Abstract

Background
General practitioners play a pivotal role in the diagnosis attention-deficit/hyperactivity disorder (ADHD) in adults. This systematic review aims to determine the effectivity and feasibility of screening tools for ADHD in adults in primary care.

Method
A literature search was performed in PubMed, Cochrane Library, Ovid, ERIC, PsycInfo, PSYNDEX and Embase in November 2022. Sensitivity and specificity were considered as primary outcomes. Further psychometric properties, feasibility in general practice as well as digital practicability were evaluated as secondary outcomes. Risk of bias was assessed via QUADAS-2/C. A narrative data synthesis and meta-analysis was performed (PROSPERO: CRD42022374597).

Results
A total of fifty-eight studies were included in data analysis. These studies referred to eighty-four various screening tools. ASRS-6 (DSM-V), WURS-25, CAARS-s:sV and TRAQ10 are suitable instruments for screening of ADHD in adults in primary care. The highest test accuracy was shown by ASRS 6 (DSM-V) (Sensitivity=0.83 [0.67–0.92], Specificity=0.87 [0.93–0.8], AUC=0.92, I2=8.6–12.3 %).

Limitations
Included studies used rating scales as reference standard. Some studies compared study groups to control groups with an unknown ADHD status and there is a large degree of heterogeneity between the populations. Some studies referred to the best-balanced results of sensitivity and specificity under a certain cut-off, that has not been determined before.

Conclusion
Feasibility studies are needed to provide more evidence for WURS-25 and CAARS-s:sV. The determination of sufficient cut-offs is important, to improve the identification of ADHD in adults by general physicians.

Introduction

Attention-deficit/hyperactive disorder (ADHD) according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and hyperkinetic disorder (F90) or attention deficit without hyperactivity (F98.8) according to the International Classification of Diseases, editions 10 and 11 (ICD-10/11)) is commonly known as a childhood disorder which is characterized by altered hyperactivity, inattention and impulsivity (Drechsler et al., 2020). These symptoms persist until adulthood in about 50 % of all diagnosed patients (Sibley et al., 2017, 2022). Moreover, patients show characteristic features, which include executive dysfunction, disorganization and emotional distress, leading to an impairment of their daily lives (Barkley, 1997; Wender, 1998). Common comorbidities are depression, borderline personality disorder, social phobia, anxiety, or substance abuse (Fayyad et al., 2017; Kessler et al., 2006). Although a prevalence of approximately 2–3 % of ADHD in adults is estimated, only 0.2–0.4 % are actually diagnosed in Germany (Fayyad et al., 2017; Bachmann et al., 2017; de Zwaan et al., 2012). A possible reason seems to be a gap in medical care for young adults in a time of transition after leaving the pediatric setting (Eklund et al., 2016; Robb and Findling, 2013). Moreover, ADHD might be masked by other psychiatric symptoms and comorbidities (Retz et al., 2013). A missing or failed diagnosis prevents access to optimal medical care in the form of an evidence-based treatment of affected adults. General practitioners are considered to act as so-called „gatekeepers“, a role that is characterized by the initial identification of patients (Kwon et al., 2023; French et al., 2020). Consequently, there is a distinct need for appropriate diagnostic tools in primary care, as has already been identified in relevant guidelines (Eom and Kim, 2023; National Institute for Health and Care Excellence: Guidelines, 2018). There are many different screening tools, which differ in relevant aspects of the disorder. Some screening tools evaluate childhood symptoms, whereas others focus on current adult symptoms. Some screening tools are based on DSM-5 criteria, others on Utah criteria or no specified criteria. They differ in time or way of application, number of items, and scoring methods. For example, the choice of cutoff scores in ADHD screening tools directly influences clinical decision-making, including the initiation of treatment interventions. A higher cutoff score may exclude individuals who, despite exhibiting significant symptoms, do not meet the stringent criteria, potentially denying them access to necessary interventions. Conversely, a lower cutoff score could lead to the inclusion of individuals with mild symptoms, leading to over-treatment. The variability in cutoff points complicates the determination of treatment eligibility, potentially affecting the efficacy and efficiency of ADHD management strategies. Until, there is no comprehensive overview of validated studies including a quantitative meta-analysis (Taylor et al., 2011). Therefore, the aim of the study was to evaluate screening tools for ADHD in adults, considering sensitivity, specificity and feasibility for primary care.

Conclusion

Our findings show that screening tools as the ASRS-6 (DSM-V), the WURS-25, the CAARS-s:sV and the TRAQ10 are suitable instruments for screening of ADHD in adults in primary care due to their high validity and perceived feasibility in this setting. The best evidence exists for the ASRS-6, which was included in our meta-analysis. For more evidence concerning feasibility of the WURS-25 as well as the CAARS-s:sV, which also were part of the meta-analysis, feasibility studies are required. Regarding other tests like the TRAQ10 with equivalent promising results but insufficient options of comparison there is a need of further validation studies to create more evidence in that part. The determination of cut-offs is of great importance since it affects the ability of a screening tool distinguishing between real and false positives respectively negatives. Further research is required to identify the optimal cut-off of the different tests for a general population sample as we find it in primary care. Hence, the identification of ADHD in adults by general physicians would be improved without leading to increased misdiagnoses.

Abstract

To provide an overview of treatments in the pipeline for adults with attention-deficit/hyperactivity disorder (ADHD), we searched https://clinicaltrials.gov/and and https://www.clinicaltrialsregister.eu/ from 01/01/2010–10/18/2023 for ongoing or completed phase 2 or 3 randomised controlled trials (RCTs), assessing pharmacological or non-pharmacological interventions for adults with ADHD with no current regulatory approval. We found 90 eligible RCTs. Of these, 24 (27 %) reported results with statistical analysis for primary efficacy endpoints. While several pharmacological and non-pharmacological interventions had evidence of superiority compared to the control condition from a single RCT, centanafadine (norepinephrine, dopamine, and serotonin re-uptake inhibitor) was the only treatment with evidence of efficacy on ADHD core symptoms (small effect size=0.28–0.40) replicated in at least one additional RCT, alongside reasonable tolerability. Overall, the body of ongoing RCTs in adults with ADHD is insufficient, without any intervention on the horizon to match the efficacy of stimulant treatment or atomoxetine and with better tolerability profile. Additional effective and well tolerated treatments for adults with ADHD require development and testing.

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is characterised by developmentally inappropriate and impairing inattention plus hyperactivity and/or impulsivity (Faraone et al., 2024). ADHD is the most common neurodevelopmental disorder, affecting around 5 % of school-aged children worldwide according to a re-analysis of the Global Burden of Disease (GBD) data (Cortese et al., 2023) and 8 %, with an uneven gender distribution of 10 % for males and 5 % for females, based on an umbrella review including five systematic reviews and meta-analyses (57 unique primary studies) (Ayano et al., 2023).

Impairing symptoms of ADHD persist into adulthood in up to 75 % of the cases (Sibley et al., 2016), with an estimated prevalence of ADHD in adults at around 2.5 % (Song et al., 2021). ADHD is often comorbid with other disorders, including mood, anxiety, and substance use disorders, or dysfunctions, such as emotional dysregulation and executive dysfunction (Faraone et al., 2021), as well as physical disorders, including obesity and asthma (Arrondo et al., 2022).

Treatment options proposed for ADHD include pharmacological – encompassing stimulant and non-stimulant medications – and non-pharmacological interventions (Cortese, 2020). In currently available guidelines, pharmacotherapy plays an important role in the management of ADHD in adults. For instance, the 2018 (updated in 2019) National Institute for Healthcare and Excellence (NICE) guidelines (National Institute For Health and Care Excellence (NICE), 2019) suggested that medication (stimulants as first line, followed by the non-stimulant atomoxetine) should be offered after environmental modifications (such as reducing noise or distractions) have been implemented but ADHD symptoms are still impairing. Current medications for ADHD in adults are efficacious, albeit with lower effect sizes compared to children, especially in relation to stimulants for which effects sizes have been found to be high in children and medium in adults (Cortese et al., 2018). However, there are concerns around the safety of currently available ADHD medications, including their possible cardiovascular effects (Cortese and Fava, 2024) and limited abuse potential – even though the risk-benefit profile in general favours the use of medications, as recently highlighted by the ADDUCE project, a naturalistic, longitudinal, controlled study in 27 European child and adolescent mental health centres (e.g., Buitelaar et al., 2022). Therefore, there is a need for additional efficacious and safer medications for adults with ADHD.

Results

3.1. Overview of included RCTs
We initially identified 115 potentially eligible RCTs (Table S1). However, 25 of the RCTs of pharmacological treatments tested medications already approved for adults with ADHD for core symptoms of ADHD (Table S2), which will not be discussed further in the present article. Of the remaining 90 RCTs, around 27 % (n = 24) reported results with statistical analysis for primary efficacy endpoints; in the rest (73 %, n = 66), results with statistical analysis of significance were not reported/available (ongoing trials: 38 %, completed trials: 38 %, unknown status: 14 %, terminated: 4 %, not yet recruiting: 6 %).

Completed RCTs with positive results on at least one primary outcome (n = 26) and those with negative results on every primary outcome (n = 8) are reported in Table 1 (pharmacological treatment) and Table 2 (non-pharmacological treatment). When available, Tables 1–2 report also data on tolerability, in terms of percentage of participants who dropped out due to adverse events or those who experienced adverse events defined as serious by the study authors, in line with the above-mentioned FDA classification.

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that impacts many areas of a person’s life. So far little is known on how ADHD affects the learning and usage of additional languages. The present study investigates what potential challenges and benefits adults with ADHD experience in second language (L2) learning, and what strategies they have developed to offset ADHD-related differences in cognition and behaviour. As part of a larger questionnaire, 59 participants with ADHD provided written responses, answering questions on how ADHD has influenced their learning and use of multiple languages. After a multiple-step classification process, three overarching topics were identified: (1) the effects of cognition on language learning and use; (2) how different language components and language modalities are affected by ADHD; and (3) what language learning strategies adults with ADHD apply. In our analysis, we present authentic quotes from individuals with ADHD and place them into the larger context of research on neurodivergence and L2 acquisition. Our results highlight the great heterogeneity in learning experiences and pathways in adults with ADHD. Interestingly, many respondents embrace their neurodiversity and develop individual strategies to enhance L2 proficiency. Our research aims to contribute to a better understanding of multilingualism within neurodiverse populations.

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder known to significantly impact various aspects of an individual’s life. ADHD affects approximately 5.3–7.2 percent of children and youth, and 2.5 to 6.8 percent of adults worldwide (cf. Polanczyk et al., 2014; Song et al., 2021), often co-occurring with speech and communication disorders such as language disorder, social pragmatic communication disorder, and dyslexia (Tannock, 2018; Willcutt and Pennington, 2000). While the impact of dyslexia on second language acquisition is well studied (e.g., Nijakowska, 2020; Schneider and Crombie, 2003), so far limited attention has been given to exploring the effects that ADHD has on acquiring and using additional languages. The present study aims to address this research gap by featuring the individual experiences and reflections of people diagnosed with ADHD on how their disorder affects the way they learn or use multiple languages. The findings from this study can lay the foundation for more individualized language learning strategies as well as more inclusive instructional programs that are better suited to the specific needs of adult second language learners with ADHD.

1.1. Diversity of ADHD
Despite ADHD being an acknowledged psychiatric diagnostic category (American Psychiatric Association, 2013), it is important to highlight the behavioural and cognitive heterogeneity of people diagnosed with ADHD. First, three different presentations of ADHD can be distinguished: (1) the inattentive presentation, characterized by for instance difficulties to maintain focus, easily getting distracted and making careless mistakes; (2) the hyperactive-impulsive presentation, marked by individuals showing high levels of physical restlessness and difficulties with impulse control; and (3) the combined presentation, where individuals exhibit a combination of inattentive and hyperactive-impulsive symptoms (American Psychiatric Association, 2013).

Conclusions

The current study investigated how ADHD impacts foreign language learning and usage. The main aim was to present the experiences and reflections of adults with ADHD and situate them within the broader context of existing research on cognitive deficits and second language acquisition. Before we summarize the main findings and present conclusions, we would like to point out several limitations of the current study. First, the group of adults with ADHD consisted of more female than male respondents, mostly situated in Norway, and diagnosed in adulthood. Second, we cannot exclude that there is a sampling bias in the sense that more people with a specific interest in languages completed our survey. Furthermore, it is important to emphasize that the data reflect participants’ subjective experiences regarding how they believe ADHD impacts their L2 learning and use. It remains unclear whether these experiences are actually attributable to ADHD, aspects of their personality, or common challenges associated with L2 acquisition. Considering these biases in our sample as well as the qualitative nature of our analysis, it remains to be seen whether our findings are representative of the population of adults with ADHD at large.

While most previous research has focused on the language and communication abilities of children with ADHD (Carruthers et al., 2022; Korrel et al., 2017), our findings provide valuable insights into the inner workings of adults with ADHD. From our data, a diverse picture emerged with lots of individual variation. Depending on their individual cognitive and behavioural symptom profiles as well as personality traits, adults with ADHD experienced different effects of their condition on foreign language learning and use. Difficulties with inattention made it challenging for some respondents to focus during traditional classroom instruction and led them to making careless mistakes in written texts. On the flip side, many respondents with ADHD also experienced periods of hyperfocus, in which they were highly productive. Cognitive deficits related to working memory made it difficult for some adults with ADHD to memorize vocabulary and grammatical forms, and to retrieve already acquired lexical items on demand during real-time interactions. Following and participating in conversations in a second language can also be challenging as it requires paying attention and processing multiple verbal and non-verbal cues simultaneously and deriving correct interpretations on the fly. The linguistic domain that appeared to be most affected by ADHD was pragmatics. Some respondents mentioned impulsive or hyperactive behaviours in communication such as talking excessively, interrupting others, and speaking without thinking first. The latter might result in grammatical errors that are more difficult to recover from in a second language. People with ADHD also exhibited different preferences for written or spoken modality. A learning style mentioned by several respondents was characterized by association, leading to an intuition or gut feeling about correct language use. In sum, our findings provide evidence that for many adults with ADHD, their disorder fundamentally affects the way they learn or use a foreign language, supporting the far-reaching effect of ADHD on different domains of a person’s life.

Abstract

Background
Cyclothymia seems to be often associated with coexisting ADHD symptoms, although this comorbidity is understudied. Emotional dysregulation is a core symptom of both conditions.

Methods
Adult subjects with cyclothymia were consecutively enrolled at the outpatient service of the Second Psychiatry Unit of the Pisa University Hospital (Italy). Screening for ADHD was performed using the Adult ADHD Self-Report Scale (ASRS). We analyzed differences in sociodemographic and clinical characteristics between subjects with and without ADHD symptomatology.

Results
Of the total sample of 107 subjects, 43 % screened positive for ADHD. ADHD+ subjects were significantly younger than ADHD- subjects, had a lower level of education, a higher prevalence of psychiatric comorbidity, and a more frequent family history for ADHD and alcohol use disorder. In addition, ADHD+ subjects scored higher than ADHD- subjects on the affective instability, negative emotionality, and emotional impulsivity subscales of the RIPoSt-40 questionnaire, as well as on the 40‐item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40) total score. They also showed a stronger association with the cyclothymic and depressive subscales of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) scale.

Limitations
the small sample size, the cross-sectional nature of the study, the use of self-report questionnaires, and the use of a screening test to assess comorbidity with ADHD symptomatology.

Conclusions
ADHD symptomatology is very common in cyclothymic individuals, and emotional dysregulation blurs the diagnostic boundaries between the two disorders. Several clinical features suggest the need for systematic evaluation of ADHD in patients with cyclothymic disorder.

Introduction

In the DSM-5, cyclothymic disorder belongs to the bipolar spectrum of mood disorders and is defined by the presence of at least 2 years of both hypomanic and depressive periods that never meet the criteria for a full-blown affective episode (American Psychiatric Association, 2013). Although cyclothymia is considered a very common psychiatric disorder, comprehensive epidemiologic data are lacking. In clinical samples, it occurs more frequently in women than in men, and the incidence ranges from 0.4 % to 13 %, depending on the criteria used (Van Meter et al., 2012).

The way of current diagnostic classifications to describe cyclothymia only in terms of alternating depressive and hypomanic symptoms in an attenuated form completely neglects psychological aspects, behavioral symptoms, and important clinical features such as excessive mood reactivity, impulsivity, and anxiety, leading to a limited understanding of the disorder and, consequently, its underdiagnosis.

Actually, the core features of cyclothymia are emotional dysregulation (ED), i.e., rapid oscillations of intense affect with a difficulty in regulating these oscillations or their behavioral consequences, and marked mood reactivity, whether in terms of intensity and duration. Indeed, as early as adolescence, cyclothymic individuals report a stable trait of exaggerated sensitivity to both positive or negative external stimuli of psychological, environmental, chemical, and physical nature (Perugi et al., 2015). Mood reactivity and instability are invariably associated with a number of psychological and behavioral consequences that may be the main complaints or symptoms for many of these individuals.

Conclusions

Future studies are needed to explore the relationships between cyclothymia and ADHD in clinical samples. ED is a key feature of both syndromes, which often blurs the diagnostic boundaries between the two disorders and facilitates misdiagnosis. It is useful for clinicians to identify the elements that, when present in the individual with cyclothymia, suggest the need for further evaluation for ADHD. ADHD+ patients appear to represent a subpopulation characterized by higher rates of familiarity with ADHD, earlier onset of affective disorders, higher rates of comorbidity with other psychiatric disorders, significantly higher ED burden, poorer course of illness, and greater functional impairment. Obesity and uncontrolled eating disorders may be additional factors indicating comorbid ADHD symptomatology. Finally, cyclothymic individuals with ADHD exhibit predominantly negative emotionality and appear to lack the type of positive emotionality which is typical of patients with ADHD without comorbid cyclothymia (Christiansen et al., 2019).

Abstract

Background
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurological and mental developmental disorders in children. Published systematic reviews (SRs) and meta-analyses (MAs) concerning the use of acupuncture for ADHD have compared the efficacy of acupuncture treatment to that of drug therapies. However, the quality of these articles has not been evaluated and the evidence varies widely.

Objective
To summarize and assess the efficacy of acupuncture for ADHD based on existing SRs and MAs.

Methods
A systematic search of the literature was conducted from inception until September 16 2021, using seven electronic databases. The AMSTAR-2 tool was used to evaluate the quality of SRs and MAs, and the GRADE system was used to assess the quality of evidence.

Results
There are a total of five SRs and MAs included in this overview. Using the AMSTAR-2, three articles were rated as having ‘Low’ quality, while two were rated as having of ‘Critically Low’ quality. The GRADE system was used to measure the quality of evidence for ten outcomes (five response rate outcomes, three Conners’ Index of Hyperactivity (CIH) score outcomes, one Conners’ rating scale score outcome, and one Chinese medicine syndrome outcome) across the five included MAs. Four of the ten outcomes demonstrated ‘moderate’ quality, four demonstrated ‘low’ quality, and two demonstrated ‘very low’ quality. The risk of bias and inconsistency accounted for most downgrading factors in the included reviews.

Conclusion
It is still debatable whether acupuncture is efficacious in improving the CIH score and the Response rate. Considering the heterogeneity of clinical trials and the fact that this study did not search and evaluate the relevant data of each randomized controlled trial, large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions regarding acupuncture’s role in treating ADHD. Due to the poor quality of existing available evidence, little inference can be drawn from the included studies.

Introduction

Attention deficit hyperactivity disorder (ADHD), characterized by abnormal inattention, hyperactive behavior, and impulsivity is one of the most common neurological and mental developmental disorders observed in children.1 According to recent studies,2., 3. the prevalence of ADHD in China is roughly 5.6 % and the estimated global prevalence in children is between 8 % and 12 %. The prevalence of ADHD is increasing alongside the development of society, and the disorder is potentially burdensome for the individuals suffering from it, as well as their families and communities.4 Strategies for treating ADHD should be individualized, integrated, and multimodal, incorporating both non-pharmacological therapies (e.g., cognitive training and evidence-based behavioral therapies) and pharmacological therapies (e.g., psychostimulants).5 In China, Chinese medicine (CM) offers complementary and alternative therapies for ADHD in addition to pharmaceutical therapies.6 Although stimulants are the most effective therapeutic medications for treating the symptoms of ADHD, non-stimulants are also useful management tools.5 Notably, drug treatments may entail adverse side effects such as insomnia, abdominal pain, headache, dry mouth, nausea, and others.7

Traditional therapies based on the theory of Chinese Medicine (CM) have been practiced and developed for centuries. Acupuncture is a wonderful mode of CM. Based on the theory of the differentiation of CM syndromes, acupuncture plays an important role in the correction of Qi (i.e., vital energy), blood imbalances, Yin-Yang imbalances, and so on.8 Acupuncture therapy includes manual acupuncture, electroacupuncture, auricular acupuncture, scalp acupuncture, etc. From the perspective of CM, ADHD is a disease related to pathological congenital insufficiency and a lack of postnatal nourishment.6 The CM theory of meridians and collaterals has guided the clinical practice of Chinese medicine for thousands of years and provides the theoretical basis for acupuncture. Acupuncture induces a unique feeling known as ‘needle sensation,’ which is a manifestation of its therapeutic effect. The stimulation of specific acupoints regulates the function of Qi, blood, and immunological function.6

Conclusion

According to the evidence of the five SRs/MAs involved in this overview, acupuncture as an alternative therapy for ADHD may be therapeutically effective and improve ADHD scale scores. However, because of methodological flaws in the included studies, conclusive evidence is still lacking. Large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions about the value of acupuncture in the treatment of ADHD.

Abstract

     In this paper, we examine the relationships between school suspensions and/or ADHD diagnoses and delinquency across different school disciplinary and special education climates. Given how these childhood interventions are intended to improve schoolchildren’s behavior and create a safe and predictable learning environment, it is critical for scholars to compare how these diverse yet connected responses to child misbehavior influence delinquent behavior. We use data from the Fragile Families and Child Well-Being Study (n = 2,267). Results from binomial regression models show that delinquency scores are higher among suspended children and children receiving both suspension and ADHD treatment, compared to young people who experience neither. Further, school context has a direct association with delinquency scores, as children attending schools with higher rates of school suspensions and special education enrollment have lower delinquency scores. Moreover, the relationship between individual childhood experiences with school suspension and/or ADHD treatment and delinquency is moderated by school context, especially regarding special education enrollment rates.

Introductin

     Each year, approximately 2.5 million U.S. students are suspended from school (Civil Rights Data Collection (CRDC), 2021). At the same time, 6.1 million school-aged children are diagnosed with attention deficit hyperactivity disorder (ADHD), with nearly 2 in 3 receiving therapy or taking prescription medication for their diagnoses (Danielson et al., 2018) and roughly 2 million children are enrolled in in special education behavior plans for ADHD and similar conduct problems (Civil Rights Data Collection (CRDC), 2021). The use of suspension or medical diagnoses and special education for perceived childhood behavior problems reflects different philosophies regarding misbehavior and involve different institutions, leading to different approaches (Hinshaw & Scheffler, 2014; Kern et al., 2019; Lamont, 2013). School suspensions are punishments imposed by schools that rely on negative consequences (e.g., exclusion) for misconduct to encourage good behavior (Bandura, 1977; Bear, 2012). ADHD diagnoses entail medical decisions made between doctors and caregivers, utilizing therapy and/or medication, and often involve schools implementing special education plans to promote appropriate behavior.

Results

     Table 1 presents descriptive statistics for all variables in the study for the total sample and for each category of individual suspension and ADHD treatment (i.e., neither suspended nor received ADHD treatment, received only ADHD treatment, only suspended, and both suspended and received ADHD treatment). Notably, almost half of the respondents had experiences with suspension and/or ADHD treatment. The proportion of respondents who experienced neither exclusion nor ADHD diagnoses is 0.506, 0.075 were diagnosed with ADHD without experiencing exclusionary discipline, 0.307 experienced exclusion without ADHD diagnoses, and 0.111 experienced both exclusion and ADHD diagnoses. The average delinquency score in the sample is 1.1 delinquent behaviors and varies by suspension/ADHD experience. Among those who receive neither ADHD treatment nor suspension, the average delinquency score is 0.6, compared to an average delinquency score of 0.7 for those who receive only ADHD treatment, 1.7 for those who experience suspension only, and 2.1 for those who receive both ADHD treatment and suspension. School punishment and special education rates also vary by suspension/ADHD category. Overall, the average school special education rate is 15.5. For children who are neither suspended nor treated for ADHD, the average school special education rate is 14.5, compared to an average rate of 14.7 for those only treated for ADHD, 16.6 for those only suspended, and 17.7 for those who are both suspended and treated for ADHD. The average school punishment rate is 12.5 for the total sample, compared to 9.8 for those who are nether treated for ADHD nor suspended, 8.6 for those only treated for ADHD, 16.6 for those only suspended, and 15.6 for those who are both suspended and treated for ADHD.

ABSTRACT

1. Introduction

2. Materials and methods

3. Results

4. Discussion

5. Limitations

Declarations

References

Abstract

Introduction
There is little known about the association between non-parental care in early childhood and attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers. Therefore, we examined the association between childcare from grandparents/babysitters during infancy/preschool and ADHD symptoms in preschoolers.

Methods
Using stratified random sampling, we developed a sample comprising 1597 parents of children aged 1.6–7 years who were enrolled in preschool in rural and urban areas of China. Parental reports of ADHD symptoms were assessed using the preschool version of the ADHD Rating scale-IV. A regression analysis was used to examine the association between childcare from grandparents/babysitters and ADHD symptoms.

Results
Childcare from grandparents during infancy was associated with ADHD symptoms in childhood (β = 1.03, P < 0.0001). Significant associations between grandparental care and ADHD symptoms were also observed in children from families with more than one child (β = 0.64, P = 0.0035) and children living in rural areas (β = -0.78, P = 0.0032). A babysitter as the primary child caregiver in preschool was especially strongly correlated with ADHD symptoms in girls (β = 7.95, P = 0.0042). Moreover, region was strong factor associated with ADHD symptoms without adjustment for the non-parental caregivers’ age and education, whereas family income was not strongly associated with ADHD symptoms.

Conclusion
Non-parental caregiving (i.e., from grandparents or babysitters) in early childhood was associated with more ADHD symptoms in children. Certain characteristics in children, such as female gender and the existence of siblings, were stronger moderating factors than were family income and region.

1. Introduction

Attention-deficit/hyperactivity disorder (ADHD), one of the most common childhood brain disorders, is characterized by a persistent pattern of inattention, and impulsivity and hyperactivity [[1]]. The disorder affects approximately 7% of children worldwide [[2]], and the prevalence in preschoolers ranges from 3.3% to 5.4% [[3], [4], [5]]. Both genetic and environmental factors are believed to contribute to ADHD. Among the contributing environmental factors, multiple indicators of psychosocial adversity have been implicated, including poor parenting quality, a poor general home environment, and a low socioeconomic status (SES) [[6], [7], [8]].

Negative early childcare experiences are a risk and a likely causal risk factor for the development of ADHD [[10]]. A hospital-based case-control study conducted in South Africa found that early traumatic life events and non-maternal childcare, included care received at daycare centers and from grandparents, were associated with ADHD symptoms [[11]]. Quasi-experimental studies (based in orphanages) suggested that extreme forms of early deprivation can result in ADHD-type symptoms as well as autism-like symptoms among English and Romanian adoptees [[12], [13], [14]]. However, it remains unclear whether more common types of early experiences, such as non-parental childcare during infancy, are associated with a risk of developing ADHD symptoms.

The non-parental childcare in the present study was narrowly focused on grandparental care and babysitter care at children’s personal homes, which are the most common childcare arrangements due to the absence of early childcare systems in China. Our argument of the effect of non-parental care on children’s development focused on types of care, quality and quantity of non-parental care, and on the exposure period in early childhood. The present study sought to examine the associations between grandparental/babysitter care in different periods of early childhood and ADHD symptoms.

Abstract

Introduction

Materials and Methods

Results

Discussion

Conclusion

Data Availability

Conflicts of Interest

Authors’ Contributions

Acknowledgments

References

Copyright

Related articles

Abstract

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental brain disorders in childhood. Despite extensive researches, the neurobiological mechanism underlying ADHD is still left unveiled. Since the deficit functions, such as attention, have been demonstrated in ADHD, in our present study, based on the oddball P3 task, the corresponding electroencephalogram (EEG) of both healthy controls (HCs) and ADHD children was first collected. And we then not only focused on the event-related potential (ERP) evoked during tasks but also investigated related brain networks. Although an insignificant difference in behavior was found between the HCs and ADHD children, significant electrophysiological differences were found in both ERPs and brain networks. In detail, the dysfunctional attention occurred during the early stage of the designed task; as compared to HCs, the reduced P2 and N2 amplitudes in ADHD children were found, and the atypical information interaction might further underpin such a deficit. On the one hand, when investigating the cortical activity, HCs recruited much stronger brain activity mainly in the temporal and frontal regions, compared to ADHD children; on the other hand, the brain network showed atypical enhanced long-range connectivity between the frontal and occipital lobes but attenuated connectivity among frontal, parietal, and temporal lobes in ADHD children. We hope that the findings in this study may be instructive for the understanding of cognitive processing in children with ADHD.

1. Introduction

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders, characterized by age-inappropriate symptoms of inattention, hyperactivity, and impulsivity [1]. It arises in childhood and often persists into adolescence, even adulthood. The reduced-capacity [2] or dysfunctional attention [3] was not the major cause of ADHD symptoms; event-related potential (ERP), such as P2, N2, and P3, has consistently suggested the cognitive deficits in multiple stages of sensory and cognitive processing in ADHD [4]. P2, a positive deflection peaking around 150-250 ms after stimuli presentation, plays a crucial role when measuring attention [5], which could reflect not only early comprehension but also index updating of a representation in response to new incoming information [6]. A smaller P2 in ADHD reflects an underactivation of the early orienting process and a poor allocation of attentional resources [7]. Besides, N2, peaking at around 200-250 ms after stimuli onset, could reflect the cognitive control for successful inhibitory control and interference suppression [8] and has also been found to be reduced in ADHD patients [9]. P3 is a later ERP component and peaks around 250-600 ms and is widely used to investigate cognitive mechanisms in neuropsychiatric disorders, including ADHD [10]. For example, Li et al. suggested that the rest and task P3 electroencephalogram (EEG) could actually provide comprehensive information to reliably classify schizophrenia patients from healthy controls (HCs) [11]. Additionally, its amplitude has also been found to be decreased in ADHD [12]. As illustrated, the early stage may influence subsequent response processes [13]; since P2, N2, and P3 index different stages of cognitive information processing, in this work, all of these components were investigated to uncover the cognitive deficits in ADHD children.

1- Introduction

2- Methods

3- Results

4- Discussion

References

Abstract

Eating disorders and attention deficit/hyperactivity disorder (ADHD) are highly comorbid. The majority of research on this comorbidity has focused on impulsivity, which is a shared vulnerability between ADHD and eating disorders characterized by binge eating. Less is known about which shared factors may contribute to the co-occurrence of other eating disorders (i.e., anorexia nervosa, restricting subtype) and ADHD. Furthermore, little research has focused on other potential overlapping vulnerabilities, though deficits in emotion regulation have been implicated as an additional shared vulnerability. The current study (N = 306 undergraduate students) uses path analysis to examine if emotion regulation difficulties and negative urgency (i.e., impulsivity during negative mood state) are unique or shared vulnerabilities for ADHD symptoms (inattention, hyperactivity-impulsivity) and eating disorder symptoms (bulimic symptoms, drive for thinness). Emotion regulation difficulties were uniquely associated with all dimensions of ADHD and eating disorder symptoms, and negative urgency was uniquely associated with global eating disorder symptoms, bulimic symptoms, and drive for thinness. These results suggest that emotion regulation difficulties are a shared vulnerability factor for the development of diverse presentations of ADHD and eating disorder symptoms, and may be an important prevention target. Additionally, our results support a unique relationship between negative urgency and drive for thinness. Future research should examine these associations prospectively and experimentally to determine directionality and inform preventative interventions for ADHD and eating disorders.

Introduction

Eating disorders (EDs) and attention deficit/hyperactivity disorder (ADHD) are frequently comorbid. Prevalence estimates suggest 3%–7.6% of individuals with ADHD have an ED (Bleck & DeBate, 2013; Brewerton & Duncan, 2016), and 11.1%–31.6% of individuals with an ED have a diagnosis of ADHD (Nazar et al., 2016; Yates, Lund, Johnson, Mitchell, & McKee, 2009). Beyond the high prevalence of comorbidity, research indicates that the co-occurrence of ADHD and EDs contributes to increased impairment and worse treatment outcomes (Biederman et al., 2007; Nazar et al., 2016). More research is needed to understand the development of these two co-occurring conditions in order to inform prevention efforts. Research on ADHD and EDs has primarily focused on bulimic symptoms and suggests individuals with ADHD are at higher risk for binge eating and purging (Bleck & DeBate, 2013; Bleck, DeBate, & Olivardia, 2015; Davis, Levitan, Smith, Tweed, & Curtis, 2006). Cognitive symptoms, such as drive for thinness (DT; i.e., extreme desire to be thinner, concerns about dieting, and weight gain fears; Garner, Olmstead, & Polivy, 1983) are far less researched. DT is implicated as a core symptom of EDs and precedes ED development (Stice, 2002), and thus represents an important factor to consider in developmental models of EDs. DT is especially important in understanding ADHD and ED comorbidity, as research indicates adolescents with ADHD have higher DT than healthy peers (Mikami et al., 2010; Neumark-Sztainer, Story, Resnick, Garwick, & Blum, 1995). Investigating DT, in addition to bulimic symptoms, may clarify what accounts for the comorbidity of ADHD and EDs not characterized by binge eating and purging behaviors (e.g., anorexia nervosa, restricting subtype). The relationship between ED symptoms and ADHD is theorized to be explained, in part, by impulsivity.

Objective: To investigate the relationship between prenatal maternal alcohol consumption and the risk of attention deficit hyperactivity disorder (ADHD), the strengths and difficulties questionnaire (SDQ) score and abnormal hyperactivity score in seven-year-old children. Methods: This study is a retrospective analysis of the Millennium Cohort Study (MCS). Questionnaires were used to gather data on gestational alcohol consumption when children were 9 months old and neurodevelopmental outcomes in offspring at 7 years of age (N = 13,004). Alcohol consumption was classified into never, light, moderate and heavy. Crude and adjusted logistic regression models were used for data analysis. Results: The total number of women who reported drinking alcohol in pregnancy (the light, moderate and heavy drinking group) was 3916 (30.1%). No significant association was found between light, moderate or heavy gestational alcohol consumption and ADHD (adjusted odds ratio [aOR] for light = 0.80, 95% confidence interval [CI] = [0.53,1.22], aOR for moderate = 0.83, [0.40, 1.74]; aOR for heavy = 1.27, [0.54, 2.98]); for abnormal SDQ score (aOR for light = 0.94, [0.78,1.13], aOR for moderate = 0.70, [0.49,1.00]; aOR for heavy = 1.08, [0.70, 1.66]); for abnormal Hyperactivity score (aOR for light = 1.02, [0.89,1.17]; aOR for moderate = 1.05, [0.82, 1.34]; aOR for heavy = 0.90, [0.62, 1.32]), in offspring. Conclusion: Light, moderate or heavy antenatal alcohol consumption was not associated with an increased susceptibility to ADHD or behavioural outcomes in this study. However, due to the limited number of cases we cannot rule out an increased risk of ADHD in relation to heavy alcohol consumption.

Introduction

Existing literature links prenatal alcohol exposure to numerous adverse neurodevelopmental outcomes in offspring (Carmichael Olson et al., 1997; Banerjee et al., 2007; Jones et al., 1973). Long-term neurobehavioral deficits, including hyperactivity, even at low doses of prenatal alcohol exposure have been demonstrated in animal literature (Riley, 1990; Sood et al., 2001). Conversely, there is conflicting evidence cited in the literature suggesting that low levels of maternal alcohol consumption in pregnancy (MACP) may not be associated with adverse neurodevelopmental and health outcomes in early childhood (Kelly et al., 2009; Kelly et al., 2012; Robinson et al., 2010; O’Leary et al., 2010; Alati et al., 2008; Eriksen et al., 2012; Testa et al., 2003; Gallagher et al., 2018). Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterised by developmentally inappropriate and impairing inattention, impulsivity and/or overactivity (Thapar and Cooper, 2016). ADHD is the most common cognitive and behavioural disorder diagnosed among school children, with an estimated worldwide prevalence of 3.4% (Polanczyk et al., 2015) ADHD incurs a significant economic burden and is associated with subpar social, academic, adaptive and occupational functioning (Barkley, 2002; Banerjee et al., 2007; Gupte-Singh et al., 2017; Polanczyk et al. 2015).

1. Introduction

2. Method

3. Results

4. Discussion

Acknowledgements

References

Abstract

The relationships children form with their teachers in early childhood are known to be important in the context of their ongoing learning and development. This study investigated student–teacher relationship quality (STRQ) in grade one students with (n = 177) and without (n = 208) attention-deficit/hyperactivity disorder (ADHD). We also examined whether a range of child and teacher factors were associated with STRQ. Children (M = 7.3 years; SD = 0.4) were recruited through 43 schools and screened for ADHD using parent and teacher screening questionnaires (Conners 3 ADHD index). ADHD cases were confirmed using the diagnostic interview schedule for children version IV. STRQ was rated by teachers using the student–teacher relationship scale — short form. Results showed that children with ADHD experienced poorer STRQ compared to children without ADHD (Cohen’s d = 1.11). STRQ was associated with child sex, medication use, ADHD subtype, cognitive/academic functioning and behavior, teacher experience, and self-efficacy, and parent education and socio-economic status. After controlling for school and teacher clustering, children’s prosocial behavior and teacher years of experience were positively associated with STRQ in both groups. In children with ADHD, conduct problems and child sex (boys) predicted poorer teacher relationship quality. For children without ADHD, higher socio-economic status was associated with better STRQ. Targeting modifiable factors associated with STRQ for children with and without ADHD and their teachers may be one way ofimproving school outcomes for at-risk children. Promoting prosocial behavior in classrooms may benefit STRQ for all children.

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder affecting approximately 5% of children worldwide (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014). ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, impulsivity, and co-occurring behavior and self-regulation difficulties (American Psychiatric Association, 2013). Due to symptoms and characteristics associated with the disorder, children with ADHD tend to experience considerable difficulties in the school environment (Kos, Richdale, & Hay, 2006). Children with ADHD have been found to experience academic underachievement (Massetti et al., 2008), and are rated below their peers on behaviors that enable academic success, such as classroom engagement, academic motivation, interpersonal skills and study skills (Vile Junod, DuPaul, Jitendra, Volpe, & Cleary, 2006; Volpe et al., 2006). Over the longterm, educational outcomes remain poor and social difficulties are likely to persist (Loe & Feldman, 2007). ADHD in childhood predicts a reduced overall quality of life and ADHD remains associated with substantial social, health and economic problems later in life (Barkley, Fischer, Smallish, & Fletcher, 2006; Harpin, 2005).

While school difficulties experienced by children with ADHD are well recognized, little is known about the factors that may protect children with ADHD from poor school functioning. One possible buffer is the extent to which a child has a supportive, non-conflictual relationship with his/her classroom teacher (Baker, 2006; Roorda,Koomen, Spilt, & Oort, 2011).Whilst student–teacher relationships for children with behavioral difficulties (e.g., aggression) have been shown to involve more conflict and less closeness (Crum, Waschbusch, & Willoughby, 2016; Lei, Cui, & Chiu, 2016), little is known about the nature of student–teacher relationships for children with ADHD. It is also unclear whether poor student–teacher relationship quality (STRQ) arises primarily from behavioral problems that often accompanyADHD, or whether there are other importantfactors that may offer opportunity for interventions tailored to children with ADHD. This cross-sectional study compared STRQ between children with and without ADHD in a large community sample in grade one (second year of schooling) with the aim of identifying child and teacher-level factors associated with STRQ.

Background: There are high rates of comorbidity between ADHD and ASD; however, there has been limited work parsing rates by ADHD presentation. In addition, commonly used questionnaires have demonstrated reduced utility in capturing ADHD symptoms in individuals with ASD. We examined the prevalence of comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) parsed by DSM-5 presentation in clinic-referred youth with Autism Spectrum Disorder (ASD) without intellectual disability (ID). We compared common rating scales to determine which most effectively identified comorbid ADHD. Method: We examined comorbid ADHD diagnoses from archival assessment data for 419 youth with ASD without ID. We examined diagnostic discriminability of the parent and teacher ADHD Rating Scale (ADHD R-S), and Attention and ADH Problems Scales of the Child Behavior Checklist and Teacher Report Form using receiver operating characteristic (ROC) curves. Hierarchical logistic regression was used to examine measures’ unique contribution to ADHD diagnosis. Results: Sixty-one percent of the study sample met DSM-5 criteria for an attention disorder. ADHD, Combined (ADHD-C) represented the largest proportion of ADHD diagnoses (76.8%), followed by Inattentive (ADHD-I;19.7%), Hyperactive/Impulsive (.02%), and Un-/Other Specified (.02%). Measures provided greater diagnostic discriminability in identifying ADHD-C relative to ADHD-I. The ADHD R-S inattentive symptom count provided the greatest discriminability for both subtypes and was the only scale that provided clinically meaningful differentiation between those with ASD only and ASD + ADHD-I. Conclusions: These results support using the ADHD R-S to capture comorbid ADHD symptoms in ASD. The findings underscore the need for more thorough examination of inattentive symptoms to rule out ADHD-I.

Introduction

Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common comorbid disorders diagnosed in children with Autism Spectrum Disorder (ASD) with rates of co-occurrence ranging from 30 to 70% (Antshel, Zhang-James, Wagner, Ledesma, & Faraone, 2016; Joshi et al., 2017; Lee & Ousley, 2006; Leitner, 2014; Leyfer et al., 2006; Simonoff et al., 2008; Sinzig, Walter, & Doepfner, 2009; Taurines et al., 2012). Joshi et al. (2017) report that the clinical presentation of ADHD in youth with ASD is similar to its presentation outside the context of ASD with respect to age of onset, distribution of diagnostic presentations, symptom profile, and symptom severity. In their psychiatrically referred sample of 140 youth with ASD without intellectual disability (ID), 76% also met diagnostic criteria for ADHD per the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Moreover, 41% of youth with ASD with comorbid ADHD had not been identified as having an attention disorder until their participation in the study, and thereby were less likely to have received appropriate treatment. Evidence suggests that individuals with comorbid ASD and ADHD benefit from pharmacological interventions that address symptoms of ADHD (Santosh, Baird, Pityaratstian, Tavare, & Gringras, 2006; Taurines et al., 2012); thus, failing to appropriately identify a comorbid ADHD diagnosis may preclude these children from receiving evidence-based treatments and contribute to greater adaptive and/or behavioral challenges (Jang et al., 2013; Joshi et al., 2017; Posserud, Hysing, Helland, Gillberg, & Lundervold, 2018; Yerys et al., 2009). In fact, the growing awareness of, and evidence for, the presence of functionally impairing co-occurring ADHD symptoms in youth with ASD led to the removal of the exclusivity clause between the diagnoses with the most recent iteration of the DSM (5th ed.; DSM-5; American Psychiatric ssociation, 2013; Antshel et al., 2016; Colombi & Ghaziuddin, 2017; Goldstein & Schwebach, 2004; Russell, Rodgers, & Ford, 2013; Sprenger et al., 2013; Yoshida & Uchiyama, 2004). The majority of studies examining ASD and ADHD comorbidity do not parse the different presentations of ADHD, and existing studies were completed prior to the publication of DSM-5 (2013).