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Objective:To determine the effects of cognitive-behavioral therapy (CBT) on resting-state brain functional changes in adults with attention-deficit/hyperactivity disorder (ADHD).Methods:Participants including 10 adults with ADHD aged 18-65 years,diagnosed with the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ) and 12 age-and gender-matched healthy controls.The ADHD symptoms and executives functions were assessed using the ADHD Rating Scale (ADHD-RS) and Behavior Rating Inventory of Executive Function (BRIEF) respectively and resting-state functional magnetic resonance imaging were acquired before and after 12-session,CBT for ADHD patients.The healthy controls were also scanned.We used the regional homogeneity (ReHo) to capture the changes of regional brain function between pre-and post-CBT in ADHD for measuring the effects of CBT.Results:After CBT,the total scores of ADHD-RS [(43 ± 7) vs.(31 ± 7),P ＜ 0.01],the subscale of inattention and subscale of hyperactivity/impulsivity were decreased in ADHD adults.As for the executive functions,the subs cales of monitor [(15 ± 2) vs.(11 ± 2),P ＜ 0.01] and organization [(19 ± 5) vs.(14 ± 4),P ＜ 0.01] in BRIEF were reduced significantly in adults with ADHD after CBT training.The ReHo was increased in the regions involved in default mode network and fronto-parietal network,i.e.,right parahippocampa gyrus,fight precentral gyms,fight postcentral gyms and left postcentral gyrus (Voxels with P ＜ 0.05 and cluster size ＞3051mm3,which resulted in a corrected threshold of P ＜ 0.01 determined by AlphaSim).Conclusion:These findings support that CBT could selectively modulate the regional brain function in the default mode network and fronto-parietal network which may contribute to the improvement of ADHD symptoms and executive functions.
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Objective:To explore the association between CYP2D6 gene polymorphism of cytochrome and clinical response to atomoxetinein children with attention-deficit/hyperactivity disorder.Methods:Totally 111 Han Chinese boys meeting criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edi-tion (DSM-IV)were recruited.Atomoxetine treatment was given in titrated doses in order to achieve optimal re-sponse.Behavior changes were measured with the ADHD Rating Scale (ADHD-RS)at baseline and after optimal doses were reached.The decrease of ADHD-RS scores were primary measures of the treatment effect,the scores of the items in the ADHD-RS was less than or equal to 1 for the remission criteria.The three SNPs of CYP2D6 genes(rs1080985,rs1065852,rs16947)were genotyped by polymerase chain reaction (PCR).Results:There was no asso-ciation between single polymorphisms andatomoxetine after adjusting for baseline rating scores (P >0.05).In con-trast,haplotype analysis revealed that some patients with GAC haplotype achieved significant remission [remission vs.non-remission haplotype frequency (rate):5 /56 (8.9%)vs.3 /164(1.8%),P <0.05 ].After multiple testing correction still existed significant trend(P =0.082)and also found correlation trends after correlation analysis be-tween GAC haplotype and clinical response to atomoxetine (P =0.078),8 patients with GAC haplotype carriers were all effective response to treatment,non-responders without this haplotype.Conclusion:These results suggest association between polymorphisms of CYP2D6 gene and ADHD better clinical improvement with atomoxetine treatment,it is worth further exploration in a large sample.
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Objective:To study the differences of brain functions between children with attention deficit hyperactivity disorder(ADHD) predominantly inattentive (ADHD-I) and combined(ADHD-C) subtypes in resting state using functional magnetic resonance imaging(fMRI).Methods:A newly reported regional homogeneity(ReHo) approach was used to analyze blood oxygen level-dependent fMRI(BOLD-fMRI) data in resting state among 6 ADHD-C,9 ADHD-I and 15 normal control boys.Results:The brain regions showing differences among the three groups included bilateral frontal lobe,right cuneus and right inferior temporal gyrus.Compared with the normal controls,ADHD-C showed decreased ReHo in left frontal lobe and right inferior temporal gyrus,ADHD-I showed decreased ReHo in bilateral frontal and temporal lobe and right cerebellum and increased ReHo in bilateral occipital lobe and right inferior parietal gyrus.There were no brain regions showing different ReHo between ADHD-C and ADHD-I.Conclusion:Although both ADHD-C and ADHDI showed abnormal neural activity in resting state compared with the normal controls,there were no differences for brain functions in resting state between ADHD-C and ADHD-I.
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Objective:To explore whether methylphenidate(MPH) can improve the executive function(EF) of attention deficit hyperactivity disorder(ADHD) children and the degree of the improvements.Method:We conducted an open study of 29 children(25 boys and 4 girls) who met DSM-Ⅳ criteria for ADHD.The variations of their EF before and after methylphenidate extended-release tablets [osmotic release oral system(OROS) methylphenidate] treatment were evaluated,and the differences of EF between 24 ADHD boys before and after treatment and 24 age-matched typically developing control boys were compared.The research instruments included Stroop color-word task,Rey complex figure test,digit span test,trail making test,tower of Hanoi and verbal fluency test.Results:The performances of errors in Stroop 1,time and errors of Stroops 2 and 4;the immediate memory and delay recalling of structure and detail score of RCFT;time of number-letter trail making,shifting time;total time and steps,rule violation of tower of Hanoi improved significantly after OROS methylphenidate treatment as compared with those before treatment.They were no significant differences between ante-and post-treatment. The initiation planning time of tower of Hanoi was significantly shorter after treatment as compared with that before treatment.Conclusion:This study suggests that methylphenidate can improve the executive function in the aspects of inhibition,visual working memory,set shifting and planning in ADHD children,and almost all aspects of EF can reach the normal level except the inhibition.
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Objective:To test the effect of extended-released methylphenidate(Concerta) on ecological executive function for attention deficit hyperactivity disorder(ADHD) and to evaluate the correlation between the improvement of ecological executive function and that of the core symptom of ADHD.Methods:We conducted a 4-6-week open-trial study of extended-released methylphenidate(18-54 mg/d) in 26 children with ADHD,aged 8-14 years.Ecological executive function and ADHD symptoms were ascertained by the parent form of behavior rating inventory of executive function(BRIEF),ADHD-Ⅳ rating scale and Conners short form rating scales before and after the treatment.Results:The mean item raw score of global executive composite(GEC),metacognition index(MI),working memory,monitor and inhibition subscale of BRIEF were significantly decreased after the treatment(t=2.763-3.380,P
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Objective:To explore the effect of methylphenidate on the balance function of children with attention deficit hyperactivity disorder,and the correlation between the variations of balance function and subjective clinical assessment before and after treatment.Methods:From July to December 2006,23 children(19 boys and 4 girls) who met DSM-Ⅳ criteria for ADHD participated in an open study conducted at Institute of Mental Health,Peking University.The variation of their balance functions before and after methylphenidate extended-release tablets(OROS methylphenidate) treatment were evaluated,and the differences of balance functions between 19 ADHD boys pre-and post-treatment and 38 age-matched typically developing control boys were compared.Balance functions were assessed with sensory organization test(SOT) provided by SMART EquiTest system.Subjective clinical assessments were measured with ADHD rating scale-Ⅳ and IOWA Conners rating scale.Results:The equilibrium score(ES) in SOT5,SOT6,and composite score (61.84?14.19,65.88?15.41,and 75.70?10.30,respectively),and the strategy score(SS) in SOT4 and SOT5(89.20?3.17 and 83.22?6.56),and the sensory analysis of vestibular ratio(67.64?14.43) improved significantly after OROS methylphenidate treatment compared to those before treatment(49.81?16.26,57.61?16.72,68.70?11.96,86.84?4.49,78.55?6.55,and 54.46?17.27,respectively,P0.05). Conclusion:This study suggests that methylphenidate can improve the balance function of children with ADHD through direct effect on the balance system.