March 9, 2022

Nationwide cohort study finds Cesarean delivery does not appear to be a risk factor for ADHD after adjusting for familial confounding

Previous meta-analyses have found an association between cesarean delivery (CD) and subsequent ADHD in children delivered in that manner. Some have theorized that by bypassing the birth canal, children delivered via CD may acquire their first microbiota from the hospital environment rather than from their mothers, which could disturb the normal development of the nervous system, including the brain.

Nevertheless, earlier studies have not fully explored the role of confounding factors.

A team of Swedish researchers availed themselves of the country's all-encompassing system of national population and health care registers to examine a cohort of over a 1.1 million single births from 1990 through 2003 and followed up through 2013.

They distinguished between planned CD and intrapartum (i.e., during the act of birth) CD. The latter is performed in response to complications with childbirth. This distinction could matter both because of different levels of exposure to the maternal gut microbiota, and because "intrapartum CD is often the result of complications during pregnancy (e.g., preeclampsia) or delivery (e.g., fetal distress), which could affect brain development."

Of 1,179,341 individuals, 1,048,838 were delivered vaginally, 59,514 were delivered by planned CD, and 70,989 were delivered by intrapartum CD.

After adjusting for the child's year of birth, gestational age, age of mother and father at birth, parity, mother's highest education level at birth, maternal smoking during pregnancy, maternal and paternal history of psychiatric disorders, maternal hypertension, maternal diabetes, maternal infections during pregnancy, fetal MAL presentation, large for gestational age, polyhydramnios, oligohydramnios, preeclampsia, and pelvic disproportion, children born by planned CD were 17% more likely to have ADHD.

After adjusting for all previously listed variables plus placenta disorders, dystocia failed induction, and fetal distress, children born by intrapartum CD were 10% more likely to have ADHD.

So far, the analysis confirmed results from previous meta-analyses.

But by exploring such a large cohort, it also became possible to compare ADHD prevalence, not only among unrelated individuals, but also among siblings and cousins, and thereby assess the role of confounders arising from genetics or shared environment.

Whether between full siblings or full maternal cousins, the associations between both types of CD and subsequent ADHD became weak and statistically non-significant.

The authors concluded, "The findings of this study suggest that the association between CD and increased risk of neurodevelopmental disorders in the children was most likely explained by unmeasured familial confounding."

Tianyang Zhang, Gustaf Brander, Ängla Mantel, RalfKuja-Halkola, Olof Stephansson, Zheng Chang, Henrik Larsson, David Mataix-Cols, Lorena Fernández de la Cruz, "Assessment of Cesarean Delivery and neurodevelopmental and Psychiatric Disorders in the Children of population-Based Swedish Birth Cohort,". JAMA Network Open(2020)4(3):e210837,https://doi:10.1001/jamanetworkopen.2021.0837.

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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