Attention-Deficit/Hyperactivity Disorder in adults. Clinical characteristics and pre- and perinatal risk factors

Attention-deficit/hyperactivity disorder (ADHD) is currently a prevalent diagnosis in child psychiatry, typically affecting 2-5 % of school-aged children world-wide. The recent and increasing awareness that ADHD may persist to adulthood for a considerable proportion of the affected children has created a need for more knowledge about ADHD as a lifespan disorder. Aims: The aims of the thesis were to: 1) assess occupational functioning among adults with ADHD; 2) explore the relationship between ADHD and mood disorders; 3) investigate the role of pregnancy- and birth related complications as possible risk factors for persistent ADHD; 4) study the effect of an impaired serotonin production in utero on the development of ADHD symptoms and related behaviour. Material and methods: The thesis is based on four separate articles (Paper I-IV). The first two papers are clinical studies based on questionnaires obtained from 414 and 510 adults with a clinical diagnosis of ADHD, respectively, and controls (n=359/417) from the general population. The third paper is an epidemiologic population-based study using data from the Medical Birth Registry of Norway (MBRN), in which we compared pre- and perinatal risk factors of a national cohort of 2123 adults with ADHD and the rest of the Norwegian adult population born in the same time period (n=1.17 million). The fourth study explores the possible causative role of reduced serotonin production in ADHD related symptoms and behaviour by studying the presence and effects of mutations in the tryptophan hydroxylase 1 gene (TPH1) in adult ADHD patients, their family members and controls. Results: In paper I we showed that only 24 % of adult ADHD patients (mean age 34.5 years) were currently in work, compared to 79 % of controls (mean age 29.9 years). Having been diagnosed and treated for ADHD in childhood was the strongest predictor for being in work as an adult, independently of symptom severity, psychiatric comorbidity, and current treatment (OR 3.2, p=0.014). In the second paper, 51 % of ADHD patients screened positive for a bipolar spectrum disorder (BSD) according to the Mood Disorder Questionnaire (MDQ), compared to 8.3 % of the controls. Patients screening positive for a BSD had lower occupational functioning and significantly more drug problems than patients with low levels of affective symptoms. In the epidemiological population-based study from the MBRN, we found that low birth weight, preterm birth, and low Apgar scores were associated with ADHD in adulthood, with the highest risk for the lowest measures. We also found that maternal epilepsy and infant oral cleft were associated with ADHD in the adult offspring. In the last study, sequencing of TPH1 in 646 adults (patients and controls) resulted in the identification of 7 different missense mutations, of which 6 resulted in reduced enzyme function in vitro compared to wild type TPH1. Family based analyses showed that offspring of mothers with TPH1 mutations had higher levels of ADHD related symptoms and behaviour, compared to offspring of fathers with such mutations or controls, independently of the individuals’ own TPH1 status. Conclusions: Adults with a clinical diagnosis of ADHD had an impaired occupational functioning and a high prevalence of comorbid psychiatric problems. Symptoms of affective disorders were frequent among adults with ADHD, and were associated with lower occupational functioning and more substance abuse. Patients who were diagnosed and treated for ADHD in childhood had a more favourable outcome in adult life compared to patients who were first diagnosed in adulthood. Factors indicating a suboptimal foetal development, such as being born extremely preterm or with very low birth weight, were associated with development of ADHD. Impaired maternal serotonin production in early embryonic life may be a causative pathway in the putative altered brain development, resulting in subsequent ADHD related symptoms and behaviours

Optical and Electrical studies of GaAs Nanowire arrays on Si substrates

Syv ulike prøver bestående av GaAs/AlGaAs grodd ved den selvkatalyserte teknikken har blitt analysert ved bruk av elektron mikroskopi og fotoluminsense spectroskopi. Målet var å optimalisere veksten ved å finne en fri exciton emissjon. Prøvene har blitt analysert ved en temperature på 12 K. Fysiske størrelser og fotoluminisens spekter har blitt brukt for å gjøre denne analysen. Noen kolkusjoner har blitt forsøkt dratt ut i fra disse målingene. Målet med optimaliseringen har ikke blitt nådd. Ingen av prøvene har vist noen konsistent fri exciton emission

Barns lek med brettspillet «Veien til Sola»

Den verden vi lever i er i stadig endring. Den blir mer digitalisert og utvikler seg raskere enn noen gang før. Dagens barn vokser opp i en verden sentrert rundt multimedia, som vil påvirke hva de kan gjøre og forstå (Yelland, Carmel, & Butler, 2014, s. 23). Matematikk er også en viktig del av rammeplanen for barnehagen. Rammeplanen sier noe hva som skal foregå i barnehagen, både når det gjelder innhold og det faglige. (Stai, 2020) Dette er et viktig føringsdokument for alle barnehagelærere, som skal brukes aktivt i rollen som profesjonsutøver. Den matematiske læringen og undringen er meget viktig på veldig mange området i barnehagen og gjør at vi som barnehagelærere har et viktig ansvar for å få introdusert dette til barna på en god måte. En god måte å gjøre dette på, er gjennom spill. Derfor er det svært interessant hvordan et tiltenkt spill kan legge til rette for matematiske erfaringer. Problemstillingen er noe jeg har jobbet med gjennom hele arbeidet med oppgaven: Hvilke matematiske erfaringer gjør barnet seg gjennom lek med brettspillet? Jeg hadde tidlig sett for meg å gjøre noe knyttet til brettspillet, som jeg kommer til å forklare nærmere senere i oppgaven.publishedVersio

Optical and Electrical studies of GaAs Nanowire arrays on Si substrates

Syv ulike prøver bestående av GaAs/AlGaAs grodd ved den selvkatalyserte teknikken har blitt analysert ved bruk av elektron mikroskopi og fotoluminsense spectroskopi. Målet var å optimalisere veksten ved å finne en fri exciton emissjon. Prøvene har blitt analysert ved en temperature på 12 K. Fysiske størrelser og fotoluminisens spekter har blitt brukt for å gjøre denne analysen. Noen kolkusjoner har blitt forsøkt dratt ut i fra disse målingene. Målet med optimaliseringen har ikke blitt nådd. Ingen av prøvene har vist noen konsistent fri exciton emission

Attention Network Test in adults with ADHD - the impact of affective fluctuations

Background: The Attention Network Test (ANT) generates measures of different aspects of attention/executive function. In the present study we investigated whether adults with ADHD performed different from controls on measures of accuracy, variability and vigilance as well as the control network. Secondly, we studied subgroups of adults with ADHD, expecting impairment on measures of the alerting and control networks in a subgroup with additional symptoms of affective fluctuations. Methods: A group of 114 adults (ADHD n = 58; controls n = 56) performed the ANT and completed the Adult ADHD Rating Scale (ASRS) and the Mood Disorder Questionnaire (MDQ). The latter was used to define affective fluctuations. Results: The sex distribution was similar in the two groups, but the ADHD group was significantly older (p = .005) and their score on a test of intellectual function (WASI) significantly lower than in the control group (p = .007). The two groups were not significantly different on measures of the three attention networks, but the ADHD group was generally less accurate (p = .001) and showed a higher variability through the task (p = .033). The significance was only retained for the accuracy measure when age and IQ scores were controlled for. Within the ADHD group, individuals reporting affective fluctuations (n = 22) were slower (p = .015) and obtained a lower score on the alerting network (p = .018) and a higher score on the conflict network (p = .023) than those without these symptoms. The significance was retained for the alerting network (p = .011), but not the conflict network (p = .061) when we controlled for the total ASRS and IQ scores. Discussion: Adults with ADHD were characterized by impairment on accuracy and variability measures calculated from the ANT. Within the ADHD group, adults reporting affective fluctuations seemed to be more alert (i.e., less impacted by alerting cues), but slower and more distracted by conflicting stimuli than the subgroup without such fluctuations. The results suggest that the two ADHD subgroups are characterized by distinct patterns of attentional problems, and that the symptoms assessed by MDQ contribute to the cognitive heterogeneity characterizing groups of individuals with ADHD

Attention-Deficit/Hyperactivity Disorder in Offspring of Mothers With Inflammatory and Immune System Diseases

AbstractBackgroundPrenatal inflammatory mechanisms may play a role in the pathogenesis of psychiatric disorders and could be relevant for attention-deficit/hyperactivity disorder (ADHD). We investigated maternal chronic somatic diseases with immune components as possible risk factors for ADHD in offspring.MethodsWe performed a population-based nested case-control study by linking data from longitudinal Norwegian registers. We included all individuals born during the period 1967–2008 and alive at record linkage (2012). Individuals receiving ADHD medication during the years 2004–2012 were defined as patients with ADHD (N = 47,944), and all remaining individuals (N = 2,274,713) were defined as control subjects. The associations between maternal diseases and ADHD in offspring were analyzed using logistic regression models.ResultsThe following chronic diseases with immune components were related to ADHD in offspring: multiple sclerosis (adjusted odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.2–2.5), rheumatoid arthritis (adjusted OR = 1.7; 95% CI = 1.5–1.9), type 1 diabetes (adjusted OR = 1.6; 95% CI = 1.3–2.0), asthma (adjusted OR = 1.5; 95% CI = 1.4–1.6), and hypothyroidism (adjusted OR = 1.2; 95% CI = 1.1–1.4). In contrast, chronic hypertension and type 2 diabetes showed no significant associations. Estimates were almost unchanged with additional adjustment for parental ADHD, infant birth weight, and gestational age. Although point estimates for male and female offspring were different for some diseases (e.g., maternal asthma [adjusted OR = 1.7; 95% CI = 1.5–1.8 for female offspring and adjusted OR = 1.5; 95% CI = 1.4–1.6 for male offspring]), none of the associations differed significantly by offspring sex.ConclusionsSeveral maternal somatic diseases with immune components were found to increase the risk of ADHD in offspring. The associations could involve several causal pathways, including common genetic predisposition and environmental factors, and increased insight into the mechanisms behind these relationships could enhance our understanding of the etiology of ADHD

A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder

Background. There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. Methods. We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. Results. The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the shortterm, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. Conclusions. Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD

Goal management training improves executive control in adults with ADHD: an open trial employing attention network theory to examine effects on attention

Background Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) typically experience poorer attentional control. According to the attention network theory, attentional control relies on three interacting networks of alerting, orienting, and executive control. In ADHD, it is mainly the alerting and executive control networks that are suggested and found to be compromised. Methods In the current study, we investigated if a group-based metacognitive remediation program (Goal Management Training [GMT]) in adults with ADHD would enhance attentional control using an experimental measure of the attention network theory. We expected that GMT would specifically enhance the executive control and alerting networks. Results Data from post- and follow up-assessments of 21 adults (age: 39.05 [11.93]) with ADHD who had completed GMT were included. Linear mixed-effects modeling revealed significant improvements in the functioning of the executive control network for the majority of the participants, although a small subset of participants showed a negative development following the intervention. Results also showed an improvement in the orienting network at follow up, but no change in the alerting network. Conclusion The results may indicate that improvements in the functioning of the executive control network are central to the positive effects of GMT reported in disorders characterized by impaired attentional control.publishedVersio

Variation in attitudes toward diagnosis and medication of ADHD: a survey among clinicians in the Norwegian child and adolescent mental health services

Prevalence and medication rates of ADHD vary geographically, both between and within countries. No absolute cutof exists between ADHD and normal behavior, making clinician attitudes (leading to local practice cultures) a potential explanation for the observed variation in diagnosis and medication rates. The objective of this study was to describe variation in attitudes toward diagnosis and medication of ADHD among clinicians working in child and adolescent mental health services (CAMHS). We hypothesized that attitudes would vary along a spectrum from “restrictive” to “liberal”. We also explored whether diferences in attitudes between clinicians were related to professional background and workplace (clinic). A survey in the form of a web-based questionnaire was developed. All CAMHS outpatient clinics in Norway were invited. Potential respondents were all clinicians involved in diagnosing and treating children and adolescents with ADHD. To investigate the existence of attitudes toward diagnosis and medication as latent constructs, we applied confrmatory factor analysis (CFA). We further examined how much of variance in attitudes could be ascribed to profession and clinics by estimating intraclass correlation coefcients. In total, 674 respondents representing 77 (88%) of the clinics participated. We confrmed variation in attitudes with average responses leaning toward the “restrictive” end of the spectrum. CFA supported “attitude toward diagnosis” and “attitude toward medication” as separate, and moderately correlated (r=0.4) latent variables, representing a scale from restrictive to liberal. Professional background and workplace explained only a small part of variance in these attitudes

Strategisk samarbeid for økt byliv i transformasjonsområder - Med case på Økern

Studien tar for seg hvordan strategisk samarbeid mellom private grunneiere og Oslo kommune påvirker økt byliv i transformasjonsområder, med case på Økern. Når man gjennomfører by- og eiendomsutvikling i transformasjonsområder, er det nødvendig med tett samarbeid og koordinering mellom den private eiendomsutvikleren og den lokale planmyndigheten. Private eiendomsutviklere tar ofte initiativet til, finansierer og gjennomfører planer, mens plan- og bygningsetaten, som lokal planmyndighet, har betydelig innflytelse på byutviklingen. Dette skaper en gjensidig avhengighet mellom partene. Hovinbyen er Oslos største byutviklingsområde, med formål om transformasjon. Transformasjonsområder med bymessige utviklingsformål krever en revitalisering som tilrettelegger for byliv, gjennom sosial bærekraft og innovasjon. Overlappende formelle og uformelle planer skaper ulike forståelser av narrativet om Hovinbyen. Mens grunneiere og utbyggere ser dette som et bidrag til uforutsigbart for investeringer og finansiering av nye planer, mener planmyndigheten at dette er nødvendige verktøy i planprosessen. I studien har vi gjennom tre forskningsspørsmål undersøkt hvordan forutsigbarhet og fleksibilitet i samarbeidet mellom grunneiere og Oslo kommune påvirker transformasjonsprosjekter, samt hvilke strategier som benyttes for å ivareta sosial bærekraft og fremme innovasjon. For å besvare dette har vi anvendt kvalitativ metode, og har da hentet inn data gjennom intervju, dokumentanalyse og observasjon. Gjennom et teoretisk grunnlag har vi utarbeidet synteser som legger grunnlaget for å tolke, analysere og sammenligne empiriske funn. Studien viser at et godt strategisk samarbeid mellom aktørene krever vilkår som må ligge til grunn i komplekse utvikling- og transformasjonsområder. Disse beror hovedsakelig på fem vilkår; klare retningslinjer og forutsigbarhet, fleksibilitet for å møte lokale behov, inkluderende planprosesser, langsiktige strategiske planer og midler. Effektivt samarbeid krever klare og forutsigbare rammer. På Økern viser overlappende planer behovet for koordinering. Dette for å unngå ineffektive planprosesser. En veldefinert prosess gir grunnlag for å iverksette økonomiske investeringer, som er avgjørende for prosjektenes kvalitet og gjennomførbarhet. Fleksibilitet og dynamiske planer etter lokale behov er viktig, inkludert midlertidige tiltak og strategier som modner området og sikrer økt byliv.The thesis examines how strategic collaboration between private property developers and Oslo municipality affects the increase of urban life in transformation areas, using the case study of Økern. When conducting urban and property development in transformation areas, close cooperation and coordination between private property developers and the local planning authority is essential. Private property developers often initiate, finance, and execute plans, while the Planning and Building Authority, as the local planning authority, significantly influences urban development. This creates a mutual dependence between the parties involved. Hovinbyen is Oslo's largest urban development area, with an aim of urban transformation. Transformation areas with urban development purposes require revitalization that facilitates urban life through social sustainability and innovation. Overlapping formal and informal plans create a fragmented narrative of Hovinbyen. Where landowners and developers view this as unpredictable for investments in and financing of new plans, the planning authority on the other hand considers these necessary tools in the planning process. In the thesis through three research questions, we investigated how predictability and flexibility in the collaboration between landowners and Oslo municipality impact transformation projects, as well as which strategies are used to maintain social sustainability and promote innovation. To address this, we employed qualitative methods and collected data through interviews, document analysis, and observation. Based on a theoretical foundation, we developed syntheses that form the basis for interpreting, analyzing, and comparing empirical findings. The thesis shows that effective strategic collaboration between the parties requires certain conditions to be met in complex development and transformation areas. These mainly depend on five conditions: clear guidelines and predictability, flexibility to meet local needs, inclusive planning processes, long-term strategic plans, and temporary measures for areal maturation. Effective collaboration requires clear and predictable frameworks. In Økern, overlapping plans highlight the need for coordination to avoid inefficient planning processes. A well-defined process provides a foundation for economic investments, which are critical to the quality and feasibility of projects. Flexibility and dynamic plans tailored to local needs are important, with temporary measures and strategies that mature the area and enhances the city life