Age-Related Considerations in the Treatment of ADHD

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S23) ◽  
pp. 10-13 ◽  
Author(s):  
Jeffrey H. Newcorn
Keyword(s):  
Time Management ◽  
Task Completion ◽  
Occupational Performance ◽  
Social Situations ◽  
Attentional Function ◽  
Hyperactivity Disorder ◽  
Age Related ◽  
Adolescents And Adults ◽  
Core Symptoms ◽  
High Degree

Although the symptoms of attention-deficit/hyperactivity disorder (ADHD) can be found in many “normal” people, these symptoms are present to a greater extent in those affected by the disorder. In these patients, ADHD symptoms cause substantial functional impairment. Therefore, the goal of treatment is not simply to reduce core symptoms, but also to decrease the level of impairment caused by these symptoms.Common impairments in adolescents and adults include academic and occupational problems that are particularly evident in the context of tasks requiring a high degree of organization or attentional function. These impairments result in problems related to task completion, prioritizing work and other obligations, and time management, etc. These symptoms often impact successful completion of tasks in school or at work, and can also result in a variety of problems in initiating and managing relationships (Slide 1).Mood and anxiety disorders often co-occur with ADHD in adults. The accumulation of experiences related to impaired academic and/or occupational performance, and or persistent relationship problems, due to the symptoms of ADHD, can lead to either depressed mood or anxiety related to performance and/or social situations. Therefore, in treating adults with ADHD, reduction of those co-occurring symptom presentations is also an important goal.

Forty years of methylphenidate treatment in Attention-Deficit/Hyperactivity Disorder

2002 ◽  
Vol 6 (1_suppl) ◽  
pp. 17-30 ◽  
Author(s):  
C. K. Conners
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Drug Effects ◽  
Long Term Effects ◽  
Stimulant Treatment ◽  
Hyperactivity Disorder ◽  
Subject Selection ◽  
Methodological Rigor ◽  
Adolescents And Adults ◽  
Core Symptoms

This paper reviews approximately 40 years of stimulant drug treatment of children with behavior and learning problems. These patients generally fall under the rubric of Attention-Deficit/Hyperactivity Disorder (ADHD), with core symptoms of hyperactivity, impulsivity, and inattention being the most studied and most robust of the targets for stimulant treatment. In addition, the drug effects on other targets, such as cognitive and academic function, are included. The largest selection of studies involves methylphenidate. Both qualitative studies and meta-analytic studies from major reviews are examined. Variations in the methodology of the reviews are described and some of the discrepancies in interpretation examined. Despite wide variations in subject selection, types of trials, degree of methodological rigor, and the decade in which the studies took place, the evidence is remarkably consistent. The overall results suggest significant clinical impact upon the core features of ADHD. More studies of long-term effects and special populations such as older adolescents and adults will be necessary, though existing evidence strongly supports similar findings as for the younger patients with a diagnosis of ADHD.

ADHD: Prevalence, Diagnosis, and Issues of Comorbidity

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S6) ◽  
pp. 1-5 ◽  
Author(s):  
Timothy E. Wilens
Keyword(s):  
Primary Care Physicians ◽  
Brain Disorder ◽  
Children With Adhd ◽  
Hyperactivity Disorder ◽  
Adolescents And Adults ◽  
Stimulant Medications ◽  
Long Acting ◽  
Core Symptoms ◽  
The Brain

AbstractAttention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that begins in childhood and continues with adult manifestations related to the core symptoms. Approximately 50% to 75% of children with ADHD continue to meet criteria for the disorder as adolescents and adults. Adults with the disorder increasingly present to primary care physicians, psychiatrists, and other practitioners for diagnosis and treatment. Understanding the diagnosis of ADHD in adults requires knowledge of age-dependent decline of symptoms over time. Retrospective recall of symptoms and impairment are valid methods of diagnosing the disorder. ADHD is also a brain disorder with a strong neurobiologic basis, complex etiology, and genetic component. Genetic and environmental vulnerabilities give rise to abnormalities in the brain and subsequent behavioral and cognitive deficits, which may produce the symptoms associated with ADHD. Magnetic resonance imaging studies of ADHD have provided evidence that abnormalities in the brain are caused by the disorder itself rather than treatment of the disorder. Psychiatric comorbidity is common among patients with ADHD and tends to complicate treatment. Acute and long-term use of long-acting stimulant formulations (methylphenidate and amphetamine compounds) have shown robust efficacy and tolerability consistent with the treatment response established in children with ADHD. Non-stimulant medications have demonstrated efficacy as well, and may be preferred in patients with tic and substance use disorders.

scholarly journals Meditation-based therapies for attention-deficit/hyperactivity disorder in children, adolescents and adults: a systematic review and meta-analysis

2018 ◽  
Vol 21 (3) ◽  
pp. 87-94 ◽  
Author(s):  
Junhua Zhang ◽  
Amparo Díaz-Román ◽  
Samuele Cortese
Keyword(s):  
Systematic Review ◽  
Attention Deficit Hyperactivity Disorder ◽  
High Risk ◽  
Attention Deficit ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Hyperactivity Disorder ◽  
Adolescents And Adults ◽  
Randomised Controlled ◽  
Core Symptoms

BackgroundThe efficacy of meditation-based therapies for attention deficit/hyperactivity disorder (ADHD) across the lifespan remains uncertain.ObjectiveTo conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy of meditation-based therapies for ADHD core symptoms and associated neuropsychological dysfunctions in children/adolescents or adults with ADHD.MethodsWe searched Pubmed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge with no language, date or type of document restriction, up to 5 May 2018. Random-effects model was used. Heterogeneity was assessed with Cochran’s Q and I2 statistics. Publication (small studies) bias was assessed with funnel plots and the Egger’s test. Studies were evaluated with the Cochrane risk of bias (RoB) tool. Analyses were conducted using Comprehensive Meta-Analysis.Findings13 RCTs (seven in children/adolescents, n=270 and six in adults, n=339) were retained. Only one RCT was double-blind.Meditation-based therapies were significantly more efficacious than the control conditions in decreasing the severity of ADHD core symptoms (inattention+hyperactivity/impulsivity: children/adolescents: Hedge’s g=-0.44, 95% CI −0.69 to −0.19, I20%; adults: Hedge’s g=−0.66, 95% CI –1.21 to −0.11, I281.81%). No significant effects were found on neuropsychological measures of inattention and inhibition in children/adolescents. In adults, significant effects were detected on working memory and inhibition, although these results were based on a small number of studies (n=3). 57% and 43% of the studies in children/adolescents were rated at overall unclear and high risk of bias, respectively. In adults, 33% and 67% of the studies were deemed at overall unclear and high risk of bias, respectively. No evidence of publication bias was found.ConclusionsDespite statistically significant effects on ADHD combined core symptoms, due to paucity of RCTs, heterogeneity across studies and lack of studies at low risk of bias, there is insufficient methodologically sound evidence to support meditation-based therapies for ADHD.Trial registration numberPROSPERO 2018 [CRD42018096156].

Disorder-specific alterations of tactile sensitivity in neurodevelopmental disorders

2020 ◽  
Author(s):  
Jason He ◽  
Ericka Wodka ◽  
Mark Tommerdahl ◽  
Richard Edden ◽  
Mark Mikkelsen ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Autism Spectrum ◽  
Typically Developing ◽  
Hyperactivity Disorder ◽  
The Core ◽  
Children With Asd ◽  
Tactile Detection ◽  
Spectrum Disorders ◽  
Sensory Processes ◽  
Core Symptoms

Alterations of tactile processing have long been identified in autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD). However, the extent to which these alterations are disorder-specific, rather than disorder-general, and how they relate to the core symptoms of each disorder, remains unclear. We measured and compared tactile detection, discrimination and order judgment thresholds between a large sample of children with ASD, ADHD, ASD + ADHD combined and typically developing controls. The pattern of results suggested that while difficulties with tactile detection and order judgement were more common in children with ADHD, difficulties with tactile discrimination were more common in children with ASD. Strikingly, subsequent correlation analyses found that the disorder-specific alterations suggested by the group comparisons were also exclusively related to the core symptoms of each respective disorder. These results suggest that disorder-specific alterations of lower-level sensory processes exist and are specifically related to higher-level clinical symptoms of each disorder.

How adolescents and adults translate motivational value to action: Age-related shifts in strategic physical effort exertion for monetary rewards

2019 ◽  
Author(s):  
Alexandra M Rodman ◽  
Katherine Powers ◽  
Catherine Insel ◽  
Erik K Kastman ◽  
Katherine Kabotyanski ◽  
...  
Keyword(s):  
Young Adults ◽  
Early Adulthood ◽  
Theoretical Models ◽  
Incentive Motivation ◽  
Reward Processing ◽  
Monetary Reward ◽  
Physical Effort ◽  
Monetary Rewards ◽  
Age Related ◽  
Adolescents And Adults

Adults titrate the degree of physical effort they are willing to expend according to the magnitude of reward they expect to obtain, a process guided by incentive motivation. However, it remains unclear whether adolescents, who are undergoing normative developmental changes in cognitive and reward processing, translate incentive motivation into action in a way that is similarly tuned to reward value and economical in effort utilization. The present study adapted a classic physical effort paradigm to quantify age-related changes in motivation-based and strategic markers of effort exertion for monetary rewards from adolescence to early adulthood. One hundred and three participants aged 12-23 years completed a task that involved exerting low or high amounts of physical effort, in the form of a hand grip, to earn low or high amounts of money. Adolescents and young adults exhibited highly similar incentive-modulated effort for reward according to measures of peak grip force and speed, suggesting that motivation for monetary reward is consistent across age. However, young adults expended energy more economically and strategically: whereas adolescents were prone to exert excess physical effort beyond what was required to earn reward, young adults were more likely to strategically prepare before each grip phase and conserve energy by opting out of low reward trials. This work extends theoretical models of development of incentive-driven behavior by demonstrating that layered on similarity in motivational value for monetary reward, there are important differences in the way behavior is flexibly adjusted in the presence of reward from adolescence to young adulthood.

scholarly journals Improved Mutual Understanding for Human-Robot Collaboration: Combining Human-Aware Motion Planning with Haptic Feedback Devices for Communicating Planned Trajectory

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3673
Author(s):  
Stefan Grushko ◽  
Aleš Vysocký ◽  
Petr Oščádal ◽  
Michal Vocetka ◽  
Petr Novák ◽  
...  
Keyword(s):  
User Study ◽  
Haptic Feedback ◽  
Fundamental Aspect ◽  
Task Completion ◽  
Good Efficiency ◽  
Notification System ◽  
Movement Data ◽  
Novel Approach ◽  
Machine Interface ◽  
High Degree

In a collaborative scenario, the communication between humans and robots is a fundamental aspect to achieve good efficiency and ergonomics in the task execution. A lot of research has been made related to enabling a robot system to understand and predict human behaviour, allowing the robot to adapt its motion to avoid collisions with human workers. Assuming the production task has a high degree of variability, the robot’s movements can be difficult to predict, leading to a feeling of anxiety in the worker when the robot changes its trajectory and approaches since the worker has no information about the planned movement of the robot. Additionally, without information about the robot’s movement, the human worker cannot effectively plan own activity without forcing the robot to constantly replan its movement. We propose a novel approach to communicating the robot’s intentions to a human worker. The improvement to the collaboration is presented by introducing haptic feedback devices, whose task is to notify the human worker about the currently planned robot’s trajectory and changes in its status. In order to verify the effectiveness of the developed human-machine interface in the conditions of a shared collaborative workspace, a user study was designed and conducted among 16 participants, whose objective was to accurately recognise the goal position of the robot during its movement. Data collected during the experiment included both objective and subjective parameters. Statistically significant results of the experiment indicated that all the participants could improve their task completion time by over 45% and generally were more subjectively satisfied when completing the task with equipped haptic feedback devices. The results also suggest the usefulness of the developed notification system since it improved users’ awareness about the motion plan of the robot.

Dopaminergic loss of cyclin-dependent kinase-like 5 recapitulates methylphenidate-remediable hyperlocomotion in mouse model of CDKL5 deficiency disorder

2020 ◽  
Vol 29 (14) ◽  
pp. 2408-2419
Author(s):  
Cian-Ling Jhang ◽  
Hom-Yi Lee ◽  
Jin-Chung Chen ◽  
Wenlin Liao
Keyword(s):  
Movement Control ◽  
Motor Dysfunction ◽  
Signaling Proteins ◽  
Cyclin Dependent Kinase ◽  
Serine Threonine Kinase ◽  
Hyperactivity Disorder ◽  
Dopamine Content ◽  
Therapeutic Development ◽  
Dopamine Signaling ◽  
Core Symptoms

Abstract Cyclin-dependent kinase-like 5 (CDKL5), a serine-threonine kinase encoded by an X-linked gene, is highly expressed in the mammalian forebrain. Mutations in this gene cause CDKL5 deficiency disorder, a neurodevelopmental encephalopathy characterized by early-onset seizures, motor dysfunction, and intellectual disability. We previously found that mice lacking CDKL5 exhibit hyperlocomotion and increased impulsivity, resembling the core symptoms in attention-deficit hyperactivity disorder (ADHD). Here, we report the potential neural mechanisms and treatment for hyperlocomotion induced by CDKL5 deficiency. Our results showed that loss of CDKL5 decreases the proportion of phosphorylated dopamine transporter (DAT) in the rostral striatum, leading to increased levels of extracellular dopamine and hyperlocomotion. Administration of methylphenidate (MPH), a DAT inhibitor clinically effective to improve symptoms in ADHD, significantly alleviated the hyperlocomotion phenotype in Cdkl5 null mice. In addition, the improved behavioral effects of MPH were accompanied by a region-specific restoration of phosphorylated dopamine- and cAMP-regulated phosphoprotein Mr 32 kDa, a key signaling protein for striatal motor output. Finally, mice carrying a Cdkl5 deletion selectively in DAT-expressing dopaminergic neurons, but not dopamine receptive neurons, recapitulated the hyperlocomotion phenotype found in Cdkl5 null mice. Our findings suggest that CDKL5 is essential to control locomotor behavior by regulating region-specific dopamine content and phosphorylation of dopamine signaling proteins in the striatum. The direct, as well as indirect, target proteins regulated by CDKL5 may play a key role in movement control and the therapeutic development for hyperactivity disorders.

Neurobiology and Genetics of ADHD in Adults

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S13) ◽  
pp. 5-7 ◽  
Author(s):  
Thomas J. Spencer
Keyword(s):  
Adult Adhd ◽  
Extended Release ◽  
Treatment Strategies ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Norepinephrine Reuptake Inhibitor ◽  
Adults And Children ◽  
Core Symptoms ◽  
Adhd Medications

AbstractTreatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments.

Modeling the blood lactate kinetics at maximal short-term exercise conditions in children, adolescents, and adults

2005 ◽  
Vol 99 (2) ◽  
pp. 499-504 ◽  
Author(s):  
Ralph Beneke ◽  
Matthias Hütler ◽  
Marcus Jung ◽  
Renate M. Leithäuser
Keyword(s):  
Blood Lactate ◽  
Muscle Mass ◽  
Body Mass ◽  
Short Term ◽  
Wingate Anaerobic Test ◽  
Blood Compartment ◽  
Test Conditions ◽  
Age Related ◽  
Adolescents And Adults ◽  
Anaerobic Test

Whether age-related differences in blood lactate concentrations (BLC) reflect specific BLC kinetics was analyzed in 15 prepubescent boys (age 12.0 ± 0.6 yr, height 1.54 ± 0.06 m, body mass 40.0 ± 5.2 kg), 12 adolescents (16.3 ± 0.7 yr, 1.83 ± 0.07 m, 68.2 ± 7.5 kg), and 12 adults (27.2 ± 4.5 yr, 1.83 ± 0.06 m, 81.6 ± 6.9 kg) by use of a biexponential four-parameter kinetics model under Wingate Anaerobic Test conditions. The model predicts the lactate generated in the extravasal compartment (A), invasion ( k1), and evasion ( k2) of lactate into and out of the blood compartment, the BLC maximum (BLCmax), and corresponding time (TBLCmax). BLCmax and TBLCmax were lower ( P < 0.05) in boys (BLCmax 10.2 ± 1.3 mmol/l, TBLCmax 4.1 ± 0.4 min) than in adolescents (12.7 ± 1.0 mmol/l, 5.5 ± 0.7 min) and adults (13.7 ± 1.4 mmol/l, 5.7 ± 1.1 min). No differences were found in A related to the muscle mass (AMM) and k1 between boys (AMM: 22.8 ± 2.7 mmol/l, k1: 0.865 ± 0.115 min−1), adolescents (22.7 ± 1.3 mmol/l, 0.692 ± 0.221 min−1), and adults (24.7 ± 2.8 mmol/l, 0.687 ± 0.287 min−1). The k2 was higher ( P < 0.01) in boys (2.87 10−2 ± 0.75 10−2 min−1) than in adolescents (2.03 × 10−2 ± 0.89 × 10−2 min−1) and adults (1.99 × 10−2 ± 0.93 × 10−2 min−1). Age-related differences in the BLC kinetics are unlikely to reflect differences in muscular lactate or lactate invasion but partly faster elimination out of the blood compartment.

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