Food intolerance and the few-foods(or oligoantigenic)diet in children with attention-deficit hyperactivity disorder

The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.

Clarifying the relationship and analyzing the influential factors of bronchial asthma in children with attention-deficit hyperactivity disorder

BACKGROUND Bronchial asthma is closely related to the occurrence of attention-deficit hyperactivity disorder(ADHD)in children,which can easily have adverse effects on children’s learning and social interactions.Studies have shown that childhood asthma can increase the risk of ADHD and the core symptoms of ADHD.Compared with children with ADHD alone,children with asthma and ADHD are more likely to show high levels of hyperactivity,hyperactive-impulsive and other externalizing behaviors and anxiety in clinical practice and have more symptoms of somatization and emotional internalization.AIM To explore the relationship between ADHD in children and bronchial asthma and to analyze its influencing factors.METHODS This retrospective cohort study was conducted at Dongying People's Hospital from September 2018 to August 2023.Children diagnosed with ADHD at this hospital were selected as the ADHD group,while healthy children without ADHD who underwent physical examinations during the same period served as the control group.Clinical and parental data were collected for all participating children,and multivariate logistic regression analysis was employed to identify risk factors for comorbid asthma in children with ADHD.RESULTSSignificant differences were detected between the ADHD group and the control group in terms of family history ofasthma and allergic diseases, maternal complications during pregnancy, maternal use of asthma and allergymedications during pregnancy, maternal anxiety and depression during pregnancy, and parental relationshipstatus (P < 0.05). Out of the 183 children in the ADHD group, 25 had comorbid asthma, resulting in a comorbidityrate of 13.66% (25/183), compared to the comorbidity rate of 2.91% (16/549) among the 549 children in the controlgroup. The difference in the asthma comorbidity rate between the two groups was statistically significant (P <0.05). The results of the multivariate logistic regression analysis indicated that family history of asthma and allergicdiseases, maternal complications during pregnancy, maternal use of asthma and allergy medications duringpregnancy, maternal anxiety and depression during pregnancy, and parental relationship status are independentrisk factors increasing the risk of comorbid asthma in children with ADHD (P < 0.05).CONCLUSIONChildren with ADHD were more likely to have comorbid asthma than healthy control children were. A familyhistory of asthma, adverse maternal factors during pregnancy, and parental relationship status were identified asrisk factors influencing the comorbidity of asthma in children with ADHD. Clinically, targeted interventions basedon these factors can be implemented to reduce the risk of comorbid asthma. This information is relevant for resultssections of abstracts in scientific articles.

A retrospective study on professor Gui-Qi Xuan’s experience in traditional Chinese medicine treatment on attention-deficit hyperactivity disorder: based on data mining and network pharmacology

Background:To investigate the clinical medication approach of Professor Guiqi Xuan(Prof.Xuan)in treating pediatric patients with attention-deficit hyperactivity disorder(ADHD)and the potential mechanism of the core herbal prescription.Methods:Following medical record information pretreatment,the Traditional Chinese Medicine(TCM)inheritance computing platform system V3.0 was utilized to analyze the standardized data.The associate rules were summarized to identify the core prescription for treating ADHD.The extracted core herbal prescription’s active compounds and potential targets were used to establish a protein-protein interaction network of active ingredient-disease targets.Cytoscape 3.9.1 software was used to analyze the network’s topological parameters to obtain the key active ingredients and their targets.The Bioconductor data package of R4.0.2 was used to analyze the gene ontology biological functions and Kyoto Encyclopedia of Genes and Genomes pathways of key targets.Results:Two hundred and twenty-seven entries derived from TCM record information were selected.Through data mining,it was found that 62.5%of pediatric patients had short-tempered behavior,nearly half had sleep problems,and 30%-40%had picky eating and polyphagia issues.The highest-frequency syndrome type was kidney deficiency and liver hyperactivity.Deficiency,fire,phlegm,and dyspeptic food were the main pathological factors for ADHD.Prof.Xuan’s treatment of ADHD mainly focused on replenishing kidney essence and subduing Yang(active,external,ascending,warm,bright,functional and excited pertain to Yang).The core herbal prescription for ADHD included Yuan-zhi,Yi-zhi,Gui-jia,Bai-shao,Long-chi,Ci-shi,Shi-chang-pu,Yu-jin,Fu-shen,and Huang-jing.The protein-protein interaction network showed that MAOA,ADRB2,FOS,MAOB,and SLC6A3 were the five key targets essential in treating ADHD with core herbal prescriptions.The gene ontology biological function of crucial targets mainly involved G protein-coupled amine receptor activity,catecholamine binding,and neurotransmitter transmembrane transporter activity.Analysis of Kyoto Encyclopedia of Genes and Genomes pathways showed that the dopaminergic synapse signaling and neuroactive ligand-receptor interaction pathways were significantly enriched and may be the primary routes for the main treatment of ADHD.Conclusion:Prof.Xuan’s treatment of ADHD has achieved satisfactory clinical effects by supplementing the kidney,replenishing the essence,opening the orifices,nourishing the Yin(static,internal,descending,cold,dim,organic,depressed and pertain to Yin),and subduing the Yang.The major prescription predominantly affects catecholamine binding,neuroactive ligand-receptor interaction,G protein-coupled amine receptor function,and signaling pathways for dopaminergic synapses.Our findings showed that the methodology and software used in this research could explore and analyze the mechanism behind Prof.Xuan’s clinical medication rule for treating ADHD in children.

Deficiency of transmembrane AMPA receptor regulatory protein γ-8 leads to attention-deficit hyperactivity disorder-like behavior in mice

Attention-deficit hyperactivity disorder(ADHD) is a neurodevelopmental disorder prevalent in schoolage children. At present, however, its etiologies and risk factors are unknown. Transmembrane α-amino-3-hydroxy-5-methyl-4-isoxazolepropionicacid(AMPA) receptor regulatory protein γ-8(TARP γ-8,also known as calcium voltage-gated channel auxiliary subunit gamma 8(CACNG8)) is an auxiliary AMPA receptor(AMPAR) subunit. Here, we report an association between TARP γ-8 and ADHD,whereby adolescent TARP γ-8 knockout(KO) mice exhibitedADHD-likebehaviors,including hyperactivity, impulsivity, anxiety, impaired cognition,and memory deficits. Human single-nucleotide polymorphism(SNP) analysis also revealed strong associations between intronic alleles in CACNG8genes and ADHD susceptibility. In addition,synaptosomal proteomic analysis revealed dysfunction of the AMPA glutamate receptor complex in the hippocampi of TARP γ-8 KO mice.Proteomic analysis also revealed dysregulation of dopaminergic and glutamatergic transmissions in the prefrontal cortices of TARP γ-8 KO mice.Methylphenidate(MPH), which is commonly used to treat ADHD, significantly rescued the major behavioral deficits and abnormal synaptosomal proteins in TARP γ-8 KO mice. Notably, MPH significantly reversed the up-regulation of Grik2 and Slc6a3 in the prefrontal cortex. MPH also significantly improved synaptic AMPAR complex function by up-regulating other AMPAR auxiliary proteins in hippocampal synaptosomes. Taken together, our results suggest that TARP γ-8 is involved in the development of ADHD in humans.This study provides a useful alternative animal model with ADHD-like phenotypes related to TARP γ-8deficiency, which has great potential for the development of new therapies.

Voxel-based statistical analysis of regional cerebral glucose metabolism in children with attention-deficit hyperactivity disorder

The technique of region of interest-based positron emission tomography is limited by its poor reli-ability and relatively few examined brain regions. In the present study, we compared brain metabo-lism assessed using fluorine-18-fluorodeoxyglucose positron emission tomography between 14 at-tention-deficit hyperactivity disorder （ADHD） patients and 15 normal controls with scoliosis at resting state by statistical parametric mapping. Glucose metabolism was decreased in the left parahippo-campal gyrus, left hippocampus, left anterior cingulate gyrus, right anterior and posterior lobes of the cerebellum, left superior temporal gyrus, left insula, left medial and middle frontal gyri, right medial frontal gyrus, and left basal ganglia （putamen, amygdala, and caudate nucleus） in children with ADHD. These data suggest that children with ADHD exhibit hypometabolism in various brain regions compared to controls, indicating that ADHD symptoms are unlikely the result of abnormalities in specific areas.

Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Patients with Chronic Pain

Aims: To investigate rates of attention-deficit hyperactivity disorder (ADHD) in patients with chronic pain attending a pain clinic, the effects of a screening measure for ADHD in patients with chronic pain, and the effects of ADHD drugs on both pain and ADHD symptoms. Methods: We retrospectively surveyed 110 patients with chronic pain visiting the Anesthesiology and Pain Relief Center at the University of Tokyo in Japan, who had also consulted a psychiatrist, between April 2012 and July 2015. Results: Of the total of 110 patients with chronic pain, 35 (31.8%) were also diagnosed with ADHD, and the average Wender Utah Rating Scale (WURS) score among the ADHD patients was 39.0 ± 22.1 (n = 25). Only 36.0% of these patients exceeded the cutoff value, suggesting that 64.0% of the patients with ADHD were not identified by screening with the WURS. Twenty-six patients initiated treatment with ADHD medication, with dosage adjustment completed in 21. Of these 21 patients 20 (95.0%) had improved ADHD symptoms. Improved pain symptoms were observed in 14 patients (66.6%), with a reduction in the pain numerical rating scale of 64.7% ± 30.1%. Conclusions: This is the first study investigating the comorbidity of ADHD and chronic pain at pain clinics showing a high level of comorbidity and amelioration of pain and ADHD symptoms with treatment. Careful interpretation is required when the WURS is used to screen patients with chronic pain.

MicroRNAs as potential biomarkers for diagnosis of attention deficit hyperactivity disorder

Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of children with attention deficit hyperactivity disorder are affected,and these symptoms may persist to adulthood if they are not treated.The diagnosis of attention deficit hyperactivity disorder is only based on symptoms and objective tests for attention deficit hyperactivity disorder are missing.Treatments for attention deficit hyperactivity disorder in children include medications,behavior therapy,counseling,and education services which can relieve many of the symptoms of attention deficit hyperactivity disorder but cannot cure it.There is a need for a molecular biomarker to distinguish attention deficit hyperactivity disorder from healthy subjects and other neurological conditions,which would allow for an earlier and more accurate diagnosis and appropriate treatment to be initiated.Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of attention deficit hyperactivity disorder.The recent studies reviewed had performed microRNA profiling in whole blood,white blood cells,blood plasma,and blood serum of children with attention deficit hyperactivity disorder.A large number of microRNAs were dysregulated when compared to healthy controls and with some overlap between individual studies.From the studies that had included a validation set of patients and controls,potential candidate biomarkers for attention deficit hyperactivity disorder in children could be miR-140-3p,let-7g-5p,-30e-5p,-223-3p,-142-5p,-486-5p,-151a-3p,-151a-5p,and-126-5p in total white blood cells,and miR-4516,-6090,-4763-3p,-4281,-4466,-101-3p,-130a-3p,-138-5p,-195-5p,and-106b-5p in blood serum.Further studies are warranted with children and adults with attention deficit hyperactivity disorder,and consideration should be given to utilizing rat models of attention deficit hyperactivity disorder.Animal studies could be used to confirm microRNA findings in human patients and to test the effects of targeting specific microRNAs on disease progression and behavior.

Nutritional epigenetics education improves diet and attitude of parents of children with autism or attention deficit/hyperactivity disorder

BACKGROUND Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations,creating conditions for the neurodevelopmental disorders known as autism and attention deficit/hyperactivity disorder(ADHD).Children with these disorders have difficulty metabolizing and excreting heavy metals from their bloodstream,and the severity of their symptoms correlates with the heavy metal levels measured in their blood.Psychiatrists may play a key role in helping parents reduce their ultra-processed food and dietary heavy metal intake by providing access to effective nutritional epigenetics education.AIM To test the efficacy of nutritional epigenetics instruction in reducing parental ultra-processed food intake.METHODS The study utilized a semi-randomized test and control group pretest-posttest pilot study design with participants recruited from parents having a learning-disabled child with autism or ADHD.Twenty-two parents who met the inclusion criteria were randomly selected to serve in the test(n=11)or control(n=11)group.The test group participated in the six-week online nutritional epigenetics tutorial,while the control group did not.The efficacy of the nutritional epigenetics instruction was determined by measuring changes in parent diet and attitude using data derived from an online diet survey administered to the participants during the pre and post intervention periods.Diet intake scores were derived for both ultra-processed and whole/organic foods.Paired sample t-tests were conducted to determine any differences in mean diet scores within each group.RESULTS There was a significant difference in the diet scores of the test group between the pre-and post-intervention periods.The parents in the test group significantly reduced their intake of ultra-processed foods with a preintervention diet score of 70(mean=5.385,SD=2.534)and a post-intervention diet score of 113(mean=8.692,SD=1.750)and the paired t-test analysis showing a significance of P<0.001.The test group also significantly increased their consumption of whole and/or organic foods with a pre-intervention diet score of 100(mean=5.882,SD=2.472)and post-intervention diet score of 121(mean=7.118,SD=2.390)and the paired t-test analysis showing a significance of P<0.05.CONCLUSION Here we show nutritional epigenetics education can be used to reduce ultra-processed food intake and improve attitude among parents having learning-disabled children with autism or ADHD.

Identification and treatment of individuals with attentiondeficit/ hyperactivity disorder and substance use disorder: An expert consensus statement

Attention-deficit/hyperactivity disorder(ADHD)often co-occurs with substance use(SU)and/or substance use disorder(SUD).Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment.This can be further complicated by the context in which services are delivered.Also,when working with young people and adults with co-existing ADHD and SU/SUD,there is uncertainty among healthcare practitioners on how best to meet their needs.In February 2022,the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues.Following presentations providing attendees with an overview of the literature,group discussions were held synthesizing research evidence and clinical experience.Topics included:(1)A review of substances and reasons for use/misuse;(2)identification,assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services;and(3)identification,assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services.Discussions highlighted inter-service barriers and fragmentation of care.It was concluded that a multimodal and multi-agency approach is needed.The consensus group generated a table of practice recommendations providing guidance on:identification and assessment;pharmacological and psychological treatment;and multi-agency interventions.

Multimodal integrated intervention for children with attentiondeficit/hyperactivity disorder

BACKGROUND Attention-deficit/hyperactivity disorder(ADHD)is one of the most common disorders in child and adolescent psychiatry,with a prevalence of more than 5%.Despite extensive research on ADHD in the last 10 to 20 years,effective treatments are still lacking.Instead,the concept of ADHD seems to have become broader and more heterogeneous.Therefore,the diagnosis and treatment of ADHD remains challenging for clinicians.AIM To investigate the effects of a multimodal integrated intervention for children with ADHD.METHODS Between March 2019 and September 2020,a total of 100 children with ADHD who were diagnosed and treated at our hospital were assessed for eligibility,two of whom revoked their consent.A case-control study was conducted in which the children were equally assigned,using a randomized number table,to either a medication group(methylphenidate hydrochloride extended-release tablets and atomoxetine hydrochloride tablets)or a multimodal integrated intervention group(medication+parent training+behavior modification+sensory integration therapy+sand tray therapy),with 49 patients in each group.The clinical endpoint was the efficacy of the different intervention modalities.RESULTS The two groups of children with ADHD had comparable patient characteristics(P>0.05).Multimodal integrated intervention resulted in a significantly higher treatment efficacy(91.84%)than medication alone(75.51%)(P<0.05).Children who received the multimodal integrated intervention showed lower scores in the Conners Parent Symptom Questionnaire and the Weiss Functional Impairment Rating Scale than those treated with medication alone(P<0.05).The Sensory Integration Scale scores of children in the multimodal integrated intervention group were higher than those of children in the medication group(P<0.05).Children who received the multimodal integrated intervention had higher compliance and family satisfaction and a lower incidence of adverse events than those treated with medication alone(P<0.05).CONCLUSION Multimodal integrated intervention effectively alleviated symptoms associated with ADHD in children.It enhanced their memory and attention with high safety and parental satisfaction,demonstrating good potential for clinical promotion.

Diet and food in attention-deficit hyperactivity disorder

Deficiencies of nutrients,including vitamins,minerals and polyunsaturated fatty acids,and surpluses of food items,such as sucrose and artificial food additives,have not convincingly been shown to be involved in the etiology of ADHD.At group level,there is no conclusive evidence supporting dietary interventions for the treatment of ADHD.The identification of a role of food compounds in ADHD is hindered by the complex and ill-defined nature of ADHD.In view of the heterogeneity of the disorder,potential therapeutic benefits of nutritional interventions could be confined to subpopulations of children with ADHD as yet unidentified.The cumulative benefits of the range of ingredients comprising healthy diets may result in better outcomes compared to a supplementation of individual nutrients.Diet and nutrition interact with other lifestyle factors,such as physical activity,and the interrelationship between nutrition and lifestyle should play a more prominent role in research on treatment approaches to ADHD.The few-foods or oligoallergenic diet allows the design of individually tailored diets and may offer treatment opportunities in subgroups of children diagnosed with ADHD.Further research is required to demonstrate the utility of nutrition-related interventions alone or in combination with other treatment approaches in ADHD.

An Open-label, Self-control, Prospective Study on Cognitive Function, Academic Performance, and Tolerability of Osmotic-release Oral System Methylphenidate in Children with Attention-deficit Hyperactivity Disorder

Background： Attention-deficit hyperactivity disorder （ADHD） is the most common mental and behavioral disorder in school-aged children. This study evaluated the effect of osmotic-release oral system （OROS） methylphenidate （MPH） on cognitive function and academic performance of Chinese school-aged children with ADHD. Methods： This 12-week, prospective, multicenter, open-label, self-controlled study enrolled 153 Chinese school-aged children with ADHD and 41 non-ADHD children. Children with ADHD were treated with once-daily OROS-MPH （18 mg, 36 mg, or 54 mg）. The primary endpoints were Inattention/Overactivity （I/O） with Aggression Conners Behavior Rating Scale （IOWA） and Digit Span Test at week 12 compared with baseline. Secondary endpoints included opposition/defiant （O/D） subscale of IOWA, Clinical Global Impression （CGI）, Coding Test, Stroop Color-word Test, Wisconsin Card Sorting Test （WCST）, academic performance on teacher-rated school examinations, and safety at week 12 compared with baseline. Both non-ADHD and ADHD children received the same frequency of cognitive operational test to avoid the possible bias caused by training. Results： A total of 128 patients were evaluated with cognitive assessments. The OROS-MPH treatment significantly improved IOWA Conners I/O subscale scores at week 12 （3.8 ± 2.3） versus baseline （10.0 ± 2.4; P 〈 0.0001）. Digit Span Test scores improved significantly （P 〈 0.0001 ） with a high remission rate （81.1%） at week 12 versus baseline. A significant （P 〈 0.0001 ） improvement was observed in O/D subscale of IOWA, CGI, Coding Test, Stroop Color-word Test, WCST, and academic performance at week 12 versus baseline. Very few practice-related improvements were noticed in the non-ADHD group at week 12 compared with baseline. No serious adverse events and deaths were reported during the study. Conclusions： The OROS-MPH treatment effectively controlled symptoms of ADHD and significantly improved academic performance and cognitive fimction of Chinese school-aged children with ADHD. The treatment was found to be sate and generally well-tolerated over 12 weeks.

Effect of non-pharmacological treatment on the full recovery of social functioning in patients with attention deficit hyperactivity disorder

BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder(ADHD)is associated with adverse events,such as nausea and vomiting,dizziness,and sleep disturbances,and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients’social functioning.AIM To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD.METHODS A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group(methylphenidate hydrochloride and tomoxetine hydrochloride)or the non-pharmacological group(parental training,behavior modification,sensory integration therapy,and sand tray therapy),with 45 cases in each group.Outcome measures included treatment compliance,Swanson,Nolan,and Pelham,Version IV(SNAP-IV)scores,Conners Parent Symptom Questionnaire(PSQ)scores,and Weiss Functional Impairment Rating Scale(WFIRS)scores.RESULTS The non-pharmacological interventions resulted in significantly higher compliance in patients(95.56%)compared with medication(71.11%)(P<0.05).However,no significant differences in SNAP-IV and PSQ scores,in addition to the learning/school,social activities,and adventure activities of the WFIRS scores were observed between the two groups(P>0.05).Patients with non-pharmacological interventions showed higher WFIRS scores for family,daily life skills,and self-concept than those in the pharmacological group(P<0.05).CONCLUSION Non-pharmacological interventions,in contrast to the potential risks of adverse events after longterm medication,improve patient treatment compliance,alleviate patients’behavioral symptoms of attention,impulsivity,and hyperactivity,and improve their cognitive ability,thereby improving family relationships and patient self-evaluation.

Group Psychological Intervention for Children with Hyperactivity Disorder

ADHD is a broad psychiatric disorder that affects children of normal or near-normal intelligence.It is character-ized by inattention,hyperactivity,and age-inappropriate impulsivity,and it is often accompanied by learning dif-ficulties,behavioral,emotional,and interpersonal problems.On the other hand,hyperactive tendencies in children with ADHD exhibit ADHD-like behaviors such as lack of self-control,inattention,hyperactivity,and emotional impulsivity.However,because their symptoms are less severe,they do not meet the diagnostic criteria for ADHD but are ADHD or at risk of developing ADHD.The purpose of this study is to alleviate and reduce children’s hyperactivity symptoms by investigating the current situation of the children studied,and systemati-cally intervening and educating children with ADHD through psychological group intervention.Research data shows that ADHD is most commonly diagnosed in school-age children,and in 70%–80%of children with ADHD,symptoms persist into adolescence and 30%into adulthood.Through the use of group psychological intervention in the experiment,the prevalence rate of children with hyperactivity disorder tendency has been effectively reduced.This shows that group psychological intervention training has a significant effect on improving hyper-activity symptoms in children with ADHD tendency.

Clinical Observation on Modified Huan'gan Lipi Decoction Combined with Acupuncture in Treating Spleen Deficiency and Liver Hyperactivity Type Tic Disorders

[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.

Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder

Background In this research the symptom improvement of attention-deficit hyperactivity disorder (ADHD) of children was assessed by oral vitamin D administration in Tabriz,Iran.Methods In this double-blind,randomized clinical trials,96 children (2-18 years) were enrolled to placebo and vitamin D groups.Children took vitamin D pearl (50,000 IU/week) or placebo for 6 weeks.Children,who had the change in methylphenidate dosage and received any anticonvulsants and corticosteroids were excluded from the research.ADHD symptoms were diagnosed by Conners parent rating scale (CPRS) test at baseline and after intervention.ADHD Conners divided into inattention (IA),hyperactivity/impulsivity (H/I) and combination type (C) subscales.Vitamin D serum level was assessed at baseline and after 8 weeks in both groups.Results The differences between CPRS and its subscales were not significant at baseline (P > 0.05).The Conners IA score was decreased in vitamin D group (P < 0.05;adjusted with age and baseline values).ADHD Conners and all subscale scores reduced remarkably after intervention in patients with insufficient level of vitamin D compared to placebo (P < 0.05).Conclusions Oral vitamin D improved ADHD symptoms with a particular effect on inattention symptoms.In addition,symptoms related to all subscales were improved remarkably in patients with insufficient level of vitamin D.Vitamin D treatment in children with ADHD could be considered due to the expand benefit of vitamin D in body.

Attention-deficit/hyperactivity disorder and suicide:A systematic review

AIM To investigate suicidality and attention-deficit/hyperactivity disorder(ADHD), this paper aims to systematically review the literature as an extension of previous reviews.METHODS We searched five databases(Ovid MEDLINE, Psychinfo, PubM ed, Scopus, Web of Science) with two categories of search terms:(1) suicide; suicidal; suicide behavior; suicide attempt; suicidal thought; and(2) ADHD. RESULTS The search resulted 26 articles. There is a positive association between ADHD and suicidality in both sexes and in all age groups. Comorbid disorders mediate between suicidality and ADHD. CONCLUSION Recognizing ADHD, comorbid conditions and suicidality is important in prevention.

Alcohol and drug use disorders in adult attentiondeficit/hyperactivity disorder:Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation

BACKGROUND High risk of alcohol and drug use disorders in people with attentiondeficit/hyperactivity disorder(ADHD)calls for exploratory research of relationships with clinical features of ADHD.AIM To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation,in adults with ADHD.METHODS This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo,Norway(2014-2018).Five-hundred and fifty-eight eligible patients diagnosed with ADHD(Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria)agreed to participate.Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview(MINI).Dependence and abuse were merged into“use”disorder as in MINI version 7.0/DSM-5.Questions were related both to lifetime and the past 12-mo.ADHD severity was assessed by the Adult ADHD Self Report Scale(ASRS).Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately.Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale-Self Report.RESULTS The 12-mo prevalence was 5.3%for alcohol use disorder and 13.7%for drug use disorder.The lifetime prevalence was 12.0%for alcohol use disorder and 27.7%for drug use disorder.Men had higher rates of both alcohol use disorder and drug use disorder compared to women.The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes.The drugs most participants reported having used were(in descending order):Amphetamine(19.1%),cannabis(17.1%),cocaine or ecstasy(7.4%),benzodiazepines(7.4%),and heroin or other opioids(2.9%).Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity.Lifetime alcohol use disorder,on the other hand,was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.CONCLUSION Patients with ADHD have a high lifetime prevalence of drug use disorder,which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.

Generalized structural equation modeling:Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy

BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterogeneity.AIM To use generalized structural equation modeling(GSEM)to show how the heterogeneous nature of hyperactivity/impulsivity(H/I)symptoms in ADHD,irritable oppositional defiant disorder(ODD),and the presentation of aggression in children interferes with treatment responses in ADHD.METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests.ODD scores from the Swanson,Nolan,and Pelham,version IV scale were obtained.The child behavior checklist(CBCL)and parent’s satisfaction questionnaire were completed.The relationships were analyzed by GSEM.RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD,ODD symptoms,and childhood aggressive behavior.ODD directly mediated ADHD symptom severity.The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494%[=exp(2.602)]in children with comorbid ADHD and ODD[odds ratio(OR)=2.602,95%confidence interval(CI):1.832-3.373,P=0.000]after adjusting for the effects of other factors.Childhood aggression mediated ODD symptom severity.The chance of reaching remission based on ODD symptoms was lowered by 11.000%[=1-exp(-0.117)]in children with more severe baseline symptoms of aggression based on the CBCL score at study entry[OR=-0.117,95%CI:(-0.190)-(-0.044),P=0.002].CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity.More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment,e.g.,symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.

Attention-Deficit/Hyperactivity Disorder in Adults with High-Functioning Pervasive Developmental Disorders in Japan

Aims: This study was designed to verify the proportion of Japanese adults with pervasive developmental disorder (PDD) who met the diagnostic criteria (other than E) for attention-deficit/hyperactivity disorder (ADHD) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Furthermore, we examined to what extent adults with PDD think that they exhibit ADHD symptoms. Methods: We developed an original Japanese self-report questionnaire to determine the presence or absence of 18 symptoms from the diagnostic criteria for ADHD in the DSM-IV-TR. We administered the questionnaire to 64 adults with high-functioning PDD (45 men and 19 women) and 21 adults with ADHD (10 men and 11 women), aged 18 to 59 years, with a full-scale intelligence quotient ≥75. Target patients were evaluated for ADHD by their psychiatrists. Results: Twenty-nine (45.3%) adults with PDD also had ADHD. The percentage of these adults who had over six perceived inattention symptoms from the DSM-IV-TR was 96.6%. The percentage of these adults who had over six perceived hyperactivity-impulsivity symptoms was 65.5%. Thirty-five (55.6%) adults with PDD responded that they were aware of having ADHD symptoms at the level of the relevant diagnostic criteria. Conclusions: The present study is the first to examine the frequency of objective and perceived ADHD symptoms in adults with PDD in Japan. Our results show that both objective and perceived ADHD symptoms frequently appear in a large number of adults with PDD. This suggests that it is necessary to attend to concomitant ADHD symptoms in the medical care of adults with PDD.