The Latest Research

The Latest Research and Studies

Are you interested in the latest research into ADHD but don’t know where to start looking? Well you have found the right place!

Note: This is a new part of the ADHD Done Differently Website from July 2023. Therefore, at this stage there is limited research here. However, this will be added to as new research is published.

This information below is not related to ADHD Done Differently or their current research (unless explicitly stated). The information provided is simply a summary of some of the current research into ADHD, therefore, not all of this research will be neurodiversity-affirming and often uses medical model language.

Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning and co-morbidity outcomes (Johnson et al, 2023)

December 2023 PDF available here

Johnson, M., Johnels, J.Å., Östlund, S. et al. Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes. Eur Arch Psychiatry Clin Neurosci (2024). https://doi.org/10.1007/s00406-023-01744-1

Background Information, Study Limitations and summary of current article
The major limitation of this trial is an open uncontrolled design, and the reliance of clinincal ADHD ratings conducted by the clinicians involved in intervention. The results may be influenced by effects of time and age, positive attitude bias (this refers to a tendency to focus on positive information and relatively neglect negative information) and a small sample size. The majority of children and adolescents in the trial used stimulant medications with only a few children and adolescents on non-stimulant medications. The strengths identified were a relatively long term follow up study (2 years), prospective observational study design and inclusion of a sample of children and adolescents with co-occuring conditions, which is more representative of real-world clinical practice.
Summary of current article: All patients in the study had been referred to the Child Neuropsychiatry Clinic, at Sahlgrenska University Hospital in Sweden. All patients had been diagnosed with ADHD according to the DSM-5 or DSM-IV criteria. Patients: Children and adolescents aged 6-18 years with ADHD (any presentation) and on stimulant ADHD medication. For full inclusion and exclusion criteria and participant details see article (link above). Outcome Measures: The primary outcome of the study was changes in ADHD symptom severity measured by Clinical Global Impression- Severity (CGI-S) and Improvement Scales (CGI-I) during 2 years of well-controlled ADHD medication. Secondary outcomes focused on changes in the ADHD-Rating Scale-IV (ADHD-RS) scores. As well as changes in everyday activities in areas often believed to be impacted by ADHD. These included family, school learning and behaviour, life skills, self-concept, social activities and risky activities. These were measured using the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P). After one year they also investigated symptom levels and rate of of co-occuring conditions, assessed by a Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime (K-SADS-PL interview). Results: PRIMARY & Secondary outcome measure: CGI-S/ADHD-RS * Significant improvement of symptoms one month after commencing stimulant medication (for all presentations of ADHD). * At 12 months 46% of participants achieved scores expected of a child without ADHD. At 24 months 61% achieved scores expected of a child without ADHD. Secondary outcome measures: WFIRS-P * Significant (mainly moderate effect sizes) improvements over time * Greatest improvement in Family Life Functioning and lowest improvement in School Learning. K-SADS-PL interview * Significant reduction in co-occuring conditions (called comorbidities in this study). Side effects: * Most side effects were transient (lasting 1-2 months) * Common side effects of stimulant medication were poor appetite, low mood, insomnia, irritability and anxiety. Mild temporary weight loss was common in the stimulant group, but prolonged significant weight loss occured in only 3% of participants. This is usually sold as Ritalin, Artige, Concerta, Vyvanse or dexamphetimine in Australia. * Common side effects of guanfacine (non-stimulant) were fatigue, low mood, irritability, mood swings and vertigo. This is usually sold as Intuniv in Australia. * Common side effects with atomoxetine (non-stimulant) were abdominal pain, low mood, irritability and fatigue. This is usually sold as Strattera in Australia. * Substance use development was rare.

Background Information, Study Limitations and summary of current article

The major limitation of this trial is an open uncontrolled design, and the reliance of clinincal ADHD ratings conducted by the clinicians involved in intervention. The results may be influenced by effects of time and age, positive attitude bias (this refers to a tendency to focus on positive information and relatively neglect negative information) and a small sample size. The majority of children and adolescents in the trial used stimulant medications with only a few children and adolescents on non-stimulant medications.

The strengths identified were a relatively long term follow up study (2 years), prospective observational study design and inclusion of a sample of children and adolescents with co-occuring conditions, which is more representative of real-world clinical practice.

Summary of current article:
All patients in the study had been referred to the Child Neuropsychiatry Clinic, at Sahlgrenska University Hospital in Sweden. All patients had been diagnosed with ADHD according to the DSM-5 or DSM-IV criteria.

Patients: Children and adolescents aged 6-18 years with ADHD (any presentation) and on stimulant ADHD medication. For full inclusion and exclusion criteria and participant details see article (link above).

Outcome Measures: The primary outcome of the study was changes in ADHD symptom severity measured by Clinical Global Impression- Severity (CGI-S) and Improvement Scales (CGI-I) during
2 years of well-controlled ADHD medication.

Secondary outcomes focused on changes in the ADHD-Rating Scale-IV (ADHD-RS) scores. As well as changes in everyday activities in areas often believed to be impacted by ADHD. These included family, school learning and behaviour, life skills, self-concept, social activities and risky activities. These were measured using the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P). After one year they also investigated symptom levels and rate of of co-occuring conditions, assessed by a Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime (K-SADS-PL interview).

Results:
PRIMARY & Secondary outcome measure: CGI-S/ADHD-RS
* Significant improvement of symptoms one month after commencing stimulant medication (for all presentations of ADHD).
* At 12 months 46% of participants achieved scores expected of a child without ADHD. At 24 months 61% achieved scores expected of a child without ADHD.

Secondary outcome measures:
WFIRS-P
* Significant (mainly moderate effect sizes) improvements over time
* Greatest improvement in Family Life Functioning and lowest improvement in School Learning.

K-SADS-PL interview
* Significant reduction in co-occuring conditions (called comorbidities in this study).

Side effects:
* Most side effects were transient (lasting 1-2 months)
* Common side effects of stimulant medication were poor appetite, low mood, insomnia, irritability and anxiety. Mild temporary weight loss was common in the stimulant group, but prolonged significant weight loss occured in only 3% of participants. This is usually sold as Ritalin, Artige, Concerta, Vyvanse or dexamphetimine in Australia.
* Common side effects of guanfacine (non-stimulant) were fatigue, low mood, irritability, mood swings and vertigo. This is usually sold as Intuniv in Australia.
* Common side effects with atomoxetine (non-stimulant) were abdominal pain, low mood, irritability and fatigue. This is usually sold as Strattera in Australia.
* Substance use development was rare.

Completed 19/12/2023 – The ‘medical model’ language used here is reflective of the language used in the article.

The Emerging Evidence on the association between symptoms of ADHD and gaming disorder: A systematic reivew and meta-analysis

December 2023 Link to full article

Koncz, P., Demetrovics, Z., Takacs, Z. K., Griffiths, M. D., Nagy, T., & Király, O. (2023). The emerging evidence on the association between symptoms of ADHD and gaming disorder: A systematic review and meta-analysis. Clinical Psychology Review, 106, 102343. https://doi.org/10.1016/j.cpr.2023.102343

Glossary, Background Information and summary of current article
Glossary/Background Information Gaming Disorder (ICD-11) is also called Video-Game Addiction or Internet Gaming Disorder (DSM-5). In order to fulfil the DSM-5 criteria for Internet Gaming Disorder (IGD) you must fulfil 5 (or more) of the following 9 criteria. (It’s important to note that the DSM-5 has listed IGD as a ‘condition for further study’ and therefore not yet officially recognised as a “formal mental disorder.”) 1. Preoccupation: constantly thinking about gaming, even when not playing. 2. Withdrawal: Feeling negative or upset when unable to play games. 3. Tolerance: Needing to spend more and more time gaming to feel satisfied. 4. Loss of Control: Trying unsuccessfully to cut down on gaming. 5. Giving up other activities; Losing interest in hobbies and activities because of gaming. 6. Continuation: Keep playing games despite knowing it causes problems. 7. Deception: lying to family or therapists about how much time is spent gaming. 8. Escape: Using games to feel better when in a negative mood. 9. Negative Consequences: Experiencing problems in relationships, work or school due to gaming. In order to fulfil the criteria for Gaming Disorder (GD) in the ICD-11 you must fulfill all four criteria. Unlike the DSM-5, the ICD-11 DOES classify GD as a mental disorder. 1. Impaired control over gaming: Difficulty controling the amount of time spent gaming or the inability to stop or reduce gaming despite attempts to do so. 2. Priorisiting gaming over other activities: Increasing importance to gaming activities over other life activities, leading to neglect or disinterest in other essential tasks, hobbies or relationships. 3. Continued Gaming Despite Negative Consequences: Despite experiencing negative consquences (such as physical, psychological, social or educational issues) a person will continue to game. 4. Significant distress or impairment in important areas of life: Gaming habits lead to significant distress, disruption or impairment in various areas of life, such as work, education, relationships or other crucial functions. Early indicators or warning signs of video game addiction include spending most or all available hours playing a video game, diminished job and/or educational productivity, choosing to play video games rather than socialize and/or sleep, lying or being secretive about video game use, and avoiding or no longer participating in other activities in order to spend more time playing video games.
Summary of current article: This study looked at 39 studies on Gaming Disorder and how they connect to inattention and hyperactivity. It suggests there is a strong relationship between ADHD and GD, however no causality or directional association has been established. The results: – found a medium to moderate connection between GD severity and the ADHD symptoms of inattention and hyperactivity/impulsivity. – more recent studies are showing larger differences in gaming disorder symptom severity between ADHD and non-ADHD groups. – Self-reported ratings or non-clinical samples often showed smaller differences between the groups than professional or clinical samples. – interestingly, the same differences were not seen between ADHD and non-ADHD groups for problematic internet use amoung predominantly videogame player samples. When looking at individual studies the researchers found: – small-scale studies reported ADHD and GD co-occuring at the rate of 12.5% to 83.3% – a larger study found the co-existence of ADHD in 32.7% of GD presentations – Another study found individuals who fulfilled the criteria for GD were 13 times more likely to have an ADHD diagnosis compared to those without GD. – Six longitudinal studies were found. The results of these studies were varied. Some suggested a unidirectional link (ADHD predicts problematic gaming) while others found bidirectional association (ADHD predicts problematic gaming and problematic gaming predict ADHD). Further research suggested: – Exploring the underlying mechanisms to determine why ADHD and GD often co-occur. – Impulsivity, emotional and social difficulties and different brain circuitry (including reward craving) were suggested as potential contributors to the co-occurrence of ADHD and GD. – Better longitudinal studies are needed to understand the link between ADHD and GD. Methodological Considerations: The studies included in this article maintained a ‘good quality’ level. There were some studies with sampling or selection bias (using less reliable tools for assessment of GD or IGD). However, studies comparing people with GD against people without GD showed consistently high quality without any identified systematic issues.

Glossary, Background Information and summary of current article

Glossary/Background Information

Gaming Disorder (ICD-11) is also called Video-Game Addiction or Internet Gaming Disorder (DSM-5).

In order to fulfil the DSM-5 criteria for Internet Gaming Disorder (IGD) you must fulfil 5 (or more) of the following 9 criteria. (It’s important to note that the DSM-5 has listed IGD as a ‘condition for further study’ and therefore not yet officially recognised as a “formal mental disorder.”)
1. Preoccupation: constantly thinking about gaming, even when not playing.
2. Withdrawal: Feeling negative or upset when unable to play games.
3. Tolerance: Needing to spend more and more time gaming to feel satisfied.
4. Loss of Control: Trying unsuccessfully to cut down on gaming.
5. Giving up other activities; Losing interest in hobbies and activities because of gaming.
6. Continuation: Keep playing games despite knowing it causes problems.
7. Deception: lying to family or therapists about how much time is spent gaming.
8. Escape: Using games to feel better when in a negative mood.
9. Negative Consequences: Experiencing problems in relationships, work or school due to gaming.

In order to fulfil the criteria for Gaming Disorder (GD) in the ICD-11 you must fulfill all four criteria. Unlike the DSM-5, the ICD-11 DOES classify GD as a mental disorder.
1. Impaired control over gaming: Difficulty controling the amount of time spent gaming or the inability to stop or reduce gaming despite attempts to do so.
2. Priorisiting gaming over other activities: Increasing importance to gaming activities over other life activities, leading to neglect or disinterest in other essential tasks, hobbies or relationships.
3. Continued Gaming Despite Negative Consequences: Despite experiencing negative consquences (such as physical, psychological, social or educational issues) a person will continue to game.
4. Significant distress or impairment in important areas of life: Gaming habits lead to significant distress, disruption or impairment in various areas of life, such as work, education, relationships or other crucial functions.

Early indicators or warning signs of video game addiction include spending most or all available hours playing a video game, diminished job and/or educational productivity, choosing to play video games rather than socialize and/or sleep, lying or being secretive about video game use, and avoiding or no longer participating in other activities in order to spend more time playing video games.

Summary of current article:
This study looked at 39 studies on Gaming Disorder and how they connect to inattention and hyperactivity. It suggests there is a strong relationship between ADHD and GD, however no causality or directional association has been established.

The results:
– found a medium to moderate connection between GD severity and the ADHD symptoms of inattention and hyperactivity/impulsivity.
– more recent studies are showing larger differences in gaming disorder symptom severity between ADHD and non-ADHD groups.
– Self-reported ratings or non-clinical samples often showed smaller differences between the groups than professional or clinical samples.
– interestingly, the same differences were not seen between ADHD and non-ADHD groups for problematic internet use amoung predominantly videogame player samples.

When looking at individual studies the researchers found:
– small-scale studies reported ADHD and GD co-occuring at the rate of 12.5% to 83.3%
– a larger study found the co-existence of ADHD in 32.7% of GD presentations
– Another study found individuals who fulfilled the criteria for GD were 13 times more likely to have an ADHD diagnosis compared to those without GD.
– Six longitudinal studies were found. The results of these studies were varied. Some suggested a unidirectional link (ADHD predicts problematic gaming) while others found bidirectional association (ADHD predicts problematic gaming and problematic gaming predict ADHD).

Further research suggested:
– Exploring the underlying mechanisms to determine why ADHD and GD often co-occur.
– Impulsivity, emotional and social difficulties and different brain circuitry (including reward craving) were suggested as potential contributors to the co-occurrence of ADHD and GD.
– Better longitudinal studies are needed to understand the link between ADHD and GD.

Methodological Considerations:
The studies included in this article maintained a ‘good quality’ level. There were some studies with sampling or selection bias (using less reliable tools for assessment of GD or IGD). However, studies comparing people with GD against people without GD showed consistently high quality without any identified systematic issues.

Completed 19/12/2023 – The ‘medical model’ language used here is reflective of the language used in the article.

White matter alterations in ADHD – A Systematic Review

July 2023 Link to full article

Parlatini, V., Itahashi, T., Lee, Y. et al. White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review of 129 diffusion imaging studies with meta-analysis. Mol Psychiatry (2023). https://doi.org/10.1038/s41380-023-02173-1

Summary & Glossary
Summary of current article: This presented the findings of a systematic review of 129 studies with a total of 6739 ADHD participants and 6476 controls represented. The Meta-analysis of TBSS studies found consistent organisational differences in reductions in white matter pathways in the CC in ADHD adults (compared to neurotypical adult brains). The specific areas are crucial for cognitive and motor functions and connect with regions associated with attention, working memory and executive functions. The differences in these areas may lead to attention challenges during demanding tasks. The alterations were associated with symptom severity. The differences were not affected by gender or exposure to ADHD medication. Interestingly, the findings were not the same in the paediatric meta-analysis. The researchers wondered if this is related to the later development of certain brain fibres. However, interestingly paediatric ADHDers, still have similar executive function and attentional challenges. Methodological Considerations: The study authors highlighted the need for better imaging techniques and consistent reporting of data quality to improve accuracy and reliability of findings in ADHD research.
Glossary: *White Matter:* is the tissue in the brain made of nerve fibres (axons) and supporting cells (glial cells that form connections between different parts of the brain. These nerve fibres create communication pathways, allowing different parts of the brain communicate with each other. Tract-Based Spatial Statistics (TBSS) focuses on analysing differences in white matter pathways between different groups. Researchers used it to compare white matter pathways of ADHDers and neurotypical’s brains in these studies. Fractional Anisotropy (FA) is a way to measure the direction, organisation and strength of the white matter pathways in the brain. It is used in diffusion tensor imaging (DTI), which is a type of MRI imaging that examines how water molecules move across brain tissue. This allows scientists to identify any changes in the diffusion patterns or condition of these pathways. The corpus callosum (CC) is the biggest white matter pathway in the brain. It is like a bridge that connects the left and right hemispheres of the brain. It helps both sides communicate and share information with each other, allowing the brain’s different areas to work together and coordinate functions like movement, sensory perspetion and executive functions. The fronto-striatal pathways are white matter connections between the frontal lobes of the brain and the striatum, a part of the brain’s reward and movement systems. These pathways are crucial for various cognitive functions, including decision-making, attention, planning, and regulating behaviour. Their communication is vital for coordinating movements and guiding executive functions.

Summary & Glossary

Summary of current article:
This presented the findings of a systematic review of 129 studies with a total of 6739 ADHD participants and 6476 controls represented.

The Meta-analysis of TBSS studies found consistent organisational differences in reductions in white matter pathways in the CC in ADHD adults (compared to neurotypical adult brains). The specific areas are crucial for cognitive and motor functions and connect with regions associated with attention, working memory and executive functions. The differences in these areas may lead to attention challenges during demanding tasks. The alterations were associated with symptom severity. The differences were not affected by gender or exposure to ADHD medication.

Interestingly, the findings were not the same in the paediatric meta-analysis. The researchers wondered if this is related to the later development of certain brain fibres. However, interestingly paediatric ADHDers, still have similar executive function and attentional challenges.

Methodological Considerations:
The study authors highlighted the need for better imaging techniques and consistent reporting of data quality to improve accuracy and reliability of findings in ADHD research.

Glossary:
White Matter: is the tissue in the brain made of nerve fibres (axons) and supporting cells (glial cells that form connections between different parts of the brain. These nerve fibres create communication pathways, allowing different parts of the brain communicate with each other.

Tract-Based Spatial Statistics (TBSS) focuses on analysing differences in white matter pathways between different groups. Researchers used it to compare white matter pathways of ADHDers and neurotypical’s brains in these studies.

Fractional Anisotropy (FA) is a way to measure the direction, organisation and strength of the white matter pathways in the brain. It is used in diffusion tensor imaging (DTI), which is a type of MRI imaging that examines how water molecules move across brain tissue. This allows scientists to identify any changes in the diffusion patterns or condition of these pathways.

The corpus callosum (CC) is the biggest white matter pathway in the brain. It is like a bridge that connects the left and right hemispheres of the brain. It helps both sides communicate and share information with each other, allowing the brain’s different areas to work together and coordinate functions like movement, sensory perspetion and executive functions.

The fronto-striatal pathways are white matter connections between the frontal lobes of the brain and the striatum, a part of the brain’s reward and movement systems. These pathways are crucial for various cognitive functions, including decision-making, attention, planning, and regulating behaviour. Their communication is vital for coordinating movements and guiding executive functions.

Completed 18/12/2023

Parental Stress in the Parents of the Children Diagnosed with ADHD

July 2023 Link to abstract

Citation: Seda Sarıkaya Erdil, Rümeysa Yeni Elbay, Emrah Karadere & Aynur Görmez (2023): Parental Stress in the Parents of the Children Diagnosed with ADHD, Child & Family Behavior Therapy, DOI: 10.1080/07317107.2023.2240311

Summary
Previous research has reported that parental stress (defined as stress when a parent’s perceived parenting needs exceed their coping resources) is significantly higher in parents of ADHD children. Research has found that the life satisfaction of parents with children with oppositional behaviour (often co-occuring with ADHD) is negatively impacted. However to date the correlation between life satisfaction and parental stress in parents with ADHD children has not previously been researched.
Previous research has shown a significant correlation between life satisfaction and psychological flexibility. Psychological flexibility involves being able to adapt your actions according to your beliefs and values. It involves paying attention to what’s happening right now and dealing with your thoughts and emotions as they come up, rather than getting too caught up in them. Parental psychological flexibility is associated with less parental stress.
Parental stress isn’t always directly related to ADHD itself, but numerous studies have found the following all impacts on a parent’s stress levels: * The severity of ADHD symptoms * The type of treatments * Co-occuring conditions (particularly ‘conduct’ issues) * Parental behaviour and parenting * Parental mental health status. * Parent’s belief in their own capacity to support their child * Parents self-efficacy (A parent’s belief in their ability to complete task necessary to achieve a goal).
This study: A Case control study Hypothesis: Parents of children with ADHD experience high levels of parental stress and low life satisfaction. They also proposed that parental stress is related to the parent’s levels of psychological flexability. Study included 66 mothers and 18 fathers. Inclusion criteria for experimental group: Being a parent (mother’s and father’s only) of a child diagnosed with ADHD, but no co-occuring psychiatric disorders other than Oppositional Defiant Disorder (ODD). The parents were not able to have any “cognitive impairment.” Control group: parents of children with ‘typical development’ and no psychiatric history. The following scales/questionnaires were completed; * Conners Parent Rating Scale – Revised Short Form (CPRS-SF) – Screening for ADHD symptoms and ‘problematic behaviour’ * Acceptance and Action Questionnaire-II (AAQ-II) – Assesses levels of psychological inflexibility * The Parental Stress Index short form (PSI-SF) – Assesses parental stress levels. It has 3 different subtests: Parental distress, Parent-Child Dysfunctional Interaction and Difficult Child. * Satisfaction with Life Scale (SWLS) – measures life satisfaction
Results: *Comparative analyses* * No statistically significant difference between the control group and ADHD Parent group on AAQ-II & Parental Distress subtest of the PSI-SF. * No statistically significant difference between psychological flexibility in either parent group. * Statistically significant difference between the control group and ADHD Parent Group on – The Parent-Child Dysfunction interaction subscale, Difficult Child subscale and the PSI total score, with the ADHD parent group scoring higher. – The SWLS score was significantly lower in the ADHD parent group. *Correlation Analyses* * No correlation between levels of psychological inflexibility and Inattention, Hyperactivity and ADHD-Index scores in parents. * Small positive connection between the psychological inflexibility scale and oppositional scale. * Parental stress was slightly connected to Inattention, Hyperactive and ADHD-Index. * Parental stress was moderately connected to the oppositional and total scale. * Parental stress was also moderately connected to a negative life satisfaction score.
Discussion: * Improvement in psychological flexibility of parents will reduce the stress experienced by them. * A family based approach may be able to improve overall family well-being. Limitations: * Data of this study is parental perspective only. * This study was conducted in COVID-19 pandemic, which may have contributed to higher parenting stress levels.

* I am not a fan of the terminology used in this article!

July 2023 Link to pre-print article

Comorbidity and causality among ADHD, dyslexia, and dyscalculia (pre-print)

Citation: van Bergen, E., de Zeeuw, E., Hart, S. A., Boomsma, D., de Geus, E., & Kan, K. J. (2023, July 26). Comorbidity and causality among ADHD, dyslexia, and dyscalculia. https://doi.org/10.31234/osf.io/epzgy

Summary
Children’s data were from a subsample from the Netherlands Twin Register. From 3613 children used, 4.2% of children were ADHD, 10.3% presented with dyslexia and 3.0% presented with dyscalculia.
Children with ADHD were more than twice as likely to have an additional learning disorder diagnosis (dyslexia or dyscalculia) and vice versa. Children who fulfilled the criteria for learning disorder were 3-4 times as likely to fulfil the criteria for the other learning disorder.
Children were assessed in two waves (once at age 7 and once at age 10).
*The following results were found:* * Correlations between reading ability and inattention challenges. At both ages 7 and 10, the child who had challenges with reading, also had challenges with inattention. * ADHD, dyslexia and dyscalculia are all heritable. * Both genetics and environment contributed to ADHD traits and academic skills. * ADHD symptoms, reading, spelling and maths skills all somewhat predicted each other over time. However, this is likely due to genetics rather than causality.
*They recommended:* * Clinical and school interventions should target each challenge separately, and avoid assuming that treating one challenge area will improve the skills in the other. * There is a substantial genetic predisposition associated with all of these challenges and therefore, need to take this into consideration when often ‘parent blaming’ is used.

Date: July 2023 Link to open access article

The global prevalence of ADHD in children and adolescents

Bottom Line: This analysis looked at 61 studies. They found that approximately 7.6% of children (aged 3-12 years) and approximately 5.6% of teenagers (aged 12-18) have ADHD, globally.

Citation: Salari, N., Ghasemi, H., Abdoli, N. et al. The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Ital J Pediatr 49, 48 (2023). https://doi.org/10.1186/s13052-023-01456-1

Summary
* The researchers looked at the prevalence of ADHD in children and adolescents by conducting a systematic review and meta-anaylsis of cross-sectional data. For children 3-12 years of age: * 53 Studies, with a total sample size of 96, 904 participants were used to determine the prevalence of ADHD to be 7.6%. * The findings of 24 studies found that for this age group, 33.2% of ADHDers had the Inattentive presentation, 30.3% had the Hyperactive/Impulsive presentation and 31.4% had Combined Presentation. For teenagers 12-18 years of age: * 25 studies, were used to determine the prevalence of ADHD in this age group is 5.6% * The finding of 5 studies found that for this age group, 37.3% of ADHDers have the Inattentive presentation, 23.1% had the Hyperactive/Impulsive Presentation and 31.1% had Combined presentation. Interestingly, the researchers looked at different diagnostic criteria to determine the prevalence of ADHD. They compared the prevalence of ADHD when using the current DSM-5 criteria, compared with other diagnostic criteria. More people are being diagnosed using the DSM-5 criteria than other diagnostic driteria.
Things to keep in mind * One of the limitations with this study is there is a large variation in the age groups. The researchers wanted to look at the prevalence of two different age groups, however due to multiple research papers combining both age groups, it is difficult to be accurate in their results. * The study is only used cross-sectional papers, which means that only looked at information from one point in time. They couldn’t follow participants over time to track symptom changes.

Summary

* The researchers looked at the prevalence of ADHD in children and adolescents by conducting a systematic review and meta-anaylsis of cross-sectional data.

For children 3-12 years of age:
* 53 Studies, with a total sample size of 96, 904 participants were used to determine the prevalence of ADHD to be 7.6%.
* The findings of 24 studies found that for this age group, 33.2% of ADHDers had the Inattentive presentation, 30.3% had the Hyperactive/Impulsive presentation and 31.4% had Combined Presentation.

For teenagers 12-18 years of age:
* 25 studies, were used to determine the prevalence of ADHD in this age group is 5.6%
* The finding of 5 studies found that for this age group, 37.3% of ADHDers have the Inattentive presentation, 23.1% had the Hyperactive/Impulsive Presentation and 31.1% had Combined presentation.

Interestingly, the researchers looked at different diagnostic criteria to determine the prevalence of ADHD. They compared the prevalence of ADHD when using the current DSM-5 criteria, compared with other diagnostic criteria. More people are being diagnosed using the DSM-5 criteria than other diagnostic driteria.

Things to keep in mind
* One of the limitations with this study is there is a large variation in the age groups. The researchers wanted to look at the prevalence of two different age groups, however due to multiple research papers combining both age groups, it is difficult to be accurate in their results.

* The study is only used cross-sectional papers, which means that only looked at information from one point in time. They couldn’t follow participants over time to track symptom changes.

Date: July 5, 2023

Link to article

Does taking stimulant medication put you at risk of later substance abuse disorder?

Bottom Line: This study found that children who take prescription stimulant medication for ADHD do not use more or less harmful substances and were at no increased or decreased risk of substance use disorder as young adults (mean age of 25).

Citation: Molina BSG, Kennedy TM, Howard AL, et al. Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood. JAMA Psychiatry. Published online July 05, 2023. doi:10.1001/jamapsychiatry.2023.2157

Summary
Researchers investigated possible associations between stimulant medication use in ADHD children and subsequent substance use in adulthood. Other studies have investigated the link between stimulant medication prescribed for ADHD and later substance use/abuse. Some studies have suggested there is actually a protective effect of prescription stimulant medication, while others have not found any effect at all. This randomised control trial found that there was no evidence that stimulant treatment provided protection for subtance use disorder (SUD). LIkewise, they did not find an association between stimulant use during childhood and an increase of substance misuse in their young adulthood.
Things to keep in mind! * 579 children were investigated in this study. However, it is important to note that 80% of them were male.

Summary

Researchers investigated possible associations between stimulant medication use in ADHD children and subsequent substance use in adulthood.

Other studies have investigated the link between stimulant medication prescribed for ADHD and later substance use/abuse. Some studies have suggested there is actually a protective effect of prescription stimulant medication, while others have not found any effect at all.

This randomised control trial found that there was no evidence that stimulant treatment provided protection for subtance use disorder (SUD). LIkewise, they did not find an association between stimulant use during childhood and an increase of substance misuse in their young adulthood.

Things to keep in mind!
* 579 children were investigated in this study. However, it is important to note that 80% of them were male.

Date: July, 2023

Link to poster

Are women and girls with ADHD underdiagnosed or misdiagnosed?

Bottom Line: Women and girls are much more likely to be underdiagnosed, undertreated and frequently misdiagnosed. This is due to a lack of recognition of the gender specific presentation, culutral perception, and the effect of masking on symptom presentation.

Citation: Blair, K. N., & Kim, M. Y. (2023). Sex and Gender Differences in Attention-Deficit/Hyperactive disorder (ADHD): A Literature Review.

Summary
The poster which outlines the results of their literature review is available online HERE.

Date: April 2023 Link to full text article

Annual Research Review on ADHD

Citation: Sonuga-Barke, E.J.S., Becker, S.P., Bölte, S., Castellanos, F.X., Franke, B., Newcorn, J.H., Nigg, J.T., Rohde, L.A. and Simonoff, E. (2023), Annual Research Review: Perspectives on progress in ADHD science – from characterization to cause. J Child Psychol Psychiatr, 64: 506-532.

Summary
Some of the main points from this research review were: Charaterisation Charting the developmental Course Significant progress has been made in understanding ADHD. It is not a simple condition and challenges the assumptions we used to have about it. * ADHD is complex and persists over time, but it may present differently in different individuals. * ADHD traits fluctuate even though the underlying condition remains. Some researchers believe this is because of the environmental demands change over time and a genetic predisposition makes ADHDers more sensitive to these changes. * Male-to-female ratio of ADHD appear to become more balanced with age. However this might be more likely due to referral bias (boys are more likely to be referred than girls). However, further research needs to be done into whether puberty related changes may impact females more, whether this is a result of the diagnostic criteria to diagnose ADHD data we have relates mostly to males and whether ‘masking’ of ADHD by females falls apart in the adolescent years. * There are interconnected genetic and environmental factors that influence whether a person will show their ADHD traits or not. Correlated characteristics and co-occuring conditions * We must recognise that ADHD often co-occurs with other conditions (including but not limited to anxiety, depression, Specific Learning Difficulties or Autism) and ensure the person is supported for all challenges. * Emotional impulsivity and challenges with self-regulation may be used to further improve our understanding and description of ADHD in diverse ways. * Long term data shows that ADHDers -primarily those with inattentive presentation and individuals with “sluggish cognitive tempo” (SCT) will have different school outcomes. SCT is more connected to reading challenges, whereas ADHD – inattention is more linked to maths challenges. Poor sleep duration (which a lot of ADHDers have!) can increase inattentive symptoms (but not hyperactive/impulsive symptoms) in adolescent ADHDers. * Maltreatment rates are elevated for ADHDers, twin studies have found that ADHD traits may receive negative responses, which could be the reason for later co-occuring conditions. Impact of living with ADHD * Focusing solely on ADHD symptoms and treatment in research neglects the quality of life and performance of ADHDers. There are recent recommendations to include functioning scales in the diagnostic process. This includes things like physical functions, daily activities, participating in activites and how the environment is influencing symptoms. * There have been genetic correlations between cannabis use and ADHD. Environment * Scientists are finding new insights into how our genetic makeup and the things around us play a role in ADHD. These risk scores are calculated from genetic data and help researchers see how our genes might interact with specific factors, like low birth weight or maternal depression, to influence our expression of ADHD. Brains * Really interesting research is emerging around the action of neuro-moderators to account for the heterogeneity in ADHD. Researchers in 2021, found that ADHDers have lower levels of Orexins, which play a key role in modulating a range of ADHD traits (e.g. reward pathway, attention, arousal, appetite and sleep). Further research opportunities identified in this article: * Can we predict when and if a child will be an ADHDer so we can put early supports in place. * What impact does ADHD have on the elderly brain? * What positive outcomes do ADHDers have? There has been SO much research on the negative impact on ADHD – but we need to look at what positive impact ADHD has when a strengths-based approach is utilised. * Further research is needed to focus on understanding ADHD, particularly how it presents in females. It’s important to examine the social factors of how ADHD is perceived. * Involving people with ADHD research should be a focus of research, as it is crucial to gain insight and understand of ADHD from a neurodiversity affirming context. * Emotional regulation should be considered when looking at ADHD, and we should again, be including this in diagnostic evaluation of ADHD. * We need to look at changing the way we diagnose ADHD as it is currently based on what we “see” on the outside, not biological markers or brain design. In shifting our diagnostic criteria, we can create more accurate and valid classifications. * ADHD needs to be viewed from a balanced view of positive traits and the requirement of supports. * Does intervention that focuses on removing the barriers to functioning rather than focusing on “cure” work? Or is it important to ensure removal of barriers to functioning AND psychological interventions empower and increase well-being? * Does getting an ADHD diagnosis increase, reduce or have no impact on stigma? And are there any differences between sex/gender stigma? * Only risk factors have been identified using molecular genetic studies of ADHD. However, genetic factors may also identify resilience factors. This idea of genetic resilience is important to explore further in ADHD research to understand how gene resilience factors affect the condition. * Early caregiving plays a significant role in either amplifying or dampening the overall expression of ADHD. More research, including genetically informative studies and experimental parenting interventions, are needed in this area. * The relationship between the ubiquitous use of digital devices and ADHD is an important area of research. ADHDers may be especially vulnerable to problematic use of screens and mobile devices, and further examination is needed to understand the possible positive and negative effects.
Things to note: * It was exciting to read about research recommendations that included neurodiversity affirming language and ideas – however there are still LOTS of ableist language and research recommendations. We still have a long way to go! * Sluggish Cognitive Tempo is a combination of cognitive and motor challenges. It is thought to include things like excessive daydreaming and feeling mentally foggy, being less active and moving slowly. Approximately 25-40% of young people, particularly with ADHD – inattentive or combined presentations, experience these signs. However although there is an overlap between ADHD and sluggish cognitive tempo, research indicates that it a difference condition.

Summary

Some of the main points from this research review were:
Charaterisation
Charting the developmental Course
Significant progress has been made in understanding ADHD. It is not a simple condition and challenges the assumptions we used to have about it.
* ADHD is complex and persists over time, but it may present differently in different individuals.
* ADHD traits fluctuate even though the underlying condition remains. Some researchers believe this is because of the environmental demands change over time and a genetic predisposition makes ADHDers more sensitive to these changes.
* Male-to-female ratio of ADHD appear to become more balanced with age. However this might be more likely due to referral bias (boys are more likely to be referred than girls). However, further research needs to be done into whether puberty related changes may impact females more, whether this is a result of the diagnostic criteria to diagnose ADHD data we have relates mostly to males and whether ‘masking’ of ADHD by females falls apart in the adolescent years.
* There are interconnected genetic and environmental factors that influence whether a person will show their ADHD traits or not.

Correlated characteristics and co-occuring conditions
* We must recognise that ADHD often co-occurs with other conditions (including but not limited to anxiety, depression, Specific Learning Difficulties or Autism) and ensure the person is supported for all challenges.
* Emotional impulsivity and challenges with self-regulation may be used to further improve our understanding and description of ADHD in diverse ways.
* Long term data shows that ADHDers -primarily those with inattentive presentation and individuals with “sluggish cognitive tempo*” (SCT) will have different school outcomes. SCT is more connected to reading challenges, whereas ADHD – inattention is more linked to maths challenges.
* Poor sleep duration (which a lot of ADHDers have!) can increase inattentive symptoms (but not hyperactive/impulsive symptoms) in adolescent ADHDers.
* Maltreatment rates are elevated for ADHDers, twin studies have found that ADHD traits may receive negative responses, which could be the reason for later co-occuring conditions.

Impact of living with ADHD
* Focusing solely on ADHD symptoms and treatment in research neglects the quality of life and performance of ADHDers. There are recent recommendations to include functioning scales in the diagnostic process. This includes things like physical functions, daily activities, participating in activites and how the environment is influencing symptoms.
* There have been genetic correlations between cannabis use and ADHD.

Environment
* Scientists are finding new insights into how our genetic makeup and the things around us play a role in ADHD. These risk scores are calculated from genetic data and help researchers see how our genes might interact with specific factors, like low birth weight or maternal depression, to influence our expression of ADHD.

Brains
* Really interesting research is emerging around the action of neuro-moderators to account for the heterogeneity in ADHD. Researchers in 2021, found that ADHDers have lower levels of Orexins, which play a key role in modulating a range of ADHD traits (e.g. reward pathway, attention, arousal, appetite and sleep).

Further research opportunities identified in this article:
* Can we predict when and if a child will be an ADHDer so we can put early supports in place.
* What impact does ADHD have on the elderly brain?
* What positive outcomes do ADHDers have? There has been SO much research on the negative impact on ADHD – but we need to look at what positive impact ADHD has when a strengths-based approach is utilised.
* Further research is needed to focus on understanding ADHD, particularly how it presents in females. It’s important to examine the social factors of how ADHD is perceived.
* Involving people with ADHD research should be a focus of research, as it is crucial to gain insight and understand of ADHD from a neurodiversity affirming context.
* Emotional regulation should be considered when looking at ADHD, and we should again, be including this in diagnostic evaluation of ADHD.
* We need to look at changing the way we diagnose ADHD as it is currently based on what we “see” on the outside, not biological markers or brain design. In shifting our diagnostic criteria, we can create more accurate and valid classifications.
* ADHD needs to be viewed from a balanced view of positive traits and the requirement of supports.
* Does intervention that focuses on removing the barriers to functioning rather than focusing on “cure” work? Or is it important to ensure removal of barriers to functioning AND psychological interventions empower and increase well-being?
* Does getting an ADHD diagnosis increase, reduce or have no impact on stigma? And are there any differences between sex/gender stigma?
* Only risk factors have been identified using molecular genetic studies of ADHD. However, genetic factors may also identify resilience factors. This idea of genetic resilience is important to explore further in ADHD research to understand how gene resilience factors affect the condition.
* Early caregiving plays a significant role in either amplifying or dampening the overall expression of ADHD. More research, including genetically informative studies and experimental parenting interventions, are needed in this area.
* The relationship between the ubiquitous use of digital devices and ADHD is an important area of research. ADHDers may be especially vulnerable to problematic use of screens and mobile devices, and further examination is needed to understand the possible positive and negative effects.

Things to note:
* It was exciting to read about research recommendations that included neurodiversity affirming language and ideas – however there are still LOTS of ableist language and research recommendations. We still have a long way to go!

* Sluggish Cognitive Tempo is a combination of cognitive and motor challenges. It is thought to include things like excessive daydreaming and feeling mentally foggy, being less active and moving slowly. Approximately 25-40% of young people, particularly with ADHD – inattentive or combined presentations, experience these signs. However although there is an overlap between ADHD and sluggish cognitive tempo, research indicates that it a difference condition.

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