In order to study the treatment of the children with attention deficit hyperactivity disorder (ADHD), the integrated visual and auditory continuous performance test (IVA-CPT) was clinically applied to evaluate the effectiveness of electroencephalogram (EEG) biofeedback training. Of all the 60 children with ADHD aged more than 6 years, the effective rate of EEG biofeedback training was 91.6% after 40 sessions of EEG biofeedback training. Before and after treatment by EEG biofeedback training, the overall indexes of IVA were significantly improved among predominately inattentive, hyperactive, and combined subtype of children with ADHD (P<0.001). It was suggested that EEG biofeedback training was an effective and vital treatment on children with ADHD.
Attention Deficit Disorder with Hyperactivity/physiopathology ; Attention Deficit Disorder with Hyperactivity/*therapy ; Biofeedback (Psychology) ; Brain/*physiopathology ; Electroencephalography

PURPOSE: To investigate the symptoms of attention deficit hyperactivity disorder (ADHD) as reported by parents in children with intermittent exotropia [X(T)] and to determine whether strabismus surgery for X(T) affects ADHD symptoms. MATERIALS AND METHODS: Fifty-one consecutive children undergoing muscle surgery for X(T) were prospectively recruited. One parent of each child completed the ADHD rating scale IV (ADHD RS-IV) assessment consecutively before and one year after surgery. Patients whose preoperative scores were above the cut-off point, the 90th percentile based on a Korean sample, were regarded as demonstrating the ADHD trait. The impact of muscle surgery on ADHD symptoms was assessed by comparing the preoperative scores with the post-operative scores. RESULTS: Eight (15.7%) of the 51 patients demonstrated the ADHD trait. ADHD RS-IV scores following strabismus surgery significantly decreased in patients with the ADHD trait (p=0.014), while they did not differ in patients without the ADHD trait. Seven (87.5%) of the 8 patients with the ADHD trait showed improvement in their ADHD RS-IV scores after surgery. There was no difference in surgical success rates between X(T) patients with and without the ADHD trait. CONCLUSION: The ADHD trait was relatively common in children with X(T), and the parent-reported symptoms of the children with the ADHD trait improved after strabismus surgery. These results suggest that childhood X(T) may be one contributing factor to ADHD-related symptoms.
Attention Deficit Disorder with Hyperactivity/*diagnosis ; Child ; Child, Preschool ; Exotropia/*physiopathology ; Female ; Humans ; Male ; *Parents ; Strabismus/*surgery

OBJECTIVETo investigate the cognitive characteristics in early school-age children with attention deficit hyperactivity disorder (ADHD) using event-related potential (ERP) and Achenbach Child Behavior Checklist (CBCL), as well as the correlation between ERP and behavioral problems.

METHODSA total of 22 children aged 6-7 years with ADHD and 19 healthy children matched by age were enrolled. Continue Performance Test-AX (CPT-AX) was performed for ERP test. The amplitude and latency of N2 and P3 of Go and Nogo were compared. The CBCL was completed by the parents, and the correlation between behavioral factors and ERP was analyzed.

RESULTSThe ADHD group had a significantly higher number of ERP omissions than the normal control group (10±8 vs 5±4; P<0.05), while the reaction time and number of commission errors showed no significant differences between the two groups (P>0.05). The ADHD group showed a significantly lower Go-N2 amplitude than the normal control group (-8±5 μV vs -10±4 μV; P<0.05). In the ADHD group, the detection rates of hyperactivity, attack, and discipline violation were 27%, 27% and 9% respectively. The scores on attack and discipline violation subscales were negatively correlated with the Go-N2 amplitude of ERP (r=-0.43 and -0.48 respectively; P<0.05), while the score on hyperactivity subscale was positively correlated with the latency of Go-P3 (r=0.50, P<0.05).

CONCLUSIONSThe early school-age children with ADHD show the tendency to the impairment of attention/executive function, but the inhibition function defect has not been noted. In early school-age children with ADHD, the behavioral problems such as hyperactivity, attack, and discipline violation are associated with ERP.

Attention Deficit Disorder with Hyperactivity ; physiopathology ; psychology ; Child ; Child Behavior Disorders ; etiology ; Evoked Potentials ; physiology ; Humans

OBJECTIVETo assess comorbidities and functional impairments in children with attention deficit hyperactivity disorder (ADHD), and to investigate their relationship with the core symptoms (attention deficit and hyperactivity) of ADHD.

METHODSA total of 319 children with suspected ADHD were included in the study. The Vanderbilt ADHD Parent Rating Scale (VADPRS) was completed by their parents. Diagnosis and classification were performed based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Comorbidities and functional impairments were evaluated according to the VADPRS. Children with various types of ADHD were compared in terms of comorbidities and functional impairments, and their relationship with the core symptoms of ADHD was analyzed.

RESULTSOf the 319 children, 196 were diagnosed with ADHD, including 84 cases of predominantly inattentive type (ADHD-I), 35 cases of predominantly hyperactive-impulsive type (ADHD-HI) and 77 cases of combined type (ADHD-C); 123 did not meet the diagnostic criteria for ADHD. At least one other psychiatric disorder (oppositional defiant disorder, conduct disorder or emotional disorder) was seen in 63.8% (125/196) of the children with ADHD, versus 37.4 % (46/123) of the children without ADHD (P<0.05). The incidence of oppositional defiant disorder and conduct disorder in the ADHD-C subgroup was significantly higher than in the ADHD-I subgroup (P<0.05). The sums of oppositional defiant disorder, conduct disorder and emotional disorder symptoms were weakly correlated with the sums of hyperactive-impulsive and inattentive symptoms (P<0.01). Up to 89.8% of children with ADHD and 74.8% of children without ADHD showed functional impairments (P<0.05). The ADHD-C subgroup had a significantly higher overall incidence of functional impairments than the ADHD-I and ADHD-HI subgroups (P<0.05). The sum of inattentive symptoms was weakly correlated with the scores of learning ability, sibling relationship and participation in organized activities (P<0.01), and the sum of hyperactive-impulsive symptoms was weakly correlated with the score of sibling relationship (P<0.01).

CONCLUSIONSThe incidence of comorbidities and functional impairments among children with ADHD is high, especially in those with ADHD-C. The severity of core symptoms in children with ADHD can influence the occurrence of comorbidities and functional impairments. The incidence of psychiatric disorders and functional impairments is also high in children with suspected ADHD who do not meet the diagnostic criteria for ADHD, so attention also needs to be paid to interventions among these children.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; physiopathology ; psychology ; Child ; Child, Preschool ; Comorbidity ; Female ; Humans ; Male

BACKGROUNDAttention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorder in childhood. ADHD children with overlapping symptoms and signs of motor problems have more serious prognosis than that of children with ADHD only. However, the motor and sensory processing problems in children with ADHD have not been studied well. Few people adopt the technique of computerized dynamic posturography (CDP) in the study of ADHD, which is applied widely in clinical and laboratory research to objectively evaluate human's balance performance. This study aimed to assess the characteristics of postural control and sensory information processing of boys with two subtypes of ADHD by using CDP, so as to provide the proof for non-drug therapy of ADHD.

METHODFrom June 2003 to September 2004, a total of 73 boys (7-15 years of age) with ADHD and 73 normal developing boys matched by age and intelligence quotient from Peking University Institute of Mental Health were recruited in the study. The Sensory Organization Test was adopted to test the static balance performance under six sensory input conditions by SMART EquiTest 8.0 (NeuroCom) instrument. The sensory information from three sensory systems were available under condition 1, the visual inputs were removed or distorted under condition 2 or 3, the somatosensory inputs were in conflict with or without the visual inputs removed under condition 4 or 5, and both the visual and somatosensory inputs were in conflict under condition 6. The indexes of equilibrium score, somatosensory, vestibular, and visual ratios, and strategy scores were analyzed to indicate the subjects' postural control ability.

RESULTSADHD boys had significantly lower composite equilibrium score (CES) than the normal group (P < 0.05). Under condition 1 and conditions 3-6, the equilibrium scores (ES) of the ADHD group were significantly lower (all P < 0.05) than those of the control. Significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 were found in boys with ADHD compared with the control group (P < 0.05). Boys of ADHD-predominantly inattentive (ADHD-I) type had a significantly lower CES and ES under conditions 4-6 than the controls (all P < 0.05) while the ESs of ADHD-combined type (ADHD-C) boys under each condition were similar with that of boys with ADHD-I and no significant difference was found between boys with ADHD-C and the control group (all P > 0.05). Compared with the control group, the ADHD-I boys showed significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 whereas the ADHD-C boys showed a trend of lower visual ratio (all P < 0.05).

CONCLUSIONSADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control. Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys. These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits. Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; physiopathology ; Case-Control Studies ; Child ; Humans ; Male ; Postural Balance ; physiology

BACKGROUNDAccumulating evidence indicates that attention deficit hyperactivity disorder (ADHD) is associated with core deficits in executive function (EF) which predicts poorer academic and occupational functioning. This makes early intervention targeting EF impairments important to prevent long-term negative outcomes. Cognitive training is a potential ADHD treatment target. The present study aimed to explore the efficacy, feasibility, and acceptability of a cognitive training program (targeting child's multiple EF components and involving parent support in daily life), as a nonpharmacological intervention for children with ADHD.

METHODSForty-four school -age children with ADHD and their parents participated in 12 sessions of EF training (last for 12 weeks) and 88 health controls (HC) were also recruited. Training effects were explored using both neuropsychological tests (Stroop color-word test, Rey-Osterrieth complex figure test, trail making test, tower of Hanoi, and false-belief task) and reports of daily life (ADHD rating scale-IV, Conners' parent rating scale, and behavior rating inventory of executive function [BRIEF]) by analysis of paired sample t-test and Wilcoxon signed-rank test. The differences on EF performances between children with ADHD after training and HC were explored using multivariate analysis.

RESULTSThe results (before vs. after EF training) showed that after intervention, the children with ADHD presented better performances of EF both in neuropsychological tests (word interference of Stroop: 36.1 ± 14.6 vs. 27.1 ± 11.1, t = 4.731, P < 0.001; shift time of TMT: 194.9 ± 115.4 vs. 124.8 ± 72.4, Z = -4.639, P < 0.001; false-belief task: χ2 = 6.932, P = 0.008) and reports of daily life (global executive composite of BRIEF: 148.9 ± 17.5 vs. 127.8 ± 17.5, t = 6.433, P < 0.001). The performances on EF tasks for children with ADHD after EF training could match with the level of HC children. The ADHD symptoms (ADHD rating scale total score: 32.4 ± 8.9 vs. 22.9 ± 8.2, t = 6.331, P < 0.001) and behavioral problems of the children as reported by parents also reduced significantly after the intervention. Participants reported that the EF training program was feasible to administer and acceptable.

CONCLUSIONSThe EF training program was feasible and acceptable to children with ADHD and parents. Although replication with a larger sample and an active control group are needed, EF training program with multiple EF focus and parent involving in real-life activities could be a potentially promising intervention associated with significant EF (near transfer) and ADHD symptoms improvement (far transfer).

Attention Deficit Disorder with Hyperactivity ; physiopathology ; Child ; Executive Function ; physiology ; Female ; Humans ; Male ; Neuropsychological Tests

OBJECTIVEAttention deficit hyperactivity disorder (ADHD) is a common behavioral disorder in children. When the children fulfill cognition tasks, brain theta wave activity increases and beta wave activity weakens. This study aimed to explore the efficacy of electroencephalographic (EEG) biofeedback therapy for ADHD in children by assessing the changes of the ratio of brain theta to beta waves and the integrated visual and auditory continuous performance test (IVA-CPT).

METHODSEEG biofeedback therapy was performed in 30 children with ADHD. The ratio of brain theta to beta waves was measured before and after therapy. IVA-CPT was used to assess the effectiveness of biofeedback therapy.

RESULTSAfter two courses of treatment, the mean ratio of brain theta to beta waves in the 30 children with ADHD was significantly reduced from 12.32+/-4.35 (before treatment) to 6.54+/-1.27 (p<0.01). IVA-CPT demonstrated that the values of six indexes measured, including integrate reaction control quotient, integrate attention quotient, auditory and visual reaction control quotients, auditory and visual attention control quotients, were significantly increased after biofeedback therapy (p<0.01).

CONCLUSIONSEEG biofeedback can reduce the ratio of brain theta to beta waves and lead to significant decreases in inattention and hyperactivity and it is effective for treatment of ADHD in children.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; physiopathology ; therapy ; Biofeedback, Psychology ; Child ; Electroencephalography ; Female ; Humans ; Male

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 Disorder with Hyperactivity ; diagnosis ; physiopathology ; Brain ; physiopathology ; Case-Control Studies ; Child ; Cognition Disorders ; diagnosis ; physiopathology ; Electroencephalography ; Evoked Potentials ; Humans

OBJECTIVEImpulsivity is one of the core symptoms of children with attention deficit hyperactivity disorder (ADHD). In order to understand the neuromechanism of the impulsive behaviors in ADHD children, this study investigated the specific functional areas of the brain by functional MRI.

METHODSThe subjects consisted of 10 ADHD children with impulsivity, 7 ADHD children without impulsivity and 9 normal children. A functional MRI examination was performed when the subjects were instructed to finish GO and STOP tasks with the GO-STOP impulsivity paradigm. The MRI data during the two tasks of GO and STOP were averaged and the corresponding activation regions between groups were compared.

RESULTSThe data from the GO task revealed that the main activation regions of the normal children included frontal pole (superior frontal gyrus, middle frontal gyrus and medial frontal gyrus); the main activation regions of ADHD children without impulsivity were cerebellum (posterior lobe and anterior lobe bouton) and cingulated gyrus; those of ADHD children with impulsivity were medial globus pallidus and insula. The data from the STOP task showed that the main activation regions of normal children included superior frontal gyrus and middle frontal gyrus; those of ADHD children without impulsivity were middle frontal gyrus and cingulate gyrus; those of ADHD children with impulsivity were uncus and putamen. The activation regions of ADHD children with impulsivity were much fewer than the other two groups.

CONCLUSIONSThe behavior of impulsivity-control involves a number of specific functional areas in the cerebral cortex. Compared with normal children, ADHD children without impulsivity have weaker brain function and brain activation, and ADHD children with impulsivity demonstrate much fewer brain activation regions, worse brain function and little awareness of the cerebral cortex.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; physiopathology ; Brain ; physiopathology ; Child ; Humans ; Impulsive Behavior ; physiopathology ; Magnetic Resonance Imaging ; Male

The hypothesis 'whether subjects with attention-deficit/ hyperactivity disorder (ADHD), who showed under-reactivity of the hypothalamic-pituitary-adrenal (HPA) axis to stress, would make more commission errors in attention tasks', was examined. Forty-three boys, with ADHD, who visited the psychiatric outpatient clinic, at Kangbuk Samsung Hospital, were the subjects of this study. Both pre- and post-test morning saliva samples were collected from the patients at the Korean Educational Development Institute-Wechsler Intelligence Scale for Children (KEDI-WISC), and Tests of Variables of Attention (T.O.V.A.) performed. The Standard scores of the T.O.V.A were compared between the patients with decreases, or increases, in the salivary cortisol levels after the test. Decreases, or increases in the salivary cortisol levels after the test were shown in 28 and 15 patients, respectively. The patients with decreased cortisol levels after the test tended to make more commission errors in compared with those with increased cortisol levels. The patients with the decreased cortisol levels after test had more omission errors in the first quarter of the test, and more commission errors in the second half of the test compared to those with the increased cotisol levels. Subjects who show decreased salivary cortisol levels after stress make more commission errors in attention tests. This suggests that the blunted HPA axis response to stress is related to the impulsivity in patients with ADHD.
Attention ; Attention Deficit Disorder with Hyperactivity/*physiopathology/psychology ; Child ; Human ; Hydrocortisone/analysis ; Hypothalamo-Hypophyseal System/*physiopathology ; Intelligence ; Male ; Pituitary-Adrenal System/*physiopathology ; Saliva/chemistry