Ways - 'errors' in the diagnosis and treatment of ADHD (Attention Deficit Hyperactivity Disorder)

Im Rahmen der Dissertation Wege - "Irrwege" der Diagnostik und Behandlung des ADHS wurden 52 Kinder und Jugendliche, Patienten in einer Kinder- und Jugendpsychiatrischen Praxis mit ihren Familien hinsichtlich ihrer Behandlungsgeschichte befragt. Auf dem Boden von Fragebögen und den bei einem Interview sowie im Laufe der Diagnostik erhobenen Daten wurden zehn Hypothesen hinsichtlich ihrer Gültigkeit überprüft. Neben einer unzureichenden regionalen kinder- und jugendpsychiatrischen und psychotherapeutischen Versorgungssituation fanden sich Hinweise darauf, dass eine späte Diagnosestellung eher mit einem unzureichenden Informationsstand des Erstuntersuchers als mit der Intensität der Symptomatik korreliert. Eltern, Kindergärtnerinnen und Lehrer erleben die Kinder in der Regel früh als "anders" und stellen diese auch wegen ihres "Andersseins" bei Kinderärzten und Beratungsstellen vor. Es vergehen aber trotzdem oft noch Jahre bevor die Diagnose ADHS gestellt wird und eine adäquate Behandlung eingeleitet werden kann. Nicht selten finden sich dann schon sekundäre Störungen und eine gescheiterte Schullaufbahn. Der Teil der betroffenen Kinder die zu diesem Zeitpunkt schon kostenintensive Jugendhilfemaßnahmen in Anspruch nehmen müssen ist deutlich erhöht. Die befragten Eltern monierten neben der schlechten Versorgungs- und Informationssituation, den mangelnden Kenntnisstand und unzureichendes Engagement einzelner Institutionen, fühlten sich mit ihrem "Problemkind" oft unverstanden und alleine gelassen. Ingesamt fanden sich aber Hinweise darauf, dass bei weiterhin bestehenden regionalen Versorgungsengpässen der bessere Informationsstand und die Vernetzung der unterschiedlichen Institutionen bereits positive Effekte zeigt. Zahlreiche Veranstaltungen und Artikel in Fachzeitschriften in den letzten Jahren und eine spürbare Enttabuisierung der psychopharmakologischen Behandlung dieses Störungsbildes sind hier zu nennen.Objective To evaluate the ways "errors" in the diagnosis and treatment of Attention Deficit Hyperactivity Syndrome. Design Retrospective study evaluation of questionnaires and consultation records of the database during the diagnostic search. Setting 52 children and adolescent patients in a clinic of child and adolescent psychiatry and their families were interviewed regarding the diagnostic process and their history. Intervention Examination of ten hypothetical assumptions results there was evidence that beside desolate regional provision of services for child and adolescent psychiatry as well as the psychotherapeutic provision, the initial consulting physician showed a lack of information regarding the subject and those resulted in the diagnosis being delayed. There was evidence that a delay in the diagnosis was most likely due to an inefficient experience and education on behalf of the consulting physician than it being correlated to the intensity of symptoms. Parents, nursery nurses and teachers see their children usually early as being "different", and present them because of this to paediatricians and advisory groups. But many years go by before the diagnosis of ADHS is made and appropriate treatment started. We found often secondary disturbances and a failed school pathway. The need for expensive social services input in that group of affected children is significantly higher. The interviewed parents complained that the lack of resources and information as well as the ignorance and weak engagement of different institutions made them feel left alone and misunderstood with their "problem child". Altogether we found that regardless of regional lack of resources a collaboration between different institutions and the improved standard of information showed positive effects. To name are a number of meetings held and papers presented in medical journals over the last years as well the acceptance in the treatment with a psychopharmacological drug of this syndrome

Behavioral and neurocognitive effects of judo training on working memory capacity in children with ADHD: A randomized controlled trial

Children with Attention Deficit Hyperactivity Disorder (ADHD) face deficits in working memory capacity that often persist into adulthood. In healthy peers, exercise targeting motor skill acquisition benefits visuospatial working memory, but its potential to reduce ADHD-related deficits remains unclear. We investigated the effect of a judo training program targeting motor skills on behavioral and neurocognitive indices of working memory capacity in children with ADHD.; Children with ADHD aged 8 to 12 years (N = 57) were randomly allocated to a judo training group and a wait-list control group. The training program encompassed 120 min of judo per week over three months. Before and after the intervention period, participants completed a bilateral Change Detection task with low and high memory load conditions and the Movement Assessment Battery for Children-2 (MABC-2). The contralateral delay activity (CDA) elicited by the cognitive task was recorded using electroencephalography.; Compared to the control group, the judo training group showed a higher K-score on the Change Detection task and an increased negativity of the CDA on the high load condition following the intervention, when pretest scores (and confounders) were accounted for. In contrast, no group differences were found for MABC-2 score.; In children with ADHD, judo training may complement the pharmacological treatment by increasing the effectiveness of working memory maintenance processes. On a behavioral level, this improvement is accompanied with an increased capacity to store visuospatial information

Martial Arts and Cognitive Control in Children with Attention-Deficit Hyperactivity Disorder and Children Born Very Preterm: A Combined Analysis of Two Randomized Controlled Trials

Ludyga S, Hanke M, Leuenberger R, et al. Martial Arts and Cognitive Control in Children with Attention-Deficit Hyperactivity Disorder and Children Born Very Preterm: A Combined Analysis of Two Randomized Controlled Trials. Medicine & Science in Sports & Exercise . 2023;55(5):777-786.IntroductionVery preterm birth and attention-deficit hyperactivity disorder (ADHD) are associated with impairments in response inhibition that often persist beyond childhood. Athletes skilled in martial arts show a neurocognitive profile that is associated with an improved inhibition processing stream, suggesting that engagement in this kind of sport has the potential to reduce impairments in this cognitive function. We investigated the behavioral and neurocognitive effects of judo training on response inhibition in children born very preterm and children with ADHD by a combined analysis of two randomized controlled trials.MethodsIn both the CHIPMANC (n = 65) and JETPAC (n = 63) studies, participants were randomly allocated to a waitlist or a 12-wk judo training program in a 1:1 ratio. At pretest and posttest, participants completed a Go/NoGo task, the Movement Assessment Battery for Children-2 and a physical work capacity test on a bicycle ergometer. During the cognitive task, event-related potentials (N2, P3a, P3b) were recorded via electroencephalography.ResultsThe effects of the judo training were moderated by the study group. In contrast to children with ADHD (JETPAC), judo training reduced the commission error rate on the Go/NoGo task and increased the P3a amplitude in children born very preterm (CHIPMANC). No treatment effects were found for N2, P3b and physical fitness outcomes.ConclusionsThe neurodevelopmental condition influences the cognitive benefits of judo training. Whereas judo may be ineffective in children with ADHD, children born very preterm can expect improved response inhibition due to a more effective engagement of focal attention to resolve the task-related response conflict

Long-term Effects of Multimodal Treatment on Adult Attention-Deficit/Hyperactivity Disorder Symptoms Follow-up Analysis of the COMPAS Trial

IMPORTANCE Knowledge about the long-term effects of multimodal treatment in adult attention-deficit/hyperactivity disorder (ADHD) is much needed. OBJECTIVE To evaluate the long-term efficacy of multimodal treatment for adult ADHD. DESIGN, SETTING, AND PARTICIPANTS This observer-masked, 1.5-year follow-up of the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS), a prospective, multicenter randomized clinical trial, compared cognitive behavioral group psychotherapy (GPT) with individual clinical management (CM) and methylphenidate (MPH) with placebo (2 x 2 factorial design). Recruitment started January 2007 and ended August 2010, and treatments were finalized in August 2011 with follow-up through March 2013. Overall, 433 adults with ADHD participated in the trial, and 256 (59.1%) participated in the follow-up assessment. Analysis began in November 2013 and was completed in February 2018. INTERVENTIONS After 1-year treatment with GPT or CM and MPH or placebo, no further treatment restrictions were imposed. MAIN OUTCOMES AND MEASURES The primary outcome was change in the observer-masked ADHD Index of Conners Adult ADHD Rating Scale score from baseline to follow-up. Secondary outcomes included further ADHD rating scale scores, observer-masked ratings of the Clinical Global Impression scale, and self-ratings of depression on the Beck Depression Inventory. RESULTS At follow-up, 256 of 433 randomized patients (baseline measured in 419 individuals) participated. Of the 256 patients participating in follow-up, the observer-masked ADHD Index of Conners Adult ADHD Rating Scale score was assessed for 251; the mean (SD) baseline age was 36.3 (10.1) years; 125 patients (49.8%) were men; and the sample was well-balanced with respect to prior randomization (GPT and MPH: 64 of 107; GPT and placebo: 67 of 109; CM and MPH: 70 of 110; and CM and placebo: 55 of 107). At baseline, the all-group mean ADHD Index of Conners Adult ADHD Rating Scale score was 20.6, which improved to adjusted means of 14.2 for the GPT arm and 14.7 for the CM arm at follow-up with no significant difference between groups (difference, -0.5; 95% CI, -1.9 to 0.9; P=.48). The adjusted mean decreased to 13.8 for the MPH arm and 15.2 for the placebo arm (difference, -1.4; 95% CI, -2.8 to -0.1; P=.04). As in the core study, MPH was associated with a larger reduction in symptoms than placebo at follow-up. These results remained unchanged when accounting for MPH intake at follow-up. Compared with participants in the CM arm, patients who participated in group psychotherapy were associated with less severe symptoms as measured by the self-reported ADHD Symptoms Total Score according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) of Conners Adult ADHD Rating Scale (AMD, -2.1; 95% CI, -4.2 to -0.1; P=.04) and in the subscale of reducing pure hyperactive symptoms, measured via the Diagnostic Checklist for the diagnosis of ADHD in adults (AMD, -1.3; 95% CI, -2.8 to 0.1; P=.08). Regarding the Clinical Global Impression scale assessment of effectiveness, the difference between GPT and CM remained significant at follow-up (odds ratio, 1.63; 95% CI, 1.03-2.59; P=.04). No differences were found for any comparison concerning depression as measured with the Beck Depression Inventory. CONCLUSIONS AND RELEVANCE Results from COMPAS demonstrate a maintained improvement in ADHD symptoms for adults 1.5 years after the end of a 52-week controlled multimodal treatment period. The results indicate that MPH treatment combined with GPT or CM provides a benefit lasting 1.5 years. Confirming the results of the core study, GPT was not associated with better results regarding the primary outcome compared with CM. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN5409620