Central stimulants in the treatment of attention-deficit hyperactivity disorder (ADHD) in children and adolescents. A naturalistic study of the prescription in Sweden, 1977-2007.

BACKGROUND: An increased prescription of central stimulants (CS) for treatment of attention-deficit hyperactivity disorder (ADHD) in children and adolescents has been reported in Sweden. AIMS: To follow-up the treatment with CS as concerns total as well as regional differences in prescription rate. Efficacy and side-effects reported and gender differences in prescription over time also have been summarized. METHODS: Data from the Swedish Medical Products Agency (MPA) of individual licences, annual reports about patients on individual or clinic licences from the MPA and sales statistics from the National Pharmacy (Apoteket AB) have been used. RESULTS: The number of new licences and prescriptions increased dramatically from 1992 to 2007 and a change of preparations was seen. Great differences (fivefold) between the 21 counties of Sweden were noticed. In the follow-up reports to the MPA, a good/moderate treatment effect was reported in 92% and adverse effects were reported in 4% leading to discontinuation of medication in 46% of them. Abuse/misuse of the preparation was suspected in 0.2% of the reports. A tendency of a reduction of the proportion of boys to girls treated through individual licences has been seen. CONCLUSIONS: The study, although observational, supports good efficacy, limited adverse effects and a low degree of misuse in clinical use of CS for children and adolescents with ADHD.

How well do measures of inhibition and other executive functions discriminate between children with ADHD and controls?

The aim of the present study was to evaluate the usefulness of Barkley's (1997a) model of inhibition and executive functioning in describing the deficits associated with Attention Deficit Hyperactivity Disorder (ADHD). Besides group differences, the present study addressed the question of independent effects of inhibition and the other executive functions in discriminating between children with ADHD and controls and how well, in terms of sensitivity and specificity, these measures can classify the children into the correct group. The results showed that children with ADHD differed significantly from controls with regard to measures of inhibition as well as all other executive function measures, except repetition of hand movements. In logistic regression models, three different measures tapping inhibition, working memory and emotion regulation were shown to be significant independent predictors of group membership. The sensitivity for these three variables as a set was 76.2, the specificity was 90.5, with a total of 86% of the sample correctly classified. When excluding the parental rating of emotion regulation, the overall classification rate decreased some, but was still relatively high in comparison with previous studies within this area of research.

The FTF (Five to Fifteen): the development of a parent questionnaire for the assessment of ADHD and comorbid conditions.

This paper describes the development of a new parent questionnaire ("Five to Fifteen", or the FTF) for elicitation of symptoms and problems typical of ADHD and its comorbidities. The FTF comprises 181 statements related to behavioural or developmental problems that can be endorsed as either "does not apply" (0), applies sometimes or to some extent" (1), "definitely applies" (2), plus a number of open-ended questions including some about the child's strengths. The items are arranged into eight different domains (memory, learning, language, executive functions, motor skills, perception, social skills, and emotional/behavioural problems), most of which can be subdivided into subdomains. For each domain, a mean score ranging from 0-2 can be calculated. A representative sample (n=1350) of the total population of 6-15-year-old children was targeted. Parents of 63% of these completed a questionnaire and returned it to the researchers. Boys showed significantly more problems than did girls across domains and age. Younger children had more problems than pre-adolescents and adolescents (except in the domains of social skills and emotional/behavioural problems). Executive dysfunction was common, and 5.3% of all children in the population had clear problems suggesting a diagnosis of ADHD according to parent report. The paper provides means, medians, and 90(th) and 95(th) centiles for individual items as well as for the eight domains. The Discussion centres on whether or not the FTF can (or should) be used in school-aged children for the identification of children at risk for ADHD or other early childhood onset neuropsychiatric disorder.

Inhibition and executive functioning in Type A and ADHD boys.

The present study was aimed at clarifying the standing of Type A behavior, as measured by behavioral observations, relative to Attention Deficit Hyperactivity Disorder (ADHD), using measures of inhibitory control and executive functioning. The study sample included 20 boys exhibiting Type A behavior, 21 boys exhibiting Type B behavior and 14 boys diagnosed with ADHD, ranging in age from 7 to 12 years. The results of the present study showed that the Type A children differed from Type B children on two time-related variables, response latency and reaction time, in accordance with the view of Type As as time-urgent and impatient. Furthermore, in comparisons with the ADHD group, the Type A boys were found to be superior on several performance tasks, such as Go/no-go omissions, time reproduction, story recall and memory for sequences of hand movements, although similarities between Type A and ADHD boys were evidenced in terms of response latency and reaction time. In other words, although Type A boys were similar to ADHD boys in terms of overt displays of time-urgency and impatience, Type As do not display deficits with regard to executive functioning, of the kind often found when ADHD children are compared with normal controls. It may thereby be concluded that Type A behavior and hyperactivity/ADHD appear to be well differentiated except with regard to what may be interpreted as impatience. Speculations concerning differing origins of overtly similar characteristics of Type A behavior and ADHD should be considered in future research.