This summary is based on the research article: Sugaya, L. S., Farhat,

Effectiveness: Stimulants, including methylphenidate and lisdexamfetamine, significantly reduced ADHD symptoms . These findings support their use when behavioral interventions alone are insufficient.

Age-Specific Recommendations:

• Ages 3-4: BPT is recommended as first-line treatment. Stimulants may be considered if symptoms are severe or if BPT is ineffective or inaccessible.
• Ages 5-7: Stimulants, especially methylphenidate, may be appropriate when ADHD significantly impairs functioning.

Medication Recommendations:

• Methylphenidate: Recommended as the first-line stimulant due to its well-established efficacy and relatively better tolerability in preschoolers. It has the most robust evidence base, demonstrating consistent symptom reduction across multiple studies, with side effects that are generally mild and manageable.
• Lisdexamfetamine: Considered as an alternative if methylphenidate is ineffective or poorly tolerated. Lisdexamfetamine also shows significant efficacy in symptom reduction, but it may have a different side effect profile that includes a higher likelihood of appetite suppression and insomnia. Close monitoring is required to manage these potential adverse effects.
• Alpha-Agonists (Clonidine, Guanfacine): Used with caution, particularly when stimulants are not tolerated or are ineffective. Although alpha-agonists like clonidine and guanfacine have been reported to help manage ADHD symptoms, their effectiveness in preschoolers is primarily supported by case reports and retrospective studies, rather than robust double-blind studies. Before use, clinicians should carefully evaluate for hypotension, underlying cardiac conditions, and a family history of QTc prolongation due to the risk of significant side effects.
• Atomoxetine: Evaluated in one studiesfor children aged 5-6 years, atomoxetine showed some effectiveness in reducing ADHD symptoms. However, many children remained moderately to severely symptomatic at the end of the study. Common side effects include decreased appetite, gastrointestinal upset, and sedation, impacting overall tolerability and compliance. Atomoxetine may be considered when stimulants are not suitable, though it may be less effective in managing symptoms compared to stimulants.

Treatment vs. Therapy:

• First-Line Therapy: Behavioral interventions are preferred for younger preschoolers.
• Medication Use: Stimulants can be introduced if behavioral therapy is insufficient, particularly as children approach school age.
• Combination Approach: Combining medication with behavioral therapy often yields better outcomes by addressing both symptoms and behavioral challenges.

Behavioral Parent Training (BPT) and Stimulant Use:

• BPT is strongly recommended for children with comorbid conditions like ODD or conduct problems, or when parents struggle with behavior management.
• Stimulants can be considered without prior BPT for children over 4 with moderate to severe symptoms, especially when BPT is inaccessible or pharmacological treatment is preferred.

Safety and Side Effects: Common side effects: decreased appetite, irritability, insomnia. Serious side effects were rare, but close monitoring is essential due to potential impacts on growth and cardiovascular health (e.g., heart rate, blood pressure).

Clinical Monitoring: Regular follow-ups are crucial to monitor effectiveness and side effects, including growth and cardiovascular health.

Long-Term Considerations:

• While short-term efficacy is well-supported, further research is needed on long-term safety, especially regarding growth and cardiovascular health.
• Medication trials should be part of a broader, individualized treatment plan, particularly where behavioral interventions are limited

Study Overview: The review assessed five randomized controlled trials (RCTs) involving 489 preschoolers (ages 3-7, mostly boys, average age 5).

Citation

This summary is based on the research article:
Sugaya, L. S., Farhat, L. C., Califano, P., & Polanczyk, G. V. (2023). Efficacy of stimulants for preschool attention‐deficit/hyperactivity disorder: A systematic review and meta‐analysis. Journal of Child and Adolescent Mental Health, Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil, & National Institute of Developmental Psychiatry (INPD), CNPq, São Paulo, Brazil. DOI: 10.1002/jcv2.12146.

Disclaimer: The information provided is a summary of research findings and is intended for educational and informational purposes only. It should not be construed as medical advice, diagnosis, or treatment. While every effort has been made to ensure the accuracy of the information, it may contain errors or omissions. This summary is for reference purposes only, and readers are encouraged to consult the original source documents for verified, peer-reviewed content. Always seek the guidance of a qualified healthcare professional with any questions you may have regarding a medical condition or treatment.

Conclusion: Increasing intervention intensity does not necessarily improve developmental outcomes for young autistic children. An individualized approach to intervention planning is recommended.

Study Overview: A meta-analysis by Sandbank et al., published in JAMA Pediatrics (2024), assessed whether increasing the amount of intervention (20-40 hours per week) improves developmental outcomes for young autistic children. The analysis included 144 studies with 9,038 children.

Key Metrics Analyzed:

• Daily Intensity: Hours per day.
• Duration: Total days of intervention.
• Cumulative Intensity: Total hours over the entire duration.

Types of Interventions:

• Behavioral Interventions: Including Early Intensive Behavioral Intervention (EIBI), based on Applied Behavior Analysis (ABA).
• Naturalistic Developmental Behavioral Interventions (NDBIs)
• Technology-Based Interventions
• Developmental Interventions

Findings:

• No significant, positive association between intervention amount and developmental outcomes.
• The intensity of intervention did not lead to better outcomes across various intervention types (Behavioral, NDBIs, Technology-based, Developmental).

Implications:

• Current guidelines recommending high-intensity interventions lack robust evidence.
• Health professionals should consider developmentally appropriate intervention amounts.
• High-intensity interventions may limit time for social interaction, rest, and family activities, which are crucial for development.

Policy Recommendations:

• Re-evaluate guidelines advocating for high-intensity interventions.
• Future research should determine optimal intervention amounts that balance benefits and avoid potential harms.

Conclusion: Increasing intervention intensity does not necessarily improve developmental outcomes for young autistic children. An individualized approach to intervention planning is recommended.

For more details:

Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children A Meta-Analysis

Micheal Sandbank, PhD; James E. Pustejovsky, PhD; Kristen Bottema-Beutel, PhD; Nicolette Caldwell, PhD; Jacob I. Feldman, PhD; Shannon Crowley LaPoint, PhD; Tiffany Woynaroski, PhD, CCC-SLP

JAMA Pediatr. doi:10.1001/jamapediatrics.2024.1832 published June 24, 2024.

Link here - https://hass.eu.qualtrics.com/jfe/form/SV_2sJ7mvDo6eTCzUW

I am researching psychological safety levels in Autism/ADHD as part of my master's dissertation project. This is an Autism/ADHD led project in collaboration with clinical psychologists. I am happy to share findings and hope some of you will participate. The survey is anonymous and takes 10-15 minutes to complete.

We feel this research is imperative to providing better mental health support to our community. Ethical approval by Strathclyde University SEC.

Thank you!

The research paper "Empathy Impairment in Individuals With Autism Spectrum Conditions From a Multidimensional Perspective: A Meta-Analysis" looks at how people with autism have trouble with empathy. It analyzed 51 studies involving more than 2,000 people with autism and almost 3,000 people without autism.

Here are the key findings, explained:

1. Different Parts of Empathy: The study found that not all parts of empathy are affected in the same way in people with autism.
   • Trait-Cognitive Empathy: This is the ability to understand other people's thoughts and feelings over time. People with autism have trouble with this.
   • Trait-Empathic Concern: This is the ability to feel concern for others consistently. People with autism also have trouble with this.
   • Trait-Empathic Accuracy: This is being able to feel what others are feeling accurately. Surprisingly, people with autism can sometimes do this better than people without autism.
   • State-Cognitive Empathy: This is understanding others' thoughts and feelings in the moment. People with autism have trouble with this too.
   • State-Empathic Concern: This is feeling concern for others in the moment. This is also impaired in people with autism.
   • State-Empathic Accuracy: This is feeling what others are feeling in the moment. People with autism can do this as well as people without autism.
2. Influence of Gender and Age:
   • Gender: Boys and girls with autism show different levels of trouble with empathy. For instance, girls may have less trouble with understanding others' feelings than boys.
   • Age: Younger and older people with autism show different levels of empathy trouble. For example, younger individuals might struggle more with understanding others' thoughts and feelings than older individuals.
3. Culture: The study found that culture does not significantly change how people with autism experience empathy. People from different parts of the world showed similar patterns of empathy trouble.

In summary, people with autism have specific difficulties with understanding and feeling for others, and these difficulties can vary based on their gender and age. However, the ability to feel what others feel in the moment is not as affected and can sometimes be better in people with autism.

Song Y, Nie T, Shi W, Zhao X, Yang Y. Empathy Impairment in Individuals With Autism Spectrum Conditions From a Multidimensional Perspective: A Meta-Analysis. Front Psychol. 2019 Oct 9;10:1902. doi: 10.3389/fpsyg.2019.01902. PMID: 31649570; PMCID: PMC6794557.

B12, B9 (folate), L-5-MTH, B6, D, E, C, glutathione, omega-3 fatty acids, and choline

Recent peer-reviewed studies highlight the critical role of B Vitamins in Autism Spectrum Disorder (ASD). Key insights and recommendations include:

1. Homocysteine, Vitamin B12, and Folate Levels:
   • Children with ASD often have elevated homocysteine and reduced Vitamin B12 and folate levels, contributing to oxidative stress and neuronal damage (Nesa et al., 2022).
2. DNA Methylation and Epigenetics:
   • Impaired methylation capacity in children with ASD can be improved with B9 (folate) and B12 supplementation, helping to mitigate symptoms (Abugharsa, 2024).
3. Supplementary Therapies:
   • High-dose folinic acid benefits children with ASD who have folate receptor autoantibodies, improving cognitive and behavioral outcomes (Ramaekers et al., 2019).
   • Other effective supplements include B6, D, E, and C, glutathione, omega-3 fatty acids, and choline, which enhance methylation and reduce oxidative stress (Abugharsa, 2024).
4. Clinical Trials and Recommendations:
   • Regular screening for homocysteine, Vitamin B12, and folate levels is recommended for early management and intervention (Nesa et al., 2022).
   • Addressing nutritional deficiencies with targeted vitamin supplementation significantly improves ASD symptoms (Ramaekers et al., 2019).

Editor's Note: Consult a doctor for vitamin and homocysteine level testing. Deficiencies and homocysteine levels are individualized and depend on your DNA and diet.

Summary: Supplementing B Vitamins, especially B12, and folate, can improve metabolic and epigenetic abnormalities in ASD, offering a potential path for better symptom management. Several authors recommend regular lab monitoring and tailored supplementation.

"This review paper summarizes the findings of the supplementary therapy studies of ASD, showing that supplements, including B9, B12, B6, D, E, C, glutathione, omega-3, and choline, are highly effective in modifying methylation in autism, improving many nutrient and metabolic problems, and resulting in significant improvements in symptoms.
(PDF) Supplementary Therapy for DNA Methylation in Autism. Available from: DOI: 10.21608/eajbsc.2024.352744

Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review https://doi.org/10.1007/s40120-022-00392-2

The narrative surrounding Attention-Deficit Hyperactivity Disorder (ADHD) predominantly orbits around its cardinal inattention, impulsivity, and hyperactivity symptoms. However, lurking beneath the surface lies a darker dimension of ADHD, characterized by a heightened propensity towards incarceration, aggression, and violent behaviors. Central to ADHD are the deficits in executive function and impulse control that often endure beyond childhood. The specter of genetics looms large, with twin studies indicating a 70-80% heritability in ADHD symptomatic variations (Faraone, 2005)(Nikolas, 2010). Despite this, I am optimistic regarding the many tangible paths to improved outcomes. While this genetic imprint doesn't dictate one's destiny, it emphasizes the importance of early detection and adept management of ADHD.

The confluence of ADHD with Intermittent Explosive Disorder (IED) further unveils this grim facet. Coccaro, Lee, and McCloskey (2016) found a 12.7% lifetime prevalence of IED among individuals with ADHD, starkly contrasting to the 1.4-2.7% in the general populace. This shared impulsivity and challenged behavioral control hint at potential intertwined genetic influences over both disorders (Mick et al., 2005). Moreover, the ripple effects of ADHD extend into familial dynamics, where paternal ADHD symptoms exacerbate child aggression by fostering a chaotic home environment (Farbiash, Berger, Atzaba-Poria, & Auerbach, 2014).

The justice system reverberates with these grim narratives, with a startling 40% prevalence of ADHD among long-term male prison inmates, as highlighted in a study published in BMC Psychiatry (2010). A mere 2 in 30 prison inmates with confirmed ADHD had received a childhood ADHD diagnosis, despite a glaring need for health and educational support. This study also spotlighted pervasive Substance Use Disorder (SUD), mood, and anxiety disorders, with a quarter exhibiting Autism Spectrum Disorder (ASD) traits, signifying a severe impact on inmates regarding coexisting disorders and compromised executive functions, even when adjusted for IQ.

The overrepresentation of ADHD within incarcerated populations isn't isolated to a single study. Young et al. (2015) corroborated this in their meta-analysis, showcasing a 25-40% ADHD prevalence among the incarcerated, as opposed to the approximate 5% prevalence in the general population. Furthermore, Dalsgaard et al. (2015) disclosed that men with ADHD faced a 4.4 times higher incarceration rate than their neurotypical counterparts. This narrative extends to violent comorbidities, where ADHD significantly elevates the risks of Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and Antisocial Personality Disorder (ASPD) (Nock et al., 2006; Gadow et al., 2002; Mannuzza et al., 2008).

Despite this, I am optimistic regarding the tangible path to improved outcomes. The past decade has witnessed tremendous strides in understanding the genetics, metabolism, and treatment modalities and identifying ADHD. Yet, a chasm persists as clinical and patient practices lag far behind. For example, surprisingly few practitioners are aware of widely available medical lab testing such as Methylation Profile (Comprehensive), Plasma" and "Neurotransmitter Panel (Comprehensive), Urine." that identify treatable metabolic markers associated with ADHD. We live with the outcome. For example, The potential of reducing intimate partner violence (IPV) by addressing ADHD symptoms, as demonstrated in a study by Buitelaar et al. (2019), further accentuates the transformative potential of well-rounded ADHD care. This unveils a hopeful horizon wherein addressing the core challenges of ADHD significantly betters individual and societal outcomes, heralding a promising path forward as we continue to shine light into the dark corners of ADHD.

-Alex

References:

Faraone, S.V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Mol Psychiatry 24, 562–575. https://doi.org/10.1038/s41380-018-0070-0

Nikolas, M. A., & Burt, S. A. (2010). Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: A meta-analysis. Journal of Abnormal Psychology, 119(1), 1–17. https://doi.org/10.1037/a0018010

Coccaro, E. F., Lee, R., & McCloskey, M. S. (2016). ADHD and lifetime aggression. Comprehensive Psychiatry, 70, 56-59. https://doi.org/10.1016/j.comppsych.2015.12.006

Farbiash, T., Berger, A., Atzaba-Poria, N., & Auerbach, J. G. (2014). Prediction of preschool aggression from DRD4 risk, parental ADHD symptoms, and home chaos. Journal of Abnormal Child Psychology, 42(3), 489-499. https://doi.org/10.1007/s10802-013-9791-3

Young, S., Moss, D., Sedgwick, O., Fridman, M., & Hodgkins, P. (2015). A Meta-Analysis of the Prevalence of Attention Deficit Hyperactivity Disorder in Incarcerated Populations. Psychological Medicine, 45(2), 247-258. DOI: https://doi.org/10.1017/S0033291714000762

Dalsgaard, S., Ostergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. The Lancet, 385(9983), 2190-2196. DOI: https://doi.org/10.1016/S0140-6736(14)61684-661684-6)

Nannet J L Buitelaar et al. (2019). The Impact of ADHD Treatment on Intimate Partner Violence in a Forensic Psychiatry Setting. Journal of Attention Disorders. DOI: 10.1177/1087054719879502