Functional deficits in basal ganglia of children with attention-deficit/hyperactivity disorder shown with functional magnetic resonance imaging relaxometry.

Attention-deficit/hyperactivity disorder is a highly heritable and prevalent neuropsychiatric disorder estimated to affect 6% of school-age children. Its clinical hallmarks are inattention, hyperactivity and impulsivity, which often respond substantially to treatment with methylphenidate or dextroamphetamine. Etiological theories suggest a deficit in corticostriatal circuits, particularly those components modulated by dopamine. We developed a new functional magnetic resonance imaging procedure (T2 relaxometry) to indirectly assess blood volume in the striatum (caudate and putamen) of boys 6-12 years of age in steady-state conditions. Boys with attention-deficit/hyperactivity disorder had higher T2 relaxation time measures in the putamen bilaterally than healthy control subjects. Relaxation times strongly correlated with the child's capacity to sit still and his accuracy in accomplishing a computerized attention task. Daily treatment with methylphenidate significantly changed the T2 relaxation times in the putamen of children with attention-deficit/hyperactivity disorder, although the magnitude and direction of the effect was strongly dependent on the child's unmedicated activity state. There was a similar but nonsignificant trend in the right caudate. T2 relaxation time measures in thalamus did not differ significantly between groups, and were not affected by methylphenidate. Attention-deficit/hyperactivity disorder symptoms may be closely tied to functional abnormalities in the putamen, which is mainly involved in the regulation of motor behavior.

Circadian rest-activity disturbances in children with seasonal affective disorder.

OBJECTIVE: Seasonal affective disorder (SAD) affects from 1.7% to 5.5% of children. Previous studies found that nonseasonally depressed children had a blunted circadian rhythm, while adults with SAD had a delayed and poorly entrained rhythm. The purpose of this study was to determine whether pediatric SAD more closely resembles nonseasonal pediatric depression or adult SAD. METHOD: Twelve normal, healthy volunteers (11.6 +/- 3.7 years; 6 female, 6 male) and 14 unmedicated children with SAD (11.0 +/- 3.3 years; 9 female, 5 male) meeting Rosenthal/NIMH criteria for SAD and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version criteria for major depression had their levels of activity recorded for 72 hours (weekdays) using belt-worn actigraphs. RESULTS: The SAD group had blunted circadian amplitudes that were 10% lower than normal (p = .004). They were more poorly modeled by the standard cosinor equation (p = .001), and a circadian rhythm accounted for 39% less of the variability in their activity profile (p = .007). The amplitude of the 12-hour harmonic rhythm was markedly increased. There were no differences between SAD and control children in the timing of the circadian rhythm and degree of entrainment. CONCLUSIONS: Children with SAD displayed dysregulated circadian activity rhythms comparable with those reported in nonseasonally depressed children, yet different from those observed in adults.

Medication education for children. Is it worthwhile?

Child psychiatric inpatients have little or no control over their treatment. Anxiety and fear are normal reactions to the hospitalization and treatment process. Pharmacotherapy is an intervention that the child often perceives as an indicator of pathology. This article presents various methodologies to teach children about their medication treatment. Puppetry, graphics, art, and discussion were techniques used in a peer group to impart knowledge and decrease anxiety, fear, and negativity.