Association of Brain White Matter Structure With Autism Spectrum Disorder and ADHD

MedicalResearch.com Interview with:

Dr. Adriana Di Martino, MD Associate Professor, Department of Child and Adolescent Psychiatry NYU Langone Health

Dr. Di Martino

Dr. Adriana Di Martino, MD
Associate Professor, Department of Child and Adolescent Psychiatry
NYU Langone Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While there has been an increased awareness of the co-occurrence of symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children with a primary diagnosis of ASD, only recently has there been an appreciation that a substantial proportion of children with ADHD may also have ASD traits. These symptom domains overlap pose a challenge for accurate recognition and targeted treatments, yet their underlying mechanisms have been unknown.

With more traditional diagnostic group comparisons we detected a significant influence of ASD on white matter organization, but our analyses of the severity of symptoms across individuals revealed an association between autistic traits and white matter organization, regardless of the individual’s diagnosis. These findings were mostly centered around the corpus callosum, a structure that enables communication between the left and right cerebral hemispheres.

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Risk of Suicide Attempts With Methylphenidate Treatment for ADHD

MedicalResearch.com Interview with:
Professor Ian Chi Kei Wong and
Kenneth KC Man, Senior Research Assistant
Department of Social Work and Social Administration, Faculty of Social Science
Department of Pharmacology and Pharmacy, LKS Faculty of Medicine
The University of Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Patients with attention-deficit/hyperactivity disorder (ADHD) are at higher risk of various mental health problems. Previous studies suggested that individuals with ADHD are having a higher chance of both attempted and completed suicide. Methylphenidate is a psychostimulant that is recommended for the treatment of ADHD. With the increasing usage of methylphenidate over the past decade, there are concerns about the safety of the medication, in particular, psychiatric adverse effects such as suicide attempt.

The current study looked into over 25,000 patients aged 6 to 25 years in Hong Kong who were receiving methylphenidate in 2001 to 2015. Using the self-controlled case series design, in which the patients act as their own control, we found that the risk of suicide attempt was 6.5 fold higher during a 90-day period before methylphenidate was initiated, remained elevated 4-fold during the first 90 days of treatment, and returned to the normal level during ongoing treatment.

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ADHD Medications Reduce Risk of Motor Vehicle Crashes

MedicalResearch.com Interview with:
Zheng Chang PhD MSc
Department of Medical Epidemiology and Biostatistics (MEB)
Karolinska Institutet
Stockholm Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: About 1.25 million people worldwide die annually because of motor vehicle crashes (MVCs). ADHD is a prevalent neurodevelopmental disorder with symptoms that include poor sustained attention, impaired impulse control and hyperactivity. ADHD affects 5 percent to 7 percent of children and adolescent and for many people it persists into adulthood. Prior studies have suggested people with ADHD are more likely to experience MVCs. Pharmacotherapy is a first-line treatment for the condition and rates of ADHD medication prescribing have increased over the last decade in the United States and in other countries.

Among the more than 2.3 million patients with ADHD (average age 32.5), we found patients with ADHD had a higher risk of an MVC than a control group of people without ADHD. The use of medication in patients with ADHD was associated with reduced risk for motor vehicle crashes in both male and female patients.

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ADHD Less Common in Girls, But Has More Serious Consequences

MedicalResearch.com Interview with:

Professor Jill Pell MD Director of Institute (Institute of Health and Wellbeing) Associate (School of Medicine, Dentistry and Nursing) University of Glasgow

Prof. Pell

Professor Jill Pell MD
Director of Institute (Institute of Health and Wellbeing)
Associate (School of Medicine, Dentistry and Nursing)
University of Glasgow

MedicalResearch.com: What is the background for this study?

Response: The novelty of our study lies in its scale and scope. In terms of scope, it reported on six educational outcomes and three health outcomes in the same group of children.

In terms of scale, it is the first study of a whole country to compare educational outcomes of children with treated ADHD with their unaffected peers and is more than 20 times larger than previous studies on similar educational outcomes. The only previous countrywide study on health outcomes, included only children with very severe ADHD who were in psychiatric hospitals.

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Subtle Differences in Brain Volume Detected On MRI In ADHD

MedicalResearch.com Interview with:
M. (Martine) Hoogman PhD.

Postdoc and PI of ENIGMA-ADHD
Radboud universitair medisch centrum
Department of Human Genetics
Nijmegen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many neuro-imaging studies aimed at investigating structural brain changes related to ADHD, but the results are often inconclusive.

There are two main reasons for this:

1) the small sample size of the studies and
2) the heterogeneous methods used.

We tried to address these issues by forming an international collaboration to provide a sample size sufficient to detect even small effects in volume differences. And in addition, we analyzed all the raw scans again using homogenized methods. There are data of more than 1700 patients (aged 4-63 years of age) and more than 1500 healthy controls in our dataset, coming from 23 sites around the world. We studied the possible volume differences between cases and controls of 7 subcortical regions and intracranial volume by performing mega- and meta-analysis.

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More Medical Students May Have Non-Apparent Disabilities

MedicalResearch.com Interview with:  

Lisa Meeks , PhD
Director, Medical Student Disability
UCSF Medical Center

Lisa Meeks , PhD Director, Medical Student Disability UCSF Medical Center

Dr. Lisa Meeks

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was the first study to include students with AD/HD, learning, psychological, and chronic health conditions. This study found that the prevalence of students with disabilities is up to four times higher than previous studies indicated.

AD/HD, learning, and psychological disabilities were the most prevalent, suggesting that most students with disabilities in medicine have non-apparent disabilities. Within MD granting programs, the number of students self-reporting disability varied between 0% and 12%. Explanations for the high variability between programs are unknown, however, anecdotal reports suggest the degree to which programs have dedicated resources and inclusive practices for students with disabilities influence student disclosure.

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ADHD: Heritability of Structural and Functional Brain Connectivity in Families

MedicalResearch.com Interview with:

Gustavo Sudre, PhD Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch National Human Genome Research Institute Bethesda, Maryland

Dr. Gustavo Sudre

Gustavo Sudre, PhD
Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch
National Human Genome Research Institute
Bethesda, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ADHD is the most common childhood neuropsychiatric disorder, affecting 7-9% of school age children. It is highly heritable (h2=0.7), but few risk genes have been identified. In this study, we aimed to provide quantitative brain-based phenotypes to accelerate gene discovery and understanding.

ADHD is increasingly viewed as resulting from anomalies of the brain’s connectome. The connectome is comprised of the structural connectome (white matter tracts joining different brain regions) and the functional connectome (networks of synchronized functional activity supporting cognition). Here, we identified features of the connectome that are both heritable and associated with ADHD symptoms.

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Specific Genetic Mutations Present in Many Children With ADHD

MedicalResearch.com Interview with:
Dr. Josephine Elia, M.D.

Neuroscience Center
Department of Child and Adolescent Psychiatry
Nemours/Alfred I. DuPont Hospital for Children

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Glutamate neurotransmission may play an important role in ADHD and other neuropsychiatric disorders. The purpose of this study is to determine the frequency of genetic mutations involving specific genes (GRM network genes) which influence glutamatergic neurotransmission. A total of 23 study sites across the USA enrolled 1,013 children, aged 6-17 years who had been previously diagnosed with ADHD. Saliva samples were submitted to The Center for Applied Genomics (CAG) at CHOP for analysis of mutations of interest. Information on medical history, including other neuropsychiatric diagnoses and family history as well as areas of academic and social concern were also collected.

Overall, the mutation frequency was 22%, with a higher prevalence of 25% observed in patients aged 6-12. When compared to mutation negative ADHD patients, the patients with the mutations of interest were more likely to have concerns about anger control and disruptive behaviors.

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Treating ADHD Reduces Risk of Injuries, STDs and Substance Abuse

MedicalResearch.com Interview with:

Anna Chorniy PhD Postdoctoral Research Associate Center for Health and Wellbeing 321 Wallace Hall, Princeton University Princeton NJ 08544

Dr. Chorniy

Anna Chorniy PhD
Postdoctoral Research Associate
Center for Health and Wellbeing
Princeton University
Princeton NJ 08544

MedicalResearch.com: What is the background for this study?

Response: Attention-deficit/hyperactivity disorder (ADHD) is one of the common chronic mental conditions affecting children. In the U.S., 11% of children ages 4–17 (6.4 million) are estimated to have an ADHD diagnosis and almost 70% of them report taking medication for the condition (e.g. Visser et al., 2014). However, little evidence exists on the effects of ADHD treatment on children’s outcomes.
We use a panel data set of South Carolina Medicaid claims paid out in 2003–2013 to investigate the effects of ADHD medication treatment on a seldom studied set of outcomes associated with this condition: adolescent risky behaviors and the incidence of injuries.

The occurrence of injuries allows us to evaluate short-term effects of ADHD treatment, while substance abuse and risky sexual behavior outcomes speak for the long-term effects of medication. Second, we use Medicaid spending on treatment of these negative events to evaluate the impact of ADHD drugs on the severity of ADHD, and compare the cost of ADHD treatment with the costs of negative health events. Continue reading

ADHD and OCD Patients Differ Fundamentally in Brain Abnormalities

MedicalResearch.com Interview with:

Katya Rubia, PhD Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology, and Neuroscience King’s College London London, England

Dr. Katya Rubia

Katya Rubia, PhD
Department of Child and Adolescent Psychiatry
Institute of Psychiatry, Psychology, and Neuroscience
King’s College London
London, England

MedicalResearch.com:  What are the main findings?

Dr. Rubia: ADHD and OCD patients both suffer from poor inhibitory control and in both disorders this has been associated with structural and functional deficits in fronto-striatal networks. However, it is not clear to what extent the two disorders differ in their underlying neural substrates. This study therefore conducted a meta-analysis of all published whole brain structural and functional MRI studies of inhibitory control in both disorders.

MedicalResearch.com: What are the main findings?

Dr. Rubia: The main findings are that ADHD and OCD patients differ quite fundamentally in their structural and functional brain abnormalities. OCD patients have enlarged volume in basal ganglia and insula, while ADHD patients have reduced volumes in these regions. In fMRI, in the left hemisphere this was also observed for the left insula and putamen, which were increased in OCD and reduced in ADHD. In addition both disorders have different frontal deficits. OCD patients have deficits in rostro-dorsal medial frontal regions that are important for top-down control of affect while ADHD patients had reduced activation in lateral inferior frontal cortex, a key area of attention and cognitive control. The findings fit into the notion of fronto-striatal dysregulation in OCD where basal ganglia are overactive and poorly controlled by medial frontal regions and a delayed fronto-striatal maturation in ADHD where both lateral frontal regions and the basal ganglia/insula are smaller, and presumably less developed in structure and in function in ADHD.

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