- Email: [email protected]
HYPERACTIVITY DISORDER
NEW RESEARCH POSTERS 6.61 – 6.63
comorbid psychiatric diagnosis. The most common treatment modality was stimulants only (55.8 percent), followed by stimulants and therapy (21.3 percent) and then therapy only (6.4 percent). There was a group of children who received no treatment at all (16.5 percent). Of the patients who were diagnosed with ADHD, those who had comorbid psychiatric diagnosis were more likely to receive any treatment (38.0% vs 29.4%, p<0.03), as were those in the 13-18 years-old range (61.2% vs 53.1%, p<0.02). However, among those diagnosed with ADHD, race and insurance were not associated with receiving treatment. Conclusions: This study supports the previously identified trend demonstrating age disparities in treating ADHD in children. Also, the high percentage of children in this sample who were white (87 percent) compared to the percentage of white children in the US population overall (51.6 percent) suggests racial disparities in diagnosing ADHD. Once identified with ADHD, there was no evidence of race impacting the receipt of treatment. This suggests barriers to accessing care. Future research should focus on identifying the sources of these barriers in order to design interventions to reduce racial and age inequalities.
ADHD DEMF SAC http://dx.doi.org/10.1016/j.jaac.2016.09.379
6.61 PREDICTIVE VALUE OF GLUTAMATERGIC NETWORK GENE MUTATION TESTING FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN CHILDREN AND ADOLESCENTS IN AN OUTPATIENT PSYCHIATRY SETTING Hakon Hakonarson, MD, Children’s Hospital of Philadelphia and University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA; Charlly Kao, PhD; Liza A. Squires, MD; Josephine Elia, MD Objectives: This study aimed to estimate the predictive value of rare, recurring copy number variants (CNVs) of specific metabotropic glutamate receptor (GRM, mGluR) and related network genes for ADHD in an outpatient pediatric psychiatry population. Methods: Recently, a large-scale, genome-wide study comparing copy number variations (CNVs) in 3,500 ADHD cases vs. w13,000 controls revealed that rare, recurring CNVs impacting specific glutamate receptor metabotropic (GRM) genes (i.e., GRM1, GRM5, GRM7, and GRM8) occurred in ADHD patients at significantly higher frequencies compared with healthy controls (Elia et al. Nat Genet, 2012). The Children’s Hospital of Philadelphia (CHOP) Center for Applied Genomics (CAG) biorepository includes genotyped samples from over 80,000 patients and first-degree relatives seen at CHOP. A search of the CAG repository identified 3,445 subjects previously seen at CHOP psychiatry clinic who had been genotyped on the 550HH or 610Q SNP arrays from Illumina and evaluated for mGluR mutations as previously described. Results: Of 155 subjects with GRM network CNVs, 138 subjects had been diagnosed with ADHD according to electronic medical records (EMRs). Of the 17 subjects without EMR diagnosis of ADHD, parents of 14 subjects were contacted by phone. Of these, parents of 12 subjects reported that their children had been diagnosed with ADHD; 1 had been diagnosed with Down’s Syndrome; 1 subject had no history of ADHD. Conclusions: In this population of children/adolescents identified as having mGluR network mutations of interest, 97% were identified as having ADHD based upon EMR review and/or parent interview. These results suggest that rare recurrent CNVs in mGluR network genes may play an important role in the pathobiology underlying ADHD.
ADHD GS Supported by The Children's Hospital of Philadelphia Center for Applied Genomics http://dx.doi.org/10.1016/j.jaac.2016.09.380
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www.jaacap.org
6.62 VALUE OF PARENT AND CLINICIAN RATINGS AND GENDER DIFFERENCES IN THE PREDICTABILITY OF RESPONSES TO INTEGRATED COMPUTER-PRESENTED AND PHYSICAL BRAINTRAINING EXERCISES Lawrence Anthony Vitulano, PhD, Yale Child Study Center, 163 Carroll Road, Fairfield, CT 06824-3070; Heidi Grantz, MSW; Angeli Landeros-Weisenberger, MD; Liliya Katsovich; Bekir Artukoglu, MD; Selin Aktan, MD; Ming-Yu Wang, MD; Corinne Geoffrion, BA; Michael Vitulano, PhD; Bruce Wexler, MD Objectives: ADHD is a common neurodevelopmental disorder characterized by compromised Executive Function (EF). Children with or at high risk for ADHD did computer-presented and physical brain-training exercises designed to promote activity-dependent development enhancement of neural systems supporting EF, aimed at clinically significant symptom reduction. Methods: 93 children ages 5-9 years who screened positive for ADHD were randomly assigned to a 15-week program of computer-presented and physical brain-training exercises or Treatment as Usual. Parent SNAP-IV, clinician SNAP-IV ratings and neurocognitive assessments were completed during initial and follow-up assessments. Results: Defining improvement or treatment response as at least 30 percent reduction in parent ratings of ADHD symptoms, children were significantly more likely to improve with the brain-training than during treatment-as-usual (41 percent, 27/66 vs. 20 percent, 13/66, McNemar p ¼ .02). Based on 30 percent improvement on clinician SNAP ratings, there were 24 percent (18/76) responders and 76 percent (58/76) non-responders. According to parent ratings, there was no statistically significant difference in the response rate among boys and girls, Chi-square (df¼1) ¼1.41, p¼0.23). Response rate was much higher in definite ADHD Inattentive and Combined Subtypes than in Hyperactive-Impulsive subtype (53 percent vs. 8 percent, p ¼ .003), based upon pre and post parent SNAP scores. Conversely, there was no statistically significant difference in the response rate among children responders with definite ADHD Inattentive and Combined Subtypes (20 percent,10/51) and in Hyperactive Subtype (38 percent, 5/13), (p¼0.16). Conclusions: These findings suggest that 1) Gender may not be a significant factor in determining response to brain training among children with ADHD; 2) a subset of children with ADHD of the inattentive or combined types may respond to brain-training with benefit generalized to both symptoms and cognitive function; and 3) only parent SNAP ratings differentiated between the response rates among different subtypes of ADHD. Responders (inattentive and combined subtypes) improved in both inattentive and hyperactive symptoms, suggesting that response to this type of treatment depends on child-specific characteristics rather than dimension of symptoms.
ADHD RCT SAC Supported by NIMH grant R01HD070821 http://dx.doi.org/10.1016/j.jaac.2016.09.381
6.63 CHILDHOOD MALTREATMENT CORRELATES WITH EMOTIONAL LABILITY SYMPTOMS IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Laura Gisbert, MD, Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute, Passeig de la Vall d’Hebron, 119-129, Barcelona 08035, Spain; ~ez, MS; Vanesa Richarte, MD; Montserrat Corrales, PhD; Pol Iban Mireia Pagerols, MS; Paula Rovira, MS; Marta Ribases, PhD; Josep Antoni Ramos-Quiroga, MD Objectives: The study examined whether exposure to maltreatment in childhood predicts higher rates of emotion lability (EL) in ADHD patients. Methods: Participants were 720 subjects who met ADHD DSM-IV diagnostic criteria in adulthood and childhood. Exclusion criteria were intellectual quotient <85, psychotic disorders, symptoms of substance intoxication and
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
NEW RESEARCH POSTERS 6.64 – 6.65
withdrawal. The Spanish version of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID part II) was used for the diagnostic of ADHD. Childhood maltreatment was assessed with the following items, included in “environmental risk factors” of CAADID’s part I: sexual abuse, physical abuse, psychological maltreatment, domestic violence, negligence, malnutrition and significant traumas occurred during childhood. EL was evaluated with the self-reported Conners Adult ADHD Rating Scale-long version. The EL factor consisted of the following items: “I am irritable”, “I have unpredictable moods”, “Many things set me off easily”, “I have a hot temper/I lose patience easily”, “I still throw tantrums” and “I get frustrated easily”. A total score of 12 or more was considered the threshold to divide the sample in “presence of emotional lability” (study group) and absence of “emotional lability” (control group). Comorbidity was assessed with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders DSM-IV Axis I/II. Results: Participants in the study group (N¼244) were significantly older (mean age: 33.43 vs 31.59 p¼0.028) and female sex was the most prevalent (40.2 percent vs 29.6 percent p¼0.004) in comparison with the control group (N¼476). ADHD combined subtype was the most frequent in both groups 69.3 percent and 47,8 percent. Participants in the study group experienced more comorbidities (P<0.05) except for substance use disorder (p¼0.120). Childhood maltreatment ratio was higher in the study group: 60.6 percent vs 43.1 percent; Pearson’s Chi-squared test obtained a p value of 0.000 with an odds ratio of 2.04. Logistic regression analyses revealed a significant interaction between maltreatment and EL. This interaction was still significant after controlling for covariates p¼0.002. Conclusions: Results of our study clearly highlight the need to search for history of childhood maltreatment in patients suffering from ADHD as these events are associated with higher emotion lability symptoms and a worse outcome.
CAN IMD RF http://dx.doi.org/10.1016/j.jaac.2016.09.382
6.64 AN INITIAL INVESTIGATION OF BRAIN FUNCTIONAL REORGANIZATION FOLLOWING ORGANIZATIONAL SKILLS TRAINING IN CHILDREN WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Bosi Chen, BA, Child Study Center at New York University Langone Medical Center, 1 Park Avenue, 6th Floor, New York, NY 10016; Krishna Somandepalli, MS; Howard B. Abikoff, PhD; Richard Gallagher, PhD; Christina Di Bartolo, LCSW; Emma Stanislawski, BA; Eva Petkova, PhD; Michael P. Milham, MD; F. Xavier Castellanos, MD; Adriana DiMartino, MD Objectives: Organizational Skills Training (OST), is a 10-week psychosocial intervention found effective in improving organizational, time management, and planning (OTMP) skills in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Little is known about the feasibility of identifying brain markers for treatment response. Using resting state fMRI (R-fMRI), we aimed to examine neuronal correlates of post-treatment change as a first step toward larger controlled studies of objective predictors of treatment response. Methods: We examined pre- and post-OST R-fMRI data of 15 children (12 males; mean age: 91 year) with ADHD and significant impairments in OTMP skills indexed by total scores on Children’s Organizational Skills Scales-Parent (COSS-P) or Teacher (COSS-T). Our primary outcome measure was the change in COSS-P scores. As secondary summary outcome measure, we used prepost Z-score differences averaged across COSS-T, Homework Problems Checklist, Academic Progress Report and Academic Performance Rating scales. We selected a priori the intrinsic functional connectivity (iFC) of the dorsal anterior cingulate cortex (dACC), based on its role on cognitive control. Multivariate distance matrix regression (MDMR) analysis additionally allowed for whole-brain explorations. Follow-up iFC analyses were conducted on regions with significant within-subject post-OST differences by MDMR analysis.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Results: COSS-P decreased significantly (t¼7.1, p< 0.0001). In a cluster involving striatum bilaterally, dACC iFC decreased post-OST; these decreases were positively correlated with COSS-P improvements (r¼.34, NS) and to improvements in the summary outcome (r¼.63; p<0.03). MDMR analyses revealed iFC changes in the right medial and lateral precentral cortex. Followup seed-based iFC analyses of this region showed significant decreases in cortico-striatal iFC post-OST. Conclusions: Results support the feasibility of identifying changes in brain iFC after OST. Two distinct analysis converged on decreased corticosubcortical iFC post-treatment which related to change in clinical measures. As decreases in striato-cortical iFC characterize typical development, results suggest regionally-specific enhanced maturational effects of OST.
ADHD IMAGS P http://dx.doi.org/10.1016/j.jaac.2016.09.383
6.65 IMPACT ON THE FAMILY UNIT OF EARLYMORNING FUNCTIONING IMPAIRMENTS IN STIMULANT-TREATED CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Russell J. Schachar, MD, Psychiatry, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada; Russell Barkley, PhD; Stephen V. Faraone, PhD Objectives: To assess the impact of Early Morning Functioning (EMF) impairments on the family unit (caregivers, spouse, and siblings) in stimulanttreated children/adolescents with ADHD compared with families of children without ADHD. Methods: An online quantitative survey was conducted with parents (65 percent) and/or primary caregivers (referred to as “caregivers”) of children/adolescents (aged 6–17 years) with or without ADHD (referred to as “children/child”). Caregivers of children with ADHD answered qualifying questions to ensure: 1) their child was currently taking a stimulant as the primary ADHD medication; 2) their child was taking a stable dose for 3 months prior to the survey; and 3) they rated their child’s ADHD symptoms during the Early Morning Routine (EMR)—defined as the moment the child awakens to the time they leave for school—as 2 on a 10-point Likert severity scale, with 1 denoting “mild” and 10 denoting “severe”. All eligible caregivers were then asked to rate the severity and frequency in family dysfunction resulting from their child’s EMF impairments during the EMR. Results: There were 330 caregivers of children with ADHD who met the first 2 criteria above, and 300 who met all inclusion criteria (91 percent of sample) and completed the survey. Fifty caregivers of children without ADHD also completed the survey. The severity of EMF impairments during the EMR was significantly higher in families of children with ADHD vs. families of children without ADHD (6.2 vs. 1.5, respectively). The majority of caregivers reported their child’s early morning ADHD symptoms (87 percent) and impairment of EMF (77 percent) as moderate to severe (rating of 5–10). Caregivers of children with ADHD reported a higher severity (up to 6-fold higher) and frequency (up to 7.6-fold higher) in family dysfunction on all measured domains during the EMR resulting from their child’s inadequately controlled ADHD symptoms compared to caregivers of children without ADHD. Conclusions: To the best of our knowledge, the findings herein are the first to demonstrate that caregivers of children with ADHD report more severe and frequent family dysfunction as a result of their child’s inadequately controlled ADHD symptoms and related EMF impairments during the EMR compared to caregivers of children without ADHD.
ADHD FAM SAC Supported by Ironshore Pharmaceuticals & Development, Inc. http://dx.doi.org/10.1016/j.jaac.2016.09.384
www.jaacap.org
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comorbid psychiatric diagnosis. The most common treatment modality was stimulants only (55.8 percent), followed by stimulants and therapy (21.3 percent) and then therapy only (6.4 percent). There was a group of children who received no treatment at all (16.5 percent). Of the patients who were diagnosed with ADHD, those who had comorbid psychiatric diagnosis were more likely to receive any treatment (38.0% vs 29.4%, p<0.03), as were those in the 13-18 years-old range (61.2% vs 53.1%, p<0.02). However, among those diagnosed with ADHD, race and insurance were not associated with receiving treatment. Conclusions: This study supports the previously identified trend demonstrating age disparities in treating ADHD in children. Also, the high percentage of children in this sample who were white (87 percent) compared to the percentage of white children in the US population overall (51.6 percent) suggests racial disparities in diagnosing ADHD. Once identified with ADHD, there was no evidence of race impacting the receipt of treatment. This suggests barriers to accessing care. Future research should focus on identifying the sources of these barriers in order to design interventions to reduce racial and age inequalities.
ADHD DEMF SAC http://dx.doi.org/10.1016/j.jaac.2016.09.379
6.61 PREDICTIVE VALUE OF GLUTAMATERGIC NETWORK GENE MUTATION TESTING FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN CHILDREN AND ADOLESCENTS IN AN OUTPATIENT PSYCHIATRY SETTING Hakon Hakonarson, MD, Children’s Hospital of Philadelphia and University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA; Charlly Kao, PhD; Liza A. Squires, MD; Josephine Elia, MD Objectives: This study aimed to estimate the predictive value of rare, recurring copy number variants (CNVs) of specific metabotropic glutamate receptor (GRM, mGluR) and related network genes for ADHD in an outpatient pediatric psychiatry population. Methods: Recently, a large-scale, genome-wide study comparing copy number variations (CNVs) in 3,500 ADHD cases vs. w13,000 controls revealed that rare, recurring CNVs impacting specific glutamate receptor metabotropic (GRM) genes (i.e., GRM1, GRM5, GRM7, and GRM8) occurred in ADHD patients at significantly higher frequencies compared with healthy controls (Elia et al. Nat Genet, 2012). The Children’s Hospital of Philadelphia (CHOP) Center for Applied Genomics (CAG) biorepository includes genotyped samples from over 80,000 patients and first-degree relatives seen at CHOP. A search of the CAG repository identified 3,445 subjects previously seen at CHOP psychiatry clinic who had been genotyped on the 550HH or 610Q SNP arrays from Illumina and evaluated for mGluR mutations as previously described. Results: Of 155 subjects with GRM network CNVs, 138 subjects had been diagnosed with ADHD according to electronic medical records (EMRs). Of the 17 subjects without EMR diagnosis of ADHD, parents of 14 subjects were contacted by phone. Of these, parents of 12 subjects reported that their children had been diagnosed with ADHD; 1 had been diagnosed with Down’s Syndrome; 1 subject had no history of ADHD. Conclusions: In this population of children/adolescents identified as having mGluR network mutations of interest, 97% were identified as having ADHD based upon EMR review and/or parent interview. These results suggest that rare recurrent CNVs in mGluR network genes may play an important role in the pathobiology underlying ADHD.
ADHD GS Supported by The Children's Hospital of Philadelphia Center for Applied Genomics http://dx.doi.org/10.1016/j.jaac.2016.09.380
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www.jaacap.org
6.62 VALUE OF PARENT AND CLINICIAN RATINGS AND GENDER DIFFERENCES IN THE PREDICTABILITY OF RESPONSES TO INTEGRATED COMPUTER-PRESENTED AND PHYSICAL BRAINTRAINING EXERCISES Lawrence Anthony Vitulano, PhD, Yale Child Study Center, 163 Carroll Road, Fairfield, CT 06824-3070; Heidi Grantz, MSW; Angeli Landeros-Weisenberger, MD; Liliya Katsovich; Bekir Artukoglu, MD; Selin Aktan, MD; Ming-Yu Wang, MD; Corinne Geoffrion, BA; Michael Vitulano, PhD; Bruce Wexler, MD Objectives: ADHD is a common neurodevelopmental disorder characterized by compromised Executive Function (EF). Children with or at high risk for ADHD did computer-presented and physical brain-training exercises designed to promote activity-dependent development enhancement of neural systems supporting EF, aimed at clinically significant symptom reduction. Methods: 93 children ages 5-9 years who screened positive for ADHD were randomly assigned to a 15-week program of computer-presented and physical brain-training exercises or Treatment as Usual. Parent SNAP-IV, clinician SNAP-IV ratings and neurocognitive assessments were completed during initial and follow-up assessments. Results: Defining improvement or treatment response as at least 30 percent reduction in parent ratings of ADHD symptoms, children were significantly more likely to improve with the brain-training than during treatment-as-usual (41 percent, 27/66 vs. 20 percent, 13/66, McNemar p ¼ .02). Based on 30 percent improvement on clinician SNAP ratings, there were 24 percent (18/76) responders and 76 percent (58/76) non-responders. According to parent ratings, there was no statistically significant difference in the response rate among boys and girls, Chi-square (df¼1) ¼1.41, p¼0.23). Response rate was much higher in definite ADHD Inattentive and Combined Subtypes than in Hyperactive-Impulsive subtype (53 percent vs. 8 percent, p ¼ .003), based upon pre and post parent SNAP scores. Conversely, there was no statistically significant difference in the response rate among children responders with definite ADHD Inattentive and Combined Subtypes (20 percent,10/51) and in Hyperactive Subtype (38 percent, 5/13), (p¼0.16). Conclusions: These findings suggest that 1) Gender may not be a significant factor in determining response to brain training among children with ADHD; 2) a subset of children with ADHD of the inattentive or combined types may respond to brain-training with benefit generalized to both symptoms and cognitive function; and 3) only parent SNAP ratings differentiated between the response rates among different subtypes of ADHD. Responders (inattentive and combined subtypes) improved in both inattentive and hyperactive symptoms, suggesting that response to this type of treatment depends on child-specific characteristics rather than dimension of symptoms.
ADHD RCT SAC Supported by NIMH grant R01HD070821 http://dx.doi.org/10.1016/j.jaac.2016.09.381
6.63 CHILDHOOD MALTREATMENT CORRELATES WITH EMOTIONAL LABILITY SYMPTOMS IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Laura Gisbert, MD, Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute, Passeig de la Vall d’Hebron, 119-129, Barcelona 08035, Spain; ~ez, MS; Vanesa Richarte, MD; Montserrat Corrales, PhD; Pol Iban Mireia Pagerols, MS; Paula Rovira, MS; Marta Ribases, PhD; Josep Antoni Ramos-Quiroga, MD Objectives: The study examined whether exposure to maltreatment in childhood predicts higher rates of emotion lability (EL) in ADHD patients. Methods: Participants were 720 subjects who met ADHD DSM-IV diagnostic criteria in adulthood and childhood. Exclusion criteria were intellectual quotient <85, psychotic disorders, symptoms of substance intoxication and
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
NEW RESEARCH POSTERS 6.64 – 6.65
withdrawal. The Spanish version of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID part II) was used for the diagnostic of ADHD. Childhood maltreatment was assessed with the following items, included in “environmental risk factors” of CAADID’s part I: sexual abuse, physical abuse, psychological maltreatment, domestic violence, negligence, malnutrition and significant traumas occurred during childhood. EL was evaluated with the self-reported Conners Adult ADHD Rating Scale-long version. The EL factor consisted of the following items: “I am irritable”, “I have unpredictable moods”, “Many things set me off easily”, “I have a hot temper/I lose patience easily”, “I still throw tantrums” and “I get frustrated easily”. A total score of 12 or more was considered the threshold to divide the sample in “presence of emotional lability” (study group) and absence of “emotional lability” (control group). Comorbidity was assessed with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders DSM-IV Axis I/II. Results: Participants in the study group (N¼244) were significantly older (mean age: 33.43 vs 31.59 p¼0.028) and female sex was the most prevalent (40.2 percent vs 29.6 percent p¼0.004) in comparison with the control group (N¼476). ADHD combined subtype was the most frequent in both groups 69.3 percent and 47,8 percent. Participants in the study group experienced more comorbidities (P<0.05) except for substance use disorder (p¼0.120). Childhood maltreatment ratio was higher in the study group: 60.6 percent vs 43.1 percent; Pearson’s Chi-squared test obtained a p value of 0.000 with an odds ratio of 2.04. Logistic regression analyses revealed a significant interaction between maltreatment and EL. This interaction was still significant after controlling for covariates p¼0.002. Conclusions: Results of our study clearly highlight the need to search for history of childhood maltreatment in patients suffering from ADHD as these events are associated with higher emotion lability symptoms and a worse outcome.
CAN IMD RF http://dx.doi.org/10.1016/j.jaac.2016.09.382
6.64 AN INITIAL INVESTIGATION OF BRAIN FUNCTIONAL REORGANIZATION FOLLOWING ORGANIZATIONAL SKILLS TRAINING IN CHILDREN WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Bosi Chen, BA, Child Study Center at New York University Langone Medical Center, 1 Park Avenue, 6th Floor, New York, NY 10016; Krishna Somandepalli, MS; Howard B. Abikoff, PhD; Richard Gallagher, PhD; Christina Di Bartolo, LCSW; Emma Stanislawski, BA; Eva Petkova, PhD; Michael P. Milham, MD; F. Xavier Castellanos, MD; Adriana DiMartino, MD Objectives: Organizational Skills Training (OST), is a 10-week psychosocial intervention found effective in improving organizational, time management, and planning (OTMP) skills in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Little is known about the feasibility of identifying brain markers for treatment response. Using resting state fMRI (R-fMRI), we aimed to examine neuronal correlates of post-treatment change as a first step toward larger controlled studies of objective predictors of treatment response. Methods: We examined pre- and post-OST R-fMRI data of 15 children (12 males; mean age: 91 year) with ADHD and significant impairments in OTMP skills indexed by total scores on Children’s Organizational Skills Scales-Parent (COSS-P) or Teacher (COSS-T). Our primary outcome measure was the change in COSS-P scores. As secondary summary outcome measure, we used prepost Z-score differences averaged across COSS-T, Homework Problems Checklist, Academic Progress Report and Academic Performance Rating scales. We selected a priori the intrinsic functional connectivity (iFC) of the dorsal anterior cingulate cortex (dACC), based on its role on cognitive control. Multivariate distance matrix regression (MDMR) analysis additionally allowed for whole-brain explorations. Follow-up iFC analyses were conducted on regions with significant within-subject post-OST differences by MDMR analysis.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Results: COSS-P decreased significantly (t¼7.1, p< 0.0001). In a cluster involving striatum bilaterally, dACC iFC decreased post-OST; these decreases were positively correlated with COSS-P improvements (r¼.34, NS) and to improvements in the summary outcome (r¼.63; p<0.03). MDMR analyses revealed iFC changes in the right medial and lateral precentral cortex. Followup seed-based iFC analyses of this region showed significant decreases in cortico-striatal iFC post-OST. Conclusions: Results support the feasibility of identifying changes in brain iFC after OST. Two distinct analysis converged on decreased corticosubcortical iFC post-treatment which related to change in clinical measures. As decreases in striato-cortical iFC characterize typical development, results suggest regionally-specific enhanced maturational effects of OST.
ADHD IMAGS P http://dx.doi.org/10.1016/j.jaac.2016.09.383
6.65 IMPACT ON THE FAMILY UNIT OF EARLYMORNING FUNCTIONING IMPAIRMENTS IN STIMULANT-TREATED CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Russell J. Schachar, MD, Psychiatry, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada; Russell Barkley, PhD; Stephen V. Faraone, PhD Objectives: To assess the impact of Early Morning Functioning (EMF) impairments on the family unit (caregivers, spouse, and siblings) in stimulanttreated children/adolescents with ADHD compared with families of children without ADHD. Methods: An online quantitative survey was conducted with parents (65 percent) and/or primary caregivers (referred to as “caregivers”) of children/adolescents (aged 6–17 years) with or without ADHD (referred to as “children/child”). Caregivers of children with ADHD answered qualifying questions to ensure: 1) their child was currently taking a stimulant as the primary ADHD medication; 2) their child was taking a stable dose for 3 months prior to the survey; and 3) they rated their child’s ADHD symptoms during the Early Morning Routine (EMR)—defined as the moment the child awakens to the time they leave for school—as 2 on a 10-point Likert severity scale, with 1 denoting “mild” and 10 denoting “severe”. All eligible caregivers were then asked to rate the severity and frequency in family dysfunction resulting from their child’s EMF impairments during the EMR. Results: There were 330 caregivers of children with ADHD who met the first 2 criteria above, and 300 who met all inclusion criteria (91 percent of sample) and completed the survey. Fifty caregivers of children without ADHD also completed the survey. The severity of EMF impairments during the EMR was significantly higher in families of children with ADHD vs. families of children without ADHD (6.2 vs. 1.5, respectively). The majority of caregivers reported their child’s early morning ADHD symptoms (87 percent) and impairment of EMF (77 percent) as moderate to severe (rating of 5–10). Caregivers of children with ADHD reported a higher severity (up to 6-fold higher) and frequency (up to 7.6-fold higher) in family dysfunction on all measured domains during the EMR resulting from their child’s inadequately controlled ADHD symptoms compared to caregivers of children without ADHD. Conclusions: To the best of our knowledge, the findings herein are the first to demonstrate that caregivers of children with ADHD report more severe and frequent family dysfunction as a result of their child’s inadequately controlled ADHD symptoms and related EMF impairments during the EMR compared to caregivers of children without ADHD.
ADHD FAM SAC Supported by Ironshore Pharmaceuticals & Development, Inc. http://dx.doi.org/10.1016/j.jaac.2016.09.384
www.jaacap.org
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