Association of adult attention deficit hyperactivity disorder subtypes and response to methylphenidate HCL treatment: A magnetic resonance spectroscopy study

Unal, G.A.; Kenar, Ayşe Nur İnci; Herken, Hasan; Kıroğlu, Yılmaz

doi:10.1016/j.neulet.2015.08.006

Cited by 3 publications

(5 citation statements)

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“…A number of analyses of adult ADHD treatment response (e.g. Unal, Kenar, Herken, & Kiroglu, ) and consequences (e.g. Yoon, Jain, & Shapiro, ) are based on this 3‐part subtyping scheme.…”

Section: Introductionmentioning

confidence: 99%

“…The latter approach would be the more attractive one due to the fact that the DSM system specifies that patients with ADHD can be divided into those with presentations characterized by either AD only, HD-only, and combined AD and HD. A number of analyses of adult ADHD treatment response (e.g., Unal et al , 2015) and consequences (e.g., Yoon et al , 2013) are based on this 3-part subtyping scheme. If emotional dyscontrol is an adult variant of the hyperactivity and/or impulsivity of childhood ADHD, we would expect that a person-level analysis would find evidence of one or more presentations featuring elevated emotional dyscontrol.…”

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confidence: 99%

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The structure of adult ADHD

Adler

Faraone

Spencer

et al. 2017

Int J Methods Psych Res

100

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Although DSM-5 stipulates that symptoms of attention-deficit/hyperactivity disorder (ADHD) are the same for adults as children, clinical observations suggest that adults have more diverse deficits than children in higher-level executive functioning and emotional control. Previous psychometric analyses to evaluate these observations have been limited in ways addressed in the current study, which analyzes the structure of an expanded set of adult ADHD symptoms in 3 pooled U.S. samples: a national household sample, a sample of health plan members, and a sample of adults referred for evaluation at an adult ADHD clinic. Exploratory factor analysis found 4 factors representing executive dysfunction/inattention (including, but not limited to, all the DSM-5 inattentive symptoms, with non-DSM symptoms having factor loadings comparable to those of DSM symptoms), hyperactivity, impulsivity, and emotional dyscontrol. Empirically-derived multivariate symptom profiles were broadly consistent with the DSM-5 inattentive-only, hyperactive/impulsive-only, and combined presentations, but with inattention including executive dysfunction/inattention and hyperactivity-only limited to hyperactivity without high symptoms of HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscriptimpulsivity. These results show that executive dysfunction is as central as DSM-5 symptoms to adult ADHD, while emotional dyscontrol is more distinct but prominent resent in the combined presentation of adult ADHD. Keywordsadults; ADHD; attention-deficit hyperactivity disorder; epidemiology Adult Attention Deficit Hyperactivity Disorder (ADHD) is a commonly-occurring childhood-onset disorder that often persists into adulthood (Kessler et al., 2006). Although DSM-5 requires fewer symptoms among adults than children (American Psychiatric Association., 2013), the symptoms are stipulated to be the same for adults as children despite the fact that clinical observations suggest that the frank hyperactivity of childhood ADHD manifests more as a sense of internal restlessness among adults (Adler and Cohen, 2004) and that adults have a more diverse set of deficits than children in higher-level executive functioning and emotional control (Barkley et al., 2008; Faraone et al., 2010;Surman et al., 2011;Ward et al., 1993).A number of researchers have attempted to confirm these clinical observations by developing expanded assessments that include deficits in executive functioning and in emotional control along with the DSM symptoms of inattention (AD) and hyperactivityimpulsivity (HD) and carrying out exploratory factor analyses of this expanded symptom set among patients with ADHD and controls (Amador-Campos et al., 2014;Christiansen et al., 2011;Conners et al., 1999; Kessler et al., 2010; Marchant et al., 2013; Marchant et al., 2015). These studies have found a 2-factor structure in studies of the clinician-administered Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) (Marchant et al., 2013) and the self-report ...

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“…A number of analyses of adult ADHD treatment response (e.g. Unal, Kenar, Herken, & Kiroglu, ) and consequences (e.g. Yoon, Jain, & Shapiro, ) are based on this 3‐part subtyping scheme.…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

The structure of adult ADHD

Adler

Faraone

Spencer

et al. 2017

Int J Methods Psych Res

100

View full text Add to dashboard Cite

show abstract

“…26 Another study by the current group concerning genetic polymorphism in ADHD patients reported that patients with the 10/10 genotype DAT1 gene showed increased Cr levels after MPH uptake in the cerebellum and in patients with the SNAP-25 Mnll polymorphism G/G genotype and Ddel polymorphism T/T genotype, NAA levels were significantly increased after MPH treatment compared with pretreatment levels in the ACC. 27,28 There are several limitations of the current study. Lack of control groups, the inevitable effects of other stimulants on the patients such as smoking, low-filed MR imaging and the unilateral area evaluating can be considered as limitations.…”

Section: Dovepressmentioning

confidence: 89%

“…11 Five of these studies were conducted in adult ADHD. [11][12][13][14][15] In these studies, changes in the brain were examined before and after MPH. Different results have been reported.…”

Section: Introductionmentioning

confidence: 99%

Association of Age and Response to Methylphenidate HCL Treatment in Adult ADHD: A Proton Magnetic Resonance Spectroscopy Study

Unal,

Kenar

2024

NDT

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This study investigated the age-dependent effects of methylphenidate (MPH) on brain metabolites including choline (Cho), N-acetyl aspartate (NAA) and creatine (Cr) levels in the dorsolateral prefrontal cortex (DLPFC), striatum, cerebellum, and anterior cingulate cortex (ACC) regions of the brain in adult patients with attention deficit hyperactivity disorder (ADHD). Patients and Methods:The study was included 60 patients with ADHD between the ages of 18 and 60 years. The patients were grouped with respect to their ages as follows: 18-24 years, 25-30 years, and 31 and over years. Levels of NAA, Cr and Cho in DLPFC, ACC, cerebellum and striatum were measured with magnetic resonance spectroscopy (MRS). Subjects were then given 10 mg of oral MPH and the same metabolite levels were measured 30 minutes apart. Results: Twelve (20%) of the cases were female and 48 (80%) were male. The age distribution of the cases is as follows: 15 subjects between the ages of 18-24, 26 subjects between the ages of 25-30 and 19 subjects over the age of 30. NAA levels were higher after MPH in the DLPFC of the 18-24 age group (p = 0.016) and in the cerebellum of the 25-30 age group (p = 0.041). No increase in Cho and Cr levels was observed after treatment compared to before (p > 0.05). Conclusion:It is thought that treatment of MPH can be effective on metabolites in different brain regions and this effect can vary upon age adult ADHD patients. After MPH treatment, both the 18-24 age group (in the DLPFC) and the 25-30 age group (in the cerebellum) was detected significantly higher NAA levels compared to pre-treatment levels. This increase in NAA levels suggested that pharmacotherapy, especially at early ages, may be effective on neuronal damage.

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“…The first study reported no significant difference in the Cho/ Cr ratio in the cerebellum and DLPFC, after one oral dose of methylphenidate, in adults with ADHD (Kenar et al, 2017). The second spectroscopic study in adults with ADHD assessed the acute effect of methylphenidate (a second scan was done after 30 minutes) and showed no significant differences between ADHD subtypes before and after acute methylphenidate treatment in ROIs, including the cerebellum, although an increase in choline level after the medication was seen in the striatum in the combined type participants (Unal et al, 2015). They stated that these findings suggest more cellular damage in the striatum in ADHD, with no more reason.…”

Section: Discussionmentioning

confidence: 99%

Fronto-Cerebellar Neurometabolite Alterations After Methylphenidate in Children and Adolescents With ADHD: A Proton Magnetic Resonance Spectroscopy Study

2023

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Objective: The fronto-cerebellar circuit is involved in ADHD pathophysiology. Methylphenidate, as a first-line medication for ADHD, affects different brain regions, however, its effect on the fronto-cerebellar circuit is not investigated sufficiently. We aimed to investigate the effect of 8-week treatment with methylphenidate on neurometabolite ratios in the fronto-cerebellar circuit in ADHD participants using magnetic resonance spectroscopy (MRS). Methods: Fifteen drug-naïve ADHD children and adolescents were enrolled in the present study. Two single-voxel MR spectra were acquired from the right dorsolateral prefrontal cortex (DLPFC) and left Crus 1, before and after the medication. Also, neuropsychological and behavioral assessments were administered. Results: After medication, the glutamate/creatine in the DLPFC and the choline/creatine in the Crus 1 decreased in the ADHD participants. Conclusion: These findings propose that methylphenidate-induced metabolite changes in the fronto-cerebellar circuit could be associated with improvement in cognitive/behavioral characteristics in ADHD. Also, results highlighted cerebellar engagement in ADHD pathophysiology.

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Association of adult attention deficit hyperactivity disorder subtypes and response to methylphenidate HCL treatment: A magnetic resonance spectroscopy study

Cited by 3 publications

References 16 publications

The structure of adult ADHD

The structure of adult ADHD

Association of Age and Response to Methylphenidate HCL Treatment in Adult ADHD: A Proton Magnetic Resonance Spectroscopy Study

Fronto-Cerebellar Neurometabolite Alterations After Methylphenidate in Children and Adolescents With ADHD: A Proton Magnetic Resonance Spectroscopy Study

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