August

Co-occurrence of Motor Problems and Autistic Symptoms in Attention-Deficit/Hyperactivity Disorder.

Reiersen et al, investigated the relationship between parent reports of motor problems and clinically significant autistic symptoms in children with and without attention deficit/hyperactivity disorder (ADHD).

The subjects of this project were some 521 males and 330 female twins from an epidemiological study of ADHD. They were aged from to 19 years of age. Some 1,647 Parent-rated Social Responsiveness Scale questionnaires were returned for individuals who participated in the interviews. After certain exclusions 851 were available for the study analysis. Within each ADHD subtype, they examined the relation between the Child Behavior Checklist motor problem endorsement and elevated autistic symptoms on the Social Responsiveness Scale.

They found that motor problems and high levels of autistic traits were most common in individuals with combined type ADHD. Within each of the clinically relevant DSM-IV and latent class ADHD subtypes, individuals with the combination of motor problems and ADHD were more likely to have high levels of autistic traits and those with ADHD alone.

Reiersen et al concluded that children with the combination of ADHD and parent-reported motor coordination deficits have elevated level of autistic symptoms. And targeted treatment and prevention interventions any be warranted. The exclusion criteria for DSM-IV ADHD should be revised to reflect these population-based findings.

Co-occurrence of Motor Problems and Autistic Symptoms in Attention-Deficit/Hyperactivity Disorder.REIERSEN, ANGELA M. M.D.; CONSTANTINO, JOHN N. M.D.; TODD, RICHARD D. Ph.D, M.D. Journal of the American Academy of Child & Adolescent Psychiatry. 47(6):662-672, June 2008.

Does Childhood Treatment of ADHD With Stimulant Medication Affect Substance Abuse in Adulthood?

If interested in reading what Volkow and Swanson have to say re this matter in their review of other research in this matter please go to:Review. This will take you to their article in the American Journal of Psychiatry. 165:553-555, May 2008

July

Dorsolateral prefrontal and anterior cingulate cortex volumetric abnormalities in adults with attention-deficit/hyperactivity disorder identified by magnetic resonance imaging.

Seidman et al investigated if the adults with ADHD showed the same gray and white matter volume deficits as did children with ADHD.

Twenty four adults with DSM-IV ADHD and eighteen healthy controls; comparable on age, socioeconomic status, sex, handedness, education, IG, and achievement test performance had an MRI on a 1.5T scanner.

Cortical and sub-cortical gray and while matter were segmented. Seidman et al, focused on prefrontal, anterior cingulated cortex (ACC) and overall gray matter volumes. General linear analyses of the volumes of brain regions, adjusting for age, sex and total cerebral volumes were used to compare the two groups.

Seidman et al, found that relative to the controls, those with ADHD had significantly smaller overall cortical gray matter, prefrontal and ACC volumes.

They concluded that adults with ADHD have differences in the volume of brain regions in areas involved in attention and executive control. This data is largely consistent with studies of children and support the idea that adults with ADHD have a valid disorder with persistent biological features.

Dorsolateral prefrontal and anterior cingulate cortex volumetric abnormalities in adults with attention-deficit/hyperactivity disorder identified by magnetic resonance imaging. Seidman LJ, Valera EM, Makris N, Monuteaux MC, Boriel DL, Kelkar K, Kennedy DN, Caviness VS, Bush G, Aleardi M, Faraone SV, Biederman J. Biological Psychiatry. 2006 Nov 15;60(10):1071-80. Epub 2006 Jul 28

June

Parenting in mothers with and without attention-deficit/hyperactivity disorder.

Murray and Johnston investigated the impact of maternal attention-deficit hyperactivity disorder on mother’s parenting behaviors. They recruited sixty mothers between the ages of 31 and 50 (all who had children with ADHD). Of these participants 30 were mothers with ADHD and 30 without ADHD.

These mothers completed self-report and laboratory measures of monitoring of child behaviour, consistency in parenting and parenting problem solving abilities.

The mothers with ADHD were found to be poorer at monitoring child behaviour, less consistant disciplinarians and there was some evidence which supported the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than the mothers without ADHD.

They also stated that these results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.

Parenting in mothers with and without attention-deficit/hyperactivity disorder.Murray C, Johnston C. Journal Abnormal Psycholgy. 2006 Feb;115(1):52-61.

May

The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

Faraone et al, studied the persistence of attention deficit hyperactivity disorder (ADH) into adulthood. They analyzed the data of published follow-up studies of ADHD. Their study needed to meet the following criteria. The studies needed to include a control group, it was clear from the method of the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of ADHD. They used a regression model to separately assess the syndromatic and symptomatic persistence of ADHD.

When Faraone et al, found that when they defined only those meeting the full criteria for ADHD, as having persistent ADHD, this rate of persistence is low, approximately 15% at 25 years of age. However, when they included cases consistant with the DSM-IV’s definition of ADHD in partial remission, the rate of persistence is much higher at approximately 65%.

Faraone et al, concluded that the estimates of ADHD’s persistence rely heavily on how persistence is defined. However, regardlss of definition, their analyses showed evidence that ADHD lessens with age. More work is needed to be done to determine if this reflects three remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for ADHD.

Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicence 2006 Feb;36(2):159-65

 

April

ABT-089, a neuronal nicotinic receptor partial agonist, for the treatment of attention-deficit/hyperactivity disorder in adults: results of a pilot study. Wilens TE, Verlinden MH, Adler LA, Wozniak PJ, West SA.

Wilens et al, designed a study to evaluate ABT-089 (a neuronal nicotinic receptor partial agonist), as treatment of adult attention deficit hyperactivity disorder ( ADHD).  Adults with ADHD received either a placebo, 2gm, 4mg or 20mg of ABT-089 for two weeks in a randomized, double-blind, placebo-controlled, 4 x 4 Latin square design  for a total of 8 weeks. In addition to the primary outcome, the Conner’s Adutls ADHD rating scale (CAARS), secondary rating scales and neuropsychological and safety assessments were completed.   

Wilens et al, found with the eleven adults with well characterized ADHD completed the crossover study, that ABT-089 was superior to the placebo for the CAARS total symptom score, was superior to the placebo for the CAARS ADHD Index and Hyperactive/Implusive scores and the Clinical Impression ADHD Severity score.

Wilens et al, concluded that the data from the pilot study suggests that ABT-089 migh be effective in treating adult ADHD and that it is well tolerated. On the basis of these promising results,  larger parallel-group studies of ABT-089 are warranted.

ABT-089, a neuronal nicotinic receptor partial agonist, for the treatment of attention-deficit/hyperactivity disorder in adults: results of a pilot study.Wilens TE, Verlinden MH, Adler LA, Wozniak PJ, West SA. Biological Psychiatry 2006 Jun 1;59(11):1065-70. Epub 2006 Feb 23

March

A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder.

 Wingo et al, were interested in the increasingly recognized and frequently reported coexistence of ADHD with Bipolar Disorder. Concurrently diagnosis of adult ADHD and Bipolar Disoder remains controversial.  Wingo et al conducted a systematic review to examine the concept of comorbid adult ADHD and Bipolar Disorder.

Wingo et al found the following studies which met their inclusion criteria. Six studies on comorbid rates, four on phenomenology, three on course of illness and two on heredity and one on treatment response.  They found that the proposed comorbid syndrome is fairly common (47% of adults ADHD and 21% of Bipolar Disorder populations) with a more severe course of illness compared with that of Bipolar Disorder alone and high rates of comorbidity with other psychiatric disorders. Treatment appears to require initial mood stabilization.

Wingo et al concluded that adult ADHD and Bipolar Disorder has not been sufficiently studied. More emphasis on comorbidity rates and less data on course neurobiology, heredity and treatment. The diagnostic validity of adults ADHD/Bipolar Disorder as a true comorbidity is not well extablished. More studies are greatly needed to further clarify the diagnostic validity and treatment.

Reference: A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder.Wingo AP, Ghaemi SN Journal of  Clinical Psychiatry. 2007 Nov;68(11):1776-84

Towards further understanding of the co-morbidity between attention deficit hyperactivity disorder and bipolar disorder: a MRI study of brain volumes

                      Beiderman et al state that although ADHD and Bipolar Disorder frequently co-occur and represent a particularly morbid clinical form of both disorders, and as there was little neuroimaging research which related to this comorbidity their aim was to evaluate the morphometric magnetic imaging (MRI) underpinnings of the comordidity of ADHD with Bipolar.

They compared the morphometric MRI findings of 31 adults with ADHD and Bipolar, with 18 with Bipolar alone, 26 with ADHD alone and 23 healthy controls.

They found that Bipolar was associated with significantly smaller orbital prefrontal cortexes and a larger right thalamus, and this same pattern was found in the subjects with both ADHD and Bipolar. Likewise those with ADHD and Bipolar when compared with those with ADHD alone, which was  associated with significantly less neocortical grey matter and less overall frontal lobe and superior prefrontal cortex volumes, a smaller right anterior cingulated cortex and less cerebeller gray matter, had the same pattern.

Biederman et al concluded that their results supported the hypothesis that ADHD and BPD independently contribute to volumetric alternations of selective and distinct brain structures.  When ADHD and Bipolar are comorbid, the brain profile of volumentric abnormalities consists of structures that are altered in both disorder individually. They also consider that attention needs to be given to comorbidity to help clarify the heterogeneous neuroanatomy of both ADHD and Bipolar.

Reference: Towards further understanding of the co-morbidity between attention deficit hyperactivity disorder and bipolar disorder: a MRI study of brain volumes. Biederman J, Makris N, Valera EM, Monuteaux MC, Goldstein JM, Buka S, Boriel DL, Bandyopadhyay S, Kennedy DN, Caviness VS, Bush G, Aleardi M, Hammerness P, Faraone SV, Seidman LJ. Psychological Medicene 2007 Oct 15;:1 -12

February

Working memory impairments in children withattention-deficit hyperactivity disorder with and without comorbid language learning disorders.

                      Martinussen and Tannock examined whether children with ADHD were impaired on one or more components of working memory, being independent of comorbid language learning disorder, and whether the working memory impairments was strongly related to the symptoms of inattention than those of hyperactivity-impulsivity. They used four groups of children. Some 62 children with ADHD alone, 32 with ADHD learning difficulties, and 15 with learning difficulties alone and a control group of some 34 typically developing children. They used four simple and brief measures of working memory, ie auditory-verbal and visual-spatial.

The ADHD children without comoribd language learning disorders showed deficits in visual-spatial storage and verbal visual-spatial central executive functions. While the children regardless of comorbidity with ADHD, showed impairments in both verbal and spatial storage as well as central executive functions of working memory. While the symptoms of inattention and not the symptoms of hyperactivity/impulsivity predicted -performance on verbal and visual-spatial central executive measures independent of age, verbal cognitive ability, reading and language performance.

Martinussen and Tannock findings were consistent with other data implicating neuropsychological impairments in ADHD. The results were also consistent with prior research which showed the neuropsychological impairments are more strongly associated with the inattention symptoms than with the hyperactive-impulsive symptoms.

Reference: Martinussen R. Tannock R. Journal of Clinical and Experimental Neuropsychology 28 October 2006 (7):1073-1094

A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder.

                      Biederman et al aims were to evaluate the safety and efficacy of once-daily OROS methylphenidate (Ritalin) in the treatment of adults with ADHD. They conducted a randomized 6 week, placebo controlled parallel design study of OROS methylphenidate in 141 adults with ADHD. The OROS methylphenidate was started at 36mg per day and titrated for optimal response depending on efficacy and tolerability.  Beiderman et al found that the OROS methylphenidate resulted in statistically significant reductions in the symptoms of inattenting and hyperactivity/impulsivity when compared with those treated with the placebo. At the end point of the trial, they found that 66% of the subjects receiving OROS methylphenidate and 39% of the subjects receiving the placebo attained a response of much or very much improved on the Clinical Global Impression-Improvement scale with a greater than 30% reduction in Adult ADHD Investigator System Report Scale score.They also noted  that OROS MPF was also associated with a small but statistically significant increases in diastolic and systolic blood pressure and heart rate.

Biederman et al, concluded that OROS methylphenidate in daily doses of up to 1.3mg/kg/day was effective in the treatment of adults with ADHD. However due to the potential for increases in blood pressure and heart rate, subjects receiving treatment with methylphenidate should be monitored for changes in blook pressure duing treatment..

Reference: Biederman J, Mick E, Surman C, Doyle R, Hammerness P, Harpold T, Dunkel S, Dougherty M, Aleardi M, Spencer T.Biological Psychiartry 2006. 1 May 59(9):829-835.

January

A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder.

Beiderman et al, were interested in the best therapeutic approached to chronic tic disorder with chomorbid ADHD. They evalualted the tolerability and efficacy of the noradrenergic tricyclic antidepressant desipramine hydrochloride in the treatment of forty one children and adolescents with chronic tic disorders and with comorbid ADHD. These children were studied in a 6 week, double-blind, placebo controlled parallel trial. The tic symptoms and; the ADHD symptoms were monitered weekly with the desipramine being titrated weekly up to 3.5mg/kg per day. The children were also monitored for adverse effects.

Beiderman et al, found that the desiprmaine was well tolerated without any meaningful adverse effects. The subject childrens’ core symptoms of ADHD were decreased relative to those on the placebo and their tic symptoms were significantly reduced. There was small but statistically significant differences between desipramine and the placbo heart rate and blood pressure. Beiderman et al concluded that treatment with desipramine was well tolerated and was associated with clinically significant reductions in tic and ADHD symptoms in children and adolescents with chronic tic disorders and ADHD.

Spencer T, Biederman J, Coffey B, Geller D, Crawford M, Bearman SK, Tarazi R, Faraone SV.Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, MA 02114, USA. Journal of Clinical Psyschopharmacology. June;19(3):257-64

Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder.

Biederman et al were aware that despite the increasing awareness of ADHD in adults that there was a limited number of controlled pharmacologic studies of this disorder and that most clinical trials had focused on psychostimulants. As the tricyclic anti-depressant desipramine had been found effective in treating children with ADHD, Biederman et al tested the efficacy of desipramine in adults with ADHD. They conducted a randomized 6 week, placebo controlled, parallel-design study of desipramine at a daily target dose of 200mg in 41 adults with ADHD. They used separate assessments of ADHD, depressive and anxiety symptoms at a baseline and at each biweekly visit.

Beiderman et al found there was a significant differences in the reduction of ADHD symptoms between the adults receiving desipramine and the placebo. There was reduction in the broad categories of hyperactivity, impulsivity and inattentiveness. While the placebo-treated patients showed no differences between baseline and end point for any of the ADHD symptoms assessed. The response to desipramine was independent of dose, level of impairment, gender or lifetime psychiatric comorbidity with anxiety or depressive disorders. They concluded that as with similar findings in children and adolescents with ADHD their results indicated that desipramine is effective in the treatment of adults with ADHD.

Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. Wilens TE, Biederman J, Prince J, Spencer TJ, Faraone SV, Warburton R, Schleifer D, Harding M, Linehan C, Geller D. Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA. Arch Gen Psychiatry. 2002 Jul;59(7):649-56