The Impact of Sleep Restriction on Daytime Functioning in School-Age Children With and Without ADHD: A Narrative Review of the Literature Fiona Davidson, Benjamin Rusak, Christine Chambers, Penny Corkum Canadian Journal of School Psychology (2018)DOI: https://doi.org/10.1177/0829573518770593 Abstract The purpose of this narrative review was to synthesize the existing literature on the impact of sleep on daytime functioning in both typically developing (TD) children and children with attention-deficit/hyperactivity disorder (ADHD). Correlational studies in children suggest that insufficient sleep and impaired daytime functioning are significantly associated; however, this does not address the causal relationships between sleep and daytime functioning. The review results indicated that there is limited experimental sleep manipulation research in children. In the eight studies that employed experimental methods to examine sleep restriction, the consequences of insufficient sleep were greatest for attention and inconsistent for other domains, such as cognition and emotion regulation. Despite the significant co-occurrence of ADHD and sleep problems, the experimental sleep research focused on the daytime impact of shorter sleep in children with ADHD is extremely limited and as such more research is needed.

Blood-bourne MicroRNA Biomarker Evaluation in Attention-Deficit/Hyperactivity Disorder of Han Chinese Individuals: An Exploratory Study Liang-Jen Wang, Sung-Chou Li, Min-Jing Lee, Miao-Chun Chou, Wen-Jiun Chou, Sheng-Yu Lee, Chih-Wei Hsu, Lien-Hung Huang, Ho-Chang Kuo 

Front. Psychiatry (2018)doi: 10.3389/fpsyt.2018.00227 Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly genetic neurodevelopmental disorder, and its dysregulation of gene expression involves microRNAs (miRNAs). The purpose of this study was to identify potential miRNAs biomarkers and then use these biomarkers to establish a diagnostic panel for ADHD.  Design and methods: RNA samples from white blood cells of five ADHD patients and five healthy controls were combined to create one pooled patient library and one control library. We identified 20 candidate miRNAs with the next-generation sequencing (NGS) technique (Illumina). Blood samples were then collected from a Training Set (68 patients and 54 controls) and a Testing Set (20 patients and 20 controls) to identify the expression profiles of these miRNAs with real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). We used receiver operating characteristic (ROC) curves and the area under the curve (AUC) to evaluate both the specificity and sensitivity of the probability score yielded by the support vector machine (SVM) model. Results: We identified 13 miRNAs as potential ADHD biomarkers. The ΔCt values of these miRNAs in the Training Set were integrated to create a biomarker model using the SVM algorithm, which demonstrated good validity in differentiating ADHD patients from control subjects (sensitivity: 86.8%, specificity: 88.9%, AUC: 0.94, p < 0.001). The results of the blind testing showed that 85% of the subjects in the Testing Set were correctly classified using the SVM model alignment (AUC: 0.91, p < 0.001). The discriminative validity is not influenced by patients’ age or

gender, indicating both the robustness and the reliability of the SVM classification model. Conclusion: As measured in peripheral blood, miRNA-based biomarkers can aid in the differentiation of ADHD in clinical settings. Additional studies are needed in the future to clarify the ADHD-associated gene functions and biological mechanisms modulated by miRNAs.

What is the effect of ADHD stimulant medication on heart rate and blood pressure in a community sample of children? Meagan D. St. Amour; Deborah D. O’Leary; John Cairney; Terrance J. Wade Canadian Journal of Public Health (2018)DOI: https://doi.org/10.17269/s41997-018-0067-0 Abstract ObjectiveThis study examines the effect of ADHD (attention deficit hyperactivity disorder) diagnosis and stimulant medication for ADHD treatment on child heart rate (HR) and blood pressure (BP) in a community sample compared to children without ADHD. MethodsData came from the HBEAT Study. From 49 schools, 2013 participants from southern Ontario in grades 5–8 were included. Linear regression analyses examined the effects of ADHD medications on systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate adjusting for age, sex and body mass index (BMI). Results

Compared to non-ADHD children and adjusting for age, sex and BMI, children with ADHD on stimulant medication had a 12.3-bpm higher HR, and 3.0-mmHg higher SBP and DBP (all statistically significant). Children with ADHD on no stimulant medication had no differences in HR and BP compared to those children without a diagnosis of ADHD. ConclusionStimulant medications used to treat ADHD are associated with elevated HR and higher BP. While it is unknown whether children on ADHD medications may be at risk for longer-term cardiovascular issues, this study supports the need to examine the long-term consequences of ADHD medication.

Assessment of Social Skills and Self-Esteem of School Children with ADHD at Selected Settings Catherine T. Golden, Nancy R.Grace., Mala K.Kanchana, Kanniammal C., Arullapan Judie International Journal of Nursing EducationYear : 2018, Volume : 10, Issue : 2 Page: 99-102DOI : 10.5958/0974-9357.2018.00050.8 Abstract Attention Deficit Hyperactivity Disorder is a prevalent neurobehavioral disorder of childhood that affects scholastic skills, self-esteem and social functioning of school-age children. The objective were (i) to assess the level of social skills and self-esteem of school children with Attention Deficit Hyperactivity Disorder and (ii) to associate social skills and self-esteem with their selected demographic variables. Quantitative research approach utilizing non-experimental descriptive research design was adopted. The study was conducted in the selected Government, Matriculation and Public Schools. The samples were 140 school children aged 8–11 years utilizing

purposive sampling technique. Social competence scale and Metcalfe behavioral checklist of self-esteem were the tools in the study. The analysis revealed 57.1%(80) children to have moderate social skills, 41.4%(58) have mild social skills, 1.4% (2) have poor social skills and none have adequate social skills. With regards to self-esteem 64.3% (90) of children have low self-esteem, 35.7% (50) have middle self-esteem and none have high self-esteem. The mean score for social skills was 54.24 and standard deviation 10.05 and for self-esteem the mean score and standard deviation was found to be 45 and 9.38. Type of caregiver and treatment underwent was associated with social skills and in self-esteem, religion and type of caregiver was associated.

Developmental Trajectory of Motor Deficits in Preschool Children with ADHD. Sweeney KL, Ryan M, Schneider H, Ferenc L, Denckla MB, Mark Mahone E. Dev Neuropsychol. 2018 May 14:1-11. doi: 10.1080/87565641.2018.1466888. Abstract Motor deficits persisting into childhood (>7 years) are associated with increased executive and cognitive dysfunction, likely due to parallel neural circuitry. This study assessed the longitudinal trajectory of motor deficits in preschool children with ADHD, compared to typically developing (TD) children, in order to identify individuals at risk for anomalous neurological development. Participants included 47 children (21 ADHD, 26 TD) ages 4-7 years who participated in three visits (V1, V2, V3), each one year apart (V1=48-71 months, V2=60-83 months, V3=72-95 months). Motor variables assessed included speed (finger tapping and sequencing), total overflow, and axial movements from the Revised Physical and Neurological Examination for

Subtle Signs (PANESS). Effects for group, visit, and group-by-visit interaction were examined. There were significant effects for group (favoring TD) for finger tapping speed and total axial movements, visit (performance improving with age for all 4 variables), and a significant group-by-visit interaction for finger tapping speed. Motor speed (repetitive finger tapping) and quality of axial movements are sensitive markers of anomalous motor development associated with ADHD in children as young as 4 years. Conversely, motor overflow and finger sequencing speed may be less sensitive in preschool, due to ongoing wide variations in attainment of these milestones.

Improving the quality of physical health monitoring in CAMHS for children and adolescents prescribed medication for ADHD. Oxley C, Moghraby OS, Samuel R, Joyce DW. BMJ Open Qual. 2018 May 5;7(2):e000213. doi: 10.1136/bmjoq-2017-000213. eCollection 2018. Abstract Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by a persistent, pervasive pattern of inattention, impulsivity and hyperactivity. Stimulant medication such as methylphenidate has an established evidence base in the treatment of children and adolescents with ADHD. However, it is also associated with a risk of side effects which may include decreased appetite, increased blood pressure and possible reduced growth. Monitoring physical health in children and adolescents prescribed medication for ADHD is a key clinical responsibility and includes a number of parameters as outlined in the National Institute for Health and Care Excellence Guidelines. Ascertaining the centiles of physical observations is essential to put these into developmental context and accurately inform treatment

decisions. This quality improvement project aimed to improve physical health monitoring in children and adolescents prescribed stimulant medication for ADHD within a large specialist urban inner-city Child and Adolescent Mental Health Service (CAMHS) in South London and Maudsley NHS Foundation Trust. Baseline data were obtained to establish the quality of physical monitoring including blood pressure, height, weight and centiles. Targeted interventions included the development of a novel web-based application designed to calculate and record centiles. We report an improvement in total proportion compliance with physical health monitoring from 24% to 75%. The frequency of recording baseline blood pressure centiles increased from 0% to 62%; recording baseline height centiles increased from 37% to 81% and recording baseline weight centiles increased from 37% to 81%. Improvement in the delivery of high-quality care was achieved and sustained through close collaboration with clinicians involved in the treatment pathway in order to elicit and respond effectively to feedback for improvement and codevelop interventions which were highly effective within the clinical system. We believe this model to be replicable in other CAMHS services and ADHD clinics to improve the delivery of high-quality clinical care.

Inter- and Intraindividual Variation of Methylphenidate Concentrations in Serum and Saliva of Patients with Attention-Deficit/Hyperactivity Disorder. Preiskorn J, Studer S, Rauh R, Lukačin R, Geffert C, Fleischhaker C, Clement HW, Schulz E, Biscaldi M. Ther Drug Monit. 2018 May 3. doi: 10.1097/FTD.0000000000000520. Abstract Background

Therapeutic drug monitoring (TDM) is becoming increasingly important in psychiatric therapy; especially in children. However, for several reasons, it cannot yet be implemented as a daily routine in clinical or outpatient settings. To evaluate new, non-invasive procedures; blood and saliva (oral fluid) samples were collected from patients with attention-deficit/hyperactivity disorder (ADHD) who were also being administered methylphenidate (MPH). The study's main purposes were to correlate MPH concentrations in serum and saliva between subjects; and to analyze intraindividual variation of serum concentration. MethodsThirty-six ADHD patients (27 children and 9 adults) on methylphenidate medication were included for drug analysis. MPH and its major metabolite ritalinic acid (RA) were quantified using LC-MS/MS measurements. The following correlations were investigated: 1) between drug concentrations in serum and saliva, and 2) between pH value and saliva to serum concentration ratio. Furthermore, the mean intraindividual MPH-concentration fluctuation in saliva under constant frame conditions was analyzed. ResultsAfter quantification, MPH concentrations were approximately 5 times higher in the saliva than in the serum, while the concentrations of RA were much lower in saliva. We found significant correlations between concentrations of MPH in serum and saliva (r=0.51, p<0.05). Saliva MPH measures, compared to serum, were pH-dependent(r=-0.56, p<0.01). Daily coefficient of variance of saliva concentration in children taking constant medication was 27.3% (11%-42 %), while the coefficient of variance for the ratio of saliva to serum was 122% (2%-2060%). ConclusionsOur data indicates that the interindividual variation in saliva to serum concentrations is rather high, while the

intraindividual variation is fairly low, as already shown in the literature for repeated citalopram serum measurements. Saliva may well serve as an alternative matrix for TDM of MPH in ADHD patients, especially for follow-up examinations. Future research should focus on analyzing the relationship between drug levels in saliva and clinical effects; as well as on understanding the mechanisms that generate saliva drug concentrations. These are essential steps prior to potential clinical use.

The Compensatory ADHD Behaviors Scale (CABS): Development and Initial Validation. Castagna PJ, Roye S, Calamia M. Assessment. 2018 May 1:1073191118774841. doi: 10.1177/1073191118774841. Abstract Several measures are available that assess inattention, hyperactivity/impulsivity, and executive functioning deficits. Treatments for adults with attention-deficit/hyperactivity disorder (ADHD) and skill-based academic interventions focus on improving compensatory strategies to ameliorate functional impairment; however, no measure exists that examines the compensatory behaviors adults utilize to compensate for the functional deficits associated with inattention and hyperactivity/impulsivity. The current study aimed to determine the psychometric properties of the Compensatory ADHD Behaviors Scale (CABS). Five-hundred participants ( Mage = 36.83, SD = 11.57) completed measures of ADHD symptomatology, executive functioning, functional impairment, mood disorder symptoms, and the CABS. Analyses revealed that scales assessing both use and effectiveness of compensatory behaviors subscales had similar factor structures, reflecting present- and future-oriented behaviors. The present-, but not future-oriented, behaviors significantly related to ADHD symptomatology,

executive dysfunction, and functional impairment; effectiveness of present-oriented compensatory behaviors demonstrated incremental validity in predicting impairment. Compensatory strategies may be a useful variable to measure when examining functional impairment associated with inattention and hyperactivity/impulsivity. The current study provides preliminary evidence of the ability of CABS to validly measure various strategies associated with (clinical and subclinical) ADHD symptomatology, executive functioning, and overall impairment.

Health and educational implications of prematurity in the United States: National Survey of Children's Health 2011/2012 data. Kelly MM. J Am Assoc Nurse Pract. 2018 Mar;30(3):131-139. doi: 10.1097/JXX.0000000000000021. Abstract BACKGROUND AND PURPOSE:Preterm birth is a significant public health issue, with children born prematurely experiencing educational and health difficulties throughout childhood. The aim of the descriptive secondary data analysis was to compare health implications and educational experiences in children born prematurely compared with children born at term. METHODS:The 2011/2012 National Survey of Children's Health data set was explored using separate chi-square tests of homogeneity to investigate differences in the occurrence of chronic health conditions and educationally relevant outcomes: individualized family services plan/individualized education plan (IFSP/IEP), and grade repetition between

children born prematurely compared with those born at term. CONCLUSIONS:The six most frequently occurring chronic health conditions that disproportionally affected children born prematurely include the following: attention deficit disorder/attention deficit hyperactive disorder (odds ratio [OR], 1.59), anxiety (OR, 1.63), asthma (OR, 1.7), learning disability (OR, 2.07), speech problems (OR, 2.27), and developmental delay (OR, 3.17). Preterm birth negatively affects the educational experience of CBP as measured by increased report of IFSP/IEP and repeated grades across all age categories. IMPLICATIONS FOR PRACTICE:All health care providers have an important role in preventing preterm birth and in supporting the children and families affected by preterm birth. Appreciation of the incidence and prevalence of the health conditions and educational difficulties associated with preterm birth is essential for facilitating access to appropriate resources. Beyond patient interactions, these modifiable yet additive factors should inform health policy and planning.

A Prospective Birth Cohort Study on Early Childhood Lead Levels and Attention Deficit Hyperactivity Disorder: New Insight on Sex Differences. Ji Y, Hong X, Wang G, Chatterjee N, Riley AW, Lee LC, Surkan PJ, Bartell TR, Zuckerman B, Wang X. J Pediatr. 2018 May 8. pii: S0022-3476(18)30488-8. doi: 10.1016/j.jpeds.2018.03.076. Abstract OBJECTIVE:To investigate the prospective associations between early childhood lead exposure and subsequent risk of attention

deficit hyperactivity disorder (ADHD) in childhood and its potential effect modifiers. STUDY DESIGN:We analyzed data from 1479 mother-infant pairs (299 ADHD, 1180 neurotypical) in the Boston Birth Cohort. The child's first blood lead measurement and physician-diagnosed ADHD was obtained from electronic medical records. Graphic plots and multiple logistic regression were used to examine dose-response associations between lead exposure and ADHD and potential effect modifiers, adjusting for pertinent covariables. RESULTS:We found that 8.9% of the children in the Boston Birth Cohort had elevated lead levels (5-10 µg/dL) in early childhood, which was associated with a 66% increased risk of ADHD (OR, 1.66; 95% CI, 1.08-2.56). Among boys, the association was significantly stronger (OR, 2.49; 95% CI, 1.46-4.26); in girls, the association was largely attenuated (P value for sex-lead interaction = .017). The OR of ADHD associated with elevated lead levels among boys was reduced by one-half if mothers had adequate high-density lipoprotein levels compared with low high-density lipoprotein, or if mothers had low stress compared with high stress during pregnancy. CONCLUSIONS:Elevated early childhood blood lead levels increased the risk of ADHD. Boys were more vulnerable than girls at a given lead level. This risk of ADHD in boys was reduced by one-half if the mother had adequate high-density lipoprotein levels or low stress. These findings shed new light on the sex difference in ADHD and point to opportunities for early risk assessment and primary prevention of ADHD.

Differentiating between ADHD and ASD in childhood: some directions for practitioners 

Nanda Rommelse; Janne Visser; Catharina Hartman European Child & Adolescent Psychiatry (2018)DOI: https://doi.org/10.1007/s00787-018-1165-5 Introduction Autism Spectrum Disorders (ASD) belong to a wider group of neurobiological developmental disorders, along with Attention-Deficit/Hyperactivity Disorders (ADHD) and other disorders in specific areas of development [1]. All of these disorders manifest through many common characteristics and often appear simultaneously, which can make it hard to differentiate between two or more disorders. This especially holds true for ASD and ADHD: many publications in European Child and Adolescent Psychiatry have documented on the frequent co-morbidity and resemblance in associated factors between both disorders (e.g., [2, 3, 4, 7, 8]). There is no diagnostic test, standardised observation or questionnaire that is specially designed to distinguish between ADHD and ASD. The question is to what extent this is a feasible or even sensible goal and has additive value for the parent or the child. A significant percentage of children does in fact show characteristics of both disorders, in which sometimes criteria for both disorders are met, but sometimes just not met [9, 10]. The basic idea that is often employed is to examine which symptoms are the most conspicuous (regardless of which of the two disorders they belong to) and cause the most suffering and/or contribute to functional impairments. When the symptoms can largely be attributed to ASD, the legitimate question has to be asked whether it adds any value for the child and the parents to also diagnose ADHD. In our view, the answer would be: only when the ADHD symptoms cause significant suffering and/or lead to impairments in everyday life and, therefore, require ADHD-specific interventions. This holds equally true the other way around.

Demographic and Clinical Predictors of Hospitalization in Preschoolers With ADHD. Peskin M, Rotem A, Golubchik P, Weizman A, Manor I. J Atten Disord. 2018 May 1:1087054718772145. doi: 10.1177/1087054718772145 Abstract OBJECTIVE:This chart review study characterized demographic and clinical indicators of the need for hospitalization in preschoolers with ADHD. METHOD:Medical records of preschoolers with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) ADHD during 2009-2012 were systematically reviewed. The cohort included 111 children (aged 5.13 ± 0.55 years, 77.47% boys). The demographic and clinical variables of hospitalized at a day-care unit ( n = 30) and nonhospitalized ( n = 81) preschoolers were compared. RESULTS:Hospitalized preschoolers were younger ( p < .0001), had higher rates of unmarried mothers ( p < .001), and a higher number of comorbidities. The number of inattentive/hyperactivity-impulsivity symptoms was similar in both groups. Neurodevelopmental comorbidity ( p < .0001), but not externalized ( p = .82) or internalized ( p = .20) psychopathology, was significantly higher in the hospitalized group. CONCLUSION:ADHD severity in preschoolers tends to be associated with younger age, specific parenthood constellations, and a high rate of neurodevelopmental, but not other, comorbidities. These findings emphasize the importance of the

neurodevelopmental context in planning ADHD interventions at preschool age.

Development of the Subtle ADHD Malingering Screener. Ramachandran S, Holmes ER, Rosenthal M, Banahan BF 3rd, Young J, Bentley JP. Assessment. 2018 May 1:1073191118773881. doi: 10.1177/1073191118773881. Abstract The objective of this study was to develop a subtle self-report scale-the Subtle ADHD Malingering Screener (SAMS)-to screen for malingering among individuals reporting symptoms of attention deficit/hyperactivity disorder (ADHD). This study employed a cross-sectional experimental design with an ADHD group, a control group-comprising individuals without ADHD-and a malingering group-comprising individuals without ADHD who were instructed to feign ADHD in their responses. Factor analysis and psychometric testing were conducted to develop a final scale that could distinguish the malingering from the other groups. A 10-item, two-factor solution was obtained for the SAMS, with a sensitivity of 90.3% and specificity of 80.1%. The SAMS presents an innovative approach to help reduce overdiagnosis of ADHD and misuse of prescription stimulants. The efficient, straightforward form of the measure particularly enhances its potential application in both medical and psychosocial clinical settings.

QT prolongation by dexamphetamine: Does experience matter? Schrantee A, Václavů L, Reneman L, Verberne HJ, Booij J, Tan HL. 

J Cardiovasc Electrophysiol. 2017 Aug;28(8):912-916. doi: 10.1111/jce.13235.  Abstract INTRODUCTION:Case reports of life-threatening cardiac arrhythmias and sudden cardiac arrest (SCA) among amphetamine users have raised serious concerns about the cardiac safety of this class of drugs. This is important in light of the high prevalence of dexamphetamine (dAMPH) prescription for attention-deficit/hyperactivity disorder (ADHD), and its rising use as a recreational drug. The objective was to investigate electrocardiogram (ECG) parameters upon intravenous administration of a single dAMPH dose in habitual recreational dAMPH users (users) and healthy gender/age/ intelligence-quotient-matched controls (non-users). METHODS AND RESULTS:ECG recordings were made in 18 users and 18 non-users during administration of dAMPH (0.3 mg/kg body weight). Baseline ECG was normal in both groups. dAMPH elicited increased heart rate and corrected QT time (QTc) prolongation in both groups (all P < 0.001, QTc = 502 in one individual). QTc prolongation was attenuated in users compared to non-users, exhibiting a significant interaction effect (P = 0.04). CONCLUSION:SCA associated with amphetamine use may be related to its QTc prolonging effects, particularly during first-time use. These observations may provide a rationale for conducting ECG analysis immediately after the first-time use of amphetamines, as this could potentially unmask vulnerable individuals.

Preliminary evidence of altered gray matter volume in subjects with internet gaming disorder: associations

with history of childhood attention-deficit/hyperactivity disorder symptoms. Lee D, Namkoong K, Lee J, Jung YC. Brain Imaging Behav. 2018 May 11. doi: 10.1007/s11682-018-9872-6. Abstract Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid with Internet gaming disorder (IGD). Although childhood ADHD symptoms may decline during late brain maturation, structural alterations in some brain areas may persist into adulthood. This study investigated whether young adults with IGD and a history of childhood ADHD symptoms had gray matter volume (GMV) alterations that were distinct from subjects without a history of childhood ADHD. As an exploratory investigation, we conducted a whole-brain voxel-based morphometry with the diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm and applied an uncorrected threshold at the voxel level for multiple comparisons. GMVs of IGD subjects with a history of childhood ADHD (IGDADHD+ group; n = 20; 24.5 ± 2.5 years) were compared to those of subjects without a history of childhood ADHD (IGDADHD- group; n = 20; 23.9 ± 2.5 years) and controls (n = 20; 22.7 ± 2.4 years). Compared with controls, both IGD groups had a smaller GMV in the right anterior cingulate cortex, the left inferior frontal gyrus, and the left insula, yet had a larger GMV in the right angular gyrus. The IGDADHD+ group had a larger GMV in the right precuneus than the IGDADHD- group and controls. When controlling for other comorbid psychiatric symptoms, the IGDADHD+ group also had a smaller GMV in the right inferior frontal gyrus. In conclusion, we found that young adults with IGD and a history of childhood ADHD symptoms had characteristic GMV alterations, which may be linked with their manifestation of childhood ADHD.

Associations between attention-deficit/hyperactivity disorder symptoms and dietary habits in elementary school children. Kim KM, Lim MH, Kwon HJ, Yoo SJ, Kim EJ, Kim JW, Ha M, Paik KC. Appetite. 2018 May 11. pii: S0195-6663(18)30140-5. doi: 10.1016/j.appet.2018.05.004. Abstract OBJECTIVE:The aim of the present study was to investigate the associations between dietary habits and attention deficit/hyperactivity disorder (ADHD) symptoms in elementary school children. METHODS:The parents of 16,831 participating children assessed the ADHD symptoms of their children by responding to the Korean version of the ADHD rating scale (K-ARS). Parents also responded to the food habit questionnaire, which consists of 8 items regarding the eating pace, the frequency of overeating, and patterns of eating six types of food: fast food, soft drinks, instant noodles, fruit and vegetables, and milk. RESULTS:K-ARS scores were positively associated with higher consumption of foods categorized as unhealthy, including fast food, soft drinks, and instant noodles, and negatively associated with higher consumption of fruit and vegetables categorized as healthy foods. K-ARS scores were also higher in the groups who overate more frequently and ate faster or slower compared to other family members. CONCLUSION:

Our findings may provide useful clinical information for dietary interventions in children with ADHD.

Visual processing as a potential endophenotype in youths with attention-deficit/hyperactivity disorder: A sibling study design using the counting Stroop functional MRI. Fan LY, Shang CY, Tseng WI, Gau SS, Chou TL. Hum Brain Mapp. 2018 May 10. doi: 10.1002/hbm.24214. Abstract Deficits in inhibitory control and visual processing are common in youths with attention-deficit/hyperactivity disorder (ADHD), but little is known about endophenotypes for unaffected siblings of youths with ADHD. This study aimed to investigate the potential endophenotypes of brain activation and performance in inhibitory control and visual processing among ADHD probands, their unaffected siblings, and neurotypical youths. We assessed 27 ADHD probands, 27 unaffected siblings, and 27 age-, gender-, and IQ-matched neurotypical youths using the counting Stroop functional magnetic resonance imaging and two tasks of the Cambridge Neuropsychological Test Automated Battery (CANTAB): rapid visual information processing (RVP) for inhibitory control and spatial span (SSP) for visual processing. ADHD probands showed greater activation than their unaffected siblings and neurotypical youths in the right inferior frontal gyrus (IFG) and anterior cingulate cortex. Increased activation in the right IFG was positively correlated with the mean latency of the RVP in ADHD probands. Moreover, ADHD probands and their unaffected siblings showed less activation in the left superior parietal lobule (SPL) than neurotypical youths. Increased activation

in the left SPL was positively correlated with the spatial length of the SSP in neurotypical youths. Our findings suggest that less activation in the left SPL might be considered as a candidate imaging endophenotype for visual processing in ADHD.

Methylphenidate Induced Lip and Tongue Biting. Gokcen C, Karadag M, Aksoy I. Clin Psychopharmacol Neurosci. 2018 May 31;16(2):218-220. doi: 10.9758/cpn.2018.16.2.218. Abstract Attention deficit hyperactivity disorder (ADHD) is a life-long neurodevelopmental disorder and treatment depends on pharmacotherapy because of its biological origin. Stimulant drugs are the most commonly used treatment for ADHD and they have various side effects. Herein, we report a case who bit off the tip of her tongue with Osmotic Release Oral System methylphenidate (OROS MPH) 36 mg/day, bit the tip of her lower lip with immediate release (IR) MPH 10 mg/day and lateral part of her tongue with IR MPH 20 mg/day. A diagnosis of epilepsy was unlikely because of the normal neurological examination and electroencephalography findings. This case was considered as an atypical side effect of MPH such as perseverative/compulsive behaviours and movement disorders. Clinicians should be aware of that stimulant medications may cause lip and tongue biting behavior and this may effect treatment compliance tremendously.

Circadian activity rhythm in adult attention-deficit hyperactivity disorder. Tonetti L, Conca A, Giupponi G, Filardi M, Natale V. 

J Psychiatr Res. 2018 May 6;103:1-4. doi: 10.1016/j.jpsychires.2018.05.002. Abstract The aim of the present study was to analyze the features of circadian motor activity rhythm of adult attention-deficit hyperactivity disorder (ADHD) patients, by means of functional linear modeling, within the theoretical framework of the two-process model of sleep regulation. Thirty-two ADHD patients and 32 healthy controls (HCs) participated the study. Actiwatch AW64 actigraph was used to quantify motor activity data in 1-min epochs. Participants wore the actigraph on the non-dominant wrist for seven consecutive days. Results show that ADHD patients had significantly higher motor activity than HCs from 4:00 to 7:00, with a peak around 5:00, and from 12:00 to 18:00, with another peak around 14:00. According to the two-process model of sleep regulation, the circadian activity rhythm of ADHD patients may indicate a lower homeostatic sleep pressure, as reflected by the absence of post-lunch dip, which could be considered a potential trait marker of adult ADHD.

Effects of mindfulness and psychoeducation on working memory in adult ADHD: A randomised, controlled fMRI study. Bachmann K, Lam AP, Sörös P, Kanat M, Hoxhaj E, Matthies S, Feige B, Müller H, Özyurt J, Thiel CM, Philipsen A. Behav Res Ther. 2018 May 7;106:47-56. doi: 10.1016/j.brat.2018.05.002.  Abstract Adult attention-deficit/hyperactivity disorder (ADHD) is a serious mental disorder associated with impaired neurocognitive performance related to working memory

function. Recent clinical trials have suggested that mindfulness is a promising intervention in adults with ADHD. We performed a randomised controlled clinical trial to investigate working memory (WM) with an n-back task in adults with ADHD during fMRI before and after an 8-week mindfulness intervention (MAP) compared with psychoeducation (PE). ADHD symptoms were assessed using the self- and observer-rated Conners Adult ADHD Rating Scales (CAARS). The complete pre-post data of 21 MAP and 19 PE participants were analysed. We found no group difference in ADHD symptoms or task performance at the pre-measurement, but there was a significant decrease in ADHD symptoms and significant improvement in task performance in both groups at the post-measurement. Furthermore, we found a significant increase in task-related activation in the right parietal lobe, with no difference between groups. Exploratory two-sample paired t-tests revealed significant increased brain activation after MAP in the bilateral inferior parietal lobule, right posterior insula and right precuneus. A decrease in self-rated 'Inattention/Memory Problems' after MAP compared to baseline was associated with stronger activation in parts of the left putamen, globus pallidus and thalamus.

Reduced hemispheric asymmetry of brain anatomical networks in attention deficit hyperactivity disorder. Li D, Li T, Niu Y, Xiang J, Cao R, Liu B, Zhang H, Wang B. Brain Imaging Behav. 2018 May 11. doi: 10.1007/s11682-018-9881-5. Abstract Despite many studies reporting a variety of alterations in brain networks in patients with attention deficit hyperactivity disorder (ADHD), alterations in hemispheric anatomical networks are still unclear. In this study, we investigated topology alterations in hemispheric white

matter in patients with ADHD and the relationship between these alterations and clinical features of the illness. Weighted hemispheric brain anatomical networks were first constructed for each of 40 right-handed patients with ADHD and 53 matched normal controls. Then, graph theoretical approaches were utilized to compute hemispheric topological properties. The small-world property was preserved in the hemispheric network. Furthermore, a significant group-by-hemisphere interaction was revealed in global efficiency, local efficiency and characteristic path length, attributed to the significantly reduced hemispheric asymmetry of global and local integration in patients with ADHD compared with normal controls. Specifically, reduced asymmetric regional efficiency was found in three regions. Finally, we found that the abnormal asymmetry of hemispheric brain anatomical network topology and regional efficiency were both associated with clinical features (the Adult ADHD Self-Report Scale and Wechsler Adult Intelligence Scale) in patients. Our findings provide new insights into the lateralized nature of hemispheric dysconnectivity and highlight the potential for using brain network measures of hemispheric asymmetry as neural biomarkers for ADHD and its clinical features.

Measuring Impulsivity in Children: Adaptation and Validation of a Short Version of the UPPS-P Impulsive Behaviors Scale in Children and Investigation of its Links With ADHD Marie Geurten, Corinne Catale, Philippe Gay, Sandrine Deplus, Joël Billieux Journal of Attention Disorders (2018)DOI: https://doi.org/10.1177/1087054718775831 Abstract Objective: 

Impulsivity is a multifaceted construct known to play a crucial role in the development and maintenance of a wide range of problematic behaviors and psychological disorders in children.  Method: In this study, we adapted the short French adult version of the UPPS-P (urgency–premeditation–perseverance–sensation seeking–positive urgency) Impulsive Behaviors Scale for use with children (short UPPS-P-C) and tested its psychometric properties.  Results: Confirmatory factor analyses conducted on a sample of 425 children (aged 8-14 years) supported the five-factor structure of the scale. Additional analyses emphasized the good internal and test–retest reliability of the short UPPS-P-C. Furthermore, our results also revealed that lack of premeditation, positive urgency, and negative urgency subscales were able to discriminate between children diagnosed with ADHD and their matched controls.  Conclusion: These results suggest that the short UPPS-P-C may be considered as a promising time-saving tool to assess impulsivity traits in healthy children and in children with psychiatric disorders.

Use and Characteristics of Antipsychotic/Methylphenidate Combination Therapy in Children and Adolescents with a Diagnosis of Attention-Deficit/Hyperactivity Disorder Scholle O, Banaschewski T, Enders D, Garbe E, Riedel O. J Child Adolesc Psychopharmacol. 2018 May 16. doi: 10.1089/cap.2018.0024. Abstract

 OBJECTIVE:Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) frequently have comorbidities that are potential indications for antipsychotics (APs). Some studies have suggested that the combined use of methylphenidate (MPH) and APs is increasing in this population group. Longitudinal analyses and in-depth investigations on the substance level are lacking. This study aimed to estimate the cumulative proportion of concomitant AP/MPH use in children and adolescents with ADHD over a follow-up of up to 9 years and to describe patient characteristics stratified by specific AP drug. METHODS:Based on claims data, concomitant AP/MPH use was identified among 67,595 children and adolescents with ADHD starting MPH treatment between 2005 and 2013. Characteristics and diagnoses-including those indicating appropriateness of AP use according to approved indications and/or guidelines-were examined at the time of first AP/MPH combination therapy. In addition, subsequent use of AP/MPH combination therapy was evaluated. RESULTS:The cumulative proportion of individuals with any AP/MPH combination therapy rose to over 6% within 9 years after initiating MPH. The most frequent APs first used in combination with MPH were risperidone (72%), pipamperone (15%), and tiapride (8%). Percentages of psychiatric hospitalization in the year preceding the first combination therapy with MPH were 33%, 43%, and 19%, respectively. The proportion of individuals with potentially appropriate use was high (>72%) in risperidone/MPH and tiapride/MPH and low (15%) in pipamperone/MPH combination users. Conduct disorders and tic disorders were frequent in users who were prescribed MPH with risperidone and tiapride, respectively. One-quarter of

patients with AP/MPH combination therapy were one-time-only combination users. CONCLUSION:Our study suggests that a considerable proportion of children and adolescents with ADHD receive MPH in combination with APs and that this is a factor not only during the first years of MPH treatment. ADHD guidelines should specify algorithms concerning the use of AP medication.

No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD Muris P, Roodenrijs D, Kelgtermans L, Sliwinski S, Berlage U, Baillieux H, Deckers A, Gunther M, Paanakker B, Holterman I. Child Psychiatry Hum Dev. 2018 May 16. doi: 10.1007/s10578-018-0812-x. Abstract In this naturalistic clinical study, we explored the applicability and clinical effectiveness of Cogmed WMT, pharmacotherapy, and their combination for clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Ninety youth with ADHD (ages 6-16 years) and their parents were offered the possibility to choose one of the three interventions. The motives for choosing various interventions were quite different. Medication was chosen because this treatment was expected to be most effective, but also because the Cogmed WMT program was regarded as too taxing. The choice for Cogmed WMT was mainly negatively motivated: participants tended to be strongly against the use of medication, found it a too rigorous step,

or feared side effects and addiction problems. The choice for the combination treatment was strongly positively motivated: parents and youth indicated that they wanted to receive the best possible intervention and part of them also had high expectations of Cogmed WMT. In terms of clinical effectiveness, pharmacotherapy with stimulant medication and the combination treatment produced larger reductions in ADHD symptomatology than Cogmed WMT. Further, results indicated that Cogmed WMT selectively enhanced working memory performance. Finally, after conducting Cogmed WMT, youths and parents were more 'open' to accept pharmacotherapy as intervention, probably because the training increased greater insight in and awareness of the problematic features of ADHD.

25-Hydroxvitamin D concentrations are not lower in children with bronchial asthma, atopic dermatitis, obesity, or attention-deficient/hyperactivity disorder than in healthy children Reinehr T, Langrock C, Hamelmann E, Lücke T, Koerner-Rettberg C, Holtmann M, Legenbauer T, Gest S, Frank M, Schmidt B, Radkowski K, Jöckel KH. Nutr Res. 2018 Apr;52:39-47. doi: 10.1016/j.nutres.2018.01.002. Abstract Vitamin D (vitD) is involved in immune regulation, and its receptor has been identified in several tissues including lung, adipose tissue, brain, and skin. Based on these observations, it has been suggested that vitD has an essential role not only in bone metabolism but also in other diseases such as atopic dermatitis (AD), bronchial asthma (BA), attention-deficit/hyperactivity disorder (ADHD), and obesity because the affected tissues express vitD receptors. Furthermore, obesity, AD, and BA are regarded as inflammatory diseases. Therefore, we hypothesized that

vitD concentrations are lower in children with AD, BA, ADHD, and obesity compared to healthy children. We measured 25-hydroxyvitamin D concentrations in 235 children (60% boys, age 9.3±1.7years) with obesity, BA, AD, or ADHD and compared them to those of 3352 children from a healthy population. Additionally, parathyroid hormone was measured in the children with obesity, ADHD, BA, and AD. VitD concentrations were not lower in children with obesity, ADHD, BA, and AD compared to healthy children. In multiple regression analyses adjusted to migration background, time period of blood sample, age, and sex, VitD levels correlated significantly with the severity of AD measured by SCORing Atopic Dermatitis index and attention deficit measured by Conners questionnaire in ADHD. VitD levels were not linked to hyperactivity in ADHD, the severity of BA measured as forced expiration volume in the first second, or body mass index standard deviation score. Parathyroid hormone was not associated with the activity of any analyzed disease. In conclusion, most of our findings do not support the hypothesis that vitD is involved in the pathogenesis of these entities.

Estimated prevalence and incidence of diagnosed ADHD and health care utilization in adults in Sweden - a longitudinal population-based register study Polyzoi M, Ahnemark E, Medin E, Ginsberg Y. Neuropsychiatr Dis Treat. 2018 May 7;14:1149-1161. doi: 10.2147/NDT.S155838. eCollection 2018. Abstract BACKGROUND:Although the worldwide prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults is estimated to be between 2% and 5%, it is considered to be underdiagnosed. This register study explored the prevalence of diagnosed ADHD and incidence of newly

diagnosed ADHD in Swedish adults over time, and assessed comorbidities and pharmacologic treatment. METHODS:National Patient Register data were used to estimate the overall prevalence of adults (≥18 years) with a registered ADHD diagnosis from 2006 to 2011, and the incidence of newly registered diagnoses from 2007 to 2011. Data from the Prescribed Drug Register were used to estimate the mean dose of the most frequently prescribed ADHD medication. RESULTS:The estimated annual prevalence (N=44,364) of diagnosed ADHD increased from 0.58 per 1,000 persons in 2006 to 3.54 per 1,000 persons in 2011. The estimated annual incidence of newly diagnosed ADHD (N=24,921) increased from 0.39 per 1,000 persons to 0.90 per 1,000 persons between 2007 and 2011. At least one comorbidity was diagnosed in 52.6% of adults with ADHD (54.0% of newly diagnosed adults), with anxiety, substance use disorders, and depression being the most common. Among all adults with ADHD, 78.9% (65.7% of newly diagnosed adults) were prescribed ADHD medication and one-third were prescribed more than one add-on medication. Osmotic release oral system methylphenidate was the most commonly used medication. The mean daily dose was 51.5 mg, and was significantly higher in males, patients with substance use disorders, patients with drug holidays, and patients with at least one add-on medication. The most frequent concomitant medications were anxiolytics and hypnotics. CONCLUSION:In Sweden, the number of adults diagnosed with ADHD increased between 2006 and 2011, and the majority of patients were prescribed ADHD-specific medication. Over one-half of patients had psychiatric comorbidities; one-third were prescribed more than one add-on medication.

Consumption of pharmacologic ADHD medication was high in specific patient subpopulations.

Association of Inattention, Hyperactivity, and Hypersomnolence in Two Clinic-Based Adult Cohorts Régis Lopez, Jean-Arthur Micoulaud-Franchi, Laura Camodeca, Marie Gachet, Isabelle Jaussent, Yves Dauvilliers Journal of Attention Disorders (2018)DOI: https://doi.org/10.1177/1087054718775826 Abstract Objective: To assess the relationship between excessive daytime sleepiness (EDS), inattention, and hyperactivity/impulsivity in adults with ADHD and central hypersomnia.  Method: Drug-free adult patients with ADHD (n = 100) or hypersomnia (n = 100) were evaluated using a structured clinical interview and self-report questionnaires on ADHD symptoms and EDS.  Results: In all, 61% of patients with hypersomnia had clinically significant ADHD symptoms with 25% having an ADHD diagnosis (with both childhood and adulthood ADHD symptoms) and 36% ADHD-like symptoms, without history of childhood ADHD. EDS was reported in 47% of patients with ADHD, among whom 22% had a hypersomnolence disorder.  Conclusion: We confirmed the high frequency of ADHD and ADHD-like symptoms in central hypersomnia, and of EDS and hypersomnolence in ADHD in adults. The nature of the link between EDS, inattention, and hyperactivity appears to be

complex that may involve either a cause–effect relationship or intrinsic features of a similar neurodevelopmental dysfunction.

Neuropsychological Performance Patterns of Adult ADHD Subtypes Amy LeRoy, Claudia Jacova, Caedy Young Journal of Attention Disorders (2018)DOI: https://doi.org/10.1177/1087054718773927 Abstract Objective: Neuropsychological performance patterns associated with adult ADHD subtypes are unknown. The aim of the current systematic review was to identify and synthesize available literature regarding neuropsychological performance associated with adult ADHD subtypes.  Method: Searches were completed using the databases PsycINFO and PubMed for studies published before March 2017 addressing adult ADHD subtypes and neuropsychological performance. Data characterizing the neuropsychological tests utilized in each study were obtained and sorted into eight domains. To summarize the results of all comparisons (ADHD subtype compared with control, or to each other), we counted the proportion of tests within each domain with significant group differences.  Results/Conclusion: We deemed four domains informative in differentiating ADHD subtypes from controls. Of these, memory was the only domain that held promise in distinguishing ADHD-Inattentive and ADHD-Combined. Limitations of the available literature are highlighted and recommendations for future research are provided.

Risk of poisoning in children and adolescents with ADHD: a systematic review and meta-analysis Ruiz-Goikoetxea M, Cortese S, Magallón S, Aznárez-Sanado M, Álvarez Zallo N, Luis EO, de Castro-Manglano P, Soutullo C, Arrondo G. Sci Rep. 2018 May 15;8(1):7584. doi: 10.1038/s41598-018-25893-9. Abstract Poisoning, a subtype of physical injury, is an important hazard in children and youth. Individuals with ADHD may be at higher risk of poisoning. Here, we conducted a systematic review and meta-analysis to quantify this risk. Furthermore, since physical injuries, likely share causal mechanisms with those of poisoning, we compared the relative risk of poisoning and injuries pooling studies reporting both. As per our pre-registered protocol (PROSPERO ID CRD42017079911), we searched 114 databases through November 2017. From a pool of 826 potentially relevant references, screened independently by two researchers, nine studies (84,756 individuals with and 1,398,946 without the disorder) were retained. We pooled hazard and odds ratios using Robust Variance Estimation, a meta-analytic method aimed to deal with non-independence of outcomes. We found that ADHD is associated with a significantly higher risk of poisoning (Relative Risk = 3.14, 95% Confidence Interval = 2.23 to 4.42). Results also indicated that the relative risk of poisoning is significantly higher than that of physical injuries when comparing individuals with and without ADHD (Beta coefficient = 0.686, 95% Confidence Interval = 0.166 to 1.206). These findings should inform clinical guidelines and public health programs aimed to reduce physical risks in children/adolescents with ADHD.

Cognitive predictors of sequential motor impairments in children with dyslexia and/or attention deficit/hyperactivity disorder Marchand-Krynski MÈ, Bélanger AM, Morin-Moncet O, Beauchamp MH, Leonard G. Dev Neuropsychol. 2018 May 15:1-24. doi: 10.1080/87565641.2018.1467421. Abstract This study examined cognitive predictors of sequential motor skills in 215 children with dyslexia and/or attention deficit/hyperactivity disorder (ADHD). Visual working memory and math fluency abilities contributed significantly to performance of sequential motor abilities in children with dyslexia (N = 67), ADHD (N = 66) and those with a comorbid diagnosis (N = 82), generally without differentiation between groups. In addition, primary diagnostic features of each disorder, such as reading and inattention, did not contribute to the variance in motor skill performance of these children. The results support a unifying framework of motor impairment in children with neurodevelopmental disorders such as dyslexia and ADHD.

Cognitive Behavioral Therapy for Children With Anxiety and Comorbid Attention-Deficit/Hyperactivity Disorder Karen L. Gould, MRes, Melanie Porter, PhD, Heidi J. Lyneham, PhD, Jennifer L. Hudson, PhD Journal of the American Academy of Child & Adolescent Psychiatry (2018)DOI: https://doi.org/10.1016/j.jaac.2018.03.021 Abstract 

Objective1. To determine whether comorbid ADHD diagnosis (including subtype) predicts response to cognitive behavior therapy (CBT) for anxiety in children. 2. To examine change in ADHD symptoms after treatment of primary anxiety. MethodA sample of 842 children 5 to 18 years of age received CBT for a primary anxiety disorder. A subsample of 94 children met criteria for comorbid, mild-to-moderate ADHD, mostly comprising Predominantly Inattentive (n = 61) and Combined (n = 27) subtypes. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each timepoint (posttreatment, 3- and/or 6-month follow-up) and analyzed using linear and logistic mixed models. ResultsNeither ADHD diagnosis nor subtype predicted response or remission rates for children’s primary anxiety disorders. Children with ADHD also showed modest yet significant improvements in ADHD symptoms after CBT treatment for anxiety. ConclusionOur findings support the suitability of manualised group-based CBT for anxiety treatment in children with non-primary ADHD. Further research should examine whether the positive outcomes reported can be extended to children with primary or severe ADHD.

Mixed-Effects Modeling of Neurofeedback Self-Regulation Performance: Moderators for Learning in Children with ADHD Zuberer A, Minder F, Brandeis D, Drechsler R. Neural Plast. 2018 Mar 22;2018:2464310. doi: 10.1155/2018/2464310. eCollection 2018.

 Abstract INTRODUCTION:Neurofeedback (NF) has gained increasing popularity as a training method for children and adults with attention deficit hyperactivity disorder (ADHD). However, it is unclear to what extent children learn to regulate their brain activity and in what way NF learning may be affected by subject- and treatment-related factors. METHODS:In total, 48 subjects with ADHD (age 8.5-16.5 years; 16 subjects on methylphenidate (MPH)) underwent 15 double training sessions of NF in either a clinical or a school setting. Four mixed-effects models were employed to analyze learning: training within-sessions, across-sessions, with continuous feedback, and with transfer in which performance feedback is delayed. RESULTS:Age and MPH affected the NF performance in all models. Cross-session learning in the feedback condition was mainly moderated by age and MPH, whereas NF learning in the transfer condition was mainly boosted by MPH. Apart from IQ and task types, other subject-related or treatment-related effects were unrelated to NF learning. CONCLUSION:This first study analyzing moderators of NF learning in ADHD with a mixed-effects modeling approach shows that NF performance is moderated differentially by effects of age and MPH depending on the training task and time window. Future studies may benefit from using this approach to analyze NF learning and NF specificity. The trial name Neurofeedback and Computerized Cognitive Training in Different Settings for Children and Adolescents With ADHD is registered with NCT02358941.

Association of Maternal Exposure to Childhood Abuse With Elevated Risk for Attention Deficit Hyperactivity Disorder in Offspring. Roberts AL, Liew Z, Lyall K, Ascherio A, Weisskopf MG. Am J Epidemiol. 2018 May 14. doi: 10.1093/aje/kwy098.  Abstract Children whose mothers experienced childhood abuse are more likely to suffer various neurodevelopmental deficits. Whether an association exists specifically for attention deficit hyperactivity disorder (ADHD) is unknown. We examined the association of maternal experience of childhood abuse with ADHD in offspring, assessed by maternal report of diagnosis and validated with the ADHD Rating Scale-IV in a subsample, in the Nurses' Health Study II (n = 49,497 mothers, N offspring cases = 7,607, N offspring controls = 102,151). We examined whether ten adverse perinatal circumstances (e.g., prematurity, smoking) or socioeconomic factors accounted for a possible association. Exposure to abuse was associated with greater prevalence of ADHD in offspring (8.7% of offspring of women exposed to severe abuse vs. 5.5% of offspring of women not abused, P = 0.0001) and with greater risk for ADHD adjusted for demographic factors (male offspring, risk ratio (RR) = 1.6; 95% CI: 1.3, 1.9; female offspring, RR = 2.3, 95% CI: 1.7, 3.0). Adjusted for perinatal factors, the association of maternal childhood abuse with ADHD in offspring was slightly attenuated (male offspring, RR = 1.5; 95% CI: 1.2, 1.8; female offspring, RR = 2.1, 95% CI: 1.6, 2.8). We identified an association between maternal experience of childhood abuse and risk for ADHD in offspring, which was not explained by several important perinatal risk factors or socioeconomic status.

Psychostimulants: Influence on Body Mass Index and Height in a Pediatric Population with Attention-Deficit/Hyperactivity Disorder? Lentferink Yvette E. , van de Garde Ewoudt M.W. , Knibbe Catherijne A.J. , and van der Vorst Marja M.J Journal of Child and Adolescent Psychopharmacology (2018)DOI: http://doi.org/10.1089/cap.2017.0163 Abstract Objectives: Attention-deficit/hyperactivity disorder (ADHD) is often treated with psychostimulants. Psychostimulants' adverse effects on body mass index standard deviation score (BMI-sds) and height in children/adolescents with ADHD have been reported. However, literature is inconsistent, and it is unclear whether the observed effects are dosage- and/or BMI-dependent. Therefore, the aim of this retrospective observational study is to evaluate the influence of psychostimulants on BMI-sds and height-sds in a pediatric cohort with ADHD from an outpatient clinic, and to study the correlation between psychostimulant dosage and BMI-sds and height-sds change. Method: Participants ≤18 years of age diagnosed with ADHD who started with psychostimulants (methylphenidate) were studied. Changes in BMI-sds and height-sds over an 18-month treatment period were assessed in subgroups according to baseline BMI-sds, gender, and age. Furthermore, correlations between BMI-sds, height-sds, and psychostimulant dose were studied. Results: In total, 298 participants [median age 9.8 years, height-sds 0.0, BMI-sds 0.5, psychostimulant dosage 0.5 (0.2–1.4) mg/kg/day] were analyzed, with an underweight,

overweight, and obesity prevalence of 5%, 21%, and 7%, respectively. After 18 months of treatment a significant decline in BMI-sds (−0.4) and height-sds (−0.2) was observed. These effects were consistent in all subgroups except for no change in BMI-sds in the underweight subgroup and no change in height-sds in the overweight subgroup. Medication dosage was weakly correlated with change in BMI-sds [r = −0.3 (−0.9 to +0.5); p < 0.01] and height-sds [r = −0.2 (−0.4 to −0.1); p = 0.01]. Conclusion: After 18 months of psychostimulant treatment, a significant decline in BMI-sds and height-sds was observed. However, the correlation with psychostimulant dosage was weak, and the decline was not observed in all subgroups. Therefore, further studies on the etiology of BMI-change are warranted, particularly with regard to the ADHD symptoms.