- Email: [email protected]
HYPERACTIVITY DISORDER
NEW RESEARCH POSTERS 6.31 – 6.33
Objectives: AD are among the most prevalent comorbid conditions in pediatric bipolar disorder (PBD). There are conflicting results in the literature regarding prevalence of AD subtypes, and significant discrepancy with PBD course of illness (episodic or chronic) or diagnostic criteria (narrow or broad). Our aim in conducting meta-analysis is to investigate the prevalence of subtypes of comorbid anxiety disorders and its relations with the onset (childhood or adolescent) and course (episodic or chronic) of PBD. Methods: We have conducted a systematic research of Pubmed by using “bipolar disorder, affective psychosis, generalized anxiety disorder, panic, social phobia, obsessive compulsive disorder and anxiety disorder” as keywords to search in title/abstract until September 2015. Among 3202 articles, a total of 430 abstracts were found to be related; 82 were conducted in pediatric population, which were read in full text by at least two authors and data was extracted for outcome measures. Articles that include the data from the same population sample were excluded. Data was analyzed with random effects model using R statistical program package. Results: Data from 33 studies were included in the final analysis. The prevalence of any AD in PBD was 44 percent (95% CI 0.38–0.50), prevalence of AD subtypes were GAD 25 percent (95% CI 0.18–0.36); Separation Anxiety Disorder (SAD) 22 percent (95% CI 0.14–0.33); OCD 17 percent (95% CI 0.11– 0.23); Social Phobia (SP) 15 percent (95% CI 0.08–0.27); Panic Disorder (PD) 10 percent (95% CI 0.05–0.19). When only episodic PBD were concerned, prevalence rates differed, with any AD 38 percent (95% CI 0.28–0.48); GAD 19 percent (95% CI 0.08–0.41); SAD 21 percent (95% CI 0.10–0.40); OCD 11 percent (95% CI 0.03–0.29); SP 11 percent (95% CI 0.04–0.27); PD 9 percent (95% CI 0.03–0.23). Prevalence of any AD (34% (95% CI 0.23-0.48), GAD and SAD were found as lower and OCD, SP and PD were slightly higher in adolescent onset compared to childhood onset PBD. Conclusions: Youth with BD are at increased risk of AD; nearly one in two has an AD. GAD and SAD are among the most prevalent comorbidities. AD are seen less with episodic and adolescent onset PBD. AD should be carefully investigated alongside the mood symptoms in PBD, as comorbidity may change course, treatment and subtyping of the disorder.
ANX BD CM http://dx.doi.org/10.1016/j.jaac.2016.09.350
6.31 THE CORRELATION BETWEEN DISTRACTORINCORPORATED CONTINUOUS PERFORMANCE TEST AND NEUROPSYCHOLOGICAL TEST BATTERY RESULTS OF CHILDREN WITH ATTENTIONDEFICIT/HYPERACTIVITY DISORDER Sarper Taskiran, MD, Psychiatry, Koc University, Koc Universitesi Tip Fakultesi, Davutpasa Caddesi No 4, Topkapi, Istanbul 34010, Turkey; Tuba Mutluer, MD; Isin Sanli, MA; Evren Tufan, MD; Bengi Semerci, MD Objectives: To investigate the correlation between distractor-incorporated Continuous Performance Test (d-CPT) and Neuropsychological Test Battery (NPT) results of children diagnosed with ADHD. Methods: Study sample consisted of 29 children (mean age 9.17) with a new diagnosis of ADHD according to DSM-5 criteria, recruited from consecutive referrals to two specialty clinics between January to September 2015. Comorbid diagnoses included 17 percent ODD, 7 percent DMDD, 7 percent anxiety disorders. Eighty-three percent of the sample were recently started on methylphenidate (MPH), 10 percent on atomoxetine, 4 percent on SSRIs. MPH was washed out 24 hours prior to testing. Our NPT battery covered a broad spectrum of cognitive functions including Digit Span Learning (DSL), Benton Judgment of Line Orientation (JLO), Complex Figure Test (CFT), Letter and Symbol Cancellation Test (LCT, SCT), Stroop Color Word Test, Trail Making Test (TMT) and Wisconsin Card Sorting Test (WCST). d-CPT test included Attention (omission errors), impulsivity (commission errors), reaction time and hyperactivity (inappropriate response to target stimuli) indices. Spearman’s Correlation was used for statistical analysis. Results: Significant correlations were found for Attentional index with DSL (r ¼ .662, p .001), JLOB (r ¼ .649, p .001), CFT (r ¼ .467, p .05), LCT (r ¼ .039, p .05), SCT (r ¼ .031, p .05), Stoop (r ¼ .046, p .05) and WCST (r ¼ .482, p .05). The correlations were also significant when visual
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distractors were introduced but were lost with auditory distractors. Impulsivity index was not correlated with any of the NPT batteries. Hyperactivity index was found to be highly correlated with DSL (r ¼.571, p .05), JLOB (r ¼.549, p .05), CFT (r ¼ .716, p .001), LCT (r ¼ .769, p .001), (r ¼ .769, p .001), Stoop test (r ¼ .508, p .05), and WCST (r ¼ .535, p .05) and significant correlations were also observed when auditory, visual and combined distractors were introduced. Conclusions: Attention and Hyperactivity indices of d-CPT is found be correlated with other NPTs. Visual distractors enhance correlation significance more than auditory ones. Impulsivity index fails to show correlations; thus caution needs to be exerted when reviewing the results. Hyperactivity index is found most efficient to predict neuropsychological profiles of children with ADHD.
ADHD DIAG NEPSYC http://dx.doi.org/10.1016/j.jaac.2016.09.351
6.32 QUANTITATIVE ELECTROENCEPHALOGRAPHY REFLECTS VARIOUS EXECUTIVE FUNCTIONS IN CHILDREN WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Kyungun Jhung, MD, Department of Psychiatry & Behavioral Neuroscience, International St. Mary’s Hospital and Catholic Kwandong University, 25 Simgok-Ro 100 Beon-Gil Seo-Gu, Incheon, The Republic of Korea; Jin Young Park, MD; Jungwon Choi, MD Objectives: ADHD is a widely prevalent condition in school aged children, and making a precise diagnosis is an important clinical issue. Quantitative EEG (qEEG) has been increasingly used to evaluate patients with ADHD. This study aimed to assess the correlation of qEEG data with various executive performance tasks in patients with ADHD. Methods: Twenty-two patients with ADHD were recruited. Electroencephalography was assessed in the resting-state, and qEEG data were obtained in both eyes-open and eyes-closed state. Comprehensive Attention Test (CAT), Stroop Color-Word Inference Test (Stroop CWIT), Trail Making Test (TMT), and Wisconsin Card Sorting Test (WCST) were performed. Korean version of the ADHD Rating Scale (K-ARS) and Korean Child Behavior Checklist 6-18 (K-CBCL) was assessed. Results: In general, alpha, beta and gamma power positively correlated with the Attention Quotient (AQ), while delta and theta power negatively correlated with AQ from CAT. In the Stroop CWIT, delta and theta powers decreased, as alpha, beta and gamma powers increased, in relations to higher performance. Power of the gamma band decreased with higher TMT performance. Moreover, delta, theta and gamma power negatively correlated with good performance on the WCST, while alpha band showed a positive correlation. Conclusions: Findings suggest that qEEG may be a useful adjunctive tool in assessing patients with ADHD.
ADHD COG Supported by Seoul National Hospital, Ministry of Health & Welfare, Republic of Korea http://dx.doi.org/10.1016/j.jaac.2016.09.352
6.33 PLASMA ARGININE VASOPRESSIN AND APELIN LEVELS IN CHILDREN WITH ATTENTIONDEFICIT/HYPERACTIVITY DISORDER Ayhan Bilgi, MD, Child and Adolescent Psychiatry, Necmettin Erbakan University, NEU Meram Tip Fakultesi Cocuk ve Ergen Psikiyatrisi AD, Meram, Konya 42090, Turkey; Aysun Toker, MD; Saliha Uysal, MD Objectives: The neuropeptide arginine vasopressin plays critical roles in social communication and behavior. Apelin-13 is another neuropeptide highly concentrated in the brain that could counteract the actions of arginine vasopressin’s and has been detected to be related with a broad range of physiological functions, including locomotor activity. In the present study, we explored the plasma levels of arginine vasopressin and apelin-13 in children with ADHD.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Objectives: AD are among the most prevalent comorbid conditions in pediatric bipolar disorder (PBD). There are conflicting results in the literature regarding prevalence of AD subtypes, and significant discrepancy with PBD course of illness (episodic or chronic) or diagnostic criteria (narrow or broad). Our aim in conducting meta-analysis is to investigate the prevalence of subtypes of comorbid anxiety disorders and its relations with the onset (childhood or adolescent) and course (episodic or chronic) of PBD. Methods: We have conducted a systematic research of Pubmed by using “bipolar disorder, affective psychosis, generalized anxiety disorder, panic, social phobia, obsessive compulsive disorder and anxiety disorder” as keywords to search in title/abstract until September 2015. Among 3202 articles, a total of 430 abstracts were found to be related; 82 were conducted in pediatric population, which were read in full text by at least two authors and data was extracted for outcome measures. Articles that include the data from the same population sample were excluded. Data was analyzed with random effects model using R statistical program package. Results: Data from 33 studies were included in the final analysis. The prevalence of any AD in PBD was 44 percent (95% CI 0.38–0.50), prevalence of AD subtypes were GAD 25 percent (95% CI 0.18–0.36); Separation Anxiety Disorder (SAD) 22 percent (95% CI 0.14–0.33); OCD 17 percent (95% CI 0.11– 0.23); Social Phobia (SP) 15 percent (95% CI 0.08–0.27); Panic Disorder (PD) 10 percent (95% CI 0.05–0.19). When only episodic PBD were concerned, prevalence rates differed, with any AD 38 percent (95% CI 0.28–0.48); GAD 19 percent (95% CI 0.08–0.41); SAD 21 percent (95% CI 0.10–0.40); OCD 11 percent (95% CI 0.03–0.29); SP 11 percent (95% CI 0.04–0.27); PD 9 percent (95% CI 0.03–0.23). Prevalence of any AD (34% (95% CI 0.23-0.48), GAD and SAD were found as lower and OCD, SP and PD were slightly higher in adolescent onset compared to childhood onset PBD. Conclusions: Youth with BD are at increased risk of AD; nearly one in two has an AD. GAD and SAD are among the most prevalent comorbidities. AD are seen less with episodic and adolescent onset PBD. AD should be carefully investigated alongside the mood symptoms in PBD, as comorbidity may change course, treatment and subtyping of the disorder.
ANX BD CM http://dx.doi.org/10.1016/j.jaac.2016.09.350
6.31 THE CORRELATION BETWEEN DISTRACTORINCORPORATED CONTINUOUS PERFORMANCE TEST AND NEUROPSYCHOLOGICAL TEST BATTERY RESULTS OF CHILDREN WITH ATTENTIONDEFICIT/HYPERACTIVITY DISORDER Sarper Taskiran, MD, Psychiatry, Koc University, Koc Universitesi Tip Fakultesi, Davutpasa Caddesi No 4, Topkapi, Istanbul 34010, Turkey; Tuba Mutluer, MD; Isin Sanli, MA; Evren Tufan, MD; Bengi Semerci, MD Objectives: To investigate the correlation between distractor-incorporated Continuous Performance Test (d-CPT) and Neuropsychological Test Battery (NPT) results of children diagnosed with ADHD. Methods: Study sample consisted of 29 children (mean age 9.17) with a new diagnosis of ADHD according to DSM-5 criteria, recruited from consecutive referrals to two specialty clinics between January to September 2015. Comorbid diagnoses included 17 percent ODD, 7 percent DMDD, 7 percent anxiety disorders. Eighty-three percent of the sample were recently started on methylphenidate (MPH), 10 percent on atomoxetine, 4 percent on SSRIs. MPH was washed out 24 hours prior to testing. Our NPT battery covered a broad spectrum of cognitive functions including Digit Span Learning (DSL), Benton Judgment of Line Orientation (JLO), Complex Figure Test (CFT), Letter and Symbol Cancellation Test (LCT, SCT), Stroop Color Word Test, Trail Making Test (TMT) and Wisconsin Card Sorting Test (WCST). d-CPT test included Attention (omission errors), impulsivity (commission errors), reaction time and hyperactivity (inappropriate response to target stimuli) indices. Spearman’s Correlation was used for statistical analysis. Results: Significant correlations were found for Attentional index with DSL (r ¼ .662, p .001), JLOB (r ¼ .649, p .001), CFT (r ¼ .467, p .05), LCT (r ¼ .039, p .05), SCT (r ¼ .031, p .05), Stoop (r ¼ .046, p .05) and WCST (r ¼ .482, p .05). The correlations were also significant when visual
S214
www.jaacap.org
distractors were introduced but were lost with auditory distractors. Impulsivity index was not correlated with any of the NPT batteries. Hyperactivity index was found to be highly correlated with DSL (r ¼.571, p .05), JLOB (r ¼.549, p .05), CFT (r ¼ .716, p .001), LCT (r ¼ .769, p .001), (r ¼ .769, p .001), Stoop test (r ¼ .508, p .05), and WCST (r ¼ .535, p .05) and significant correlations were also observed when auditory, visual and combined distractors were introduced. Conclusions: Attention and Hyperactivity indices of d-CPT is found be correlated with other NPTs. Visual distractors enhance correlation significance more than auditory ones. Impulsivity index fails to show correlations; thus caution needs to be exerted when reviewing the results. Hyperactivity index is found most efficient to predict neuropsychological profiles of children with ADHD.
ADHD DIAG NEPSYC http://dx.doi.org/10.1016/j.jaac.2016.09.351
6.32 QUANTITATIVE ELECTROENCEPHALOGRAPHY REFLECTS VARIOUS EXECUTIVE FUNCTIONS IN CHILDREN WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Kyungun Jhung, MD, Department of Psychiatry & Behavioral Neuroscience, International St. Mary’s Hospital and Catholic Kwandong University, 25 Simgok-Ro 100 Beon-Gil Seo-Gu, Incheon, The Republic of Korea; Jin Young Park, MD; Jungwon Choi, MD Objectives: ADHD is a widely prevalent condition in school aged children, and making a precise diagnosis is an important clinical issue. Quantitative EEG (qEEG) has been increasingly used to evaluate patients with ADHD. This study aimed to assess the correlation of qEEG data with various executive performance tasks in patients with ADHD. Methods: Twenty-two patients with ADHD were recruited. Electroencephalography was assessed in the resting-state, and qEEG data were obtained in both eyes-open and eyes-closed state. Comprehensive Attention Test (CAT), Stroop Color-Word Inference Test (Stroop CWIT), Trail Making Test (TMT), and Wisconsin Card Sorting Test (WCST) were performed. Korean version of the ADHD Rating Scale (K-ARS) and Korean Child Behavior Checklist 6-18 (K-CBCL) was assessed. Results: In general, alpha, beta and gamma power positively correlated with the Attention Quotient (AQ), while delta and theta power negatively correlated with AQ from CAT. In the Stroop CWIT, delta and theta powers decreased, as alpha, beta and gamma powers increased, in relations to higher performance. Power of the gamma band decreased with higher TMT performance. Moreover, delta, theta and gamma power negatively correlated with good performance on the WCST, while alpha band showed a positive correlation. Conclusions: Findings suggest that qEEG may be a useful adjunctive tool in assessing patients with ADHD.
ADHD COG Supported by Seoul National Hospital, Ministry of Health & Welfare, Republic of Korea http://dx.doi.org/10.1016/j.jaac.2016.09.352
6.33 PLASMA ARGININE VASOPRESSIN AND APELIN LEVELS IN CHILDREN WITH ATTENTIONDEFICIT/HYPERACTIVITY DISORDER Ayhan Bilgi, MD, Child and Adolescent Psychiatry, Necmettin Erbakan University, NEU Meram Tip Fakultesi Cocuk ve Ergen Psikiyatrisi AD, Meram, Konya 42090, Turkey; Aysun Toker, MD; Saliha Uysal, MD Objectives: The neuropeptide arginine vasopressin plays critical roles in social communication and behavior. Apelin-13 is another neuropeptide highly concentrated in the brain that could counteract the actions of arginine vasopressin’s and has been detected to be related with a broad range of physiological functions, including locomotor activity. In the present study, we explored the plasma levels of arginine vasopressin and apelin-13 in children with ADHD.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016