The detect consensus report on Attention Deficit/Hyperactivity Disorder and its management among Turkish children and adolescents (Detect: consensus report on ADHD among Turkish youth).

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common and heritable neurodevelopmental disorders which may last through the life-span. A consensus report on diagnosis and management of ADHD among Turkish youth was prepared previously. However, the participants as well as the management options were rather limited and developments in the past decade necessitated a revision and update of the consensus. Therefore, this review aims to summarize the consensus among Child and Adolescent Psychiatrists from Türkiye on the nature and management of pediatric ADHD. For those aims, the etiology of ADHD, diagnostic and evaluation process, epidemiology, developmental presentations, differential diagnoses and comorbidities, course/outcome and pharmacological as well as non-pharmacological management options were reviewed and suggestions for clinical practice are presented. Since ADHD is a chronic disorder with wide-ranging effects on functionality that is frequently accompanied by other mental disorders, a multidimensional therapeutic approach is recommended. However, since the disorder has neurobiological basis, pharmacotherapy represents the mainstay of treatment. Additional therapies may include psychosocial therapy, behavioral therapy, school-based therapeutic approaches, and family education. This review provides recommendations for ADHD at the national and global levels. It contains information about ADHD that will contribute to and facilitate clinicians' decision-making processes. It is advisable to consider this guideline in clinical practice.

Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome.

This study aims to investigate the predictive and mediating relationships between emotion dysregulation, internalizing disorders, family functionality, loneliness preference, and executive functions (EF) in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome (ADHD + CDS). This study included 176 children and adolescents (92 boys, 84 girls) who were diagnosed with ADHD + CDS according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist, between ages 8 -12 (M = 10, SD = 1.52) with a convenience sampling method. The solitude scale for children, difficulties in emotion dysregulation scale, Child Behavior Checklist, Barkley Sluggish Cognitive Tempo Scale, Family assessment device, and CNS Vital Signs test were used. The results showed that difficulty in emotion regulation, preference for loneliness, internalizing disorders and CDS symptom severity did not have a mediating effect between family functionality and EF. Still, emotion dysregulation mediates the relationship between EF and internalizing disorders by itself and through loneliness preference. Also, preference for loneliness and emotion dysregulation had a mediating effect between family functionality and internalizing disorders. Finally, it was found that the effect of emotion regulation difficulty, loneliness preference, and internalizing disorders had a mediating role between CDS symptom severity and family functionality. In conclusion, the information obtained from this study on the etiology of CDS may guide future studies.

The association between cognitive disengagement syndrome and specific learning disorder in children and adolescents with ADHD.

This study aimed to examine the associations between Cognitive Disengagement Syndrome (CDS) and Specific Learning Disorder (SLD) in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). We included sixty "ADHD-only" cases and eighty-two "ADHD + SLD" cases with an IQ score of 80 and above, aged 8-15. We applied both a structured psychiatric interview and a mental status examination. Parents completed the ADHD-Rating Scale IV, Barkley Child Attention Scale, and Specific Learning Disorder-Evaluation Scale. The sample consisted of 94 boys and 48 girls. The mean age of the cases was 10,90 ± 2,32. The "ADHD + SLD" group had a higher proportion of cases with CDS than the "ADHD-only" group (47,6% vs 15%). The "ADHD + SLD" group had significantly higher CDS-total, CDS-sluggish, and CDS-daydreaming scores than the "ADHD-only" group. SLD score was positively associated with CDS-total, CDS-sluggish, and CDS-daydreaming scores. Even when controlled for inattentive symptoms, IQ, drug treatment duration, socioeconomic level, and parental education level, CDS-daydreaming scores but not CDS-sluggish scores were associated with higher SLD scores. The findings indicate a prominent association between CDS and SLD. CDS symptoms -mainly- CDS-daydreaming symptoms are essentially associated with SLD even when controlled for inattentive symptoms, IQ, drug treatment duration, and relevant demographic factors. Therefore, clinicians should pay attention to a possible coexistence of CDS while evaluating cases with SLD.

The Challenges of Distinguishing Cognitive Disengagement Syndrome from Childhood Absence Epilepsy in Clinical Settings.

We evaluated clinical parameters distinguishing cognitive disengagement syndrome (CDS) and childhood absence epilepsy (CAE). 40 children with CDS, 27 with CAE, and 41 controls aged 7-12 were compared regarding sleep problems, CDS, and ADHD symptoms. CDS-sluggishness symptoms, but not CDS-daydreaming symptoms, were significantly higher in CDS group than CAE group. CDS scale provided a weak discrimination value between CDS and CAE. Sleep problems and ADHD symptoms were similar between the two clinical entities. These findings highlight that CDS and CAE might have overlapping symptoms. 'Daydreaming' symptoms but not 'sluggishness' symptoms seem to be main overlapping manifestations between CDS and CAE.

The relationships of neuropsychological factors and loneliness preference in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome.

This study aimed to examine emotion dysregulation and internalizing disorders mediating the relationship between selective and sustained attention and loneliness preference in children diagnosed with attention deficit hyperactivity disorder (ADHD) and Cognitive Disengagement Syndrome (CDS). This study included 176 children and adolescents between ages 8 and 12. The solitude scale for children, Difficulties in Emotion Regulation Scale, Child Behavior Checklist, Barkley Sluggish Cognitive Tempo Scale, and CNS Vital Signs test were used. The results suggest that difficulties in emotion regulation and having an internalizing disorder had a mediating effect between difficulties in selective attention and preference for the loneliness of children with ADHD + CDS. Also, it was likely that the association between sustained attention and preference for loneliness is mediated by internalizing disorders. The results suggest that the social problems commonly exhibited by children with ADHD + CDS may be related to deficits in sustained and selective attention.

functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

Eye Movement Desensitization and Reprocessing Therapy in Adolescents With Panic Disorder: A Twelve-Week Follow-Up Study.

The aim of this study is to investigate the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) treatment in adolescents with panic disorder (PD). This follow-up study consists of 30 adolescents with PD without agoraphobia, aged 14-17 (15.53 ± .97). They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present, also the Panic and Agoraphobia Scale (PAS) and Beck Anxiety Inventory (BAI) were administered at baseline, at the end of the 4th and 12th weeks of treatment. EMDR therapy which is an eight-phase treatment approach composed of standardized protocols and procedures was applied for 12 weeks, one session per week. The baseline mean of the total PAS score decreased from 40.06 to 13.13 at fourth week and 1.2 at the end of 12th week of treatment. In addition, BAI score decreased significantly from 33.67 to 13.83 at 4 weeks and 5.31 at the end of 12th week of treatment. Overall, our results underscore the effectiveness of EMDR in adolescents with PD. Moreover, the current study suggests that EMDR may represent an effective intervention technique for PD in adolescents to protect against relapses and to overcome a fear of future attacks.

Treatment of preschool children with obsessive compulsive disorder.

The aim was to examine the clinical features of Obsessive-Compulsive Disorder (OCD) in preschool and the effectiveness of aripiprazole with a standardized Cognitive-Behavioral Family Therapy (CBFT) in the treatment of preschoolers with OCD. Twelve preschool children, 36-72 months of age were diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist. They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Childhood Yale-Brown Obsessive Compulsive Scale (CY-BOCS) at baseline, at the end of the 12th and 24th weeks of treatment. The baseline mean of total CY-BOCS score decreased from 33.67 to 13.83 at the 12th week and 5.58 at the end of the 24th week of treatment. Also, 66.7% of them had at least one psychiatric comorbidity. Overall, this study revealed the effect of aripiprazole with CBFT in preschool-aged children with OCD. Also, the presence of comorbidity that is seen frequently in preschoolers with OCD may complicate the treatment. Therefore, there is a need to increase awareness of OCD and its comorbidities in preschoolers to supply treatment at an early age.

The comparison of anxiety and depression levels of resident doctors treating and not treating COVID-19 patients.

Background: Healthcare professionals are exposed to the stress of the pandemic in the highest level and try to cope with the long-term psychological consequences. Aim: This study mainly aimed to compare the anxiety and depression levels of resident doctors (RDs) who cared and did not care for coronavirus disease 2019 (COVID-19) patients at the University Hospital, which has been serving as a pandemic hospital during the COVID-19 outbreak. Subjects and Methods: To proceed with this study, 100 RDs were included this study between March 15 and June 1, 2020. Patient Health Questionnaire (PHQ-9) was used to measure the depression levels and the Beck Anxiety Inventory (BAI) was used to measure the anxiety levels of the RDs who participated in the study. Results: The analysis of the responses showed that there were 49 RDs treating COVID-19 patients and 51 RDs not treating COVID-19 patients. The proportions of the RDs who had higher PHQ-9 and BAI scores were significantly greater in the RDs treating COVID-19 patients than in those not treating. Conclusion: Our study highlights that front-line RDs have higher levels of anxiety and depression than back-line RDs.

Methylphenidate significantly improves neurocognitive impairments in children with ADHD.

This study aimed to investigate the effects of methylphenidate (MPH) on scores on a neurocognitive test battery for individuals with various presentations of attention deficit/hyperactivity disorder (ADHD) and the effect of comorbidities on executive function. This study included 861 children and adolescents aged 7-17 years who were diagnosed with ADHD according to DSM-V criteria. The CNS Vital Signs Battery was utilized to compare the neuropsychological characteristics and MPH treatment responses of patients with predominantly inattentive (ADHD-I) and combined (ADHD-C) presentations of ADHD. Before MPH administration, a statistically significant difference was observed between groups only for complex attention. In addition, the overall prevalence rate of psychiatric comorbidities was 45.5%, and no statistically significant differences were found in the ADHD-I group pre- versus post-MPH administration. Prior to the administration of MPH, statistically significant differences were observed within the ADHD-C group between those with or without comorbidities. However, after MPH administration, these differences between the groups disappeared. The effects of MPH on improving scores on neuropsychological subtests were similar between the groups with different presentations of ADHD. Additionally, MPH treatment was effective despite the presence of comorbidities.

Investigation of possible associations of the BDNF, SNAP-25 and SYN III genes with the neurocognitive measures: BDNF and SNAP-25 genes might be involved in attention domain, SYN III gene in executive function.

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder and Sluggish Cognitive Tempo (SCT) might be a second inattention disorder that might be even affected by different attention pathways. SCT is characterized by daydreaming, mental confusion, staring blankly and hypoactivity. In the present study, we evaluated 5 common variants (rs6265, rs3746544, rs1051312, rs133946 and rs133945) located in 3 candidate genes (BDNF, SNAP25 and SYN III) that are known to take part in synaptic plasticity and neurotransmitter transmission. METHODS: We tested the effects of these variants on neuropsychological findings assessed by a computer-based neuropsychological test battery in children with inattention symptoms (SCT and/or ADHD). RESULTS: BDNF (rs6265), SNAP25 (rs3746544 and rs1051312) and SYN III (rs133946 and rs133945) polymorphisms were associated with variable cognitive measures. BDNF gene (rs6265) polymorphism Met allele carriers and SNAP25 gene (rs3746544) T allele carriers had an association with the attention domain. SNAP25 gene (rs1051312) C allele carriers were only associated with reaction time scores. Cognitive flexibility, which is one of the key components of executive function evaluation and shifting attention test scores were associated with BDNF (rs6265) Met allele and SYN III (rs133946) gene G allele. SYN III (rs133945) gene C allele carriers had an association with verbal memory correct hit scores. CONCLUSIONS: As a conclusion, BDNF, SNAP25 and SYN III genes were associated with specific neurocognitive outcomes in children with inattention symptoms. It is important to note that exploring genotyping effects on neurocognitive functions instead of a heterogeneous psychiatric diagnosis can improve our understanding of psychopathologies.

Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD.

OBJECTIVE: This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children. METHOD: The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants. RESULTS: The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses. CONCLUSION: Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD.

Atomoxetine might be more effective in improving sluggish cognitive tempo symptoms after switching from methylphenidate: A case report.

Although there is no proven evidence regarding pharmacotherapy of Sluggish Cognitive Tempo (SCT), we experienced atomoxetine had more effects in decreasing SCT symptoms after switching from methylphenidate in a case with SCT and subthreshold ADHD.

Who predict ADHD with better diagnostic accuracy?: Parents or teachers?

OBJECTIVE: The objectives of the study were to determine which parents or teachers predict attention-deficit/hyperactivity disorder (ADHD) better in children and adolescents, and to detect both diagnostical and symptomatological agreement levels across informant reports. METHOD: A total of 417 cases aged 6-14 from a non-referred community sample were assessed by a semi-structured interview, parent- and teacher-rated ADHD Rating Scale-IV. Also, impairment criteria were taken into account to ensure the gold standard diagnosis for ADHD. The measures of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated in each categorical sample. Besides, the agreement between parent and teacher reports of ADHD was investigated. RESULTS: Parents and teachers had similar diagnostic accuracy for predicting ADHD. Both parents and teachers predicted ADHD in similar accuracy in both boys and girls, separately. However, girls were found to be more predictable by both parents and teachers compared to boys. Parents with lower education levels had worse diagnostic accuracy than both parents with higher education levels and teachers. Low to moderate agreement and correlations between parent and teacher ADHD reports were detected. CONCLUSION: In general, parents and teachers seem to predict ADHD in similar accuracy. Nevertheless, child gender and parental education level may alter the predictability power for ADHD. The findings can guide for clinicians that how to evaluate observation reports of parents and teachers to make accurate ADHD diagnosis in patients.

Effects of the dopamine transporter gene on neuroimaging findings in different attention deficit hyperactivity disorder presentations.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a phenotipically and neurobiologically heterogeneous disorder. Deficiencies at different levels in response inhibition, differences in dopamine transporter genotype (DAT1) and various symptomatic presentations contribute to ADHD heterogeneity. Integrating these three aspects into a functional neuroimaging research could help unreval specific neurobiological components of more phenotipically homogeneous groups of patients with ADHD. During the Go-NoGo trial, we investigated the effect of the DAT1 gene using 3 T MRI in 72 ADHD cases and 24 (TD) controls that typically developed between the ages 8 and 15 years. In the total ADHD group, DAT1 predicted homozygosity for the 10R allele and hypoactivation in the anterior cingulate cortex and paracingulate cortex. There were no significant activation differences between DAT1 10R/10R homozygotes and 9R carriers in TD controls. Subjects with predominantly inattentive ADHD (ADHD-I) presentation with DAT1 10R/10R homozygous reduced neuronal activation during Go trial particularly in the frontal regions and insular cortex, and in the parietal regions during NoGo trial (brain regions reported as part of Default Mode Network- DMN). Additionally, DAT1 10R/10R homozygousness was associated with increased occipital zone activation during only the Go trial in the ADHD combined presentation (ADHD-C) group. Our results point the three main findings: 1) The DAT1 gene is 10R homozygous for differentiated brain activation in ADHD cases but not in the TD controls, supporting the DAT1 gene as a potential marker for ADHD, 2) The relationship between the DAT1 gene and the occipital regions in ADHD-C group which may reflect compensatory mechanisms, 3) The relationship between DAT1 gene and the reduced DMN suppression for 9R carriers probabaly stems from the ADHD-I group.

Increased cerebral blood flow in the right anterior cingulate cortex and fronto-orbital cortex during go/no-go task in children with ADHD.

OBJECTIVE: Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we aimed to compare the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls during a neurocognitive task by using event-related ASL scanning. METHODS: The study comprised of 17 healthy controls and 20 children with ADHD. The study subjects were scanned on 3 Tesla MRI scanner to obtain ASL imaging data. Subjects performed go/no-go task during the ASL image acquisition. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. RESULTS: The mean age was 10.88 ± 1.45 and 11 ± 1.91 for the control and ADHD group, respectively (p = .112). The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the frontopolar and orbitofrontal cortices (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p < .001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. CONCLUSION: These results indicate that children with ADHD needed to over-activate frontopolar cortex, anterior cingulate as well as the dorsal and ventral attention networks to compensate for the attention demanded in a given cognitive task.

Helping Clinicians to Detect ODD in Children with ADHD in Clinical Settings.

The objectives of this study were to provide a basic tool for pediatricians or other physicians to suspect and detect ODD in children with ADHD and to distinguish the symptomatic profile of ODD from ADHD. 101 subjects with ADHD, 83 with both ADHD and ODD and 342 controls aged 8 to 15 years were included in the study. A semi-structured interview was performed for evaluation of psychiatric diagnoses. Both parents and teachers completed DSM-IV Disruptive Behavior Disorders Rating Scale. We found differences among all three diagnostic subsamples in two-by-two analyses for all dimensions (Inattention, Hyperactivity/Impulsivity and ODD) both according to parent and teacher reports (p < 0.03 for all analyses). Based on parental ODD scores, ROC Curve analyses between 'only ADHD' and 'ADHD+ODD' groups showed that AUC was equal 0.80 (95%CI = 0.73-0.86) and the best cutoff point for ODD diagnosis in the ADHD subjects was 0.68. This study demonstrates the presence of a basic tool for detection and suspicion of ODD in children with ADHD for primary care clinicians or pediatricians in clinical settings. Findings also indicate that patients with ODD and ADHD have more severe inattention, hyperactivity/impulsivity and oppositional symptoms than those with only ADHD have.

Psychiatric Comorbidity in the Subtypes of ADHD in Children and Adolescents with ADHD According to DSM-IV.

INTRODUCTION: The prevalence rate of psychiatric comorbidity in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) was 60-80%. The objective of this study was to examine comorbid disorders associated with ADHD and the subtypes of ADHD in children and adolescents with the diagnosis of ADHD. METHOD: The study included 326 children and adolescents aged between 8-15 years who were diagnosed with ADHD for the first time as a result of an interview by psychiatry, in a child adolescent psychiatry clinic in Izmir. Sociodemographic form, Turgay DSM-IV Disruptive Behavior Disorders Rating Scale and Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version were used to assess psychiatric comorbidity. RESULTS: The comorbidities accompanied ADHD were disruptive behavior disorder (28.8%), depressive disorder (13.2%), obsessive-compulsive disorder (9.5%) and anxiety disorder (6.1%). When the subtypes of ADHD were assessed according to psychiatric comorbidity, oppositional defiant disorder and conduct disorder were frequently seen with ADHD combined type, whereas anxiety disorder was more frequent with ADHD inattentive type. DISCUSSION: Comorbidity in ADHD Combined type increases the severity of disease, delays treatment response and exacerbates prognosis. Therefore, it is very important to determine which psychiatric diagnosis accompany with ADHD.

Diffusion tensor imaging findings in children with sluggish cognitive tempo comorbid Attention Deficit Hyperactivity Disorder.

Objective: The construct of Sluggish Cognitive Tempo (SCT) is characterized by daydreaming, mental confusion, staring blankly and hypoactivity. Our main goal was to explore neuropsychological differences in Attention Deficit Hyperactivity Disorder-Inattentive presentation (ADHD-IA) groups with and without SCT symptoms compared to healthy controls. After detecting specific neuropsychological differences, we examined white matter microstructure using Diffusion Tensor Imaging (DTI) data obtained from 3.0 Tesla MRI scans of the cases with SCT symptoms comparing to Typically Developing (TD) controls.Method: In this study, we included 24 cases in the ADHD-IA group with SCT symptoms, 57 cases in the ADHD-IA group without SCT symptoms and, 24 children in the TD group. We applied tract-based spatial statistics to the DTI measures for obtaining fractional anisotropy (FA), axial, radial and mean diffusivity (AD, RD, MD) to explore white matter differences for the whole brain.Results: Omission error scores and longer reaction time scores were specifically associated with inattention symptoms. Commission error scores were significantly and specifically related to SCT symptoms. Cases with SCT symptoms presented increased FA in the bilateral anterior and posterior limb of the internal capsule, bilateral cerebral peduncle, and the fornix than TD group.Conclusions: Neurobiological differences in ADHD cases are still relatively unexplored. We suggest that including an assessment for SCT in the neuropsychological and neuroimaging studies of ADHD may provide more consistent results.