Bio-social aspects of Attention Deficit Hyperactivity Disorder (ADHD): Neurophysiology, maturity, motor function and how symptoms relate to family interaction

The purpose of this thesis has been to study biological and social factors of importance for Attention Deficit Hyperactivity Disorder (ADHD). Thirty children (age 6-11) with ADHD were examined with parent ratings, neurological examination, cognitive testing, cerebral blood-flow, and EEG. These children together with 14 other children the same age with ADHD, were video-taped during family-tasks before and after three months of treatment with amphetamine. Parents answered questionnaires concerning family functioning and parental well-being. Two-hundred and fifty-one children (age 6-9) were examined with skeletal bone-age, motor examination by the physical education teacher, and parent and teacher questionnaires concerning ADHD-symptoms. Thirty-five children were video-taped during neurological examination. Twenty children were examined on two occasions with four weeks between the examinations. Eighty-nine children age 5½, and 23 children age 7-9 underwent neurological examination and parents were interviewed concerning their child’s motor development. The results from the examination of cerebral blood-flow suggest that there may be at least two functional disturbances in children with ADHD, one involving the frontal lobes, especially on the right side, related to behavioural deviance, and another disturbance of the integration of the temporal lobes, the cerebellum and subcortical structures related to motor planning and aspects of cognition. The study of family function gives support to the notion that some aspects of family dysfunction may be related to the child’s ADHD behaviour. Variables related to general biological maturity did not correlate with ADHD-symptoms. The neurological “soft-signs” examination studied, was found to have good reliability and validity as a measure of motor function and can be recommended for clinical practice and research

Comparing Auditory Noise Treatment with Stimulant Medication on Cognitive Task Performance in Children with Attention Deficit Hyperactivity Disorder: Results from a Pilot Study

Background: Recent research has shown that acoustic white noise (80 dB) can improve task performance in people with attention deficits and/or Attention Deficit Hyperactivity Disorder (ADHD). This is attributed to the phenomenon of stochastic resonance in which a certain amount of noise can improve performance in a brain that is not working at its optimum. We compare here the effect of noise exposure with the effect of stimulant medication on cognitive task performance in ADHD. The aim of the present study was to compare the effects of auditory noise exposure with stimulant medication for ADHD children on a cognitive test battery. A group of typically developed children (TDC) took the same tests as a comparison. Methods: Twenty children with ADHD of combined or inattentive subtypes and twenty TDC matched for age and gender performed three different tests (word recall, spanboard and n-back task) during exposure to white noise (80 dB) and in a silent condition. The ADHD children were tested with and without central stimulant medication. Results: In the spanboard- and the word recall tasks, but not in the 2-back task, white noise exposure led to significant improvements for both non-medicated and medicated ADHD children. No significant effects of medication were found on any of the three tasks. Conclusion: This pilot study shows that exposure to white noise resulted in a task improvement that was larger than the one with stimulant medication thus opening up the possibility of using auditory noise as an alternative, non-pharmacological treatment of cognitive ADHD symptoms

Motor function and perception in children with neuropsychiatric and conduct problems : results from a population based twin study.

BACKGROUND: Children with early symptomatic psychiatric disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) have been found to have high rates of motor and/or perception difficulties. However, there have been few large-scale studies reporting on the association between Conduct Disorder (CD) and motor/perception functions. The aim of the present study was to investigate how motor function and perception relate to measures of ADHD, ASD, and CD. METHODS: Parents of 16,994 Swedish twins (ages nine and twelve years) were interviewed using the Autism-Tics, ADHD and other Comorbidities inventory (A-TAC), which has been validated as a screening instrument for early onset child psychiatric disorders and symptoms. Associations between categorical variables of scoring above previously validated cut-off values for diagnosing ADHD, ASD, and CD on the one hand and motor and/or perception problems on the other hand were analysed using cross-tabulations, and the Fisher exact test. Associations between the continuous scores for ADHD, ASD, CD, and the subdomains Concentration/Attention, Impulsiveness/Activity, Flexibility, Social Interaction and Language, and the categorical factors age and gender, on the one hand, and the dependent dichotomic variables Motor control and Perception problems, on the other hand, were analysed using binary logistic regression in general estimated equation models. RESULTS: Male gender was associated with increased risk of Motor control and/or Perception problems. Children scoring above the cut-off for ADHD, ASD, and/or CD, but not those who were 'CD positive' but 'ADHD/ASD negative', had more Motor control and/or Perception problems, compared with children who were screen-negative for all three diagnoses. In the multivariable model, CD and Impulsiveness/Activity had no positive associations with Motor control and/or Perception problems. CONCLUSIONS: CD symptoms or problems with Impulsiveness/Activity were associated with Motor control or Perception problems only in the presence of ASD symptoms and/or symptoms of inattention. Our results indicate that children with CD but without ASD or inattention do not show a deviant development of motor and perceptual functions. Therefore, all children with CD should be examined concerning motor control and perception. If problems are present, a suspicion of ADHD and/or ASD should be raised.The Swedish Research CouncilThe Swedish Research Council for Health, Working Life and WelfarePublishe

Determinants of maternal and fetal exposure and temporal trends of perfluorinated compounds.

In recent years, some perfluorinated compounds (PFCs) have been identified as potentially hazardous substances which are harmful to the environment and human health. According to limited data, PFC levels in humans could be influenced by several determinants. However, the findings are inconsistent. In the present study, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) were measured in paired maternal and cord serum samples (N = 237) collected between 1978 and 2001 in Southern Sweden to study the relationship between these and to investigate several potential determinants of maternal and fetal exposure to PFCs. Time trends of PFCs in Swedish women were also evaluated. The study is a part of the Fetal Environment and Neurodevelopment Disorders in Epidemiological Research project. PFOS, PFOA, and PFNA levels (median) were higher in maternal serum (15, 2.1, and 0.24 ng/ml, respectively) than in cord serum (6.5, 1.7, and 0.20 ng/ml, respectively). PFC levels were among the highest in women originating from the Nordic countries and the lowest in women from the Middle East, North Africa, and sub-Saharan Africa. Multiparous women had lower serum PFOA levels (1.7 ng/ml) than primiparous women (2.4 ng/ml). Maternal age, body mass index, cotinine levels, and whether women carried male or female fetuses did not affect serum PFC concentrations. Umbilical cord serum PFC concentrations showed roughly similar patterns as the maternal except for the gestational age where PFC levels increased with advancing gestational age. PFOS levels increased during the study period in native Swedish women. In summary, PFOS levels tend to increase while PFOA and PFNA levels were unchanged between 1978 and 2001 in our study population. Our results demonstrate that maternal country of origin, parity, and gestational age might be associated with PFC exposure

Perinatal, maternal, and fetal characteristics of children diagnosed with attention-deficit-hyperactivity disorder: results from a population-based study utilizing the Swedish Medical Birth Register.

Aim The aim of this study was to evaluate the impact of pre- and perinatal factors on the risk of developing attention-deficit-hyperactivity disorder (ADHD). Method We investigated the medical history of 237 children (206 male; 31 female) from Malmö, Sweden born between 1986 and 1996 and in whom a diagnosis of ADHD (Diagnostic and Statistical Manual of Mental Disorders-IIIR or IV) was subsequently made at the Department of Child and Adolescent Psychiatry, Lund University, and a reference group of 31 775 typically developing children from Malmö using data from the Swedish Medical Birth Register. Results The results of multiple logistic regression analysis revealed that ADHD was significantly associated with a young maternal age (odds ratio [OR] for 5y increase 0.87; 95% confidence interval [CI] 0.76-0.99), maternal smoking (OR 1.35; 95% CI 1.14-1.60), maternal birthplace in Sweden (OR 2.04; 95% CI 1.45-2.94), and preterm birth <32 weeks (OR 3.05; 95% CI 1.39-6.71), and a male predominance (OR 6.38; 95% CI 4.37-9.32). Apgar scores at 5 minutes below 7 were significantly associated with ADHD in the univariable analysis (OR 2.60; 95% CI 1.15-5.90). The population-attributable fraction of ADHD caused by the perinatal factors studied was estimated to be 2.8%. Interpretation The results indicate that the studied factors constitute weak risk factors for developing ADHD

Bumetanide for autism : Open-label trial in six children

Aim: Bumetanide, a diuretic agent, that reduces intracellular chloride—thereby reinforcing GABAergic inhibition—has been reported to improve core symptoms of autism in children. Given the positive results reported from French trials of bumetanide in children with autism, we decided to evaluate its effects in a small-scale pilot study, in advance of a larger randomised controlled study (RCT). Methods: This was an open-label three-month trial of bumetanide on six children (five boys), aged 3–14 years with autism. Ratings according to the Parental Satisfaction Survey (PASS) were used after four and twelve weeks to assess symptom change. Blood electrolyte status was monitored. Results: Improvement in the PASS domain “Communicative and cognitive abilities” was marked or very marked in four children, and two had some improvements. Few negative side effects were reported. Conclusion: Our small cohort responded well to bumetanide, particularly with regard to “Communicative and cognitive abilities”. Taken with the evidence from larger-scale RCTs, we suggest that bumetanide should be considered for inclusion in ethically approved treatment/management trials for children with autism, subject to rigorous follow-up in large-scale RCTs

Treatment of Attention Deficit/Hyperactivity Disorder With Amphetamine: Short-Term Effects on Family Interaction.

Objective: This research seeks to study the impact on family function after 3 months of treatment with amphetamine. Method: A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent—child interactions. Results: The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the children's behavior and the mother's well-being and some aspects of parent-reported and observer-rated family functioning improved. Conclusion: This study gives support to the notion that some aspects of family dysfunction may be related to the child's ADHD behavior