flexibility, self-acceptance and knowledge of ADHD were assessed at baseline, 1 week post-intervention and 3 months later, to explore preliminary effectiveness. RESULTS: Feasibility was demonstrated by the high attendance ratings and satisfaction with the intervention, although there was only moderate confidence in the ability to complete the home practices. Quality of life (mean increase 9.69, 95% CI 7.57-11.80), self-acceptance (mean increase 0.19, 95% CI 0.10-0.28) and knowledge of ADHD (mean increase 1.55, 95% CI 1.23-1.82) were significantly improved post-intervention. The effects were maintained at the 3-month follow-up. Psychological flexibility did not significantly change immediately post-intervention, but increased significantly at the 3-month follow-up (mean increase 0.42, 95% CI 0.26-0.58). CONCLUSIONS: Overall, UMAAP is a feasible intervention for adults with ADHD. Findings highlighted the feasibility of delivering psychological interventions online in group settings, to increase access to support for adults with ADHD.

Abnormal Structure and Function of Parietal Lobe in Individuals With Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review Study.

Introduction: Abnormal brain structure and function have been reported in individuals with attention deficit hyperactivity disorder (ADHD). This study investigated the parietal lobe structure and function alteration in individuals with ADHD. Methods: In this systematic review, we searched English papers in accordance with the PRISMA (the preferred reporting items for systematic reviews and meta-analyses) approach. Studies were published between January 2010 and May 2021. Our search was conducted in two parts. Our first search was in July 2020, and our final search was in June 2021. A literature search identified 20 empirical experiments. Results: Functional magnetic resonance imaging (MRI) studies generally reported low activity and poor connectivity; structural MRI studies reported less gray matter in this lobe, and an echo study reported atrophy. In addition, electroencephalographic studies reported less connectivity of the parietal lobes in ADHD. Furthermore, the transcranial direct current stimulation intervention has shown that activation of this lobe improves attention and executive functions in children with ADHD. Finally, a deep transcranial magnetic stimulation study has demonstrated that activation of this lobe improves working memory. Conclusion: Functional and structural alteration of the parietal cortex has been reported in ADHD, which has a causal relationship with cognitive impairments. In sum, all included studies reported abnormal structure, function, or connectivity of the parietal lobe or improvement of cognitive functions with parietal lobe stimulation.

Case Report: Methylphenidate and venlafaxine improved abdominal nociplastic pain in an adult patient with attention deficit hyperactivity disorder, autism spectrum disorder, and comorbid major depression.

Introduction: Nociplastic pain (NP), classified as a third type of pain alongside nociceptive and neuropathic pain, is chronic pain arising from the amplification of nociceptive stimuli through central sensitization, despite the absence of tissue damage, sensory nerve damage, or disease. An important clinical feature of NP is that it is not only associated with pain but also with sensory hypersensitivity to sound and light and cognitive dysfunction, including mood and attention disorders. Recent studies have suggested that depression and developmental disorders, such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), coexist with NP at high frequency. Additionally, cognitive impairment in individuals with NP may be associated with these psychiatric comorbidities. However, to our knowledge, there are no reports on (1) multidimensional evaluation and diagnostic details of abdominal NP in adults with ADHD/ASD; (2) how ADHD drugs and antidepressants are administered when ADHD and depression coexist with NP; and (3) how central sensitization, brain function, and family relationship problems underlying NP are altered by treatments of ADHD and depression. Case presentation: Herein, we present the case of a 51-year-old woman with abdominal NP. She developed severe right lower abdominal pain and underwent a thorough medical examination; however, the physical, medical cause remained unknown, making treatment challenging. Additionally, she took time off work as she began to complain of insomnia and anxiety. She was referred to our pain center, where a diagnosis of depression, ADHD, and ASD was confirmed, and treatment with ADHD medication was initiated. While ADHD medications alone did not yield sufficient improvement, a combination of methylphenidate and the antidepressant venlafaxine eventually led to improvements in abdominal NP, depression, ADHD symptoms, central sensitization, and family relationship issues. During treatment, cerebral blood flow in the anterior cingulate, prefrontal, and parietal cortices also improved. Conclusion: The treatment of comorbid depression is important while treating NP, and venlafaxine may be effective, especially in cases of comorbid ADHD/ASD. Screening for developmental disorders and depression is required in patients with abdominal NP.

Examination of Excessive Mind-Wandering Following Attention-Deficit and Hyperactivity Disorder Treatment in Adults.

Although mind-wandering (MW) is a part of attention deficit and hyperactivity disorder (ADHD), the impact of psychostimulants on excessive MW remains unclear. We aimed to elucidate how psychostimulants impact the MW of adult ADHD patients post treatment. This cross-sectional cohort study consisted of 54 randomly selected ADHD patients who applied to our psychiatry outpatient clinic and 40 healthy controls. The ADHD patients were administered methylphenidate or atomoxetine. A Semi-Structured Sociodemographic and Clinical Data Form, the Adult ADHD Self-Report Scale (ASRS), and the Mind Excessively Wandering Scale (MEWS) were applied. Routine psychiatric assessments in the 1st, 2nd, and 3rd months of pharmacological treatment were carried out by a psychiatrist. The pre-treatment MEWS score of the ADHD patients was 26.09 ± 1.92, which significantly decreased to 12.78 ± 2.54 post-treatment (F = 715.250, p < .001). A statistically significant difference was identified between the mean pre-treatment ASRS total score (44.07 ± 10.09) and post-treatment score (27.34 ± 11.22; F = 50.364, p < .001). A lifetime history of alcohol/substance use was positively associated with the MEWS score. ADHD pharmacotherapy led to significant reductions in MW. Recognizing the interaction between MW and ADHD could help in the design of more specific and comprehensive interventions.

Corrigendum: Neurocognitive and cerebellar function in ADHD, autism and spinocerebellar ataxia.

[This corrects the article DOI: 10.3389/fnsys.2023.1168666.].

Effectiveness of virtual reality glasses versus white noise on dental anxiety in children with attention-deficit hyperactivity disorder: A randomised controlled clinical trial.

BACKGROUND: Management of children with attention-deficit hyperactivity disorder (ADHD) can be challenging due to their disruptive behaviour. Basic behaviour management techniques (BMTs) may not be sufficient, and adjunctive strategies such as virtual reality (VR) glasses or white noise can be employed. AIM: To assess and compare the effectiveness of VR, white noise and basic BMTs on dental anxiety and behaviour of children with ADHD. DESIGN: Forty-eight children with ADHD were recruited for this parallel, three-armed randomised controlled clinical trial, which involved three visits at one-week intervals, including examination, preventive measures and restorations. Children were randomly divided into three groups: VR, white noise and basic BMTs. Outcome measures were Faces Image Scale (FIS), Heart Rate (HR) and Venham's Behaviour Rating Scale (VBRS). RESULTS: No significant difference was found between the groups in FIS scores. White noise group had a significantly lower mean HR than control group in all visits. Scores of VBRS in VR and white noise groups were significantly lower than those in the control group during the restorative visit. CONCLUSIONS: VR and white noise could be beneficial in managing dental anxiety and improving behaviour in children with ADHD and could be used as adjunctive strategies to basic BMTs.

Electronic Health Records for Research on Attention-Deficit/Hyperactivity Disorder Pharmacotherapy: A Comprehensive Review.

Objectives: Randomized controlled trials (RCTs) have shown that attention-deficit/hyperactivity disorder (ADHD) medications significantly reduce symptomatology at a group level, but individual response to ADHD medication is variable. Thus, developing prediction models to stratify treatment according to individual baseline clinicodemographic characteristics is crucial to support clinical practice. A potential valuable source of data to develop accurate prediction models is real-world clinical data extracted from electronic healthcare records (EHRs). Yet, systematic information regarding EHR data on ADHD is lacking. Methods: We conducted a comprehensive review of studies that included EHR reporting data regarding individuals with ADHD, with a specific focus on treatment-related data. Relevant studies were identified from PubMed, Ovid, and Web of Science databases up to February 24, 2024. Results: We identified 103 studies reporting EHR data for individuals with ADHD. Among these, 83 studies provided information on the type of prescribed medication. However, dosage, duration of treatment, and ADHD symptom ratings before and after treatment initiation were only reported by a minority of studies. Conclusion: This review supports the potential use of EHRs to develop treatment response prediction models but emphasizes the need for more comprehensive reporting of treatment-related data, such as changes in ADHD symptom ratings and other possible baseline clinical predictors of treatment response.

ADHD and cognitive disengagement syndrome symptoms related to self-injurious thoughts and behaviors in early adolescents.

The current study examined attention-deficit/hyperactivity disorder (ADHD) dimensions and cognitive disengagement syndrome (CDS) symptoms in relation to self-injurious thoughts and behaviors (SITBs) in an early adolescent sample. Participants were 341 adolescents ages 10-12 years (52.2% female; 37.8% people of color) recruited from the community. Caregivers reported on CDS and ADHD symptoms. Adolescents completed a rating scale and were administered an interview assessing SITBs. We estimated associations using logistic regression in a stepped fashion: (1) no adjustment, (2) adjustment for sex, race, family income, and psychotropic medication use, and (3) further adjustment for depressive symptoms. In this early adolescent community sample, 22.9% reported a history of suicidal ideation, 8.2% reported a history of a suicide plan, 6.2% reported a history of non-suicidal self-injury (NSSI), and 16.4% met a clinical cutoff for current suicide risk. Across most analyses using rating scale or interview methods, higher mean CDS scores were related to endorsement of suicidal ideation and planning. ADHD inattentive (IN) and hyperactive-impulsive (HI) symptoms were associated with endorsement of NSSI, and ADHD-IN symptoms were associated with thoughts of suicide and/or plan measured via questionnaire, though effects were less robust and not significant, potentially due to low base rates impacting statistical power. This study adds to a growing body of research highlighting the importance of screening for CDS symptoms among individuals with and without ADHD. More research, especially longitudinal work, is needed that examines possible differential pathways to SITBs by ADHD and CDS symptoms to advance SITB prevention, early detection, and intervention.

Methylphenidate and the risk of acute central nervous system oxygen toxicity: a rodent model and observational data in human divers.

Introduction: The effects of methylphenidate, a stimulant often prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD), on the development of central nervous system oxygen toxicity (COT) have not been experimentally evaluated. Methods: The records of all pure-oxygen-rebreather divers evaluated at our institution from 1975-2022 were assessed. Cases of COT were defined as a new onset of tinnitus, tunnel vision, myoclonus, headache, nausea, loss of consciousness, or seizures resolving within 15 minutes from breathing normobaric air, and matched 4:1 with similar controls. Any medications issued to the diver in the preceding three months, including methylphenidate, were recorded. In the animal arm of this study, male mice were exposed to increasing doses of methylphenidate orally, with subsequent exposure to hyperbaric O2 until clinically evident seizures were recorded. Results: Seventy-five cases of COT were identified in divers, occurring at a median of 80 (range 2-240) minutes after dive initiation at a median depth of 5 m (2-13). Hypercarbia was documented in 11 (14.7%) cases. Prescription of methylphenidate in the preceding three months was not associated with increased risk (OR 0.72, 95% CI 0.16-3.32) of COT. In mice, increasing methylphenidate exposure dose was associated with significantly longer mean COT latency time being 877 s (95% CI 711-1,043) with doses of 0 mg·kg⁻¹; 1,312 s (95% CI 850-1,773) when given 0.75 mg·kg⁻¹; and 1,500 s (95% CI 988-2,012) with 5 mg·kg⁻¹ (F = 4.635, P = 0.014). Conclusions: Observational human data did not demonstrate an association between methylphenidate and an increased risk of COT. Methylphenidate exposure in mice prolongs COT latency and may have protective effects against COT.

The Clinical Utility of Finding Unexpected Subclinical Spikes Detected by High-Density EEG During Neurodiagnostic Investigations.

This study aimed to analyze the frequency of unexpected subclinical spikes (USCS) in pediatric patients who underwent high-density electroencephalogram (HD-EEG). Of the 4481 successful HD-EEG studies, 18.5% (829) were abnormal, and 49.7% of these abnormal studies showed SCS, of which 64.1% were USCS. USCS were found to be correlated with attention/concentration deficits and executive dysfunction, often accompanied by the dual psychiatric diagnosis of ADHD. MRI revealed abnormal findings in 32.6% of the subjects with USCS, such as abnormal signal or signal hyperintensity in brain parenchyma, temporal or arachnoid cysts, and vascular malformations. Moreover, the USCS group who received neuropsychiatric testing scored lower than the population mean on Full-Scale Intelligence Quotient, Working Memory Index, and Processing Speed Index. This study highlights the potential of USCS as biomarkers that can lead to changes in clinical management and outcomes, provide valuable information about pathophysiological mechanisms, and suggest potential treatment pathways.

Role of vesicular monoamine transporter-2 for treating attention deficit hyperactivity disorder: a review.

RATIONALE: The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) classifies attention deficit hyperactivity disorder (ADHD) as a neurodevelopmental disorder that interferes with human functioning and development. As the clinical presentation of ADHD involves a deficiency in executive function, neurocognitive deficits involving distinctive neuropathological changes must be present for clinical diagnosis. OBJECTIVES: The vesicular monoamine transporter (VMAT), specifically VMAT-2, plays a role in ADHD pathogenesis. In addition, experimental data show that the stimulants (amphetamines and methylphenidate) are first-line treatments for the condition because of their extensive interaction with VMAT-2. The interactions of peptides, bupropion, and nutritional supplements with VMAT-2 receptors have been researched, but more evidence is needed to elucidate their pharmacodynamic properties. Therefore, this literature review evaluated the current pharmacological treatment modalities, peptides, and nutritional supplements for ADHD that target the VMAT-2 system. METHODS, RESULTS, AND CONCLUSIONS: We obtained relevant studies from several platforms, including the National Center for Biotechnology, Clinical Key, Access Medicine, and PubMed. From the results of these studies, we observed that stimulants interact highly with the VMAT-2 transporter, with omega-3 fatty acids, peptides, and bupropion exerting some modulatory activity on VMAT-2. These agents should be considered for the future treatment of ADHD, although clinical-level research involving human participants is necessary.

Real world analysis of treatment change and response in adults with attention-deficit/hyperactivity disorder (ADHD) alone and with concomitant psychiatric comorbidities: results from an electronic health record database study is the United States.

BACKGROUND: The objectives of this study were to examine the association of psychiatric comorbidities and patient characteristics with treatment change and response as well as to assess the association between treatment change and healthcare resource utilization (HCRU) among adult patients with attention-deficit/hyperactivity disorder (ADHD) and psychiatric comorbidities. METHODS: De-identified electronic health records from the NeuroBlu Database (2002-2021) were used to select patients ≥ 18 years with ADHD who were prescribed ADHD-specific medication. The index date was set as the first prescription of ADHD medication. The outcomes were treatment change (discontinuation, switch, add-on, or drop) and HCRU (inpatient, outpatient, composite) within 12 months of follow-up. Cox proportional-hazard model was used to assess the association between clinical and demographic patient characteristics and treatment change, while generalized linear model with negative binomial distribution and log link function was used to assess the association between key risk factors linked to treatment change and HCRU rates. RESULTS: A total of 3,387 patients with ADHD were included (ADHD only: 1,261; ADHD + major depressive disorder (MDD): 755; ADHD + anxiety disorder: 467; ADHD + mood disorder: 164). Nearly half (44.8%) of the study cohort experienced a treatment change within the 12-month follow-up period. Treatment switch and add-on were more common in patients with ADHD and comorbid MDD and anxiety disorder (switch: 18.9%; add-on: 20.5%) compared to other cohorts (range for switch: 8.5-13.6%; range for add-on: 8.9-12.1%) Survival analysis demonstrated that the probability of treatment change within 12 months from treatment initiation in the study cohort was estimated to be 42.4%. Outpatient visit rates statistically significantly increased from baseline (mean [SD] 1.03 [1.84] visits/month) to 3 months post-index (mean [SD] 1.62 [1.91] visits/month; p < 0.001), followed by a gradual decline up to 12 months post-index. Being prescribed both a stimulant and a non-stimulant at index date was statistically significantly associated with increased risk of treatment change (adjusted hazard ratio: 1.64; 95% CI: 1.13, 2.38; p = 0.01). CONCLUSIONS: This real-world study found that treatment change was common among patients with ADHD and psychiatric comorbidities. These findings support the need for future studies to examine the unmet medical and treatment needs of this complex patient population.