1. Possible association between attention deficit hyperactivity disorder and attempted suicide in adolescents - A pilot study.

Manor I, Gutnik I, Ben-Dor DH, Apter A, Sever J, Tyano S, Weizman A, Zalsman G.
Geha Mental Health Center, Department of Psychiatry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eur Psychiatry. 2009 Aug 19.

OBJECTIVE: Both adolescent suicide and attention deficit hyperactivity disorder (ADHD) are troubling phenomena with high comorbidity, including impulsivity, depression and personality disorders (PD). Studies on the association between these two phenomena are relatively rare. This pilot study's aim was to estimate the rate of ADHD in adolescents attempting suicide.
METHOD: Subjects constituted consecutive admissions to the psychiatric emergency room (ER) who were admitted as a result of attempting suicide. Assessment included the use of the Kiddie-SADS, Strengths and Difficulties Questionnaire (SDQ) and the Conners' Rating Scale (CRS). Those diagnosed as suffering from ADHD were assessed by a standardized Continuous Performance Test (Test of Variables of Attention [TOVA]) that included methylphenidate (MPH) challenge. Twenty-three (23) adolescents completed the study. M:F ratio was 5:18, respectively.
RESULTS: Of the 23 participants who completed the study, 65% were diagnosed with ADHD, 43.5% with depression and 39% with clusterB PD. ADD/ADHD ratio was 66%:34%. Only five of the patients were formerly diagnosed as ADHD, only three had been medicated and 14 out of 15 adolescents responded well to MPH challenge.
CONCLUSION: These preliminary results suggest a significant association between ADHD and suicidal behavior in adolescents. Further study is needed to establish this association and assess the causality.

2. Do sluggish cognitive tempo symptoms predict response to methylphenidate in patients with attention-deficit/hyperactivity disorder-inattentive type?

Ludwig HT, Matte B, Katz B, Rohde LA.
ADHD Outpatient Program, Division of Child Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil .
J Child Adolesc Psychopharmacol. 2009 Aug;19(4):461-5.

In this naturalistic study, we assessed the effect of sluggish cognitive tempo (SCT) symptoms in the response to methylphenidate (MPH) in 88 children and adolescents with attention-deficit/hyperactivity disorder-Inattentive Type (ADHD-I) according to Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV) criteria. SCT symptoms were assessed in these subjects by means of the Child Behavior Checklist (CBCL) scale. The response to MPH after 1 month of treatment was assessed by parental scores in the Swanson, Nolan, and Pelham Questionnaire-Version IV (SNAP-IV) scale. No significant differences were found between subjects with and without SCT symptoms in the response to MPH either assessing presence of SCT symptoms categorically (at least 1 symptom) or dimensionally (p < 0.5 for both analyses; effect size [ES] = 0.24). Our findings corroborate previous phenotypic data suggesting that SCT symptoms do not define a clinically relevant type of ADHD-I.

3. Randomized, placebo-controlled, crossover study of methylphenidate for attention-deficit/hyperactivity disorder symptoms in preschoolers with developmental disorders.

Ghuman JK, Aman MG, Lecavalier L, Riddle MA, Gelenberg A, Wright R, Rice S, Ghuman HS, Fort C.
University of Arizona , Child and Adolescent Psychiatry, Tucson, Arizona 85724-5002, USA.
J Child Adolesc Psychopharmacol. 2009 Aug;19(4):329-39.

OBJECTIVE: The aim of this study was to investigate the short-term efficacy and safety of methylphenidate (MPH) to treat attention-deficit/hyperactivity disorder (ADHD) symptoms in an understudied population of preschoolers with pervasive developmental disorder (PDD) or intellectual disability (ID).
METHODS: Fourteen preschoolers with developmental disorders (DD, n = 14; PDD, n = 12; ID, n = 2) underwent MPH titration in a single-blind manner followed by a 4-week double-blind crossover phase. Each child was administered placebo for 2 weeks and "optimal dose" for 2 weeks. The primary outcome measure was the Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV) ADHD subscale of the Conners' Parent Rating Scale-Revised (CPRS-R-DSM-IV-ADHD).
RESULTS: MPH improved parent-rated ADHD symptoms of the preschoolers; 50% were rated as responders. The CPRS-R-DSM-IV-ADHD subscale was significant for the PDD subgroup (p = 0.005, Cohen d = 0.97) and marginally significant for the entire DD sample (p = 0.08, Cohen d = 0.50). Half of the preschoolers experienced side effects with MPH, including reports of increased stereotypic behavior, upset stomach, sleep-related difficulties, and emotional lability. One child discontinued during titration due to side effects.
CONCLUSION: The predominant direction of response in these preschoolers with both ADHD and PDD/ID favored MPH, even though the response was more subtle and variable than in older and typically developing children. Due to high rates of adverse effects, preschoolers should be monitored closely.

4. Development of Cortical Asymmetry in Typically Developing Children and Its Disruption in Attention-Deficit/Hyperactivity Disorder
Shaw P, Lalonde F, Lepage C, et al
Arch Gen Psychiatry. 2009;66:888-896
During normal development of the human brain, anatomic asymmetries become apparent that appear to be associated with normal lateralization of motor and cognitive functions. Although disruption of these asymmetries may underlie the pathogenesis of attention-deficit/hyperactivity disorder (ADHD) and other neurodevelopmental disorders, no previous study has used longitudinal neuroanatomic data to evaluate the development of cortical asymmetry.
The goal of this longitudinal study was to assess the development of cortical asymmetry in children with and without ADHD. At the Government Clinical Research Institute, 1133 prospectively acquired neuroanatomic magnetic resonance images (MRIs) were compared for 218 children with ADHD and 358 children with typical development.
In right-handed children with typical development, there was a mean increase with age in the relative thickness of the right orbitofrontal and inferior frontal cortex of 0.011 ± 0.0018 mm per year (P < .001), coupled with a relative left-hemispheric increase in the occipital cortical regions of 0.013 ± 0.0015 mm per year (P < .001). In non-right-handed children with typical development, age-related change in asymmetry was less extensive and was localized to different cortical regions. The prefrontal component of normally evolving asymmetry was lost in children with ADHD, but the posterior component was preserved.
Viewpoint
Study limitations include small sample size for non-right-handed individuals with ADHD, inability to determine longitudinal effects of medication status, and possible MRI artifacts occurring where the falx curves, as in the occipital pole.
Notwithstanding these limitations, this longitudinal study with neuroanatomic imaging amply illustrates how in typical development, the increased dimensions of the right frontal and left occipital cortical regions emerge in adulthood from the reversed pattern of childhood cortical asymmetries. In ADHD, loss of the prefrontal component of this evolving asymmetry may reflect the observed disruption of prefrontal function. Further study of development of cortical asymmetries, or of disruption of this process, may help to elucidate the pathophysiology of other neurodevelopmental disorders.

5. Attention Deficit Hyperactivity Disorder (ADHD) and road traffic - special considerations for the treatment of adolescents with ADHD

Ludolph AG, Kölch M, Plener PL, Schulze UM, Spröber N, Fegert JM.
Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm.

Z Kinder Jugendpsychiatr Psychother. 2009 Jul;37(4):405-11.

Attention Deficit Hyperactivity Disorder (ADHD) is not only a childhood disorder but symptoms persist into adolescence and adulthood in approximately one third of the patients. Especially inattention and poor concentration impair driving performance in road traffic. Adolescents and young adults with ADHD are twice as likely to be involved in traffic accidents as people of the same age. This review sums up the legal situation in Germany and provides an overview of the current existing experimental studies on driving performance of adolescents and young adults with ADHD. Psychostimulant therapy seems to improve driving performance in ADHD patients. At the same time psychostimulants are prohibited, according to the road traffic act. Atomoxetine as a non-stimulant is not mentioned there. Therefore it could be unproblematically prescribed, however, the evidence for improved driving is not as unequivocal as for methylphenidate. The psychoeducation of adolescents and young adults with ADHD concerning their increased risk in road traffic often seems to be insufficient in clinical practice. Given the high number of traffic deaths in these young age groups consulting regarding this matter should be of high priority.