Which Factor Is More Relevant to the Effectiveness of the Cognitive Intervention? A Meta-Analysis of Randomized Controlled Trials of Cognitive Training on Symptoms and Executive Function Behaviors of Children With Attention Deficit Hyperactivity Disorder

Objective: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmentally inappropriate inattention, hyperactivity, and impulsivity. Multiple cognitive training appeared to be more effective than working memory training, but the evidence remains insufficient, particularly for the subgroup symptoms and executive function behaviors at home. Further analysis of the impact of factors on the effectiveness would facilitate the development of cognitive training.Methods: We searched PubMed, Cochrane Library, Psyche, Embase, Chinese Biomedical Literature Database, CNKI, and Weifang Database, and included randomized controlled trials (RCTs) of children with ADHD undergoing cognitive intervention. Metaanalysis and univariate metaregression were performed by STATE. The risk of bias was assessed with the Cochrane risk of bias tool 2.0 by the two investigators separately. This study was registered with INPLASY, number INPLASY202140065.Results: We included 17 RCTs in the systematic review, with a combined 1,075 participants. For metaanalyses of both subgroups of ADHD symptoms and the executive function behaviors, the test of published bias failed to reach the p < 0.05 level. When all of the training are considered together, cognitive training can improve the presentation of inattention symptoms [SMD = −0.390, 95%CI (−0.675, −0.104)] and executive function behaviors (SMD = −0.319, 95%CI (−0.527, −0.111)]. In the subgroup analysis, the effects of working memory training on both presentations were not statistically significant. In contrast, the multiple cognitive training had significant effects on the presentation of inattention symptoms [SMD = −0.507, 95% CI (−0.722, −0.292)], hyperactivity/impulsivity [SMD = −0.305, 95% CI (−0.518, −0.09)], and the executive function behaviors [SMD = −0.499, 95%CI (−0.707, −0.290)]. In addition, metaregression analysis showed that only training frequency did significantly impact the symptoms of ADHD and the executive function behaviors.Conclusion: This study showed that improvements in symptoms and executive function behaviors were related to the domains of cognitive intervention. The findings suggest that multiple domains of cognitive training and moderate training frequency may have wider clinical benefits. All the above results highlight further research in refining the executive functions of children with ADHD and developing individually tailored cognitive intervention on homes based for children with vulnerable executive functions.Systematic Review Registration: [http://inplasy.com/], [INPLASY202140065].

Sleep disturbances in ADHD: investigating the contribution of polygenic liability for ADHD and sleep-related phenotypes

Sleep disturbances are common in attention deficit hyperactivity disorder (ADHD) and associated with poor outcomes. We tested whether, in children with ADHD, (1) polygenic liability for sleep phenotypes is over- or under-transmitted from parents, (2) this liability is linked to comorbid sleep disturbances, and (3) ADHD genetic risk is associated with comorbid sleep disturbances. We derived polygenic scores (PGS) for insomnia, chronotype, sleep duration, and ADHD, in 758 children (5–18 years old) diagnosed with ADHD and their parents. We conducted polygenic transmission disequilibrium tests for each sleep PGS in complete parent–offspring ADHD trios (N = 328) and an independent replication sample of ADHD trios (N = 844). Next, we tested whether insomnia, sleep duration, and ADHD PGS were associated with co-occurring sleep phenotypes (hypersomnia, insomnia, restless sleep, poor sleep quality, and nightmares) in children with ADHD. Children’s insomnia and chronotype PGS did not differ from mid-parent average PGS but long sleep duration PGS were significantly over-transmitted to children with ADHD. This was supported by a combined analysis using the replication sample. Insomnia, sleep duration, and ADHD PGS were not associated with comorbid sleep disturbances. There is weak evidence that children with ADHD over-inherit polygenic liability for longer sleep duration and do not differentially inherit polygenic liability for insomnia or chronotype. There was insufficient evidence that childhood sleep disturbances were driven by polygenic liability for ADHD or sleep traits, suggesting that sleep disturbances in ADHD may be aetiologically different to general population sleep phenotypes and do not index greater ADHD genetic risk burden.

Synaptosomal-Associated Protein 25 Gene Polymorphisms Affect Treatment Efficiency of Methylphenidate in Children With Attention-Deficit Hyperactivity Disorder: An fNIRS Study

Methylphenidate (MPH) is the first-line drug for the treatment of children with attention-deficit hyperactivity disorder (ADHD); however, individual curative effects of MPH vary. Many studies have demonstrated that synaptosomal-associated protein 25 (SNAP-25) gene MnlI polymorphisms may be related to the efficacy of MPH. However, the association between SNAP-25MnlI polymorphisms and changes in brain hemodynamic responses after MPH treatment is still unclear. This study used functional near-infrared spectroscopy (fNIRS) to preliminarily investigate the interaction of MPH treatment-related prefrontal inhibitory functional changes with the genotype status of the SNAP-25 gene in children with ADHD. In total, 38 children with ADHD aged 6.76–12.08 years were enrolled in this study and divided into the following two groups based on SNAP-25 gene MnlI polymorphisms: T/T genotype group (wild-type group, 27 children) and G allele carrier group (mutation group, 11 children). The averaged oxygenated hemoglobin concentration changes [Δavg oxy-Hb] and deoxyhemoglobin concentration changes [Δavg deoxy-Hb] in the frontal cortex before MPH treatment and after 1.5 h (post-MPH1.5h) and 4 weeks (post-MPH4w) of MPH treatments were monitored using fNIRS during the go/no-go task. SNAP-IV scores were evaluated both pre-MPH and post-MPH4w treatments. In the T/T genotype group, [Δavg oxy-Hb] in the dorsolateral prefrontal cortex was significantly higher after 4 weeks of MPH (post-MPH4W) treatment than pre-treatment; however, in the G allele group, no significant differences in [Δavg oxy-Hb] were observed between pre- and post-treatments. In the go/no-go task, the accuracy was significantly increased post-MPH4w treatment in the T/T genotype group, while no significant differences were observed in response time and accuracy of the “go” sand no-go task in the G allele group for pre-MPH, post-MPH1.5h, and post-MPH4w treatments. The T/T genotype group exhibited a significant decrease in SNAP-IV scores after MPH treatment, while the G allele group showed no significant difference. In conclusion, fNIRS data combined with SNAP-25 MnlI polymorphism analysis may be a useful biomarker for evaluating the effects of MPH in children with ADHD.

Association of ADHD and Obesity in Hispanic Children on the US-Mexico Border: A Retrospective Analysis

Pediatric obesity and Attention Deficit Hyperactivity Disorder (ADHD) are rising health concerns in the United States, especially among Hispanic children and adolescents. Research on Hispanic children and adolescents indicates disproportionately higher prevalence rates of obesity in this community but scant data on ADHD prevalence rates. In contrast, a plethora of research studies across the general population examines the relationship between childhood obesity and ADHD. In addition, there is a lack of research that examines the role of ethnicity and sub-ethnic group correlations in ADHD, particularly in the Hispanic population. Existing studies in the general population indicate ADHD may be a risk factor for being overweight compared to normal controls. The objective of the present study is to examine the prevalence of obesity in children with ADHD compared to children in the general population in a predominately Hispanic sample on the US-Mexico border. A total of 7,270 pediatric medical records were evaluated. The retrospective analysis included Body Mass Index (BMI) and related health variables, and ethnicity and showed that children with ADHD are more likely to be underweight. In conclusion, no significant relationship existed between obesity and ADHD among Hispanic children on the US-Mexico Border, and instead we found the opposite correlation.

The usefulness of virtual, augmented, and mixed reality technologies in the diagnosis and treatment of attention deficit hyperactivity disorder in children: an overview of relevant studies

Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by attention problems, excessive physical activity, and impulsivity. ADHD affects not only the patients but also their families. The development and use of technologies such as virtual reality (VR), augmented reality (AR), and mixed reality (MR) for ADHD has increased over recent years. However, little is known about their potential usefulness. This overview aimed to clarify the current knowledge about the use of these three innovative technologies for the diagnosis and treatment of children with ADHD. Methods This overview was conducted using the PubMed, Web of Science, and Scopus databases until January 24th, 2021. The following descriptive information was compiled from the identified studies: country, year of publication, sample size, study design, ADHD diagnosis methods, applied technology, hardware equipment, clinical target, and main findings. Results The initial database searches yielded 409 articles, but 103 were removed as duplicates. Eventually, 30 eligible studies remained for analysis, the majority of which were case-control (n = 22, 73%). Regarding the applied technology/hardware equipment, VR (n = 27; 90%), head-mounted displays (n = 19, 63%), VR-based continuous performance tests (VR-CPT) (n = 21, 70%) were most frequently used. Most studies (n = 21, 70%) used the DSM criteria for the diagnosis of childhood ADHD. They primarily evaluated the utility of these technologies in assessing ADHD symptoms (n = 10, 33%) and improving the ADHD diagnostic process (n = 7, 23%). Conclusion This comprehensive overview evaluated the studies on the use of VR, AR, and MR technologies for children with ADHD. These technologies seem to be promising tools for improving the diagnosis and management of ADHD in this population.

Enhancing neural markers of attention in children with ADHD using a digital therapeutic

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition characterized by diminished attentional control. Critically, these difficulties are related to negative consequences in real-life functioning both during development and into adulthood. There is now growing evidence that modulating the underlying neural circuits related to attention can improve behavior and brain function in children with ADHD. We have previously shown that game-based digital therapeutics targeting a key neural marker of attention–midline frontal theta (MFT)–yield positive effects on attentional control in several populations. However, the effects of such digital therapeutics in children with ADHD and no other comorbidities has not been yet examined. To address this gap, we assessed a sample of 25 children with ADHD (8–12 years old) on neural, behavioral, and clinical metrics of attention before and after a 4-week at-home intervention on an iPad targeting MFT circuitry. We found that children showed enhancements on a neural measure of attention (MFT power), as well as on objective behavioral measures of attention and parent reports of clinical ADHD symptoms. Importantly, we observed relationships between the neural and behavioral cognitive improvements, demonstrating that those children who showed the largest intervention-related neural gains were also those that improved the most on the behavioral tasks indexing attention. These findings provide support for using targeted, digital therapeutics to enhance multiple features of attentional control in children with ADHD. Study registration: ClinicalTrials.gov registry (NCT03844269) https://clinicaltrials.gov/ct2/show/NCT03844269.

Combined use of osteopathic correction and transcranial micropolarization of the brain in the treatment of children with attention deficit hyperactivity disorder

Introduction. Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that occurs in 5-8 % of school-age children and persists into adulthood in 60 % of cases. At the present stage of neurology development, a number of significant drawbacks have been noted in the pharmacological correction of ADHD: the need for a long course of medication, the problem of polypragmasia, side effects and allergic reactions. Thus, there is a real need to develop non-drug ways to correct ADHD. Previous studies have demonstrated a sufficiently high clinical efficacy of transcranial micropolarization of the brain in the treatment of this patients group. Some studies have shown the effectiveness of the osteopathic correction use, which can increase the effectiveness of selective and sustained attention in children with ADHD. At the same time, the question of the possibility of combining various non-drug methods of treatment is quite acute.The aim of the study is to research the feasibility of osteopathic correction using in combination with transcranial micropolarization of the brain in the complex treatment of children with ADHD.Materials and methods. A controlled randomized trial was conducted in the period from January 2018 to February 2020 in Ekaterinburg and St. Petersburg. 68 patients with the established diagnosis attention deficit hyperactivity disorder aged 6 to 10 years, including 42 boys and 26 girls, were under observation. All patients, depending on the used treatment method, were divided by simple randomization into two comparable groups: the main group — 34 people, 22 boys and 12 girls, average age 7,4±1,2 years; the control group consisted of 34 people, 20 boys and 14 girls, with an average age 7,8±1,1 years. Patients received drug therapy with hopanthenic acid in age-related dosages (30 mg/kg body weight), course duration of 2 months, and transcerebral micropolarization of the brain. Each patient received one course of micropolarization, consisting of 15 sessions, the duration of each session was 30 minutes. Patients of the main group received osteopathic correction in addition to the therapy described above. In total, 4 sessions of 60 minutes each were held. The interval between the first sessions was 10 days, between subsequent sessions — from 10 to 14 days. There were evaluated the osteopathic status, the severity of ADHD manifestations and the short-term memory indicators, and the type and properties of the nervous system were determined for all patients, regardless of the group, before the start of treatment, as well as after the completion of the course of complex therapy.Results. After the therapy, there was a statistically significant decrease (p<0,05) in scores quantity on the ADHD assessment scale (ICD-10 criteria) both in the main and in the control groups, which reflects a decrease in the severity of clinical manifestations of this syndrome and demonstrates the effectiveness of the used therapy methods. In patients of the main group who received osteopathic correction, compared with the control group, there was also a significant (p<0,05) decrease in the number of regional dominant somatic dysfunctions, an increase in short-term memory indicators and a change in the type and properties of the nervous system (from weak to stable).Conclusion. The therapy carried out both with the use of osteopathic correction and without it, equally leads to a decrease in the degree of manifestations of ADHD. This indicates the clinical effectiveness of both studied integrated approaches to the treatment of children with ADHD. At the same time, osteopathic correction in the treatment of patients with ADHD significantly increases the indicators characterizing short-term memory and changes the type of response of the nervous system. These changes can be regarded as a potential opportunity to increase the learning ability of children and improve their socialization.

O Transtorno do Défict de Atenção e Hiperatividade na Educação Infantil: Das Dificuldades às Principais Conquistas / Attention Deficit Hyperactivity Disorder in Early Childhood Education: From Difficulties to Major Achievements

O presente estudo traz uma temática que tem sido um grande desafio para a educação, o Transtorno de Déficit de Atenção e Hiperatividade (TDAH), pois é um dos transtornos que, no âmbito escolar, tem provocado um olhar diferenciado, onde escola e pais precisam ser parceiros para contribuírem com o desenvolvimento da criança e sua adaptação no ambiente escolar. Teve como objetivo, conhecer as causas e o diagnóstico do TDAH, assim como analisar o processo da construção e efetivação da aprendizagem, identificar as dificuldades e conquistas da criança com TDAH no universo escolar. O trabalho tem caráter bibliográfico e de natureza qualitativa, embasando nas pesquisas de autores como: Afonso (2011), Andrade (1997), Antunes (2001), Giacomini (2006), Pereira (2010), Silva (2003) e outros. Investigou-se os conceitos, as características e diagnósticos, buscando ampliar os conhecimentos a respeito do TDAH no processo de ensino-aprendizagem, tendo como público-alvo a etapa de ensino da Educação Infantil e seus educadores. ---This study brings a theme that has been a great challenge for education, attention deficit hyperactivity disorder (ADHD), as it is one of the disorders that, in the school environment, has caused a different look, where school and parents need to be partners to contribute to the child's development and adaptation to the school environment. Its objective was to know the causes and diagnosis of ADHD, as well as to analyze the process of construction and realization of learning, to identify the difficulties and achievements of children with ADHD in the school environment. The work is bibliographical and qualitative in nature, based on the research of authors such as: Afonso (2011), Andrade (1997), Antunes (2001), Giacomini (2006), Pereira (2010), Silva (2003) and others. The concepts, characteristics and diagnoses were investigated, seeking to expand knowledge about ADHD in the teaching-learning process, having as target audience the stage of teaching Early Childhood Education and its educators.