Serum magnesium levels in attention deficit hyperactive disorder in 6-17 years age group: a study in tertiary care center

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and one of among the most prevalent chronic health conditions affecting school-age children. Magnesium is a crucial mineral and appropriate levels in the body are essential for normal cognitive function and mental health. Seventy-two to 96% of those diagnosed with ADHD have been found to be significantly deficient in magnesium. Studies have shown that in these patients, supplementation with magnesium improves attention and working memory and decreases anxiety, depression and emotional dysregulation. Objective of the study was to measure the serum levels of magnesium in children with attention deficit hyperactive disorder and to assess the relation between serum Magnesium levels and Attention deficit hyperactive disorder (ADHD).Methods: The study was conducted at Niloufer Institute of Child Health, which is tertiary care referral hospital and a teaching institute, affiliated under the esteemed Osmania Medical College, Hyderabad. Ethical committee clearance was taken before conducting the study, 50 cases of ADHD are selected from the outpatient department of the Psychiatry clinic for children and adolescents. And 50 controls are also selected for this study. Serum magnesium levels are assessed in both groups.Results: In ADHD group children with serum Magnesium level <1.5 meq/L are 24% whereas in control group it is 6%. When subgroups were analyzed, 25% of hyperactive ADHD group, 18.75% of inattentive ADHD group and 27.27% of combined ADHD group had serum magnesium levels of less than 1.5 meq/l.Conclusions: The study suggest that there is deficiency of magnesium in ADHD children when compared to healthy controls. Further, the study also recommends that further research is needed to help to identify the etiology, impact, and possible therapeutic implications of magnesium status in ADHD.

Attention-Deficit Hyperactive Disorder (ADHD) Presenting with Major Depression in an Adolescent: A Case Report

@#Major depressive disorder is an important psychiatric illness that can be a lifethreatening condition when it presents with suicidality. This case report describes an adolescent who presented with major depressive disorder but with an underlying undiagnosed attention deficit hyperactive disorder (ADHD). The 17-year-old male adolescent presented with psychosomatic complaint of non-resolving left sided chest pain. He also had major depressive symptoms and suicidal ideation. His ADHD was being missed. This case highlights the difficulty of diagnosing ADHD during adolescence as the presentation may not be as typical as during earlychildhood years.

Chinese character semantic and behavioral problems in 7-8 years old children with attention deficit hyperactivity disorder:an ERP study / 中华行为医学与脑科学杂志

Objective To explore Chinese character semantic processing feature and the relationship with behavioral problems in early childhood with ADHD.Methods Twenty ADHD children and twenty normal children (7-8 years old) performed a Chinese character semantic judgment task through event related potential (ERP),meanwhile Conners parent rating scale (PSQ) was completed by parents to analyze behavior problems in children.The relationship between behavioral problems and ERPs was analyzed.Results (1) ADHD group showed smaller amplitudes of P200 compared to the normal group (related (6.6±4.8) μV vs (11.6±6.4) μV;unrelated (6.7±3.7) μN vs (10.8±5.0) μV),and longer latency (related(240±30) ms vs (198±17)ms;the unrelated (232±26)ms vs (194±16)ms;psudoword (233±26)ms vs (197±15)ms),all P＜0.05).The amplitudes of N400 wave only showed a decreasing trend in ADHD group(P＞0.05),while the latency of N400 was significantly longer than that in normal children in three conditions(P＜0.05).(2) Four subscale scores of CPSQ(conduct problem,learning problem,hyperactivity-impulsion and hyperactivity index) were significantly higher in ADHD children compared with normal group.(3)The amplitudes of P200 in related condition had negative correlation with the scores of CPSQ subscale (conduct problem,psychoso matic disorder,hyperactivity-impulsion and hyperactivity index) (r=-0.51,-0.47,-0.45,-0.46,all P＜0.05.The latency of P200 in related condition had positive correlation with psychosomatic disorder scores (r =0.54,P=0.01).Conclusion Early semantic recognition disorder exists in 7～ 8 years old ADHD children.P200 can be used as an objective index to evaluate early childhood ADHD's language cognition,and P200 is related to behavior problems (such as conduct problem,impulsions).

Progresses of EEG in attention-deficit/hyperactivity disorder / 国际儿科学杂志

Attention deficit hyperactive disorder(ADHD) is one of the commonest behavioral disorders in children and adolescents.Its etiology and pathogenesis has not been fully elucidated.The diagnosis of ADHD is based on the description of parents and teachers.Previous validation studies have found that the EEG of ADHD children with an increase in theta power and a decrease in alpha and beta power.This review attempts to delineate the characteristic of EEG in ADHD children and discuss its potential clinical significance.

Clinical Diagnosis and Non-Verbal Ability of Primary-One School Children with LD

More school children were referred for learning difficutly (LD), especially after the introduction of LINUS sccreening programme by Ministry of Education Malaysia. To study the clinical diagnosis and non-verbal ability of primary-one school children with LD after paediatric assessment, as well as associated behavioural issues and socio-economincal background. Assessment findings by Paediatricians and Naglieri Non-Verbal Ability Test® (NNAT®) results of all primary-one school children referred in year 2010 with LD were studied retrospectively. Ninety-three children were included (62.4% male), and 72.0% of them failed the LINUS screening programme. The commonest diagnoses were Borderline Intellectual Disability (ID, 37.6%) and Mild ID (19.4%). Other diagnoses included Attention Deficit Hyperactive Disorder (ADHD, 11.8%), Specific Learning Disability (SLD, 10.8%), Autistic Spectrum Disorder (n = 5) and Severe Language Disorder (n = 3). Mean NNAT scores were 84.6 ± 11.8 (n = 85), of which 9.4% children scored less than 70 (<2nd percentile), while 63.7% scored between 71 and 90 (3rd-24th percentile). Twenty-three children(27.1%) scored 90 - 110 (25th-75th percentile) and 111-119 (76th-90th percentile). More than two-thirds of the parents never attended school, or only received education up to Form 3. Nearly 80% of mothers were housewife and 78.7% of fathers were labour or semi-skilled workers. A significant numbers of children with ADHD, Borderline ID, Mild ID and Severe Language Disorder / SLD had significant or borderline internalizing and/or externalizing behaviours.Majority of primary-one school children referred for LD do not have intellectual disability. Their clinical diagnosis and non-verbal ability were very variable. A significant number of them have poor socio-economical background and associated behavioural problems. A more realistic education system and targeted program should be offered.

Switching from Methylphenidate-Immediate Release (MPH-IR) to Methylphenidate-OROS (OROS-MPH): A Multi-center, Open-label Study in Korea

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of methylphenidate HCL OROS extended-release (OROS-MPH) among children with attention deficit hyperactivity disorder (ADHD) who had been previously treated with methylphenidate HCL immediate-release (MPH-IR). METHODS: The sample included 102 children aged 6-12 (9.4+/-2.6) years who had been diagnosed with ADHD according the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV; American Psychiatric Association, 1994) and who were attending seven centers in Korea. All participants had been medicated with a stable dose of MPH (10-60 mg/day) for at least 3 weeks before entry into the study. Doses of OROS-MPH were comparable to daily doses of MPH. Efficacy was assessed at baseline (day 0) and at day 28 with the Inattentive-Overactive with Aggression (IOWA) Conners Rating Scale, which was completed by parents/caregivers and teachers, the Peer Interaction Rating Items, which were completed by teachers, and the Clinical Global Impression (CGI) scale, which was completed by child psychiatrists. Paired t-tests were used, and P-values were set at the 0.05 level. RESULTS: Of the subjects, 92.2% were boys and 79.4% were students in the first to fourth grades of elementary school. 72% were diagnosed with the combined type of ADHD, 23% were diagnosed with the inattentive type, and 5% were diagnosed with the hyperactive-impulsive type. The results of the parents' responses to the Inattention/Hyperactivity (I/H) and Oppositional/Defiant (O/D) subscales of the IOWA Conners scale indicated statistically significant improvement in childrens behavior after 4 weeks of treatment with OROS-MPH (t=6.28, p<.001, t=4.12, p<.001). However, the teachers' responses to the Conners I/H and O/D subscales indicated no significant improvement at 4 weeks. The teachers also reported no significant improvements under the OROS-MPH compared with the MPH-IR condition with respect to peer interactions. Scores on the CGI scale showed that 46.1% of children with ADHD were rated by psychiatrists as "minimally improved", 27.5% as "much improved," 1.0% as "very much improved," 3.9% as "minimally worse," and 16.7% as showing "no change". Children exhibited significantly fewer tics with OROS-MPH treatment than with MPH-IR treatment (19.6% vs. 27.7%). We found no differences between in sleep and appetite problems according to medication. CONCLUSION: The results of this study indicated that an MPH-IR regimen can be successfully changed to a once-daily OROS-MPH regimen without any serious adverse effects. The changes in parent/caregiver IOWA Conners ratings suggested that OROS-MPH improved the control of symptoms after school, a finding that is consistent with the 12-h duration of action of this medication. Because the therapeutic effect of OROS-MPH is sufficiently longer than that of a b.i.d. dose of MPH-IR, OROS-MPH had significant positive effects on oppositional/defiant behavior in addition to its effects on the core symptoms of ADHD.

MMPI Characteristics of Parents of Children with ADHD

OBJECTIVES: The current study investigated the personality characteristics of parents of children with attention-deficit hyperactivity disorder (ADHD) using the Minnesota Multiphasic Personality Inventory (MMPI), which is commonly used in clinical medicine. METHODS: Participants were 117 parents of children with ADHD (96 boys and 21 girls) and 77 parents of comparison children (50 boys and 27 girls), who completed the Korean version of the MMPI. RESULTS: The MMPI scores of the fathers of ADHD children were significantly higher on the Psychopathic Deviate (Pd), Masculinity-Femininity (Mf), Paranoia (Pa), and Psychasthenia (Pt) scales than the comparison group's were. In addition, the mothers of ADHD children had higher MMPI scores on the traits of Hypochondriasis (Hs), Psychopathic Deviate (Pd), and Schizophrenia (Sc) than the comparisong roup had, but were not significantly higher. CONCLUSION: The fathers of ADHD children might be antisocial, irresolute, passive, paranoid, and anxious. In addition, mothers of ADHD children might have hypochondriacal, antisocial, and/or psychological confusional traits, but these were not be significantly high. These results suggest that the psychopathology of parents of ADHD children might correlate with their children's ADHD.

Analysis of Relationships between Parenting Stress, Maternal Depression, and Behavioral Problems in Children at Risk for Attention Deficit Hyperactive Disorder

PURPOSE: In this study differences in behavioral problems between children at risk for Attention Deficit Hyperactive Disorder (ADHD) and normally developing children were identified. Further, relationships between parental stress, depression, and child behavioral problems according to ADHD symptoms were explored. METHODS: Participants were 222 elementary school children and their parents. The ADHD risk group was determined by the Korean-ADHD Rating Scale. Data were collected using the Korean-ADHD Rating Scale, Korean version of Child Behavior CheckList (K-CBCL), Parenting Stress Index, and Beck Depression Inventory. Data were analyzed using t-test, Pearson correlation coefficients, and regression analysis. RESULTS: 1) The ADHD risk group showed higher levels of behavioral problems, parenting stress, and maternal depression than the normal group. 2) There were significant relationships between ADHD scores and parenting stress (r=.66), maternal depression (r=.35), internal behavioral problems (r=.47), and external problems (r=.55), but, ADHD risk scores were negatively correlated with social competence (r=-.40). 3) The regression analysis revealed that ADHD levels affected the child's internal behavioral problems, mediated by maternal depression (beta=.29, p<.001). CONCLUSION: The study results show that higher risk scores for ADHD indicate a significant effect for behavioral problems. Also, parenting stress and depression influence child's behavioral problems. These results suggest that identification of children at risk for ADHD and development of parental education programs would contribute to the prevention of behavioral problems and aggravation of the ADHD symptoms.

Trastorno afectivo bipolar en niños / Bipolar Disorder in Children

Introducción: La presentación clínica de los niños con posible diagnóstico de trastorno afectivo bipolar (TAB) es un gran reto para el psiquiatra, el neurólogo y el pediatra. Objetivos: Proporcionar una visión clínica actualizada sobre el diagnóstico del TAB en los niños, que sirva de herramienta clínica para el psiquiatra, el neurólogo y el pediatra. Método: Se realizó una revisión selectiva con énfasis en la literatura reciente del TAB en los niños, en especial sobre los cambios en el estado de ánimo y el comportamiento; además, se revisó la literatura sobre el diagnóstico frente a otros trastornos de psiquiatría infantil. Resultados: Este artículo plantea dos puntos clave para realizar el abordaje clínico del niño con un posible diagnóstico de TAB, el primero se refiere al reconocimiento de las características de niños y adolescentes eutímicos (normales) y de los bipolares, y el segundo, al diagnóstico diferencial, de acuerdo con tres grupos de edad: preescolar, escolar y adolescente. Conclusiones: El psiquiatra general, el neurólogo y el pediatra tienen suficientes herramientas para identificar y diagnosticar el TAB pediátrico y diferenciarlo de otros trastornos infantiles.

Introduction: A children clinical presentation of a possible diagnosis of bipolar disorder (BD), becomes a great challenge for the psychiatrist, neurologist and/or pediatrician. Objective: To provide an updated clinical perspective of children with BD diagnosis, that will serve as clinical tool for the psychiatrist, neurologist and/or pediatrician. Method: a selective review of recent literature of children with BD was performed; especially about mood and behavioral changes, and differential diagnosis from other child psychiatry disorders. Results: This paper proposed two key points for the clinical assessment of a child with a possible diagnosis of BD, the first refers to recognize the children and adolescents’ features of euthymic (normal) and bipolar, and the second, to the differential diagnosis accordingly to 3 age groups: preschoolers, scholars and adolescents. Conclusions: the psychiatrist, neurologist and pediatrician have enough tools to identify and diagnose Pediatric BD and differentiate it from other child psychiatry disorders.

Hallazgos de una encuesta sobre la experiencia del manejo clínico del TDAH / Findings from a Survey on ADHD Clinical Management Experience

Introducción: El manejo del trastorno por déficit de atención e hiperactividad (TDAH) se debe ajustar a las necesidades y recursos de Latinoamérica, y para lograrlo se sugiere elaborar un consenso para el abordaje y manejo del TDAH en cada país. Objetivo: Describir la opinión de los profesionales colombianos sobre el manejo clínico del TDAH, con el fin de elaborar un documento base para un futuro consenso. Método: Se diseñó la “Encuesta sobre la experiencia del manejo clínico del TDAH” y se aplicó a 78 expertos en TDAH colombianos (psiquiatras infantiles y neuropediatras). Resultados: Los profesionales informaron acerca del perfil de sus pacientes y del proceso de evaluación y manejo clínico del TDAH. El tratamiento de elección generalmente es el metilfenidato, acompañado de la modificación de la conducta y, en muy pocas ocasiones, de otras terapias. El 52% de los pacientes no termina la evaluación inicial o no regresa para el seguimiento durante el primer año. El seguimiento de los casos de TDAH se dificulta por diferentes causas, entre ellas las relacionadas con el sistema de salud y la información de los medios de comunicación. La escasa adherencia al tratamiento puede deberse, en parte, a los prejuicios de los padres sobre el TDAH y su tratamiento. Conclusión: La encuesta mostró la tendencia actual de manejo del TDAH de los profesionales colombianos y las limitaciones para seguir el tratamiento de estos pacientes en Colombia.

Introduction: Attention Deficit-Hyperactivity Disorder (ADHD) treatment must be adapted to the needs and resources of Latin America, and to achieve this, it is suggested that a consensus for the ADHD approach and management of be made in each country. Objective: to describe the opinion of the Colombian professionals about clinical management of ADHD in order to make a base document for a future consensus. Method: A “Survey on ADHD Clinical Management Experience” was designed and applied to 78 Colombian ADHD specialists (child psychiatrist and neurologists). Results: These specialists informed on the profiles of their patients. as well as the assessment and clinical management of ADHA Methylphenidate is generally the chosen treatment, combined with behavioral changes, and with other therapies in a few cases. About 52% of patients do not finish the initial evaluation or drop out during the first year. The follow-up of ADHD cases is difficult due to different causes, among these those related to the health care system and media information. Poor treatment compliance may be due, in part, to the parents' prejudice against ADHD and its treatment. Conclusions: This survey showed the current trend regarding the clinical management of ADHD among the Colombian specialist, and some limitations in the follow-up of these patients in Colombia.

Characteristics of Event Related Potentials and Intelligence of Children with Attention Deficit Hyperactive Disorder / 实用儿科临床杂志

Objective To improve objectivity and accuracy of the diagnosis,prognosis,treatment efficiency and observe the levels of cognitive and intelligent deficits of children with attention deficit hyperactive disorder(ADHD).Methods Event related potentials(ERP)P3 wave test provocated by audition and Wechsler intelligence scale for children(C-WISC) test were detected and compared in 60 children with ADHD(ADHD group) and 60 cases of healthy children(healthy control group).The ERP P3 wave test results between 2 groups of children which had different intelligent balance ability were also compared.Results Compared with the healthy control group,there was a significantly longer latency of P3 wave(P