Jan-Olov Larsson

Altered Cortical Activity in Children With Attention-Deficit/Hyperactivity Disorder During Attentional Load Task

OBJECTIVE To evaluate whether cortical activity recorded during attentional load in children with ADHD is different compared with controls. METHOD Quantitative electroencephalography (QEEG) was performed at open eyes and during performance of the Continuous Performance Task. RESULTS Children with ADHD showed an altered pattern of QEEG activity, especially during the attentional load task, with increased slow cortical activity (mainly over the frontal areas) and decreased fast cortical activity. CONCLUSIONS The findings indicate a different arousal level in children with ADHD, which could be due to a delay in functional cortical maturation. To evaluate the clinical importance of these findings, a longitudinal follow-up will be conducted.

Genetic and environmental influences on adult attention deficit hyperactivity disorder symptoms: a large Swedish population-based study of twins.

BACKGROUND Attention deficit hyperactivity disorder (ADHD) frequently persists into adulthood. Family and twin studies delineate a disorder with strong genetic influences among children and adolescents based on parent- and teacher-reported data but little is known about the genetic and environmental contribution to DSM-IV ADHD symptoms in adulthood. We therefore aimed to investigate the impact of genetic and environmental influences on the inattentive and hyperactive-impulsive symptoms of ADHD in adults. METHOD Twin methods were applied to self-reported assessments of ADHD symptoms from a large population-based Swedish twin study that included data from 15 198 Swedish male and female twins aged 20 to 46 years. RESULTS The broad heritability [i.e., A + D, where A is an additive genetic factor and D (dominance) a non-additive genetic factor] was 37% (A = 11%, D = 26%) for inattention and 38% (A = 18%, D = 20%) for hyperactivity-impulsivity. The results also indicate that 52% of the phenotypic correlation between inattention and hyperactivity-impulsivity (r = 0.43) was explained by genetic influences whereas the remaining part of the covariance was explained by non-shared environmental influences. These results were replicated across age strata. CONCLUSIONS Our findings of moderate broad heritability estimates are consistent with previous literature on self-rated ADHD symptoms in older children, adolescents and adults and retrospective reports of self-rated childhood ADHD by adults but differ from studies of younger children with informant ratings. Future research needs to clarify whether our data indicate a true decrease in the heritability of ADHD in adults compared to children, or whether this relates to the use of self-ratings in contrast to informant data.

Coexisting Psychiatric Problems and Stressful Life Events in Adults With Symptoms of ADHD—A Large Swedish Population-Based Study of Twins:

Objective: To explore the associations of subtypes of adult ADHD with other psychiatric problems, stressful life events, and sex differences. Method: Odds ratios were calculated using information from 17,899 participants from a population-based survey of adult twins born in Sweden between 1959 and 1985. Results: Symptoms of attention deficit hyperactivity disorder (ADHD) were associated with an increased risk for symptoms of (odds ratio [95% confidence interval]): generalized anxiety disorder (5.6 [4.3; 6.5]), major depression (2.8 [2.4; 3.2]), bipolar disorder (8.0 [5.1; 12.6]), obsessive-compulsive disorder (3.9 [3.1; 4.9]), and alcohol dependence (2.6 [2.2; 3.1]). Symptoms of ADHD were found to be associated with an increased risk for stressful life events (1.8 [1.3; 2.4]). No significant difference in comorbidity was observed between the two sexes. Conclusion: Both women and men with ADHD are at increased risk for symptoms of other psychiatric disorders. They are also at increased risk for stressful life events.

ADHD and Disruptive behavior scores – associations with MAO-A and 5-HTT genes and with platelet MAO-B activity in adolescents

BackgroundPharmacological and genetic studies suggest the importance of the dopaminergic, serotonergic, and noradrenergic systems in the pathogenesis of Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorder (DBD). We have, in a population-based sample, studied associations between dimensions of the ADHD/DBD phenotype and Monoamine Oxidase B (MAO-B) activity in platelets and polymorphisms in two serotonergic genes: the Monoamine Oxidase A Variable Number of Tandem Repeats (MAO-A VNTR) and the 5-Hydroxytryptamine Transporter gene-Linked Polymorphic Region (5-HTT LPR).MethodsA population-based sample of twins, with an average age of 16 years, was assessed for ADHD/DBD with a clinical interview; Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Blood was drawn from 247 subjects and analyzed for platelet MAO-B activity and polymorphisms in the MAO-A and 5-HTT genes.ResultsWe found an association in girls between low platelet MAO-B activity and symptoms of Oppositional Defiant Disorder (ODD). In girls, there was also an association between the heterozygote long/short 5-HTT LPR genotype and symptoms of conduct disorder. Furthermore the heterozygote 5-HTT LPR genotype in boys was found to be associated with symptoms of Conduct Disorder (CD). In boys, hemizygosity for the short MAO-A VNTR allele was associated with disruptive behavior.ConclusionOur study suggests that the serotonin system, in addition to the dopamine system, should be further investigated when studying genetic influences on the development of Disruptive Behavior Disorders.

Long‐term relationships between symptoms of Attention Deficit Hyperactivity Disorder and self‐esteem in a prospective longitudinal study of twins

Aim: To study the long-term relationship between symptoms of Attention Deficit Hyperactivity Disorder and the developing self-esteem in a population-based sample of twins. Methods: The cohort is al ...

Low Sense of Coherence (SOC) is a mirror of general anxiety and persistent depressive symptoms in adolescent girls - a cross-sectional study of a clinical and a non-clinical cohort

BackgroundThe Sense of Coherence (SOC) scale is assumed to measure a distinct salutogenic construct separated from measures of anxiety and depression. Our aim was to challenge this concept.MethodsThe SOC-scale, Becks Depression Inventory (BDI), Becks Anxiety Inventory (BAI) , the emotional subscale of the Strengths and Difficulties Questionnaire (SDQ-em) and self-assessed health-related and physiological parameters were collected from a sample of non-clinical adolescent females (n = 66, mean age 16.5 years with a range of 15.9-17.7 years) and from female psychiatric patients (n = 73), mean age 16.8 years with a range of 14.5-18.4 years), with diagnoses of major depressive disorders (MDD) and anxiety disorders.ResultsThe SOC scores showed high inverse correlations to BDI, BAI and SDQ-em. In the non-clinical sample the correlation coefficient was -0.86 to -0.73 and in the clinical samples -0.74 to -0.53 (p < 0.001). Multiple regression models showed that BDI was the strongest predictor of SOC in the non-clinical (beta coefficient -0.47) and clinical sample (beta coefficient -0.52). The total degree of explanation of self assessed anxiety and depression on the SOC variance estimated by multiple R2 = 0.74, adjusted R2 = 0.73 in the non-clinical sample and multiple R2 = 0.66, adjusted R2 = 0.65 in the clinical sample.Multivariate analyses failed to isolate SOC as a separate construct and the SOC-scale, BDI, BAI and SDQ-em showed similar patterns of correlations to self-reported and physiological health parameters in both samples. The SOC-scale was the most stable measure over six months.ConclusionsThe SOC-scale did not appear to be a measure of a distinct salutogenic construct, but an inverse measure of persistent depressive symptoms and generalized social anxiety similar to the diagnostic criteria for major depressive disorder (MDD), dysthymic disorder, generalized anxiety disorder (GAD) or generalized social anxiety disorder (SAD) according to DSM-IV. These symptoms were better captured with SOC than by the specialized scales for anxiety and depression. Self-assessment scales that adequately identify MDD, dysthymic disorder, GAD and SAD need to be implemented. Comorbidity of these disorders is common in adolescent females and corresponds to a more severe symptomatology and impaired global function.

Genetic Disposition for Global Maturity: An Explanation for Genetic Effects on Parental Report on ADHD

Attention deficit hyperactivity disorder (ADHD) has been shown to be substantially influenced by genetic factors. However it is still not known how these effects are mediated. The aim of this study is to evaluate whether genetic disposition for global maturity could be a mediator of the well-known findings of genetic factors for ADHD symptoms. A total of 1480 pairs of twins aged 8-9 years were identified through the population-based Swedish Twin Registry. A mailed questionnaire with items from DSM-III-R for ADHD and items concerning global maturity were completed by the parents. The results showed that global maturity mediated part of genetic effects for ADHD for both boys and girls. There were also genetic, shared environmental, as well as nonshared environmental effects unique to ADHD not in common with global maturity. Thus, there are at least two pathways through which genetic effects can influence ADHD: one through predisposition for maturational lag and one unique to ADHD, possibly mediated by personality. The results indicate that maturational lag could be of importance for treatment and prognosis of ADHD.

The differentiation between depressive and anxious adolescent females and controls by behavioural self-rating scales

BACKGROUND This study aimed to validate the ability of frequently used self-assessment scales in Swedish child and adolescent psychiatric practice to differentiate between adolescent girls with manifest anxiety disorders and depression from those with less severe symptoms. METHODS The receiver-operating characteristic (ROC) curve was calculated for Becks Depression Inventory (BDI), Becks Anxiety Inventory (BAI), Hospital Anxiety and Depression Scale (HAD), the emotional subscale (SDQ-em), the impact score and the total difficulties score of the Strengths and Difficulties Questionnaire and Sense of Coherence (SOC) in a sample of 73 adolescent, female patients, diagnosed with one or several anxiety disorders and/or depression. ROC was also calculated for 66 age-matched controls. RESULTS SOC and the SDQ-em showed the best ability to differentiate cases of anxiety disorders and/ or depression from non-cases. SOC and SDQ-em had an equivalent ability to differentiate depression from non-cases compared to the specialised scales for depression, BDI and HAD-dep. SOC and SDQ-em were significantly better in differentiating cases of anxiety from non-cases than the specialised scales BAI and HAD-anx. Selection bias and several forms to fill in can have influenced the result. CONCLUSIONS SOC and SDQ-em seemed to be valid tools for identifying girls with anxiety disorders and depression. This is of clinical importance since self-reported symptoms of anxiety and depression show a major increase in adolescent girls and methods to identify those in need of treatment are needed.

Psychiatric problems associated with subthreshold ADHD and disruptive behaviour diagnoses in teenagers

Aim:  To study the coexistence of subthreshold diagnoses of both attention deficit hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBD) with other symptoms of child and adolescent psychiatric disorders as well as risk behaviours associated with smoking, alcohol and drug use.

Social factors in childhood and risk of depressive symptoms among adolescents - a longitudinal study in Stockholm, Sweden

BackgroundIn Sweden, self-reported depressive symptoms have increased among young people of both genders, but little is known about social differences in the risk of depressive symptoms among adolescents in welfare states, where such differences can be less pronounced. Therefore, the aim was to investigate whether multiple measures of low social status in childhood affect depressive symptoms in adolescence. A secondary aim was to explore potential gender effect modification.MethodsParticipants were recruited in 1998 for a longitudinal study named BROMS. The study population at baseline consisted of 3020 children, 11-12 years-old, from 118 schools in Stockholm County, followed up through adolescence. This study is based on 1880 adolescents answering the follow-up survey in 2004, at age 17-18 (62% of the initial cohort). Parental education, occupation, country of birth, employment status and living arrangements were reported at baseline, by parents and adolescents. Depressive symptoms were self-reported by the adolescents in 2004, using a 12-item inventory. The associations between childhood social status and depressive symptoms in adolescence are presented as Odds Ratios (OR), estimated through logistic regression. Gender interaction with social factors was estimated through Synergy Index (SI).ResultsIncreased risk of depressive symptoms was found among adolescents whose parents had low education (OR 1.8, CI = 1.1-3.1), were unskilled workers (OR 2.1, CI = 1.2-3.7), intermediate non-manual workers (OR 1.8, CI = 1.0-3.0), or self-employed (OR 2.2, CI = 1.2-3.7), compared to parents with high education and high non-manual work. In addition, adolescents living exclusively with one adult had an increased risk compared to those living with two (OR 2.8, CI = 1.1-7.5), while having foreign-born parents was not associated with depressive symptoms. An interaction effect was seen between gender and social factors, with an increased risk for girls of low-educated parents (SI = 3.4, CI = 1.3-8.9) or living exclusively with one adult (SI = 4.9, CI = 1.4-6.8).ConclusionsThe low social position in childhood may increase the risk of depressive symptoms among adolescents even in countries with small social differences and a highly developed welfare system, such as Sweden. Girls with low educated parents or living exclusively with one adult may be particularly vulnerable. This knowledge is of importance when planning preventive interventions or treatment.