Association Between Allergic Diseases and Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Children Aged 6–12 Years Using the Filipino Version of the Vanderbilt ADHD Parent Rating Scale

BACKGROUND: Over the last decades, the hypothesis that an allergic response could lead to the development of attention-deficit/hyperactivity disorder (ADHD) was raised and clinical studies investigated the co-existence of both. These studies had shown that allergic diseases and neurobehavioral disorders were concurrent and could be associated with genetic factors, neuroimmunity and microbial dysbiosis. To date, this was the first study in the Philippines to evaluate the prevalence and association of allergic diseases, its severity and ADHD symptoms. OBJECTIVE: The objective of this study was to determine the association of allergic diseases and ADHD symptoms among children aged 6–12 years based on parental report using the Filipino version of the Vanderbilt ADHD Parent Rating Scale. METHODS: School-aged children between 6 and 12 years with physician diagnosed allergies (bronchial asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, drug allergy, food allergy and/or acute or chronic urticaria) were randomly selected. Skin prick test (SPT) to aeroallergens was done. The parents completed the Filipino version of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), a screening tool for ADHD. RESULTS: Among the 415 patients, 135 (32.5%) of them screened positive for ADHD symptoms. Upon assessment of the Vanderbilt parent rating subscale responses, 13.49% of the children were categorized as predominantly inattentive subtype, 6.02% as predominantly hyperactive/impulsive subtype and 13.01% as combined inattention/hyperactivity. Three hundred and seventy six (91%) children were diagnosed with asthma. Among these asthmatics, 119 (32%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (13.56%), predominantly hyperactive/impulsive subtype (5.05%) and combined inattention/hyperactivity (13.03%). Combined inattention/hyperactivity subtype had a significant proportion of severe asthmatics, as compared to mild or moderate asthma (p value = 0.026). Furthermore, 389 (94%) children were diagnosed with allergic rhinitis. Among these patients, 130 (33%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (13.62%), predominantly hyperactive/impulsive subtype (6.43%) and combined inattention/hyperactivity (13.37%). However, evidence was not sufficient to demonstrate an association between ADHD subtypes and allergic rhinitis severity. Lastly, 206 (50%) children were diagnosed with atopic dermatitis. Among these patients, 71 (34%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (14.56%), predominantly hyperactive/impulsive subtype (4.85%) and combined inattention/hyperactivity (15.05%). However, there was insufficient evidence to demonstrate a link between ADHD subtypes and atopic dermatitis severity. CONCLUSION: Children with allergies, especially those with severe asthma, are more likely to have ADHD symptoms. Key words: attention deficit hyperactivity disorder, allergic disease, allergic sensitization, asthma

MMP-2, MMP-9, TNF-α Levels in Relation to Sub types of Attention Deficit Hyperactivity Disorder

Many authors have suggested the association between Attention Deficit Hyperactivity Disorder (ADHD) and inflammation through various mechanisms among which increased serum cytokines.30 newly diagnosed ADHD children, aged 6-12and of both sexes were collected from outpatient clinic, Psychiatry Department, Al Zahraa University Hospital and a matched control group of 30 children. They were subjected to Clinical assessment, Whechsler Intelligence Scale for children (WISC), Conners' Parent Rating Scale-Revised & serum MMP-2, MMP-9, TNF-α levels were determined. There was statistical significant difference between patient and control groups regarding MMP-2 level (648.50 ± 81.94 vs 344.13 ± 32.02), MMP-9 level (143.00±16.98 vs 102.90 ± 4.13) & TNF-α level (345 ± 7.1.vs 202 ± 22.3). Hyperactive/impulsive subtype represented 16(53.3%), Inattentive subtype represented 6(20%), Combined subtype represented 8(26.7%) of the ADHD group. MMP-2, MMP-9, TNF-α levels were all higher among the Hyperactive/impulsive subtype, followed by thecombined subtype then the Inattentive subtype with high statistical significant difference. A high statistical significant difference was found in all subscales of Conners' scale among the 3 subtypes of ADHD. A positive correlation was found between TNF-α level and age, whereas, a negative correlation exists between MMP-2, MMP-9, TNF-α level and IQ. In addition, correlation was found between MMP-2, MMP-9 levels and cognitive problems, TNF-α level and inattention.Our study illustrates the co-occurrence of inflammatory process and ADHD, but further studies on larger sample are needed.

The Socio-Demographic and Clinical Profiles of Adult ADHD Patients in a University Hospital in Oman

Objectives: Although typically considered a condition affecting children, scientific evidence has shown that 30–50% of those diagnosed with ADHD in childhood continue to suffer from this condition after the age of 18. This study sought to address the gap in the literature, and to describe the socio-demographic and clinical characteristics of ADHD patients in a sample of adult patients attending an outpatient clinic at a tertiary care hospital in Oman, and to evaluate their association with the different subtypes of the disorder. Methods: Data from adult patients with ADHD from the outpatient clinic at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, were retrospectively collected from medical records from January 2018 to April 2020. Socio-demographic characteristics, clinical profiles and psychiatric co morbidities were examined. Results: This study included 100 adults who fulfilled the standard diagnosis of ADHD, with 54% (n=54), and 46% (n=46) from the inattentive and combined subtypes, respectively. It was found that ADHD was more prevalent among males (64.0%) compared to females (36%), with the inattentive subtype being more predominant among females. The ADHD patients with the inattentive subtype were associated with co-morbid substance use disorders (OR=11.29, P = 0.049), personality disorders (OR=7.96, P = 0.017), and major depressive disorder (OR=15.94, P = 0.002) compared to patients with the predominantly combined subtype. Conclusion: This study from Oman echoes the findings from the current literature, that adult patients with ADHD commonly have co-morbid psychiatric disorders, leading to significant functional impairment. Psychiatric co-morbidities must be identified and urgently treated, to allow for better clinical and functional outcomes in adult patients with ADHD. Keywords: ADHD, co-morbidity, hyperactivity, Oman, psychiatry

The Inattentiveness of Children with ADHD may Worsen During the COVID-19 Quarantine

Objective: The coronavirus disease 2019 pandemic has caused school closures worldwide. Japan's Prime Minister declared a state of emergency based on the coronavirus pandemic for Tokyo, Chiba, and other prefectures on April 7, 2020. Children with ADHD are particularly vulnerable to the distress caused by the pandemic and physical distancing measures, and they might display increased behavioral problems. We surveyed 15 children with ADHD, aged 11.8 ± 2.8 years old; 13 were males and 2 were females (combined subtype, n=12; inattentive subtype, n=3). The children's ADHD-RS scores were assessed by their mother (n=12), father (n=1), or nursing home staff (n=2) from before the emergency declaration (in February or March 2020) to after the emergency declaration (April or May 2020). There were no changes of treating physician, drug type or quantity, or psychotherapy or assessment person from January 2020 to May 2020. Results: A comparison of the baseline scores and secondary outcomes reveals that the ADHD-RS total score and inattentive subscore worsened significantly during this period, whereas the hyper/impulsive subscore did not. In conclusion, we suggest that policymakers, healthcare providers and families should be mindful of the potential development of inattentiveness among children with ADHD who are quarantined because of COVID-19.

Delay Maturation in Occipital Lobe in Girls With Inattention Subtype of Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder. Differences in the presentations of ADHD between boys and girls have been well established. Three subtypes of ADHD exist. In addition to sex difference, different mechanisms may underlie different subtypes. The present study enrolled 30 girls with the inattentive subtype of ADHD and 30 age-matched controls. Low-resolution electromagnetic tomography (LORETA) and instantaneous frequency were used to analyze electroencephalography (EEG) for investigating the brain area and EEG bands involved in girls with inattentive ADHD. We found that the instantaneous frequencies in all EEG channels in girls with ADHD were lower than those in controls. Alpha 2 was the only EEG band that showed significant difference in current density between the ADHD and control groups ( P = .0014). In the entire brain area, the posterior cingulate cortex, cingulate gyrus, and precuneus demonstrated the most significant difference between the ADHD and control groups. Our results suggest that brain maturation delay in the posterior areas might result in the inattention subtype of ADHD. In addition, posterior cingulate cortex, cingulate gyrus, and precuneus may play a critical role in the pathogenesis of ADHD. Our study provides a new approach method and possible mechanism of girls with inattentive subtype ADHD.

Influence of Attention-Deficit Hyperactivity Disorder (ADHD) on Academic Achievement of Learners in International Primary Schools in Mombasa (Kenya) and Kampala (Uganda): A Comparative Study

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders among school-going children. The aim of this study was to compare academic achievement of learners with and without ADHD in international primary schools of Mombasa (Kenya) and Kampala (Uganda). A comparative study was conducted among 377 respondents using Attention Deficit Hyperactivity Disorder Scale Questionnaire (SNAP-IV) which assessed the three ADHD subtypes in form of a closed-ended questionnaire. Results revealed that learners with ADHD had low overall academic achievement compared to those without ADHD in Mombasa (p <.001) and Kampala, (p <.001). Boys with ADHD in Mombasa had better grades than girls (M = 168.51, SD = 32.50 vs. M = 160.00, SD = 39.07) while girls with ADHD in Kampala had better grades than boys (M = 103.50, SD = 24.77 vs. M = 93.45, SD = 24.71). Learners with ADHD Inattentive subtype were greatly impaired compared to those with ADHD Hyperactive-Impulsive and Combined subtypes in both cities. ADHD significantly predicted academic achievement with higher variability in Kampala (55%) than Mombasa (10%). Attention-deficit hyperactivity disorder has a negative impact on academic achievement of learners with the condition. The study recommended integration of ADHD screening in school health services to enable early detection and management of the condition.

Latent Class Analysis of ADHD Symptoms in Korean Children and Adolescents

Objective: The objective of this study was to conduct latent class analysis (LCA) of ADHD symptoms to characterize the underlying structure of ADHD. Method: Participants were recruited from September 2012 to January 2015 from the Department of Psychiatry of Asan Medical Center, Seoul, Korea. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie–Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version (K-SADS-PL). We performed LCA of ADHD symptoms in those who had ( n = 141, age = 8.1 ± 2.3 years, 106 boys) and did not have ( n = 82, age = 9.1 ± 2.5 years, 40 boys) ADHD. Results: A three-class solution was found to be the best model, revealing classes of children with mostly combined and hyperactive/impulsive subtypes of ADHD (Class 1), non-ADHD (Class 2), and inattentive subtype of ADHD (Class 3). Conclusion: The three-class solution with LCA supports a two-factor two-class structure of ADHD symptoms.