February 13, 2024

Meta-analysis Reports Weak Evidence for Mindfulness Interventions for Children and Adolescents with ADHD

Mindfulness involves focusing on the present moment. Mindfulness meditations include choosing a point of focus, such as breathing, and focusing on it continuously. They may also involve focusing single-mindedly on body movements, as in Yoga. This could be potentially useful because in focusing on the present moment with attention and emotion regulation, it addresses regulatory capacities impaired in ADHD.

Previous studies of efficacy of mindfulness interventions have been inconclusive, limited by low methodological quality. A Taiwanese study team tried to remedy this with a fresh meta-analysis of randomized controlled trials (RCTs).

The team included three types of RCTs: yoga intervention, mindfulness-based psychological intervention, and mediation training. There was a lot of variation in the length of individual sessions and in the total number of hours of intervention.

Five studies used a waiting list control group. Two studies used treatment as usual or standard care as control groups. Only four studies followed best practices of using an active control group, such as a listening task, behavioral therapy, cooperative activities, or an emotional education program.

Twelve studies scored between 4 and 7 points from a possible total of 10 points, suggesting at best moderate methodological quality. More seriously, there was no indication of patient and therapist blinding.

With all these limitations, the one nominally positive result was for improvement in ADHD symptoms. A meta-analysis of seven RCTs with a combined 184 participants found a large reduction in ADHD symptoms post-treatment that did not persist at follow-up a couple months later. But between-study variation (heterogeneity) was extreme, with evidence of publication bias. The authors did not offer a revised estimate of efficacy based on the standard trim-and-fill adjustment.

Two additional meta-analyses, of seven RCTs with 200 participants, and seven RCTs with 215 participants, found no improvement in either externalizing or internalizing behaviors post-treatment. This time there was no sign of publication bias in either case. For externalizing behaviors, there was negligible heterogeneity, and moderate heterogeneity for internalizing behaviors.

A meta-analysis of four RCTs combining 122 participants found a moderate improvement in child mindfulness post-treatment, but it was not statistically significant.

Yi-Chen Lee, Chyi-Rong Chen, and Keh-Chung Lin, “Effects of Mindfulness-Based Interventions in Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” International Journal of Environmental Research and Public Health (2022) 19, 15198, https://doi.org/10.3390/ijerph192215198.

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News Tuesday: Fidgeting and ADHD

A recent study delved into the connection between fidgeting and cognitive performance in adults with Attention-Deficit/Hyperactivity Disorder. Recognizing that hyperactivity often manifests as fidgeting, the researchers sought to understand its role in attention and performance during cognitively demanding tasks. They designed a framework to quantify meaningful fidgeting variables using actigraphy devices.

(Note: Actigraphy is a non-invasive method of monitoring human rest/activity cycles. It involves the use of a small, wearable device called an actigraph or actimetry sensor, typically worn on the wrist, similar to a watch. The actigraph records movement data over extended periods, often days to weeks, to track sleep patterns, activity levels, and circadian rhythms. In this study, actigraphy devices were used to measure fidgeting by recording the participants' movements continuously during the cognitive task. This data provided objective, quantitative measures of fidgeting, allowing the researchers to analyze its relationship with attention and task performance.)

The study involved 70 adult participants aged 18-50, all diagnosed with ADHD. Participants underwent a thorough screening process, including clinical interviews and ADHD symptom ratings. The analysis revealed that fidgeting increased during correct trials, particularly in participants with consistent reaction times, suggesting that fidgeting helps sustain attention. Interestingly, fidgeting patterns varied between early and later trials, further highlighting its role in maintaining focus over time.

Additionally, a correlation analysis validated the relevance of the newly defined fidget variables with ADHD symptom severity. This finding suggests that fidgeting may act as a compensatory mechanism for individuals with ADHD, aiding in their ability to maintain attention during tasks requiring cognitive control.

This study provides valuable insights into the role of fidgeting in adults with ADHD, suggesting that it may help sustain attention during challenging cognitive tasks. By introducing and validating new fidget variables, the researchers hope to standardize future quantitative research in this area. Understanding the compensatory role of fidgeting can lead to better management strategies for ADHD, emphasizing the potential benefits of movement for maintaining focus.

July 16, 2024

Identifying Autistic-Like Symptoms in Children with ADHD

NEWS TUESDAY: Identifying Autistic-Like Symptoms in Children with ADHD

A recent study investigated the presence of autistic-like symptoms in children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). Given the overlapping social difficulties in both ADHD and Autism Spectrum Disorder (ASD), distinguishing between the two disorders can be challenging. This study aims to pinpoint specific patterns of autistic symptoms in children with ADHD, comparing them to those with ASD using the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2).

The research involved 43 school-age children divided into two groups:

  • ADHD Group (25 children): Initially referred for ASD symptoms but later diagnosed with ADHD.
  • ASD Group (18 children): Children diagnosed with ASD.

Researchers used ADOS-2 to evaluate differences in communication deficits, social interaction challenges, and repetitive behaviors between the two groups. The study also compared IQ, age, ADOS-2 domain scores, and externalizing/internalizing problems.

Key Findings:

  • Significant differences were found between the ADHD and ASD groups in ADOS-2 domain scores, including Social Affect, Restricted and Repetitive Behavior, and Total Score.
  • On an individual item level, children with ADHD displayed similar atypical behaviors as those with ASD in social-communication areas such as "Pointing" and "Gestures".
  • Both groups showed comparable frequencies in behaviors like "Stereotyped/idiosyncratic words or phrases", "Mannerisms", and "Repetitive interests and behaviors".

The study highlights the importance of identifying transdiagnostic domains that overlap between ADHD and ASD. The transdiagnostic domain refers to a set of symptoms or behaviors that are common across multiple diagnostic categories rather than being specific to just one. Identifying these domains in mental health practice and in psychological research is crucial to understanding, properly diagnosing, and treating conditions with overlapping features. This understanding could pave the way for tailored treatments addressing the specific needs of children with ADHD, particularly those exhibiting autistic-like symptoms.

July 9, 2024

Non-stimulant Medications for Adults with ADHD: An Overview

NEW STUDY: Non-stimulant Medications for Adults with ADHD: An Overview

Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is commonly treated with stimulant medications such as methylphenidate and amphetamines. However, not all patients respond well to these stimulants or tolerate them effectively. For such cases, non-stimulant medications provide an alternative treatment approach.

Recent research by Brancati et al. reviews the efficacy and safety of non-stimulant medications for adult ADHD. Atomoxetine, a well-studied non-stimulant, has shown significant effectiveness in treating ADHD symptoms in adults. The review highlights the importance of considering dosage, treatment duration, safety, and the presence of psychiatric comorbidities when prescribing atomoxetine.

Additionally, certain antidepressants, including tricyclic compounds, bupropion, and viloxazine, which possess noradrenergic or dopaminergic properties, have demonstrated efficacy in managing adult ADHD. Antihypertensive medications, especially guanfacine, have also been found effective. Other medications like memantine, metadoxine, and mood stabilizers show promise, whereas treatments like galantamine, antipsychotics, and cannabinoids have not yielded positive results.

The expert opinion section of the review emphasizes that while clinical guidelines primarily recommend atomoxetine as a second-line treatment, several other non-stimulant options can be utilized to tailor treatments based on individual patient needs and comorbid conditions. Despite these advancements, the authors call for further research to develop and refine more personalized treatment strategies for adults with ADHD.

This review underscores the growing landscape of non-stimulant treatment options, offering hope for more personalized and effective management of ADHD in adults.

June 25, 2024