ADHD Brain Marker Value in Doubt

Longstanding links between attention-related problems and changes in the brain’s cortex during childhood and adolescence could simply be due to developmental differences between the sexes, a study suggests.

The findings, in PNAS, showed that links between attention problems and slowed rates of cortical thinning were no longer evident after taking sex into account.

The results call into question proposals to use brain maturation patterns as biomarkers for attention deficit/hyperactivity disorder (ADHD) and related conditions.

More generally, they reveal the importance of accounting for sex differences during scientific investigations.

“For nearly two decades, delayed age-related cortical thinning has been widely viewed as a neurodevelopmental marker of attention-related psychopathology and ADHD,” reported Shannon O’Connor, PhD, from the University of Vermont, and co-workers.

“However, our findings suggest that this association may be largely confounded by sex differences in cortical development.”

Delayed thinning of the brain’s cortex—its outermost layer of grey matter—has long been proposed as a biomarker for ADHD-related conditions.

To investigate its value further, O’Connor and team studied 26,496 MRI scans from 11,025 adolescents.

The team initially found there was a link between attention problems and reduced rates of age-related cortical thinning across predominantly frontoparietal regions. Reduced rates of age-related thinning were associated with higher scores relating to attention problems.

However, this link dramatically reduced after accounting for sex differences in cortical thickness trajectories.

There were no significant age and attention problem interactions on cortical thickness when the sexes were studied separately. Furthermore, the genetic risk of ADHD was also not associated with slowed thinning in this region of the brain.

“Taken together, these findings suggest that previously reported associations between attention problems and delayed cortical thinning are largely attributable to unaccounted-for sex differences in neurodevelopment,” the authors concluded.

“Our results call into question an influential framework in developmental neuroscience and psychiatry that has shaped clinical understanding of ADHD for nearly 20 years, underscoring that cortical maturation patterns should not be interpreted as biomarkers for attention-related psychopathology without rigorous accounting for sex-related variation in brain development.”

The post ADHD Brain Marker Value in Doubt appeared first on Inside Precision Medicine.

<![CDATA[Learn why adult ADHD often hides behind anxiety or depression, how childhood history and family risk guide diagnosis, and why stimulants still matter.]]>

Cannabigerol Oil for Adolescents With ADHD (CAN-ADHD)

Conditions: Attention-Deficit/Hyperactivity Disorder (ADHD)

Interventions: Drug: Experimental: Full-spectrum CBG oil 30 mg/mL; Drug: Placebo oil (MCT oil)

Sponsors: Universidade do Sul de Santa Catarina; Associação Brasileira de Cannabis Medicinal

Recruiting

Validation of a criterion-based screening and triage pathway for adult ADHD: a prospective observational study of safety and operational efficiency

BackgroundThe increasing demand for adult attention-deficit hyperactivity disorder (ADHD) assessments has required the development of efficient triage pathways. This study provides a formal assessment of a criterion-based screening model designed to prioritise patient safety and operational efficiency within a National Health Service (NHS) specialist secondary care setting.MethodsA prospective observational validation design was employed, involving 49 consecutive adults referred for ADHD assessment none of whom had a previous ADHD diagnosis. The Comprehensive ADHD Screening Questionnaire (CASQ), a clinician-administered instrument based on DSM-5 criteria, was utilised by four trained Physician Assistants. To ensure an assessment of triage safety, a universal assessment model was adopted: all participants received a blinded, gold-standard diagnostic assessment (NICE-compliant) regardless of the initial triage recommendation thereby eliminating verification bias. The primary outcome measure was the Number Needed to Harm (NNH), defined as the number of people screened before a single false-negative result occurs.ResultsOf the 48 participants who completed the diagnostic process, six (12.5%) received an ADHD diagnosis. The triage pathway correctly identified all six cases, resulting in a sensitivity of 100.0% (95% CI: 61.0%–100.0%) and an infinite NNH. Specificity was 45.2% (95% CI: 31.2%–59.9%), with a positive predictive value of 20.7%. The pathway permitted 39.6% (n = 19) of referrals to be triaged to alternative pathways rather than full ADHD assessment, potentially saving significant specialist clinician time. Exploratory analyses indicated that score magnitude did not reliably distinguish between true and false positives within the group triaged as appropriate for further assessment.ConclusionsThese preliminary findings suggest that criterion-based screening conducted by appropriately trained non-specialist clinicians can achieve high levels of safety whilst improving service efficiency. The findings support the feasibility of task-shifting models in adult ADHD services, provided that triage thresholds are calibrated to prioritise sensitivity. These results require replication in adequately powered multi-site studies before firm conclusions regarding pathway safety can be drawn. Further research is required to establish inter-rater reliability and cost-effectiveness across diverse clinical settings.
<![CDATA[Expert shares the use of liquid formulation ADHD medication and how to discuss with patients.]]>