Journal of Attention Disorders最新文献

Background: ADHD is one of the most common mental disorders in children and adolescents. While international research on health service utilization, barriers to care, and treatment satisfaction is growing, evidence from Germany remains limited. This study aimed to examine the utilization of mental health care services in a sample of German children and adolescents with an administrative ADHD diagnosis registered with their health insurance company. Treatment satisfaction, belief in treatment efficacy and factors influencing mental health care utilization were examined.

Methods: As part of the consortium project INTEGRATE-ADHD, data from 4,948 children and adolescents were analyzed. Parents of 7- to 17-year-olds participated in an online survey answering questions about their child's ADHD health care utilization, treatment satisfaction and efficacy, and factors influencing utilization using established instruments. Sociodemographic factors, geographic characteristics, ADHD symptom severity, and parental psychopathology were also assessed. Descriptive analyses and multivariate logistic regressions were conducted.

Results: Approximately 40% of the children and adolescents with an administrative ADHD diagnosis were currently receiving ADHD treatment. The majority of parents (76%) were satisfied with the treatment, and 85% considered the treatment effective. Children with more severe ADHD symptoms had a threefold higher likelihood of receiving treatment, while youths with a migration background were less likely to receive mental health care. The most common reasons for not utilizing mental health care included the treatment having already ended, a lack of available treatment options, long waiting times, a lack of motivation among children, or the inability to continue treatment due to the COVID-19 pandemic.

Conclusions: To overcome the identified barriers in ADHD treatment, we recommend improving access to evidence-based ADHD treatment and expanding its implementation to prevent undertreatment and the associated individual suffering and societal costs.

Objectives: Interest in the role of female hormones in ADHD has grown in recent years and, with an increasing number of women diagnosed with ADHD later in life, it is important hormonal changes across the lifespan are considered. This exploratory study examines the relationships between ADHD status (diagnosis and medication use) and symptoms, and menopause stage (pre/peri/post) and symptoms.

Methods: Employing a cross-sectional approach, we recruited a sample of 656 women aged 45 to 60 years, of which 245 had an existing diagnosis of ADHD. Women completed several questionnaires assessing their ADHD symptoms (Adult Self-Report Scale, ASRS) and menopausal experiences (Women's Health Questionnaire, WHQ; Menopause-Specific Quality of Life Questionnaire, MENQoL; Hot Flush Rating Scale, HFRS; Hot Flush Related Daily Interference Scale, HFDIS).

Results: ANCOVA revealed no significant effects of an ADHD diagnosis or interaction effects between diagnosis and menopause stage after applying an FDR correction. Similarly, when medication was considered (i.e., non-ADHD, ADHD with medication, and ADHD without medication) there were no main effects of group or interaction effects with menopause stage.

Conclusions: These results indicate women with ADHD do not experience greater menopausal complaints than women without at any menopausal stage. However, there were significant correlations between ADHD symptoms and menopausal complaints across all participants but at a group level, these were less prominent in those with ADHD, which could indicate different attribution of symptoms in women with ADHD. Future research should further explore menopause in women with ADHD considering longitudinal designs and qualitative studies to examine potential overlap of symptoms and symptom attribution.

Background: ADHD is the most common neurodevelopmental disorder. While much is known about the functional and academic impacts of ADHD, impacts on long-term health-related quality of life (HRQoL) are less well-documented.

Aims: To explore, in children aged 4 to 17 years, associations between clinical ADHD symptoms and (1) children's HRQoL; (2) whether internalizing or externalizing problems attenuate this association; and (3) factors contributing to this association.

Methods: Data were drawn from the Longitudinal Study of Australian Children at child ages 4 to 17 years (N = 4,194). Clinical ADHD symptoms (e.g., score >8) were measured using the hyperactivity scale from the Strengths and Difficulties Questionnaire (SDQ). Internalizing or externalizing problems were classified as children with scores ≥5 on the Emotional Problems and scores ≥4 on the Conduct Problems scale on the SDQ, respectively. Children's HRQoL was measured using the Pediatric Quality of Life Inventory (PedsQL). Linear mixed models were used, adjusting for child and family factors.

Results: Compared to those with no ADHD symptoms, children with ADHD symptoms had significantly lower HRQoL across all domains from 4 to 17 years (mean difference = 7.65, 95% CI [6.09, 9.19]). Internalizing and externalizing problems slightly attenuated the association between ADHD symptoms and children's HRQoL (mean difference = 4.91, 95% CI [3.40, 6.43]). Being a female or having autism or other medical conditions, or taking ADHD/ADD medication or caregiver having mental health problems was associated with poorer HRQoL while having two or more siblings was associated with better HRQoL.

Conclusion: ADHD clinical symptoms are associated with poorer children's HRQoL from 4 to 17 years. Given that co-occurring medical conditions and poor caregiver mental health are associated with poorer child HRQoL, ADHD treatment needs to identify and address co-occurring conditions and parental mental health.

Objective: Children born preterm are at an elevated risk of developmental challenges, often exhibiting a distinct "preterm behavioral phenotype" characterized by particular attention difficulties. This review focuses on examining the phenotypical attention profile in preterm children aged 5 to 11 years, considering both clinical and neuropsychological aspects.

Method: Following the PRISMA reporting guidelines, 22 peer-reviewed studies were analyzed.

Result: According to behavioral-clinical aspects, preterm children appear to be at heightened risk for inattentive attention problems, including a predisposition to the predominantly inattentive presentation of ADHD. Regarding neuropsychological attention, deficits were identified in top-down controlled intensity processes as well as in certain components of selectivity and executive functioning.

Conclusion: This review yields evidence that preterm children exhibit distinct and specific attention deficits during preschool and school age, characterized by a phenotypical clinical and neuropsychological attentional profile. Early identification of these issues is crucial, as it enables timely interventions to support school participation and mitigate the risk of learning difficulties, academic failure, and other secondary complications associated with attention deficits.

Objective: This study aims to verify the therapeutic efficacy and safety of a traditional Chinese medicine, Jingling Oral Liquid, in treating ADHD through a multicenter, randomized, double-blind, placebo-controlled trial (ChiCTR-IPR-17012293).

Method: Eighty-five children with ADHD underwent 8 weeks of strictly monitored treatment. Forty children (8.2 ± 2.1 years old, nine girls) were randomly assigned to be treated with Jingling Oral Liquid (Liaoning Dongfangren Pharmaceutical Co., Ltd.), and 41 children (8.6 ± 2.5 years old, six girls) received placebo treatment.

Results: Significant improvement was observed in the total score of ADHD rating scale (-4.8, 95% CI [-8.4, -1.1], p = .011) and in the hyperactivity/impulsivity score (-3.0, 95% CI [-4.8, -1.1], p = 0.002) for the Medicine group compared with the Placebo group, but not for inattention score (-1.9, 95% CI [-4.0, 0.2], p = 0.078). No significant changes were observed in the physiological indicators of the children pre- and post-treatment, and no definite drug-related adverse reactions were reported.

Conclusion: Jingling Oral Liquid has shown efficacy in managing ADHD, specifically targeting hyperactivity and impulsivity symptoms, and maintaining a favorable safety profile.

Objective: Inhibition is a critical executive function for stopping routine responses and facilitating planned behaviour. Although the results are mixed, individuals with ADHD are reported to have poorer inhibition performance; however, this remains a subject of ongoing debate. Findings in the literature suggest that the central executive component of working memory and resource allocation could play a role. The present study investigated whether varying maintenance demands would influence inhibition performance among children with and without ADHD.

Materials and methods: The study sample comprised 80 children aged between 7 and 11 years (60 males and 20 females; M_age = 9.01). For the first time in the literature, participants completed a Go/no-go Task with four levels of gradually increased working memory load. The data was analysed using mixed repeated measures ANOVA.

Results and conclusion: A significant main effect of group, load and interaction were obtained. There was no significant difference in inhibition performance between the two groups when there was no working memory load. However, in the presence of a load, the ADHD group consistently scored lower across all load conditions. Their inhibition performance declined as the load increased. Under the heaviest load condition, the ADHD group obtained the worst scores, whereas the control group's performance improved. In conclusion, introducing a working memory load has a large negative impact on the inhibition performance of the ADHD group but not the control group. These results suggest that children with ADHD struggle to allocate enough resources to meet the increased task demand for optimal inhibition performance.

Objective: The effectiveness of behavioural interventions to improve sleep in children with ADHD has been demonstrated, although most treatments are conducted in-person, with limited evidence for paediatric telehealth approaches. Study 1 is a randomised controlled trial evaluating the ADHD Sleeping Sound^© intervention to compare outcomes between in-person and telehealth modalities. Study 2 examined whether baseline sleep problems and treatment response were predicted by baseline symptom presentation, attachment security, and family functioning.

Method: Children aged 5 to 12 years (65.4% male) with ADHD received either in-person (n = 40) or telehealth (n = 38) treatment. Subjective (Children's Sleep Habits Questionnaire) and objective (actigraphy) sleep variables were assessed at baseline, post-intervention (1 week), and follow-up (3 months).

Results: As expected, subjectively measured sleep disturbance significantly improved post-treatment, with no significant difference in rate of change between in-person and telehealth modalities. For Study 2, baseline measures comprised the Conners CBRS, Attachment Insecurity Screening Inventory, Security Scale, and Family Assessment Device. Latent growth curve modelling analysed data via intention-to-treat (primary) and per protocol (secondary) methods. Higher attachment insecurity and lower family functioning were significantly associated with greater (subjective) baseline sleep problems. Additionally, attachment security predicted changes in sleep duration over time, highlighting the importance of considering relational family factors when designing sleep interventions.

Conclusion: Telehealth ADHD sleep interventions represent a promising approach to enhancing health equity and access for families experiencing geographical and/or structural barriers to in-person treatment.Trial RegistrationANZCTR, ACTRN12621001681842. Registered 9 December 2021 - https://anzctr.org.au/ACTRN12621001681842.aspx.

Objective: The goal of this review was to more clearly understand what encourages or discourages treatment adherence in individuals with ADHD across different points in life. Instead of simply listing barriers, we set out to identify true, evidence-based strategies that could help patients and clinicians maximize long-term dedication to care.

Method: Following PRISMA guidelines, we systematically reviewed 52 peer-reviewed articles between 2014 and 2024. The primary sources used were five electronic databases (Scopus, Science Direct, PubMed, and Taylor & Francis). The studies included heterogeneous age groups-children, adolescents, and adults-and had diverse methodologies ranging from randomized controlled trials to qualitative interviews.

Results: Adherence to treatment for ADHD remains a problem, especially among teenagers. We organized the influencing factors into five main areas: sociodemographic, psychological/clinical features, medication-related issues, beliefs and attitudes, and broader systemic or environmental challenges. Conversely, interventions like pharmacological strategies, digital interventions and mobile-based reminders, psychoeducational and behavioral approaches, multimodal and long-term interventions, and consent-based strategies were all linked to improved adherence.

Conclusion: Improving adherence in ADHD requires a multifaceted, personalized approach that considers clinical, psychological, and contextual factors. Interventions that integrate pharmacologic and psychosocial strategies, while addressing barriers such as stigma, system fragmentation, and cultural mismatch, are essential to achieving better treatment outcomes and quality of life for individuals with ADHD.

Objective: ADHD and obesity frequently co-occur in children, yet differences in visceral adipose tissue (VAT) distribution between co-occurring ADHD + Obesity and obesity alone are incompletely characterized. This study compared depot-specific adiposity between these groups.

Methods: This cross-sectional analysis (December 2022-2024, Beijing Children's Hospital) included 306 children (6-12 years) stratified into: ADHD + Obesity (n = 65), obesity-only (n = 77), and Control (n = 164). Body composition was assessed using bioelectrical impedance. Group comparisons for depot-specific adiposity and metabolic markers were performed using multivariable linear regression, adjusting for age, sex, and BMI z-score.

Results: The ADHD + Obesity group exhibited significantly greater visceral adiposity than the Obesity-only group, as reflected by a 16.84 cm² larger visceral fat area (VFA) and a 1.03 kg/m² higher fat mass index (FMI). The ADHD + Obesity group also showed a more adverse metabolic profile, including elevated liver enzymes and fasting glucose.

Conclusion: Excess visceral adiposity represents a distinct phenotypic feature of ADHD + Obesity. These findings support the need for integrated clinical management addressing both neurobehavioral and metabolic domains and inform future mechanistic investigations.