Neurological Soft Signs in Patients with Attention Deficit Hyperactivity Disorder Aged 6 to 18 Years Old at a University Hospital: A Cross-sectional Study

Abstract

Attention defi cit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children persisting into adulthood. Evidence suggests that the condition is etiologically related to delayed brain maturation. The detection of the presence of neurological soft signs can be a means to assess neuromaturation. The objective of this study was to assess the prevalence of neurological soft signs in ADHD patients and determine any correlation between the presence of neurological soft signs with age, gender, severity and type of ADHD which could give further insights into this disorder. Methods: A cross-sectional study was conducted at the Child Neurology and Developmental Pediatrics outpatient clinic which included patients 6-18 years old diagnosed with ADHD as well as healthy controls. Patients with other neurodevelopmental conditions (intellectual disability, metabolic disorder, cerebral palsy, abnormal MRI fi ndings), or any condition that may lead to failure to complete the given tasks such as physical handicaps were excluded. Neurological soft signs were measured by utilizing the Physical and Neurological Evaluation for Soft Signs (PANESS) scale. Key Findings: A total of 48 patients between 6 and 18 years of age (24 ADHD patients and 24 healthy controls) were examined. Neurological soft signs were signifi cantly higher in patients with ADHD and were present regardless of gender, type and severity of ADHD. ADHD patients performed worse on the given tasks as evidenced by higher PANESS scores. There was a weak negative correlation between neurological soft signs and age indicating that soft sign scores decrease with increasing age. There was no statistically signifi cant difference in neurological soft sign scores between those with medication versus without treatment, except for dysrhythmia which was signifi cantly higher in the drug-naive group.

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

“…described in attention-deficit hyperactivity disorder (ADHD), [22][23][24][25][26][27][28][29][30][31][32] obsessive compulsive disorder (OCD), 22,23,[33][34][35][36][37][38] autism, 22,23,32,[39][40][41][42][43] and Sydenham chorea, [44][45][46][47] and may also indicate basal ganglia dysfunction. The prevalence of these findings in PANS is not known.…”

“…[16][17][18] PANS classification criteria requires abrupt-onset or abrupt-recurrence of obsessive-compulsive symptoms and/or eating restriction with two or more additional new and abrupt-onset neuropsychiatric symptoms which commonly include: emotional lability; irritability, aggression, severely oppositional behaviors; behavioral regression and/or behavior outbursts, deterioration in school performance (often due to new-onset reading and math challenges), sensory amplification, motor abnormalities (most commonly tics, "piano-playing" finger movements, handwriting deterioration, clumsiness), sleep disturbances, and urinary issues (enuresis and urinary frequency). [19][20][21] While "hard" neurological exam findings of basal ganglia dysfunction such as chorea or dystonia suggest a condition other than PANS, "neurological soft signs" (NSS) such as voluntary movement overflow have been described in attention-deficit hyperactivity disorder (ADHD), [22][23][24][25][26][27][28][29][30][31][32] obsessive compulsive disorder (OCD), 22,23,[33][34][35][36][37][38] autism, 22,23,32,[39][40][41][42][43] and Sydenham chorea, [44][45][46][47] and may also indicate basal ganglia dysfunction. The prevalence of these findings in PANS is not known.…”