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Öğe Altered structural connectivity is related to attention deficit/hyperactivity subtypes: A DTI study(Elsevier Ireland Ltd, 2016) Ercan, Eyup Sabri; Suren, Serkan; Bacanli, Ali; Yazici, Kemal Utku; Calli, Cem; Ardic, Ulku Akyol; Aygunes, Duygu; Kosova, Buket; Ozyurt, Onur; Aydin, Cahide; Rohde, Luis AugustoThis study aimed to provide novel insights into the white matter (WM) microstructural properties of Attention Deficit/Hyperactivity Disorder (ADHD) subtypes by recruiting a relatively large sample of stimulant-naive children and adolescents who had no comorbidity other than Oppositional Defiant Disorder and were homogenous according to the DAT1 gene polymorphism. A sample of 72 ADHD subjects and 24 controls aged 8-15 years were enrolled in the study. We applied tract-based spatial statistics to the DTI measures for obtaining fractional anisotropy (FA) and axial, radial diffusivity (AD, RD) measures to explore ADHD type-related differences in WM for the whole brain. Comparing ADHD-Combined group (ADHD-C) with the ADHD predominantly inattentive group (ADHD-I) we detected increased RD in several bilateral brain area and increased AD mostly in left side of the brain, including the body and splenium of the corpus callosum; the anterior and posteriors limbs of the internal capsule; the superior, anterior and posterior corona radiata; the posterior thalamic radiation; and the superior longitudinal fasciculus. Likewise, mostly in the overlapping brain areas, the ADHD-C group presented increased AD values than ADHD-RI. Significant differences among ADHD types could be a preliminary evidence that they have distinct microstructural properties. There were no significant differences in diffusivity between controls and both the ADHD group as whole or any ADHD subgroups. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Öğe Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis(Amer Acad Pediatrics, 2018) Franz, Adelar Pedro; Bolat, Gul Unsel; Bolat, Hilmi; Matijasevich, Alicia; Santos, Ina Silva; Silveira, Rita C.; Procianoy, Renato Soibelmann; Rohde, Luis Augusto; Moreira-Maia, Carlos RenatoCONTEXT: Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined. OBJECTIVE: To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age. DATA SOURCES: We used PsycINFO, Medline, Embase, and Cochrane databases. STUDY SELECTION: We selected cross-sectional, prospective, or retrospective studies with no time or language restriction. DATA EXTRACTION: Independent reviewers screened and extracted data using predefined standard procedures. RESULTS: In 12 studies (N = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies (N = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls. LIMITATIONS: Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions. CONCLUSIONS: With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.Öğe Comparisons between sluggish cognitive tempo and ADHD-restrictive inattentive presentation phenotypes in a clinical ADHD sample(Springer Wien, 2019) Unsel-Bolat, Gul; Ercan, Eyup Sabri; Bolat, Hilmi; Suren, Serkan; Bacanli, Ali; Yazici, Kemal Utku; Rohde, Luis AugustoThere is a debate how different ADHD cases with a comorbid sluggish cognitive tempo (SCT) phenotype are from subjects with a pure inattentive ADHD presentation (ADHD-restrictive inattentive presentation). in this study, 214 patients aged 8-15 years from an ADHD outpatient clinic were assessed, and 100 typically developing controls (TD) were recruited as comparisons. No psychiatric comorbidities except for oppositional defiant disorder were allowed. We compared 29 cases with ADHD + SCT with 34 ADHD-RI cases and 92 TD subjects on sociodemographic profiles, CBCL subscales scores and neurocognitive findings. Regarding sociodemographic profiles (age, gender and parental education) and CBCL subscales, ADHD + SCT and ADHD-RI cases did not differ in any score (all p > 0.05). Comparing with SCT cases, ADHD-RI cases presented slower psychomotor speed and worse neurocognitive index (p < 0.001). We found that only SCT was independently associated with a lower performance in total memory score. ADHD-RI was independently associated with longer reaction time. Our findings suggest that although SCT might be expected to present longer reaction time, we found that slower psychomotor speed and longer reaction time scores were related to inattention. Overall, SCT and ADHD-RI groups were distinguished by differential associations with measures of memory and reaction time.Öğe Decreasing ADHD phenotypic heterogeneity: searching for neurobiological underpinnings of the restrictive inattentive phenotype(Springer, 2016) Ercan, Eyup Sabri; Suren, Serkan; Bacanli, Ali; Yazici, Kemal Utku; Calli, Cem; Ozyurt, Onur; Aygunes, Duygu; Kosova, Buket; Franco, Alexandre Rosa; Rohde, Luis AugustoDuring the process of developing the DSM-5, a new phenotype of ADHD was proposed-the ADHD restrictive inattentive presentation (ADHD-RI), describing subjects with high endorsement of inattentive symptoms and a low level of hyperactivity. However, this phenotype was not included in the DSM-5 because of the lack of robust neurobiological data. We aimed to assess the specific neurobiological underpinnings of individuals presenting ADHD-RI. We compared a sample of 301 subjects (101 ADHD-Combined; 50 ADHD-RI; 50 ADHD predominantly inattentive type and 100 typically developing subjects) aged 8-15 years, using a complete neuropsychological battery, molecular genetic data (DRD4 and DAT1 most studied polymorphisms) and functional MRI during a Go-No/Go task. Subjects with ADHD-RI had a significantly different neuropsychological profile compared with the other groups, including lower psychomotor speeds, longer reaction times and the worst overall performance in the global neurocognitive index. The proportion of subjects with the presence of DRD4-7 repeat allele was significantly higher in ADHD-RI. The fMRI data suggested that more attention-related posterior brain regions (especially temporo-occipital areas) are activated in ADHD-RI during both Go and No-Go cues compared to TD controls and ADHD predominantly inattentive type. ADHD-RI may represent a different phenotype than other types of ADHD. In addition, our results suggest that reducing the phenotypic heterogeneity may aid in the search for the neurobiological underpinnings of ADHD.Öğe Helping Clinicians to Detect ODD in Children with ADHD in Clinical Settings(Springer, 2020) Tahillioglu, Akin; Dogan, Nurhak; Ercan, Eyup Sabri; Rohde, Luis AugustoThe objectives of this study were to provide a basic tool for pediatricians or other physicians to suspect and detect ODD in children with ADHD and to distinguish the symptomatic profile of ODD from ADHD. 101 subjects with ADHD, 83 with both ADHD and ODD and 342 controls aged 8 to 15 years were included in the study. A semi-structured interview was performed for evaluation of psychiatric diagnoses. Both parents and teachers completed DSM-IV Disruptive Behavior Disorders Rating Scale. We found differences among all three diagnostic subsamples in two-by-two analyses for all dimensions (Inattention, Hyperactivity/Impulsivity and ODD) both according to parent and teacher reports (p < 0.03 for all analyses). Based on parental ODD scores, ROC Curve analyses between 'only ADHD' and 'ADHD+ODD' groups showed that AUC was equal 0.80 (95%CI = 0.73-0.86) and the best cutoff point for ODD diagnosis in the ADHD subjects was 0.68. This study demonstrates the presence of a basic tool for detection and suspicion of ODD in children with ADHD for primary care clinicians or pediatricians in clinical settings. Findings also indicate that patients with ODD and ADHD have more severe inattention, hyperactivity/impulsivity and oppositional symptoms than those with only ADHD have.Öğe Investigation of possible associations of the BDNF, SNAP-25 and SYN III genes with the neurocognitive measures: BDNF and SNAP-25 genes might be involved in attention domain, SYN III gene in executive function(Taylor & Francis Ltd, 2022) Bolat, Hilmi; Unsel-Bolat, Gul; Ozgul, Semiha; Pariltay, Erhan; Tahillioglu, Akin; Rohde, Luis Augusto; Akin, HalukObjectives Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder and Sluggish Cognitive Tempo (SCT) might be a second inattention disorder that might be even affected by different attention pathways. SCT is characterized by daydreaming, mental confusion, staring blankly and hypoactivity. In the present study, we evaluated 5 common variants (rs6265, rs3746544, rs1051312, rs133946 and rs133945) located in 3 candidate genes (BDNF, SNAP25 and SYN III) that are known to take part in synaptic plasticity and neurotransmitter transmission. Methods We tested the effects of these variants on neuropsychological findings assessed by a computer-based neuropsychological test battery in children with inattention symptoms (SCT and/or ADHD). Results BDNF (rs6265), SNAP25 (rs3746544 and rs1051312) and SYN III (rs133946 and rs133945) polymorphisms were associated with variable cognitive measures. BDNF gene (rs6265) polymorphism Met allele carriers and SNAP25 gene (rs3746544) T allele carriers had an association with the attention domain. SNAP25 gene (rs1051312) C allele carriers were only associated with reaction time scores. Cognitive flexibility, which is one of the key components of executive function evaluation and shifting attention test scores were associated with BDNF (rs6265) Met allele and SYN III (rs133946) gene G allele. SYN III (rs133945) gene C allele carriers had an association with verbal memory correct hit scores. Conclusions As a conclusion, BDNF, SNAP25 and SYN III genes were associated with specific neurocognitive outcomes in children with inattention symptoms. It is important to note that exploring genotyping effects on neurocognitive functions instead of a heterogeneous psychiatric diagnosis can improve our understanding of psychopathologies.Öğe Is the prevalence of ADHD in Turkish elementary school children really high?(Springer Heidelberg, 2015) Ercan, Eyup Sabri; Bilac, Oznur; Ozaslan, Taciser Uysal; Rohde, Luis AugustoPrevious findings in Turkish samples of children have suggested higher prevalence of ADHD than those detected in Western cultures. Methodological problems might explain these findings. Here, we aimed to re-check the prevalence rate of Attention-Deficit/Hyperactivity Disorder (ADHD) along with other childhood psychiatric disorders in a representative school sample of elementary school children in A degrees zmir, Turkey. The sample consisted of 419 randomly selected primary school children aged 6-14-year-old. We were able to interview 417 cases (99.5 % of the sample). Psychiatric diagnoses in children were assessed using the K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version) and an impairment criterion scale. The prevalence rates of ADHD were 21.8 and 12.7 % in children without and with impairment, respectively. The following major mental disorders were significantly more prevalent in ADHD cases than controls: oppositional defiant disorder (ODD) (9.4 versus 0 %), conduct disorder (15.1 versus 0 %), anxiety (17 versus 0.5 %), and mood (5.7 versus 0.8 %). Our results confirmed a substantially higher ADHD prevalence rate (more than double) than the suggested pooled worldwide prevalence, although similar to the one recently detected in a representative populational sample of children in the US (11 %). These findings, consistent with previous developmental epidemiology studies from Turkey, confirm that ADHD is highly prevalent in Turkish elementary school children.Öğe Is the prevalence of ADHD in Turkish elementary school children really high?(Springer Heidelberg, 2015) Ercan, Eyup Sabri; Bilac, Oznur; Ozaslan, Taciser Uysal; Rohde, Luis AugustoPrevious findings in Turkish samples of children have suggested higher prevalence of ADHD than those detected in Western cultures. Methodological problems might explain these findings. Here, we aimed to re-check the prevalence rate of Attention-Deficit/Hyperactivity Disorder (ADHD) along with other childhood psychiatric disorders in a representative school sample of elementary school children in A degrees zmir, Turkey. The sample consisted of 419 randomly selected primary school children aged 6-14-year-old. We were able to interview 417 cases (99.5 % of the sample). Psychiatric diagnoses in children were assessed using the K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version) and an impairment criterion scale. The prevalence rates of ADHD were 21.8 and 12.7 % in children without and with impairment, respectively. The following major mental disorders were significantly more prevalent in ADHD cases than controls: oppositional defiant disorder (ODD) (9.4 versus 0 %), conduct disorder (15.1 versus 0 %), anxiety (17 versus 0.5 %), and mood (5.7 versus 0.8 %). Our results confirmed a substantially higher ADHD prevalence rate (more than double) than the suggested pooled worldwide prevalence, although similar to the one recently detected in a representative populational sample of children in the US (11 %). These findings, consistent with previous developmental epidemiology studies from Turkey, confirm that ADHD is highly prevalent in Turkish elementary school children.Öğe Is the prevalence of ADHD in Turkish elementary school children really high?(Springer Heidelberg, 2015) Ercan, Eyup Sabri; Bilac, Oznur; Ozaslan, Taciser Uysal; Rohde, Luis AugustoPrevious findings in Turkish samples of children have suggested higher prevalence of ADHD than those detected in Western cultures. Methodological problems might explain these findings. Here, we aimed to re-check the prevalence rate of Attention-Deficit/Hyperactivity Disorder (ADHD) along with other childhood psychiatric disorders in a representative school sample of elementary school children in A degrees zmir, Turkey. The sample consisted of 419 randomly selected primary school children aged 6-14-year-old. We were able to interview 417 cases (99.5 % of the sample). Psychiatric diagnoses in children were assessed using the K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version) and an impairment criterion scale. The prevalence rates of ADHD were 21.8 and 12.7 % in children without and with impairment, respectively. The following major mental disorders were significantly more prevalent in ADHD cases than controls: oppositional defiant disorder (ODD) (9.4 versus 0 %), conduct disorder (15.1 versus 0 %), anxiety (17 versus 0.5 %), and mood (5.7 versus 0.8 %). Our results confirmed a substantially higher ADHD prevalence rate (more than double) than the suggested pooled worldwide prevalence, although similar to the one recently detected in a representative populational sample of children in the US (11 %). These findings, consistent with previous developmental epidemiology studies from Turkey, confirm that ADHD is highly prevalent in Turkish elementary school children.Öğe Prevalence and diagnostic stability of ADHD and ODD in Turkish children: a 4-year longitudinal study(Bmc, 2013) Ercan, Eyup Sabri; Kandulu, Rasiha; Uslu, Erman; Ardic, Ulku Akyol; Yazici, Kemal Utku; Basay, Burge Kabukcu; Aydin, Cahide; Rohde, Luis AugustoBackground: This study was designed to assess the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) in a representative sample of second grade students from a country in a region where no previous rates are available (Turkey). The second aim is to evaluate the differences in ADHD and ODD prevalence rates among four different waves with one-year gap in reassessments. Method: Sixteen schools were randomly selected and stratified according to socioeconomic classes. The DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) was delivered to parents and teachers for screening in around 1500 children. Screen positive cases and matched controls were extensively assessed using the K-SADS-PL and a scale to assess impairment criterion. The sample was reassessed in the second, third and fourth waves with the same methodology. Results: The prevalence rates of ADHD in the four waves were respectively 13.38%, 12.53%, 12.22% and 12.91%. The ODD prevalence was found to be 3.77% in the first wave, 0.96% in the second, 5.41% in the third and 5.35% in the fourth wave. Mean ODD prevalence was found to be 3.87%. Conclusions: The prevalence rates of ADHD in the four waves were remarkably higher than the worldwide pooled childhood prevalence. ADHD diagnosis was quite stable in reassessments after one, two and three years. A mean ODD prevalence consistent with the worldwide-pooled prevalence was found; but diagnostic stability was much lower compared to ADHD.Öğe Validity of proposed DSM-5 ADHD impulsivity symptoms in children(Springer, 2016) Bolat, Gul Unsel; Ercan, Eyup Sabri; Salum, Giovanni Abrahao; Bilac, Oznur; Massuti, Rafael; Ozaslan, Taciser Uysal; Bolat, Hilmi; Rohde, Luis AugustoThe American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.
