Balance Deficit and Brain Connectivity in Children with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE: We aimed to assess disturbances in postural and gait balance and functional connectivity within the brain regions controlling balance in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Thirteen children with ADHD and 13 age- and sex-matched controls were recruited. Gait balance was assessed by the difference in the center of pressure (COP) between the left and right foot, as well as the difference in plantar pressure between the left and right foot during gait. Neuroimaging data were acquired using a 3.0 Tesla MRI scanner. Functional connectivity between the vermis of the cerebellum and all other brain regionswas assessed. RESULTS: The difference in plantar pressure between the left foot and right foot in the ADHD group was greater than that observed in the control group. The average COP jerk score of the right foot in the ADHD group was higher than that observed in the control group. A higher functional connectivity between the cerebellum and the right middle frontal gyrus (premotor cortex) and medial frontal gyrus (cingulate gyrus) was observed in the control group relative to the ADHD group. In the ADHD group, the difference in plantar pressure between the left and right foot was also negatively correlated with the beta-value within the middle frontal gyrus. CONCLUSION: Children with ADHD had disturbance of balance as assessed by plantar pressure. Decreased brain connectivity from the cerebellum to the premotor cortex and anterior cingulate was associated with disturbances of posture and balance in children with ADHD.

Clinical Practice Guidelines for Major Comorbid Disorders with Attention-Deficit Hyperactivity Disorder / 신경정신의학

Attention-deficit hyperactivity disorder (ADHD) occurs with a high prevalence of comorbid disorders, and these comorbid disorders can affect assessment, clinical symptoms, prognosis, and treatment strategies for children with ADHD. The goal of this study was to develop a clinical practice guideline for ADHD and its specific comorbid disorders. Due to limited numbers of previous clinical studies, current recommendations are based on literature review and expert consensus among Korean child and adolescent psychiatrists. We suggest the use of multidisciplinary evaluations, interview techniques, and assessment tools in order to differentiate major comorbid disorders from ADHD. Specific ADHD comorbid disorders (e.g., medical comorbidity, oppositional defiant disorder, conduct disorder, bipolar disorder, major depressive disorder, anxiety disorder, specific learning disorder, tic disorder, and substance use disorder) have suggested treatment protocols that include pharmacological and behavioral treatments. Children and adolescents with ADHD may have comorbid disorders. The use of current clinical practice guidelines will be helpful when treating ADHD children with comorbid disorders.

The Guideline of Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder: Developed by ADHD Translational Research Center

Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric conditions. In 2007, the Korean Academy of child and Adolescent Psychiatry developed Korean ADHD practice parameter. Advances in the scientific evidence of ADHD caused practice parameter to be modified and updated. The present guidelines developed by ADHD translational research center summarize current literature for the treatment of ADHD in children and adults. This parameter includes the clinical evaluation for ADHD, comorbid conditions associated with ADHD, clinical feature and course, research on the etiology of the disorder, and psychopharmacological and non-pharmacological treatments for ADHD.

Internet Gaming Disorder Treatment Options in the Hospital Setting

Internet gaming disorder (IGD), one of the common subtypes of internet addiction, is now classified in Section 3 of DSM-5 and is increasingly regarded as a growing health concern in many parts of the world. Consequently, many psychotherapeutic and psychopharmacological approaches have been considered and some research regarding therapeutic strategies has been conducted. However, treatment of IGD is in its early stages and therefore is not yet well established. This article reviews multiple therapeutic modalities including our own treatment model for IGD according to clinical and biological effects, thus providing suggestions for standard treatment strategies. The two main streams are psychopharmacological treatment and cognitive-behavior treatment, and the cognitive-behavior approach includes cognitive reconstruction, psychoeducation, and parenting coach. Many other non-pharmacological treatments are also recommended for personalized treatment of IGD.

Exercise Effect in Children with Attention-Deficit Hyperactivity Disorder : Meta-Analysis of Domestic Study / 신경정신의학

The aim of this meta-analysis study was to examine the effectiveness of exercise interventions on attention-deficit hyperactivity disorder (ADHD) pertaining to cognitive function such as attention and impulsivity in children.ZA comprehensive literature search was conducted using databases including Korean Information Service System, DBpia, Research Information Sharing Service, and National Assembly Library from 1995 to 2014. Search terms included 'ADHD', 'children', 'exercise', 'physical activity', and 'sports'. Standardized mean difference and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Q statistic. That is, these results revealed that effectiveness of exercise groups was higher by approximately 32% compared with control groups.ZEight studies (n=150) satisfied the inclusion criteria. The meta-analysis suggested that exercise has a moderate to large effect on core symptoms involved in attention [effect size (ES)=0.93] and impulsivity (ES=0.92) in children with ADHD. The main findings indicate that exercise, based on several types of exercise intervention, appears to be effective for mitigating symptoms such as attention, impulsivity in children with ADHD. From this perspective, exercise might be an effective adjunctive therapy for enhancing the effects of medication in children with ADHD. Future study related to exercise effect on ADHD symptoms is required in order to understand the specific evidence of relationship between exercise and core symptoms.

Increased Cortical Thickness in Professional On-Line Gamers

OBJECTIVE: The bulk of recent studies have tested whether video games change the brain in terms of activity and cortical volume. However, such studies are limited by several factors including cross-sectional comparisons, co-morbidity, and short-term follow-up periods. In the present study, we hypothesized that cognitive flexibility and the volume of brain cortex would be correlated with the career length of on-line pro-gamers. METHODS: High-resolution magnetic resonance scans were acquired in twenty-three pro-gamers recruited from StarCraft pro-game teams. We measured cortical thickness in each individual using FreeSurfer and the cortical thickness was correlated with the career length and the performance of the pro-gamers. RESULTS: Career length was positively correlated with cortical thickness in three brain regions: right superior frontal gyrus, right superior parietal gyrus, and right precentral gyrus. Additionally, increased cortical thickness in the prefrontal cortex was correlated with winning rates of the pro-game league. Increased cortical thickness in the prefrontal and parietal cortices was also associated with higher performance of Wisconsin Card Sorting Test. CONCLUSION: Our results suggest that in individuals without pathologic conditions, regular, long-term playing of on-line games is associated with volume changes in the prefrontal and parietal cortices, which are associated with cognitive flexibility.