Insight into ADHD diagnosis with deep learning on Actimetry: Quantitative interpretation of occlusion maps in age and gender subgroups.

Attention Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood that often persists into adulthood. Objectively diagnosing ADHD can be challenging due to the reliance on subjective questionnaires in clinical assessment. Fortunately, recent advancements in artificial intelligence (AI) have shown promise in providing objective diagnoses through the analysis of medical images or activity recordings. These AI-based techniques have demonstrated accurate ADHD diagnosis; however, the growing complexity of deep learning models has introduced a lack of interpretability. These models often function as black boxes, unable to offer meaningful insights into the data patterns that characterize ADHD. OBJECTIVE: This paper proposes a methodology to interpret the output of an AI-based diagnosis system for combined ADHD in age and gender-stratified populations. METHODS: Our system is based on the analysis of 24 hour-long activity records using Convolutional Neural Networks (CNNs) to classify spectrograms of activity windows. These windows are interpreted using occlusion maps to highlight the time-frequency patterns explaining ADHD activity. RESULTS: Significant differences in the frequency patterns between ADHD and controls both in diurnal and nocturnal activity were found for all the populations. Temporal dispersion also presented differences in the male population. CONCLUSION: The proposed interpretation techniques for CNNs highlighted gender- and age-related differences between ADHD patients and controls. Leveraging these differences could potentially lead to improved diagnostic accuracy, especially if a larger and more balanced dataset is utilized. SIGNIFICANCE: Our findings pave the way for the development of an AI-based diagnosis system for ADHD that offers interpretability, thereby providing valuable insights into the underlying etiology of the disease.

[Trend in medicines use for attention deficit hyperactivity disorder in children and adolescents (2010-2019).] / Tendencia del consumo de fárma-cos en el trastorno por déficit de atención e hiperactividad en niños y adolescentes (2010-2019).

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder characterised primarily by three core symptoms: inattention, hyperactivity and impulsivity. It is one of the most commonly diagnosed childhood psychiatric disorders, with a worldwide prevalence of between 3% and 5%, and between 6% and 7% in the Spanish population. The aim of the study is to analyse the trend in the consumption of drugs used for the treatment of ADHD between 2010-2019 in Castilla y León. METHODS: Epidemiological registry study of all dispensing in pharmacies in Castilla y León between 2010 and 2019 to patients under 19 years of age, of active substance N06BA04 (methylphenidate), N06BA09 (atomoxetine), N06BA12 (lisdexamfetamine), N06BA07 (modafinil) and C02AC02 (guanfacine). Data on drug use were obtained from the information system for the pharmaceutical provision of Castilla y León, CONCYLIA. Frequencies in absolute values and the corresponding percentages were calculated. Student's t-test was used to estimate differences between continuous variables and Pearson's Chi-square test for categorical variables, while the trend in consumption was analysed using the Cochran-Armitage test. RESULTS: ADHD medication was dispensed annually to 1.77% of the population, with consumption being more than three times higher in boys than in girls (2.69% vs 0.81%; p=0.001). The age group with the highest peak use was 10-14 years with 3.42%. Methylphenidate was the drug used by the highest percentage of the population (2.44%) followed by lisdexamfetamine (0.37%). CONCLUSIONS: Approximately 2 out of every 100 people aged 0-19 years were treated with some ADHD medication, mainly methylphenidate, in Castilla y León between 2010 and 2019.

OBJETIVO: El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno común del neurodesarrollo infantil que se caracteriza fundamentalmente por tres síntomas a nivel central: falta de atención, hiperactividad e impulsividad. Se trata de uno de los trastornos psiquiátricos infantiles más comúnmente diagnosticados, con una prevalencia a nivel mundial que oscila entre el 3% y el 5%, y entre el 6% y el 7% en la población española. El objetivo del estudio es analizar la tendencia del consumo de los fármacos utilizados para el tratamiento del TDAH entre los años 2010-2019 en Castilla y León. METODOS: Estudio epidemiológico de registro de todas las dispensaciones realizadas en las oficinas de farmacia de Castilla y León entre el año 2010 y 2019 a pacientes menores de 19 años, de los principios activos N06BA04 (metilfenidato), N06BA09 (atomoxetina), N06BA12 (lisdexanfetamina), N06BA07 (modafinilo) y C02AC02 (guanfacina). Los datos de utilización de medicamentos se obtuvieron a partir del sistema de información para la prestación farmacéutica de Castilla y León, CONCYLIA. Se calcularon frecuencias en valores absolutos y los porcentajes correspondientes. Se utilizó el test-t de Student para estimar diferencias entre variables continuas y el test Chi-cuadrado de Pearson para las categóricas, mientras que la tendencia de consumo se analizó mediante el test de Cochran-Armitage. RESULTADOS: Se dispensaron anualmente los medicamentos para el TDAH al 1,77% de la población, siendo el consumo más de tres veces mayor en niños que en niñas (2,69% vs 0,81%; p=0,001). La franja de edad donde se observó el mayor pico de consumo fue de los 10 a 14 años con un 3,42%. El metilfenidato fue el medicamento consumido por un mayor porcentaje de la población (2,44%) seguido de la lisdexanfetamina (0,37%). CONCLUSIONES: Aproximadamente 2 de cada 100 personas entre 0 y 19 años fueron tratadas con algún medicamento para la TDAH, fundamentalmente metilfenidato, en Castilla y León entre 2010 y 2019.

Objective ADHD Diagnosis Using Convolutional Neural Networks Over Daily-Life Activity Records.

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents. However, its etiology is still unknown, and this hinders the existence of reliable, fast and inexpensive standard diagnostic methods. OBJECTIVE: This paper proposes an end-to-end methodology for automatic diagnosis of the combined type of ADHD. METHODS: Diagnosis is based on the analysis of 24 hour-long activity records using Convolutional Neural Networks to classify spectrograms of activity windows. RESULTS: We achieve up to [Formula: see text] average sensitivity, [Formula: see text] specificity and AUC values over [Formula: see text]. Overall, our figures overcome those obtained by actigraphy-based methods reported in the literature as well as others based on more expensive (and not so convenient) acquisition methods. CONCLUSION: These results reinforce the idea that combining deep learning techniques together with actimetry can lead to a robust and efficient system for objective ADHD diagnosis. SIGNIFICANCE: Reliance on simple activity measurements leads to an inexpensive and non-invasive objective diagn-ostic method, which can be easily implemented with daily devices.

[Multiple birth trends in the region of Castilla y León (Spain) in a 13 year period]. / Evolución temporal de los partos múltiples en Castilla y León durante 13 años.

INTRODUCTION: Multiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13years and the subsequent impact on foetal and maternal health. MATERIAL AND METHODS: Data was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. RESULTS: A pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5-4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilization showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4-11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95%CI: 1.04-1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. CONCLUSION: Multiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality.

Criterion validity and clinical usefulness of Attention Deficit Hyperactivity Disorder Rating Scale IV in attention deficit hyperactivity disorder (ADHD) as a function of method and age.

BACKGROUND: The aim of this research is to analyze Attention Deficit Hyperactivity Disorder Rating Scales IV (ADHD RS-IV) criteria validity and its clinical usefulness for the assessment of Attention Deficit Hyperactivity Disorder (ADHD) as a function of assessment method and age. METHODOLOGY: A sample was obtained from an epidemiological study (n = 1095, 6-16 years). Clinical cases of ADHD (ADHD-CL) were selected by dimensional ADHD RS-IV and later by clinical interview (DSM-IV). ADHD-CL cases were compared with four categorical results of ADHD RS-IV provided by parents (CATPA), teachers (CATPR), either parents or teachers (CATPAOPR) and both parents and teachers (CATPA&PR). Criterion validity and clinical usefulness of the answer modalities to ADHD RS-IV were studied. RESULTS: ADHD-CL rate was 6.9% in childhood, 6.2% in preadolescence and 6.9% in adolescence. Alternative methods to the clinical interview led to increased numbers of ADHD cases in all age groups analyzed, in the following sequence: CATPAOPR> CATPRO> CATPA> CATPA&PR> ADHD-CL. CATPA&PR was the procedure with the greatest validity, specificity and clinical usefulness in all three age groups, particularly in the childhood. CONCLUSIONS: Isolated use of ADHD RS-IV leads to an increase in ADHD cases compared to clinical interview, and varies depending on the procedure used.

Prevalence of oppositional defiant disorder in Spain.

INTRODUCTION: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. OBJECTIVE: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). MATERIAL AND METHODS: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. RESULTS: An overall prevalence rate of 5.6% was found (95% CI: 4.2%-7%). Male gender prevalence=6.8%; female=4.3%. Prevalence in secondary education=6.2%; primary education=5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). CONCLUSIONS: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning.

Automatic diagnosis of ADHD based on multichannel nonlinear analysis of actimetry registries.

Attention-Deficit Hyperactivity Disorder (ADHD) is the most common mental health problem in childhood and adolescence. It is commonly diagnosed by means of subjective methods which tend to overestimate the severity of the pathology. A number of objective methods also exist, but they are either expensive or time-consuming. Some recent proposals based on nonlinear processing of activity registries have deserved special attention. Since they rely on actigraphy measurements, they are both inexpensive and non-invasive. Among these methods, those shown to have higher reliability are based on single-channel complexity assessment of the activity patterns. This way, potentially useful information related to the interaction between the different channels is discarded. In this paper we propose a new methodology for ADHD diagnosis based on joint complexity assessment of multichannel activity registries. Results on real data show that the proposed method constitute a useful diagnostic aid tool reaching 87:10% sensitivity and 84.38% specificity. The combination of ADHD indicators extracted with the proposed method with single-channel complexity-based indices previously proposed lead to sensitivity and specifity values above 90%.

[Utility of a statistical model of cognitive styles in attention deficit hyperactivity disorder]. / Utilidad de un modelo estadístico de estilos cognitivos en el trastorno por déficit de atención con hiperactividad.

The purpose of this study was to determine the best statistical model of cognitive styles, based on the MFFT-20, CEFT and Stroop tests to predict attention deficit hyperactivity disorder (ADHD), analyzing the validity of the model for the diagnosis of the disease. We studied 100 ADHD cases (DSM-IV criteria) and 100 controls, age ranging between 7 and 11 years. Controls were randomly recruited and matched in age, gender and sociodemographic area with ADHD cases. On average, ADHD cases showed more impulsiveness (d: 1.28), less cognitive flexibility (d: 0.91) and more field dependence (d: 1.62) than controls. The logistic regression model that predicts ADHD best is made up of age, CEFT, MFFT-20 and Stroop tests and the formula derived from the model shows 85% sensitivity and 85% specificity for ADHD, regarding the DSM-IV criteria as the standard. The statistical model of cognitive styles presents valid indicators to diagnose ADHD, contributing to an increase in the objectivity of its analysis.

[Usefulness of the Stroop test in attention deficit hyperactivity disorder]. / Utilidad del test de Stroop en el trastorno por déficit de atencion/hiperactividad.

AIMS: The aim of this study is to analyse the differences in the Stroop effect between cases with attention deficit hyper-activity disorder (ADHD) and controls. It also seeks to find the best model based on the third task of the colours and words test (Stroop-CW) for predicting ADHD and to analyse the validity of the Stroop-CW test for diagnosing the disorder. SUBJECTS AND METHODS: The sample studied consisted of 100 cases of ADHD -according to Diagnostic and statistical manual of mental disorders (DSM-IV) criteria- and 100 controls, between 7 and 11 years of age, who were evaluated using the Stroop test. The controls were recruited at random and paired by age, sex and sociodemographic area with the cases. RESULTS: The cases present a mean cognitive style that is significantly less flexible (d = -1.06) and they also display a lower capacity to inhibit or control automatic responses than the controls at all ages (7 years: d = 1.67; 8 years: d = 1.02; 9 years: d = 1.32; 10 years: d = 2.04; 11 years: d = 0.89). The model of logistic regression analysis that best predicts ADHD is made up of age and Stroop-CW. The formulation derived from the model offers a sensitivity of 81% and a specificity of 72%, taking the criteria of the DSM-IV for ADHD as the reference test. CONCLUSIONS: The Stroop-CW test presents usefulness and complementary criteria validity for the diagnosis of ADHD.