Objective To assess atomoxetine and methylphenidate therapy for attention- deficit/ hyperactivity disorder (ADHD) .Methods We electronically searched the Cochrane Library (Issue 2, 2008), PubMed (1970 to 2008), MEDLINE (1971 to 2008), EMbase (1971 to 2008), Medscape (1990 to 2008), CBM (1978 to 2008), and NRR (1950 to 2008). We also hand-searched some published and unpublished references. Two independent reviewers extracted data. Quality was assessed by the Cochrane Reviewer’s Handbook 4.0. Meta-analysis was conducted by The Cochrane Collaboration’s RevMan 4.2.8 software. Results We finally identified 3 randomized controlled trials that were relevant to the study. Treatment response (reducing ADHD-RS Inattention subscale score) was significantly greater for patients in the methylphenidate group than in the atomoxetine group with WMD= – 1.79 and 95%CI – 2.22 to 1.35 (Plt;0.000 01). There was no statistical difference in other outcome measures between two groups (Pgt;0.05). Conclusions The effectiveness and tolerance of methylphenidate and atomoxetine are similar in treatment of ADHD. Further large randomized, double blind, placebocontrolled trials with end-point outcome measures in long-term safety and efficacy are needed.
ObjectiveTo observe the effect of sensory integration training combined with methylphenidate hydrochloride on attention deficit hyperactivity disorder (ADHD). MethodsThe clinical data of 96 patients with ADHD diagnosed between January 2009 and March 2013 were retrospectively analyzed. The patients were divided into two groups by the table of random number. The trail group (n=48) received the combination therapy of sensory integration training combined with methylphenidate hydrochloride; while the control group (n=48) only received the medication of methylphenidate hydrochloride. The scores of sensory integration ability rating scale, integrated visual and auditory continuous performance test (IVA-CPT), Conner's behavior rating scale, Chinese Wechsler Intelligence Scale for Children (C-WISC) and adverse reactions were observed and compared between the two groups. ResultsThe scores of the sensory integration ability rating scale, FRCQ, FAQ (IVA-CPT), PIQ, VIQ, FIQ, C factor (C-WISC) in both of the two groups were significantly higher after the therapy; while the scores of the study, behavior, somatopsychic disturbance, impulsion, hyperactivity index and anxiety factor significantly decreased after the treatment (P<0.05). Compared with the control group, the trial group's scores of sensory integration ability rating scale, IVA-CPT, Conner's behavior rating scale, C-WISC were improved obviously, and the adverse reactions were significantly less (P<0.05). ConclusionThe sensory integration training combined with methylphenidate hydrochloride is sage and effective on children with attention deficit hyperactivity disorder.
This study aims to explore the differences of event related potential (ERP) between attention deficit hyperactivity disorder (ADHD) and normal children, so that these differences provide scientific basis for the diagnosis of ADHD. Eight children were identified to be ADHD group by the diagnostic criteria of DSM IV (diagnostic and statistical manual of mental disorders IV), and the control group also consisted of 8 normal children. Modified visual continuous performance test (CPT) was used as the experiment paradigm. The experiment included two major conditions, i.e. Go and NoGo. All the 16 subjects participated in the study. A high density EEG acquisition instrument was used to record the EEG signal and processed these EEG data by means of ERP and spectrum analysis. P2 N2 peak peak value and spectral peak around 11 Hz were analyzed between ADHD subjects and those in the control group, and then statistical tests were applied to these two groups. Results showed that: ① Under the condition of Go, ADHD group had a significant lower P2 N2 peak peak value than the values in the control group ( P< 0.05); but under the condition of NoGo there was no significant difference in between. ② Compared with the control group, the ADHD group had significant lower spectral amplitude around 11 Hz under the condition of NoGo ( P< 0.05). However, under the condition of Go the difference was insignificant. In conclusion, there is certain cognitive dysfunction in ADHD children. P2-N2 peak-peak value and spectral peak around 11 Hz could be considered as clinical evaluation indexes of ADHD children′s cognitive function. These two objective indexes provide an early diagnosis and effective treatment of ADHD .
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neuro-developmental disorders occurring in childhood, characterized by symptoms of age-inappropriate inattention, hyperactivity/impulsivity, and the prevalence is higher in boys. Although gray matter volume deficits have been frequently reported for ADHD children via structural magnetic resonance imaging, few of them had specifically focused on male patients. The present study aimed to explore the alterations of gray matter volumes in medicated-naive boys with ADHD via a relatively new voxel-based morphometry technique. According to the criteria of DSM-IV-TR, 43 medicated-naive ADHD boys and 44 age-matched healthy boys were recruited. The magnetic resonance image (MRI) scan was performed via a 3T MRI system with three-dimensional (3D) spoiled gradient recalled echo (SPGR) sequence. Voxel-based morphometry with diffeomorphic anatomical registration through exponentiated lie algebra in SPM8 was used to preprocess the 3D T1-weighted images. To identify gray matter volume differences between the ADHD and the controls, voxel-based analysis of whole brain gray matter volumes between two groups were done via two sample t-test in SPM8 with age as covariate, threshold at P＜0.001. Finally, compared to the controls, significantly reduced gray matter volumes were identified in the right orbitofrontal cortex (peak coordinates [-2,52,-25], t=4.01), and bilateral hippocampus (Left: peak coordinates [14,0,-18], t=3.61; Right: peak coordinates [-14,15,-28], t=3.64) of ADHD boys. Our results demonstrated obvious reduction of whole brain gray matter volumes in right orbitofrontal cortex and bilateral hippocampus in boys with ADHD. This suggests that the abnormalities of prefrontal-hippocam-pus circuit may be the underlying cause of the cognitive dysfunction and abnormal behavioral inhibition in medicated-naive boys with ADHD.
ObjectiveTo systematically review the methodological quality of guidelines concerning attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsGuidelines concerning ADHD were electronically retrieved in PubMed, EMbase, VIP, WanFang Data, CNKI, NGC (National Guideline Clearinghouse), GIN (Guidelines International Network), NICE (National Institute for Health and Clinical Excellence) from inception to December 2013. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 guidelines concerning ADHD in children and adolescents were included, with development time ranging from 2004 to 2012. Among 9 guidelines, 4 were made by the USA, 3 in Europe and 2 by UK. The levels of recommendations were Level A for 2 guidelines, and Level B for 7 guidelines. The scores of guidelines according to the domains of AGREE Ⅱ decreased from "clarity of presentations", "scope and purpose", "participants", "applicability", "rigour of development" and "editorial independence". Three evidence-based guidelines scored the top three in the domain of "rigour of development". There were slightly differences in the recommendations of different guidelines. ConclusionThe overall methodological quality of ADHD guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE Ⅱ vary with scores, while the scores of evidence-base guidelines are higher than those of non-evidence-based guidelines. The guidelines on ADHD in children and adolescents should be improved in "rigour of development" and "applicability" in future. Conflicts of interest should be addressed. And the guidelines are recommended to be developed on the basis of methods of evidence-based medicine, and best evidence is recommended.
Attention deficit/hyperactivity disorder (ADHD) is a behavioral disorder syndrome found mainly in school-age population. At present, the diagnosis of ADHD mainly depends on the subjective methods, leading to the high rate of misdiagnosis and missed-diagnosis. To solve these problems, we proposed an algorithm for classifying ADHD objectively based on convolutional neural network. At first, preprocessing steps, including skull stripping, Gaussian kernel smoothing, et al., were applied to brain magnetic resonance imaging (MRI). Then, coarse segmentation was used for selecting the right caudate nucleus, left precuneus, and left superior frontal gyrus region. Finally, a 3 level convolutional neural network was used for classification. Experimental results showed that the proposed algorithm was capable of classifying ADHD and normal groups effectively, the classification accuracies obtained by the right caudate nucleus and the left precuneus brain regions were greater than the highest classification accuracy (62.52%) in the ADHD-200 competition, and among 3 brain regions in ADHD and the normal groups, the classification accuracy from the right caudate nucleus was the highest. It is well concluded that the method for classification of ADHD and normal groups proposed in this paper utilizing the coarse segmentation and deep learning is a useful method for the purpose. The classification accuracy of the proposed method is high, and the calculation is simple. And the method is able to extract the unobvious image features better, and can overcome the shortcomings of traditional methods of MRI brain area segmentation, which are time-consuming and highly complicate. The method provides an objective diagnosis approach for ADHD.
A great number of studies have demonstrated functional abnormalities in children with attention-deficit/hyperactivity disorder (ADHD), although conflicting results have also been reported. And few studies analyzed homotopic functional connectivity between hemispheres. In this study, resting-state functional magnetic resonance imaging (MRI) data were recorded from 45 medication-naïve ADHD children and 26 healthy controls. The regional homogeneity (ReHo), degree centrality (DC) and voxel-mirrored homotopic connectivity (VMHC) values were compared between the two groups to depict the intrinsic brain activities. We found that ADHD children exhibited significantly lower ReHo and DC values in the right middle frontal gyrus and the two values correlated with each other; moreover, lower VMHC values were found in the bilateral occipital lobes of ADHD children, which was negatively related with anxiety scores of Conners' Parent Rating Scale (CPRS-R) and positively related with completed categories of Wisconsin Card Sorting Test (WCST). Our results might suggest that less spontaneous neuronal activities of the right middle frontal gyrus and the bilateral occipital lobes in ADHD children.