“A Massive Long Way”: Interconnecting Histories, a “Special Child,” ADHD, and Everyday Family Life

Focusing on one family from a study of dual-earner middle-class families carried out in Los Angeles, California, this article draws on interview and video-recorded data of everyday interactions to explore illness and healing as embedded in the microcultural context of the Morris family. For this family, an important aspect of what is at stake for them in their daily lives is best understood by focusing on 9-year-old Mark, who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). In this article, we grapple with the complexity of conveying some sense of how Mark’s condition is experienced and relationally enacted in everyday contexts. Through illuminating connections between lives as lived and lives as told, we explore the narrative structuring of healing in relation to Mark’s local moral world with the family at its center. We examine how his parents understand the moral consequences of the child’s past for his present and future, and work to encourage others to give due weight to his troubled beginnings before this child joined the Morris family. At the same time, we see how the Morris parents act to structure Mark’s moral experience and orient to a desired future in which Mark’s “success” includes an appreciation of how he is accountable to others for his actions. Through our analyses, we also seek to contribute to discussions on what is at stake in everyday life contexts for children with ADHD and their families, through illuminating aspects of the cultural, moral and relational terrain that U.S. families navigate in contending with a child’s diagnosis of ADHD. Further, given that ADHD is often construed as a “disorder of volition,” we seek to advance anthropological theorizing about the will in situations where volitional control over behavior is seen to be disordered.     

Insecure maternal attachment is associated with depression in ADHD children

The objective of this study was to analyze the possible association between maternal attachment style and comorbidity associated with childhood ADHD. We evaluated a total of 103 children with ADHD treated at a Child and Adolescent Mental Health Centre and their mothers. Comorbidity was evaluated using the MINI-KID interview. Maternal attachment was evaluated using the Adult Attachment Questionnaire. We considered child variables that could be associated with the clinical course of ADHD, such as symptom severity, age, gender, evolution time, academic level, and current pharmacological treatment; parental variables, such as the mother’s psychiatric history, current psychopathology, marital status, academic level, income, and employment, were also considered. We found an association between maternal insecure attachment and comorbid depressive disorder in childhood ADHD. An insecure maternal attachment style must be considered in the assessment and treatment of childhood ADHD with comorbid depression.     

Learning Courage: Child Labour as Moral Practice in Northeast Brazil

This article explores the moral dimensions of child labour as cultural practice in Northeast Brazil. It reveals a link between children's participation in labour and local constructions of childhood as a period of ontological uncertainty and impending transition. Through detailed ethnographic exegesis, the article reveals the symbolic dimensions surrounding children's engagement in productive endeavours, and shows how the local opposition between ‘work’ and ‘play’ arises out of an encompassing moral process. The article critiques the tendency within protectionist influenced anthropological literature to acknowledge the important contribution that children make towards material survival, while denying that contribution any deeper cultural significance.     

Laminar Thickness Alterations in the Fronto-Parietal Cortical Mantle of Patients with Attention-Deficit/Hyperactivity Disorder

Although Attention-Deficit/Hyperactivity Disorder (ADHD) was initially regarded as a disorder exclusive to childhood, nowadays its prevalence in adulthood is well established. The development of novel techniques for quantifying the thickness of the cerebral mantle allows the further exploration of the neuroanatomical profiles underlying the child and adult form of the disorder. To examine the cortical mantle in children and adults with ADHD, we applied a vertex-wise analysis of cortical thickness to anatomical brain MRI scans acquired from children with (n = 43) and without ADHD (n = 41), as well as a group of adult neurotypical individuals (n = 31), adult patients with a history of stimulant treatment (n = 31) and medication-naïve adults with ADHD (n = 24). We observed several clusters of reduced laminar cortical thickness in ADHD patients in comparison to neurotypical individuals. These differences were primarily located in the dorsal attention network, including the bilateral inferior and superior parietal cortex and a section of the frontal cortex (centered on the superior frontal and precentral gyrus bilaterally). Further laminar thickness deficits were observed in the bilateral orbitofrontal cortex and medial occipital cortex. The deficits in the cortical surface were especially pronounced in the child sample, while adult patients showed a more typical laminar thickness across the cerebral mantle. These findings show that the neuroanatomical profile of ADHD, especially the childhood form of the disorder, involves robust alterations in the cortical mantle, which are most prominent in brain regions subserving attentional processing.     

Psychosoziale Belastungen, familiäre Konflikte und Therapieverantwortung bei Diabetes im Kindes- und Jugendalter

Children and youth with type 1 diabetes show an enhanced prevalence of psychiatric disorders, especially depression and eating disorders. Their parents suffer from constant vigilance, fear of hypoglycaemia and worries about their child’s future. Children’s quality of life corresponds largely to the quality of life of healthy peers, but is influenced by glycemic control and family conflicts. Illness related family conflicts increase in adolescence, when parental supervision of diabetes therapy run contrary to adolescents’ needs of autonomy. A stepwise transfer of treatment responsibility, which is adjusted to the child’s developmental status, should begin in adolescence at the earliest. The psychosocial care of patient families from diagnosis on should be an integral part of treatment and include patient education programs as well as psychological single case and group intervention.     

Role of neurotrophic factors in attention deficit hyperactivity disorder

Neurotrophins (NTs), a family of proteins including nerve growth factor, brain-derived neurotrophic factor (BDNF), neurotrophin-3, and neurotrophin-4, are essential for neural growth, survival, and differentiation, and are therefore crucial for brain development. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by problems of inattention and/or hyperactivity-impulsivity. ADHD is one of the most common childhood onset psychiatric disorders. Studies have suggested that both genetic and environmental factors influence the development of the disorder, although the precise causes of ADHD have not yet been identified. In this review, we assess the role of NTs in the pathophysiology of ADHD. Preclinical evidence indicates that BDNF knockout mice are hyperactive, and an ADHD rodent model exhibited decreased cerebral BDNF levels. Several lines of evidence from clinical studies, including blood level and genetic studies, have suggested that NTs are involved in the pathogenesis of ADHD and in the mechanism of biological treatments for ADHD. Future directions for research are proposed, such as using blood NTs as ADHD biomarkers, optimizing NT genetic studies in ADHD, considering NTs as a link between ADHD and other comorbid mental disorders, and investigating methods for optimally modulating NT signaling to discover novel therapeutics for treating ADHD.     

Child social ethology and peer relations: a developmental review of methodology and findings

During the last three decades, developmental research has increasingly emphasized the relevance of peer relations in children’s socialization. However, most studies of child development still focus upon individual differences in social status, tacitly neglecting relational constraints inherent in the ecology of the peer group. In contrast, socioethological approaches have stressed that natural groups provide a variety of distinct social roles that may have a differential impact upon individual growth and development. However, ethological analyses have often been limited to aggressive relations and group dominance structures. Comparable studies of affiliative organization have been hampered by the paucity of models for the study of cohesive social structure, only recently having begun to overcome this obstacle. A potential third dimension of preschool peer group ethology, object use, has been relatively neglected in studies of peer relations. However, recent research suggests that object use is a salient and important component of the social world of the young child. This article reviews methodology and recent findings in the area of peer relations and discusses the developmental implications of this work. Received: 8 December 1998 / Received in revised form: 26 March 1999 / Accepted: 31 March 1999     

Transgenic mouse models for ADHD

Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder characterized by symptoms of inattention, impulsivity and hyperactivity that adversely affect many aspects of life. Whereas the etiology of ADHD remains unknown, growing evidence indicates a genetic involvement in the development of this disorder. The brain circuits associated with ADHD are rich in monoamines, which are involved in the mechanism of action of psychostimulants and other medications used to treat this disorder. Dopamine (DA) is believed to play a major role in ADHD but other neurotransmitters are certainly also involved. Genetically modified mice have become an indispensable tool used to analyze the contribution of genetic factors in the pathogenesis of human disorders. Although rodent models cannot fully recapitulate complex human psychiatric disorders such as ADHD, transgenic mice offer an opportunity to directly investigate in vivo the specific roles of novel candidate genes identified in ADHD patients. Several knock-out and transgenic mouse models have been proposed as ADHD models, mostly based on targeting genes involved in DA transmission, including the gene encoding the dopamine transporter (DAT1). These mutant models provided an opportunity to evaluate the contribution of dopamine-related processes to brain pathology, to dissect the neuronal circuitry and molecular mechanisms involved in the antihyperkinetic action of psychostimulants and to evaluate novel treatments for ADHD. New transgenic models mouse models targeting other genes have recently been proposed for ADHD. Here, we discuss the recent advances and pitfalls in modeling ADHD endophenotypes in genetically altered animals.     

Propositions pour une perspective ph��nom��nologique dans l��autisme infantile

During the twentieth century, many clinical psychiatrists established links with ??continental phenomenology.?? In France, the most famous were Minkowski, Tatossian and Lantéri-Laura. They worked on schizophrenia and bipolarity disorders in adulthood. So, they were not interested in child development disorders. In the same time, Kanner described autism in a phenomenological way. But, this had been sometimes forgotten or neglected. Keeping in mind the work of these famous psychiatrists, we first discuss the interest of phenomenology in child and adolescent psychiatry, especially in case of autism. Second, in spite of Rutter??s critics, using phenomenology, we try to explain why Kanner chose the word ??autism?? to name the syndrome he had described. Third, taking a phenomenological point of view, we show the impact of sameness and sensory disorders on children with autism and their families. In conclusion, we insist on the interest of phenomenology in childhood autism to link research in developmental and cognitive psychology and the day-to-day life of the child or the adolescent.     

Prevalence of adult ADHD in an all-female prison unit

There is increasing evidence suggesting a link between ADHD and criminality, including a strong association between ADHD symptoms and the likelihood of being on probation or in prison. Most studies investigating the prevalence of ADHD in prison populations have focused on adult male offenders. In the current study, 69 female prisoners were screened for both childhood and adult ADHD symptoms using the Barkley Adult ADHD Rating Scale-IV. The results indicate that 41 % of the prisoners met the diagnostic criteria for ADHD in childhood and continued to meet criteria for ADHD as adults. More importantly, young female prisoners (aged 18–25) were significantly more likely to report symptoms of ADHD than older prisoners. Prisoners who reported symptoms of ADHD also reported high levels of impairment associated with these symptoms. A better understanding of the prevalence of ADHD in female prison units can highlight specific areas for intervention during rehabilitation, as well as the management of serious incidents within prison.     

Transgenic mice expressing a human mutant beta1 thyroid receptor are hyperactive, impulsive, and inattentive

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed childhood psychiatric disorder. We have found that a transgenic mouse bearing a human mutant thyroid receptor (TRbeta1) expresses all of the defining symptoms of ADHD--inattention, hyperactivity, and impulsivity--as well as a 'paradoxical' response to methylphenidate (MPH). As with ADHD, the behavioral phenotypes expressed by the TRbeta transgenic mice are dynamic and sensitive to changes in environmental conditions, stress, and reinforcement. TRbeta transgenic mice are euthyroid except for a brief period during postnatal development, but the behavioral phenotypes, elevated dopamine turnover, and paradoxical response to MPH persist into adulthood. Thus, like the vast majority of children with ADHD, the TRbeta transgenic mice exhibit the symptoms of ADHD in the complete absence of thyroid abnormalities. This suggests that even transient perturbations in developmental thyroid homeostasis can have long-lasting behavioral and cognitive consequences, including producing the full spectrum of symptoms of ADHD.     

Early maladaptive schemas in adult patients with attention deficit hyperactivity disorder

The main purpose of this study was to examine whether adult patients with attention deficit hyperactivity disorder (ADHD) demonstrate sets of dysfunctional cognitive beliefs and behavioural tendencies according to Jeffrey Young’s schema-focused therapy model. Sets of dysfunctional beliefs (maladaptive schemas) were assessed with the Young Schema Questionnaire (YSQ-S2) in 78 adult ADHD patients and 80 control subjects. Patients with ADHD scored significantly higher than the control group on almost all maladaptive schemas. The ‘Failure’, ‘Defectiveness/Shame’, ‘Subjugation’ and ‘Emotional Deprivation’ schemas were most pronounced in adult ADHD patients, while only ‘Vulnerability to Harm or Illness’ did not differ between the two groups. The schemas which were most pronounced in adult patients with ADHD correspond well with their learning histories and core symptoms. By demonstrating the existence of early maladaptive schemas in adults suffering from ADHD, this study suggests that schema theory may usefully be applied to adult ADHD therapy.     

ADHD in adults: a concept in evolution

Although attention-deficit/hyperactivity disorder (ADHD) has been recognized as a disorder affecting individuals across the life cycle since the end of the nineties, there is still considerable debate on how to conceptualize the disorder in adults, and on the best way to operationalize diagnostic criteria for this age range. In this comprehensive non-systematic review of the literature, we provide data about prevalence and presentation of ADHD in adulthood as well as discuss major problems in applying criteria developed for children in assessing adults (clinical utility, threshold of symptoms for diagnosis, full ADHD diagnosis in childhood, information source, and additional dimensions for diagnosis-executive functioning impairment and emotional impulsivity). In addition, we provide some recommendations for improving ADHD diagnostic criteria in adulthood.     

Developmental comorbidity in attention-deficit/hyperactivity disorder

With the present review, we intend to highlight the importance of considering the age- and development-dependent occurrence of comorbidity in ADHD and to outline distinct trajectories of symptom progression with possible impact on course and outcome of ADHD. The review will focus on introducing the concepts of "developmental epidemiology" and "developmental comorbidity". Psychiatric and non-psychiatric age-dependent comorbidity can be seen in the majority of children, adolescents and adults with ADHD, resulting in a severe impairment of everyday life with considerable functional and psychosocial problems. Concerning the temporal order of occurrence, psychiatric conditions may be present before the appearance of first definite ADHD symptoms ("pre-comorbidity", such as temperament factors, sleep disturbance, autism spectrum disorders and atopic eczema). They may coincide with the time when ADHD symptoms reach a clinically significant level ("simultaneous comorbidity": enuresis, encopresis, developmental dyslexia). The majority of comorbidity, however, appears after the onset of ADHD in the course of disease ("post-comorbidity": tic disorder, depression and suicidality, anxiety disorders, obsessive compulsive disorder, bipolar disorder, conduct and substance use disorders, obesity and personality disorders). The aetio-pathophysiology of ADHD and its comorbid disorders and also the nature of comorbidity itself being highly heterogeneous, we additionally discuss possible models of comorbidity. In the future, longitudinal data on distinct patterns of symptom and comorbidity progression would help to refine disease classification systems, strengthen the power of future genetic studies and finally allow for more specific treatment strategies.     

The use of actigraphy in the monitoring of methylphenidate versus placebo in ADHD: a meta-analysis

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. There is an increasing need to find objective measures and markers of the disorder in order to assess the efficacy of the therapy and to improve follow-up strategies. Actigraphy is an objective method for recording motor activity and sleep parameters using small, computerized, watch-like devices worn on the body, and it has been used in many clinical trials to assess methylphenidate efficacy and adverse effects in ADHD. Our article aim is to systematically review and perform a meta-analysis of the current evidence on the role of actigraphy in both the detection of changes in activity and in sleep patterns in randomized clinical trials that compared methylphenidate against placebo in the treatment of ADHD. A comprehensive literature search of PubMed/MEDLINE, Scopus, Embase, Cochrane Library, CINHAL and PsycINFO databases was carried out to find randomized clinical trials comparing methylphenidate versus placebo in children with ADHD, using actigraphic measures as an outcome. No start date limit was used and the search was updated until June 2013. The primary outcome measures were ‘total sleep time’ and daytime ‘activity mean’. As secondary outcomes, we analyzed ‘sleep onset latency’, ‘sleep efficiency’ and ‘wake after sleep onset’. Eight articles comprising 393 patients were included in the analysis. Children with ADHD using MPH compared to placebo have a significant difference of a large effect with a diminishing value in the activity mean. For the total sleep time, we found a significant and large effect in the decrease in sleep in MPH group. This study shows that MPH may effectively reduce mean activity in ADHD children, but it may negatively affect total sleep time.     

Adherence to stimulants in adult ADHD

Although stimulant medication can reduce symptoms and lessen the degree of functional impairment associated with attention deficit hyperactivity disorder (ADHD), the adherence rate in adults diagnosed with ADHD is reportedly <12 %. The article explores the contexts that influence stimulant medication adherence in adults diagnosed with ADHD. Using a mixed-method design, data on ADHD-related quality of life and stimulant adherence were collected from 67 adults with ADHD. Next, 18 of those adults, based on adherence/quality of life, completed semi-structured interviews. Qualitative data were analyzed using thematic narrative inquiry, based on the Health Belief Model. Findings revealed no direct relation between stimulant adherence and quality of life. Instead, the doctor/patient relationship was a strong predictor of a person’s quality of life. Physicians treating adults with ADHD must be aware of individual variation in stimulant response, seek to understand the functional limitations of their patients and strive to communicate effectively.     

Chronotype and its relationship with sleep disorders in children with attention deficit hyperactivity disorder

Chronotype can be classified as morningness types, people who prefer morning hours for their physical and mental activities; eveningness types, people who prefer the afternoon or evening hours; and intermediate types, those who show characteristics of both morningness and eveningness types. Attention deficit hyperactivity disorder (ADHD) has been linked with disturbances in chronotype, particularly increased eveningness. Despite the possibility of an association between chronotypes, sleep disturbances and ADHD symptoms, there is little evidence of this association considering the child population. The purpose of this study was to examine chronotype preferences in children aged between 7 and 12 years who were diagnosed as having ADHD in the context of sleep disturbances. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version, Conner’s Rating Scales, Children’s Sleep Habit Questionnaire and Children’s Chronotype Questionnaire were used for the evaluation of children with ADHD and healthy controls. The ADHD group was 73% combined-type, and the eveningness scores of the ADHD group (n = 52) were significantly higher than the control group (n = 52) (p < 0.01). There was a positive correlation between the higher scores of eveningness and total scores on resistance to sleep time (p < 0.09), respiratory problems during sleep and daytime sleepiness in the ADHD group. CSHQ total score was found to be a predictive factor for eveningness among children with ADHD (p < 0.01). These findings highlight possible reciprocal links between ADHD symptoms, sleep disturbances and chronotype in children aged 7–12 years, which might lead to individualized treatment options.     

Malleability,plasticity, and individuality: How children learn and develop in context1

ABSTRACT

This article synthesizes foundational knowledge from multiple scientific disciplines regarding how humans develop in context. Major constructs that define human development are integrated into a developmental system framework, this includes—epigenetics, neural malleability and plasticity, integrated complex skill development and learning, human variability, relationships and attachment, self-regulation, science of learning, and dynamics of stress, adversity and resilience. Specific attention is given to relational patterns, attunement, cognitive flexibility, executive function, working memory, sociocultural context, constructive development, self-organization, dynamic skill development, neural integration, relational pattern making, and adverse childhood experiences. A companion article focuses on individual-context relations, including the role of human relationships as key drivers of development, how social and cultural contexts support and/or undermine individual development, and the dynamic, idiographic developmental pathways that result from mutually influential individual-context relations across the life span. An understanding of the holistic, self-constructive character of development and interconnectedness between individuals and their physical, social, and cultural contexts offers a transformational opportunity to study and influence the children’s trajectories. Woven throughout is the convergence of the science of learning – constructive developmental web, foundational skills, mindsets (sense of belonging, self-efficacy, and growth mindset), prior knowledge and experience, motivational systems (intrinsic motivation, achievement motivation, and the Belief-Control-Expectancy Framework), metacognition, conditions for learning , cultural responsiveness and competence, and instructional and curricular design- and its importance in supporting in integrative framework for children’s development. This scientific understanding of development opens pathways for new, creative approaches that have the potential to solve seemingly intractable learning and social problems.     

A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults

Attention deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition. It frequently persists into adulthood and can have serious health and other adverse consequences. The majority of previous adult ADHD studies have focused on young adults so that relatively little is known about ADHD symptoms and their effects in mid and late life. In addition, effects of subclinical levels of attention deficit and hyperactivity have not been studied in detail. In this study we investigated ADHD symptoms and related impairment in a large population-based sample of middle-aged Australian adults (n = 2091; 47% male). Applying the WHO adult ADHD Self Report Screener (ASRS) we observed that 6.2% of participants had scores that were previously associated with ADHD diagnosis. No significant gender difference in the distribution of ASRS scores was observed. Multiple regression analyses indicated strong positive correlations between symptoms of ADHD and depression/anxiety and significant negative associations (p<0.01) with employment, financial stress, relationship quality, health and well-being measures in this age group. Importantly, associations were highly significant even when few ADHD symptoms were reported. Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms. Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied. Our results suggest that ADHD symptoms continue to be associated with ill-health and functional impairment in mid-life and are, therefore, likely to be a major, previously unrecognized source of late-life morbidity with associated social and economic costs. Thus, there is a compelling need for better understanding and development of age-appropriate approaches to the diagnosis and treatment of ADHD in mid- to late-life.