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Objectives: Medication is the predominant treatment for childhood attention-deficit hyperactivity disorder (ADHD) but has side effects and limited longer-term effects. Mindfulness for children and their parents could be an alternative as it targets children's core symptoms and supports parents. This study compared the effectiveness of a family mindfulness-based intervention to methylphenidate in children with ADHD. Method: We conducted a randomised controlled trial (RCT) and a preference trial (PT) for families who refused randomisation. Mindfulness ("MYmind") consisted of 2-months weekly group-based 1.5-hr mindfulness sessions for children and parallel mindful parenting for their parents, plus a follow-up session 2 months later. Medication concerned 4-months short-acting methylphenidate. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed using multilevel modelling. Both parents and adolescents (not children) completed questionnaires on child ADHD pre-treatment, and at 2-, 4-, and 10-months follow-up, whereas teachers and blind observers completed these questionnaires at pre-treatment and 2-months follow-up only. Similarly, neuropsychological attention measures were administered pre-treatment and at 2-months follow-up only. Results: In the RCT, 91 children with ADHD (Mage=11.29, range 9–18, 71% boys), 172 parents (91 mothers, 81 fathers), 81 teachers, and 85 observers participated, and in the PT, 29 children (Mage=11.57, 55% boys), 52 parents (28 mothers, 24 fathers), 24 teachers, and 26 observers. Medication was more effective than family mindfulness at 2 and 4 months on multi-informant questionnaires but not on objective (neuropsychological and blind observer) measures. Differences between treatments diminished at mid-term even though in the medication group treatment was continued after 2 months while the mindfulness training was already finished at 2 months. Differences between treatment groups disappeared at 10 months, but note that in the long-term, children from the mindfulness arm started taking medication and vice versa, so that we cannot be sure to what extent the long-term results are caused by mindfulness, medication, or its combination. Findings in the PT and according to PP analyses were similar. Note moreover that 1 in 4 children (26%) discontinued taking medication during the first 2 months versus almost no families (2%) discontinued mindfulness, suggesting that mindfulness was more easily accepted. Conclusions: Overall, although mindfulness alone might not be sufficient for some families, family mindfulness training in general can be considered a non-pharmacological alternative or addition in the treatment of childhood ADHD. Preregistration: https://onderzoekmetmensen.nl/nl/trial/22179, 11.10.2013. [ABSTRACT FROM AUTHOR]

Background: Bipolar disorders (BDs) are co-morbid with attention deficit hyperactivity disorder (ADHD), making diagnosis and management more difficult and associated with poorer outcomes. So, this study was planned to find the prevalence and clinical implication of co-morbid ADHD in BD. Materials and Methods: In this cross-sectional study, a total of 110 euthymic BD patients were taken. They were screened for childhood ADHD symptoms and adult ADHD symptoms using the Wender Utah Rating Scale for ADHD and Adult ADHD Self-Report Screening Scale for DSM-5. Those were divided into three groups: Group A included BD patients without ADHD, Group B included bipolar patients with co-morbid adult ADHD (BD-aADHD), and Group C included bipolar patients who had a diagnosis of childhood ADHD (BD-cADHD). Results: The ADHD prevalence of 27% was found in bipolar patients. The age of onset of an episode of BD was significantly earlier and the total duration of illness was significantly higher in BD-aADHD and BD-cADHD compared to the BD without ADHD. The BD-aADHD and BD-cADHD groups showed a significantly higher number of total, manic and major depressive episodes as compared to the BD without ADHD group. BD-aADHD showed a significant greater number of hypomanic episodes as compared to BD without ADHD. Conclusions: The present study concludes that ADHD is a lifetime co-morbid condition in adults with BD. These patients have a more chronic and disabling course of BD which underscores the need to understand the potential benefit of controlling ADHD symptoms in this population. [ABSTRACT FROM AUTHOR]

Objectives: Knowledge of the urinary metabolomic profiles of healthy children and adolescents plays a promising role in the field of pediatrics. Metabolomics has also been used to diagnose disease, discover novel biomarkers, and elucidate pathophysiological pathways. Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in childhood. However, large-sample urinary metabolomic studies in children with ADHD are relatively rare. In this study, we aimed to identify specific biomarkers for ADHD diagnosis in children and adolescents by urinary metabolomic profiling. Methods: We explored the urine metabolome in 363 healthy children aged 1–18 years and 76 patients with ADHD using high-resolution mass spectrometry. Results: Metabolic pathways, such as arachidonic acid metabolism, steroid hormone biosynthesis, and catecholamine biosynthesis, were found to be related to sex and age in healthy children. The urinary metabolites displaying the largest differences between patients with ADHD and healthy controls belonged to the tyrosine, leucine, and fatty acid metabolic pathways. A metabolite panel consisting of FAPy-adenine, 3-methylazelaic acid, and phenylacetylglutamine was discovered to have good predictive ability for ADHD, with a receiver operating characteristic area under the curve (ROC–AUC) of 0.918. A panel of FAPy-adenine, N-acetylaspartylglutamic acid, dopamine 4-sulfate, aminocaproic acid, and asparaginyl-leucine was used to establish a robust model for ADHD comorbid tic disorders and controls with an AUC of 0.918. [ABSTRACT FROM AUTHOR]

Background and aims: Studies have indicated that maternal prenatal substance use may be associated with offspring attention deficit hyperactivity disorder (ADHD) via intrauterine effects. We measured associations between prenatal smoking, alcohol and caffeine consumption with childhood ADHD symptoms accounting for shared familial factors. Design First, we used a negative control design comparing maternal and paternal substance use. Three models were used for negative control analyses: unadjusted (without confounders), adjusted (including confounders) and mutually adjusted (including confounders and partner's substance use). The results were meta‐analysed across the cohorts. Secondly, we used polygenic risk scores (PRS) as proxies for exposures. Maternal PRS for smoking, alcohol and coffee consumption were regressed against ADHD symptoms. We triangulated the results across the two approaches to infer causality. Setting: We used data from three longitudinal pregnancy cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom, Generation R study (GenR) in the Netherlands and Norwegian Mother, Father and Child Cohort study (MoBa) in Norway. Participants: Phenotype data available for children were: NALSPAC = 5455–7751; NGENR = 1537–3119; NMOBA = 28 053–42 206. Genotype data available for mothers was: NALSPAC = 7074; NMOBA = 14 583. Measurements A measure of offspring ADHD symptoms at age 7–8 years was derived by dichotomizing scores from questionnaires and parental self‐reported prenatal substance use was measured at the second pregnancy trimester. Findings The pooled estimate for maternal prenatal substance use showed an association with total ADHD symptoms [odds ratio (OR)SMOKING = 1.11, 95% confidence interval (CI) = 1.00–1.23; ORALCOHOL = 1.27, 95% CI = 1.08–1.49; ORCAFFEINE = 1.05, 95% CI = 1.00–1.11], while not for fathers (ORSMOKING = 1.03, 95% CI = 0.95–1.13; ORALCOHOL = 0.83, 95% CI = 0.47–1.48; ORCAFFEINE = 1.02, 95% CI = 0.97–1.07). However, maternal associations did not persist in sensitivity analyses (substance use before pregnancy, adjustment for maternal ADHD symptoms in MoBa). The PRS analyses were inconclusive for an association in ALSPAC or MoBa. Conclusions: There appears to be no causal intrauterine effect of maternal prenatal substance use on offspring attention deficit hyperactivity disorder symptoms. [ABSTRACT FROM AUTHOR]

Efforts to parse ADHD's heterogeneity in the DSM system has generally relied on subtypes, or presentations, based on different symptom combinations. Promising recent work has suggested that biologically-relevant and clinically predictive subgroups may be identified via an alternative feature set based on either a) temperament traits or b) executive function measures. Yet, the potential additive ability of these domains for specifying ADHD sub-phenotypes remains unknown. We thus sought to determine whether temperament traits and executive function, together, could facilitate a more nuanced and clinically meaningful subgrouping of children with ADHD. Participants included 828 children aged 7–11 years (62% with ADHD, 38% female). Latent profile and community detection analyses using both temperament and cognitive input features provided support for a primarily temperament-based three-subgroup solution (i.e., "Mild," "Irritable," and "Surgent"), although the distinction between Surgent and Mild subgroups may have been better explained as an ADHD symptom severity effect. There was also evidence of a five-subgroup solution, in which cognitive measures differentiated the Surgent subgroup into those with and without cognitive impairment. Cognitive measures also appeared to differentiate the Irritable subgroup based on severity, although differences in resulting subgroups appeared better explained via differences in negative affect and shyness. Subgroups within the five-subgroup solution meaningfully differed with respect to concurrent comorbidity. The utility of the five-subgroup solution for predicting comorbid diagnoses 2 years later was more limited. Additional work is needed to fully characterize the integration of cognitive and affective functioning in ADHD and their overlapping or additive value for clinical prediction. [ABSTRACT FROM AUTHOR]

Objective: Conflict monitoring is well known to be modulated by context. This is known as the Gratton effect, meaning that the degree of interference is smaller when a stimulus-response conflict had been encountered previously. It is unclear to what extent these processes are changed in ADHD. Method: Children with ADHD (combined subtype) and healthy controls performed a modified version of the sequence flanker task. Results: Patients with ADHD made significantly more errors than healthy controls, indicating general performance deficits. However, there were no differences regarding reaction times, indicating an intact Gratton effect in ADHD. These results were supported by Bayesian statistics. Conclusion: The results suggest that the ability to take contextual information into account during conflict monitoring is preserved in patients with ADHD despite this disorder being associated with changes in executive control functions overall. These findings are discussed in light of different theoretical accounts on contextual modulations of conflict monitoring. [ABSTRACT FROM AUTHOR]

This paper presents a novel approach to screening children with ADHD, one of the most prevalent childhood disorders. We have designed the robot-assisted, game-like test that directly reflects children's behavior on measuring ADHD symptoms. Using the sensors in the robot system, most of the children's behavior is automatically measured during the entire course of the test. We collected real data by carrying out tests to 326 children from 3rd to 4th grades in the field. A unified frame that classifies multiple categories of ADHD, ADHD-at-Risk and normal has been set up to investigate a wide spectrum of classifiers and their optimal hyper-parameters. The results of the data analysis show highly confident ADHD classification, up to 97% (F1 score). It could be a practical tool for clinicians and special teachers to use in the diagnosis of childhood ADHD. [ABSTRACT FROM AUTHOR]

The objective of this study was to analyze the possible association between maternal attachment style and comorbidity associated with childhood ADHD. We evaluated a total of 103 children with ADHD treated at a Child and Adolescent Mental Health Centre and their mothers. Comorbidity was evaluated using the MINI-KID interview. Maternal attachment was evaluated using the Adult Attachment Questionnaire. We considered child variables that could be associated with the clinical course of ADHD, such as symptom severity, age, gender, evolution time, academic level, and current pharmacological treatment; parental variables, such as the mother's psychiatric history, current psychopathology, marital status, academic level, income, and employment, were also considered. We found an association between maternal insecure attachment and comorbid depressive disorder in childhood ADHD. An insecure maternal attachment style must be considered in the assessment and treatment of childhood ADHD with comorbid depression. [ABSTRACT FROM AUTHOR]

Background: Attention-Deficit-Hyperactivity-Disorder (ADHD) is, with a prevalence of 5%, a highly common childhood disorder, and has severe impact on the lives of youngsters and their families. Medication is often the treatment of choice, as it currently is most effective. However, medication has only short-term effects, treatment adherence is often low and most importantly; medication has serious side effects. Therefore, there is a need for other interventions for youngsters with ADHD. Mindfulness training is emerging as a potentially effective training for children and adolescents with ADHD. The aim of this study is to compare the (cost) effectiveness of mindfulness training to the (cost) effectiveness of methylphenidate in children with ADHD on measures of attention and hyperactivity/impulsivity. Methods/design: A multicenter randomized controlled trial with 2 follow-up measurements will be used to measure the effects of mindfulness training versus the effects of methylphenidate. Participants will be youngsters (aged 9 to 18) of both sexes diagnosed with ADHD, referred to urban and rural mental healthcare centers. We aim to include 120 families. The mindfulness training, using the MYmind protocol, will be conducted in small groups, and consists of 8 weekly 1.5-h sessions. Youngsters learn to focus and enhance their attention, awareness, and selfcontrol by doing mindfulness exercises. Parents will follow a parallel mindful parenting training in which they learn to be fully present in the here and now with their child in a non-judgmental way, to take care of themselves, and to respond rather than react to difficult behavior of their child. Short-acting methylphenidate will be administered individually and monitored by a child psychiatrist. Assessments will take place at pre-test, post-test, and at follow-up 1 and 2 (respectively 4 and 10 months after the start of treatment). Informants are parents, children, teachers, and researchers. Discussion: This study will inform mental health care professionals and health insurance companies about the clinical and cost effectiveness of mindfulness training for children and adolescents with ADHD and their parents compared to the effectiveness of methylphenidate. Limitations and several types of bias that are anticipated for this study are discussed. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine differences in the clinical presentation of very-early-onset ( VEO) and early-onset ( EO) bipolar disorder ( BD) not fully explored previously. Methods We selected two groups of subjects with BD from the Maritime Bipolar Registry based on age at onset of first major mood episode ( VEO with onset prior to age 15 years; EO ranging from 15 to 18 years) and compared them with a reference group (onset after 18 years of age). There were 363 subjects (240 with bipolar I disorder and 123 with bipolar II disorder; mean age 44.2 ± 12.8 (SD) years), with 41 subjects in the VEO and 95 in the EO groups. Results In comparison with the EO and reference groups, more subjects in the VEO group developed major depression as an index episode (88% for the VEO group versus 61% for the EO group and 54% for the reference group), and had an unremitting clinical course (65% versus 42% and 42%, respectively), rapid cycling (54% versus 34% and 28%, respectively), and comorbid attention-deficit hyperactivity disorder (17% versus 1% and 3%, respectively); a higher proportion of the VEO group had first-degree relatives with affective disorders compared with the EO and reference groups (0.41 versus 0.32 and 0.29, respectively), and they had lower scores on the Global Assessment of Functioning scale (mean scores of 64 versus 70 and 70). Overall, the EO group was similar to the reference group on most measures, except for increased suicidal behavior VEO 53%, EO 44% and reference group 25%). The results of polychotomous logistic regression also support the view that VEO BD represents a rather specific subtype of BD. Conclusions Our results suggest the recognized correlates of early-onset BD may be driven by subjects at the lowest end of the age at onset spectrum. [ABSTRACT FROM AUTHOR]

Objective. We hypothesized that relatives of bipolar patients would have increased rate of attention deficit hyperactivity disorder (ADHD) and subsyndromal manifestations compared to demographically matched relatives of healthy controls. Method. Forty consecutive patients with bipolar disorder were recruited from inpatient and outpatient units of Sisli Etfal Teaching and Research Hospital, Psychiatry Department. Seventy-three first-degree relatives of bipolar disorder group were included. A control group of first-degree relatives of individuals without DSM-IV Axis I psychopathology were also recruited. The Turkish version of the Structural Clinical Interview for DSM-IV, Wender Utah Rating Scale, Turgay's Adult ADD/ADHD DSM-IV based Diagnostic and Rating Scale were administered to participants. Results. Overall rate of adult ADHD in RBD group was significantly higher than RC group (9.6 vs. 1.5%; P = 0.04). Participants with adult ADHD in the RBD group had significantly higher rate of alcohol abuse compared to those without adult ADHD (14.3 vs. 1.5%; P = 0.05). Rates of OCD and dysthimia were significantly higher in the subjects with ADHD in the RBD group than the subjects without ADHD (28.6 vs. 4.5%; P = 0.02, 14.3 vs. 1.5%; P = 0.05 respectively). Conclusion. Our findings indicate that relatives of bipolar patients have a risk for suffering from ADHD, and support the hypothesis that relatives of bipolar patients are at a risk for developing attentional and behavioral problems. [ABSTRACT FROM AUTHOR]

Objective: Up to one-third of patients with bulimia nervosa (BN) report a history of attention-deficit/hyperactivity disorder (ADHD) symptoms, and the dopaminergic genes, especially the dopamine receptor D4 ( DRD4), have been associated independently with both binge eating and ADHD. Method: The purpose of this study was to (1) compare the frequency of DRD4 exon III VNTR variants in 157 BN probands and equal number of healthy controls; (2) assess transmission of DRD4 alleles in 68 families of patients with BN; and (3) explore the possible role of DRD4 gene in childhood ADHD history in a subgroup of 81 women with BN. Results: Our results showed that the BN probands and controls did not differ in DRD4 allele frequency. We also did not find evidence for preferential transmission of any DRD4 variant to the affected offspring with BN. However, the presence of either the 2-repeat or 7-repeat allele was associated with a history of childhood ADHD in BN ( p = .038, odds ratio = 3.2). Discussion: Our findings suggest that although DRD4 may not be associated with the diagnosis of BN, its variants are associated with a history of childhood ADHD in BN probands. This may have relevance for the understanding, prevention, and treatment of BN that evolves in the context of childhood ADHD. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Objectives. Several pharmacological and genetic studies support the involvement of the dopamine neurotransmitter system in the aetiology of attention-deficit hyperactivity disorder (ADHD). Based on this information we evaluated the contribution to ADHD of nine genes involved in dopaminergic neurotransmission ( DRD1, DRD2, DRD3, DRD4, DRD5, DAT1, TH, DBH and COMT). Methods. We genotyped a total of 61 tagging single nucleotide polymorphisms (SNPs) in a sample of 533 ADHD patients (322 children and 211 adults), 533 sex-matched unrelated controls and additional 196 nuclear ADHD families from Spain. Results. The single- and multiple-marker analysis in both population and family-based approaches provided preliminary evidence for the contribution of DRD1 to combined-type ADHD in children ( P = 8.8e-04; OR = 1.50 (1.18-1.90) and P = 0.0061; OR = 1.73 (1.23-2.45)) but not in adults. Subsequently, we tested positive results for replication in an independent sample of 353 German families with combined-type ADHD children and replicated the initial association between DRD1 and childhood ADHD ( P = 8.4e-05; OR = 3.67 (2.04-6.63)). Conclusions: The replication of the association between DRD1 and ADHD in two European cohorts highlights the validity of our finding and supports the involvement of DRD1 in childhood ADHD. [ABSTRACT FROM AUTHOR]

Objectives. Exposure to maternal smoking during pregnancy may be a significant risk factor for attention-deficit/hyperactivity disorder (ADHD) independently of family history of ADHD. The main aim of this study was to examine whether the clinical profile of ADHD differs between children with and without exposure to maternal smoking during pregnancy. Methods. This was a case-control study of boys and girls with and without ADHD ascertained from psychiatric and paediatric sources. Maternal smoking during pregnancy was defined by interviews with subjects' mothers. Main outcome measures were ADHD symptoms and associated clinical features in children with and without exposure to maternal smoking during pregnancy. Results. No significant differences were found between ADHD children with and without exposure to maternal smoking during pregnancy on clinical characteristics. When these analyses were repeated in the subgroup of subjects without parental history of ADHD, there were also no statistically significant differences found. Conclusions. Despite adequate statistical power, no significant differences were found between ADHD children with and without exposure in the clinical features of ADHD and associated disorders. Results provide support for the notion that ADHD cases resulting from exposure to maternal smoking during pregnancy have similar clinical profiles as other ADHD cases. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the frequency of adult attention deficit hyperactivity disorder (ADHD) comorbidity with lifetime bipolar disorder, and the influence of this comorbidity on various demographic and clinical variables in patients. Patients ( n = 159) with a previous diagnosis of bipolar disorder (79 female, 80 male) were included in this study. All patients were interviewed for the presence of current adult and childhood ADHD diagnosis and other axis I psychiatric disorder comorbidities using the structured clinical interview for DSM-IV (SCID) and the Schedule for Affective Disorders and Schizophrenia for School Age Children—Present and Lifetime Version (K-SADS-PL). The subjects also completed a Wender Utah rating scale (WURS-25) and a Current Symptoms Scale for ADHD symptoms. In particular, patients’ clinical characteristics, the age of onset of bipolar disorder, and the number of episodes were noted. Twenty-six of the 159 bipolar patients (16.3%) were diagnosed with adult ADHD, while another subgroup of patients ( n = 17, 10.7%) received a diagnosis of childhood ADHD but did not fulfill criteria for adult ADHD. Both of these two subgroups (patients with adult ADHD, and patients with only childhood ADHD) had an earlier age of onset of the disease and a higher number of previous total affective or depressive episodes than those without any lifetime ADHD comorbidity. However only bipolar patients with adult ADHD comorbidity had higher lifetime comorbidity rates for axis I psychiatric disorders, such as panic disorder and alcohol abuse/dependence, compared to patients without lifetime ADHD. Bipolar patients with comorbid adult ADHD did not differ from bipolar patients with comorbid childhood ADHD in terms of any demographic or clinical variables except for adult ADHD scale scores. In conclusion, ADHD is a common comorbidity in bipolar patients, and it adversely affects the course of the disease and disrupts the social adjustment of the patients. Regular monitoring of ADHD will help to prevent problems and complications that could arise in the course of the disease, particularly in patients with early onset bipolar disorder. [ABSTRACT FROM AUTHOR]

Atomoxetine is the only FDA-approved non-stimulant to treat ADHD. We report a case of Atomoxetine-related exacerbation of nocturnal bruxism in a 12-yr old boy with ADHD, subsiding on discontinuing the drug, but re-worsening with retrial, finally subsiding upon adding Buspirone. This is the first report of its kind showing such an association, not included in any pre- or post-marketing data. Clinical implications and possible mechanisms are discussed. [ABSTRACT FROM AUTHOR]