Attention 2.0 Professional Edition, Summer 2010
The Latest Research
with atomoxetine efficacy for treatment of
attention-deficit/hyperactivity disorder in children and
Scott, Nakia Gray; Ripperger-Suhler, Jane;
Rajab, M. Hasan; Kjar, Dean.
Journal of Child and Adolescent Psychopharmacology, June 2010,
v20 n3, pp. 197-203.
OBJECTIVES: The aims of this study were to determine if
relationships exist between the efficacy of atomoxetine for treatment of
attention-deficit/hyperactivity disorder (ADHD) and demographic
characteristics, specific co-morbid diagnoses, subtype of ADHD, and/or
additional use of a stimulant medication.
METHOD: A retrospective chart review was performed using data from an
institutional electronic medical record system. Children aged 5-17 years
who were diagnosed with ADHD and prescribed atomoxetine were included;
432 study subjects were categorized as treatment success (TS), treatment
failure (TF), or undetermined. Co-morbid diagnoses, demographic factors,
subtype of ADHD, and additional use of stimulant medications were
examined for association with TS.
RESULTS: A total of 88 children were categorized as TS, 197 as TF, and
147 as undetermined. More subjects in the TS group were receiving
stimulant medication in addition to the atomoxetine than in the TF group
(p = 0.0319; 95% Wald confidence interval [CI], 1.064-3.972). There was
no significant difference between groups for any demographic
characteristic, the presence of any co-morbid diagnosis, or type of
ADHD. In particular, the presence of anxiety or depression was not
associated with a response to atomoxetine.
CONCLUSION: Children who were prescribed a stimulant medication in
addition to atomoxetine had better outcomes in treating ADHD than those
receiving only atomoxetine.
Inconsistent Self-Report of Delinquency by
Adolescents and Young Adults with ADHD
Sibley, Margaret H.; Pelham, William E.; Molina, Brooke S. G.;
Waschbusch, Daniel A.; et al.
Journal of Abnormal Child Psychology, July 2010, v38 n5, pp.
645-656 [March 22, 2010, Online Early]
The purpose of the current study was to test the ability of adolescents
and young adults with childhood ADHD to reliably self-report delinquency
history. Data were examined from the Pittsburgh ADHD Longitudinal Study
(PALS), a follow-up study of children diagnosed with ADHD between 1987
and 1996. Self-report of lifetime delinquency history was compared to
concurrent parent-report and to self-report 1 year later. Participants
included 313 male probands and 209 demographically similar comparison
individuals without ADHD. Results indicated that adolescents and young
adults with childhood ADHD were more likely than comparison participants
to fail to report delinquent acts reported by a parent and to recant
acts they endorsed 1 year earlier. This trend was most apparent for acts
of mild to moderate severity. After controlling for several covariates,
current ADHD symptom severity and parent-report of the participant's
tendency to lie predicted reporting fewer delinquent acts than one's
parent. Current ADHD symptom severity also predicted more recanting of
previously endorsed acts. Based on these findings, several
recommendations are made for the assessment of delinquency history in
adolescents and young adults with childhood ADHD.
Parental adherence to clinical
recommendations in an ADHD evaluation clinic
Dreyer, A. Samantha; O'Laughlin, Liz; Moore, Janna; Milam,
Journal of Clinical Psychology, June 24, 2010, Online
The present study examined perceived barriers to parental adherence with
child psychological assessment recommendations. Eighty caregivers of
children referred to an attention-deficit/hyperactivity disorder (ADHD)
evaluation clinic completed a telephone interview 4 to 6 weeks after
receiving evaluation feedback. Caregivers reported adherence to 81.5% of
recommendations and were equally likely to engage in self-help
recommendations (i.e., information on ADHD) and those for
professional-nonpsychological services (i.e., medication consultation).
Caregivers were least likely to follow through on recommendations for
psychological services (e.g., parental behavior training, individual
therapy for children with symptoms of anxiety/depression). Higher rather
than lower levels of parenting stress were associated with greater
adherence. The most commonly reported barriers were lack of time and
perceptions that the child's teacher was uncooperative with implementing
school-based recommendations. © 2010 Wiley Periodicals,
Inc. J Clin Psychol 66:1-20, 2010.
Meditation therapies for
attention-deficit/hyperactivity disorder (ADHD)
Krisanaprakornkit, Thawatchai; Ngamjarus, Chetta; Witoonchart,
Chartree; Piyavhatkul, Nawanant.
Cochrane Database of Systematic Reviews, 2010, Issue 6,
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of
the most common developmental disorders experienced in childhood and can
persist into adulthood. The disorder has early onset and is
characterized by a combination of overactive, poorly modulated behavior
with marked inattention. In the long term it can impair academic
performance, vocational success and social-emotional development.
Meditation is increasingly used for psychological conditions and could
be used as a tool for attentional training in the ADHD population.
OBJECTIVES: To assess the effectiveness of meditation therapies as a
treatment for ADHD.
SEARCH STRATEGY: Our extensive search included: CENTRAL, MEDLINE,
EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts,
LILACS, Virtual Health Library (VHL) in BIREME, Complementary and
Alternative Medicine specific databases, HSTAT, Informit, JST, Thai
Psychiatric databases and ISI Proceedings, plus grey literature and
trial registries from inception to January 2010.
SELECTION CRITERIA: Randomized controlled trials that investigated the
efficacy of meditation therapy in children or adults diagnosed with
DATA COLLECTION AND ANALYSIS: Two authors extracted data independently
using a pre-designed data extraction form. We contacted study authors
for additional information required. We analyzed data using mean
difference (MD) to calculate the treatment effect. The results are
presented in tables, figures and narrative form.
MAIN RESULTS: Four studies, including 83 participants, are included in
this review. Two studies used mantra meditation while the other two used
yoga compared with drugs, relaxation training, non-specific exercises
and standard treatment control. Design limitations caused high risk of
bias across the studies. Only one out of four studies provided data
appropriate for analysis. For this study there was no statistically
significant difference between the meditation therapy group and the drug
therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49
to 3.05, 15 patients). Likewise, there was no statistically significant
difference between the meditation therapy group and the standard therapy
group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84,
17 patients). There was also no statistically significant difference
between the meditation therapy group and the standard therapy group in
the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17
AUTHORS' CONCLUSIONS: As a result of the limited number of included
studies, the small sample sizes and the high risk of bias, we are unable
to draw any conclusions regarding the effectiveness of meditation
therapy for ADHD. The adverse effects of meditation have not been
reported. More trials are needed.
Exposure to Polyfluoroalkyl Chemicals and
Attention Deficit Hyperactivity Disorder in U.S. Children Aged 12-15
Hoffman, Kate; Webster, Thomas F.; Weisskopf, Marc G.; Weinberg, Janice;
Vieira, Verónica M.
Environmental Health Perspectives, June 15, 2010, Online
INTRODUCTION: Polyfluoroalkyl chemicals (PFCs) have been widely
used in consumer products. Exposures in the U.S. and world populations
are widespread. PFC exposures have been linked previously to various
health impacts, and data in animals suggest that PFCs may be potential
OBJECTIVES: We evaluated the associations between exposures to four PFCs
and parental report of diagnosis of attention deficit hyperactivity
METHODS: Data were obtained from the National Health and Nutrition
Examination Survey (NHANES) 1999-2000 and 2003-2004 for children aged
12-15 years. Parental report of a previous diagnosis by a doctor or
healthcare professional of ADHD in the child was the primary outcome
measure. Perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid
(PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid
(PFHxS) levels were measured in serum samples from each child.
RESULTS: Of the 586 children in the sample, 51 reported a diagnosis of
ADHD. When PFOS was treated as a continuous predictor, a 1.03 fold
increased odds was observed for each ìg/L increase in serum PFOS
after adjustment for confounding (95% CI 1.01-1.05). There were also
significant dose response relationships between PFOA and PFHxS levels
and ADHD (OR=1.12; 95% CI 1.01-1.23 and OR=1.06; 95% CI 1.02-1.11
respectively). Similarly, children with higher PFNA levels were more
likely to have ADHD (OR=1.32; 95% CI 0.86-2.02).
CONCLUSIONS: Our results, using cross-sectional data, are consistent
with increased odds of ADHD in children with higher serum PFC levels.
Given the extremely prevalent exposure to PFCs, follow-up of these data
with cohort studies is needed.
A Naturalistic 10-Year Prospective Study
of Height and Weight in Children with Attention-Deficit Hyperactivity
Disorder Grown Up: Sex and Treatment Effects
Biederman, Joseph; Spencer, Thomas J.; Monuteaux, Michael C.;
Faraone, Stephen V.
Journal of Pediatrics, June 7, 2010, Online Early.
OBJECTIVE: To assess the effect of
attention-deficit/hyperactivity disorder (ADHD) and its treatment on
growth outcomes in children followed into adulthood.
STUDY DESIGN: Two identically designed, longitudinal, case-control
studies of males and females with and without ADHD were combined; 124
and 137 control and subjects with ADHD, respectively, provided growth
information at the 10- to 11-year follow-up. We used linear growth curve
models to estimate the effect of time on change in height and whether
this effect differed by sex and ADHD status. We also examined the effect
of stimulant treatment on growth outcomes.
RESULTS: We found no evidence that ADHD was associated with trajectories
of height over time or differences at follow-up in any growth outcomes.
Similarly, we found no evidence that stimulant treatment was associated
with differences in growth. However, among subjects with ADHD, major
depression was associated with significantly larger weight in females
and smaller height in males.
CONCLUSIONS: Our results do not support an association between deficits
in growth outcomes and either ADHD or psychostimulant treatment for
ADHD. These findings extend the literature on this topic into young
adulthood and should assist clinicians and parents in formulating
treatment plans for children with ADHD.
Chiropractic care for paediatric and
adolescent Attention-Deficit/Hyperactivity Disorder: A systematic
Karpouzis, Fay; Bonello, Rod; Pollard,
Chiropractic & Osteopathy, June 2, 2010,
BACKGROUND: Psychostimulants are first line of therapy for paediatric
and adolescent AD/HD. The evidence suggests that up to 30% of those
prescribed stimulant medications do not show clinically significant
outcomes. In addition, many children and adolescents experience
side-effects from these medications. As a result, parents are seeking
alternate interventions for their children. Complementary and
alternative medicine therapies for behavioural disorders such as AD/HD
are increasing with as many as 68% of parents having sought help from
alternative practitioners, including chiropractors.
OBJECTIVE: The review seeks to answer the question of whether
chiropractic care can reduce symptoms of inattention, impulsivity and
hyperactivity for paediatric and adolescent AD/HD. METHODS: Electronic
databases (Cochrane CENTRAL register of Controlled Trials, Cochrane
Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI
Web of Science, Index to Chiropractic Literature) were searched from
inception until July 2009 for English language studies for chiropractic
care and AD/HD. Inclusion and exclusion criteria were applied to select
studies. All randomised controlled trials were evaluated using the Jadad
score and a checklist developed from the CONSORT (Consolidated Standards
of Reporting Trials) guidelines.
RESULTS: The search yielded 58 citations of which 22 were intervention
studies. Of these, only three studies were identified for paediatric and
adolescent AD/HD cohorts. The methodological quality was poor and none
of the studies qualified using inclusion criteria.
CONCLUSIONS: To date there is insufficient evidence to evaluate the
efficacy of chiropractic care for paediatric and adolescent AD/HD. The
claim that chiropractic care improves paediatric and adolescent AD/HD,
is only supported by low levels of scientific evidence. In the interest
of paediatric and adolescent health, if chiropractic care for AD/HD is
to continue, more rigorous scientific research needs to be undertaken to
examine the efficacy and effectiveness of chiropractic treatment.
Adequately-sized RCTs using clinically relevant outcomes and
standardised measures to examine the effectiveness of chiropractic care
verses no-treatment/placebo control or standard care (pharmacological
and psychosocial care) are needed to determine whether chiropractic care
is an effective alternative intervention for paediatric and adolescent
Conditioned Placebo Dose Reduction: A New Treatment in Attention-Deficit
Sandler, Adrian D.; Glesne, Corrine E.; Bodfish, James
Journal of Developmental and Behavioral Pediatrics, June 2010,
v31 n5, pp. 369-375 [May 20, 2010, Online Early]
OBJECTIVE: This study examined if pairing a placebo with stimulant
medication produces a placebo response that allows children with
attention-deficit hyperactivity disorder (ADHD) to be maintained on a
lower dose of stimulant medication. The primary aim was to determine the
efficacy, side effects, and acceptability of a novel conditioned placebo
dose reduction procedure.
METHOD: Participants included 99 children ages 6 to 12 years with ADHD.
After an initial double-blind dose finding to identify optimal dose of
mixed amphetamine salts, subjects were randomly assigned to 1 of 3
treatments of 8-week duration: (a) conditioned placebo dose reduction
condition (50% reduced dose/placebo [RD/P]) or (b) a dose reduction only
condition (RD) or (c) a no reduction condition (full dose). The
innovative conditioned placebo dose reduction procedure involved daily
pairing of mixed amphetamine salts dose with a visually distinctive
placebo capsule administered in open label, with full disclosure of
placebo use to subjects and parents.
RESULTS: Seventy children completed the study. There were no differences
in subject retention among the 3 groups. Most subjects in the RD/P group
remained stable during the treatment phase, whereas most in the RD group
deteriorated. There was no difference in control of ADHD symptoms
between the RD/P group and the full dose group, and both RD/P and full
dose groups showed better ADHD control than the RD group. Treatment
emergent side effects were lowest in the RD/P group.
CONCLUSION: Pairing placebos with stimulant medication elicits a placebo
response that allows children with ADHD to be effectively treated on 50%
of their optimal stimulant dose.
Detection of feigned ADHD in college
Sollman, Myriam J.; Ranseen, John D.; Berry, David T. R.
Psychological Assessment, June 2010, v22 n2, pp. 325-335.
Significant motivations and incentives exist for young-adult
students to seek a diagnosis of attention-deficit/hyperactivity disorder
(ADHD). With ADHD information readily accessible on the Internet,
today's students are likely to be symptom educated prior to evaluation.
This may result in false-positive diagnoses, particularly when students
are motivated to convey symptoms. We evaluated the utility of ADHD
symptom checklists, neurocognitive tests, and measures initially
developed to detect feigned neurocognitive or psychiatric dysfunction
(symptom validity tests [SVTs]). The performance of 31 undergraduates
financially motivated and coached about ADHD via Internet-derived
information was compared to that of 29 ADHD undergraduates following
medication washout and 14 students not endorsing symptomatology. Results
indicated malingerers readily produced ADHD-consistent profiles. Symptom
checklists, including the ADHD Rating Scale and Conners's Adult ADHD
Rating Scale-Self-Rating Form: Long, were particularly susceptible to
faking. Conners's Continuous Performance Test-II findings appeared more
related to motivation than condition. Promising results were seen with
all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory
Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test),
particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs
demonstrated very high specificity for the ADHD condition and moderate
sensitivity to faking, which translated into high positive predictive
values at rising base rates of feigning. Combining 2 or more failures
resulted in only modest declines in sensitivity but robust specificity.
Results point to the need for a thorough evaluation of history,
cognitive and emotional functioning, and the consideration of
exaggerated symptomatology in the diagnosis of ADHD. (PsycINFO Database
Record © 2010 APA, all rights reserved).
A Randomized, Single-Blind, Substitution
Study of OROS Methylphenidate (Concerta) in ADHD Adults Receiving
Immediate Release Methylphenidate
Spencer, Thomas J.; Mick, Eric; Surman, Craig B. H.; Hammerness, Paul;
Journal of Attention Disorders, May 21, 2010, Online
OBJECTIVE: The main aim of this study was to examine the efficacy,
tolerability, and compliance of an extended-release formulation of
methylphenidate (OROS-MPH) in adults with ADHD receiving
immediate-release methylphenidate (IR-MPH).
METHOD: Participants were outpatient adults with ADHD who were stable on
IR-MPH-administered TID. Participants were randomized (4:1) to
equipotent doses of OROS-MPH or to continue IR-MPH and were assessed
weekly for 6 weeks with the Adult ADHD Investigator System Symptom
Report Scale (AISRS). RESULTS: Randomization of 53 IR-MPH responders to
IR- or OROS-MPH had no effect on AISRS score at endpoint (11.2 +/- 6.9
vs. 10.7 +/- 5.1, p = .8). Participants stabilized on IR-MPH and
switched to OROS-MPH remained satisfied over 71% of the time. However,
the IR-MPH group missed more doses (7.3 +/- 6.8 vs. 3.3 +/- 4.2, p =
.02) than the OROS-MPH group.
CONCLUSION: Findings showed that adults with ADHD can be successfully
switched from an effective regimen of IR-MPH TID to once-daily OROS-MPH.
Results also demonstrated better compliance with OROS-MPH than with
and Urinary Metabolites of Organophosphate Pesticides
Bouchard, Maryse F.; Bellinger, David C.; Wright, Robert O.; Weisskopf,
Pediatrics, May 17, 2010, Online Early.
OBJECTIVE: The goal was to examine the association between
urinary concentrations of dialkyl phosphate metabolites of
organophosphates and attention-deficit/hyperactivity disorder (ADHD) in
children 8 to 15 years of age.
METHODS: Cross-sectional data from the National Health and Nutrition
Examination Survey (2000-2004) were available for 1139 children, who
were representative of the general US population. A structured interview
with a parent was used to ascertain ADHD diagnostic status, on the basis
of slightly modified criteria from the Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition.
RESULTS: One hundred nineteen children met the diagnostic criteria for
ADHD. Children with higher urinary dialkyl phosphate concentrations,
especially dimethyl alkylphosphate (DMAP) concentrations, were more
likely to be diagnosed as having ADHD. A 10-fold increase in DMAP
concentration was associated with an odds ratio of 1.55 (95% confidence
interval: 1.14-2.10), with adjustment for gender, age, race/ethnicity,
poverty/income ratio, fasting duration, and urinary creatinine
concentration. For the most-commonly detected DMAP metabolite, dimethyl
thiophosphate, children with levels higher than the median of detectable
concentrations had twice the odds of ADHD (adjusted odds ratio: 1.93
[95% confidence interval: 1.23-3.02]), compared with children with
CONCLUSIONS: These findings support the hypothesis that organophosphate
exposure, at levels common among US children, may contribute to ADHD
prevalence. Prospective studies are needed to establish whether this
association is causal.
ADHD Across Cultures: Is There Evidence
for a Bidimensional Organization of Symptoms?
Bauermeister, Jose J.; Canino, Glorisa; Polanczyk, Guilherme;
Rohde, Luis A.
Journal of Clinical Child and Adolescent Psychology, May 2010,
v39 n3, pp. 362-372.
We examined the phenotypic expression of
attention-deficit/hyperactivity disorder (ADHD) across cultures by
assessing the factor/latent class structure of its core symptoms. We
conducted a systematic review of the literature published from January
1987 to November 2008 using Medline and PsycINFO. We systematically
reviewed 2,511 article abstracts, and 48 of these abstracts were
included in this review. Research with school-age children from 15
countries including different samples, informants, and rating
instruments supported a two-factor ADHD model consisting of inattention
and combined hyperactivity and impulsivity. This model was not supported
for preschool children. Cross-cultural equivalence for the two-factor
model was suggested in some studies. Latent class analyses using
parental data and more recent approaches like factor mixture modeling
are generally consistent with factor analyses. These findings argue in
favor of a cross-cultural validity of the syndrome. The implications of
these findings for further research and classificatory systems in mental
health like the Diagnostic and Statistical Manual of Mental Disorders
(5th ed.) are discussed.