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The goal of this study was to explore the development and implementation of a protocol for real-time fMRI neurofeedback (rtfMRI-nf) and to assess the potential for enhancing the selective brain activation using stimuli from Virtual Reality (VR). In this study we focused on two specific brain regions, supplementary motor area (SMA) and right inferior frontal gyrus (rIFG). Publications by other study groups have suggested impaired function in these specific brain regions in patients with the diagnoses Attention Deficit Hyperactivity Disorder (ADHD) and Tourette’s Syndrome (TS). This study explored the development of a protocol to investigate if attention and contextual memory may be used to systematically strengthen the procedure of rtfMRI-nf.

Background: Child and adolescent psychological trauma exposure is associated with psychopathology in the adult population in general, but literature on childhood trauma (CT) in adults with ADHD is scarce. Aims: To determine the prevalence of CT among adult patients with ADHD, and whether a history of CT implies different adult outcomes of psychiatric comorbidities, and functional impairment than without. Method: Previously unmedicated adult outpatients with ADHD (n=250, median age 32 years) entered the study. Participants were diagnosed with ADHD using the Diagnostic Interview for ADHD in Adults, second edition (DIVA 2.0), and were assessed by historical data, validated questionnaires, and structured clinical interviews for CT and mental disorders including post-traumatic stress disorder (PTSD) and functional impairment. Analyses compared ADHD patients with and without CT. Results: Prevalence of CT was 44%. Of those with PTSD (n=21), many had CT (85%, p<0.001). In binary logistic regression analyses, CT was linked to an increased likelihood of concomitant panic disorder (unadjusted odds ratio, OR = 3.0, p<0.001, and adjusted OR = 2.7, p<0.01) and any anxiety disorders and two or more comorbid psychiatric disorders (adjusted OR = 1.9, p<0.05 and OR = 1.7, p<0.05, respectively), and was associated with significant functional impairment. Conclusions: These findings suggest that awareness of child and adolescent trauma is clinically relevant among young to middle-aged adult ADHD patients, and implications for earlier detection of CT and treatment warrant further studies. [ABSTRACT FROM AUTHOR]

Attention-deficit hyperactivity disorder (ADHD) is associated with disrupted sleep and circadian rhythm. Medication for ADHD may have side effects aggravating sleep-disturbances, however beneficial effects on ADHD may contribute to improve sleep. This pilot study aims to examine outcomes of first time stimulant treatment on objective and subjective sleep characteristics, and psychiatric symptoms, in adult ADHD patients with pretreatment sleep problems, but without any primary sleep disorder. In total, 9 previously unmedicated adult ADHD subjects who reported pretreatment sleep problems, completed polysomnography (PSG) and questionnaires on subjective sleep disturbances and psychiatric symptoms. Data was collected before and after 6 weeks on first time medication with immediate-release methylphenidate (MPH-IR), mean daily dose 43 mg. Subjects on-medication showed an increased percentage of Stage 2 sleep compared to their non-treated baseline (46.6% versus 55.2%, p =.011). Otherwise, there were no significant changes in PSG variables. There were no firm changes in daytime sleepiness or symptoms of sleep disturbances. These findings should be interpreted cautiously given the open-label design and small sample size, and should be examined in larger studies with more rigorous study designs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine whether reaction time parameters in adult patients with ADHD could predict their response to methylphenidate (MPH). Method: Previously unmedicated patients (N = 123) were administered the Conners' Continuous Performance Test II (CPT II) at baseline and after 6 weeks of treatment with immediate-release MPH. In addition to traditional CPT measures, we extracted intraindividual raw data and analyzed time series using linear and nonlinear mathematical models. Results: Clinical responders, assessed with the Clinical Global Impression-Improvement scale, showed significant normalization of target failures, reduced variability and skewness, and increased complexity of reaction time series after 6 weeks of treatment, while nonresponders showed no significant changes. Prior to treatment, responders had significantly higher variability and skewness, combined with lower complexity, compared with nonresponders. Conclusion: These results show that the CPT test is useful in the evaluation of treatment response to MPH. [ABSTRACT FROM AUTHOR]

Introduction and objective: This study explores the utility of the Adult ADHD Self-Report Scale (ASRSv1.1) tracking outcome of treatment with methylphenidate in medication naive adults with ADHD [1]. In U.S. ASRSv1.1 has documented psychometric properties [2, 3]. Methods: Included patients are diagnosed according to the DSM-IV criteria (N = 80), comorbidity examined by diagnostic interview (M.I.N.I.). The outcome measured by changes in the ASRSv1.1 symptoms checklist, and compared with investigator’s assessment (CGI), self-rating of symptom-checklist-90-revised (SCL-90-R), and the Wender Utah rating scale (WURS); performed ANOVA statistics (SPSS, v16.0). Results: At baseline ASRSv1.1 sumscore correlated significant with WURS25, and the general symptoms (GSI) of SCL-90R. Repeated measurements demonstrated significant average reduction (39%) at 6 weeks sustaining at 3 months (p = 0.005) (effect size 0.72), as did the ASRS-Screener, attained thresholds-values, constructs of attention- deficits and hyperactivity–impulsivity. Discussion: ASRS is originally a screening-instrument, however in our results scores correlated with other measures assessing outcome, even subconstructs demonstrated change. Bias of self-ratings, repeated performance and translation not cultural validated are discussed. Conclusion: The ASRS-scores corresponded with other measures of outcome, and demonstrated a significant improvement during 3-month treatment. [ABSTRACT FROM AUTHOR]