attention deficit disorder with hyperactivity

ADHD Diagnosis and Treatment in Children and Adolescents

Alex Haga — Fri, 05 Apr 2024 00:54:05 +0000

Date Added:

April 4, 2024

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

March 1, 2024

URL:

ADHD Diagnosis and Treatment in Children and Adolescents

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.23970/AHRQEPCCER267

An evidence-based summary of what we currently know about the diagnosis and treatment of children with ADHD. James W. Mold, MD, MPH

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Objective. The systematic review assessed evidence on the diagnosis, treatment, and monitoring of attention deficit hyperactivity disorder (ADHD) in children and adolescents to inform a planned update of the American Academy of Pediatrics (AAP) guidelines.

Data sources. We searched PubMed®, Embase®, PsycINFO®, ERIC, clinicaltrials.gov, and prior reviews for primary studies published since 1980. The report includes studies published to June 15, 2023.

Review methods. The review followed a detailed protocol and was supported by a Technical Expert Panel. Citation screening was facilitated by machine learning; two independent reviewers screened full text citations for eligibility. We abstracted data using software designed for systematic reviews. Risk of bias assessments focused on key sources of bias for diagnostic and intervention studies. We conducted strength of evidence (SoE) and applicability assessments for key outcomes. The protocol for the review has been registered in PROSPERO (CRD42022312656).

Results. Searches identified 23,139 citations, and 7,534 were obtained as full text. We included 550 studies reported in 1,097 publications (231 studies addressed diagnosis, 312 studies addressed treatment, and 10 studies addressed monitoring). Diagnostic studies reported on the diagnostic performance of numerous parental ratings, teacher rating scales, teen/child self-reports, clinician tools, neuropsychological tests, EEG approaches, imaging, and biomarkers. Multiple approaches showed promising diagnostic performance (e.g., using parental rating scales), although estimates of performance varied considerably across studies and the SoE was generally low. Few studies reported estimates for children under the age of 7. Treatment studies evaluated combined pharmacological and behavior approaches, medication approved by the Food and Drug Administration, other pharmacologic treatment, psychological/behavioral approaches, cognitive training, neurofeedback, neurostimulation, physical exercise, nutrition and supplements, integrative medicine, parent support, school interventions, and provider or model-of-care interventions. Medication treatment was associated with improved broadband scale scores and ADHD symptoms (high SoE) as well as function (moderate SoE), but also appetite suppression and adverse events (high SoE). Psychosocial interventions also showed improvement in ADHD symptoms based on moderate SoE. Few studies have evaluated combinations of pharmacological and youth-directed psychosocial interventions, and we did not find combinations that were systematically superior to monotherapy (low SoE). Published monitoring approaches for ADHD were limited and the SoE is insufficient.

Conclusion. Many diagnostic tools are available to aid the diagnosis of ADHD, but few monitoring strategies have been studied. Medication therapies remain important treatment options, although with a risk of side effects, as the evidence base for psychosocial therapies strengthens and other nondrug treatment approaches emerge.

Author/s:

Peterson, BS, Trampush, J, Maglione, M, Bolshakova, M, Brown, M., Rozelle, M

ADHD Pharmacotherapy and Mortality in Individuals With ADHD

Erin Blanchette — Tue, 26 Mar 2024 16:21:44 +0000

Date Added:

March 26, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 12, 2024

Issue:

Volume:

331

Pages:

850-860

URL:

ADHD Pharmacotherapy and Mortality in Individuals With ADHD

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2024.0851

Keywords

ADHD

ADHD treatment

Death

central nervous system stimulants

PMID (1):

38470385

MeSH

attention deficit disorder with hyperactivity

Attention Deficit Disorder with Hyperactivity* / mortality

Attention Deficit Disorder with Hyperactivity* / drug therapy

Central Nervous System Stimulants* / therapeutic use

Central Nervous System Stimulants

Mortality

Premature

This cohort study suggests that pharmacological treatment of a patients with ADHD increases their life expectancy by reducing unnatural deaths (suicides, homicides, MVAs, etc.). James W. Mold, MD, MPH

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Importance: Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death, but it is unclear whether ADHD pharmacotherapy influences the mortality risk.

Objective: To investigate whether initiation of ADHD pharmacotherapy was associated with reduced mortality risk in individuals with ADHD.

Design, setting, and participants: In an observational nationwide cohort study in Sweden applying the target trial emulation framework, we identified individuals aged 6 through 64 years with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first.

Exposures: ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis.

Main outcomes and measures: We assessed all-cause mortality within 2 years of ADHD diagnosis, as well as natural-cause (eg, physical conditions) and unnatural-cause mortality (eg, unintentional injuries, suicide, and accidental poisonings).

Results: Of 148 578 individuals with ADHD (61 356 females [41.3%]), 84 204 (56.7%) initiated ADHD medication. The median age at diagnosis was 17.4 years (IQR, 11.6-29.1 years). The 2-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10 000 individuals) than in the noninitiation treatment strategy group (48.1 per 10 000 individuals), with a risk difference of -8.9 per 10 000 individuals (95% CI, -17.3 to -0.6). ADHD medication initiation was associated with significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (2-year mortality risk, 25.9 per 10 000 individuals vs 33.3 per 10 000 individuals; risk difference, -7.4 per 10 000 individuals; 95% CI, -14.2 to -0.5; HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (2-year mortality risk, 13.1 per 10 000 individuals vs 14.7 per 10 000 individuals; risk difference, -1.6 per 10 000 individuals; 95% CI, -6.4 to 3.2; HR, 0.86; 95% CI, 0.71 to 1.05).

Conclusions and relevance: Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.

Author/s:

Lin Li, Nanbo Zhu, Le Zhang, Ralf Kuja-Halkola, Brian M D'Onofrio, Isabell Brikell, Paul Lichtenstein, Samuele Cortese, Henrik Larsson, Zheng Chang

More than 50 long‑term effects of COVID‑19: a systematic review and meta‑analysis

Saige Blanchard — Fri, 13 Aug 2021 18:17:11 +0000

Date Added:

August 13, 2021

Journal/Publication:

Nature Portfolio

Publisher:

Springer Nature

URL:

More than 50 long‑term effects of COVID‑19: a systematic review and meta‑analysis

Keywords

MeSH

attention deficit disorder with hyperactivity

COVID-19

headache

Publications

The SARS-2 COVID-19 virus is a nasty little germ. It seems to cause a host of long-lasting symptoms. James W. Mold, MD, MPH

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COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to
months after initial recovery. This systematic review and meta-analysis aims to identify studies
assessing the long-term efects of COVID-19. LitCOVID and Embase were searched to identify articles
with original data published before the 1st of January 2021, with a minimum of 100 patients. For
efects reported in two or more studies, meta-analyses using a random-efects model were performed
using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were
followed. A total of 18,251 publications were identifed, of which 15 met the inclusion criteria. The
prevalence of 55 long-term efects was estimated, 21 meta-analyses were performed, and 47,910
patients were included (age 17–87 years). The included studies defned long-COVID as ranging from 14
to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2
developed one or more long-term symptoms. The fve most common symptoms were fatigue (58%),
headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary
teams are crucial to developing preventive measures, rehabilitation techniques, and clinical
management strategies with whole-patient perspectives designed to address long COVID-19 care.

Author/s:

S., Wegman-Ostrosky, T., Perelman, C., Sepulveda, R., Rebolledo, P. A., Cuapio, A., Villapol, S.

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials

John Bayhi — Fri, 13 Sep 2019 17:29:29 +0000

Date Added:

September 13, 2019

Journal/Publication:

World Psychiatry

Publisher:

World Psychiatric Association

Publication Date:

October 1, 2019

Issue:

Volume:

Pages:

308-324

URL:

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/wps.20672

Keywords

depression

dietary supplements

mineral supplements

attention deficit disorder with hyperactivity

omega-3 fatty acids

PMID (1):

31496103

MeSH

depressive disorder, major

depression

attention deficit disorder with hyperactivity

mood disorders

mental health

folic acid

eicosapentaenoic acid

fatty acids

unsaturated

Several nutritional supplements appear to be helpful in the treatment of some mental health problems. The strongest evidence was found for eicosapentaenoic acid (an omega 3 fatty acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention‐deficit/hyperactivity disorder. High‐dose methylfolate appears to be helpful as an adjunct to antidepressants and counseling in major depressive disorder. There was emergent evidence for N‐acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. James W. Mold, MD, MPH

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The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from "nutrient supplements", such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta-review of this top-tier evidence, we identified, synthesized and appraised all meta-analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high-dose methylfolate in major depressive disorder. There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.

Author/s:

Firth, J, Teasdale, SB, Allott, K, Siskind, D, Marx, W, Cotter, J, Veronese, N, Schuch, F, Smith, L, Solmi, M, Carvalho, AF, Vancampfort, D, Berk, M, Stubbs, B, Sarris, J

Treatment of Adult ADHD: A Clinical Perspective

Jeffrey Wilson — Sun, 24 Feb 2019 19:28:31 +0000

Date Added:

February 24, 2019

Journal/Publication:

Therapeutic Advances in Psychopharmacology

Publisher:

Sage

Publication Date:

January 1, 2018

Issue:

Volume:

Pages:

25-32

URL:

Treatment of Adult ADHD: A Clinical Perspective

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1177/2045125317734977

Keywords

ADD

ADHD

attention deficit disorder with hyperactivity

PMID (1):

29344341

MeSH

attention deficit disorder with hyperactivity

anxiety

This is a nice review of the treatment options for adults with ADHD.

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Adult attention deficit/hyperactivity disorder (ADHD) has moved from the blurred edge of clinical focus to clear recognition as a prevalent and significant disorder in its own right. It is a relatively common comorbidity which if identified and treated may open the door to better outcomes for hard-to-treat patients. Conversely, failure to identify and treat adult ADHD is linked to negative outcomes. The recognition of the importance of adult ADHD in a subset of our patients challenges us to overcome our anxiety about this diagnosis and prevent the societal marginalization of vulnerable patients. Adult ADHD responds well to integrated pharmacological and psychotherapeutic intervention. Its treatment responsiveness reduces disability and allows the comorbidity which is typically present to be addressed. Mastering this challenge can make the diagnosis and treatment of adult ADHD a rewarding experience.

Author/s:

Geffen, Josh, Forster, Kieran

Antipsychotics for Children with Hyperactivity or Disruptive Disorders

Tracy Ashby — Wed, 23 Jan 2019 06:00:00 +0000

Date Added:

January 23, 2019

Journal/Publication:

PCORI

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

March 1, 2018

URL:

Antipsychotics for Children with Hyperactivity or Disruptive Disorders

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

attention deficit disorder with hyperactivity

problem behavior

child

The adverse effects of antipsychotics in children with behavioral disorders including ADHD often outweigh the modest benefits.

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New evidence can help clinicians, caretakers, and others weigh the benefits and harms of antipsychotic treatment for children and adolescents.

The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5

Jeffrey Wilson — Thu, 23 Aug 2018 18:01:22 +0000

Date Added:

August 23, 2018

Journal/Publication:

JAMA Psychiatry

Publisher:

American Medical Association

Publication Date:

May 1, 2017

Issue:

Volume:

Pages:

520-526

URL:

The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapsychiatry.2017.0298.

Keywords

ADHD

DSM

Self report

PMID (1):

28384801

MeSH

self report

diagnostic and statistical manual of mental disorders

attention deficit disorder with hyperactivity

The article reports the high sensitivity, specificity, and positive predictive value of a new 6-item self-administered screening test for adult ADHD.

The actual test and scoring rules can be found here. If you use an unweighted scoring method, it’s free. If you want to use the weighted scoring method, you have to get permission and probably pay something.

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IMPORTANCE:

Recognition that adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria.

OBJECTIVES:

To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization AdultADHD Self-Report Scale (ASRS) for screening.

DESIGN, SETTING, AND PARTICIPANTS:

Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016.

MAIN OUTCOMES AND MEASURES:

The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS.

RESULTS:

Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5/Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%).

CONCLUSIONS AND RELEVANCE:

The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.

Author/s:

Ustun, Berk, Adler, Lenard A., Rudin, Cynthia, Faraone, Stephen V., Spencer, Thomas J., Berglund, Patricia, Gruber, Michael J., Kessler, Ronald C.