Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan

Background/aim Patients with attention-deficit hyperactivity disorder (ADHD) manifest symptoms of hyperactivity, impulsivity, and/or inattention. ADHD medications available in Japan are limited compared with those in Western countries. Prescribing status has not been sufficiently evaluated in clinical settings in Japan. This study investigated the current use of ADHD medications and characteristics of patients who received multiple ADHD medications in a clinical setting in Japan. Methods Study participants were those who visited the Department of Child and Adolescent Psychiatry, Kohnodai Hospital between April 2015 and March 2020. We investigated patients who received osmotic-controlled release oral delivery system methylphenidate, atomoxetine, or guanfacine. A retrospective case–control design was used to evaluate the characteristics of patients who received multiple ADHD medications. Patients who were given three ADHD medications were defined as the case group. Randomly sampled sex- and age-matched patients diagnosed with ADHD were defined as the control group. We compared data for child-to-parent violence, antisocial behavior, suicide attempt or self-harm, abuse history, refusal to attend school, and two psychological rating scales (the ADHD-Rating Scale and Tokyo Autistic Behavior Scale). Results Among the 878 patients who were prescribed any ADHD medications, 43 (4.9%) received three ADHD medications. Logistic regression revealed that children with severe ADHD symptoms, autistic characteristics, or tendency of child-to-parent violence were more likely to have been prescribed three medications during their treatment. Conclusions Our findings suggest the approach to prevent the use of multiple ADHD medications. A prospective study to investigate the causality between prescribing status and clinical characteristics is warranted.

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High Attention-Deficit/Hyperactivity Disorder Scale Scores Among Patients with Persistent Chronic Nonspecific Low Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2021/24/e299 ◽

2021 ◽

pp. E299-E307

Author(s):

Satoshi Kasahara

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Low Back Pain ◽

Back Pain ◽

Attention Deficit ◽

Rating Scales ◽

Rating Scale ◽

Pain Clinic ◽

Low Back ◽

Hyperactivity Disorder ◽

Scale Scores

Background: Associations between attention-deficit/hyperactivity disorder (ADHD) and chronic pain disorders, such as fibromyalgia, have been reported. However, associations between persistent chronic nonspecific low back pain (CNLBP) and ADHD have not yet been investigated. Objectives: This study aimed to investigate the positive rates of possible ADHD, as assessed by selfreported ADHD scales, in patients with persistent CNLBP, using data from self-reported questionnaires completed by patients and their families. This study also aimed to compare the self-reported scores obtained from existing standardized data for healthy individuals, and to examine whether the ADHD scale scores of patients with persistent CNLBP are associated with pain variables. Study Design: Cross-sectional study. Setting: The specialized pain clinic at our university hospital. Methods: This cross-sectional study included 60 consecutive patients with persistent CNLBP who were diagnosed with a possible somatic symptom disorder and were referred to a psychiatrist in our pain clinic. The Conners’ Adult ADHD Rating Scales (CAARS) self-report (CAARS-S) and observer-rated (CAARS-O) questionnaires were utilized. We investigated the CAARS scores, and the association between the CAARS subscale scores and pain variables (pain duration and pain Numeric Rating Scale) in patients with persistent CNLBP. Results: Of the 60 patients, 19 (31.7%) were positive on both CAARS-S and CAARS-O questionnaires (T-score > 65). The ADHD indices, which comprised subscales of the CAARS estimating the necessity of treatment for ADHD, were significantly higher in both male and female patients with persistent CNLBP than in the Japanese standardized sample (P < 0.005). CAARS-S hyperactivity/restlessness, CAARS-O hyperactivity/restlessness, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition hyperactive-impulsive symptom subscale scores also correlated with the pain intensity (P < 0.05). Limitations: In this study, ADHD tendency was evaluated using only a self-reported questionnaire. Hence in the future, accurate and precise assessments of ADHD symptoms using structured clinical interviews conducted by ADHD experts are warranted. Additionally, the study only included patients with persistent CNLBP. Therefore in the future, it will be valuable to investigate ADHD scale scores (e.g., CAARS) among patients with CNLBP and nonspecific low back pain with larger sample sizes. Conclusions: Our findings revealed that the subscale scores on an ADHD scale were considerably high in patients with persistent CNLBP. As a previous study of our clinical experience indicates that persistent CNLBP can be substantially relieved by administering ADHD medications, ADHD screening is warranted in the treatment of persistent CNLBP. Key words: Attention-deficit/hyperactivity disorder, neurodevelopmental disorders, chronic nonspecific low back pain, chronic pain, Conners’ Adult ADHD Rating Scales (CAARS), Numeric Rating Scale, pain duration, pain clinic, somatic symptom disorder

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Attention Deficit Hyperactivity Disorder and Scientific School Performances Among Moroccan Children

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.032 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s248-s248

Author(s):

F.Z. Rouim ◽

F.Z. Azzaoui ◽

A.O.T. Ahami

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

School Performance ◽

Attention Deficit ◽

Natural Science ◽

Rating Scales ◽

Rating Scale ◽

Behavioral Difficulties ◽

Scientific School ◽

Children With Adhd ◽

Hyperactivity Disorder

Background and aimAttention deficit hyperactivity disorder (ADHD) is classified as neurodevelopmental disorders. ADHD is one of the major problems in childhood encountered most often in schools. A study realized by Platt in 2011 show that children with ADHD often experience difficulties in mathematics. The aim of this study is to assess whether there is a relationship between school performance in scientific subjects (mathematics and natural science) and attention deficit hyperactivity disorder.MethodsThe study was realized among 239 children studying in a urban school in Kenitra city (North-West of Morocco), and aged from 6 to 16 years. To evaluate the relationship between ADHD and the average class results of mathematics and natural science, Conners rating scale (parent and teacher short version) and the academic transcripts are used.ResultsThe results show that there is a significant correlation (P < 0.05, P < 0.01) between the average class results in each natural science and mathematics and three components of Conners rating scales (parent's version), which are behavioral difficulties, learning difficulties and hyperactivity/impulsivity. Furthermore, the Conners rating scale (teacher's version) show, also, that there is a significant correlation (P < 0.05, P < 0.01) between behavioral difficulties, hyperactivity/impulsivity and Inattention passivity and the average class results in natural science and in mathematics.ConclusionAs known, children with ADHD are not less intelligent than other children, although our study show that children with ADHD represent low marks in natural science and in mathematics. In fact, deeper investigations are needed to study the possible factors that could affect ADHD children's school performance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Behaviour planning and inhibitory control in Sepedi-speaking primary school children with attention-deficit/hyperactivity disorder

South African Journal of Psychology ◽

10.1177/0081246319838104 ◽

2019 ◽

Vol 50 (1) ◽

pp. 11-23 ◽

Cited By ~ 1

Author(s):

Maria Mokobane ◽

Basil Joseph Pillay ◽

Anneke Meyer

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Primary School ◽

School Children ◽

Response Inhibition ◽

Attention Deficit ◽

Rating Scale ◽

Primary School Children ◽

Control Group ◽

Hyperactivity Disorder ◽

Gender And Age

Attention-deficit hyperactivity disorder is one of the most common disorders that can occur in children. The symptoms are thought to result from a deficit in executive functions. This study investigated whether children with attention-deficit hyperactivity disorder subtypes differed in behavioural planning and response inhibition, two of the domains of executive functioning, from a control group without attention-deficit hyperactivity disorder symptoms. Furthermore, it examined whether the three attention-deficit hyperactivity disorder subtypes differed from each other in terms of performance. The sample ( n = 320) consisted of primary school children, aged between 6 and 14 years, from the Moletjie circuit (Limpopo). It consisted of an attention-deficit hyperactivity disorder group ( n = 160) and a control group ( n = 160). The Disruptive Behavioural Disorder rating scale was used to establish the symptoms of attention-deficit hyperactivity disorder. The Tower of London was used to measure planning ability, and the inhibition subtest (arrows and shapes) from the NEPSY-II (Developmental Neuropsychological Assessment, second edition) to measure response inhibition. Analysis of variance was employed to establish differences in subtype, gender, and age group. The results showed that children with the combined attention-deficit hyperactivity disorder subtype demonstrated significantly more deficits than the control group, in both behavioural planning and inhibition control. No significant differences between the hyperactive/impulsive and inattentive attention-deficit hyperactivity disorder subtypes and the control group were found. Gender and age did not influence performance with regard to planning and inhibition tasks. Correlations between planning behaviour and response inhibition were low, which suggests that they are distinct processes.

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The Relationship between Second-to-Fourth Digit Ratios, Attention-Deficit/Hyperactivity Disorder Symptoms, Aggression, and Intelligence Levels in Boys with Attention-Deficit/Hyperactivity Disorder

Psychiatry Investigation ◽

10.30773/pi.2020.0003 ◽

2020 ◽

Vol 17 (6) ◽

pp. 596-602

Author(s):

Ümit Işık ◽

Faruk Kılıç ◽

Evrim Aktepe ◽

Bilal Tanrıtanır

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Rating Scales ◽

Control Group ◽

Left Hand ◽

Hyperactivity Disorder ◽

Right Hand ◽

Interesting Study ◽

Treatment Naïve ◽

The Right

Objective Observations of sex differences have led some scientists to doubt whether the neuroendocrine system is involved in attentiondeficit/hyperactivity disorder (ADHD) etiology. One of the interesting study subjects in this context is prenatal steroid hormone exposure. The aim of the present study was to replicate and extend previous work by addressing two research questions: 1) Are second-tofourth digit (2D:4D) ratios lower in ADHD than in controls? 2) Is there a correlation between 2D:4D ratios and symptoms of ADHD, aggression and intelligence scores in boys with ADHD?Methods The study included 100 treatment-naive male children diagnosed with ADHD and 55 healthy male children. We measured the ratios of 2D:4D and administered a Wechsler Intelligence Scale for Children-Revised to assess IQ scores, as well as behavioral rating scales, in children with ADHD and comparison individuals.Results We observed lower 2D:4D ratios in the right hand in ADHD in comparison to the control group. The left-hand ratios of 2D:4D, however, did not differ between ADHD and control groups. There were negative correlations between the left-hand 2D:4D ratios and the hyperactivity scores. However, no significant correlation was detected between right-hand 2D:4D ratios and the psychological questionnaire scores.Conclusion These results provide further evidence that fetal androgen exposure may contribute to the pathophysiology of ADHD, at least in boys.

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Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD), Part 2: A Multicentre Evaluation of an Assessment and Treatment Package

British Journal of Occupational Therapy ◽

10.1177/030802260707001005 ◽

2007 ◽

Vol 70 (10) ◽

pp. 439-448 ◽

Cited By ~ 8

Author(s):

Sidney Chu ◽

Frances Reynolds

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Occupational Therapy ◽

Attention Deficit ◽

Goodness Of Fit ◽

Rating Scales ◽

Small Sample ◽

Control Group ◽

Hyperactivity Disorder ◽

Assessment And Treatment ◽

Treatment Package

A family-centred occupational therapy assessment and treatment package for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The package involves a multidimensional evaluation and a multifaceted intervention, which are aimed at achieving a goodness-of-fit between the child, the task demands and the environment in which the child carries out the task. The package lasts for 3 months, with 12 weekly contacts with the child, parents and teacher. A multicentre study was carried out, with 20 occupational therapists participating. Following a 3-day training course, they implemented the package and supplied the data that they had collected from 20 children. The outcomes were assessed using the ADHD Rating Scales, pre-intervention and post-intervention. The results showed behavioural improvement in the majority of the children. The Measure of Processes of Care – 20-item version (MPOC-20) provided data on the parents' perceptions of the family-centredness of the package and also showed positive ratings. The results offer some support for the package and the guiding model of practice, but caution should be exercised in generalising the results because of the small sample size, lack of randomisation, absence of a control group and potential experimenter effects from the research therapists. A larger-scale randomised controlled trial should be carried out to evaluate the efficacy of an improved package.

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MITOCHONDRIAL DNA COPY NUMBER IS ASSOCIATED WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

10.31219/osf.io/qtmg4 ◽

2020 ◽

Author(s):

Hakan Öğütlü ◽

İbrahim Selçuk Esin ◽

Haktan Bağış Erdem ◽

Abdülgani Tatar ◽

Onur Burak Dursun

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Mitochondrial Dna ◽

Mitochondrial Dysfunction ◽

Attention Deficit ◽

Copy Number ◽

Control Group ◽

Case Group ◽

Adhd Group ◽

Mtdna Copy Number ◽

Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children. Several hypotheses have been proposed to explain its etiology. Mitochondrial dysfunction (MD) is suggested to be one of the causes of Attention Deficit Hyperactivity Disorder. The objective of the study was to evaluate the relationship between MD and ADHD by investigating mitochondrial DNA (mtDNA) levels from peripheral blood leukocytes, one of the best biomarkers of mitochondrial dysfunction.Subjects and methods: This study included 56 children aged 6-16 years who were diagnosed with ADHD for the first time and 56 age- and sex-matched children without ADHD. Real-time PCR was performed to determine the relative mtDNA copy number in each study participant.Results: The mean mtDNA copy number of the case group was 57.623±24.827 and that of the control group was 44.204±18.926 (p=0.002). The mtDNA copy number of the case group was higher than that of the control group. Results of ROC curve analysis provided a mtDNA cutoff value of 45.Conclusion: Significantly higher mtDNA copy number in ADHD group may suggest mitochondrial dysfunction in the etiopathogenesis of ADHD.

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Comparison of The Effects of Methylphenidate Plus Betahistine and Methylphenidate Plus Placebo on Attention Deficit Hyperactivity Disorder in Children

10.21203/rs.3.rs-143737/v1 ◽

2021 ◽

Author(s):

Reza Ghanei Gheshlagh ◽

Sajedeh Nourbehesht ◽

Pedram Andalibi ◽

Ebrahim Ghaderi ◽

Fayegh Yousefi ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Rating Scale ◽

Control Group ◽

Age Difference ◽

Adhd Symptoms ◽

Double Blind ◽

Hyperactivity Disorder ◽

Double Blind Clinical Trial ◽

Impairment In Functioning

Abstract Background: Attention deficit hyperactivity disorder (ADHD) is a common disorder during childhood that leads to impairment in functioning in academic and career domains and social responsibility. Methylphenidate is a common treatment for ADHD that may not be taken by patients due to its complications. The goal of the present study is to examine and compare the effects of Methylphenidate plus Betahistine and Methylphenidate plus placebo on ADHD in Children.Methods: This was a randomized double-blind clinical trial with control group conducted with 76 children with ADHD referred to Be’sat Hospital in Sanandaj, Iran in 2019. The data was collected using the demographic form, a researcher-made form for assessing the reported complications of Methylphenidate and Betahistine, ADHD Rating Scale and the Clinical Global Impression – Severity scale (CGI-S).Results: There was no age difference between the two experimental groups. Both groups experienced a reduction in intensity of ADHD symptoms according to mean scores, but there was more reduction in the Methylphenidate plus Betahistine than the other group. The most common complications in the two groups were lack of appetite (weeks 2 and 4) and agitation and vertigo (week 2).Conclusion: Betahistine plus Methylphenidate may be more effective in treating ADHD symptoms compared to Methylphenidate alone.

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Prenatal and Early Postnatal Exposure to A Natural Disaster and Attention-Deficit/Hyperactivity Disorder Symptoms in Indian Children

10.21203/rs.3.rs-1229737/v1 ◽

2022 ◽

Author(s):

Tomasz Hanć ◽

Aleksandra Gomula ◽

Natalia Nowak-Szczepanska ◽

Raja Chakraborty ◽

Sławomir Kozieł

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Natural Disaster ◽

Attention Deficit ◽

Rating Scale ◽

Control Group ◽

Stressful Event ◽

Fetal Life ◽

Adhd Symptoms ◽

Indian Children ◽

Hyperactivity Disorder

Abstract The aim of this study was to assess the relation between early exposure to stressful event and a level of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in children, based on outcomes from a natural experiment. It was hypothesized that children pre- and postnatally exposed to cyclone Aila have a higher level of ADHD symptoms compared to the controls, and the effect depends on timing of exposure. Indian children (8-11y) prenatally (N=336) and early postnatally (N=216) exposed to Aila were compared to non-exposed control group of their peers (N=285). ADHD symptoms were assessed using the Conner’s Teacher Rating Scale Revised. The main effect of exposure to the cyclone on total ADHD symptoms’ score, ADHD index, Hyperactivity and Oppositional symptoms was significant and independent of covariates. Both prenatally and postnatally exposed girls, and only postnatally exposed boys, showed significantly higher level of Oppositional symptoms compared to the controls. Cognitive problems/Inattention symptoms were increased in both prenatally and postnatally exposed boys, but not girls, compared to non-exposed children. The timing of programming the later behavior characteristics by stressful experiences due to natural disaster is not limited to fetal life but extends at least into infancy. Sex is a significant modulator of the early stress-ADHD symptoms association.

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Using Mobile Electroencephalography and Actigraphy to Diagnose Attention-Deficit/Hyperactivity Disorder: Case-Control Comparison Study

JMIR Mental Health ◽

10.2196/12158 ◽

2020 ◽

Vol 7 (6) ◽

pp. e12158 ◽

Cited By ~ 1

Author(s):

Kuo-Chung Chu ◽

Hsin-Ke Lu ◽

Ming-Chun Huang ◽

Shr-Jie Lin ◽

Wen-I Liu ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Repeated Measures ◽

Performance Test ◽

Diagnostic Tools ◽

Control Group ◽

Case Group ◽

Impulsive Behavior ◽

Hyperactivity Disorder ◽

Significant Difference

Background Children with attention-deficit/hyperactivity disorder (ADHD), a neurobehavioral disorder, display behaviors of inattention, hyperactivity, or impulsivity, which can affect their ability to learn and establish proper family and social relationships. Various tools are currently used by child and adolescent psychiatric clinics to diagnose, evaluate, and collect information and data. The tools allow professional physicians to assess if patients need further treatment, following a thorough and careful clinical diagnosis process. Objective We aim to determine potential indicators extracted from a mobile electroencephalography (EEG) device (Mindset; NeuroSky) and an actigraph (MotionWatch 8; CamNtech) and to validate them for diagnosis of ADHD. The 3 indicators are (1) attention, measured by the EEG; (2) meditation, measured by the EEG; and (3) activity, measured by the actigraph. Methods A total of 63 participants were recruited. The case group comprised 40 boys and 9 girls, while the control group comprised 5 boys and 9 girls. The groups were age matched. The test was divided into 3 stages—pretest, in-test, and posttest—with a testing duration of 20 minutes each. We used correlation analysis, repeated measures analysis of variance, and regression analysis to investigate which indicators can be used for ADHD diagnosis. Results With the EEG indicators, the analysis results show a significant correlation of attention with both hit reaction time (RT) interstimulus interval (ISI) change (r=–0.368; P=.003) and hit standard error (SE) ISI change (r=–0.336; P=.007). This indicates that the higher the attention of the participants, the smaller both the hit RT change and the hit SE ISI change. With the actigraph indicator, confidence index (r=0.352; P=.005), omissions (r=0.322; P=.01), hit RT SE (r=0.393; P=.001), and variability (r=0.351; P=.005) were significant. This indicates that the higher the activity amounts, the higher the impulsive behavior of the participants and the more target omissions in the continuous performance test (CPT). The results show that the participants with ADHD present a significant difference in activity amounts (P<0.001). The actigraph outperforms the EEG in screening ADHD. Conclusions When the participants with ADHD are stimulated under restricted conditions, they will present different amounts of activity than in unrestricted conditions due to participants’ inability to exercise control over their concentration. This finding could be a new electronic physiological biomarker of ADHD. An actigraph can be used to detect the amount of activity exhibited and to help physicians diagnose the disorder in order to develop more objective, rapid auxiliary diagnostic tools.

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Molecular Analysis of STin2 (Intron 2) Variant of The SLC6A4 Gene in Children and Adolescents With Attention Deficit Hyperactivity Disorder

10.21203/rs.3.rs-727233/v1 ◽

2021 ◽

Author(s):

Shahrokh Amiri ◽

Mahan Asadian ◽

Mahmoud Shekari Khaniani ◽

Sima Mansouri Derakhshan ◽

Negar Pourhossein Rahmani ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Children And Adolescents ◽

Attention Deficit ◽

Control Group ◽

P Value ◽

Case Group ◽

Retrospective Case ◽

Hyperactivity Disorder ◽

Significant Difference ◽

Intron 2

Abstract Background Attention deficit hyperactivity disorder (ADHD) is recognized as one of the most familiar childhood psychiatric disorders. Many molecular genetic reviews suggest that genes play a crucial role in susceptibility to ADHD. The serotonin transporter gene (SLC6A4) has polymorphisms that seem to correlate with ADHD development. The association between ADHD and the SLC6A4 gene variants in the Iranian population has not been investigated yet. This study analyzes the STin2 (intron 2) variant of the SLC6A4 gene in Iranian children and adolescents with ADHD . Materials and Methods In this retrospective case-control study, 86 ADHD patients and 99 healthy volunteers aged 5 to 14 years old were enrolled as the case group and the control group, respectively. The STin2 (intron2) fragment of the SLC6A4 gene was amplified using specific primers by conventional PCR, and three STin2 alleles of the SLC6A4 gene (STin2.9, STin2.10, and STin2.12) were examined using the acrylamide gel method. Results We found no significant difference between the ADHD and the control groups in STin2.9(34.9% vs 39.4%, p-value = 0.824), STin2.10(29.1% vs 23.2%, p-value = 1.354), and STin2.12(36% vs 36.4%, p-value = 0.986) variants. Conclusion It is concluded that there was no association between the frequency of STin2 variant alleles of the SLC6A4 gene andADHD, but in the study of risk estimation, it was found that allele 10 of this variant is a risk allele in ADHD patients.

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