ADHD IN CHILDHOOD. Marina Danckaerts, UPC-K.U.Leuven. Highlights in Psychiatry, 2007. Disclosure. Have served in Advisory Boards of Cephalon, Janssen, Lilly, Medice, Novartis, Pfizer, UCB Have received support for public speaking from Astra-Zeneca, Janssen, Lilly, Novartis, UCB
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Marina Danckaerts, UPC-K.U.Leuven
Highlights in Psychiatry, 2007
Casey ea 2007, Curr Opin Neurol; Swanson ea 2007, Neuropsychol Rev
MRI and fMRI studies systematically show abnormalities in prefrontal cx, n.caudatus, cerebellum & parietal cx
Increased long-range and decreased short range connectivity with age
Fair et al., 2007
Delay or interruption in these developmental processes might be associated with cognitive deficits in ADHD.
Possession of the DRD4 7-repeat allele was associated with a thinner right orbitofrontal/inferior prefrontal and posterior parietal cortex.
Participants with ADHD carrying the DRD4 7-repeat allele had a better clinical outcome and a distinct trajectory of cortical development with normalization of the right parietal cortical region.
Shaw ea 2007, Arch Gen Psychiatry
Casey ea 2007, Curr Opin Neurol; Tripp & Wickens 2007, Eunethydis Meeting
Learning to “expect”
DRD4: 7-repeat allele ~ ADHD
DAT1: less reliable association
Prenatal smoking, alcohol
Low birth weight, prematurity
Low-level Lead exposureGenes / Environment
Li ea 2006, Hum Mol Genet
Nigg ea 2007, Biol. Psychiatry
(Pliszka GR et al. J Am Acad Child Adolesc Psychiatry 2000)
(Pliszka GR et al. J Am Acad Child Adolesc Psychiatry 2006)
(Taylor E et al.Eur Child Adolesc Psychiatry 1998)
(Taylor E et al.Eur Child Adolesc Psychiatry 2004)
(Banaschewski T et al.Eur Child Adolesc Psychiatry 2006)
Effect gradual over weeks
May be preferred in comorbid cases with tics, anxiety, risk of substance abuse
Effect size 10% larger
Full effect after days
Spencer ea 2007, Geller ea 2007, Kelsey ea 2007, ESCAP Posters
Conclusion: closer monitoring
14-m Treatment Stage
Combined Medication &
No Treatment from Study
36 m FU
Assessment Point (Days)
Influential study, but hard to interpret at this point in time !
Stop study Tr.
Initial treatment does not seem to make a difference.
All did better.
Continuous Med (> 50% of days) versus non-continuous Med : no difference
Jensen ea 2007
All children had 3y.multimodal treatment between 6-12y
At 11-13y and 12-14y, fewer children with preschool ADHD were well-adjusted (17,7%) than controls (71.4%)
Medication works less well in preschoolers: PATS-study: 21% normalized with medication, 13% with placebo (Daley, 2007, Eunethydis)
Psychosocial treatmentParent Management Training
Pelham ea, in press; VandenOord ea, in press; Jones ea 2007;
All work (3-P somewhat less), so far no external validation (only parent ratings)
Neuro-anatomy/ Brain development