An Open-Label Trial of Methylphenidate Treating Sluggish Cognitive Tempo, Inattention, and Hyperactivity/Impulsivity Symptoms Among 6- to 12-Year-Old ADHD Children: What Are the Predictors of Treatment Response at Home and School?

Objective: This study investigated the effects of sluggish cognitive tempo (SCT), other psychiatric symptoms, age, dose, and pretreatment ADHD severity on methylphenidate (MPH) treatment response among ADHD children in both home and school. In addition, the predictors of the MPH-SCT treatment response were examined. Methods: One hundred eighty-five (6-12 years old) ADHD children who were treated with MPH included in the study. Results: MPH improved SCT total and SCT-Daydreaming scores both at home and school while improved SCT-Sluggish scores in only school. Higher pretreatment Daydreaming score predicted lower treatment response for inattention (B = .301, p = .002), and higher Daydreaming-Sluggish scores predicted lower treatment response for total ADHD symptoms at school (B = .456, p = .006; B = .888, p = .04, respectively). Also higher oppositional defiant disorder symptoms have negative effects on MPH treatment response in ADHD. Older age positively affected the MPH-SCT treatment response in paternal and teacher ratings. Conclusion: SCT symptoms have negative effects on MPH treatment response at school.

Evaluation of Autism Spectrum Disorder in Early Childhood According to the DSM-5 Diagnostic Criteria. / DSM-5 Tani Ölçütlerine Göre Erken Çocukluk Döneminde Otizm Spektrum Bozuklugunun Degerlendirilmesi.

OBJECTIVE: The aim of this study is to investigate, the DSM5 criteria of, Autism Spectrum Disorder (ASD) and Social Communication Disorder (SCD) in young children previously diagnosed with Pervasive Developmental Disorder (PDD) on the DSM-IV-TR, and to evaluate the effects of the symptom severity, emotional-behavioral problems, and age and gender differences on the diagnoses. METHOD: The study included 80 children between the ages of 18-72 months, who were diagnosed with PDD on the DSM-IV-TR criteria. The severity of autistic symptoms was measured by the Autism Behavior Checklist (ABC) and the Childhood Autism Rating Scale (CARS). The presence of behavioral and emotional problems were evaluated by the Aberrant Behavior Checklist (AbBC). RESULTS: Among the patients previously diagnosed with PDD, 9 (11.8%) did not meet the DSM-5 ASD criteria; 6 (7.9%) met the SCD criteria while 3 could not be assessed on the SCD criteria due to their small age and therefore not included in either diagnostic classes. The mean CARS, ABC and AbBC scores of the patients who met the ASD criteria, as compared to those who did not, were significantly higher. The two groups did not differ significantly with respect to the gender distribution and mean age. CONCLUSION: The patients who had more and severe autistic symptoms had a higher likelihood of getting an ASD diagnosis based on the DSM-5 criteria. The diagnosis of the patients with subthreshold ASD symptoms may be missed on the basis of the new diagnostic criteria.

Lower-extremity rotational profile and toe-walking in preschool children with autism spectrum disorder.

The aim of this study was to establish the torsional and toe-walking profiles of children with autism spectrum disorder (ASD), and to analyze the correlations between torsion, toe-walking, autism severity score, and age. In total, 79 consecutive children with autism were examined to determine their hip rotations, thigh-foot angle, degree of toe-walking, and autism severity. Femoral and tibial torsion values, of the preschool patients, were compared statistically with age-matched controls. The hip rotation profile of the patients was similar to the normal group. Nearly a half of the patients with ASD present excessive external tibial torsion. The difference in the tibial torsion between patients and normal children was statistically significant. A weak correlation was found only between tibial torsion and the autism severity score, but no correlation was found between the other parameters. External tibial torsion is the cardinal and persistent orthopedic manifestation among patients with ASD. Toe-walking is the second most common such manifestation and is an independent orthopedic feature in these patients. External tibial torsion may potentially contribute toward the described gait abnormalities in patients with ASD.

Premenstrual syndrome health-related quality of life and psychiatric comorbidity in a clinical adolescent sample: a cross-sectional study.

OBJECTIVE: Adolescents who were admitted to the child and adolescent psychiatry clinic were compared with respect to the premenstrual symptom severity, psychiatric comorbidities and health related quality of life (HRQoL). METHODS: The research group was identified using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and Premenstrual Assessment Form. They completed the Pediatric Quality of Life Inventory (The PedsQL). RESULTS: There were 55 adolescents who were eligible for the study and 89% of participants were diagnosed with at least one psychiatric disorder. The most common psychiatric diagnoses among the diagnosed cases were anxiety and major depressive disorders. Of all of the cases, 78.2% were diagnosed with premenstrual syndrome (PMS) and among those cases, 46.5% had mild, 34.8% had moderate and 18.6% had severe PMS. Most common PMS symptom was anger/irritability. HRQoL in the group with PMS was significantly lower than that of the adolescents without PMS. Moreover, HRQoL of adolescents with PMS was found to deteriorate with the increasing severity of PMS. CONCLUSIONS: This study is of great importance since it demonstrated that PMS frequency is very high in a clinical adolescent population and negatively affects their HRQoL as similar to non-clinical adolescent population studies.

Relationship of childhood headaches with preferences in leisure time activities, depression, anxiety and eating habits: A population-based, cross-sectional study.

OBJECTIVES: The objective of this article is to determine the relationship between headache frequency and socio-demographic data, personal characteristics, habits, daily activities, daily loss of ability, depression and anxiety in the headache subtypes in the pediatric population. PATIENTS AND METHODS: Our sample group was composed of approximately 5355 children aged between 9 and 18 years. An eight-stage questionnaire was administered to the children. In the second stage of the study, headache subtypes were created according to the ICHD-II criteria. The resulting data were compared according to the results of the headache subtypes. RESULTS: In school-age children, the prevalence of recurrent headaches was 39.4%, and the prevalence of migraine was 10.3%. The subjects with migraine mostly preferred sedentary activities in their leisure time, and preferred less exercise than the subjects with the other headache types. The PedMIDAS score of the children who preferred to play sports was significantly lower than those who did not prefer to play sports. In the group that preferred reading books, an opposite relationship was found. In overweight and obese migraine sufferers, other types of headache were found to be significantly higher. CONCLUSIONS: In the management of treating childhood headaches, the association of psychiatric comorbidities should be considered. To minimize disability, children should be directed to more useful physical activities.

Depression, anxiety and obsessive-compulsive symptoms and quality of life in children with attention-deficit hyperactivity disorder (ADHD) during three-month methylphenidate treatment.

The current study was designed to investigate the changes that occur in depression, anxiety, obsessive-compulsive symptoms and health-related quality of life during methylphenidate (MPH) treatment in children with attention-deficit hyperactivity disorder (ADHD). Forty-five treatment naive children with ADHD, aged 8-14, were assessed based on self, parent and teacher reports at the baseline and at the end of the first and third month of MPH treatment regarding changes in inattention, hyperactivity, impulsivity, depression, anxiety and obsessive-compulsive symptoms. Changes in the quality of life were also noted. Repeated measures of analysis of variance (ANOVA) tests with Bonferroni corrections were conducted in order to evaluate the data. Symptoms of inattention, hyperactivity and impulsivity were significantly reduced (p < 0.017) following a three-month MPH treatment. There were significant decreases in depression (p = 0.004), trait anxiety (p = 0.000) and checking compulsion symptom scores (p = 0.001). Moreover, parents reported significant improvements in psychosocial (p = 0.001) and total scores (p = 0.009) of quality of life, despite no change in physical health scores (p > 0.05). Children's ratings of quality of life measures showed no significant changes in physical health and psychosocial scores (p > 0.05), while total scores significantly improved (p = 0.001) after the treatment. Over a three-month MPH treatment, depression, trait anxiety and checking compulsion symptoms decreased and quality of life seemed to improve along with those of inattention, hyperactivity and impulsivity.

EEG and MRI findings and their relation with intellectual disability in pervasive developmental disorders.

BACKGROUND: The diagnostic category pervasive developmental disorders (PDDs) refer to a group of five disorders: autism, Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). EEG abnormalities and seizures are considered much frequent in autistic subjects with comorbid intellectual disability (ID). In this study, we aimed to evaluate the EEG and MRI findings and their relation with ID in pervasive developmental disorder. METHODS: A retrospective, cross-sectional and non-experimental study was performed. Subjects included 81 patients diagnosed with autism or PDD-NOS according to the DSM-IV criteria. The age range of the patients was 2-15 years (mean 6.6 years, SD 3.0). Among them, 21 (25.9%) were girls and 60 boys (74.1%). RESULTS: Patients with severe ID had a higher rate of EEG abnormalities (P=0.03) than patients without ID as well as patients with mild or moderate ID. The association remained significant after the structural MRI abnormalities were controlled (P=0.04). The severity of ID was not associated with abnormal MRI. The most frequent EEG and MRI abnormalities were active epileptic anomaly/paroxysmal abnormality and cerebral atrophy/periventricular leukomalacia, respectively. Almost a third of the EEG abnormalities were associated with temporal cortex and adjacent cortical structures. CONCLUSIONS: Consistent with previous studies, almost a fourth of the patients in this relatively large sample of patients with pervasive developmental disorders had EEG and/or MRI abnormalities. EEG results indicate that temporal cortex may play a significant role in pervasive developmental disorders.

[Comparison of cerebral blood flow in children with obsessive compulsive disorder and attention deficit hyperactivity disorder]. / Obsesif kompulsif bozukluk ve dikkat eksikligi hiperaktivite bozuklugu olan çocuklarin serebral kan akimlarinin karsilastirilmasi.

OBJECTIVE: It has been reported that both obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) might be related to impairments in frontal-striatal brain circuits. Besides, these two disorders are frequently comorbid. However, there are no published studies directly comparing the neurobiological findings in these two disorders. The objective of the study was to investigate the differences in cortical blood flow between patients with OCD and ADHD. METHOD: Thirteen drug-naive OCD subjects (mean age +/- SD: 10.4 +/- 2.8), and 13 drug-naive ADHD subjects (mean age +/- SD: 10.5 +/- 2.2) were included in the study. Cerebral blood flow (CBF) was evaluated with Tc-99m-hexamethylpropyleneamine oxime (Tc99m HMPAO) brain single photon emission tomography (SPECT) during standard resting conditions in all cases. P value was set to <.006 after Bonferroni correction. RESULTS: OCD cases had significantly higher right prefrontal (p=.003) CBF than ADHD cases. There were no significant CBF differences in other brain regions. OCD symptom severity was not related to CBF. DISCUSSION: This is one of the very few studies which directly investigated brain imaging in pediatric OCD subjects. Results are consistent with previous studies reporting increased prefrontal CBF in OCD subjects. We also found that, consistent with the previous literature, ADHD subjects had lower prefrontal cortex CBF. Studies which compare subjects with comorbid ADHD and OCD with pure forms of these disorders are necessary to have a better understanding of similarities and differences of these two disorders.

[Sociodemographic and clinical factors associated with compliance to methylphenidate treatment in children with attention deficit hyperactivity disorder]. / Dikkat eksikligi hiperaktivite bozuklugunda metilfenidat tedavisine uyumda etkili olan sosyodemografik ve klinik etmenler.

OBJECTIVE: The present study aimed to determine the rate of treatment compliance in children with attention deficit hyperactivity disorder (ADHD) that were newly prescribed methylphenidate, and to evaluate the associated clinical and sociodemographic factors, as well as parental concerns about drug treatment. METHOD: The sample of this prospective and observational study consisted of 238 children aged 7-18 years with ADHD diagnosed according to DSM-IV criteria. At the end of the first year, the study sample was splitted into 2 groups; compliant and non-compliant. Parental attitudes toward drug therapy, and clinical and sociodemographic characteristics of the 2 groups were compared. A clinician rated parental concerns about drug treatment 4-6 weeks after the interview that was conducted in order to inform them about methylphenidate therapy. Regarding a minimum requirement of 5 days weekly dosage and drug holidays, cases that took more than 70% of the recommended methylphenidate dose at the end of the first year were described as compliant. RESULTS: At the end of the first year of treatment, the drug compliance rate was 80.3% (n= 191). The non-compliant group consisted of older children. A significant difference was observed between the compliant and non-compliant groups in terms of parental approach toward drug treatment. Children in the non-compliant group had parents that had doubts about pharmacotherapy and these children were less compliant with methylphenidate treatment. CONCLUSION: Parental concerns about methylphenidate treatment in ADHD may influence treatment compliance. Additionally, it is suggested that developmental psychological characteristics associated with adolescence may also be important.

[Psychopathology in parents of children with school phobia]. / Okul Korkusu Yakinmasi Olan Cocuklarin Ana Babalarinda Ruhsal Bozukluklar.

OBJECTIVE: In children, what is referred to as school phobia is usually avoidant behavior secondary to separation anxiety. The purpose of this study was to examine the psychopathology in parents of children with school phobia. METHOD: The study compared 2 groups of parents: 1) parents of children with school phobia (n = 50); 2) parents of children free of any psychiatric diagnosis (n = 50). Parents were assessed with the Structured Clinical Interview for DSM-IV (SCID-I) to determine rates of overall psychopathology by a second clinician blind to the diagnostic status of their children, and they were also administered the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Liebowitz Social Anxiety Scale (LSAS) to determine the presence of anxiety and mood disorders. Children with school phobia (n = 25), aged 6-12 years, and an age-and gender-matched control group (n= 25) were assessed based on the criteria of the DSM-IV. Parents completed the Child Behavior Checklist (CBCL) 4-18. RESULTS: All of the children with school phobia met the criteria for an anxiety disorder. Parental psychopathology was higher in parents of children with school phobia than in parents of normal children. BDI, BAI, and fear and anxiety subscale scores of the LSAS were significantly higher in the parents of school phobic children than in the control group parents. CONCLUSION: The high rates of psychopathology in parents of children with school phobia suggested that treatment of children diagnosed as anxiety disorder should include the treatment of parents as well.

Regional cerebral blood flow in children with ADHD: changes with age.

The aim of this study was to investigate the changes in regional cerebral blood flow (rCBF) with age in patients with attention deficit hyperactivity disorder (ADHD). Twenty-nine drug-naive ADHD subjects (24 boys, 5 girls; age 7-13; mean+/-SD=age 9.2+/-2.1) and 12 subjects with epilepsy (all diagnosed as having complex partial seizure, 6 boys, 6 girls; age 7-14; mean+/-SD=8.5+/-2.1) were included in the study. All cases of ADHD were diagnosed according to DSM-IV criteria. Cerebral blood flow was evaluated with Tc-99m-hexamethylpropyleneamine oxime (Tc99m HMPAO) brain single photon emission tomography (SPECT) during standard resting condition in all of the cases. Asymmetry indices for each region of interest were calculated. Absolute rCBF values were normalized as the absolute rCBF values divided by the whole brain absolute value. The prefrontal lobe asymmetry indices were significantly negatively correlated with age in ADHD cases (r=-0.408, P=0.025), which indicated the increased prefrontal rCBF lateralization from the right to the left side with age. When ADHD cases older than 7 years of age were compared with those with epilepsy, the ADHD cases had lower right prefrontal and frontal rCBF and higher left parietal rCBF. The epilepsy group showed no significant correlations between age and asymmetry indices and showed a different developmental trajectory for prefrontal asymmetry and right prefrontal rCBF values. The results indicated that the left hemisphere dominance in the prefrontal cortex significantly increases with age in ADHD cases.

Symptoms defined by parents' and teachers' ratings in attention-deficit hyperactivity disorder: changes with age.

OBJECTIVE: To determine whether Child Behavior Checklist/4-18 (CBCL) and Teacher Report Form (TRF) scores of children and adolescents with a first-time diagnosis of attention-deficit hyperactivity disorder (ADHD) are different and whether there is a similar difference in normal control subjects. METHOD: We analyzed the CBCL and TRF scores of 146 patients (124 boys and 22 girls, aged 6 to 18 years; mean age 11.0 years, SD 3.6). We analyzed the same scores for 274 age and sex-matched control subjects recruited from a nationally representative sample. RESULTS: Subjects with ADHD had significantly higher CBCL and TRF scores than control subjects. Age was significantly correlated with scores on the CBCL and TRF subscales Social Withdrawal, Somatic Complaints, and Internalization Problems; with scores on the CBCL subscale Attention Problems; and with scores on the TRF subscale Anxiety-Depression. In the group with ADHD, age was negatively correlated with scores on the CBCL and TRF subscale Externalizing Problems and with scores on the TRF subscale Aggressive Behavior. In the control group, the only significant correlation was between age and the CBCL subscale Somatic Complaints score. CONCLUSIONS: These results indicate that underdiagnosis of ADHD in childhood may cause the emergence of greater internalization problems in adolescence.