Tomasz Hanć

Growth in Stimulant-naive Children With Attention-Deficit/Hyperactivity Disorder Using Cross-sectional and Longitudinal Approaches

OBJECTIVE. The objective of this study was to investigate the growth of stimulant-naive children with attention-deficit/hyperactivity disorder in 3 aspects of development: level, trend, and structure of the process. PATIENTS AND METHOD. The study sample included 53 individuals between the ages of 6 and 17 years (mean: 11.90). The average level of growth (z scores) in prepubertal, pubertal, and postpubertal stage of development and trend of the process were estimated on the basis of a comparison with growth charts. The prediction of adolescent growth spurt was conducted using the mathematical structural growth model of Jolioceur, Pontier, and Abidi. RESULTS. Difference between boys with attention-deficit/hyperactivity and the norm was statistically significant in the prepubertal stage and for the average level of growth between the ages of 2 and 17 years. Distinct suppression of growth was found between the ages of 9 and 14. Analysis of development structure revealed an earlier onset of the adolescent growth spurt among boys (difference: 5 months) and a higher velocity of growth at this moment (difference: 0.33 cm/year) than expected values. CONCLUSIONS. The application of both cross-sectional and longitudinal analyses clearly illustrated the higher level of growth of boys with attention-deficit/hyperactivity in the prepubertal stage, the suppression of growth on the turn of prepubertal and pubertal periods, and earlier occurrence of the spurt onset. Observed differences in the level and trend of growth as well as in the parameters of adolescent growth spurt are linked with disorder-related factors.

Attention-Deficit/Hyperactivity Disorder is Related to Decreased Weight in the Preschool Period and to Increased Rate of Overweight in School-Age Boys

OBJECTIVE Previous studies have associated attention-deficit/hyperactivity disorder (ADHD) with growth deviations and obesity. However, available data regarding the growth of children with ADHD in their early childhood are insufficient. Therefore, we aimed to examine whether there are differences in body size between preschool boys with and without ADHD. METHODS The study used cross-sectional and retrospective longitudinal data concerning 112 boys with ADHD and a community-based sample of 308 boys without ADHD. The groups were homogeneous in terms of socioeconomic status, place of residence, term of birth, and birth weight. The average age of diagnosis was 8.3 years, and none of boys had been treated with stimulants before they were 7 years of age. Comparisons were made at the ages of 2, 4, and 6 years, for World Health Organization (WHO)-norm-standardized height, weight, body mass index (BMI), prevalence of underweight, overweight, and obesity. Separate analysis were made for the cross-sectional measurements of current body size. RESULTS Boys with ADHD at the age of 2 had significantly lower z scores for weight (t=-1.98, p=0.04) and BMI (t=-2.09, p=0.04), and at the age of 4 for weight (t=-2.05, p=0.04) than the boys from the control group. A significantly lower percentage of overweight/obesity was observed in boys with ADHD at the age of 2 in comparison with the control group. At the age of 6, boys with ADHD were underweight more often. Cross-sectional analysis of current body size showed that boys with ADHD had lower z scores for height (t=-3.08, p=0.002) and higher z scores (t=3.13, p=0.002) for BMI. Overweight was more frequent in this group. CONCLUSIONS Preschool boys with ADHD (age of 2-6 years) have a tendency toward lower body weight than their peers. But in subsequent phases of development, they are shorter and more frequently overweight than boys without ADHD, when place of residence, socioeconomic status, term of birth, birth weight, comorbid conditions, and treatment are controlled.

Prevalence of Overweight and Obesity in Children and Adolescents With ADHD: The Significance of Comorbidities and Pharmacotherapy.

Objective: Assessment of the prevalence of overweight and obesity in children and adolescents with ADHD with emphasis on pharmacological treatment and comorbid disorders. Method: We analyzed 408 medical records of patients with ADHD aged 7 to 18. Results: The prevalence of overweight (14.71% vs. 12.83%, χ2 = 3,586.43, p < .001) and obesity (6.37% vs. 3.45%, χ2 = 3,588.19, p < .001) was significantly higher in children with ADHD compared with the population. There was significantly higher incidence of obesity in patients with comorbid diagnosis of adjustment disorder (22.22% vs. 4.42%, χ2 = 5.66, p = .02) and mental retardation (19.05% vs. 4.42%, χ2 = 7.63, p = .005). Pharmacological treatment was associated with a higher incidence of obesity (8.37% vs. 2.76%, χ2 = 4.92, p = .03). Conclusion: Standardized body mass index (BMI), prevalence of overweight, and obesity was higher in patients with ADHD compared with the population. Higher incidence of obesity was shown in patients with analyzed comorbidities.

An association between adverse events, anxiety and body size of adolescents.

The aim of the study was to assess the relationship between adverse life events, a tendency to respond with a high level of anxiety, and height and adiposity of adolescents. The sample included 575 persons (309 girls and 266 boys) aged 10-15 (mean 12.73) from the Wielkopolska region of Poland. The influence of adverse events during the 6 months before the examination and anxiety trait, as assessed with a STAIC questionnaire, on body height and BMI was analysed. Also sex, age, chronic diseases and socioeconomic status indicators were assessed. One-way and two-way ANOVA was used for assessment of relationships. Adverse events had no influence on body height and BMI. Subjects with a high level of anxiety trait (>34 score) were shorter (difference z=0.21) than subjects with a normal level of anxiety trait (≤34 score). The association of anxiety trait and body height was significant after adjustment for sex, age, chronic diseases and history of adverse life events. The analysis showed no statistically significant influence of adverse life events on height and BMI and a significant relationship between the general tendency to respond with anxiety and body height of adolescents. This suggests that psychological characteristics associated with the cognitive tendency to interpret events as threatening, and consequently, to respond with stress, may be involved in the variability of biological traits regardless of the objective harmfulness of the situation.

Perinatal Risk Factors and ADHD in Children and Adolescents: A Hierarchical Structure of Disorder Predictors.

Objective: The aim of the study was to hierarchically assess the predictive power of low and high birth weight, pre-term and post-term birth, and low Apgar score as the risk factors for ADHD. Method: The data of 132 boys diagnosed with ADHD and 146 boys from control group, aged 6 to 18 years, have been analyzed. The boys were categorized according to term of birth, birth weight, and Apgar score. CART method (Classification and Regression Trees) was used for assessment of the relationship between perinatal factors and the risk of ADHD. Results: Low Apgar score (21.97% vs. 13.01%) and post-term birth (12.12% vs. 0.68%) were more frequent in the sample than in the control group. CART method additionally indicated low birth weight as associated with the risk of ADHD. Among analyzed risk factors, Apgar score had the highest predictive value. Conclusion: The decreased Apgar score is the most important perinatal risk factor of ADHD. Research results also indicated a high significance of post-term birth in predicting the disorder.

Multiplex PCR for identification of herpes virus infections in adolescents.

The aim of the study was to develop a multiplex PCR (mPCR) for a rapid and simultaneous detection of herpes simplex 1 (HSV‐1), herpes simplex 2 (HSV‐2), and human cytomegalovirus (HCMV) DNA in squamous oral cells obtained from adolescents. Accuracy of the method was tested in a group of 513 adolescents, almost 11% of subjects were positive for infection with herpes viruses. Correlations with gender, age, and place of residence were sought. A similar incidence of HSV‐2 and HCMV was found (4.3% and 5.4%, respectively) and the incidence of HSV‐1 was the lowest (1%) in the study group. Conversely to HSV‐2, HCMV was detected mostly in the youngest individuals. The same occurrence of all viruses was observed in boys and girls. The mPCR method described is suggested as a useful tool for epidemiologic studies of active herpes infections. J. Med. Virol. 83:267–271, 2011.

Overweight in Boys With ADHD Is Related to Candidate Genes and Not to Deficits in Cognitive Functions

Objective: The aim of the study was to assess the relationship of overweight, the polymorphisms of selected candidate genes, and deficits in the executive functions among children with ADHD. Method: We examined 109 boys with ADHD aged between 7 and 17 years. The study indicated variants of 14 polymorphisms in eight candidate genes. We applied seven neuropsychological tests to evaluate the executive functions. Overweight was diagnosed on the basis of the guidelines of the International Obesity Task Force. Results: Analyses revealed significant association between DRD4 rs1800955, SNAP25 rs363039 and rs363043, 5HTR2A rs17288723, and overweight in boys with ADHD. There were no significant differences in the level of neuropsychological test results between patients with overweight and without overweight. Conclusion: Overweight in boys with ADHD is associated with polymorphisms in three candidate genes: DRD4, SNAP25, and 5HTR2A, but not through conditioning deficits in cognitive functions.

Measurement of Growth in Stimulant-Naive Children With Attention-Deficit/Hyperactivity Disorder by Using Cross-sectional and Longitudinal Approaches: In Reply

Hanć and Cieślik1 investigated growth in untreated children with attention-deficit/hyperactivity disorder (ADHD) and showed that stimulant-naive children with ADHD aged 2 to 17 years were significantly taller than normal controls (P .002). This observation raises major concerns with regards to the impact of stimulant medication on growth. Stimulant medication has been shown to have a significant negative impact on growth. The biggest study on this issue has been the Multimodal Treatment Study of ADHD (MTA study).2 The MTA study showed that children consistently treated with stimulant medication had heights of 0.165 SDs below the population mean (height z score: 0.165) at the age of 9. A comparable normal control group had an average height z score of 0.23, implying a stimulant-associated total reduction in height z score of 0.395. In their study, Hanć and Cieœlik found that at the age of 9 years children with ADHD were actually 1.0 z scores taller than normal children. This would imply that the average 9-year-old child with ADHD would have a baseline height z score of 1.23 and that treatment with stimulant medication could be associated with a reduction in height z score of 1.625. Assuming an SD for height of 5.8 cm for boys at the age of 9 years,3 this would translate to a clinically significant height deficit of 9.4 cm for children with ADHD on stimulant medication. The authors’ findings are important, because they imply a far greater impact of stimulant medication on growth than has been shown in any other study. However, the methodology of comparing observed growth in controls with predicted growth by using mathematical modeling in subjects may require additional scrutiny.

Meeting Report: Growth and Social Environment. Proceedings of the 25th Aschauer Soiree, held at Krobielowice, Poland, November 18th 2017

Twenty-two scientists met at Krobielowice, Poland, to discuss the impact of the social environment, spatial proximity, migration, poverty, but also psychological factors such as body perception and satisfaction, and social stressors such as elite sports, and teenage pregnancies, on child and adolescent growth. The data analysis included linear mixed effects models with different random effects, Monte Carlo analyses, and network simulations. The work stressed the importance of the peer group, but also included historic material, some considerations about body proportions, and growth in chronic liver, and congenital heart disease.

Attention deficit/hyperactivity-disorder and obesity: A review and model of current hypotheses explaining their comorbidity

HIGHLIGHTSMeta‐analyses support significant association between ADHD and obesity.The underlying mechanism remain to be elucidated.We propose a comprehensive bio‐psycho‐social model explaining this association. ABSTRACT Available meta‐analyses point to a significant association between attention‐deficit/hyperactivity disorder (ADHD) and obesity. The possible mechanisms underlying this relationship are unclear. Here, we overview the studies aimed at identifying the factors contributing to the comorbidity between ADHD and obesity, including genetic factors, fetal programming, executive dysfunctions, psychosocial stress, factors directly related to energy balance, and sleep patterns alterations. The bulk of current research has focused on reduced physical activity and abnormal eating patterns as possible causes of weight gain in individuals with ADHD. Further research is needed to explore the specific role of executive dysfunctions. None of the available published studies have evaluated physiological mechanisms such as hormonal and metabolic disorders or inappropriate neurobiological regulation of appetite. Research exploring the genetic basis for the coexistence of ADHD and obesity and epigenetic mechanisms, with particular emphasis on stress, both pre‐ and postnatal, seems particularly promising. Here, we propose a biopsychosocial model to integrate current findings and move the field forward to gain insight into the ADHD‐obesity relationship.