Showing papers on "Hyperkinetic disorder published in 2013"

Randomized Controlled Double-Blind Trial of Optimal Dose Methylphenidate in Children and Adolescents with Severe Attention Deficit Hyperactivity Disorder and Intellectual Disability.

Abstract: Background: Attention deficit hyperactivity disorder is increased in children with intellectual disability. Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks. Method: One hundred and twenty two drug-free children aged 7-15 with hyperkinetic disorder and IQ 30-69 were recruited to a double-blind, placebo-controlled trial that randomized participants using minimization by probability, stratified by referral source and IQ level in a one to one ratio. Methylphenidate was compared with placebo. Dose titration comprised at least 1 week each of low (0.5 mg/kg/day), medium (1.0 mg/kg/day) and high dose (1.5 mg/kg/day). Parent and teacher Attention deficit hyperactivity disorder (ADHD) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures. Clinical response was determined with the Clinical Global Impressions scale (CGI-I). Adverse effects were evaluated by a parent-rated questionnaire, weight, pulse and blood pressure. Analyses were by intention to treat. Trial registration: ISRCTN 68384912. Results: Methylphenidate was superior to placebo with effect sizes of 0.39 [95% confidence intervals (CIs) 0.09, 0.70] and 0.52 (95% CIs 0.23, 0.82) for the parent and teacher Conners ADHD index. Four (7%) children on placebo versus 24 (40%) of those on methylphenidate were judged improved or much improved on the CGI. IQ and autistic symptoms did not affect treatment efficacy. Active medication was associated with sleep difficulty, loss of appetite and weight loss but there were no significant differences in pulse or blood pressure. Conclusions: Optimal dosing of methylphenidate is practical and effective in some children with hyperkinetic disorder and intellectual disability. Adverse effects typical of methylphenidate were seen and medication use may require close monitoring in this vulnerable group. © 2012 Association for Child and Adolescent Mental Health.

Knowledge and Attitudes about Attention-Deficit/Hyperactivity Disorder (ADHD) and its Treatment: The Views of Children, Adolescents, Parents, Teachers and Healthcare Professionals

Abstract: Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-developmental disorder that causes controversy; this may have a negative effect on the ability of families, teachers and healthcare professionals to achieve shared understanding and goals. This article reviews recent research of the knowledge and attitudes of children, adolescents, parents, teachers, healthcare professionals and the public about ADHD. Findings suggest that misconceptions about ADHD persist, and children with ADHD and their parents report stigmatizing experiences. Educational interventions to improve the knowledge of teachers about ADHD appeared to be effective in the short term. Parents and professionals working together in the diagnosis and treatment of children with ADHD may have different views about their roles in the shared decision-making process. Studies have reported both similarities and differences in parents' and professionals' views about the effectiveness of treatments for ADHD, but all stakeholders supported the principles of information-sharing and working in partnership.

Motor regulation problems and pain in adults diagnosed with ADHD

Abstract: Most children who are diagnosed with attention deficit-hyperactivity disorder (ADHD) have moderate-to-severe motor problems using the Motor Function Neurological Assessment battery (MFNU). The MFNU focuses on specific muscle adjustment problems associated with ADHD, especially motor inhibition problems and high muscle tone. Here we investigated whether adults with ADHD/hyperkinetic disorder (HKD) have similar motor problems. In our clinical experience, adults with ADHD often complain about back, shoulder, hip, and leg pain. We also investigate reported pain in adults with ADHD. Twenty-five adult outpatients diagnosed with ADHD/HKD who were responders to methylphenidate (MPH) were compared to 23 non-ADHD controls on 16 MFNU subtests and using a ‘total score’ (‘TS’) parameter. The MFNU test leader was blinded to group identity. The two groups were also compared using the Pain Drawing and Numerical Pain Rating Scale. The adult ADHD group had significantly (p < .001) more motor problems (higher TS) than controls. On the muscle regulation subtests, 36–96% of the ADHD group showed ‘moderate’ to ‘severe’ problems compared to 13–52% of the control group, and 80% of the ADHD group reported widespread pain. Highly significant differences were found between the ADHD and control groups for the variables ‘pain level’ (p < .001) and ‘pain location’ (p < .001). Significant correlations were found between TS and ‘pain location’ and between TS and ‘pain level’. These findings suggest that similar to children with ADHD, adults diagnosed with ADHD also have motor inhibition problems and heightened muscle tone. The presence of significantly higher pain levels and more widespread pain in the ADHD group compared to non-ADHD controls might indicate that pain is a long-term secondary effect of heightened muscle tone and restricted movement that can be demonstrated in children and adults by the MFNU battery.

RCT of working memory training in ADHD: long-term near-transfer effects.

Abstract: Objective The aim of the study is to evaluate the long-term near-transfer effects of computerized working memory (WM) training on standard WM tasks in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Method Sixty-seven children aged 10–12 years in Vestfold/Telemark counties (Norway) diagnosed with F90.0 Hyperkinetic disorder (ICD-10) were randomly assigned to training or control group. The training group participated in a 25-day training program at school, while the control group received treatment-as-usual. Participants were tested one week before intervention, immediately after and eight months later. Based on a component analysis, six measures of WM were grouped into composites representing Visual, Auditory and Manipulation WM. Results The training group had significant long-term differential gains compared to the control group on all outcome measures. Performance gains for the training group were significantly higher in the visual domain than in the auditory domain. The differential gain in Manipulation WM persisted after controlling for an increase in simple storage capacity. Conclusion Systematic training resulted in a long-term positive gain in performance on similar tasks, indicating the viability of training interventions for children with ADHD. The results provide evidence for both domain-general and domain-specific models. Far-transfer effects were not investigated in this article. Trial Registration: Controlled-Trials.com ISRCTN19133620

Attention Deficit Hyperactivity Disorder: Neuropsychologic and Pharmacologic Aspects

Abstract: IntroductionFew conditions in the mental health field have shown a closer link to neuropsychological constructs than the Attentional Disorders. From the word "attention", prominently listed in the current Diagnostic Statistical Manual of Mental Disorders (DSM-IV-TR) (1) nomenclature of "Attention Deficit Hyperactivity Disorder (ADHD)" and recent sophisticated neurotransmitter findings, to previous descriptions such as "minimal brain dysfunction", the disorder has been associated with neuropsychiatric substrates throughout its history (2).ADHD is noted in 3% to 9% of children and adolescents by American research, three times more commonly in males than females; it is found in 3%- 5% of adults with equal male to female ratios if the diagnostic criteria are based on the DSM (3). Clinicians in European countries tend to use criteria based on the International Classification of Diseases in which the condition is called "attention- deficit/hyperkinetic disorder", and estimate a much lower prevalence for ADD/ADHD (4). However, various studies from different countries based on similar diagnostic criteria confirm the widespread prevalence of ADHD (5,6). In 2006, 5 million individuals in the United States were prescribed psychostimulant medications, the most commonly recommended ADHD agents, 3.5 million between ages 3 to 19 years, and 1.5 million between ages 20 and 64 years (3).ADHD core featuresThe DSM-IV-TR presents a detailed list of symptoms and criteria for arriving at a diagnosis. Core features include attention dysfunction along with variable degrees of hyperactivity and impulsivity that interfere with day to day functioning (1,7). This disorder is a lifelong condition with persistence from childhood and adolescence into adulthood in approximately up to 66% of those diagnosed with ADHD in childhood (2). Sometimes, ADHD is not diagnosed until adolescence or adulthood. Inattention in childhood may evolve into difficulty sustaining attention, paralyzing procrastination, and severe disorganization skills in teens or adults. The impulsivity of childhood may persist manifesting in adults as severe impatience characterized by frequent losing one's temper, quitting or losing jobs, or ending relationships. The classical hyperactivity of childhood is observed less commonly in the older populations and may evolve into an inner restlessness, excessive talking, and/or self-selection of jobs that mask ADHD symptomatology (8).ADHD is considered a neurobehavioral disorder with abnormalities in various neurotransmitter systems, mainly dopaminergic and noradrenergic (9- 11). Neuroimaging (i.e., PET scans) and genetic studies further suggest that dopamine transporter dysfunction (6) appears to be implicated in the pathophysiology of ADHD. Heritability is about 75% with at least seven genes involved in ADHD: DRD4, DRD5, DAT, DBH, 5-HTT, HTR1B, and SNAP25 (12). Current research is attempting to identify different types of attentional dysfunction based on what areas of the brain are involved and then using specific medication to correct or moderate the identified defects; these areas include the cortex (prefrontal and parietal), brain stem (reticular formation), thalamus, basal ganglia, cingulate gyrus, and limbic structures (amygdala-hippocampus) (13). It is hoped that this brain mapping may allow more specific ADHD medications in the future.Current psychopharmacologic practicesThere are over 70 years of research noting that medication can ameliorate ADHD symptoms in children, adolescents, and adults (9). Drugs used for treatment include US Food and Drug Administration (FDA) approved stimulant and non-stimulant agents as well as other various non - FDA approved agents.FDA approved agentsa. stimulant agentsHundreds of research studies on patients with ADHD have established the beneficial effects of stimulant medications in all ages: children, adolescents, and adults (3,14-17). Approximately 75% or more of those with ADHD achieve some benefit (9) and the utilization of medication has become a standard part of management for these patients by many clinicians. …

Definition of Attention Deficit Hyperactivity Disorder in Adults

Abstract: Attention deficit hyperactivity disorder (ADHD) is a clinical syndrome defined in the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) by high levels of hyperactive, impulsive, and inattentive behaviors that begin during early childhood, are persistent over time, pervasive across situations, and lead to clinically significant impairments. Current DSM-IV criteria use a list of 18 symptom items, with 9 for hyperactivity impulsivity and 9 for inattention. Under the International Classification of Disease (ICD-10) classification system endorsed by the World Health Organization, the condition is referred to as hyperkinetic disorder, which is a more restricted definition of the disorder, describing a severe subgroup of patients with the combined subtype of ADHD.

Hyperkinetic disorders in childhood and adolescence - an analysis of KinderAGATE 2009 - 2011

Abstract: Objective: The present analysis evaluates the prevalence and medication use as well as age and sex distribution in inpatients with hyperkinetic disorders during childhood and adolescence at the KinderAGATE hospitals in 2009 – 2011. Method: Since 2009 the following information has been recorded anonymously twice a year from each patient at the participating hospitals of Kinder AGATE: age, sex, leading diagnosis, prescribed medication and dosage. The data obtained provide an excellent epidemiological basis for the observation of the prescription practice in child and adolescenct psychiatry.Results: In 2009 – 2011, 27.0% of the patients included were treated for a hyperkinetic disorder at the KinderAGATE hospitals. In our sample male patients (84.2% HPat, mean age 9.9 years) were treated much more often than female patients (15.8% HPat, 9.6 years). Methylphenidate was the most frequently prescribed substance. Apart from Amphetamine and Atomoxetine, the antipsychotics Risperidone and Pipamperone were noticeably often prescribed. Conclusion: A reserved medical treatment can be observed in child and adolescent psychiatry. In comparison to our patient collective the patients diagnosed with hyperkinetic disorders were two years younger on average and recieved more often psychopharmacological treatment. In this diagnosis group male patients predominate even stronger than in our patient collective.