The Prevalence and Effect of Comorbid Cystic Fibrosis and Attention Deficit Hyperactivity Disorders on Hospitalizations: A Retrospective Analysis

There is a lack of research that has focused on attention‐deficit hyperactivity disorder (ADHD) in people with cystic fibrosis (pwCF). Given ADHD is associated with executive functioning impairments, exploring ADHD in the context of living with cystic fibrosis (CF) is of great importance. The purpose of the current systematic review was to examine ADHD in pwCF across the lifespan in terms of its prevalence, its impact on various health outcomes, and treatments for managing ADHD. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Articles reporting studies of any design that focused on ADHD in pwCF were included. Studies were excluded if they did not meet this criterion and if they were written in languages other than English. PsycINFO, MEDLINE, EMBASE, and CINAHL databases were searched. Search items were based on three concepts: (1) terms related to CF, (2) terms related to ADHD, and (3) terms related to age. Ten studies were included in this systematic review. Reported prevalence rates of ADHD in pwCF ranged from 5.26% to 21.9%. The reported relationships between ADHD and CF and other health outcomes is inconsistent. In terms of treatment considerations, pharmacological interventions and behavioural strategies for managing ADHD in the context of living with CF have been reported as being successful. Additional research is needed to further explore ADHD in the CF population and health variables that may be associated with CF prognosis.

Section: Discussionmentioning

confidence: 99%

A systematic review of attention‐deficit/hyperactivity disorder in people living with cystic fibrosis

Power,

Shivak,

Kim

et al. 2024

“…While few studies have focused specifically on preadolescent children with CF, another small Turkish cohort found ADHD diagnosed by KSADS in 30% of children with CF ages 8 to 11 years and 10% of healthy controls ( P = .235) 13 . Male children with CF are two to three times more likely to be diagnosed with ADHD 21,87,88 ; disruptive behaviors may be less common in girls than in boys with ADHD, resulting in under‐referral despite equivalent impairment 83 . Although ADHD prevalence among adults with CF is three to four times that expected in the general population, no gender imbalance has emerged in this age group 21,22 .…”

Section: Developmental Disordersmentioning

confidence: 99%

Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention

Georgiopoulos

Christon

Filigno

et al. 2021

This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well‐being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence‐based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention‐deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.

“…Impairment in EF is a hallmark of attention‐deficit/hyperactivity disorder (ADHD), and emerging research indicates higher rates of self‐reported ADHD symptoms in adults and children with CF compared to the general population 15,16 . One study reporting on the impact of comorbid ADHD on CF in a small pediatric sample found minimal differences, with better lung function in youth with CF and ADHD compared to youth with CF alone 17 . Another study found that youth with ADHD and CF had more recent dornase alfa (a routine nebulized medication) use compared to youth with CF alone 18 .…”

Section: Introductionmentioning

confidence: 99%

“…15,16 One study reporting on the impact of comorbid ADHD on CF in a small pediatric sample found minimal differences, with better lung function in youth with CF and ADHD compared to youth with CF alone. 17 Another study found that youth with ADHD and CF had more recent dornase alfa (a routine nebulized medication) use compared to youth with CF alone. 18 Neither of the above ADHD-focused studies included details on specific ADHD symptoms or measures of executive functioning.…”

Section: Introductionmentioning

confidence: 99%

Executive functioning in pediatric cystic fibrosis: A preliminary study and conceptual model

Borschuk

Molitor

Everhart

et al. 2020

Background Research has shown that broad cognitive functioning in individuals with CF is intact. Specific executive functioning (EF) deficits have been identified, however, and adults with CF report more symptoms of ADHD than the general population. EF skills are critical to the management of a complex disease like CF although studies have not adequately examined EF mechanisms in CF. This manuscript (a) described EF in a small sample of children with CF, (b) summarized relations found between EF and psychosocial variables, and (c) presented a conceptual model by which to understand EF's impact on adherence in CF. Methods Data for this preliminary study were collected from 19 children with CF and their caregivers (ages, 6‐18). Caregivers completed questionnaires assessing their child's physical and mental health, their own functioning, and overall family functioning. EF was measured using a parent‐report rating scale. Patient health data were collected from the electronic medical record. Results This sample did not demonstrate elevated levels of EF impairment. Worse EF was related to poor family communication/cohesion, as well as higher treatment burden, worse lung function, poorer adherence, and older age. From these findings, a preliminary model was developed describing EF in the context of CF and adherence. Conclusions Findings from this preliminary study suggest that the CF regimen and associated symptoms may overload otherwise adequate EF skills. Reducing disease burden and preventing burnout should be a focus of treatment. A better understanding of EF in CF and the impact on adherence would allow for better clinical management and effective design of interventions.