OBJECTIVES: To evaluate and integrate evidence on the management of sleep disorders in children with attention deficit hyperactivity disorder (ADHD). METHODS: Literature was retrieved based on the 6S model, and evidence related to sleep disorder management in children with ADHD was extracted from the included references. RESULTS: A total of 17 studies were included, from which 16 pieces of evidence were extracted. Of these, 6 were classified as Level 1 evidence and 10 as Level 5. The evidence covered screening, assessment, non-pharmacological interventions, pharmacological interventions, follow-up, and multidisciplinary collaboration. CONCLUSIONS This study integrated evidence on the management of sleep disorders in children with ADHD using an evidence-based approach, providing an evidence-based foundation for managing sleep disorders in this population.
Humans ; Attention Deficit Disorder with Hyperactivity/complications* ; Sleep Wake Disorders/etiology* ; Child ; Evidence-Based Medicine

The neurocircuitries that constitute the cortico-striato-thalamo-cortical (CSTC) circuit provide a framework for bridging gaps between neuroscience and executive function in attention deficit hyperactivity disorder (ADHD), but it has been difficult to identify the mechanisms for regulating emotional problems from the understanding of ADHD comorbidity with disruptive behavior disorders (DBD). Research based on "cool" and "hot" executive functional theory and the dual pathway models, which are thought of as applied response inhibition and delay aversion, respectively, within the neuropsychological view of ADHD, has shed light on emotional responding before and after decontextualized stimuli, while CSTC circuit-related domains have been suggested to explain the different emotional symptoms of ADHD with or without comorbid DBD. This review discusses the role of abnormal connections in each CSTC circuit, especially in the emotion circuit, which may be responsible for targeted executive dysfunction at the neuroscience level. Thus, the two major domains - abstract thinking (cool) and emotional trait (hot) - trigger the mechanism of onset of ADHD.
Animals ; Attention Deficit Disorder with Hyperactivity ; complications ; pathology ; psychology ; Attention Deficit and Disruptive Behavior Disorders ; complications ; pathology ; psychology ; Brain ; physiopathology ; Cerebral Cortex ; physiopathology ; Corpus Striatum ; physiopathology ; Emotions ; Humans ; Inhibition (Psychology) ; Neuropsychological Tests ; Thalamus ; physiopathology

INTRODUCTIONSleep problems are a prominent feature in children with attention deficit hyperactivity disorder (ADHD). Unlike existing studies that focused on extreme samples (i.e. normal vs. ADHD), our study investigated the associations of sleep-related behaviours and ADHD features in nonclinical Chinese preschoolers.

METHODSAll participants were recruited via advertisements and screened for eligibility through a telephone interview prior to an onsite visit. The maternal reports of the Conners' Parent Rating Scale (CPRS) and Pediatric Sleep Questionnaire (PSQ) were acquired from 110 Chinese preschoolers aged six years. Regression models were used to examine the association between CPRS and PSQ scores.

RESULTSThe results obtained from regression models on the CPRS and PSQ scores of the 110 participants showed that none of the sleep-related behavioural measures (i.e. sleep-related breathing disorder [SRBD], snoring, daytime sleepiness, restless legs syndrome) was associated with inattention in our sample. However, worse SRBD was associated with higher hyperactivity.

CONCLUSIONOur study underpins the importance of understanding the relationship between sleep-related behaviours and ADHD characteristics before the usual age of clinical diagnosis in children with ADHD.

Attention Deficit Disorder with Hyperactivity ; complications ; Child ; Child, Preschool ; China ; Humans ; Male ; Regression Analysis ; Severity of Illness Index ; Sleep ; Sleep Apnea Syndromes ; complications ; Snoring ; Surveys and Questionnaires

OBJECTIVETo study the clinical features and risk factors of co-morbid tic disorder (TD) in children with attention deficit hyperactivity disorder (ADHD).

METHODSA total of 312 children with ADHD were involved in this study. Subtypes of co-morbid TD, incidences of TD in different subtypes of ADHD (ADHD-I, ADHD-HI and ADHD-C) were observed. Thirteen potential factors influencing the comorbidity rate of TD in ADHD were evaluated by univariate analysis and multiple logistic regression analysis.

RESULTSForty-two of 312 children with ADHD suffered from co-morbid TD (13.5%). Comorbidity rate of TD in children with ADHD-C (24.1%) was significantly higher than in those with ADHD-HI (10.9%) and ADHD-I (8.8%) (P<0.05). There were 21 cases (50.0%) of transient TD, 12 cases (28.6%) of chronic TD, and 9 cases (21.4%) of Tourette syndrome. The univariate analysis revealed 6 factors associated with comorbidity: addiction to mobile phone or computer games, poor eating habits, infection, improper family education, poor relationship between parents and poor relationship with schoolmates. Multiple logistic analysis revealed two independent risk factors for comorbidity: improper family education (OR=7.000, P<0.05) and infection (OR=2.564, P<0.05).

CONCLUSIONSThe incidence of co-morbid TD in children with ADHD is influenced by many factors, and early interventions should be performed based on the main risk factors.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; complications ; Child ; Comorbidity ; Female ; Humans ; Logistic Models ; Male ; Risk Factors ; Tic Disorders ; epidemiology ; etiology

Depression during adolescence is critical to the individual's own development. Hence, identifying individuals with high-risk depression at an early stage is necessary. This study aimed to identify childhood emotional and behavioral risk factors related to depressive symptoms in Korean adolescents through a longitudinal study. The first survey took place from 1998 to 2000, and a follow-up assessment conducted in 2006, as the original participants reached 13-15 yr of age. The first assessment used the Korean version of Child Behavior Checklist and a general questionnaire on family structure, parental education, and economic status to evaluate the participants. The follow-up assessment administered the Korean Children's Depression Inventory. Multiple regression analysis revealed that childhood attention problems predicted depressive symptoms during adolescence for both boys and girls. For boys, family structure also predicted adolescent depressive symptoms. This study suggests that adolescents with attention problems during childhood are more likely to experience depressive symptoms.
Adolescent ; Attention Deficit Disorder with Hyperactivity/etiology/*psychology ; Depression/complications/diagnosis/*psychology ; Depressive Disorder/complications/diagnosis/*psychology ; Family ; Female ; Humans ; Longitudinal Studies ; Male ; Questionnaires ; Republic of Korea ; Risk Factors ; Sex Factors

OBJECTIVETo examine the association between CLOCK gene T3111C polymorphism with attention deficit hyperactivity disorder (ADHD) and ADHD related sleep disturbances in children.

METHODSOne hundred and sixty-six unrelated children with ADHD diagnosed according to DSM-IV criteria and a control group of 150 normal children were enrolled in this study. Parents filled out the Sleep Disturbance Scale for Children (SDSC). Genotype and allele frequencies of T3111C of the CLOCK gene were examined by PCR-restriction fragment length polymorphisms (PCR-RFLP).

RESULTSThere were significant differences in the genotype and allele frequencies of T3111C of the CLOCK gene between the ADHD and control groups (P<0.05). C allele frequency in the ADHD group was significantly higher than in the control group (χ2=7.254, P=0.007, OR=1.740, 95%CI=1.160-2.612). The ADHD children with sleep disturbances were found to have higher C allele frequency than those without sleep disturbances (χ2=13.052, P<0.001, OR=2.766, 95%CI=1.573-4.865).

CONCLUSIONSThere is an association between CLOCK gene T3111C polymorphism and both ADHD and related sleep disturbances in children. The individuals with C allele are susceptible to ADHD as well as ADHD related sleep disturbances.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; complications ; genetics ; CLOCK Proteins ; genetics ; Child ; Child, Preschool ; Female ; Humans ; Male ; Polymorphism, Genetic ; Sleep Wake Disorders ; etiology ; genetics

It is well-known that the prevalence of attention deficit hyperactivity disorder (ADHD) is higher in epileptic children than in the general pediatric population. The aim of this study was to compare the accompaniment of ADHD in epileptic children with well-controlled seizures and no significant intellectual disability with that in healthy controls. We included epileptic children between the ages of 6 and 12 yr visiting our clinic for six consecutive months and controls without significant medical or psychiatric illnesses. We excluded patients with intellectual disability or persistent seizures during the recent three months. The diagnosis of ADHD was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). After exclusion of 84 patients, we enrolled 102 (54.8%) children (mean age, 9.4 +/- 2.0 yr). Seven (7 of 102, 6.9%) were diagnosed with ADHD. As compared to control group (4 of 110, 3.6%), there was no difference in ADHD accompaniment (P = 0.29). No difference was observed in ADHD accompaniment according to seizure type and epilepsy syndrome. In conclusion, the accompaniment of ADHD in epileptic children with well-controlled seizures and no intellectual disability may not differ from that of the general pediatric population.
Age Factors ; Attention Deficit Disorder with Hyperactivity/complications/*diagnosis ; Brain/radiography ; Child ; Electroencephalography ; Epilepsy/complications/*diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Seizures/complications/diagnosis ; Sex Factors

OBJECTIVETo estimate the prevalence of attention deficit hyperactivity disorder (ADHD) in children with epilepsy, and the factors that may contribute to the prevalence of co-morbidity between ADHD and epilepsy.

METHODSA total of 256 children aged 6-15 years old who were diagnosed with epilepsy were enrolled. The prevalence of ADHD in children with epilepsy, and the factors that may contribute to the development of co-morbidity between ADHD and epilepsy were explored.

RESULTSThe systematic evaluation in 192 patients was completed. Of the 192 children, 81 (42.2%) were diagnosed with ADHD. The earlier the epilepsy onset, the higher the frequency of the co-morbidity of ADHD occurring. The longer the period of antiepileptic medication, the higher the prevalence of the co-morbidity of ADHD. Epileptic children receiving a combination of antiepileptic drugs had a higher prevalence of ADHD. ADHD was more common in children with some specific types of epilepsy, such as Lannox-Gastaut syndrome and generalized tonic-clonic epilepsy, or epilepsy with multifocal epileptic discharges in the EEG record.

CONCLUSIONSADHD occurs frequently in children with epilepsy. The factors associated with increased risk of ADHD include the onset age of epilepsy, the types of seizures or epileptic syndromes, the epileptiform EEG discharges, and the effects of antiepileptic drugs.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; epidemiology ; etiology ; Child ; Comorbidity ; Electroencephalography ; Epilepsy ; complications ; drug therapy ; physiopathology ; Female ; Humans ; Male ; Prevalence

Attention Deficit Disorder with Hyperactivity ; complications ; Case-Control Studies ; Child ; Data Interpretation, Statistical ; Female ; Humans ; Male ; Sleep Disorders, Intrinsic ; complications

OBJECTIVEDisruptive behavior disorder (DBD) is one of the main comorbidity of attention deficit hyperactivity disorder (ADHD). Previous studies showed significantly different serotonin function between ADHD children with and without the comorbidity of DBD. Therefore, it is needed to compare these two groups in terms of serotonin receptor gene polymorphisms, which may provide further evidence for the previous studies. The current study aimed to investigate the relationship between two serotonin receptor 2C (HTR2C) gene polymorphisms, that are C-759T and G-697C polymorphisms, and ADHD with or without concomitant DBD.

METHODBlood samples were taken from 237 trios with probands of ADHD with DBD comorbidity and 251 trios with probands of ADHD without comorbidity of DBD. All the subjects were from the ADHD clinic of Peking University Sixth Hospital. DNA was extracted and PCR was performed to amplify the fragments containing both C-759T and G-697C polymorphisms. AciI was used to detect different alleles of the two polymorphisms. Both allele-based and haplotype-based TDT analyses were used to test the association of the two polymorphisms of HTR2C gene and ADHD with or without comorbidity of DBD.

RESULTSThe haplotypes -759C (chi(2) = 4.25, P = 0.04), -697G(chi(2) = 3.21, P = 0.07), as well as -759C/-697G were over-transmitted (chi(2) = 4.31, P = 0.04) to the probands of ADHD without DBD. No biased transmission of any allele and haplotype were found in families with probands of ADHD with DBD.

CONCLUSIONADHD with or without the comorbidity DBD was different at the level of HTR2C gene polymorphisms of C-759T and G-697C. HTR2C is related to ADHD without DBD, while not related to ADHD with DBD. The results suggested that the two groups may have different genetic background, at least in HTR2C.

Alleles ; Attention Deficit Disorder with Hyperactivity ; complications ; genetics ; Attention Deficit and Disruptive Behavior Disorders ; complications ; genetics ; Child ; Comorbidity ; Gene Frequency ; Genetic Predisposition to Disease ; Genetic Testing ; Genotype ; Haplotypes ; Humans ; Linkage Disequilibrium ; Polymorphism, Genetic ; Receptor, Serotonin, 5-HT2C ; genetics ; Receptors, Serotonin ; Serotonin ; genetics